Isobel Rolfe

Translating learning principles into practice: a new strategy for learning clinical skills

There are data to suggest that medical school may not adequately prepare doctors for practice and that there are deficiencies in undergraduate teaching of skills in history taking, physical examination, diagnosis and management (clinical skills). There is a need to re‐evaluate methods by which we can teach clinical skills effectively. This aim of this review was to describe the literature concerning the important principles underpinning effective clinical learning. Subsequently a structured learning tool and teaching process was developed in order to support these principles.

Time for a review of admission to medical school

Appropriate selection of medical students is a fundamental prerequisite if medical schools are to produce competent and caring doctors. The selection criteria for entry to the medical degree course at the University of Newcastle, New South Wales, are unique in Australia. The purpose of this study was to identify admission criteria that may predict performance in the first postgraduate (intern) year. Performance ratings were obtained from the clinical supervisors of two graduating classes of Newcastle University medical students during their five terms in internship (first postgraduate year). At least one rating was obtained for 93% of interns. A subset analysis of interns with multiple ratings (57%) showed that combining previous study in both humanities and science before medical school entry was predictive of higher intern performance ratings. These interns were rated more favourably than those who had studied science alone. Moreover, students who had earlier studied both humanities and science were twice as likely to complete their medical degree as those who had studied science alone. Age, gender, admission interview results, written psychometric test scores, academic marks, and whether previous tertiary study had been undertaken prior to medical school entry were not predictive of intern performance ratings. Subject spread, including a background in humanities, is important for effective medical practice, at least in the immediate postgraduate period. Perhaps it is time to evaluate the admission criteria by which medical students are selected.

The influence of admissions variables on first year medical school performance: a study from Newcastle University, Australia

This study examined the relationship between the performance of first year medical students at the University of Newcastle, Australia, and admission variables: previous educational experience, and entry classification (standard – academic or composite, Aboriginal and Torres Strait Islander, or overseas), age and gender.

Graduate entry to medical school? Testing some assumptions

Background  Debate abounds regarding the most appropriate candidates to admit to medical school. This paper examines whether there is any advantage to admitting ‘graduate’ entrants over secondary school leavers on selected medical school and practice outcomes.

Clinical competence of interns

A clinical supervisors rating form addressing 13 competencies was used to assess the clinical competence of graduates one year after qualification in New South Wales (NSW), Australia. Data from 485 interns (97.2%) showed that graduates from the problem‐based medical school were rated significantly better than their peers with respect to their interpersonal relationships, ‘reliability’ and ‘self‐directed learning’. Interns from one of the two traditional NSW medical schools had significantly higher ratings on ‘teaching’, ‘diagnostic skills’ and ‘understanding of basic mechanisms’. Graduates from international medical schools performed worse than their peers on all competencies. These results were adjusted for age and gender. Additionally, women graduates and younger interns tended to have better ratings. Junior doctors have differing educational and other background experiences and their performance should be monitored.

Factors influencing prescribing: an intern's perspective

Objectives To examine the self‐reported influences on intern prescribing practice.

Factors affecting progress of Australian and international students in a problem-based learning medical course

Research on the factors affecting progress in medical schools has typically focused on mainstream (non‐Indigenous Australian, non‐international) students in traditional, didactic programmes. These results may not be applicable to students, particularly those from culturally diverse backgrounds, undertaking problem‐based learning courses.

Competency based teaching: the need for a new approach to teaching clinical skills in the undergraduate medical education course

This paper will argue that undergraduate medical courses are failing to provide students with adequate training in the area of clinical skills. Some of the reasons for this failure include changes in the health system leading to increasing commitments for clinicians, fewer patients as clinical case examples and limitations in current teaching methods. Current clinical teaching methods measure progress through completion of clinical “blocks” of learning and one-off clinical examinations. This paper offers an alternative approach to clinical teaching in undergraduate medicine. In this approach, each students progress is measured through the attainment of a predetermined level of competency in dealing with a range of clinical conditions. Some of the benefits of a new approach to clinical teaching in undergraduate medicine include flexibility for both students and clinicians in terms of when and where clinical learning can occur, a significant emphasis on active learning, and increased generalization and integration of learning.

Patient co-payments and use of prescription medicines

Objective: To investigate how prescription co‐payments influence the medicine use of Australian patients.

The content of undergraduate health professional courses: a topic largely ignored?

Considerable debate has occurred about educational processes within undergraduate courses for healthcare professionals. Less attention appears to have been directed to issues of curriculum content.This paper examines the potential influence of curriculum content on a number of outcomes, and examines the methods that can be used determine curriculum content. The balance between different content areas in a curriculum has the potential to affect allocation of human resources, research capacity and output, and hence the power base of discipline groups. Changes to the balance of content will therefore be sensitive, and threatening to some groups. While the optimal way to determine curriculum content would be on the basis of evidence from experimental studies, such studies have not been conducted. Opinion-based approaches have been commonly used. While such processes demonstrate increasing commitment to determining content that is most relevant to producing good clinicians, the results depend on the stakeholders involved. Despite the considerable difficulties in conducting rigorous research concerning curriculum content, there is a need to develop a research agenda in this area.