Jill Gordon

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.

The effects of gender on diagnosis of psychological disturbance

This research examines the effect of patient gender on the detection of psychological disturbance. In Study 1, primary-care patients were requested to complete the General Health Questionnaire (GHQ), a measure of nonpsychiatric psychological disturbance, prior to their consultation. The patients GHQ score was compared with physician judgments about the level of disturbance in that patient (N=1913). Although there were a similar number of GHQ high scorers among males and females, the physicians classified significantly more females than males as disturbed. The doctors classified as disturbed a larger proportion of nondisturbed women than nondisturbed men. In order to explore the behavior of recent medical graduates, Study 2 examined the detection behavior of interns in an outpatient department with 384 of their patients. The interns behaved in a similar manner to the primary-care physicians.

Interns’ performances with simulated patients at the beginning and the end of the intern year

Objective:To determine whether interns’ performances of technical, preventive, and communication aspects of patient care improve during the intern year.Design:A descriptive study. At the beginning and end of the intern year, interns’ consultations with three simulated (standardized) patients were videotaped and scored according to explicit criteria set by an expert panel. Problems simulated were urinary tract infection, bronchitis, and tension headache.Setting:The casualty outpatient department in a general teaching hospital in New South Wales, Australia.Participants:Twenty-eight interns rotated to the casualty department.Results:Little improvement over the intern year in technical competence or preventive care was observed, even though initial levels of compliance with criteria were quite low for some items. Greater improvement was apparent in the area of communication skills.Conclusions:The results suggest that the internship should be restructured to more adequately teach the skills required for primary care.

Identification of simulated patients by interns in a casualty setting

Summary. Fifty‐four interns agreed to a study in which their clinical performance in an outpatient unit with standardized patients was recorded on videotape. In order to examine whether they could distinguish standardized from real patients, the interns were asked to note any patients who they thought might be simulating their complaints and report these to the researchers at the end of each 2‐day period of study. Thirty‐two of the interns were assessed again at the end of their internship, using the same clinical problems presented by different simulators. The consultations took place in the casualty department of a large urban hospital. At the beginning of the year there were 152 consultations with standardized patients and 328 consultations with appropriate genuine patients. Standardized patients were identified definitely as ‘not genuine’ in only 12 of the 152 consultations (sensitivity 7.8%) whereas 320 of the 328 genuine consultations were accepted by the interns as genuine (specificity 97.8%). When the level of confidence required to distinguish the two groups was reduced from ‘definite’ to ‘probable’, the number of correctly identified simulator consultations increased to 36/152 (27%) but the rate of misclassification of genuine patients also increased from 8 to 37 out of 328 consultations (11%). At the end of the year there were 81 consultations with standardized patients and 149 consultations with genuine patients. Identification rates were only slightly changed. We conclude that simulator identification is not a problem in applying standardized patients to evaluate the quality of care provided in a hospital casualty.

Arts and humanities

For a small group discussion on how death and dying can be portrayed in literature, a medical student selected John Donne’s Meditation XVII. It contains the line No man is an Iland, intire of it selfe; every man is a peece of the Continent, a part of the maine . The Meditation moves on to the words that Ernest Hemingway used for the title of his novel about the Spanish Civil War any man s death diminishes me, because I am involved in Mankinde; and therefore never send to know for whom the bell tolls; it tolls for thee’.

Not everything that counts can be counted

As the first editor of the Arts and Humanities section of the journal, Jane Macnaughton outlined the range and types of papers that would be suitable for publication in this section. She encouraged contributions to the journal that describe and evaluate arts and humanities programmes, demonstrate the value of engagement in the creative arts for medical students and papers that explore the relationship between arts and health and medical humanities. I can do no better than to reiterate her advice and to add a word of encouragement for contributions that consider the arts and humanities in the lives of medical graduates as well as undergraduate students.

A Problem-Based Course in Human Sexuality

A medical curriculum based on the exploration of clinical problems rather than traditional discipline content has provided an appropriate context for a course on human sexuality. The problem-based approach has ensured that students examine physical, psychological, social, religious and ethical aspects of the sexual difficulties with which doctors are commonly confronted. The course offers the opportunity for students to develop their capacity for effective communication. Assessments are also problem-based both in written format and in a role-played consultation. Explicit objectives direct student learning and tutors guide discussion in group tutorials with a minimum of formal teaching. Because the course precedes studies in the area of reproductive medicine, its aim is to equip students to communicate comfortably about sexual problems when opportunities arise later in the course.The effects of the course on the students was assessed using the Sexual Knowledge and Attitudes Test of Leif & Reid (1972). The ...

Medical humanities: state of the heart

After medical school, junior doctors demonstrate evidence of burnout. This is a longstanding problem that has been discussed and researched for years. It has been referred to as traumatic de-idealisation 10 and is assumed to represent an attitude passed down from more senior doctors. Testerman et al., however, suggest another way of looking at the phenomenon, as: a temporary by-product of the harsher aspects of the professional socialisation process, a phase that corresponds with the student s struggle to develop a professional identity while surviving demanding academic and clinical challenges in a complex and ambiguous ethical environment. 11 (p 43) The latter explanation encompasses a wider range of possible causes for this erosion of empathy, to which we might add an inherent vulnerability in many people who choose medicine as a career. In a novel approach, Marcus hypothesises that clues might be found in medical students dreams, of which he has collected almost 400. He suggests that many students start out with fantasies of becoming hero-healers , but find themselves moving on to masochistic and then sadistic fantasies that help them to deal with the anxiety-provoking experiences that are part of the territory of medical education, and which they encounter at every stage from the dissecting room to the palliative care unit.

Women in medical school and beyond

The increasing proportion of female students in Australian medical schools warrants an appraisal of the particular factors which may influence their success in their undergraduate and post‐graduate careers. Past shortages of medical manpower are giving way to a projected over‐abundance of doctors in the near future.

Broad church or bunfight? Possibilities for progress in medical education

2011;45:10–12. 12 Dornan T, Peile E, Spencer J. On ‘evidence’. Med Educ 2008;42:232– 3. 13 Dexter H, Dornan T. Technologyenhanced learning: appraising the evidence. Med Educ 2010;44:746–8. 14 Ringsted C. Developmental aspects of medical competency and training: issues of curriculum design. Med Educ 2011;45:12–16. 15 Teunissen PW, Westerman M. Opportunity or threat: the ambiguity of the consequences of transitions in medical education. Med Educ 2011;45:51–59. 16 Holmboe E, Ginsburg S, Bernabeo E. The rotational approach to medical education: time to confront our assumptions? Med Educ 2011;45:69–80. 17 Cooke M, Irby DM, O’Brien BC. Educating Physicians: A Call for Reform of Medical School and Residency. Carnegie Foundation for the Advancement of Teaching. San Francisco, CA: Jossey-Bass 2010. 18 Bordage G, Harris I. Making a difference in your curriculum reform and decision-making process. Med Educ 2011;45:87–94. 19 Hodges BD, Albert M, Arweiler D et al. The future of medical education: a Canadian environmental scan. Med Educ 2011;45:95–106. 20 Norcini JJ, Banda SS. Increasing the quality and capacity of education: the challenge for the 21st century. Med Educ 2011;45:81–86. 21 Burch VC. Medical education in the 21st century: what would Flexner say? Med Educ 2011;45:22–24. 22 Gwee MCE. Medical and health care professional education in the 21st century: institutional, national and global perspectives. Med Educ 2011;45:25–28. 23 Dixon M, Sweeney K. The Human Effect in Medicine. Theory, Research, and Practice. Abingdon: Radcliffe Medical Press 2000. 24 Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. [Carnegie Foundation Bulletin No. 4.] New York, NY: Carnegie Foundation for the Advancement of Teaching 1910. 25 Szczeklik A. Catharsis: On the Art of Medicine. Chicago, IL: University of Chicago Press 2005. 26 Sweeney K. Uniqueness in clinical practice: reflections on suffering. In: Dixon M, Sweeney K, eds. The Human Effect in Medicine. Theory, Research, and Practice. Abingdon: Radcliffe Medical Press 2000;27– 37. 27 Chantler C. The role and education of doctors in the delivery of health care. Lancet 1999;353:1178–81. 28 Sweeney K, Toy L, Cornwell J. A patient’s journey. Mesothelioma. BMJ 2009;339:b2862.