John Charles Mclachlan

Teaching anatomy without cadavers

Background  Anatomy learning is generally seen as essential to medicine, and exposure to cadavers is generally seen as essential to anatomy learning around the world. Few voices dissenting from these propositions can be identified.

Anatomy teaching : ghosts of the past, present and future

‘Ghost of the Future,’ he exclaimed, ‘I fear you more than any spectre I have seen. But as I know your purpose is to do me good, and as I hope to live to be another man from what I was, I am prepared to bear you company, and do it with a thankful heart. Will you not speak to me?’ Ebenezer Scrooge (Charles Dickens, A Christmas Carol)

THE SCOTTISH DOCTOR-LEARNING OUTCOMES FOR THE MEDICAL UNDERGRADUATE IN SCOTLAND: A FOUNDATION FOR COMPETENT AND REFLECTIVE PRACTITIONERS

This paper describes a set of learning outcomes that clearly define the abilities of medical graduates from any of the five Scottish medical schools. The outcomes are divided into 12 domains that fit into one of three essential elements for the competent and reflective medical practitioner.

Assessment of progress tests

Background  Progress testing is a form of longitudinal examination which, in principle, samples at regular intervals from the complete domain of knowledge considered a requirement for medical students on completion of the undergraduate programme. Over the course of the programme students improve their scores on the test, enabling them, as well as staff, to monitor their progress.

Widening access to UK medical education for under-represented socioeconomic groups: modelling the impact of the UKCAT in the 2009 cohort

Objective To determine whether the use of the UK clinical aptitude test (UKCAT) in the medical schools admissions process reduces the relative disadvantage encountered by certain sociodemographic groups. Design Prospective cohort study. Setting Applicants to 22 UK medical schools in 2009 that were members of the consortium of institutions utilising the UKCAT as a component of their admissions process. Participants 8459 applicants (24 844 applications) to UKCAT consortium member medical schools where data were available on advanced qualifications and socioeconomic background. Main outcome measures The probability of an application resulting in an offer of a place on a medicine course according to seven educational and sociodemographic variables depending on how the UKCAT was used by the medical school (in borderline cases, as a factor in admissions, or as a threshold). Results On univariate analysis all educational and sociodemographic variables were significantly associated with the relative odds of an application being successful. The multilevel multiple logistic regression models, however, varied between medical schools according to the way that the UKCAT was used. For example, a candidate from a non-professional background was much less likely to receive a conditional offer of a place compared with an applicant from a higher social class when applying to an institution using the test only in borderline cases (odds ratio 0.51, 95% confidence interval 0.45 to 0.60). No such effect was observed for such candidates applying to medical schools using the threshold approach (1.27, 0.84 to 1.91). These differences were generally reflected in the interactions observed when the analysis was repeated, pooling the data. Notably, candidates from several under-represented groups applying to medical schools that used a threshold approach to the UKCAT were less disadvantaged than those applying to the other institutions in the consortium. These effects were partially reflected in significant differences in the absolute proportion of such candidates finally taking up places in the different types of medical schools; stronger use of the test score (as a factor or threshold) was associated with a significantly increased odds of entrants being male (1.74, 1.25 to 2.41) and from a low socioeconomic background (3.57, 1.03 to 12.39). There was a non-significant trend towards entrants being from a state (non-grammar) school (1.60, 0.97 to 2.62) where a stronger use of the test was employed. Use of the test only in borderline cases was associated with increased odds of entrants having relatively low academic attainment (5.19, 2.02 to 13.33) and English as a second language (2.15, 1.03 to 4.48). Conclusions The use of the UKCAT may lead to more equitable provision of offers to those applying to medical school from under-represented sociodemographic groups. This may translate into higher numbers of some, but not all, relatively disadvantaged students entering the UK medical profession.

The Conscientiousness Index: A Novel Tool to Explore Students' Professionalism

Purpose Measuring professional behavior is problematic not least because the concept of professionalism is difficult to define. The authors describe a measurement tool that does not rely on qualitative judgments from respondents but, nonetheless, clearly correlates with individuals’ subjective views about what constitutes professional behavior. Method The authors devised the Conscientiousness Index (CI) of medical students’ performance in years 1 (n = 116) and 2 (n = 108) in 2006-2007. The CI scores were based on a range of objective measures of conscientiousness, including attendance and submission of required information (such as immunization status or summative assessments) by a deadline. The validity of this instrument was tested against (1) staff views of the professional behavior of individual students and (2) critical incident reports. Results The trait of conscientiousness, as measured by the CI, showed good correlation with the construct of professionalism as perceived by staff views of individual students’ professional behavior. There was also a relationship with the frequency of critical incident reporting. Together, these observations support the validity of the approach. Reliability and practicality were also acceptable. Conclusions The results suggest that the CI measures a scalar objective trait that corresponds well with professional behavior as perceived by staff members in an undergraduate medical school. The individual decisions making up the CI are objective and easy to collect, making it a relatively simple and uncontroversial method for exploring students’ professionalism.

Short communicationExploring medical students’ attitudes towards peer physical examination

With opportunities for dissection and examination of sick patients decreasing, the role of peer physical examination (PPE) is increasing. This study explores students’ attitudes towards PPE and the relationship between attitudes and demographics. A total of 129 first-year medical students from the Peninsula Medical School completed the Examining Fellow Students (EFS) questionnaire. At least 97% of students were comfortable participating in PPE of all body parts except breast and inguinal regions. Over 20% of students were unwilling to participate in PPE of the breast and inguinal regions. Students were more comfortable with PPE within gender than across gender. Females were more likely to be uncomfortable with PPE. Further research with larger sample sizes is required to determine whether attitudes are related to age and religious faith.

Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study.

Objective To determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as evaluated at Annual Review of Competence Progression (ARCP), between UK based doctors who qualified overseas and those who obtained their primary medical qualification from UK universities. Design Observational study linking ARCP outcome data from the UK deaneries with PLAB test performance and demographic data held by the UK General Medical Council (GMC). Setting Doctors in postgraduate training for a medical specialty or general practice in the UK and doctors obtaining GMC registration via the PLAB system. Participants 53 436 UK based trainee doctors with at least one competency related ARCP outcome reported during the study period, of whom 42 017 were UK medical graduates and 11 419 were international medical graduates who were registered following a pass from the PLAB route. Main outcome measure Probability of obtaining a poorer versus a more satisfactory category of outcome at ARCP following successful registration as a doctor in the UK. Results International medical graduates were more likely to obtain a less satisfactory outcome at ARCP compared with UK graduates. This finding persisted even after adjustment for the potential influence of sex, age, years of UK based practice, and ethnicity and exclusion of outcomes associated with postgraduate examination failure (odds ratio 1.63, 95% confidence interval 1.30 to 2.06). However, international medical graduates who scored in the highest twelfth at part 1 of the PLAB (at least 32 points above the pass mark) had ARCP outcomes that did not differ significantly from those of UK graduates. Conclusions These findings suggest that the PLAB test used for registration of international medical graduates is not generally equivalent to the requirements for UK graduates. The differences in postgraduate performance, as captured at ARCP, following the two routes to registration might be levelled out by raising the standards of English language competency required as well as the pass marks for the two parts of the PLAB test. An alternative might be to introduce a different testing system.

A systematic literature review of undergraduate clinical placements in underserved areas

The delivery of undergraduate clinical education in underserved areas is increasing in various contexts across the world in response to local workforce needs. A collective understanding of the impact of these placements is lacking. Previous reviews have often taken a positivist approach by only looking at outcome measures. This review addresses the question: What are the strengths and weaknesses for medical students and supervisors of community placements in underserved areas?

How we teach anatomy without cadavers

Peninsula Medical School, one of four new medical schools to open in the UK in 2002–2003, has taken this radical step. So, what was behind our thinking? We asked ourselves how doctors encounter anatomy in clinical practice. The answer is through living and surface anatomy on the one hand, and through medical imaging on the other. It therefore seemed to make more sense to teach anatomy to students in this context, right from the beginning. The whole principle of the medical school is based upon giving students authentic experiences from the start of the course. For instance, students meet their first patients in community settings in their first two weeks. They engage in clinical skills training, from the start, continuing throughout the course. Problem based learning is used to introduce them to team working and clinical reasoning. In teaching anatomy, we decided that we would rely upon living anatomy delivered to the students through the use of peer examination and life models, and on medical imaging.