Katharine Reid

Comparing the academic performance of graduate- and undergraduate-entry medical students

Medical Education 2010 44: 197–204

Working with young people: evaluation of an education resource for medical trainees.

Many health professionals report interest in consulting more effectively with young people but have unmet training needs. We set out to evaluate a teaching resource in adolescent health and medicine that was designed for Australian trainees in specialist medicine.

Teaching a fishbowl tutorial: sink or swim?

Background:  The fishbowl method is a small group teaching technique in which a number of students engage in a discussion while observers form a circle around them. We use this method to teach medical interviewing skills, with students interviewing a simulated patient (SP) whilst being observed by their peers and a clinical tutor. However, there is little evidence to guide teachers on how best to structure a fishbowl tutorial.

First-year medical students' willingness to participate in peer physical examination.

Background: There is little research on student attitudes toward participating in peer physical examination (PPE). Purpose: This study explored first-year medical students’ attitudes toward PPE and their willingness to participate in PPE before they had experience with PPE as part of their course. Methods: First-year medical students (n = 119) rated their willingness to participate in PPE for 15 body regions, with male or female peers, and when examining or being examined by others. Attitudes toward participating in PPE were also assessed. Results: Low-sensitivity examinations (e.g., hands, head) in PPE were generally accepted by male and female students. Significant variation in willingness across different body regions was, however, evident for male and female students depending on the type of examination and their examination partners gender. Students generally held positive attitudes toward participating in PPE as part of the course. Moreover, students with more positive attitudes provided higher ratings of willingness to participate in PPE for all examination types. Conclusions: Findings suggest high levels of willingness to participate in PPE for low-sensitivity examinations of the kind employed in university teaching contexts. Nonetheless, gender effects appear more complex than previously described, and for some regions of the body, there are subtle preferences for particular examination types, in particular performing examinations, rather than being examined.

Clinical assessment performance of graduate- and undergraduate-entry medical students

Background: Recent evidence suggests that graduate-entry medical students may have a marginal academic performance advantage over undergraduate entrants in a pre-clinical curriculum in both bioscience knowledge and clinical skills assessments. It is unclear whether this advantage is maintained in the clinical phase of medical training. Aim: The study aimed to compare graduate and undergraduate entrants undertaking an identical clinical curriculum on assessments undertaken during clinical training in the medical course. Methods: Clinical assessment results for four cohorts of medical students (n = 713) were compared at the beginning and at the end of clinical training for graduate and undergraduate entrants. Results: Results showed that graduate- and undergraduate-entry medical students performed similarly on clinical assessments. Female students performed consistently better than male students. Conclusion: The findings of this study suggest that any academic performance advantage held by graduate-entry medical students is limited to the early years of the medical course, and is not evident during clinical training in the later years of the course.

Taking OSCE examiner training on the road: reaching the masses

Background To ensure the rigour of objective structured clinical examinations (OSCEs) in assessing medical students, medical school educators must educate examiners with a view to standardising examiner assessment behaviour. Delivering OSCE examiner training is a necessary yet challenging part of the OSCE process. A novel approach to implementing training for current and potential OSCE examiners was trialled by delivering large-group education sessions at major teaching hospitals. Methods The ‘OSCE Roadshow’ comprised a short training session delivered in the context of teaching hospital ‘Grand Rounds’ to current and potential OSCE examiners. The training was developed to educate clinicians about OSCE processes, clarify the examiners’ role and required behaviours, and to review marking guides and mark allocation in an effort to standardise OSCE processes and encourage consistency in examiner marking behaviour. A short exercise allowed participants to practise marking a mock OSCE to investigate examiner marking behaviour after the training. Results OSCE Roadshows at four metropolitan and one rural teaching hospital were well received and well attended by 171 clinicians across six sessions. Unexpectedly, medical students also attended in large numbers (n=220). After training, participants’ average scores for the mock OSCE clustered closely around the ideal score of 28 (out of 40), and the average scores did not differ according to the levels of clinical experience. Conclusion The OSCE Roadshow demonstrated the potential of brief familiarisation training in reaching large numbers of current and potential OSCE examiners in a time and cost-effective manner to promote standardisation of OSCE processes.

Women’s experiences of working as a Clinical Teaching Associate teaching sensitive examinations: A qualitative study

Abstract Background: Increasingly, professional patient programs are used for training medical students to perform pelvic examinations, yet we know little of the experiences of women who teach medical students these sensitive examination skills. Aim: To describe the experiences of women working as Clinical Teaching Associates (CTAs) teaching medical students the technical and communication skills required to perform pelvic examinations. Methods: Twelve women employed as CTAs participated in semi-structured interviews. Individual interviews were used to identify major themes in women’s experiences of teaching sensitive examinations to medical students. Results: CTAs identified unique difficulties in their work including negative attitudes from others towards their role and the unpleasantness of the examination, although other challenges (such as teamwork issues or providing negative feedback to colleagues) were characteristic of many work situations. Effective communication was identified as central to the CTA role and the women described growth in their communication skills and assertiveness that they applied to other aspects of their work and personal lives. CTAs were motivated to join the program and remained in the program because of an interest in women’s health and a desire for meaningful work, which they believed improved the examination and communication skills of future doctors. Positive interactions with work colleagues were a valued part of the role and a primary motivator to remain in the program. Conclusions: Highlighting the experiences of women working as CTAs validates the significant teaching role these women perform and, from a pragmatic perspective, may increase understanding of the best way to attract and retain women to these important teaching roles.

Conducting Patient Assessments as a Medical Student: Frequency, Barriers, and Facilitators

Background: Opportunities for medical students to engage in deliberate practice through conducting patient assessments may be declining, but data on the numbers of patients assessed by students during training are lacking. Purposes: The study described relationships between the frequency of patient assessments, student confidence, belief they had seen sufficient patients, and their perceptions of barriers and facilitators of seeing patients. Methods: We employed survey methodology to estimate the number of patient assessments conducted across 6 rotations in the 1st year of clinical training, gather ratings of confidence and student belief they had conducted sufficient patient assessments, and barriers and facilitators of seeing patients. Results: Rotations focused on general medicine and surgery provided more opportunities for patient assessments than specialist rotations (all p < .001). Students conducting more than 10 patient assessments rated confidence in conducting patient assessments and belief they had seen enough patients for their clinical learning, higher than students who saw 10 or fewer patients (all p < .001). Conclusions: Our study demonstrated variation in the frequency of patient assessments, and weak relationships between numbers of assessments, student confidence, and barriers to seeing patients. Further investigation is warranted of the impact of fewer opportunities for deliberate practice of skills for expertise development.

The effectiveness of the internship in meeting established learning objectives: A qualitative study

Abstract Objective: To identify and explore variations in intern (Postgraduate Year 1 doctors) exposure to clinical activities defined by an established early postgraduate curriculum within the contemporary health service environment. Methods: A mixed methods study was undertaken in seven health services comprising (1) a questionnaire regarding interns’ exposure to a range of clinical activities within a two-year early post-graduate curriculum and (2) group interviews with intern supervisors and managers to explore barriers and facilitators of interns’ clinical exposure. Results: One hundred and eleven interns completed the questionnaire and seventeen intern supervisors and managers participated in group interviews. Interns’ exposure to early postgraduate curriculum activities varied significantly, with participation in patient emergency management and procedures being undertaken less frequently than interns wished. These findings were consistent across different regional settings. Of three mandatory terms, exposure to curriculum activities was greater in medicine and emergency medicine than in surgery. Conclusions: Junior doctors’ participation within the complex contemporary health service environment is constrained by barriers relating to clinical governance frameworks and health system performance, particularly in high-risk clinical activities. Solutions will require structural approaches to internship reform to ensure that placements provide the necessary safe clinical experiences required for intern training.

A resource for teaching emergency care communication.

Communication in emergency departments (EDs), often between several health professionals and patients and relatives, is a major cause of patient complaint and error; however, communication‐skills teaching for medical students largely focuses on individual clinician–patient interactions.