Margaret Boohan

Is there a place for e-learning in clinical skills? A survey of undergraduate medical students' experiences and attitudes

Background: e-learning is established in many medical schools. However the effectiveness of e-learning has been difficult to quantify and there have been concerns that such educational activities may be driven more by novelty, than pedagogical evidence. Where some domains may lend themselves well to e-learning, clinical skills has been considered a challenging area for online learning. Aims: The aims of this study are to assess undergraduate medical students? perceived level of IT ability and accessibility, and attitudes towards e-learning in basic clinical skills education, compared to other teaching methods. Methods: A self-administered questionnaire was developed to capture undergraduate medical students: (i) demographic details (ii) perceived level of IT ability and accessibility (iii) experiences and attitudes towards e-learning and clinical skills training. Responses were linked to student?s performance in a clinical skills OSCE. Results: The majority of students reported good access to computers and the internet, both on and off campus and appear confident using IT. Overall students felt that e-learning had a positive impact on their learning of clinical skills and was comparable to other traditional forms of clinical skills teaching. Students who displayed deep learning traits when using e-learning, performed better in clinical skills OSCEs. Conclusion: Undergraduate medical students value the use of e-learning in clinical skills education, however they vary in their utilization of such learning environments. Students rate e-learning just as highly as other traditional methods of clinical skills teaching and acknowledge its integration in a blended approach. Developers of clinical skills curricula need to ensure e-learning environments utilize media that encourage deeper approaches to learning.

Basic clinical skills don't leave teaching to the teaching hospitals

To compare student perception of teaching in general practice (GP), district general hospitals (DGHs) and teaching hospitals (THs) and their examination results.

Collaboration across the pond: The multi-school progress testing project

This collaborative project between the National Board of Medical Examiners and four schools in the UK is investigating the feasibility and utility of a cross-school progress testing program drawing on test material recently retired from the United States Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) examination. This article describes the design of the progress test; the process used to build, translate (localize), review, and finalize test forms; the approach taken to (web-based) test administration; and the procedure used to calculate and report scores. Results to date have demonstrated that it is feasible to use test items written for the US licensing examination as a base for developing progress test forms for use in the UK. Some content areas can be localized more readily than others, and care is clearly needed in review and revision of test materials to ensure that it is clinically appropriate and suitably phrased for use in the UK. Involvement of content experts in review and vetting of the test material is essential, and it is clearly desirable to supplement expert review with the use of quality control procedures based on the item statistics as a final check on the appropriateness of individual test items.

General practitioners' opinions regarding the need for training in dermatology at undergraduate and postgraduate levels

deflazacort. Eosinophilic fasciitis is a debilitating condition presenting initially with diffuse pain of the extremities, with subsequent development of oedema. In the latter stages the skin is taut with tethering of the skin and subcutaneous tissue to the underlying muscle. The aetiology is not yet understood; however, a number of observations have been recorded. Eosinophilic fasciitis has been associated with various haematological conditions including T-cell lymphoma and myelodysplasia. It has been noted in renal disease and has also been associated with Borrelia burgdorferi infection. Some reports have observed possible associations with various drugs. Importantly, eosinophilic fasciitis occurring after therapy with simvastatin has been documented. The Medicines and Healthcare Products Regulatory Agency and the Committee on Safety of Medicines have tracked spontaneous reports of suspected adverse reactions to atorvastatin between July 1963 and October 2004. A personal communication reports 3 reactions of eosinophilic fasciitis, 244 of myalgia, 41 of muscle cramp, 28 of muscle weakness, 17 of myopathy, 36 of myositis, 27 of rhabdomyolysis and 29 of pain in the extremities. The majority of these reactions are recognized in the current summary of product characteristic for atorvastatin. Eosinophilic fasciitis is a rare disorder, which can be very debilitating. This is the second report documenting a possible link between this condition and treatment with the HMG-CoA reductase inhibitors. As simvastatin is now available over the counter, it is important to consider this as a possible cause when diagnosing patients with eosinophilic fasciitis.

Learning styles - Do they matter?

Self-assessment ability in medical students and practising physicians is generally poor yet essential for academic progress and professional development. The aim of this study was to determine undergraduate medical students ability to accurately self assess their exam performance in a real-world, high-stakes exam setting, something not previously investigated. Year 1 and Year 2 medical students (n = 199) participated in a self-assessment exercise. Students predicted their exam score (%) on the anatomy practical exam. This exercise was completed online, immediately after the exam. Students’ predicted exam scores were correlated with their actual attained exam scores using a Pearson’s correlation. Demographic data was analysed using an independent t-test. A negative correlation was found between students’ predicted and attained exam scores. There was no relationship between the students’ entry status into medical school and self-assessment ability or between males and females. However, a relationship was determined for these variables in year 2. The number of hours of additional self-directed learning undertaken did not influence students’ self-assessment. Our results demonstrate the ‘unskilled and unaware’ phenomenon in a real-world, higherstakes and practice-related setting. Students were unable to self-assess their exam performance. Poor performers were shown to overestimate their ability, and conversely, high achievers underestimated their performance. We present evidence of a strong, significant linear relationship between medical students’ ability to self-assess their performance in an anatomy practical exam, and their actual performance; in a real world setting. These findings will enable faculty to guide students on their journey to becoming reflective practitioners and reflective anatomy students.

Feedback of audit results can improve clinical teaching (but may also impair it)

The objective of this study was to determine whether formal, written feedback to teachers would improve the quality of teaching. Twenty-seven units that were teaching clinical skills in teaching hospitals (TH), district general hospitals (DGH) and GP surgeries were used as the setting. One hundred and eighty-eight students in Audit Phase 1 (1997) and 175 students in Audit Phase 2 (1998) completed a questionnaire regarding time utilization during teaching sessions, tutor characteristics and course attributes. Feedback of results from the Audit Phase 1 questionnaire to each individual unit was combined with anonymized results of the other units. TH units (which had scored poorly in the first questionnaire) significantly improved the quality of their teaching. This was seen in increases in (1) the degree of prior preparation, (2) the number of sessions that adhered to the guidelines provided in the study guide, (3) time spent with patients and (4) the interest shown in the students. By contrast, the DGH units and GP units (which had scored well in the first questionnaire), scored poorly in the second questionnaire for prior preparation (GP units) and educational value (DGH units). It is concluded that feedback can improve the quality of student teaching. However, when presented as a contrast with other poorly performing units, feedback may induce complacency.

Scoping systematic review on the extent, nature and quality of evidence underlying ophthalmic and paraophthalmic education

Background Effective education of relevant professionals underpins provision of quality eye healthcare. Objectives This scoping systematic review had 2 aims: first to investigate the extent and nature of scholarly output published on ophthalmic and paraophthalmic education, and second to focus on the quality of reporting of randomised controlled trials (RCTs) identified. Study selection A search strategy was created and applied to PubMed. Any scholarly publications on any aspect of education of those involved in the care of patients with visual problems as the main theme or context was selected. Predefined data were extracted. Findings Of 255 studies included, the most common type of scholarly publications were descriptions of an educational innovation, opinion pieces and descriptive studies. RCTs made up 5.5% of the sample. Most of the 14 RCTs failed to report most of the items recommended in the CONSORT guidelines. Conclusions This review highlights the need for investigators, ethical committees and journals to insist on a better quality of RCT conduct than is presently apparent, but also that clinicians should not be blind to the strengths of non-RCT-based studies in the field of education.