Michelle McLean

The small group in problem-based learning: more than a cognitive 'learning' experience for first-year medical students in a diverse population

In problem-based learning (PBL) curricula, first-year students need to adapt to a new learning environment and an unfamiliar new pedagogy. The small-group tutorial potentially offers a learning environment where students can become self-directed learners, collaborating with other group members to achieve individual and group learning goals. At the end of the first six-week theme in a relatively new PBL curriculum, new medical students were canvassed about coping with PBL (self-directed learning; content; time management; resources) and the value of the small-group tutorial, the latter of which is currently being reported. Almost 84% of students (nu2009=u2009178) responded. The benefits of participating in small groups were categorized into three domains—cognitive, affective and social—as identified from student responses. Results were analysed in terms of gender and prior educational experience (secondary school vs. prior tertiary educational experience). For almost 94% of students, the small-group tutorial provided a conducive learning environment that influenced their personal development (i.e. tolerance, patience) and socialization into the faculty. Significantly more males indicated that they had developed social skills, while more school-leavers (matriculants) than mature students felt more receptive to the views of others. More mature students claimed to have made friends. Irrespective of some conflicting opinions in the literature, the present results suggest that the PBL tutorial may be important in facilitating student socialization into a new and unfamiliar academic environment, particularly when the pedagogy differs markedly from their past educational experiences. Through interacting with fellow students from diverse origins who hold different views in the intimate setting of the small group, students felt that they had not only increased their knowledge but had also developed personally and socially. It is proposed that the small group may be useful for integrating a diverse population of students into a new academic environment.

Clinical role models are important in the early years of a problem-based learning curriculum.

Following a comprehensive study of the role models identified by the first five years of students in a traditional medical programme, it was hypothesized that with curriculum reform clinical role models would assume greater importance earlier in the undergraduate medical programme. Indeed, when compared with their first- and second-year traditional curriculum colleagues, more problem-based learning students identified role models. Almost four times as many identified faculty role models (largely medically qualified) in comparison with their traditional curriculum counterparts. Concomitant with this increase was a decline in the selection by the PBL students of family members, friends and other students as role models. For all cohorts, however, the mother was the most important role model. Since students in integrated curricula have earlier clinical experience and patient contact, they interact with clinicians in hospitals and clinics as well as in the academic environment of the small-group tutorial and lecture theatres. Academic faculty members, particularly clinicians, need to be aware that students take note of their attitudes and behaviour as members of the medical profession, a profession that students had chosen as a career. Retraining of senior doctors from the traditional curriculum might be necessary to ensure that all clinicians have an equivalent understanding of patient care.

Medical Students' Views on the White Coat: A South African Perspective on Ethical Issues

There is a debate regarding the use of the white coat, a traditional symbol of the medical profession, by students. In a study evaluating final-year South African medical students perceptions, the white coat was associated with traditional symbolic values (e.g., trust) and had practical uses (e.g., identification). The coat was generally perceived to evoke positive emotions in patients, but some recognized that it may cause anxiety or mistrust. Donning a white coat generally implied a responsibility to the profession. For a few, without the coat, patients would not cooperate, resulting in some perceiving no need to be distinguished from qualified practitioners. There was thus some evidence of entitled (vs. earned) respect. In the light of the underresourced health care setting in which these students learn clinical medicine, we recommend that students be able to recognize the potential for unprofessional or unethical behavior. Students should also be able to identify role models.

Enhanced dietary awareness and lifestyle changes in first-year medical students following exposure to problem-based nutrition education

Abstract Background The ever-increasing prevalence of chronic lifestyle-associated diseases has resulted in greater awareness of the importance of preventative medicine and its incorporation as an integral component of modern undergraduate medical curricula. As excessive dietary intake and physical inactivity are widely acknowledged as leading risk factors for the onset of chronic lifestyle-associated diseases, the promotion of a healthy lifestyle is regarded as a priority for todays primary care physicians. For this reason, it was deemed appropriate by the designers of the problem-based learning (PBL) curriculum, which was introduced at the Nelson R. Mandela School of Medicine in 2001, to include a six-week Nutrition theme early in the medical students five-year curriculum. This study set out to determine the impact of this theme, which included a specific focus on the importance of nutrition in avoiding lifestyle-associated disorders, on the dietary awareness and lifestyle of the 2004 intake of medical students. Methods First-year medical students (n = 213) spent the first six weeks of their curriculum (following an orientation period) engaged in a problem-based learning Nutrition theme, which included active, personalised learning experiences such as analysing their own dietary intakes and recording their personal anthropometric measures. They were questioned two weeks after conclusion of the theme regarding (i) the impact of the theme on their dietary awareness and lifestyles, (ii) whether they had, since the start of the theme, shared their newly acquired insights with others, and (iii) the extent to which they recalled their personal measured anthropometric data and calculated kilojoule (kJ) intakes derived during the practical sessions. Results Nearly 84% of the students responded to the anonymous survey (n = 178). A greater awareness of their personal dietary intake following the completion of the Nutrition theme was acknowledged by 88.2% (n = 157), while 65.1% (n = 116) reported improvements to their general lifestyle. Eighty-five percent reported having counselled family members and friends about diet and lifestyle-related issues in the eight-week period since the start of the theme. While recall of body mass indices was higher (p >0.01) in females (85.8%) than in males (61.5%), recall of daily kJ intakes was independent of gender. Unsolicited mention by the students surveyed in this study of components of the South African Food-based Guidelines and recent alternative food pyramids suggests that these models were recognised as health priority areas by this student cohort. Conclusion The introduction of a Nutrition theme at the start of the problem-based medical learning curriculum appeared to have impacted significantly on the dietary awareness and lifestyles of the students surveyed, with a tendency among students to share this awareness with others. From the open-ended responses of the students, the findings of this study appear to confirm that medical students appreciated learning about their own health factors, and that personalising the information made the learning experience more valuable to them. Attitudinal changes and apparent internalisation of the newly acquired nutritional awareness were reflected by the high percentage of students who acknowledged that they had advised others within the two-week period following the completion of the theme. This augurs well for the potential preventative counselling practices of these future medical graduates. It will, however, be of interest to survey this student cohort longitudinally to establish whether their changed perceptions have a longer term impact and result in attitudes and practices that support preventative health care.

The pioneer cohort of curriculum reform: Guinea pigs or trail-blazers?

With curriculum reform, whether we admit it or not, the first cohort of students will be test-driving the new programme. Not only are they the pioneers of a new curriculum, but as they progress through their studies, they experience each year of the innovation for the first time. As curriculum designers, we learn from their experiences and their feedback to improve the programme content and delivery, invariably for subsequent cohorts. A considerable onus therefore rests with this pioneer group, and their contribution to curriculum design, evaluation and programme revision should be valued.

The white coat in clinical practice - the debate rages on! Final year medical students' views

Extracted from text ... Over the past two decades there has been a declining use ofnthe white coat, even in the hospital setting.1-3 For Harnett,1 thisndecline has been so marked that the white-coated doctor isnnow an endangered species. This demise warrants concern,nas some have cited erosion of public opinion of scientificnmedicine and a perceived negative effect of the white coat onnthe doctor-patient relationship as responsible for its decliningnuse.2,3 However, in the study by Douse and colleagues3 thendeclining use of the white coat in the hospital environment wasnattributed to the perception of a large proportion of doctorsn(70% of doctors v. 1% of patients) that white ..