Patricia M. Lyon

Clinical skills in junior medical officers: a comparison of self‐reported confidence and observed competence

Background  The intern year is a key time for the acquisition of clinical skills, both procedural and cognitive. We have previously described self‐reported confidence and experience for a number of clinical skills, finding high levels of confidence among Australian junior doctors. This has never been correlated with an objective measure of competence.

A model of teaching and learning in the operating theatre

Introduction  This paper extends the work of an earlier publication by the same author which reported the findings of a case study designed to investigate how medical students learn and are taught in the operating theatre. The earlier paper was descriptive in nature, examining the challenges students face as learners in theatres. These were conceptualised around 3 key domains: the challenge posed by the physical environment; the challenge of the educational task, and the challenge of managing and negotiating a role as a participant in the professional workplace of theatres. This paper focuses exclusively on the third domain. It presents an interpretive model of teaching and learning in the operating theatre, drawing largely on conceptual frameworks developed within the literature on learning in work‐based settings.

Factors affecting the utility of the multiple mini-interview in selecting candidates for graduate-entry medical school

Context  We wished to determine which factors are important in ensuring interviewers are able to make reliable and valid decisions about the non‐cognitive characteristics of candidates when selecting candidates for entry into a graduate‐entry medical programme using the multiple mini‐interview (MMI).

Making the most of learning in the operating theatre: student strategies and curricular initiatives

Background Students in medical programmes around the world are required to attend with their patient in the operating theatre, yet little is known about this area of medical education. Most of the published literature on the operating theatre is normative in character, written from the perspective of the surgeon as teacher. This paper, in contrast, reports the students perspective as learner. It is an interpretive case study conducted in the department of surgery at an Australian university.

Clinical skills in early postgraduate medical trainees: patterns of acquisition of confidence and experience among junior doctors in a university teaching hospital

Little is known about patterns of clinical skills acquisition among junior doctors undertaking clinical training in the early postgraduate period. A better understanding would assist in the design of effective educational interventions for this group.

Online CME: an effective alternative to face-to-face delivery

Background: The Pharmacotherapies Accreditation Course (PAC) is a continuing medical education (CME) course designed to prepare practitioners for accreditation as pharmacotherapies prescribers for opioid dependence. The course incorporates a preparation stage, a workshop stage and a clinical placement component. The PAC continues to be successfully delivered in face-to-face mode since 2001. From 2003 onwards, an online alternative of the PAC was also implemented. Aims: The aim of this study was to evaluate the effectiveness of an online alternative to an existing face-to-face CME workshop in preparing practitioners for accreditation as a pharmacotherapies prescriber for opioid dependence. Methods: Participants were 62 practitioners who undertook the PAC between 2003 and 2006. A pretest/posttest-control group design was used, with outcome measures across the domains of knowledge, skill, and attitudes, together with a course feedback survey for both the online and face-to-face modes of the course. Results: Results demonstrate that the online CME mode was equally as effective as the face-to face mode in preparing participants for their role in the treatment and management of opioid dependence, and was also rated highly by participants. Conclusions: The findings have implications for the effective design and delivery of e-learning environments for professional practice, in terms of equipping participants with requisite clinical knowledge and skills and facilitating the development of attitudes congruent with professional practice.

Helping students understand their learning styles: Effects on study self‐efficacy, preference for group work, and group climate

Small tutorial groups in higher education are often composed without regard to students’ gender or broad knowledge background, for example, yet research indicates that composing groups on the basis of gender and prior qualifications may have significant effects on assessment outcomes. Previous studies have also investigated the effects of composing groups on the basis of learning style preference and found no effects. The effect of combining group composition with training in learning styles is unclear, however. In this study we report on the effects of workshop training in learning styles on balanced group members’ study self‐efficacy, preference for group work, group climate, and assessment performance. Although we found no effects, students reported greater self‐awareness of their own learning and acceptance of others’ styles. We conclude that in collaborative learning environments, training may need to go beyond facilitating growth in students’ self‐awareness to include a focus on how to apply this understanding to improving group function and helping others to learn.

Student evaluation of expert and non-expert problem-based learning tutors

The role of the tutor is important in developing effectivegroup process in educational programs built around small-group,problem-based learning (PBL).The tutor’s roleincludes creating a supportive group climate,encouraging theinvolvement of group members and addressing group prob-lems when they arise.Good tutoring has the potential to enhance group processin both novice and experienced teams.It is worthwhile therefore to monitor the quality of tutorial teaching in PBLprograms and provide valid and useful feedback to individ-ual tutors.In addition to ‘expertise’in teaching,tutors may have con-tent expertise in the area(s) covered by the patient problem(s).Tutors with content expertise may facilitate students’learn-ing,for example,by intervening in students’discussion withtimely statements or questions that evoke relevant ideasand/or clinical reasoning processes.However,studies of theeffect of tutor content expertise on student learning have pro-duced inconclusive results (Schmidt & Moust,2000).Someresearch has found a positive effect on students’achievementin favour of content experts,while other studies have foundmixed or no differences between ‘expert’and ‘non-expert’tutors (see Schmidt & Moust,2000,for a comprehensivereview).The inconclusive results from this research may bedue to differences in (1) the de”nitions of content expertiseand (2) the size of samples used,(3) participating students’level of experience of PBL,(4) students’levels of prior knowl-edge,and/or (5) the amount of structure provided by the medical school curriculum (Schmidt & Moust,2000).The curriculum in Years 1 and 2 of the University ofSydney medical program is structured around PBL tutorials,supported by lectures and other teaching sessions relevant tothe problem.A total of 70 clinical problems are grouped intonine units or ‘blocks’of study.The ”rst block is introductory,seven blocks are based on body systems and the ninth blockis concerned with oncology and palliative care.Prior to eachblock,all PBL tutors are provided with printed materials spe-cially designed to support their teaching for each problem.These support materials,together with extensive web-basedstudent resources linked to the weekly case (readers mayexplore the program web site at http://www.gmp.usyd.edu.au/visitors/),provide a highly structured teaching and learn-ing environment.In this paper,we report the results of an analysis of PBLtutor evaluation data from Years 1 and 2 of the medicalprogram for the period 1998–2000.We conducted a con”r-matory factor analysis on a 24-item tutor feedback form completed by students at the end of each block,and com-pared ratings of ‘expert’and ‘non-expert’tutors,where experttutors were broadly de”ned as having medical training.Weused this de”nition of ‘expert’because tutors with medicaltraining have different levels of clinical experience in additionto knowledge of both the basic and clinical sciences.Non-experts were further subdivided into staff with basic scienceand non-basic science backgrounds.Our analysis does notinclude an examination of the relationship between tutorexpertise and student achievement in the USydMP,becausestudents change their tutors several times during Years 1 and2,and such an examination would involve a higher level ofcomplexity beyond the scope of this article.

Conceptions of problem-based learning: the perspectives of students entering a problem-based medical program

Effective learning in higher education is associated with students’ perceptions of clear goals and standards of an educational program. In programs using problem-based learning (PBL), students’ conceptions of what PBL is about could determine how well they perceive the clarity of goals and standards of their program. In this study the authors aim to investigate the relationship between the nature of first-year students’ conceptions of PBL and their perceptions of the clarity of goals and standards of a graduate-entry, problem-based medical program. Results are that most students conceive of PBL as mainly working collaboratively to solve and understand a problem, and place less emphasis on PBL as learning independently. There is no relationship between students’ conceptions and perceived clarity of course goals and standards. It is suggested that teachers not only need to help students develop their understanding of what PBL is about but also need to help students learn how to self-regulate their learning in PBL programs.

Students' perceptions of clinical attachments across rural and metropolitan settings

For many years, medical students at the University of Sydney undertook their clinical clerkships in traditional metropolitan teaching hospitals, which were regarded as the ‘gold standard’ for clinical training. In 2001 the university established a rural clinical school at which increasing numbers of students now complete a significant proportion of their medical education. The aim of the study reported here is to examine students’ perceptions of what facilitates their learning in clinical settings and to compare their perceptions across rural and metropolitan settings. Focus groups were conducted to collect students’ views on their experiences of learning in clinical settings. The findings were used to generate a questionnaire with items designed directly from focus‐group data ensuring content validity. The questionnaire was sent to all students in the 2004 cohort. Exploratory factor analysis was used to provide evidence of construct validity. The internal consistency reliability of the questionnaire was assessed using Cronbach’s alpha. Factor scores were computed to compare students’ perceptions across the two settings. Four factors were extracted: (1) clinical teachers’ orientation to teaching; (2) opportunities to develop clinical skills; (3) supportiveness of the clinical setting; and (4) student confidence and sense of self‐efficacy. Students rated the rural experience more highly and positively than the metropolitan hospital experience with regard to all four factors. This study highlights the positive role that rural attachments can play in providing an educationally sound learning experience. The findings are important in the context of both the drive, among medical programs worldwide, to seek out additional and alternative settings for clinical education and the national agenda to foster student interest in rural careers through positive rural training experiences.