Ray Peterson

Distress levels and self-reported treatment rates for medicine, law, psychology and mechanical engineering tertiary students: cross-sectional study

Objective: The aim of this research was to assess tertiary student distress levels with regards to (i) comparisons with normative population data, and (ii) the effects of discipline, year level, and student characteristics. Self-reported treatment rates and level of concern regarding perceived distress were also collected. Method: Students from all six years of an undergraduate medical course were compared with samples from Psychology, Law and Mechanical Engineering courses at the University of Adelaide, Australia. Students participated in one of three studies that were either web-based or paper-based. All studies included Kesslers Measure of Psychological Distress (K10), and questions pertaining to treatment for any mental health problems and concern regarding distress experienced. Results: Of the 955 tertiary students who completed the K10, 48% were psychologically distressed (a K10 score ≥ 22) which equated to a rate 4.4 times that of age-matched peers. The non-health disciplines were significantly more distressed than the health disciplines. Distress levels were statistically equivalent across all six years of the medical degree. Of tertiary students, 11% had been treated for a mental health problem. Levels of concern correlated with the K10 score. Conclusion: The results from this research suggest that high distress levels among the tertiary student body may be a phenomenon more widely spread than first thought. Low treatment rates suggest that traditional models of support may be inadequate or not appropriate for tertiary cohorts.

The Student Voice: Recognising the hidden and informal curriculum in medicine

Background: While there has been broad-based recognition of the concepts of both the informal and the hidden curriculum, these elements have been poorly described in the medical education literature from the student perspective. Methods: The Student Voice study used focus groups to explore student views of the informal and hidden curriculum, to establish the importance of this curriculum for the students, and to identify how students perceive the role of this curriculum in aiding their learning in medical school. Results: Students recognised that the informal curriculum existed to a greater degree in Medicine than in other degree programs, and that it revolved around the processes of ‘being’ a doctor. Conclusion: The students’ concepts of the informal curriculum highlighted a tension between the importance of the informal curriculum in focusing their learning on what was important to know for assessment, and the extremely valuable components of the informal curriculum that remained predominantly unassessed.

Becoming a peer reviewer to medical education journals

Background: Peer reviewing for medical education journals is an art, a privilege, a responsibility and a service to the profession. Writing a review report requires skills and commitment and takes time. Novice reviewers may be interested in participating in this service, but they might lack sufficient knowledge of their role as peer reviewers and the skills needed to conduct a comprehensive and fair review. Aims: The aims of this article are to help novice reviewers in their preparation of manuscript review reports and improve their confidence and skills in their role as reviewers. Methods: We reviewed the literature in this area and applied lessons learned from our experience as peer reviewers. In addition, one of the authors has presented several training workshops for faculty reviewers. Results: Incorporating all the methods described, we have developed a series of simple strategies that medical educators can utilise to perform high-quality reviews of manuscripts. Conclusions: Though the development of skills in reviewing medical education papers is the outcome of continuous practice and experience; the strategies described in this article will be of value to those starting their professional contribution as reviewers and enhance their skills in this area.

Using student-generated questions for student-centred assessment

In small groups, medical students were involved in generating questions to contribute to an online item bank. This study sought to support collaborative question‐writing and enhance students’ metacognitive abilities, in particular, their ability to self‐regulate learning and moderate understanding of subject material. The study focused on supporting students to write questions requiring higher order cognitive processes. End‐of‐year formal examinations comprised 25% student‐generated questions (SGQs), while mid‐year examination items were completely unseen. Data were gathered from repeated administration of a questionnaire and from examination results. No statistically significant changes were identified in self‐rated monitoring of understanding and regulation of learning. The activity of generating questions supported students to work collaboratively in developing questions and answers. The bank of questions was appreciated by students as a source of revision material, even though it was not strongly focused on higher order processes. Based on scores, it would appear that many students chose to memorise the question bank as a ‘high‐yield’ strategy for mark inflation, paradoxically favouring surface rather than deep learning. The study has not identified directly improvements in metacognitive capacity and this is an area for further investigation. Continual refinement of the study method will be undertaken, with an emphasis on education of students in developing questions addressing higher order cognitive processes. Although students may have memorised the questions and answers, there is no evidence that they do not understand the information.

The assessment of student reasoning in the context of a clinically oriented PBL program

Background: Doctors’ clinical reasoning ability significantly impacts upon their level of clinical competence. Throughout medical training students are given the opportunity to develop their reasoning ability in order to become appropriately clinically competent by graduation. Aim: To develop an instrument to assess students’ reasoning ability on a written case-based question which was aligned to their learning in a PBL program. Method: An instrument with 10 criteria centred upon hypothesis generation, learning issues and mechanistic explanations was developed. Experienced clinical and medical educators validated the instrument, prior to its use with 145 undergraduate first-year medical students. Results: The results enabled the establishment of the strengths and weaknesses in the reasoning performances of individuals, as well as the overall cohort. The instruments Cronbach alpha coefficient was 0.94, and it had high inter-rater and intra-rater reliability. Further validation of the instruments performance was established through qualitative evidence derived from student interviews and tutor reports for this cohort. Conclusions: Aligning written assessment to the PBL process enables students and teachers to better understand how the reasoning process is developing for individuals and a cohort, and provides a basis for further investigation into the development of student clinical reasoning.

Using a structured clinical coaching program to improve clinical skills training and assessment, as well as teachers' and students' satisfaction.

Introduction: The ability to deliver the traditional apprenticeship method of teaching clinical skills is becoming increasingly more difficult as a result of greater demands in health care delivery, increasing student numbers and changing medical curricula. Serious consequences globally include: students not covering all elements of clinical skills curricula; insufficient opportunity to practise clinical skills; and increasing reports of graduates’ incompetence in some clinical skills. Methods: A systematic Structured Clinical Coaching Program (SCCP) for a large cohort of Year 1 students was developed, providing explicit learning objectives for both students and paid generalist clinical tutors. It incorporated ongoing multi-source formative assessment and was evaluated using a case-study methodology, a control-group design, and comparison of formative assessment scores with summative Objective Structured Clinical Examination (OSCE) scores. Results: Students demonstrated a higher level of competence and confidence, and the formative assessment scores correlated with the Research students’ summative OSCE scores. SCCP tutors reported greater satisfaction and confidence through knowing what they were meant to teach. At-risk students were identified early and remediated. Discussion: The SCCP ensures consistent quality in the teaching and assessment of all relevant clinical skills of all students, despite large numbers. It improves student and teacher confidence and satisfaction, ensures clinical skills competence, and could replace costly OSCEs.

Students generating questions for their own written examinations

Assessment partnerships between staff and students are considered a vital component of the student-centred educational process. To enhance the development of this partnership in a problem-based learning curriculum, all first-year students were involved in generating a bank of formative assessment questions with answers, some of which were included in their final written examination. Important principles to guide development of a sound methodology for such an assessment partnership have been described. These include organisational issues as well as matters pertaining to participation, education and motivation of students and teaching staff.

Clinical Location and Student Learning: Outcomes From the LCAP Program in Queensland, Australia

Background: Three students in the 3rd year of a graduate entry medical program self-selected to participate in a 1-year clinical placement, each with a rural general practitioner in central western Queensland, Australia. Description: Students completed 32 weeks in a rural generalist community immersion medical program and were compared with matched students who completed their year in urban tertiary hospitals. Evaluations included teaching and learning opportunities, assessment of clinical competencies, and semistructured interviews. Views of preceptors, spouses, and community were also evaluated. Evaluation: All outcome measures were positive and many were greater for the rural immersion students than for the matched urban group. Students were able to achieve the requirements of their medical program in a nontraditional placement. Views of preceptors indicated satisfaction with long-term medical student placements including enjoyment, negligible time or financial impact, and beneficial professional and collegial support. Conclusions: Long-term immersion placements benefited student learning and had a favorable impact on the preceptors.

Curriculum and teacher evaluation/accreditation

AMEE 2006 provided considerable opportunities for participants to explore the educational impact of programs through the outcomes of a variety of evaluation initiatives and the perspectives from which they were interpreted. In the context of the theme for this spotlight, evaluation of curricula and teachers featured more prominently than aspects associated with the more formal processes of accreditation. The take home messages are discussed in four categories - curriculum evaluation, curriculum accreditation, teacher evaluation and teacher accreditation.With the growing number of simultaneous sessions at AMEE conferences, participants are frequently faced with the dilemma of which presentations to attend. Starting in 2004 the ‘Spotlight’ sessions were introduced. In these sessions, key themes are selected for review, and one participant for each theme is invited to act as Spotlight Reviewer to pull together the key messages identified by him/her during the conference sessions. These serve as an overview for participants to use for themselves, or to take back to their Institutions as short reports of what is happening in medical and healthcare professions education. The themes selected for AMEE 2006 were: (1) Undergraduate medical education; (2) Research in medical education; (3) Curriculum and teacher evaluation/accreditation; (4) New learning technologies; (5) Assessment; (6) Postgraduate education/CPD; and (7) Student learning. We are very grateful to the participants who agreed to act as Spotlight Reviewers. Part 2 covering the remaining themes will be published in a later issue.