Directing student response to early patient contact by questionnaire

Early clinical exposure in medical education: the experience from Debre Tabor University

BACKGROUND

The idea of early clinical exposure in Ethiopian medical schools is a young concept. Old and newly established universities across the nation are shifting towards incorporation of early clinical exposure (ECE) in their curricula. Debre Tabor University introduced ECE in undergraduate medical education from inception. This study generated evidence on students' experience and academic leaders' reflection on early clinical exposure implementation.

OBJECTIVE

This study was carried out to investigate medical students' perception towards early clinical exposure and its implementation process by instructors in undergraduate medical education at Debre Tabor University.

METHOD

A cross-sectional survey design that combines quantitative and qualitative methods was conducted in 2021. We asked fifth year medical students (42) to complete a self-administered questionnaire on 5-point Likert scale. The data were supplemented by semi-structured interview with 6 purposively selected academic leaders on the factors that facilitate or impede early clinical exposure implementation. The quantitative data were entered and analyzed using SPSS 20 to compute frequency, median and interquartile range. The qualitative data were analyzed thematically.

RESULTS

The study findings suggest that early clinical exposure (ECE) has a positive impact on the development of students' professional knowledge, problem-solving skills, motivation, active learning, and community orientation. Specifically, 64.3% of the surveyed students believed that ECE was effective in constructing their professional knowledge, while 52.4% felt that it improved their problem-solving skills and facilitated constructive/active learning. Additionally, 57.1% of students reported that ECE improved their motivation and 50% noted that it facilitated community orientation. The study also identified several barriers to the implementation of ECE, with the heavy workload being the most commonly mentioned (78.6%). Other challenges included a loose linkage between academic and healthcare institutions (59.5%) and a lack of orientation on the implementation process (35.7%). Academic leaders reflected that ECE was beneficial in familiarizing students with the clinical environment, but staff commitment was crucial for its successful implementation. The study also found that heavy workload, lack of assessment dedicated to ECE on the curriculum, and poorly oriented staff about the program impeded its implementation.

CONCLUSION AND RECOMMENDATIONS

The findings of this study suggest that early clinical exposure was beneficial learning method. Teachers' commitment to their roles with adequate preparation, and the contribution of curriculum in providing the learning objective and cases for each session were factors that facilitate effective implementation of ECE. Heavy workload and poor orientation about the program could impede ECE implementation.

Impacts of early clinical exposure on undergraduate student professionalism-a qualitative study

INTRODUCTION

Early clinical exposure (ECE), or authentic human contact in a social or clinical context during preclinical training, has been adopted by many medical schools. This study aims to investigate how medical students' sense of professionalism changed after ECE intervention, with the aim of informing curriculum design to enhance student awareness of the importance of medical professionalism.

METHOD

Focus groups of ECE students were held to collect data for the study. All participants read interview guidelines before starting. During the focus groups, the students discussed their medical obligations as perceived throughout the course, which offered a choice between four different ECE tracks. They were then asked to report their understanding of the situations they encountered during the course and reflect on their implications.

RESULTS

Six focus groups of 22 students in total from a medical school in northern Taiwan were held shortly after the students completed an ECE course in September 2019. From their responses, 10 categories relating to medical professionalism were deduced categorized under 5 major dimensions. An additional 8 sub-dimensions on attitudes and 2 sub-dimensions on personal well-being were also identified as new categories separate from but related to medical professionalism. After the ECE intervention, about 59% of participants redefined their understanding of medical professionalism.

CONCLUSION

ECE and intensive interaction with key stakeholders, including patients and their families, help students in the early stages of medical education form and cultivate a sense of medical professionalism. However, the relationship between participants' personalities, motivations, and clinical activities requires further investigation.

Educational Environment Assessment by Multiprofessional Residency Students: New Horizons Based on Evidence from the DREEM

INTRODUCTION

The multiprofessional residency in health (MRH) is in its initial stage situated in the long history of the Brazilian and worldwide health system. There are few published analytical data on the teaching environment as perceived by residents. Roff et al. developed a questionnaire to assess the educational environment known as the Dundee Ready Education Environment Measure (DREEM), which is widely used in international literature.

AIM

To analyse perceptions of the educational environment among residents in various undergraduate health courses at a university hospital in the Midwest Region of Brazil using the DREEM.

METHODS

The DREEM was administered to MRH students in a postgraduate health course consisting of 2 years of in-service training at a university hospital in Brazil in 2017. The results were analysed using the Statistical Package of Social Sciences (SPSS 24.0).

RESULTS

Cronbach's alpha reliability coefficient for all the items in this study was 0.76, which indicates good internal consistency. The average (95% CI) total DREEM score was 85.23 (ranging from 79.2 to 91.26), which suggests problems in the educational environment as perceived by health residents and a more negative than positive environment.

CONCLUSIONS

Several problem areas were identified in all domains of the educational environment that was assessed.

Understanding the Mentoring Environment Through Thematic Analysis of the Learning Environment in Medical Education: a Systematic Review

BACKGROUND

Mentoring's success has been attributed to individualised matching, holistic mentoring relationships (MRs) and personalised mentoring environments (MEs). Whilst there is growing data on matching and MRs, a dearth of ME data has hindered development of mentoring programme. Inspired by studies likening MEs to learning environments (LEs) and data highlighting common characteristics between the two, this systematic review scrutinises reports on LEs to extrapolate the findings to the ME context to provide a better understanding of ME and their role in the mentoring process.

METHODS

Using identical search strategies, 6 reviewers carried out independent literature reviews of LEs in clinical medicine published between 1 January 2000 and 31 December 2015 using PubMed, ERIC, Cochrane Database of Systematic Reviews, Google Scholar and Scopus databases. Braun and Clarke's (2006) approach to thematic analysis was adopted to circumnavigate LE's evolving, context-specific, goal-sensitive, learner-tutor relationally dependent nature.

RESULTS

A total of 4574 abstracts were identified, 90 articles were reviewed, and 58 full-text articles were thematically analysed. The two themes identified were LE structure and LE culture. LE structure regards the framework that guides interactions within the LE. LE culture concerns the values and practices influencing learner-tutor-host organisation interactions.

DISCUSSION

LE is the product of culture and structure that influence and are influenced by the tutor-learner-host organisation relationship. LE structure guides the evolving tutor-learner-host organisation relationship whilst the LE culture nurtures it and oversees the LE structure. Similarities between LEs and MEs allow LE data to inform programme designers of ME's role in mentoring's success.

Anesthesiology residents' perception of educational environment: comparison between different years of training

STUDY OBJECTIVES

To assess whether the year of residency in anesthesiology is associated with residents' overall perceptions of the learning environment and to evaluate the association between year of residency and each of the five domains of the Dundee Ready Education Environment Measure (DREEM) survey.

DESIGN

Cross-sectional study.

SETTING

Residency program of anesthesiology at the Cleveland Clinic.

SUBJECTS AND INTERVENTION

Residents of anesthesiology at the Cleveland Clinic were invited to complete the DREEM questionnaire and a demographic survey.

MEASUREMENTS

We assessed whether year of residency was associated with the overall standardized DREEM questionnaire score using linear regression. We also assessed the associations between year of residency and each of the 5 DREEM questionnaire domains using separate linear regression models.

RESULTS

Of the 60 residents invited to complete the DREEM questionnaire, 49 (82%) completed it. There was no association between year of residency and overall DREEM score (P = .21), students' perception of teaching (P = .38), students' perceptions of teachers (P = .28), students' academic self-perceptions (P = .03), students' perceptions of atmosphere (P = .65), or students' social self-perceptions (P = .08). The primary outcome was assessed using a significance criterion of 0.05, whereas each secondary outcome was assessed using a significance criterion of 0.01 for secondary analyses (ie, 0.05/5, Bonferroni).

CONCLUSION

Resident's perception of the learning environment in the anesthesiology residency program of the Cleveland Clinic is on the positive side, as measured by the DREEM questionnaire. We found no association between the year of training and the DREEM questionnaire overall score. Furthermore, we found no association between year of residency and any of the subscores for the 5 DREEM domains. There is room for improvement, especially in the area of self-perception.

Medical Students' Perception of Their Educational Environment and Quality of Life: Is There a Positive Association?

PURPOSE

To assess perceptions of educational environment of students from 22 Brazilian medical schools and to study the association between these perceptions and quality of life (QoL) measures.

METHOD

The authors performed a multicenter study (August 2011 to August 2012), examining students' views both of (1) educational environment using the Dundee Ready Education Environment Measure (DREEM) and (2) QoL using the World Health Organization Quality of Life Assessment, abbreviated version (WHOQOL-BREF). They also examined students' self-assessment of their overall QoL and medical-school-related QoL (MSQoL). The authors classified participants' perceptions into four quartiles according to DREEM total score, overall QoL, and MSQoL.

RESULTS

Of 1,650 randomly selected students, 1,350 (81.8%) completed the study. The mean total DREEM score was 119.4 (standard deviation = 27.1). Higher total DREEM scores were associated with higher overall QoL and MSQoL scores (P < .001 for all comparisons) and younger ages (P < .001). Mean overall QoL scores were higher than MSQoL scores (mean difference, 1.35; 95% confidence interval [CI] 1.28-1.43; P < .001). Multinomial regression models showed significant dose-response patterns: Higher DREEM quartile scores were associated with better QoL. The psychological health domain of WHOQOL-BREF was most closely associated with DREEM scores (odds ratio 4.70; 95% CI = 3.80-5.81).

CONCLUSIONS

The authors observed a positive association between QoL measures and DREEM scores. This association had a dose-response effect, independent of age, sex, and year of medical training, showing that educational environment appears to be an important moderator of medical student QoL.

Veterinary students' perceptions of their learning environment as measured by the Dundee Ready Education Environment Measure

BACKGROUND

The Dundee Ready Education Environment Measure (DREEM) has been widely used to evaluate the learning environment within health sciences education, however, this tool has not been applied in veterinary medical education. The aim of this study was to evaluate the reliability and validity of the DREEM tool in a veterinary medical program and to determine veterinary students' perceptions of their learning environment.

METHODS

The DREEM is a survey tool which quantitatively measures students' perceptions of their learning environment. The survey consists of 50 items, each scored 0-4 on a Likert Scale. The 50 items are subsequently analysed within five subscales related to students' perceptions of learning, faculty (teachers), academic atmosphere, and self-perceptions (academic and social). An overall score is obtained by summing the mean score for each subscale, with an overall possible score of 200. All students in the program were asked to complete the DREEM. Means and standard deviations were calculated for the 50 items, the five subscale scores and the overall score. Cronbach's alpha was determined for the five subscales and overall score to evaluate reliability. Confirmatory factor analysis was used to evaluate construct validity.

RESULTS

224 responses (53%) were received. The Cronbach's alpha for the overall score was 0.93 and for the five subscales were; perceptions of learning 0.85, perceptions of faculty 0.79, perceptions of atmosphere 0.81, academic self-perceptions 0.68, and social self-perceptions 0.72. Construct validity was determined to be acceptable (p < 0.001) and all items contributed to the overall validity of the DREEM. The overall DREEM score was 128.9/200, which is a positive result based on the developers' descriptors and comparable to other health science education programs. Four individual items of concern were identified by students.

CONCLUSIONS

In this setting the DREEM was a reliable and valid tool to measure veterinary students' perceptions of their learning environment. The four items identified as concerning originated from four of the five subscales, but all related to workload. Negative perceptions regarding workload is a common concern of students in health education programs. If not addressed, this perception may have an unfavourable impact on veterinary students' learning environment.

Analysis of the 'Educational Climate' in Spanish Public Schools of Dentistry using the Dundee Ready Education Environment Measure: a multicenter study

AIM

To analyse the 'Educational Climate' (EC) of dental students in Spain.

METHODS

The study group consisted of 1391 students from nine Spanish Public Schools of Dentistry, who responded to the questionnaire based on 'Dundee Ready Education Environment Measure' (DREEM). This questionnaire has 50 items that are grouped into five domains: Learning, Teachers, Academic, Atmosphere and Social.

RESULTS

The global score on the EC was 123.1 (interpretation: 'EC more positive than negative'). The scores obtained in the different domains were: 28.0 in Learning (interpretation: 'a generally positive perception of learning'), 26.8 in Teachers (interpretation: 'teachers are going in the right direction'), 20.8 in Academic (interpretation: 'feeling more on the positive side'), 29.7 in Atmosphere (interpretation: 'a generally positive atmosphere') and 17.7 in Social (interpretation: 'social perception acceptable'). In seven items (14%), an average of <2 was detected, showing that there are some educational problem areas. Regarding the EC in the different Schools of Dentistry, an average of >100 was achieved in all of them, although there were two centres that showed significantly higher values of EC.

CONCLUSIONS

Spanish dental students felt that their EC was more positive than negative and considered that the different domains were positive and acceptable. However, they pointed out the existence of several educational problem areas associated with the development of a traditional curriculum. Accordingly, and in parallel with the implementation of an innovative curriculum in all Spanish Dental Schools in the coming years, immediate educational goals must address the problem areas identified, thereby further promoting a more positive perception of EC.

Development and evaluation of a questionnaire to measure the perceived implementation of the mission statement of a competency based curriculum

BACKGROUND

A mission statement (MS) sets out the long-term goals of an institution and is supposed to be suited for studying learning environments. Yet, hardly any study has tested this issue so far. The aim of the present study was the development and psychometric evaluation of an MS-Questionnaire (MSQ) focusing on explicit competencies. We investigated to what extent the MSQ captures the construct of learning environment and how well a faculty is following--in its perception--a competency orientation in a competency-based curriculum.

METHODS

A questionnaire was derived from the MS "teaching" (Medical Faculty, Heinrich-Heine University Düsseldorf) which was based on (inter-) nationally accepted goals and recommendations for a competency based medical education. The MSQ was administered together with the Dundee Ready Education Environment Measure (DREEM) to 1119 students and 258 teachers. Cronbach's alpha was used to analyze the internal consistency of the items. Explorative factor analyses were performed to analyze homogeneity of the items within subscales and factorial validity of the MSQ. Item discrimination was assessed by means of part-whole corrected discrimination indices, and convergent validity was analyzed with respect to DREEM. Demographic variations of the respondents were used to analyze the inter-group variations in their responses.

RESULTS

Students and teachers perceived the MS implementation as "moderate" and on average, students differed significantly in their perception of the MS. They thought implementation of the MS was less successful than faculty did. Women had a more positive perception of educational climate than their male colleagues and clinical students perceived the implementation of the MS on all dimensions significantly worse than preclinical students. The psychometric properties of the MSQ were very satisfactory: Item discrimination was high. Similarly to DREEM, the MSQ was highly reliable among students (α = 0.92) and teachers (α = 0.93). In both groups, the MSQ correlated highly positively with DREEM (r = 0.79 and 0.80, p < 0.001 each). Factor analyses did not reproduce the three areas of the MS perfectly. The subscales, however, could be identified as such both among teachers and students.

CONCLUSIONS

The perceived implementation of faculty-specific goals can be measured in an institution to some considerable extent by means of a questionnaire developed on the basis of the institution's MS. Our MSQ provides a reliable instrument to measure the learning climate with a strong focus on competencies which are increasingly considered crucial in medical education. The questionnaire thus offers additional information beyond the DREEM. Our site-specific results imply that our own faculty is not yet fully living up to its competency-based MS. In general, the MSQ might prove useful for faculty development to the increasing number of faculties seeking to measure their perceived competency orientation in a competency-based curriculum.

DREEM on, dentists! Students' perceptions of the educational environment in a German dental school as measured by the Dundee Ready Education Environment Measure

OBJECTIVES

The educational climate in which future doctors are trained is an important aspect of medical education. In contrast to human medicine, it has been rather neglected in dental educational research. The aim of the study was to supplement this lack by applying and validating the Dundee Ready Education Environment Measure (DREEM) for the first time in a German-speaking sample of dental students.

METHODS

All dental students at the Medical Faculty of Heinrich-Heine-University Düsseldorf were asked to complete a German adaptation of the DREEM and the Düsseldorf Mission Statement Questionnaire (DMSQ) in a paper-pencil survey. Data from 205 participants were analysed. Psychometric validation included analysis of item homogeneity and discrimination, test reliability, criterion and construct validity (convergent, factorial).

RESULTS

DREEM item parameters were satisfactory, reliability (α = 0.87) and convergent validity (r = 0.66 with DMSQ) were also high. Factor analyses, however, yielded dimensions which did not fully correspond to the original DREEM subscales. Overall perception of the educational environment was positive (DREEM total score = 122.95 ± 15.52). Students in the clinical part of course rated the atmosphere more negatively, but their academic self-perception more positively than preclinical students.

CONCLUSIONS

Showing satisfactory psychometric properties, DREEM proved suitable for assessing educational environments among dental students. Given the right circumstances, e.g., small and early clinically oriented classes, traditional curricula can generate positive environments.

Kirkpatrick's levels and education 'evidence'

OBJECTIVES

This study aims to review, critically, the suitability of Kirkpatrick's levels for appraising interventions in medical education, to review empirical evidence of their application in this context, and to explore alternative ways of appraising research evidence.

METHODS

The mixed methods used in this research included a narrative literature review, a critical review of theory and qualitative empirical analysis, conducted within a process of cooperative inquiry.

RESULTS

Kirkpatrick's levels, introduced to evaluate training in industry, involve so many implicit assumptions that they are suitable for use only in relatively simple instructional designs, short-term endpoints and beneficiaries other than learners. Such conditions are met by perhaps one-fifth of medical education evidence reviews. Under other conditions, the hierarchical application of the levels as a critical appraisal tool adds little value and leaves reviewers to make global judgements of the trustworthiness of the data.

CONCLUSIONS

Far from defining a reference standard critical appraisal tool, this research shows that 'quality' is defined as much by the purpose to which evidence is to be put as by any invariant and objectively measurable quality. Pending further research, we offer a simple way of deciding how to appraise the quality of medical education research.

The Dundee Ready Education Environment Measure (DREEM): a review of its adoption and use

BACKGROUND

The Dundee Ready Education Environment Measure (DREEM) was published in 1997 as a tool to evaluate educational environments of medical schools and other health training settings and a recent review concluded that it was the most suitable such instrument.

AIMS

This study aimed to review the settings and purposes to which the DREEM has been applied and the approaches used to analyse and report it, with a view to guiding future users towards appropriate methodology.

METHOD

A systematic literature review was conducted using the Web of Knowledge databases of all articles reporting DREEM data between 1997 and 4 January 2011.

RESULTS

The review found 40 publications, using data from 20 countries. DREEM is used in evaluation for diagnostic purposes, comparison between different groups and comparison with ideal/expected scores. A variety of non-parametric and parametric statistical methods have been applied, but their use is inconsistent.

CONCLUSIONS

DREEM has been used internationally for different purposes and is regarded as a useful tool by users. However, reporting and analysis differs between publications. This lack of uniformity makes comparison between institutions difficult. Most users of DREEM are not statisticians and there is a need for informed guidelines on its reporting and statistical analysis.

Assessing the learning environment of a faculty: psychometric validation of the German version of the Dundee Ready Education Environment Measure with students and teachers

AIMS

The teachers' perspectives of the educational environment have as yet only been sparsely considered. This study aimed at validating the first German version of the Dundee Ready Education Environment Measure (DREEM) from the points of view of both students and teachers.

METHODS

Data from 1119 students and 258 teachers were available for analysis. Psychometric validation included the analysis of homogeneity and discrimination at item level as well as reliability (Cronbach's α), criterion and construct validity at test level. Effect sizes were calculated and the independent samples t-test was used for statistical inference testing of mean differences between two groups.

RESULTS

Item characteristics were satisfactory in both samples. Reliability was high with α = 0.92 (students) and 0.94 (teachers), respectively. Factor analyses revealed five dimensions which slightly diverged from the five subscales postulated by the DREEM authors though. The environment was evaluated significantly (p < 0.001) more positively by teachers (M = 117.63) than by students (M = 109.75). Further significant differences were observed with regard to gender, mother language, stage of studies and previous professional training among others.

CONCLUSIONS

With convincing psychometric properties at item and test levels, the suitability of DREEM not only for students but also for teachers to assess the educational environment has been demonstrated.

Ensino de massoterapia: habilidades envolvidas na relação fisioterapeuta-paciente

Desenvolvido no âmbito da disciplina Recursos Terapêuticos Manuais, o objetivo deste trabalho foi elaborar, aplicar e avaliar a eficácia de um programa de treinamento de habilidades profissionalizantes em sessão de massoterapia, com foco na relação fisioterapeuta-paciente, sem descuidar do autocuidado do terapeuta. Para elaboração do programa, foram identificadas 21 habilidades envolvidas nessa relação, com base na literatura e na observação de 120 sessões de massoterapia. Dez peritos validaram a definição operacional das habilidades, que foram organizadas em um programa de treinamento aplicado a alunos. O desempenho destes nas habilidades treinadas (classificado como adequado, parcialmente adequado, inadequado ou não-realizado) foi avaliado em prova prática. Também foi analisado relato escrito dos alunos sobre o programa. Participaram do estudo 25 graduandos. A análise dos resultados mostrou que todos realizaram 12 das 21 habilidades treinadas adequadamente. Quatro habilidades foram realizadas de forma parcialmente adequada por cinco alunos. Não ocorreu situação de execução inadequada. Na análise dos relatos, 19 dos 25 alunos afirmaram ser o treinamento importante e necessário. O autocuidado físico foi destacado como importante para o desenvolvimento profissional e apropriado para o contexto de ensino por dez alunos. O programa mostrou-se pois eficiente em capacitar os alunos para um bom relacionamento terapeuta-paciente, sendo bem aceito pelos alunos.

The postgraduate hospital educational environment measure (PHEEM) questionnaire identifies quality of instruction as a key factor predicting academic achievement

OBJECTIVE

This study analyzes the reliability of the PHEEM questionnaire translated into Portuguese. We present the results of PHEEM following distribution to doctors in three different medical residency programs at a university hospital in Brazil.

INTRODUCTION

Efforts to understand environmental factors that foster effective learning resulted in the development of a questionnaire to measure medical residents' perceptions of the level of autonomy, teaching quality and social support in their programs.

METHODS

The questionnaire was translated using the modified Brislin back-translation technique. Cronbach's alpha test was used to ensure good reliability and ANOVA was used to compare PHEEM results among residents from the Surgery, Anesthesiology and Internal Medicine departments. The Kappa coefficient was used as a measure of agreement, and factor analysis was employed to evaluate the construct strength of the three domains suggested by the original PHEEM questionnaire.

RESULTS

The PHEEM survey was completed by 306 medical residents and the resulting Cronbach's alpha was 0.899. The weighted Kappa was showed excellent reliability. Autonomy was rated most highly by Internal Medicine residents (63.7% +/- 13.6%). Teaching was rated highest in Anesthesiology (66.7% +/- 15.4%). Residents across the three areas had similar perceptions of social support (59.0% +/- 13.3% for Surgery; 60.5% +/- 13.6% for Internal Medicine; 61.4% +/- 14.4% for Anesthesiology). Factor analysis suggested that nine factors explained 58.9% of the variance.

CONCLUSIONS

This study indicates that PHEEM is a reliable instrument for measuring the quality of medical residency programs at a Brazilian teaching hospital. The results suggest that quality of teaching was the best indicator of overall response to the questionnaire.

Development and evaluation of the new module 'communication disorders' in medical education

BACKGROUND

Communication disorders are not taught as a self-contained topic in medical education, despite their high incidence and the similarities in the way in which they present clinically.

AIMS

This article describes the development of an elective subject 'Phoniatrics and Pediatric Audiology' covering five topics: hearing, language, and voice as well as psychometric tests and swallowing, with the objective of teaching a basic knowledge of the anatomy, physiology, and pathophysiology of the hearing and language system as well as symptoms, diagnostics, examination, and therapy of communication disorders. It contains theoretical background, practical exercises, and demonstrations of patient examinations.

METHODS

After initial modifications to the course, a statistical evaluation of the last two half-years in 2006 was performed.

RESULTS

The majority of students believe that the subject will be useful in their subsequent studies (94.2%) and medical practice (51.9%). All students affirmed that their expectations had been met by the course and they would choose it again.

CONCLUSIONS

Uniting several communication disorders within a self-contained topic provides the opportunity to understand pathophysiological principles, similarities, and differences between normal and impaired function of the hearing and language system and voice production. In the authors' opinion, it is a reasonable inclusion in medical training recognizing the importance of communication in today's service society.

A survey of UK medical schools' arrangements for early patient contact

BACKGROUND

Many U.K. medical schools have patient contact in the first two years of the undergraduate course.

AIM

To compare the purposes and organization of early patient contact in UK medical schools and to relate these arrangements to the schools' curricular objectives.

METHODS

A telephone survey of lead educators in UK medical schools. Categories of contact were plotted against phases of the course to discern patterns of organisation.

RESULTS

The quantity of contact varies considerably (four to 65 days). There is a pattern, with learning objectives around the social context of health and illness preceding skills based work and integrated clinical knowledge for practice coming later. Schools fall into three categories: close adherence to the preclinical/clinical split, with limited early contact acting as an introduction to social aspects of health; provision of substantial patient contact to maximize the integration of knowledge and skills; and transitional, with limited clinical goals. General practice provides between one third and one half of early patient contact.

CONCLUSIONS

Arrangements meet the objectives set by each school and reflect differing educational philosophies. Change is toward more early contact. There appears to be no national guidance which supports a minimum quantity of patient contact or specific educational purpose in the early years of U.K. basic medical training.

The Relationship of Learning Environment, Quality of Life, and Study Strategies Measures to Anesthesiology Resident Academic Performance

BACKGROUND

We designed this study to determine the academic performance of anesthesia residents as related to their differential characteristics on some affective-motivational variables, represented by perceptions about their educational environment, subjective quality of life, and learning and study strategies.

METHODS

The study sample consisted of 63 anesthesia residents who completed the World Health Organization Quality of Life Inventory, the Dundee Ready Educational Environment Measure, the Learning and Study Strategies Inventory, and a progress test on basic sciences on two to four measurement occasions during a 2-year period. A growth curve model was fit to the academic performance. Mantel-Haenszel tests identified independent predictors of academic performance on progress tests.

RESULTS

Mean rating at the first measuring occasion was 41%. There was a statistically significant improvement over time (slope = 7% per 6-m period; P < 0.01). Analysis of the random effects showed significant individual differences in the intercept. The residents' scores improved at an equivalent rate over the course of the residency. The independent predictors of academic performance were anxiety, motivation, and ability in selecting main ideas.

CONCLUSIONS

Knowledge growth on basic sciences during anesthesia residency is significantly associated to the level of anxiety related to study and achievement, to the motivation for learning and for personal improvement, and to the ability in selecting main ideas from subject matters to which residents are exposed during learning episodes.

Early patient contact in undergraduate dental education in Germany--'The Greifswald Model'

Revised regulations in Germany have allowed new curricular concepts to be introduced into the undergraduate dental curriculum. In the first 2 years of the dental curriculum at the University of Greifswald, a new teaching concept which is based on the interactions between Community Medicine and Dentistry has been introduced. It emphasises the importance of early patient contact in providing experience for students. The course consists of three principal elements: student-patient contacts in the patient's home; problem-based learning tutorials to discuss patient cases; and special training in communication skills. The aim of the course is to give students an insight into the patient's view of the illness and treatment, and the effect of their condition on his or her lifestyle. The students also learn about the communal perspective (health survey, intervention planning and implementation in a community). The first four courses were evaluated by questionnaires from the students before and after the 2-year course to assess the concept from the students' perspective. The results indicate that it is possible to provide considerable improvement of the medical/dental education as regards communication skills and understanding of the patients' perceptions, by letting the student establish contact with patients at the very beginning of the curriculum.

Medical students' perceptions of their learning about the doctor-patient relationship: a qualitative study

OBJECTIVE

To describe and discuss Year 5 medical students' perceptions of their own learning about the doctor-patient relationship.

METHODS

We carried out a qualitative study of semi-structured interviews with 16 Year 5 medical students using 3-way analysis at the School of Medicine, Federal University of São Paulo, São Paulo, Brazil.

RESULTS

For experiences at the pre-clinical stage, the subcategories were: positive aspects of the medical psychology course; great distance between theory and reality, and strong desire for clinical practice. For experiences at the clinical stage, the subcategories were: demand for opportunities to discuss the doctor-patient relationship; teachers as either role models or anti-models; clinical situations favourable for developing empathic relationships, and clinical situations unfavourable for developing empathic relationships. For views about future experiences, the subcategories were: apprehension about ethical behaviour; anxiety about handling patients' psychosocial characteristics, and fear of professional ethics cases or legal action.

DISCUSSION

To compensate for the lack of practical activities during the pre-clinical stage, students search for extracurricular activities that often overload them. Because teachers function as professional role models, their attitudes towards patients have great importance. Students fear not being able to maintain their empathic capacity in the future because of work-related issues. Knowledge of the psychological aspects of the doctor-patient relationship helps students to comprehend their experiences. Gradual contact between student and medical practice from the beginning of the course is advised. It should be followed by interdisciplinary discussions that deal with the technical aspects of cases and the doctor-patient relationship.

Beyond the chalkboard: the interacting domains in undergraduate psychiatric teaching

OBJECTIVE

To identify and describe interacting domains that are present during undergraduate psychiatric teaching and impress on educators the roles of these domains.

CONCLUSIONS

Undergraduate psychiatric teaching is an essential part of general family physicians' training and practice. Undergraduate students' exposure to psychiatry might be inadequate. Curricular goals, teaching and evaluation of students need to be aligned. Research and information technology can play a bigger role in teaching. Validation of patients, students and teachers during the teaching process is important, but not always emphasized. Educators should be aware of society's unwritten expectations, judgements and opinions of mental illness sufferers. Identifying and facilitating the various interacting domains during psychiatric teaching may contribute to better education in psychiatry, better retention of knowledge for students and an improved recruitment of students to a psychiatric career.

Comparison of clinical skills of 3rd-year students who completed structured clinical skills program with 6th-year students who acquired clinical skills in unsystematic way

BACKGROUND

The timing and methods of teaching clinical skills are some of the main concerns of medical education.

PURPOSE

The aim of this study was to compare clinical skills of the 3rd and 6th-year students who acquired clinical skills training within different years and methods.

METHODS

Randomly chosen students were observed and evaluated in the form of "did it-didn't do it" over the checklists composed of parameters of communication, history taking, and physical examination. The results were evaluated on the SPSS 10.0 for Windows program and Pearson chi-square test was used in the statistical analyses.

RESULTS

Third-year students who had clinical skills training in early years and structured methods had better results for most of the parameters (p < .05).

CONCLUSIONS

The clinical skills training given through a structured program that is widespread in the early years of medical school makes a great contribution to the development of students' clinical skills.

Compliance with common program requirements in Brazil: its effects on resident's perceptions about quality of life and the educational environment

PURPOSE

In 1981, Brazil's National Committee on Medical Residency established the Common Program Requirements (CPRs), to regulate residents' work hours. The authors studied whether program violations of the CPRs regarding residents' duty hours, time for educational activities, and faculty supervision adversely affected residents' perceptions about the quality of their lives and about the educational environment.

METHOD

From October through December 2003, 88 residents from four institutions in Florianopolis (SC), Brazil were invited to participate of the study. Residents completed four instruments: a questionnaire about their program's compliance with CPRs; the Dundee Ready Educational Environment Measure (DREEM) that assesses perceptions about the learning environment; the Quality of School Life Scale (QSL), which assesses the quality of life at school; and the WHO Quality of Life Assessment (WHOQOL), which assesses the general quality of life. Residents were categorized according to gender, institution, year of training, specialty, and their answers on the CPRs questionnaire. DREEM, SQL, and WHOQOL scores were compared between categories.

RESULTS

A total of 62 residents (70%) responded. A significant number of residents reported their program's noncompliance with CPRs. Residents reporting program compliance rated higher parameters of general quality of life, quality of life in residency, and the educational environment.

CONCLUSION

Violations of Brazil's residency program CPRs are associated with residents' worse perceptions of several aspects of general quality of life, quality of life in residency, and the educational environment.