Does a new integrated PBL curriculum with specific communication skills classes produce Pre Registration House Officers (PRHOs) with improved communication skills?

An upgrade of the Malmö model by implementing case-based teaching and learning, in an undergraduate dental education

BACKGROUND

At our dental education, the examination failure rate amongst students has increased, resulting in subsequent involuntary dropouts. One of the main problems seems to be that the students struggle with taking the necessary responsibility for their learning, as required by the problem-based learning (PBL) methodology.

AIM

To describe the background to, and the transition process from, pure PBL to case-based teaching and learning (CBT) with flipped classroom seminars at the dental programme at [anonymised for peer review].

METHODS

In this position paper, we describe our observed problems with the PBL methodology, as implemented at this faculty, and the potential benefits of a change towards CBT. The current implementation of CBT is presented, along with educational research supporting the choice of activities.

RESULTS

Tentative findings are that the flipped classroom seminars and the clearer instructions appear to be successful with higher levels of activity, engagement and attendance amongst the students, and the students have evaluated the seminars as very good learning activities.

CONCLUSION

Tentative findings suggest that the current implementation of CBT may be a fruitful way of teaching in dental education today. Most of the teaching staff have been reawakened to teaching, and as a result, the content of the courses are being reviewed and improved. The students appreciate that what is expected of them has been made clearer and that there is a variety of learning activities.

Curriculum reform at Chinese medical schools: what have we learned?

INTRODUCTION

Curriculum reform at Chinese medical schools has attracted a lot of attention recently. Several leading medical schools in China have undergone exploratory reforms and in so doing, have accumulated significant experience and have made considerable progress.

METHODS

An analysis of the reforms conducted by 38 Chinese medical colleges that were targeted by the government for upgrade was performed. Drawing from both domestic and international literature, we designed a questionnaire to determine what types of curricular reforms have occurred at these institutions and how they were implemented. Major questions touched upon the purpose of the reforms, curricular patterns, improvements in teaching methods post-reform, changes made to evaluation systems post-reform, intra-university reform assessment, and what difficulties the schools faced when instituting the reforms. Besides the questionnaire, relevant administrators from each medical school were also interviewed to obtain more qualitative data.

RESULTS

Out of the 38 included universities, twenty-five have undergone major curricular reforms. Among them, 60.0% adopted an organ system-based curriculum model, 32.0% adopted a problem-based curriculum model, and 8.0% adopted a hybrid curriculum model. About 60.0% of the schools' reforms involved both the "pre-clinical" and the "clinical" curricula, 32.0% of the schools' reforms were limited to the "pre-clinical" curricula, and 8.0% of the schools' reforms only involved the "clinical" curricula. Following curricular reform, 60.0% of medical schools experienced an overall reduction in teaching hours, 76.0% reported an increase in their students' clinical skills, and 60.0% reported an increase in their students' research skills.

DISCUSSION

Medical curricular reform is still in its infancy in China. The republic's leading medical schools have engaged in various approaches to bring innovative teaching methods to their respective institutions. However, due to limited resources and the shackle of traditional pedagogical beliefs among many faculty and administrators, progress has been significantly hindered. Despite these and other challenges, many medical schools report positive initial results from the reforms that they have enacted. Although the long term effects of such reforms remain unclear, curricular reform appears to be the inevitable solution to China's growing need for high-quality medical doctors.

Can a brief two-hour interdisciplinary communication skills training be successful in undergraduate medical education?

OBJECTIVE

To pilot-test feasibility, acceptance and learning-outcomes of a brief interdisciplinary communication skills training program in undergraduate medical education.

METHODS

A two-hour interdisciplinary communication skills program with simulated patients was developed and pilot-tested with clinical students at Hamburg University. Five psychosocial specialties facilitated the training. Composite effects were measured qualitatively and quantitatively.

RESULTS

Eighty students volunteered to participate in the pilot-program (intervention-group). Their evaluations of the program were very positive (1.1 on a six-point scale). Benefits were seen in feedback, increase of self-confidence, cross-disciplinary clinical and communication experience. Students who did not volunteer (n=206) served as the control-group. The intervention-group performed significantly better (p=0.023) in a primary care communication examination and female students performed better than males. Clinical teachers evaluated the pilot-training very positively with regard to learning-outcomes and feasibility. The positive results from the pilot-training led to implementation into the regular curriculum.

CONCLUSIONS

A two-hour interdisciplinary communication skills training program is beneficial for medical students with regard to communication competencies, self-confidence and learning-outcomes.

PRACTICE IMPLICATION

The training is feasible within given time-frames and limited staff resources. The high teaching load for small-group-training are split between five specialties. The concept might be an interesting option for other faculties.

A comparison of self-perceived competencies of traditional and reformed curriculum graduates 6 years after graduation

BACKGROUND

In 1996, the University of Liverpool reformed its medical course from a traditional lecture-based programme to an integrated, community based PBL curriculum based on the recommendations in Tomorrow's Doctors (General Medical Council, 1993).

AIM

A project has been underway since 2000 to evaluate this change.

METHODS

This article will summarize questionnaires which were distributed to the final two cohorts to graduate from the traditional curriculum with the first two cohorts to graduate from the reformed curriculum 6 years after graduation. The questionnaires asked the graduates about their preparation for the key skills required to work as doctors.

RESULTS

There were significant differences between reformed and traditional curriculum graduates on nearly all the questionnaire variables. Reformed curriculum graduates felt significantly better prepared for undertaking practical procedures, working in a team, understanding evidence-based medicine. The traditional graduates felt better prepared in variables relating to basic sciences such as understanding disease processes.

CONCLUSION

Reforming the curriculum can change the way graduates from the same medical school view their undergraduate education.

Does undergraduate curriculum design make a difference to readiness to practice as a junior doctor?

BACKGROUND

Undergraduate medicine curricula can be designed to enable smoother transition to work as a junior doctor. Evaluations should improve curriculum design.

AIM

To compare a graduate cohort from one medical school with a cohort from other medical schools in the same Foundation Year 1 (FY1) programme in terms of retrospective perceptions of readiness for practice.

METHOD

A Likert-scale questionnaire measured self-perception of readiness to practice, including general capabilities and specific clinical skills.

RESULTS

Response rate was 74% (n = 146). The Peninsula Medical School cohort reported readiness for practice at a significantly higher level than the comparison cohort in 14 out of 58 items (24%), particularly for 'coping with uncertainty'. In only one item (2%) does the comparison cohort report at a significantly higher level.

CONCLUSIONS

Significant differences between cohorts may be explained by undergraduate curriculum design, where the opportunity for early, structured work-based, experiential learning as students, with patient contact at the core of the experience, may promote smoother transition to work as a junior doctor. Evaluation informs continuous quality improvement of the curriculum.

Graduates from a reformed undergraduate medical curriculum based on Tomorrow's Doctors evaluate the effectiveness of their curriculum 6 years after graduation through interviews

BACKGROUND

In 1996 Liverpool reformed its medical curriculum from a traditional lecture based course to a curriculum based on the recommendations in Tomorrow's Doctors. A project has been underway since 2000 to evaluate this change. This paper focuses on the views of graduates from that reformed curriculum 6 years after they had graduated.

METHODS

Between 2007 and 2009 45 interviews took place with doctors from the first two cohorts to graduate from the reformed curriculum.

RESULTS

The interviewees felt like they had been clinically well prepared to work as doctors and in particular had graduated with good clinical and communication skills and had a good knowledge of what the role of doctor entailed. They also felt they had good self directed learning and research skills. They did feel their basic science knowledge level was weaker than traditional graduates and perceived they had to work harder to pass postgraduate exams. Whilst many had enjoyed the curriculum and in particular the clinical skills resource centre and the clinical exposure of the final year including the "shadowing" and A & E attachment they would have liked more "structure" alongside the PBL when learning the basic sciences.

CONCLUSION

According to the graduates themselves many of the aims of curriculum reform have been met by the reformed curriculum and they were well prepared clinically to work as doctors. However, further reforms may be needed to give confidence to science knowledge acquisition.

'The next step'--alumni students' views on their preparation for their first position as a physician

BACKGROUND

Although medical programmes are often thoroughly evaluated, these evaluations more seldom include workplace points of view. The present study focuses on how well a Swedish medical programme was judged to prepare students for work as a physician.

METHODS

Thirty-two competences in physicians' work were identified through interviews. A subsequent questionnaire was completed by 123 programme alumni who had worked for 1-2(1/2) years in different parts of the country. Alumni were asked to rate the importance of each competence, their self-assessed competence as well as how these competences were addressed during their medical training.

RESULTS

The subsequent analysis identified areas where their training programme, according to the alumni, failed to prepare them satisfactorily. Problem areas included competences in clinical skills, handling stressful situations and in applied rather than foundational knowledge about common symptoms and diseases.

CONCLUSION

Despite extensive practical training, medical education still faces some problems in the transition from education to work.

Graduates from a traditional medical curriculum evaluate the effectiveness of their medical curriculum through interviews

BACKGROUND

In 1996 The University of Liverpool reformed its medical course from a traditional lecture-based course to an integrated PBL curriculum. A project has been underway since 2000 to evaluate this change. Part of this project has involved gathering retrospective views on the relevance of both types of undergraduate education according to graduates. This paper focuses on the views of traditional Liverpool graduates approximately 6 years after graduation.

METHODS

From February 2006 to June 2006 interviews took place with 46 graduates from the last 2 cohorts to graduate from the traditional Liverpool curriculum.

RESULTS

The graduates were generally happy with their undergraduate education although they did feel there were some flaws in their curriculum. They felt they had picked up good history and examination skills and were content with their exposure to different specialties on clinical attachments. They were also pleased with their basic science teaching as preparation for postgraduate exams, however many complained about the overload and irrelevance of many lectures in the early years of their course, particular in biochemistry. There were many different views about how they integrated this science teaching into understanding disease processes and many didn't feel it was made relevant to them at the time they learned it. Retrospectively, they felt that they hadn't been clinically well prepared for the role of working as junior doctor, particularly the practical aspects of the job nor had enough exposure to research skills. Although there was little communication skills training in their course they didn't feel they would have benefited from this training as they managed to pick up had the required skills on clinical attachments.

CONCLUSION

These interviews offer a historical snapshot of the views of graduates from a traditional course before many courses were reformed. There was some conflict in the interviews about the doctors enjoying their undergraduate education but then saying that they didn't feel they received good preparation for working as a junior doctor. Although the graduates were happy with their undergraduate education these interviews do highlight some of the reasons why the traditional curriculum was reformed at Liverpool.

Medical interns' view of their undergraduate medical education in Uppsala: an alumnus study with clear attitude differences between women and men

BACKGROUND

An alumni study of graduates from the medical school in Uppsala, was performed to give input into an ongoing reform process.

AIMS

This study aimed to investigate how medical interns view their undergraduate medical education and the extent to which they felt that the curriculum prepared them for their current positions.

METHODS

A web-based questionnaire was sent out via mail in 2005 to all past graduates who had qualified in Uppsala in 2003.

RESULTS

Replies were obtained from 69 of 102 students (68%). The most apparent suggested change of the education was increased integration of preclinical and clinical teaching. Correlations were found between student satisfaction with the medical school and perceived teacher attitude, encouragement to reflect, and the graduates' perception of having sufficient practical abilities. Significant gender differences were found regarding perceived clinical ability and concerning feedback and encouragement from the teachers.

CONCLUSIONS

Our results suggest more direct feedback from the teachers and more integration between basic sciences and clinical education. Female and male students may have different needs. A key question is therefore to encourage teachers to learn about gender since female and male students should equally experience respectful encounters with teachers and doctors acting as role models.

Problem-based learning: where are we now?

The definition of problem-based learning (PBL) as an educational concept is as elusive in 2008 as it has been since the concept was first expressed over forty years ago. A definitive guide to the practice of PBL is equally elusive. Like all worthwhile educational ideas, PBL has proved attractive to those teachers who seek improvements for their courses. Its appeal has transcended the traditional boundaries in formal education so that there are examples of PBL from primary to tertiary education, and across many disciplines within these. Dissemination, however, has wrought confusion in understanding and practice, and consequent difficulties for researchers in evaluating its efficacy, and lack of clear advice for those who would like to adopt PBL. Rather than attempting to be definitive, this Guide explores the various interpretations and practices that claim the label PBL, and critiques these against the original concept and practice. The primary aim is to provide insight into the causes of the confusion about PBL in 2008. The second aim is to point a feasible way forward so that, where appropriate, the potential of PBL as a whole-of-curriculum concept may be realised; and, where it is not possible to implement the whole concept, worthwhile educational principles that have been associated more or less with PBL may be recognised as such and given value in their own right.

Preregistration house officer skill and competency assessment through questionnaires

In 1996 the University of Liverpool reformed its medical course from a very traditional lecture-based curriculum to an integrated problem-based learning curriculum. This article summarizes the results of questionnaires sent to both traditional and reformed curricula Liverpool graduates asking them to assess their competencies.