Skills of pre-registration house officers: gender differences reported in Norway

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.

Women in medicine--is there a problem? A literature review of the changing gender composition, structures and occupational cultures in medicine

BACKGROUND

Internationally, there are increasing numbers of women entering medicine. Although all countries have different health care systems and social contexts, all still show horizontal (women concentrated in certain areas of work) and vertical (women under represented at higher levels of the professions) segregation. There is much discussion and competing explanations about the implications of the increasing numbers of women in the medical profession.

AIMS

The purpose of this review was to explore the evidence, issues and explanations to understand the effects of the changing composition of the medical profession.

CONCLUSIONS

This review identified evidence that delineates some of the effects of gender on the culture, practice and organisation of medicine. There are problems with some of the research methodologies and we identify areas for further research. To understand the effects of the changing gender composition of medicine it will be necessary to use more sophisticated research designs to explore the structural, economic, historical and social contexts that interact to produce medical culture. This will provide a basis for exploring the impact and implications of these changes and has immediate relevance for workforce planning and understanding both the changing nature of health professions' education and health care delivery.

Experiences from psychiatric rotation for pre-registration house officers: contributions to subjective learning

SETTING

The clinical experience and the subjective learning of pre-registration house officers who completed 4 months' psychiatric rotation are described.

METHOD

The study was cross-sectional and based on self-report. The participants had responded to an anonymous questionnaire at the completion of their 4 months' psychiatric rotation in the period 1999-2001. Of those eligible (n = 137), 85 (61%) completed the questionnaire. The relationships between individual background variables, different factors of the learning environment, and good learning outcome were explored.

CONCLUSIONS

The subjective learning benefit and positive learning environment were most related to the amount of practical experience, the degree of tailoring of the tasks to the house officers' competence, and to the formal intramural teaching programme. Supervision, gender, previous experience, and prior interest in psychiatry did not have significant impact on subjective learning. The findings are discussed in terms of the learning model that was developed.

Pre-registration house officers and ward-based learning: a 'new apprenticeship' model

INTRODUCTION

The pre-registration house officer (PRHO) year can be seen as a formal apprenticeship into the profession of medicine, and as central to the identity construction of the doctor. The year characteristically involves rotation between specialties, including attachment to ward-based 'firms', where consultants teach PRHOs.

DISCUSSION

Teaching and learning in ward-based environments is under-researched, and the current literature displays a bias towards a psychological model of pedagogy that focuses upon transmission of knowledge and skills from one individual to another. Such a model offers a necessary, but not sufficient, explanation of how work-based learning occurs. Understanding the PRHO apprenticeship year should include reference to cultural dimensions to learning, especially socialisation into the profession. This constitutes an 'extended' (or 'hidden') curriculum model that may be theorised through contemporary ideas of activity learning within a 'new apprenticeship' framework.

CONCLUSION

The dominant psychological model can lead to an expectation for a uniform method of teaching and learning in ward round contexts that (a) ignores important differences in educational climate between established communities of practice, and (b) orients both teachers and learners to one-to-one transmission and reception, rather than sensitising to how knowledge may be held across members of a working group. The latter shifts emphasis away from reception to issues of active access. PRHOs, as novices, are not relegated to passive learning roles, but may actively co-construct knowledge with experts, offering potential transformation of the practices of ward groups.

A study of pre-registration house officers' clinical skills

BACKGROUND

Little is known about the ability of pre-registration house officers (PRHOs) to perform basic clinical skills just prior to entering the medical register.

OBJECTIVES

To find out whether PRHOs have deficiencies in basic clinical skills and to determine if the PRHOs themselves or their consultants are aware of them.

METHOD

All 40 PRHOs at the Chelsea and Westminster and Whittington Hospitals were invited to undertake a 17 station OSCE of basic clinical skills. Each station was marked by one examiner completing an overall global score after completing an itemised checklist. An adequate station performance was the acquisition of a pass/borderline pass grade. Prior to the OSCE, a questionnaire was given to each PRHO asking them to rate their own abilities (on a 5-point scale) in the skills tested. A similar questionnaire was sent to the educational supervisors of each PRHO asking them to rate their house officer's ability in each of the same skills.

RESULTS

Twenty-two PRHOs participated. Each PRHO failed to perform adequately a mean of 2.4 OSCE stations (SD 1.8, range 1-8). There were no significant correlations between OSCE performance and either self- or educational supervisor ratings. The supervisor felt unable to give an opinion on PRHO abilities in 18% of the skills assessed.

DISCUSSION

This study suggests that PRHOs may have deficiencies in basic clinical skills at the time they enter the medical register. Neither the PRHOs themselves nor their consultants identified these deficiencies. A large regional study with sufficient power is required to explore the generalizability of these concerns in more detail.