SCORPIO: a system of medical teaching

Evaluation of an online education program for healthcare professionals on best practice management of perinatal deaths: IMPROVE eLearning

BACKGROUND

The IMPROVE (IMproving Perinatal Mortality Review and Outcomes Via Education) eLearning, developed by the Stillbirth Centre of Research Excellence in partnership with the Perinatal Society of Australia and New Zealand was launched in December 2019. Based on the successful face-to-face program, the eLearning aims to increase availability and accessibility of high-quality online education to healthcare professionals providing care for families around the time of perinatal death, to improve the delivery of respectful and supportive clinical care and increase best practice investigation of perinatal deaths.

AIMS

To evaluate participants' reported learning outcomes (change in knowledge and confidence) and overall acceptability of the program.

METHODS

Pre- and post-eLearning in-built surveys were collected over two years (Dec. 2019-Nov. 2021), with a mix of Likert and polar questions. Pre- and post-eLearning differences in knowledge and confidence were assessed using McNemar's test. Subgroup analysis of overall acceptability by profession was assessed using Pearson's χ2 .

RESULTS

One thousand, three hundred and thirty-nine participants were included. The majority were midwives (80.2%, n = 1074). A significant improvement in knowledge and confidence was shown across all chapters (P < 0.01). The chapter showing the greatest improvement was perinatal mortality audit and classification (21.5% pre- and 89.2% post-education). Over 90% of respondents agreed the online education was relevant, helpful, acceptable, engaging. Importantly, 80.7% of participants considered they were likely to change some aspect of their clinical practice after the eLearning. There was no difference in responses to relevance and acceptability of the eLearning program by profession.

CONCLUSIONS

The IMPROVE eLearning is an acceptable and engaging method of delivery for clinical education, with the potential to improve care and management of perinatal deaths.

Model Development for Fat Mass Assessment Using Near-Infrared Reflectance in South African Infants and Young Children Aged 3-24 Months

Undernutrition in infants and young children is a major problem leading to millions of deaths every year. The objective of this study was to provide a new model for body composition assessment using near-infrared reflectance (NIR) to help correctly identify low body fat in infants and young children. Eligibility included infants and young children from 3–24 months of age. Fat mass values were collected from dual-energy x-ray absorptiometry (DXA), deuterium dilution (DD) and skin fold thickness (SFT) measurements, which were then compared to NIR predicted values. Anthropometric measures were also obtained. We developed a model using NIR to predict fat mass and validated it against a multi compartment model. One hundred and sixty-four infants and young children were included. The evaluation of the NIR model against the multi compartment reference method achieved an r value of 0.885, 0.904, and 0.818 for age groups 3–24 months (all subjects), 0–6 months, and 7–24 months, respectively. Compared with conventional methods such as SFT, body mass index and anthropometry, performance was best with NIR. NIR offers an affordable and portable way to measure fat mass in South African infants for growth monitoring in low-middle income settings.

Development and evaluation of TEARDROP - a perinatal bereavement care training programme for healthcare professionals

Appropriate perinatal bereavement care can benefit bereaved parents and reduce further distress. Poor training can impact healthcare professionals (HCPs) at a personal and professional-level. HCPs have reported poor preparation to care for bereaved parents. High-quality perinatal bereavement care training is essential. This study describes the TEARDROP workshop for perinatal bereavement care training, an evaluation of its pilot and first workshop, and the teaching methods applied. The TEARDROP workshop was created in line with the Irish National Bereavement Standards, and based on the SCORPIO model of teaching, offering a participant-centred teaching. Both pilot session and workshop were held in a tertiary maternity hospital. Paper-based anonymous questionnaires were used to evaluate these sessions. Overall, participants were highly satisfied with the workshop. The level of information and quality of teaching in the pilot and workshop scored very high. Most participants stated not being adequately prepared to communicate or care for bereaved parents. The pre-workshop evaluation showed that only 8% of participants received prior training on discussing post-mortems with bereaved parents. Participants (100%) would recommend the workshop be available nationally and would recommend it to a colleague. To our knowledge this is one of few participant-centred perinatal bereavement care training for maternity staff in Ireland. The workshop has been well received and results highlighted the relevance and importance of the TEARDROP programme for HCPs. Adequate training for all maternity staff is essential and TEARDROP has the potential to impact on the quality of bereavement care provided in Irish maternity units.

Planning, preparing and structuring a small group teaching session

A structured approach is critical to the success of any small group teaching session; preparation and planning are key elements in ensuring the session is systematic and effective. Learning activities guide and engage students towards the achievement of agreed learning outcomes. This paper introduces the central concepts of planning and preparing a small group teaching session. It provides an overview of key theoretical principles in lesson planning, delivery, and how to provide effective feedback in this setting.

Improving assessment of child growth in a pediatric hospital setting

BACKGROUND

Accurate anthropometric measurements are essential for assessing nutritional status, monitoring child growth, and informing clinical care. We aimed to improve height measurements of hospitalized pediatrics patients through implementation of gold standard measurement techniques.

METHODS

A quality improvement project implemented computerized training modules on anthropometry and standardized wooden boards for height measurements in a tertiary children's hospital. Heights were collected pre- and post-intervention on general pediatric inpatients under 5 years of age. Accuracy of height measurements was determined by analyzing the variance and by comparing to World Health Organization's defined biologically plausible height-for-age z-scores. Qualitative interviews assessed staff attitudes.

RESULTS

Ninety-six hospital staff completed the anthropometry training. Data were available on 632 children pre- and 933 post-intervention. Training did not increase the proportion of patients measured for height (78.6% pre-intervention vs. 75.8% post-intervention, p = 0.19). Post-intervention, wooden height boards were used to measure height of 34.8% patients, while tape measures and wingspan accounted for 42.0% and 3.5% of measurements, respectively. There was no improvement in the quality of height measurements based on plausibility (approximately 3% height-for-age z-scores measurements flagged out of range pre- and post-intervention), digit preference (13.4% of digits pre- and 12.3% post-intervention requiring reclassification), or dispersion of measurements (height-for-age z-scores standard deviation 1.9 pre- and post-intervention). Staff reported that using the wooden board was too labor consuming and cumbersome.

CONCLUSIONS

Our findings suggest that efforts to improve anthropometric measurements of hospitalized children have multiple obstacles, and further investigation of less cumbersome methods of measurements may be warranted.

Evaluation of an international educational programme for health care professionals on best practice in the management of a perinatal death: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE)

BACKGROUND

Stillbirths and neonatal deaths are devastating events for both parents and clinicians and are global public health concerns. Careful clinical management after these deaths is required, including appropriate investigation and assessment to determine cause (s) to prevent future losses, and to improve bereavement care for families. An educational programme for health care professionals working in maternal and child health has been designed to address these needs according to the Perinatal Society of Australia and New Zealand Guideline for Perinatal Mortality: IMproving Perinatal mortality Review and Outcomes Via Education (IMPROVE). The programme has a major focus on stillbirth and is delivered as six interactive skills-based stations. We aimed to determine participants' pre- and post-programme knowledge of and confidence in the management of perinatal deaths, along with satisfaction with the programme. We also aimed to determine suitability for international use.

METHODS

The IMPROVE programme was delivered to health professionals in maternity hospitals in all seven Australian states and territories and modified for use internationally with piloting in Vietnam, Fiji, and the Netherlands (with the assistance of the International Stillbirth Alliance, ISA). Modifications were made to programme materials in consultation with local teams and included translation for the Vietnam programme. Participants completed pre- and post-programme evaluation questionnaires on knowledge and confidence on six key components of perinatal death management as well as a satisfaction questionnaire.

RESULTS

Over the period May 2012 to May 2015, 30 IMPROVE workshops were conducted, including 26 with 758 participants in Australia and four with 136 participants internationally. Evaluations showed a significant improvement between pre- and post-programme knowledge and confidence in all six stations and overall, and a high degree of satisfaction in all settings.

CONCLUSIONS

The IMPROVE programme has been well received in Australia and in three different international settings and is now being made available through ISA. Future research is required to determine whether the immediate improvements in knowledge are sustained with less causes of death being classified as unknown, changes in clinical practice and improvement in parents' experiences with care. The suitability for this programme in low-income countries also needs to be established.

Impact of a Central Line Infection Prevention Bundle in Newborn Infants

OBJECTIVE To compare central line use and central line-associated bloodstream infection in newborn infants before and after the introduction of a central line infection prevention bundle in order to determine the effectiveness of the bundle and to identify areas for further improvement. DESIGN Retrospective cohort analysis of prospectively collected data. SETTING Level 5 neonatal intensive care unit in Sydney, Australia. PATIENTS Newborn infants admitted to the Royal Prince Alfred Hospital Neonatal Intensive Care Unit who had a central venous catheter (CVC) inserted. METHODS Data regarding clinical characteristics, CVC use, and infection were collected before and after the introduction of a bundle of interventions. The bundles encompassed (1) insertion of CVC, (2) maintenance of CVC, (3) an education program, and (4) ongoing surveillance and feedback. RESULTS Baseline and intervention groups were comparable in clinical characteristics. The number of CVCs inserted was reduced in the intervention group (central line utilization rate, 0.16 vs 0.2, P<.0001). Overall CVC dwell time was reduced, resulting from significant reduction in peripherally inserted CVC dwell time (6 days [95% CI, 5.0-11.8 days] vs 7.3 days [4.0-10.4 days], P=.0004). Central line-associated bloodstream infections were significantly reduced, predominantly secondary to decreased peripherally inserted CVC-related bloodstream infections (1.2/1,000 central line-days vs 11.5/1,000 central line-days, P<.0001). CONCLUSION This central line infection bundle was effective in reducing CVC use, dwell time, and central line-associated bloodstream infections. Infect Control Hosp Epidemiol 2016;37:1029-1036.

Antenatal predictors and body composition of large-for-gestational-age newborns: perinatal health outcomes

OBJECTIVE

To compare body composition of large-for-gestational-age (LGA) with appropriate-for-gestational-age (AGA) newborns and to identify antenatal predictors of LGA.

STUDY DESIGN

This cross-sectional study included 536 term, singleton infants. Anthropometric measurements were performed within 48 h of birth and included determination of body fat percentage (%BF) by air displacement plethysmography. Associations were investigated using logistic regression.

RESULT

LGA infants had greater %BF (P<0.001) compared with AGA infants. Significant predictors of LGA infants included parity (odds ratio (OR)=1.98, (95% confidence interval (CI) 1.00, 4.02)), paternal height (OR=1.08, (95% CI 1.03, 1.14)), maternal pregravid weight (65 to 74.9 kg: OR=2.77, (95% CI 1.14, 7.06)) and gestational weight gain (OR=1.09, 95% CI (1.03, 1.16)). Gestational diabetes mellitus was not associated with LGA infants (P=0.598).

CONCLUSION

Paternal height, parity, maternal pregravid weight and gestational weight gain were strongly associated with LGA infants. These results may allow early prediction and potential modification, thereby optimising clinical outcomes.

Neonatal length inaccuracies in clinical practice and related percentile discrepancies detected by a simple length-board

AIM

The study aims to assess accuracy of standard practice measurement of neonatal length compared with a gold-standard length-board technique.

METHODS

Data were obtained from a population-based, cross-sectional study of 602 term babies at Royal Prince Alfred Hospital, Sydney, Australia, in 2010. Neonatal length was measured by standard clinical practice and by a length-board (gold standard) and measurements compared. Standard growth curve percentiles were used to plot length measurements. The Bland and Altman method was used to assess agreement, and acceptable levels of agreement were set at ≤1 cm and ≤0.5 cm.

RESULTS

The limits of agreement were between -3.06 cm (95% CI -3.08 to -3.04) and 2.67 cm (95% CI 2.65 to 2.69). Neonates whose standard-practice length fell within 0.5 cm of the gold standard totalled 41% (241 neonates), while 59% (342) were >0.5 cm. The change in length resulted in a change in the percentile range of 53% (309) on a standard growth curve percentile. When examining neonates whose length was plotted at the extremes of percentile regions, the positive predictive value results of the standard practice compared with the gold standard were poor, with positive predictive values of 37.5%, 57.1% and 31.3% for neonates who were measured as <3rd, <10th and ≥90th percentile, respectively.

CONCLUSIONS

In current clinical practice, measures of neonatal length are often inaccurate, which has implications for potentially erroneous clinical care. Health-care providers should be educated on the importance of length and trained in how to measure length with the correct technique using a length-board.

A method for developing standardised interactive education for complex clinical guidelines

BACKGROUND

Although systematic use of the Perinatal Society of Australia and New Zealand internationally endorsed Clinical Practice Guideline for Perinatal Mortality (PSANZ-CPG) improves health outcomes, implementation is inadequate. Its complexity is a feature known to be associated with non-compliance. Interactive education is effective as a guideline implementation strategy, but lacks an agreed definition. SCORPIO is an educational framework containing interactive and didactic teaching, but has not previously been used to implement guidelines. Our aim was to transform the PSANZ-CPG into an education workshop to develop quality standardised interactive education acceptable to participants for learning skills in collaborative interprofessional care.

METHODS

The workshop was developed using the construct of an educational framework (SCORPIO), the PSANZ-CPG, a transformation process and tutor training. After a pilot workshop with key target and stakeholder groups, modifications were made to this and subsequent workshops based on multisource written observations from interprofessional participants, tutors and an independent educator. This participatory action research process was used to monitor acceptability and educational standards. Standardised interactive education was defined as the attainment of content and teaching standards. Quantitative analysis of positive expressed as a percentage of total feedback was used to derive a total quality score.

RESULTS

Eight workshops were held with 181 participants and 15 different tutors. Five versions resulted from the action research methodology. Thematic analysis of multisource observations identified eight recurring education themes or quality domains used for standardisation. The two content domains were curriculum and alignment with the guideline and the six teaching domains; overload, timing, didacticism, relevance, reproducibility and participant engagement. Engagement was the most challenging theme to resolve. Tutors identified all themes for revision whilst participants identified a number of teaching but no content themes. From version 1 to 5, a significant increasing trend in total quality score was obtained; participants: 55%, p=0.0001; educator: 42%, p=0.0004; tutor peers: 57%, p=0.0001.

CONCLUSIONS

Complex clinical guidelines can be developed into a workshop acceptable to interprofessional participants. Eight quality domains provide a framework to standardise interactive teaching for complex clinical guidelines. Tutor peer review is important for content validity. This methodology may be useful for other guideline implementation.

Reducing the proportion of stillborn babies classified as unexplained in Vietnam by application of the PSANZ clinical practice guideline

BACKGROUND

Over 2.6 million babies are stillborn every year mostly in low- and middle-income countries, where cause of death remains often unexplained.

AIM

To determine the applicability and utility of the Perinatal Society of Australia and New Zealand (PSANZ) Clinical Practice Guideline (CPG) for Perinatal Mortality in reducing the proportion of unexplained stillbirths in a hospital setting in Vietnam.

METHODS

An analytic cross-sectional study of stillborn babies born at a major maternity facility in Vietnam. Maternal history, external physical examination of the baby and placental macroscopic examination were performed. Two experienced classifiers independently assigned PSANZ perinatal death classification (PDC). This was compared to cause of death documented in the hospital records.

RESULTS

107 stillborn babies were born to 105 mothers. The proportion of stillborn babies classified as unexplained was reduced from 52.3 to 24.3% (P < 0.01) using the PSANZ-PDC system. Causes of death were congenital abnormalities (35.6%), hypertension (8.4%), fetal growth restriction (8.4%), specific perinatal conditions (8.4%), spontaneous preterm (6.5%), maternal conditions (5.6%) and antepartum haemorrhage (3.7%).

CONCLUSIONS

Application of the PSANZ-CPG and stillbirth classification system is effective and feasible in a low-income country facility setting and resulted in a reduction in the number of babies classified as unexplained stillbirth in Vietnam.

The Yorkshire Modular Training Programme: a model for structured training and quality assurance in obstetrics and gynaecology

Recent changes in postgraduate education have highlighted the need for structured training to ensure quality in training and optimize patient care. In Yorkshire, a "modular" approach to postgraduate education in obstetrics and gynaecology has been adopted through the Yorkshire Modular Training Programme (YMTP). The curriculum for trainees is divided into "modules" organized over five years. This provides a comprehensive educational package covering all aspects of obstetrics and gynaecology for trainees in the specialty. The YMTP provides a framework for region-wide integration and ownership of responsibility for teaching and training. It also provides quality assurance in education throughout the region and provides an "educational continuum" in which the different modules work together to meet the educational requirements of the trainees. It also aims to integrate "training" and "education" for the trainees. This paper describes the organization of the programme including its educational principles. It discusses its strengths and weaknesses. It provides a useful framework for postgraduate education that could be used by other regions.

Meeting the challenge of prescribing and administering medicines safely: structured teaching and assessment for final year medical students

OBJECTIVES

To promote safe prescribing and administration of medicines in the pre-registration house officer (PRHO) year through a programme of structured teaching and assessment for final year medical students.

DESIGN

Forty final year medical students from two medical schools were randomly allocated either to participate in a pharmacist facilitated teaching session or to receive no additional teaching. Teaching comprised five practical exercises covering seven skills through which students rotated in small groups. One month later, a random sample of 16 taught and 16 non-taught students participated in a nine-station objective structured clinical examination (OSCE) to assess the impact of the teaching.

SETTING

Manchester School of Medicine (MSM), and Kings College School of Medicine and Dentistry (KCSMD).

PARTICIPANTS

Final year medical student volunteers.

MAIN OUTCOME MEASURES

The need for teaching as indicated by student prior experience; questionnaire rating of student acceptability of teaching and assessment; self-rating of student confidence post-assessment, and student performance assessed by OSCE.

RESULTS

The study demonstrated that the taught group achieved higher scores in eight OSCE stations. Four of these were statistically significant (P < or= 0.005). Taught students felt more confident performing the skills on five stations. From 0 to 47.5% students had prior experience of the skills taught. The post-teaching questionnaire evaluated exercises positively on several criteria, including provision of new information and relevance to future work.

CONCLUSIONS

Structured teaching provided an effective and acceptable method of teaching the medicines management skills needed in the PRHO year. The structured approach complemented variable precourse clinical experience.

Anxiety and feelings of medical students conducting their first gynecological examination

We examined the anxiety of medical students when they conduct their first gynecological examination. The students (226) from two universities completed anonymous questionnaires providing measures of state and trait anxiety and anxiety and confidence feelings, before and after conducting their first bimanual and speculum examination. This took place during a structured, self-directed learning session and involved examination of a professional patient. Students state anxiety was significantly elevated immediately before and fell to below baseline levels after the examination (p < 0.001). Students' reported feelings of increased confidence during the examination (p < 0.001). Students who had personally had a Pap smear test were most anxious before (p < 0.003) but during the examination, students who had experienced a gynecological exam felt less anxious (p < 0.002). The students experiencing the greatest decreases (before to after) in state anxiety were those who had never experienced sexual intercourse (p < 0.005). Most students (96%), particularly those who were more anxious during the examination (p < 0.001) and who experienced a greater decrease in anxiety from before to after the examination (p < 0.008) would recommend this method of learning to other students. In summary, medical students are anxious when they conduct their first gynecological examination, appear to be influenced by their personal experiences and appreciate methods of learning that reduce their anxiety.

Following the forsaken: a procedural description of a problem-based learning program in a school of nursing studies

This paper reports the findings of one stage in an ongoing project to evaluate, from the students' perspectives, a student-centered problem-based learning (PBL) program in a School of Nursing Studies. We begin by making a comparison between teacher-centered education and religious devotion, and liken PBL to a congregation without a priest. A topographical account of the setting follows, describing the typical activities and events that characterize the program. Throughout the course of this account, a number of issues arise: the role of the facilitator, group dynamics, mutual responsibility and motivation for learning. These are touched on briefly, but we do not attempt to make a substantive theoretical contribution. Despite the widespread popularity of PBL in nursing schools, there have been few empirical studies conducted and, consequently, the adoption of PBL in nursing has been dependent upon the research of the very different discipline of medicine and medical education.

Innovations in teaching obstetrics and gynaecology--the Theme Afternoon

The Theme Afternoon is an exciting and popular new innovation in teaching that we have successfully introduced in Obstetrics and Gynaecology. It utilizes many of the elements of the SCORPIO and SPICES models of teaching. In particular, it involves problem-based learning and an integrated approach to teaching. One afternoon per week is set aside for each theme. So far we have introduced Theme Afternoons in Contraception and Sterilization, The Menopause and Hormone Replacement Therapy, Screening for Disease in O&G and Examination Techniques. All Theme Afternoons follow a similar structure: a targeted tutorial, 10 MCQs, a 15-minute coffee break, OSCEs, and role-play with feedback. An evaluation form is completed by each student assessing the session and the tutor. The Theme Afternoon provides the student with stimulation to learn. It has a wide appeal and has been well received by learners. Students learn at a more controlled pace and in a more sheltered environment, which may be less stressful to them. It evaluates well and is flexible in its structure. The changes that occur are student-led and the desire for it to continue is student-driven. It is easily adaptable to other medical specialties or even nonmedical curriculums. We recommend it as a realistic opportunity to raise standards and enthusiasm in medical education.

Exploring the potential of problem-based learning in nurse education

It could be argued that the role of the nurse is beginning to change from that of a medical assistant to one of a more research-aware, reflective professional. As a result, the education of nursing students has needed to adapt. This paper explores how problem-based learning (PBL) may be an appropriate means of achieving an educational preparation that can respond to changing needs. Particular attention is paid to the theoretical underpinnings of PBL, especially the concepts of adult education, cognitive processes and learning in context. Some of the relevant empirical studies are reviewed, and the authors attempt to identify the gaps in the literature, concluding by recommending a course of action to expand the existing levels of understanding and evidence that supports, or otherwise, the use of PBL.

'The buck stops here': accepting responsibility for learning and actions after graduation from a problem-based learning nursing education curriculum

Despite the increased attention that problem-based learning has received as an appropriate pedagogical technique for educating adults for professional practice, reports that evaluate the process are rare and usually relate to professions other than nursing. A study was undertaken in order to discover the graduates' own perceptions of a problem-based learning programme and its effectiveness in preparing them for the reality of their chosen profession. Twelve practising graduate nurses who had completed the programme were interviewed according to the ethnographic method. Three categories were identified from the data: 'and all of a sudden...', which describes the transition from PBL student to staff nurse; 'not an unthinking assistant', where the characteristics that the PBL graduates believe make them different from traditionally trained nurses are described; and 'the buck stops here', which describes the sense of personal responsibility that the graduates experience in terms of their learning and actions.

Gynaecological examination: a teaching package integrating assessment with learning (693)

A self-directed learning package which includes assessment was developed to allow students to acquire the psychosocial and motor skills needed to conduct a gynaecological examination with sensitivity. The package integrates assessment with learning and uses the Assessment Form as an educational instrument. The introduction, including a video of a vaginal examination and pap smear, is followed by five learning stations for groups of 3 or 4 students to visit. At each station a series of tasks are given which enable the objectives of the station to be fulfilled. The materials necessary to complete the tasks are provided. Gynaecological assistants, themselves trained by participation in the learning sessions, guide the students throughout the session and act as adviser 'patients' to help students acquire the necessary motor skills. In the assessment, students are required to integrate what they have learnt in the learning stations. The students assess themselves and the 'patient' and an observer assesses the student using the same Assessment Form. The form assesses and gives examples of the psychosocial, including legal and motor skills required. The assistants-observers give feedback to the students about their performance and make suggestions for future improvement. Of the 232 medical students completing their clinical terms in Obstetrics and Gynaecology in 1995, those students receiving the learning package rated their practical experience as significantly better. They rate the learning method, content, enjoyment and package overall very highly (median 4, 5 point scale 1-5). Open-ended comments by students confirmed these findings.

Teaching normal physical examination in a large-group interactive using artists' models

BACKGROUND

The innovative use of artists' models within the context of a large-group interactive teaching session, at Royal North Shore Hospital is reviewed.

METHODS

The models were used to teach normal physical examination skills to a group of junior medical students, during their surgical rotation. This same group of students were also exposed to traditional bedside tutorials. The students evaluated both teaching experiences.

RESULTS

In the four areas of evaluation (interaction, explanation, presentation, and organization), the large-group interactive sessions were consistently rated higher than the bedside tutorial (P < 0.001).

CONCLUSIONS

The teaching technique is presented as an effective way of delivering quality clinical training to a group of junior medical students in an environment where access to good teaching material is becoming increasingly difficult.

Competency-based learning in traumatology

BACKGROUND

A multidisciplinary, competency-based trauma teaching program was introduced for final year medical students (n = 67) at Royal Prince Alfred Hospital (RPAH) in 1994 to complement the surgical clerkship.

METHODS

The method involved small groups rotating through a series of teaching stations each structured to address a predetermined competency. Four 3-hour sessions were held on the subject areas of resuscitation, plastic, orthopedic, and neurotrauma. Performance in the trauma section of a summative Objective Structured Clinical Examination (OSCE), 6 months after the teaching, was compared with that of a control group (n = 127) from other campuses where trauma was taught by a series of discipline-based lectures. Three trauma OSCE stations were designed to test psychomotor skills while five addressed aspects of the cognitive domain. Checklists were used to ensure standardization of scoring in a range of questions asked for skills tested at each station.

RESULTS

The marks of the RPAH students (mean 78% +/- SD 9%) were significantly higher (P < 0.0005) than the controls (mean 70% +/- SD 9%) in the 8 trauma questions. There was no significant difference (P = 0.8) in marks obtained by the study group (mean 61% +/- SD 8%) and controls (mean 63% +/- SD 7%) in 22 questions sampling a wide spectrum of nontrauma subject areas. The study group performed significantly better in one of the three skills stations and three of the five problem-solving stations when compared with the control group.

CONCLUSION

The innovation has the potential to fulfill a need for an integrated trauma program in the undergraduate core curriculum.

Competency-based learning in neonatology

An educational model integrating structured teaching with clinical experience, or clerkship, has been designed to enable students to learn the core knowledge, skills and attitudes necessary to care for the newborn. The programme is run for fifth year medical students as part of four, 9-week periods in Obstetrics and Gynaecology each year. A SCORPIO teaching session is held in week 1 to introduce students to the core competencies in the subject areas of newborn examination, breastfeeding, resuscitation, respiratory distress and anthropometry. Groups of four students rotate through each topic, which is conducted by a neonatologist or registrar in training. Eight problem-based learning sessions are held during weeks 2-9. Several students assess a clinical problem, identify learning issues and meet colleagues and a facilitator to share their learning experiences and resolve the problem. The clinical experience, or clerkship, is based in the neonatal nursery where 2-3 students spend a week consolidating their clinical and procedural skills. A study group was assessed at the end of the programme by an Objective Structured Clinical Examination (OSCE) and a Multiple Choice Questionnaire (MCQ). A control group did the same assessment in week 1. All students were asked to rate the educational value of the three learning methods on a 5-point Likert scale. The study group (n = 20) achieved a mean composite mark of 66% (SD 10%). This was significantly higher (P < 0.001) than that of the control group (n = 18), mean 45% (SD 7%). All students (100%) rated the educational value of SCORPIO as high or very high, and the comparative rating for problem-based learning and clerkship was 65%, respectively. The programme was enthusiastically received by the students and resulted in mastery of a range of core competencies necessary for care of the newborn.

Towards a new model of nursing education

We are witnessing the most significant changes in the nature of the relationship between nursing education and higher education. However, there has yet to be a more philosophical explanation of what it would mean for our aims and practices as nurse educators if we were to take seriously the notion of nursing education within the context of higher education. This paper analyses the role of the university and raises the questions: What should higher education mean today? What should higher education mean for nursing? In response to the former question it is suggested there cannot be a total distinction between the concept 'higher education' and the socio-political context. Higher education has to be realized in particular historical societies and there is likely to be much controversy over how this should be done. In response to the latter question it is suggested that to warrant the title nursing 'higher education' the process should promise a freeing of the mind but also beyond, to bring about a new level of self-empowerment in the individual student. In essence, it should contain an emancipatory element. It is the articulation of normative aspirations such as these, that is so strikingly absent from so much of the debate relating to nursing education merging with higher education. Nursing education must not however fall victim to 'academic drift' which has often been regarded as a distinctive and persistent feature of higher education. It might be proposed that student nurses who move from an educational to a practice setting are subjected to 'a competing paradigm of occupational vocationalism'.(ABSTRACT TRUNCATED AT 250 WORDS)

Interprofessional cooperation

This paper presents various views on interprofessional cooperation and discusses the significant components and desired outcomes of such a relationship. Historically, the nurse-doctor relationship has been fraught with conflict; however, the challenge is to dismantle this imbalanced relationship and fashion new interdisciplinary collaboration. Collaborative practice is an ongoing, dynamic process, requiring time to develop. The creation of true partnership demands energy and commitment. Collaboration, a relationship of interdependence, is built on respect and understanding of the unique and complementary perspectives each profession makes to achieve desired outcomes. The health literature abounds with issues associated with interdisciplinary collaboration. Essential elements of collaboration, advantages and barriers to collaborative affiliation, impact of collaborative practice, and changes in practice patterns among professionals of various disciplines are some of the issues highlighted. Several universities and medical centres support faculty-practice joint appointment and believe this collaborative affiliation will bridge the accountability gap and will enhance the educational and organizational goals. The problem-based learning curriculum is permeating nursing schools. This educational strategy is valuable in that students learn team collaboration. Many studies believe that practice questions can be addressed better by merging the talents of clinicians and those in the academic setting. The authors point out that research-based knowledge is essential for clinicians to solve patient care problems. Favourable outcomes to collaborative practice outweigh the barriers. No doubt there is synergism when a new partnership is created which is the hallmark of a true interprofessional relationship. This affiliation must be nurtured and reinforced, for it holds great promise for enhancement of patient care and for providing job satisfaction in an increasingly complex and constraining world of health care.

Formative assessment: a student perspective

An educator's view would be that formative assessment has an important role in the learning process. This study was carried out to obtain a student perspective of the place of formative assessment in the curriculum. Final-year medical students at Royal Prince Alfred Hospital took part in four teaching sessions, each structured to integrate teaching with assessment. Three assessment methods were used; the group objective structured clinical examination (G-OSCE), structured short answer (SSA) questions and a pre/post-test multiple choice questionnaire (MCQ). Teaching sessions were conducted on the subject areas of traumatology, the 'acute abdomen', arterial disorders and cancer. Fifty-five students, representing 83% of those who took part in the programme, responded to a questionnaire where they were asked to rate (on a 5-point Likert scale) their response to general questions about formative assessment and 13 specific questions concerning the comparative value of the three assessment modalities. Eighty-nine per cent of respondents felt that formative assessment should be incorporated into the teaching process. The SSA assessment was regarded as the preferred modality to reinforce previous teaching and test problem-solving skills. The MCQ was the least favoured assessment method. The effect size variable between the total scores for the SSA and MCQ was 0.64. The variable between G-OSCE and SSA/MCQ was 0.26 and 0.33 respectively. Formative assessment is a potentially powerful method to direct learning behaviour. Students should have input into the methods used.

Meeting the Challenge of the Curriculum Revolution: Problem-based Learning in Nursing Education

Nursing education today faces a great challenge as it reviews the outcomes of traditional teaching strategies and seeks to explore new alternatives in preparing the nursing student for the complex and diverse profession of nursing. Problem-based learning is one alternative to meeting the needs of a society with health requirements as diverse as its population. Nurses must be capable of exploring options, asking questions, articulating explanations, and developing appropriate nursing care plans based on reflective decisions. They must continue to value learning throughout their careers to maintain their expertise. The role of the educator today is to probe student thinking toward conceptual understanding, to increase depth of subject knowledge, to provide student learning opportunities, and, by encouraging the articulation and contrasting of different points of view, to allow the emergence of common understandings. A problem-based curriculum can provide the framework for the revolution in nursing education to occur.

Integration of the surgical specialties into an innovative undergraduate curriculum

A dilemma exists concerning the most effective way to incorporate surgical specialty teaching into an innovative undergraduate curriculum. Should the specialties form part of the core curriculum or should they be available as electives? The aim of this study is to describe an educationally sound and time-effective way to give all students an exposure to the surgical specialties while maintaining the philosophy of an innovative curriculum. The SCORPIO method was used, on a trial basis, in 1992 to teach cardiothoracic surgery, neurosurgery, plastic surgery and urology to fourth-year medical students at a university teaching hospital. The teaching was evaluated by comparing group pretest performance with a posttest assessment given one month after each of the teaching sessions. Student perceptions were assessed by a questionnaire and a time analysis was carried out comparing SCORPIO with the traditional ward tutorial system. Students completed the sequence pretest, teaching and posttest on 169 occasions. Group performance increased from a pretest mean 28% (SD16) to a posttest mean 44% (SD13) P < 0.0001. Student acceptance was favourable, with high ratings given to the structured, problem-based style of teaching. The time to run the programme was one-eight that to teach by the ward tutorial system. This teaching model is a practical way to incorporate the surgical specialties into the core curriculum of a school moving towards a student centred, problem-based, integrated curriculum.

Evaluation of a method to teach cardiothoracic surgery to medical students

This report describes a method to teach undergraduate students the knowledge base and skills needed to maximize the educational value of a subsequent cardiothoracic surgical clerkship. Sixty-three fourth year medical students underwent a structured teaching programme in which groups of five students rotated through a series of six teaching stations. Subject material, presented during 20 min at each station, covered the key issues relating to coronary artery disease, congenital heart disease, chest trauma, lung cancer, prosthetic heart valves, pacemakers, thoracic sepsis and dysphagia. Group knowledge increased significantly (P < 0.001) from a mean mark of 23% (s.d. 12) in a pre-test to a mean mark of 46% (s.d. 12) in a test conducted 1 month after the teaching. The time taken to conduct the structured teaching/assessment was 5 h compared with 32 h to run the same programme by the traditional ward tutorial system. The dollar cost to stage the structured teaching was less than that to run the traditional tutorial programme. It was concluded that the teaching method is effective, economical and practical and that it has a role in an undergraduate curriculum to prepare students for clinical clerkship.

A model to teach trauma care to medical students

The following integrated trauma teaching model has been developed in response to perceived deficiencies of organized trauma content in many undergraduate surgical programmes. This method has combined structured teaching and clinical clerkship. First, a short lecture is given to the student body giving an overview of the subject. Small groups then rotate through a series of teaching stations, each structured to represent a different level in the hierarchy of management priorities involved in the care of a trauma patient. The educational value of a 150 minute teaching session was evaluated by comparing group performance in a pre-test given several days before with a post-test immediately after teaching. Forty one Year IV students increased their mark, out of a possible total of 30, from a pre-test mean 15 (SD3) to a post-test mean 21 (SD3). Thirty two year VI students increased their marks from a mean 18 (SD3) to a mean 24 (SD2). Both increases are highly significant (p < 0.001). The model has proved to be an effective way to teach students trauma skills in preparation for a subsequent clerkship or internship.

Role of the pre-test in the progressive assessment of medical students

A prospective, randomized, controlled trial was conducted to see if a pre-test, given immediately before teaching, improved performance in a subsequent post-test. The study was also used to assess the educational value of a structured teaching method. Third year medical students were randomized into study and control groups. In phase I, the study group completed a subject-specific multiple choice question (MCQ) pre-test immediately before a teaching demonstration on vascular disorders. The control group completed a placebo pre-test. At the completion of teaching both groups did the same subject-specific post-test. The experiment was repeated in phase II where the groups were crossed over and traumatology was the subject of the demonstration. In both phases of the experiment there were no significant differences between the post-test marks of the experimental and control groups (P = 0.128 and 0.397, respectively). The experimental groups did, however, increase their marks significantly when their post-test results were compared with pre-test marks (P less than or equal to 0.0001, phase I and II). It was concluded that the pre-test did not result in a measurable increase in learning. The study did demonstrate that the teaching method was effective as post-instructional knowledge increased by nearly half when compared with pre-test levels.