Experience and attitude of interns to pelvic and sensitive area examinations during their undergraduate medical course

To explore the experience of interns in sensitive area examination during their undergraduate medical course and identify factors interfering with such examinations. A cross sectional study was carried out from May to June 2010. Interns [n=315] at King Saud University College of Medicine were invited via email to complete a web-based questionnaire developed using surveymonkey.com. Out of 315 interns, 211 completed the questionnaire; 60% males and 40% females. The mean percentage of interns who never performed any of these examinations was 28.9% for digital rectal examination, 17.5% for breast, 43.1% for female pelvic examination, 13.3% for inguinal [hernia], and 34.6% for male external genitalia. Compared to females, male students conducted more rectal examinations [87 versus 63, p<0.005], and male external genitalia examinations [112 versus 26, p<0.001]. On the other hand, compared to male students, females conducted more pelvic examination [68 versus 52, p=0.03] and breast examinations [92 versus 82, p=0.27]. The most common reasons for not performing sensitive area examinations included patient's refusal [33.1%], and examining patients of opposite gender [27.6%]. Confidence in performance of these examinations was correlated to increased frequency of the examination. This study highlights that most common factors interfering with the students' conducting sensitive area examinations are patient's refusal and examining patients of the opposite sex. There is a strong correlation between increased frequency of conducting an examination and student's confidence in performance.

Seeing the wood for the trees: approaches to teaching and assessing clinical pharmacology and therapeutics in a problem-based learning course

For about 50 years, clinical pharmacology and therapeutics have been taught in the medical schools via traditional lectures and practical classes. During this time, significant changes have occurred in our understanding of medicine and basic sciences. Also the needs for our community have changed dramatically. The explosion of scientific discoveries, the use of new technologies in disease diagnosis, the availability of a wide range of therapeutic options, and the availability of knowledge to everyone via the Internet have necessitated new approaches for teaching medical and other health professional students. Finding information related to a topic has not become a priority in teaching, what has become more important is to teach undergraduate students how to think in addition to what to think. Applying information learnt and assessing its significance in real life situations has become mandatory. The aims of this paper were: (i) to discuss the model we used in introducing clinical pharmacology and therapeutics teaching in the undergraduate course at the University of Melbourne and the educational principles behind the model, and (ii) to discuss the new tools of assessment used in a problem-based learning (PBL) curriculum.

Medical education at the crossroads: which way forward?

Over the last 30 years, several changes have been introduced in medical education including the introduction of new contextualized approaches to instruction [e.g., problem-based learning [PBL]], the use of multimedia to enhance self-directed learning, the use of an integrated curriculum to address basic and clinical sciences, and the introduction of new formative and summative assessment tools that match with the curriculum changes. However, several challenges face medical education and need to be carefully researched. The list may be long and these challenges may vary depending on the needs of local and international health systems, the availability of resources, the vision of medical leaders and how they see these challenges and their impact. This paper discusses a number of challenges facing medical education including the selection of medical students and the validity of selection tools, students' learning skills, what makes a good medical curriculum, and the challenges facing a PBL curriculum

Facilitation of students' discussion in problem-based learning tutorials to create mechanisms: the use of five key questions

Without the appropriate facilitation of discussion in a problem-based learning (PBL) course and the use of specific educational tools that enhance cognitive skills, students might deprive themselves of achieving the deep learning experience expected to take place in a PBL course. One of the educational tasks in PBL is the creation of mechanisms for hypotheses made by the students, based on their knowledge of the basic sciences and the psychosocial issues raised in a particular case scenario. The whole task is student-constructed and should enhance their ability to explain the scientific basis of the symptoms and clinical signs of the patient enlisted in the case. Because students usually discuss the case without enough prior related knowledge, they might find it difficult to address different aspects of their mechanisms. These gaps in knowledge may be considered part of their "learning issues". In tutorial 2 (a PBL case is usually discussed in 2 or 3 tutorials at the maximum; each tutorial is 2 hours long), students should be able to build a comprehensive mechanism reflecting their deep understanding of the problem. However, students might not be able to integrate information learnt and their mechanisms might show a number of shortcuts and/or lack integration of information, and the flow of the pathophysiological changes may not be logical. This manuscript describes 5 key open-ended questions in PBL tutorials to facilitate students' discussions as they create their mechanisms.

Problem-based learning

Over the past 30 years there has been an increasing interest in curriculum innovation in medical schools in North America, the United Kingdom, Netherlands, and Australia. Since the introduction of problem-based learning at McMaster University in Canada in 1969, several medical schools throughout the world have adopted problem-based learning as the educational and philosophical basis of their curricula. Several studies have shown that problem-based learning is an important educational strategy for integrating the curriculum, motivating the students and helping them to identify their learning issues and set their own learning goals. However, there is a great deal of concern regarding what problem-based learning means and the advantages of problem-based learning over traditional curriculum have not been clearly addressed. In this review, a broad range of the definitions of problem-based learning have been addressed and the rationale for problem-based learning and its educational objectives are discussed

Problem-based learning Challenges, barriers and outcome issues

Although many recent studies have discussed specific issues related to problem-based learning in medical education, a comprehensive review of the literature on the consequences of its use and the outcomes of curriculum based on problem-based learning have not been accurately looked at. Furthermore, there is no available review that critically evaluates challenges and barriers to the implementation of problem-based learning curriculum in medical schools. The purpose of this part is to highlight the major challenges and barriers reported during curriculum preparation and implementation and to critically evaluate the consequences of problem-based learning introduction and its educational outcomes