Using a Lego-based communications simulation to introduce medical students to patient-centered interviewing.

PURPOSE: Teaching patient-centered interviewing skills to medical students can be challenging. We have observed that 1st-year medical students, in particular, do not feel free to concentrate on the interviewing skills because they are preoccupied with complicated technical medical knowledge. The Lego simulation we use with our 1st-year students as part of a professional-skills course overcomes that difficulty. SUMMARY: The Lego activity is a role play analogous to a doctor-patient interview that uses identical sets of Legos for the "doctor" and for the "patients" and a small construction that represents a patient history. CONCLUSIONS: With a simple questionnaire, data were collected from students at different points during instruction. Results indicate that the Lego activity was very effective in helping students learn the importance of open-ended questioning. It also was rated as highly as the very dynamic interactive part of the instructional session. The effectiveness of the Lego activity may be due to the properties of analogies.

Follow-up in train-the-trainer continuing medical education events.

BACKGROUND: The purpose of train-the-trainer (TTT) programs within the context of continuing medical education (CME) is to help facilitators acquire and/or enhance their skills at leading CME sessions. The provision of follow-up is one feature of successful CME workshops over which CME providers have some control. Follow-up is defined as any encounter between participants and workshop leaders, following an initial workshop or other development session, and is designed to enhance, maintain, reinforce, transfer, extend, or support the learning from the original workshop. In this article, we elaborate on the use of audio teleconferences to provide follow-up for a TTT workshop in Saskatchewan, a largely rural province in western Canada. METHODS: The teleconferences began 6 weeks after the workshop and were held at approximately 6-week intervals, with five conference calls in total. Each lasted about 45 minutes. Participants were interviewed to determine their view of the value of the teleconferences. RESULTS: Participants reported learning from the teleconferences and feeling more prepared to conduct CME sessions due to their participation in the teleconferences. Participants missed teleconferences only for extenuating circumstances (e.g., emergency deliveries). FINDINGS: We have found that audio teleconferences allow for and encourage professional discussion that is crucial to changing practices. They are an effective way to incorporate follow-up to TTT workshops when participants travel great distances to attend.

If students are not customers, what are they?

The answers to questions about the relationship between faculty and students-including medical students-depend on an understanding of the nature of teaching and the underlying ethical principles of our society. The authors maintain that teaching is purposive, rational, communal, and moral. They assert that Western society is based on the values of liberal democracy and that the key ethical principles for the professions that are derived from those values are autonomy, standard of care, and respect for democratic institutions. There are three candidates for ethical models on which to base the relationship between students and faculty. Two of them (clientism and paternalism) the authors reject. The one that they favor (the fiduciary model) is based on mutual trust and respect, which both students and faculty have responsibilities to maintain. Using that model, the authors conclude that students are, in some aspects, customers of faculty. This student-centered approach is balanced by treating society and other faculty as customers as well. Pathologies in medical education attributed to clientism (such as an obsession with marks and overemphasis on memorization) existed well before medical students were purportedly being treated as customers; perhaps it is not the student who is "broken" but the system in which the student is made to function. Whether students are called customers, clients, knowledge workers, or simply students, faculty must involve them more in shaping their education and in dealing with enduring problems that profoundly affect their learning.