Small-group work and assessment in a PBL curriculum: a qualitative and quantitative evaluation of student perceptions of the process of working in small groups and its assessment.

The problem based learning (PBL) curriculum at Manchester emphasizes small-group work. This is supported through group assessment where students assess key aspects of their group's function. In the study described here the authors evaluated students' perceptions of both PBL group work and what a group assessment needs to assess. They aimed to produce a description of the cognitive and motivational influences on group process and unpack the ways they contribute to a successful PBL group so that the kinds of skills an effective assessment should assess could be identified. Focus groups and a questionnaire were used to generate the data. The focus group results indicate that students support PBL group work as a method of learning, and that those groups that work cooperatively are perceived as facilitating the most motivating learning environment. The students supported the assessment being summative and felt that it could be simplified to measure: behavioural skills contributing to maximizing motivation of the group process; and cognitive skills relating to the content of the group discussion. The questionnaire results also supported the use of a summative assessment of small-group work that evaluates the domains of group process and the content of the group discussion.

Small group learning in the final year of a medical degree: a quantitative and qualitative evaluation.

The new undergraduate medical curriculum in Manchester uses problem-based learning (PBL) throughout the course. However, the major difference from other PBL schools is that in years 3 & 4 (phase 2) the students can use clinical experience when discussing the paper cases. The process is then developed further in year 5 (phase 3), in which there are no set PBL 'triggers' and students bring their own cases to the groups for discussion. In this study, we have explored what happens in the phase 3 (year 5) group sessions and how the students view them. A questionnaire and focus groups were used to generate data, from which a model was developed of what happens in a 'good' group session. The data suggest that most groups run on a case-presentation and discussion format, most commonly about clinical management and diagnosis. Students want tutors to act as an expert resource and to be flexible in allowing students to direct the discussions. University guidance about the group sessions was not generally used.

Consultation skills of medical students before and after changes in curriculum.

The University of Manchester Medical School has adopted problem-based learning as its main educational method, with a change of emphasis from a biomedical to a biopsychosocial approach. The training of junior medical students in clinical interviewing is intended to reinforce and develop their interpersonal skills. We measured the impact of this new curriculum by assessing two intakes of students covering the period before and after its introduction; a third intake was later added to examine the effect of further curriculum adjustments. 86 students, randomly selected, were videorecorded conducting diagnostic interviews with standardized patients 10 weeks after they had started to learn clinical interviewing. Two instruments were developed--a 23-item communication skills scale and a 13-item information-gathering scale and both showed acceptable inter-rater and test-retest reliability. Communication skills did not differ between years. The total score for information-gathering fell by 13% (95% confidence interval -20 to -6%, P < 0.001) in the first year after introduction of the new educational approach but returned to baseline the following year after further modification of the course. Although the new approach yielded no measurable improvement in the process of communication, assessment 10 weeks after the start of interview training may be too early to permit definitive conclusions. We conclude that it is possible to change to a more patient-centred emphasis in teaching medical interviewing. Some initial loss of information content was rectified by adjustment of the course. Our unfavourable early experience highlights the need to evaluate educational change.

The teaching of communication skills in United Kingdom medical schools.

A survey was carried out of the teaching of communication skills in medical schools in the United Kingdom during the academic year 1989/90. Comparison with previous surveys shows a considerable development over the last 10 years. Departments of psychiatry and general practice continue to play a major part in such teaching. There was wide variation in educational objectives and in the curricular time available. Concern is expressed about the methods of assessment and the degree of integration between departments. Future plans and the perceived barriers are reported and the implications discussed.

A survey of the management of psychosocial illness in general practice in Manchester.

As part of a larger study 201 urban general practitioners from five health districts provided information on 6870 consultations with patients recorded as having psychosocial disorders, 5610 of which were concerned solely with psychosocial problems. The results showed a lower percentage of consultations for such conditions than other studies, although the age and sex distribution of the patients was similar. There was a wide variation in the proportion of such disorders in the case-mix of the 201 general practitioners, a higher proportion being associated with longer consultation times. The pattern of prescribing and referral is described and discussed. Referral to non-medical agencies played a small part in the overall care of patients with psychosocial disorders. Questions are raised as to the extent of team care in this wide cross-section of practices.

The management of minor illness by general practitioners.

The management of 12 330 cases of minor illness by 201 urban general practitioners has been studied. The results were analysed by the characteristics of the patients (age and social class) and by the characteristics of the doctors (for example, age of doctor, area of practice, mean time spent with patient).The age of the patients had little effect on the management of minor illness. Prescribing rates were not found to vary with the social class of the patient but the level of home visiting was affected.Doctors working in the most affluent wards were found to be lower prescribers than those in the less affluent wards and younger doctors tended to be low prescribers while older doctors tended to be high prescribers. There was a large proportion of non-vocationally trained doctors among the high prescribers. Doctors with short mean consultation times were found to be high prescribers and were more likely to label patients as having minor illness than doctors with longer mean consultation times. In addition, those doctors who used the minor illness codes more often were higher prescribers than those who used them less often.

Effect of distance from surgery on consultation rates in an urban practice.

Introducing a microcomputer into a general practice provides an opportunity to consider how different population groups use the services offered. In a study of the effect that distance has on consultation rates the results showed that patients who lived close to the surgery consulted a third more than those who lived over two and a half miles from the surgery. Further analysis showed that patients who might be expected to have transport difficulties were particularly low users.