Pre-interns: ready to perform?

BACKGROUND: There is an expectation that interns can perform the core procedural skill of male catheterisation; however, it is unclear if our medical graduates are competent to do so, because there is no formal practical skills exit assessment in our current programme. AIM: We sought to investigate the level of experience, the self-reported confidence, and measured competency of our pre-intern (PRINT) students to perform the procedural skill of male catheterisation. METHODS: We asked 100/147 (68%) PRINT students to complete a questionnaire to elucidate their experience and confidence prior to being practically assessed on a plastic manikin, using a faculty member validated 26-item checklist. Students were also invited to attend focus groups to help identify factors that had contributed to their practical performance. RESULTS: Between 2010 and 2012, 100/147 (68%) PRINT students completed a questionnaire prior to being formatively assessed. The mean score for self-reported confidence was 78.3/100 (95% CI 74.8-81.8), and the mean performance score was 85.6/100 (95% CI 83.2-87.9); however, the correlation coefficient between the confidence score and performance score was weak (r = 0.18). Three focus groups were conducted, with a total of 12/100 (12%) students attending. Although students reported that they had sound knowledge of the skill, the lack of opportunity to perform the skill in the clinical setting had led to mediocre performance outcomes. CONCLUSION: We found no significant correlation among the level of experience, the self-reported ability and actual performance when students were assessed under direct observation.

Can we improve the delivery of bedside teaching?

BACKGROUND: Bedside teaching is a vital component of clinical training in the medical curriculum. There is growing dissatisfaction among students regarding its delivery, and the main obstacles identified are: the availability of clinical tutors and access to suitable patients. AIM: We sought to evaluate Sydney University medical students' perceptions and satisfaction with two structured bedside teaching methods. METHODS: We compared two strategies of bedside teaching. In the old, traditional method an experienced clinician was formally allocated to a group, and was 'responsible' for regular (usually weekly) bedside teaching for that group. In the new method a specified, protected clinical teaching time was chosen, during which time any tutor available (mainly Junior Medical Officers, JMOs) performed clinical bedside teaching for that student group. The strengths and weaknesses of the two methods were evaluated. RESULTS: A total of 104 students out of a possible 128 (81% participation rate) took part in this study. In the new method, 100 per cent of students had their scheduled bedside tutorial delivered every week, compared with 20 per cent in the old system, 70 per cent of tutors had patients prepared every week, compared with 25 per cent in the old system, and 64 per cent of students had 'no frustration' with clinical bedside tutorials, compared with 27 per cent in the old system. CONCLUSIONS: The new method, using protected clinical teaching time at a specific scheduled weekly time, and using opportunistically available junior clinicians, is perceived by students as superior to the old method of one constant, experienced tutor allocated to a group. The main obstacles [to bedside teaching] are: the availability of clinical tutors and access to suitable patients.

Medical student experience as simulated patients in the OSCE.

BACKGROUND: Sydney Medical School has recently introduced a practise, formative five-station Observed Structured Clinical Examination (OSCE) for junior medical students, where senior medical students act as simulated patients (SPs). We sought to evaluate students' experiences and perceptions of acting as SPs in the practise OSCE. METHODS: The study took place over 3 years from 2010 to 2012, with three cohorts of year-3 students invited to participate as SPs (n = 172). Student SPs took part in the OSCE, where stage-2 students (n = 169) were examined, and year-4 students acted as examiners. The student SPs completed a questionnaire regarding their experiences. RESULTS: Over the 3-year period, a total of 43/172 (25%) of all year-3 students took part in the programme. Student questionnaire results indicated a high level of engagement with their SP experience. Students perceived the activity to reinforce knowledge, provide insight into examination technique and develop professional attributes. CONCLUSIONS: Acting as SPs was perceived by students to provide a useful and engaging learning experience. It also has the potential to reduce logistical demands and costs on clinical schools with limited resources to run practise examinations.

Senior medical students as peer examiners in an OSCE.

BACKGROUND: At Sydney Medical School, we have recently introduced a practice objective structured clinical examination (OSCE) where our junior medical students are assessed by the senior peers. AIM: We sought to evaluate the efficacy of the programme. METHODS: The study took place in 2010 and 2011, with two cohorts of final-year students participating. A total of 40/98 (41%) of final-year students chose to participate as examiners. Following the completion of standardised marking sheets by the student examiners, the marking sheets were reviewed by a senior academic examiner, and the 'global' mark was adjusted in accordance with the marking criteria. Student examiners also completed an open and closed-ended questionnaire regarding their experience as an examiner. A total of 105/115 (91%) of year 2 medical students were examined in the OSCE over the two-year period. RESULTS: The senior academic changed a total of 94 'global' marks, reducing the majority (55%) from 'satisfactory' to 'borderline'; 12% were reduced from 'satisfactory' to 'not satisfactory' and 33% from 'borderline' to 'not satisfactory'. Student questionnaire results showed a high level of engagement with their examiner experience overall, and it was regarded as a useful learning experience. CONCLUSION: Student examiners found peer assessment to be a very useful learning activity. However, our students need further training in how to globally assess a fellow student's overall performance objectively and to provide accurate feedback.

Teaching skills for students: our future educators.

BACKGROUND: The future of medical education is under increasing strain from a paucity of clinical educators with formal teaching experience and time to fulfil their teaching roles. 'Teaching on the Run' (TOR), is a programme aimed at improving the quality of teaching by medical educators. We hypothesised that the completion of the TOR programme by senior medical students would increase student awareness of quality educational practice, thereby improving their competence and confidence in teaching and assessing their peers. METHODS: Seventeen senior medical students who participated in the TOR programme completed before and after questionnaires based on the key outcomes of the programme. All students were invited to participate in a focus group session to explore their attitudes and experiences of having completed the programme. Seven students chose to participate. RESULTS: The TOR increased students' perceived ability to apply educational principles, plan learning activities and to provide feedback. During the focus group session students expressed an appreciation that the medical school was genuinely interested in improving the quality of their teaching and learning. However, the programme did not improve students' confidence in assessing their peers. DISCUSSION: We found that the TOR programme may provide a foundation from which future medical educators may be trained. In particular, these students seem to have developed some understanding of the principles of adult learning, and may be better prepared to plan and deliver a teaching session. This augurs well for the future of medical education, which depends on the emergence of a new generation of trained medical educators.