Harassment of newly admitted undergraduates by senior students in a Faculty of Dentistry in Sri Lanka.

BACKGROUND: Harassment of new students by senior colleagues appears to be widespread in the industrialised countries. Although 'ragging' of new entrants to universities in Sri Lanka gets frequently publicised, its prevalence, severity and the consequences have not been documented. AIMS: This study aims to ascertain the extent of mistreatment of new dental students, the measures they take when harassed and any resulting negative effects. METHODS: We surveyed the year 2008 Dental students using 80 statements dealing with verbal/emotional, sexual and physical harassment. Sixty five students (91.5%) responded anonymously indicating whether a specific action occurred, the degree to which it affected them and any action taken to deal with it. RESULTS: Fifty percent of students had experienced mistreatment. Verbal and emotional abuse was more frequent than sexual or physical. Eighteen percent experienced sexual harassment, with a significantly higher proportion of males than females reporting it. A fifth of the students had upsetting memories of the event. Eighty five percent of the respondents stated that they did not suffer any ethnic or racial discrimination. CONCLUSIONS: Emotional harassment of new students by the seniors is a pervasive, yet under-reported problem. Definitive interventions need to be implemented to prevent untoward consequences that can undermine the educational goals of training.

Frequency and confidence in performing clinical skills among medical interns in Kuwait.

BACKGROUND: Several investigations suggest inadequate emphasis of basic clinical procedures during internship training. Many trainees had reported lack of competence, while some expressed confidence to manage conditions although not sufficiently experienced. AIMS: This study aimed at ascertaining the perceptions of new medical graduates regarding the performance of core clinical skills during training and confidence of performing them later. It also aimed at determining any gender variability in the confidence in performing selected clinical skills in Obstetrics & Gynaecology. METHODS: Interns trained during 2005/06 responded anonymously to a questionnaire that listed 48 core clinical skills. The 124 subjects eligible for the study comprised graduates from Kuwait (64), other Gulf Cooperation Council countries (29), Ireland (27) and Egypt. They indicated whether they felt confident to perform the skills in future, and the number of times they had performed them during training. We received 91 completed questionnaires. RESULTS: The majority felt confident in performing routine skills (basic ECG and X-ray interpretations, insertion of intravenous line, inserting urethral catheter and nasogastric feeding). Approximately two thirds had performed generic skills related to emergency resuscitation, with a half of them confident in performing them in the future. A third felt confident in performing artificial ventilation and endotracheal intubation. The confidence to perform common skills in Obstetrics & Gynaecology varied, with no significant gender variation. Approximately a fifth was confident in performing lumbar puncture, needle aspiration of joints, insertion of thoracic drainage, insertion of central venous catheter, venous cut-down and indirect laryngoscopy. A small proportion reported confidence in performing different clinical procedures although they had not undertaken them during training. CONCLUSIONS: Substantial proportions of trainees lacked confidence in performing emergency resuscitative measures and some routine clinical skills. Training needs to be closely monitored and interns who are not competent identified early for taking remedial measures.

Performance of students in the final examination in paediatrics: importance of the "short cases".

AIMS: To determine which component of the final examination in paediatrics at Kuwait University best predicted the final outcome. METHODS: The performance of 356 medical students in the short cases, the long case, multiple choice questions (MCQs), and the essay components of the final examination in paediatrics at Kuwait University was correlated with the final grade, and the mean difference between each component and the final score calculated. RESULTS: The correlation was highest for the short cases, followed by MCQs, the long case, and essays. The mean difference between the final score and that of short cases was not significant, but was highly significant for the other components. CONCLUSION: Results show that performance in the short cases component of the final examination in paediatrics is a better discriminator of competence than that in the long case.

Instructional skills of surgical tutors.

AIM OF STUDY: This study was aimed at evaluating the pattern of instructional skills of surgical tutors in a university hospital and the effect of feedback on this pattern. METHOD: Students who followed three clinical rotations at the Department of Surgery, Mubarak Al-Kabeer Teaching Hospital, Kuwait, responded anonymously to a structured questionnaire on the instructional skills of their tutors immediately after the rotation was completed. The questionnaire included six statements related to teacher-centred instructional skills and six statements related to student-centred instructional skills. The students indicated their perception on a five-point rating scale (very poor, poor, fair, good and very good). A summary of students' opinions was made available to the teachers soon after each rotation. RESULTS: The percentage of good/very good categories was significantly higher in the teacher-centred skills compared with the student-centred skills (median (range), 87.05% (85.9-91.7) compared with 79.6% (76.6-80.6), (p = 0.004, Mann Whitney U test). This difference was significant in the first two rotations (p < 0.005) but not in the third rotation (p=0.59). CONCLUSIONS: This study shows that behaviours of teachers which dealt directly with the learner's role in learning received lower emphasis than the teacher-centred activities and that feedback may modify this behaviour.

The surgical morbidity and mortality meeting as an educational tool.

PURPOSE: This study aimed at evaluating the educational value of the morbidity mortality meeting and benefits obtained from it so as to implement changes that can improve it. METHODS: Surgeons (n = 13) at a university hospital responded anonymously to a questionnaire which was structured to monitor the educational activity of the morbidity mortality meeting. They indicated their perceptions on a five-point scale (very poor, poor, fair, good and very good). Depending on the results of the first questionnaire, these changes were made: 1) Standardisation of the notice of the Meeting 2) Organization of the meeting 3) Review of the literature on the specific problems encountered. The participants were not aware of the results of the first questionnaire. Nine weeks later, the same questionnaire was repeated (n=12). Mann-Whitney test was used to compare the ratings of the two questionnaires. RESULTS: The attributes which showed significant improvement between the first and second questionnaires were a) organization (p = 0.004; (median (range) 3 (2-5) compared with 5 (3-5)) b) knowledge is up-to-date (p < 0.005; (median (range) 3 (2-4) compared with 4 (3-5)), c) discussion related to the problem (0.01; (median (range) 3 (1-4) compared with 4 (3-5)) and d) notice of the meeting (p < 0.026; (median (range) 3 (2-4) compared with 4 (2-5)). CONCLUSIONS: This study showed that specific actions can improve the educational quality of the morbidity mortality meeting.

An instrument to evaluate clinical instructional skills.

A questionnaire, which consisted of 10 statements dealing with the attributes of effective clinical instruction, was designed for use by medical students. Three groups of trainees who followed consecutive clinical rotations in paediatrics assessed the instructional skills of their tutors using the instrument. Summary reports on students' perceptions were made available to the teachers soon after each rotation. The results showed that although individual instructors exhibited varying degrees of the desired skills, they maintained a consistent pattern through the assessments. When considered on an overall basis, teacher behaviours such as allowing the students to ask questions and giving satisfactory answers, and helping in students' learning problems with relevant feedback, received a higher percentage of positive ratings than emphasizing problem-solving, demonstrating and supervising physical examinations and procedures, and stimulating the students' interest in the subject. It appears that the instrument developed is suitable for obtaining feedback from the students to identify the strengths and weaknesses of the instructional skills of their clinical teachers. Such feedback would become useful when modifying programme presentation and in planning and conducting faculty development activities.

A reappraisal of the use of multiple choice questions.

The terms Multiple True/False and Best Answer deserve wider applicability than at present when discussing multiple choice questions (MCQs). They describe the truthfulness of the choices and distinguish between the question types. The choice which matches the key in a MCQ is best called the correct answer. Multiple True/False questions contain either true (accepted) or false (unaccepted) ideas in the correct answers while in the Best Answer type, all choices are true. Using a complex recording procedure to indicate the selections already made, as in the K-type MCQ, does not assess any additional abilities. Candidates answering Multiple True/False MCQs should be asked to respond to each choice as either true or false. This helps to discriminate between those who can detect the falsity of a false choice from those who cannot. When dealing with guessing, examiners need to be cognizant of issues such as blind guessing and informed guessing, proclivity for risk-taking, extension of the marking range and probabilities according to the binomial distribution.

Learning objectives in training residents in general surgery in Kuwait.

An opinion survey of a five-year postgraduate training programme in general surgery was conducted using a questionnaire. The residents who responded indicated that the use of learning objectives needed to be given greater emphasis. They felt that learning objectives should be more clearly defined and be communicated with the learners and the instructors at an early stage in the programme. While the opportunity for learning theoretical concepts in surgery was rated as a strong feature of the programme, learning practical skills, it was pointed out, needed augmenting.

Realistic line drawings--a simple technique.

Medical teachers usually do not have ready access to a resource for obtaining good quality illustrations for routine instructional activities and, at times, even for presentation of research findings in publications or at seminars. The inadequacy is especially apparent when human figures or objects need to be shown indicating depth of vision and relative sizes of the parts accurately. Tracings of the relevant features made from photographic prints result in very satisfactory illustrations. The technique can be used by the average teacher and is not time consuming.