Pre-University education curriculum reform and the generic learning skills of medical school entrants: Lessons learned from South Africa.

Background: Pre-university education curriculum changes may increase the skills and knowledge gap between secondary (high school) and tertiary (university) education that have been identified as having a major impact on the success of students from underresourced educational backgrounds. This study investigated the impact of extensive pre-university curriculum revision on the generic learning skills of entrants to South African medical schools, which admit students directly from high school. Methods: In this prospective study, students entering four medical schools during 2008-2011 were surveyed to determine their practice of and confidence in information handling, managing own learning, technical and numeracy skills, and computer, organizational, and presentation skills in the 12-month preceding entry. The 2008 entrants were the final cohort of the old secondary school curriculum. The mean levels of practice or confidence of entrants to the four medical schools, during 2008-2011, were compared using analysis of variance. The Bonferroni's test was used for further pair-wise comparison of cohorts of students either entering in different years or different institutions. Results: While entrants at the four medical schools did not demonstrate a consistent or sustained change in their practice of or confidence in each skill category over the period of study, there were some significant differences between entrants at the respective institutions. Furthermore, entrants to one medical school were consistently less confident of their skills, despite more practice. These findings are best accounted for by the long-standing history of inequitably resourced pre-university education in South Africa. Discussion: These findings highlight the need for close monitoring of the impact of pre-university education changes on the learning skill profiles of university entrants, in order to design effective university programs which enable students from diverse backgrounds to participate and adequately meet curricula demands.

Generic skills in medical education: developing the tools for successful lifelong learning.

CONTEXT: Higher education has invested in defining the role of generic skills in developing effective, adaptable graduates fit for a changing workplace. Research confirms that the development of generic skills that underpin effectiveness and adaptability in graduates is highly context-dependent and is shaped by the discipline within which these skills are conceptualised, valued and taught. This places the responsibility for generic skills enhancement clearly within the remit of global medical education. IMPLICATIONS: Many factors will influence the skill set with which students begin their medical training and experience at entry needs to be taken into account. Learning and teaching environments enhance effective skill development through active learning, teaching for understanding, feedback, and teacher-student and student-student interaction. Medical curricula need to provide students with opportunities to practise and develop their generic skills in a range of discipline-specific contexts. Curricular design should include explicit and integrated generic skills objectives against which students' progress can be monitored. Assessment and feedback serve as valuable reinforcements of the professed importance of generic skills to both learner and teacher, and will encourage students to self-evaluate and take responsibility for their own skill development. The continual need for students to modify their practice in response to changes in their environment and the requirements of their roles will help students to develop the ability to transfer these skills at transition points in their training and future careers. CONCLUSIONS: If they are to take their place in an ever-changing profession, medical students need to be competent in the skills that underpin lifelong learning. Only then will the doctors of the future be well placed to adapt to changes in knowledge, update their practice in line with the changing evidence base, and continue to contribute effectively as societal needs change.

What do medical students understand by research and research skills? Identifying research opportunities within undergraduate projects.

BACKGROUND: Undergraduate research exposure leads to increased recruitment into academic medicine, enhanced employability and improved postgraduate research productivity. Uptake of undergraduate research opportunities is reported to be disappointing, and little is known about how students perceive research. AIM: To investigate opportunities for undergraduate participation in research, recognition of such opportunities, and associated skills development. METHOD: A mixed method approach, incorporating student focus and study groups, and documentary analysis at five UK medical schools. RESULTS: Undergraduates recognised the benefits of acquiring research skills, but identified practical difficulties and disadvantages of participating. Analysis of 905 projects in four main research skill areas - (1) research methods; (2) information gathering; (3) critical analysis and review; (4) data processing - indicated 52% of projects provided opportunities for students to develop one or more skills, only 13% offered development in all areas. In 17%, project descriptions provided insufficient information to determine opportunities. Supplied with information from a representative sample of projects (n = 80), there was little consensus in identifying skills among students or between students and researchers. Consensus improved dramatically following guidance on how to identify skills. CONCLUSIONS: Undergraduates recognise the benefits of research experience but need a realistic understanding of the research process. Opportunities for research skill development may not be obvious. Undergraduates require training to recognise the skills required for research and enhanced transparency in potential project outcomes.

Research governance: impeding both research and teaching? A survey of impact on undergraduate research opportunities.

OBJECTIVE: To explore the impact of research governance on medical students' ability to gain an understanding of research methodology, as required by the General Medical Council. METHODS: We carried out a qualitative study based on semi-structured interviews, in 3 medical schools in the UK, with 12 interviewees including academic supervisors and administrative staff. RESULTS: Research governance has the potential to facilitate medical undergraduates to experience better quality research but, unfortunately, the inhibitory effects of the current framework overwhelm this. Participants highlighted the bureaucracy of the process, particularly the complexity of securing ethical approval and the length of application forms. In addition, there is widespread confusion and uncertainty about the process at a variety of levels. For medical teachers, confusion exists around the practicalities of the current process, the boundaries between core clinical experience, audit and research, and how the process may change in the future. Academic supervisors have adopted several strategies, including amending existing research projects, and in some cases have withdrawn from student supervision altogether. CONCLUSIONS: The present research governance requirements, especially for ethical approval, are too unwieldy to facilitate medical students' assimilation of research experience as a required learning outcome. Precise and clear definitions of the types of projects that necessitate ethical approval and the development of a shortened, simplified ethical approval application form are recommended.

Student-selected components in the undergraduate medical curriculum: a multi-institutional consensus on assessable key tasks.

This paper describes further progress by the Northern Universities SSC Consortium in achieving consensus on the contribution of the Student Selected Components (SSCs) to undergraduate medical courses. Following the identification of common purposes and outcomes, the group has matched these to assessable key tasks which students may undertake in order to demonstrate competence on a range of attributes not normally fully assessed in the core curriculum. In some schools, SSCs may be the predominant route through which students gain exposure to research methods and reflective practice. In addition to opportunities to acquire knowledge and skills outside the core curriculum, SSCs can contribute towards enhancement of core skills. SSCs may also contribute to the overall longitudinal assessment of personal and professional development. The potential role of portfolios in maximizing student learning from SSCs is discussed, and future areas for development identified.

Student-selected components in the undergraduate medical curriculum: a multi-institutional consensus on purpose.

Student-selected components (SSCs) are an established part of undergraduate medical curricula in the UK. Implementation has been against a background of differing educational approaches to curricular change, together with a lack of clarity about their purpose, relationship with the core curriculum and contribution to overall assessment. This has resulted in a diversity of programmes with perceived differing importance between medical schools. This paper documents the approach used by a consortium of medical schools with diverse curricula to develop consensus on the educational purpose and learning outcomes of SSCs. Agreement on common purposes and outcomes was achieved, and consensus documents are reported. These may be valuable for other medical schools implementing any form of student-selected project work. This work will now be the starting point for further work on producing recommendations for assessment of SSCs, which will be applicable across different medical schools.

Lifelong learning skills: how experienced are students when they enter medical school?

Widening participation initiatives together with changes in school curricula in England may broaden the range of lifelong learning skills experience of new undergraduates. This project examines the experience levels of current students, as a comparative baseline. First-year medical students completed a questionnaire on arrival, investigating their practice of 31 skills during the previous two years. Responses show that most students have regularly practised transferable skills. However, significant numbers report little experience, particularly in IT skills such as email, using the Internet, spreadsheets and databases. Some remain unfamiliar with word processing. Library research, essay writing and oral presentation are also rarely practised by substantial numbers. One-third of students lack experience of evaluating their own strengths and weaknesses. Current students already show diversity of experience in skills on arrival at medical school. Changes in the near future may increase this range of experience further, and necessitate changes to undergraduate courses.

Student-selected projects: can they enhance lifelong learning skills?

Student-selected projects with clearly identified transferable skill objectives have been introduced in Year 1, to help students focus on developing their lifelong learning skills. This study aimed to assess the impact of this innovation on students' perceptions of their skills, and to compare these views with those of students from the previous course. Students' views of their skill abilities were assessed by questionnaire at the beginning and end of the first year, and at the end of each project. Students report improvements, particularly in their IT and presentation skills, but an overall decrease in confidence in their transferable skills at the end of the year compared with the previous cohort. Students appear to recognize development of new skills, but seem less able to identify improvement in existing skills. Increased emphasis on skills development, together with practice of self-evaluation, has reduced students' self-confidence, probably to a more realistic level.