AMEE Guide no.34: Teaching in the clinical environment

Abstract Teaching in the clinical environment is a demanding, complex and often frustrating task, a task many clinicians assume without adequate preparation or orientation. Twelve roles have previously been described for medical teachers, grouped into six major tasks: (1) the information provider; (2) the role model; (3) the facilitator; (4) the assessor; (5) the curriculum and course planner; and (6) the resource material creator It is clear that many of these roles require a teacher to be more than a medical expert. In a pure educational setting, teachers may have limited roles, but the clinical teacher often plays many roles simultaneously, switching from one role to another during the same encounter. The large majority of clinical teachers around the world have received rigorous training in medical knowledge and skills but little to none in teaching. As physicians become ever busier in their own clinical practice, being effective teachers becomes more challenging in the context of expanding clinical responsibilities and shrinking time for teachin

AMEE Guide no.34: Teaching in the clinical environment

Abstract Teaching in the clinical environment is a demanding, complex and often frustrating task, a task many clinicians assume without adequate preparation or orientation. Twelve roles have previously been described for medical teachers, grouped into six major tasks: (1) the information provider; (2) the role model; (3) the facilitator; (4) the assessor; (5) the curriculum and course planner; and (6) the resource material creator It is clear that many of these roles require a teacher to be more than a medical expert. In a pure educational setting, teachers may have limited roles, but the clinical teacher often plays many roles simultaneously, switching from one role to another during the same encounter. The large majority of clinical teachers around the world have received rigorous training in medical knowledge and skills but little to none in teaching. As physicians become ever busier in their own clinical practice, being effective teachers becomes more challenging in the context of expanding clinical responsibilities and shrinking time for teachin

Protection motivation theory: a proposed theoretical extension and moving beyond rationality-the case of flooding

Despite the significant financial and non-financial costs of household flooding, and the availability of products that can reduce the risk or impact of flooding, relatively few consumers choose to adopt these products. To help explain this, we combine the existing theoretical literature with evidence from 20 one-to-one discussions and three workshops with key stakeholders, as well as five round tables, to draw practical evidence of actual responses to flood risk. This analysis leads us to propose an extension to Protection Motivation Theory (PMT), which more accurately captures the decision-making process of consumers by highlighting the role of 'ownership appraisal'. We then assess the extent to which behavioral biases impact on this revised framework. By highlighting the interaction with an augmented model of PMT and behavioral biases, the paper sheds light on potential reasons behind the fact that consumers are unlikely to adopt property-level flood resilience measures and identifies strategies to increase flood protection. The Augmented PMT suggests that policymakers might focus on increasing the Ownership Appraisal element, both directly and by targeting the creation of more supportive social norms. The work presented here opens up a wide range of areas for future research in the field

Cross-sectional evaluation of a longitudinal consultation skills course at a new UK medical school

Background: Good communication is a crucial element of good clinical care, and it is important to provide appropriate consultation skills teaching in undergraduate medical training to ensure that doctors have the necessary skills to communicate effectively with patients and other key stakeholders. This article aims to provide research evidence of the acceptability of a longitudinal consultation skills strand in an undergraduate medical course, as assessed by a cross-sectional evaluation of students' perceptions of their teaching and learning experiences. Methods: A structured questionnaire was used to collect student views. The questionnaire comprised two parts: 16 closed questions to evaluate content and process of teaching and 5 open-ended questions. Questionnaires were completed at the end of each consultation skills session across all year groups during the 2006-7 academic year (5 sessions in Year 1, 3 in Year 2, 3 in Year 3, 10 in Year 4 and 10 in Year 5). 2519 questionnaires were returned in total. Results: Students rated Tutor Facilitation most favourably, followed by Teaching, then Practice & Feedback, with suitability of the Rooms being most poorly rated. All years listed the following as important aspects they had learnt during the session: • how to structure the consultation • importance of patient-centredness • aspects of professionalism (including recognising own limits, being prepared, generally acting professionally). All years also noted that the sessions had increased their confidence, particularly through practice. Conclusions: Our results suggest that a longitudinal and integrated approach to teaching consultation skills using a well structured model such as Calgary-Cambridge, facilitates and consolidates learning of desired process skills, increases student confidence, encourages integration of process and content, and reinforces appreciation of patient-centredness and professionalism

Medical graduates’ preparedness to practice: A comparison of undergraduate medical school training

Background: There is evidence that newly qualified doctors do not feel prepared to start work. This study examined views of first year Foundation doctors (F1s) regarding how prepared they felt by their undergraduate medical education for skills required during the first Foundation training year in relation to their type of training. Method: One-hundred and eighty two F1s completed a questionnaire during their first rotation of Foundation training. Analysis was conducted by type of medical school training: Problem-Based Learning (PBL), Traditional or Reformed. Results: F1s from medical schools with a PBL curriculum felt better prepared for tasks associated with communication and team working, and paperwork than graduates from the other medical school types; but the majority of F1s from all three groups felt well prepared for most areas of practice. Less than half of graduates in all three groups felt well prepared to deal with a patient with neurological/visual problems; write referral letters; understand drug interactions; manage pain; and cope with uncertainty. F1s also indicated that lack of induction or support on starting work was affecting their ability to work in some areas. Conclusions: Whilst F1s from medical schools with a PBL curriculum did feel better prepared in multiple areas compared to graduates from the other medical school types, specific areas of unpreparedness related to undergraduate and postgraduate medical training were identified across all F1s. These areas need attention to ensure F1s are optimally prepared for starting work

Selecting the right medical student

Medical student selection is an important but difficult task. Three recent papers by McManus et al. in BMC Medicine have re-examined the role of tests of attainment of learning (A’ levels, GCSEs, SQA) and of aptitude (AH5, UKCAT), but on a much larger scale than previously attempted. They conclude that A’ levels are still the best predictor of future success at medical school and beyond. However, A’ levels account for only 65% of the variance in performance that is found. Therefore, more work is needed to establish relevant assessment of the other 35%. Please see related research articles http://www.biomedcentral.com/1741-7015/11/242, http://www.biomedcentral.com/1741-7015/11/243 and http://www.biomedcentral.com/1741-7015/11/244

Of course you don't mind being seen by the students

Contact with patients plays a fundamental role in the education of healthcare students. Despite advances in simulation using models or actors playing the role of patients, there is no adequate substitute for contact with real patients suffering from real illnesses. There is increasing interest in the role of the expert patient in curriculum development or direct student teaching.1 This approach is of particular benefit in chronic illness where it is possible to draw on the experiences of a population of patients with stable disease and often with a detailed understanding of their own condition. While this approach is valuable the majority of patient–student interactions will continue to be with patients who have not been selected or trained as instructors. In most cases this will be in the context of the on-going clinical care of the patient although some patients may agree to attend as subjects for planned teaching sessions

Theory in medical education — an oxymoron?

This chapter discusses recent experiences of change in medical schools of the United Kingdom, but the principles are applied more widely. Medical education aspires at being a scientifically based discipline; its purpose is to produce medical practitioners who are capable of practicing medicine safely and effectively. Most senior practitioners regard it as axiomatic because it includes thorough training in science. The Association for the Study of Medical Education was founded in the United Kingdom with the aim, among others, of carrying out research in medical education. There has been effervescence in the creation of chairs in medical education within the United Kingdom, and most medical schools have medical education units or departments. There are a number of national and international journals dedicated to this subject. If medical education is to be recognized as truly scientific, it must develop an agreed theoretical grounding. The current state of disorganized and diverse activity in the study of medical education corresponds to pre-science theory. If medical education is to become a truly scientific endeavour, it must become grounded in theory