Student exposure to cancer patients: an analysis of clinical logbooks and focus groups in clinical year medical students

Despite cancer being the leading cause of mortality, cancer education and patient exposure are lacking in many medical schools. The aim of this study was to evaluate the nature of cancer patient exposure, relative to the clinical setting for medical students on placement and to explore their experiences. Participants were asked to maintain a logbook of cancer patient encounters and were invited to attend a structured focus group upon completion of the academic year. Eleven students submitted logbooks (rr = 6.15%) and eight participated in the focus groups (4.47%). A total of 247 cancer patient encounters were recorded. Third-year students primarily saw cancer patients in surgery (18.62%) and general practice (8.50%), whilst final year students saw cancer patients most frequently in palliative care (35.22%) and ENT surgery (13.77%). Students highlighted that the quality of their interactions with cancer patients varied significantly between clinical settings. Outpatient clinics and surgical in-patients had the lowest level of interaction, with students having a predominantly observatory role. Repeated themes of uncertainty and awkwardness regarding history, examination and discussing death and dying were outcomes of the thematic analysis. Exposure to cancer patients remains highly variable and opportunistic. Students voiced concerns for preparedness to practice and many found it worrisome that they will likely examine a primary cancer when they have graduated, without having done so during their training. Our study suggests that a more structured approach to teaching and clinical exposure to cancer patients is required

Standard setting in Australian medical schools

Background: Standard setting of assessment is critical in quality assurance of medical programs. The aims of this study were to identify and compare the impact of methods used to establish the passing standard by the 13 medical schools who participated in the 2014 Australian Medical Schools Assessment Collaboration (AMSAC). Methods: A survey was conducted to identify the standard setting procedures used by participating schools. Schools standard setting data was collated for the 49 multiple choice items used for benchmarking by AMSAC in 2014. Analyses were conducted for nine schools by their method of standard setting and key characteristics of 28 panel members from four schools. Results: Substantial differences were identified between AMSAC schools that participated in the study, in both the standard setting methods and how particular techniques were implemented. The correlation between the item standard settings data by school ranged from − 0.116 to 0.632. A trend was identified for panel members to underestimate the difficulty level of hard items and overestimate the difficulty level of easy items for all methods. The median derived cut-score standard across schools was 55% for the 49 benchmarking questions. Although, no significant differences were found according to panel member standard setting experience or clinicians versus scientists, panel members with a high curriculum engagement generally had significantly lower expectations of borderline candidates (p = 0.044). Conclusion: This study used a robust assessment framework to demonstrate that several standard setting techniques are used by Australian medical schools, which in some cases use different techniques for different stages of their program. The implementation of the most common method, the Modified Angoff standard setting approach was found to vary markedly. The method of standard setting used had an impact on the distribution of expected minimally competent student performance by item and overall, with the passing standard varying by up to 10%. This difference can be attributed to the method of standard setting because the ASMSAC items have been shown over time to have consistent performance levels reflecting similar cohort ability. There is a need for more consistency in the method of standard setting used by medical schools in Australia

Cancer Education Framework for Australian Medical Schools

The incidence, mortality, survival, and impact of cancer on the Australian health system and community highlight the need for Australian medical schools to adequately prepare medical student to care for patients with cancer. Several studies have shown that Australian medical students are ill-prepared to care for cancer patients upon graduation. At a national level, oncology and palliative care curricula have been developed. However, it is unclear as to the level of uptake of either curricula within Australian medical schools. There remains a lack of consensus on what content to include in a cancer curriculum and how best to deliver such a curriculum. This thesis presents a multiphase mixed methods approach in the development of a cancer education framework for Australian medical schools, utilising a participatory curriculum design model. A review of nationally produced cancer curriculum, was undertaken by local caner clinicians via survey and panel sessions to establish the key knowledge required by Australian medical students upon graduation. This data and a review of the international literature on cancer education relevant for medical students shaped the development of an overarching framework which was designed to facilitate the implementation of cancer education within existing medical school curricula. The framework comprises three sections: one focusing on clinical exposure to cancer patients whilst the other two focus on the principles of cancer management and cancer-specific knowledge that underpin current cancer and palliative care management. The framework was reviewed and endorsed by national and international participants as being well organised, appropriate for medical students to obtain prior to graduation and relevant to their practice as interns and junior doctors. The framework was viewed as being adaptable to existing medical curricula. Implications of the research findings and recommendations for implementation and further research are provided

Using structured clinical instruction modules (SCIM) in teaching palliative care to undergraduate medical students

Background. Student evaluation of the palliative care attachment at The University of Western Australia highlighted certain shortcomings. Methods. A 2-hour Structured Clinical Instruction Module (SCIM) workshop was designed and implemented to address these issues. Results. Preworkshop and postworkshop questionnaires showed a marked increase in self-rated competence and suggested this improvement was directly attributable to the workshop. A follow-up survey of a small number of students demonstrated this increase was sustained over time. Conclusions. SCIMs appear to be an effective instructional format in the small group setting. We covered a broad range of topics in a cost-effective manner and with minimal tutors and resources

A cancer education framework for Australian medical schools: An announcement of a new educational program

This framework draws upon national and international cancer curricula to identify the essential cancer-related learning outcomes for Australian medical students. The framework incorporates feedback from medical, radiation and surgical oncologists, haematologists, and palliative care physicians on what medical graduates need to know about cancer. The consensus view was that medical students require a basic understanding of the principles of cancer management and the opportunity to see cancer patients in a cancer service unit. The framework assumes that certain knowledge, skills, and attitudes are already embedded in current Australian medical school curricula, presenting instead only the core cancer content in order to provide a clear and concise framework designed to maximise integration within existing curricula

Using expert panels to determine the level of cancer knowledge required of junior doctors in Australia. Part 1: Methodology and results

A number of curricula have been developed to address shortfalls in cancer education. However, no standardised means of assessing medical graduates against such curricula currently exist. This paper describes the use of expert panels to determine the level of cancer-related knowledge required by junior doctors. Participants individually reviewed knowledge items from the Ideal Oncology Curriculum for Medical Students and rated the level of understanding and specificity of each. On completion, panel sessions were convened to reach consensus. Fifty-two (17 %) items were considered irrelevant for junior doctors, whilst 164 items (54 %) and 85 items (28 %) were deemed appropriate at a moderate and high level of understanding, respectively. As a result, 249 (83 %) of the 301 items were deemed appropriate for junior doctors. Expert panels provide an important insight into the requirements of junior doctors, reduce ambiguity and facilitate discussion, resulting in higher quality data than that produced solely through individual reviews

Advances in cancer management: At what cost to medical student education?

Background. Several studies have demonstrated concern over medical student exposure to cancer patients. Aim. To examine this concern and explore possible explanations. Methods. Surveys of Australian and New Zealand interns in 1990 and 2001 were compared to surveys of University of Western Australia graduates from 2002–2006. Results. Significant decreases in the number of interns who had examined cancer patients from 1990 to 2006 were evident, despite spending more time in oncology clinics. Discussion. Advances in patient management has resulted in a shift to ambulatory care reducing patient accessibility. Medical schools must identify means to provide students with adequate patent exposure