Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules

BACKGROUND: Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL) sessions. METHODS: This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year) students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10) assessing i) Knowledge Base-content Learning (KBL), ii) PBL, iii) Student Centered Learning (SCL) and iv) Group Skills (GS). RESULTS: There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in KBL (faculty 8.37 Vs resident 7.94; p-value 0.02), GS (faculty 8.06 vs. residents 7.68; p-value 0.04). Differences in faculty and resident scores in the PBL and SCL were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05). CONCLUSION: 1) Residents are an effective supplement to faculty members for PBL; 2) Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshop

Medical students' and facilitators' experiences of an Early Professional Contact course: Active and motivated students, strained facilitators

Background: Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.\ud \ud In 2001, a new "Early Professional Contact" longitudinal strand through term 1–4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.\ud \ud The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions.\ud \ud Methods: Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used.\ud \ud Results: Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining [inspiration] for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students.\ud \ud Conclusion: In this project, a new Early Professional Contact course was analysed from both student and facilitator perspectives. The students experienced the course as providing them with a valuable introduction to the physician's professional role in clinical practice. In contrast, course facilitators often experienced a heavy workload and lack of support, despite thorough preparatory education. A possible conflict between the clinical facilitator's task as educator and member of the workplace is suggested. More research is needed on how doctors combine their professional tasks with work as facilitators

Medical students' learning of the consultation and the patient-doctor relationship

Background: In medical education, learning about the consultation and the patient-doctor relationship is nowadays highly recommended. However, research from educational practice from students’ perspective is needed to facilitate a better understanding of students’ learning. The thesis is based on four studies. Aims: The overall aims were to study and analyse medical students’ learning of the consultation and patient-doctor relationship. Specific aims were to analyse students’ descriptive evaluations of a Consultation skills course and course development over five years (I), to explore final-year students’ abilities to communicate with patients (II), to analyse final-year students’ written reflective accounts of a memorable consultation (III), to assess students’ patient-centred attitudes at various stages of undergraduate medical education and to explore the association between patient-centred attitudes and gender, age and work experience in health care (IV). Method: A qualitative content analysis method was used in studies I-III, covering term 5 and term 10 (T5, T10). T5 students’ descriptive evaluations and teachers’ documentation were analysed 1995-1999. Experienced supervisors assessed T10 students’ communication abilities in video consultations with patients and supervisors’ focus group meetings were analysed. T10 students’ written reflective accounts of a memorable consultation were analysed. A cross-sectional study of students’ patient-centred attitudes was performed across the curriculum by an internationally validated instrument (Patient-Practitioner Orientation Scale, PPOS). Students’ gender, age and earlier work experience in health care were also collected and analysed statistically. Results: Learning of the consultation was facilitated when the T5 student was active in practice and could have a choice, by a link between explicit learning goals, learning activities and an examination in practice including feedback. Students’ descriptions of awareness and confidence corresponded to a strengthened relation with the facilitator and reflection. In exploring T10 students’ video consultations, an instrumental strategy was suggested as a stage in students’ consultation training. However, analysis of T10 students’ written reflective accounts of a memorable consultation displayed a view of the patient as a person beyond symptoms, an insight into the complexity of medical work and students’ search for a professional role. In contrast to previous reports, no decline of students’ patient-centred attitudes at the end of education was found. Independent of age or work experience in health care, female students had higher PPOS scores compared to men. Female students also had significantly more work experience in health care. Conclusions: Students’ learning of the skills and attitudes needed for the consultation and the patient-doctor relationship is complex. Senior students display patient-centeredness in writing but might have difficulties in integrating their know-how with the performance of physician’s clinical tasks. Learning the consultation and the patient –doctor relationship is suggested to benefit from integrating a patient-centred perspective in a student-centred learning relationship through clinical education; and by adopting a process-oriented and experience-based model including feedback and reflection