Patient attitudes towards medical students at Damascus University teaching hospitals

Background: The cooperation of patients and their consent to involve medical students in their care is vital to clinical education, but large numbers of students and lack of experience as well as loss of privacy may evoke negative attitudes of patients, which may sometimes adversely affect the clinical teaching environment. This study aimed to explore the attitudes of patients towards medical students at Damascus University hospitals, and to explore the determinants of those attitudes thus discussing possible implications applicable to clinical teaching. Methods: This cross-sectional study was conducted at three teaching hospitals affiliated to the Faculty of Medicine at Damascus University. Four hundred patients were interviewed between March and April 2011 by a trained sociologist using a structured questionnaire. Results: Of the patients interviewed, 67.8 % approved the presence of medical students during the medical consultation and 58.2 % of them felt comfortable with the presence of students, especially among patients with better socio-economic characteristics. 81.5 % of the patients agreed to be examined by students in the presence of the supervisor, while 40.2 % gave agreement even in the absence of the supervisor. Privacy was the most important factor in the patients ’ reticence towards examination by the students, whilst the relative safety and comfort if a supervisor was available determined patients ’ agreement

Factors confounding the assessment of reflection: a critical review

BACKGROUND: Reflection on experience is an increasingly critical part of professional development and lifelong learning. There is, however, continuing uncertainty about how best to put principle into practice, particularly as regards assessment. This article explores those uncertainties in order to find practical ways of assessing reflection. DISCUSSION: We critically review four problems: 1. Inconsistent definitions of reflection; 2. Lack of standards to determine (in)adequate reflection; 3. Factors that complicate assessment; 4. Internal and external contextual factors affecting the assessment of reflection. SUMMARY: To address the problem of inconsistency, we identified processes that were common to a number of widely quoted theories and synthesised a model, which yielded six indicators that could be used in assessment instruments. We arrived at the conclusion that, until further progress has been made in defining standards, assessment must depend on developing and communicating local consensus between stakeholders (students, practitioners, teachers, supervisors, curriculum developers) about what is expected in exercises and formal tests. Major factors that complicate assessment are the subjective nature of reflection's content and the dependency on descriptions by persons being assessed about their reflection process, without any objective means of verification. To counter these validity threats, we suggest that assessment should focus on generic process skills rather than the subjective content of reflection and where possible to consider objective information about the triggering situation to verify described reflections. Finally, internal and external contextual factors such as motivation, instruction, character of assessment (formative or summative) and the ability of individual learning environments to stimulate reflection should be considered

Competency Assessment

Assessment is an essential feature of the competency-based educational model because only by means of evaluation can we verify achievement of specified learning outcomes. This is especially important in the context of health professions education, where the competencies of interest impact the well-being of patients. Therefore, just as with planning the instructional component of a curriculum, development of an assessment system must start with the specification of desired learning outcomes in the form of knowledge, skills, and attitudes expected of trainees or practitioners in order to provide safe and effective patient care. Issues to consider when judging the quality of evaluation methods include the reliability of data generated by the assessment, validity of decisions based on test results, educational impact on individuals undergoing evaluation and other stakeholders, and the feasibility of implementing the assessment system. In addition to these criteria and the particular competencies to be evaluated, the choice of testing methods from among numerous available techniques should consider multiple dimensions, such as appropriate level of assessment, stage of learner development, and, very importantly, overall purpose and context of the assessment. Ultimately, no one method can assess all aspects of professional competence, but familiarity with strengths and limitations of various modalities can guide the development of appropriate assessment systems. Strengths of simulation-based methods for evaluative purposes include the ability to assess actual performance of psychomotor skills and demonstration of nontechnical professional competencies in environments that safely and authentically mirror real practice settings. In addition, the programmability of simulations permits on-demand testing of rare but important clinical situations and consistent presentation of evaluation problems to multiple examinees; this reproducibility becomes especially important when high-stakes decisions are contingent upon such assessments