Early practical experience and the social responsiveness of clinical education: Systematic review

Objectives To find how early experience in clinical and community settings (early experience) affects medical education, and identify strengths and limitations of the available evidence. Design A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. Data sources Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. Selection of studies All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. Results Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries,junior students provided preventive health care directly to underserved populations. Conclusion Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.

Assessing professionalism: theory and practice

Professional attitudes and behaviours have only recently been explicitly recognized by medical educators as legitimate and necessary components of global competence, although the idea of Fitness to Practice has always presupposed acceptable professional behaviour. Medical schools have recently begun to introduce teaching and assessment of professionalism, including attitudes and behaviours. Partly as a result of the difficulty of assessment in this area, selection of students is receiving greater attention, in the pursuit of globally competent graduates. However, selection processes may be overrated for this purpose. Assessing actual attitudes and behaviour during the course is arguably a better way of ensuring that medical graduates are competent in these areas. I argue that judgments about attitudinal and behavioural competence are legitimate, and need be no more arbitrary than those made about scientific or clinical knowledge and skills, but also that these judgments should be restricted to what is agreed to be unacceptable behaviour, rather titan attempting to rate attitudes and behaviour positively. This model introduces students to the way in which their behaviours will be judged in their professional lives by registration authorities. These theoretical positions are illustrated by a recent case of academic failure based on inadequate attitudes and behaviours.

Sharing Narratives Online: An international, self-organising curriculum in rural health

The aim of the Rural Medicine Rotation (RMR) at the University of Queensland (UQ) is to give all third year medical students exposure to and an understanding of, clinical practice in Australian rural or remote locations. A difficulty in achieving this is the relatively short period of student clinical placements, in only one or two rural or remote locations. A web-based Clinical Discussion Board (CDB) has been introduced to address this problem by allowing students at various rural sites to discuss their rural experiences and clinical issues with each other. The rationale is to encourage an understanding of the breadth and depth of rural medicine through peer-based learning. Students are required to submit a minimum of four contributions over the course of their six week rural placement. Analysis of student usage patterns shows that the majority of students exceeded the minimum submission criteria indicating motivation rather than compulsion to contribute to the CDB. There is clear evidence that contributing or responding to the CDB develops studentâ??s critical thinking skills by giving and receiving assistance from peers, challenging attitudes and beliefs and stimulating reflective thought. This is particularly evident in regard to issues involving ethics or clinical uncertainty, subject areas that are not in the medical undergraduate curriculum, yet are integral to real-world medical practice. The CDB has proved to be a successful way to understand the concerns and interests of third year medical students immersed in their RMR and also in demonstrating how technology can help address the challenge of supporting students across large geographical areas. We have recently broadened this approach by including students from the Rural Program at The Ohio State University College of Medicine. This important international exchange of ideas and approaches to learning is expected to broaden clinical training content and improve understanding of rural issues.

Stress in veterinary science students: A study at the University of Queensland

This paper reports on the results of a survey of selected University of Queensland (UQ) veterinary students aimed at elucidating factors causing stress during the five undergraduate years of the program. Students from each of the five years were asked to form six- or seven-member focus groups. Each focus group was then interviewed and their opinions sought on causes of ongoing stress and the ranking of those causes into predetermined categories. They were also asked to give their opinions on counseling services available within the university and what, if any, services they would like to see in place to help students with stress-related problems. Students in the first, third, and fourth years of the program rated academic issues as the most likely causes of ongoing stress, while students in the second and fifth years of the program ranked lifestyle and financial issues as more likely to cause ongoing stress. in most cases, students coped well with these causes of stress and tended not to use counseling services available to all UQ students. When faced with stressful issues, students looked to their classmates or family members for help and not to university counseling services. Students were also happy to approach staff members in the Veterinary School when faced with a problem. The authors nevertheless conclude that mechanisms set in place at the undergraduate level to help veterinary students cope with stress should particularly benefit those students when they become new graduates and are faced with the stresses of veterinary practice.