Clinical Undergraduate Training Research Articles

John Lennard-Jones

John Edward Lennard-Jones was a pioneering gastroenterologist and an exceptional man in many ways. Known affectionately to his colleagues as “LJ,” he was a caring and astute physician, a gentle...

Construction of competency model of clinical medical undergraduates in Guangdong

Objective To construct the competency model of and common clinical medicine undergraduates according to the competency theory. Methods Literature search was used to screen competency model. Behavioral event interview was used to interview 32 excellent clinical experts. Open questionnaire survey was conducted to 100 clinical medical undergraduates. We compiled the primary competency dictionary based on the above results. To determine the final competency dictionary, Delphi method of 50 experts was used to determine the final competency dictionary. According to the competency dictionary, a questionnaire survey was made to test the and undergraduate students. Results The 38 features of behavioral event interview and 42 features of open questionnaire survey were combined to 51 features, which were used as the first round of expert questionnaire. Two rounds of expert consultation reached a high degree of coordination. 4 first level indicators: knowledge and skills, social role+values+service characteristics, self-concept and consciousness, personality quality and motivation and 36 features were established as final compentency model. 80 clinical medical undergraduates got score of 143.65±23.53, while 100 undergraduates got score of 133.55±35.31 (t=2.29, P=0.023), which indicated the competency model could distinguish excellent and ordinary clinical undergraduates. Conclusion This competency model of clinical undergraduate students is reliable and practical, which can be used in future clinical undergraduate training and evaluation. Key words: Clinical medical undergraduate students; Talent training; Competency model

Leadership in rural medicine: The organization on thin ice?

Objective. To explore the personal experiences of and conceptions regarding leading rural primary care in Northern Norway. Design. Qualitative content analysis of focus-group interviews. Setting. Lead primary care physicians in the three northernmost counties. Subjects. Four groups with 22 out of 88 municipal lead physicians in the region. Results. Three main categories were developed and bound together by an implicit theme. Demands and challenges included the wide leadership span of clinical services and public health, placed in a merged line/board position. Constraints of human resources and time and the ever changing organizational context added to the experience of strain. Personal qualifications indicates the lack of leadership motivation and training, which was partly compensated for by a leader role developed through clinical undergraduate training and then through the responsibilities and experiences of clinical work. In Exercising the leadership, the participants described a vision of a coaching and coordinating leadership and, in practice, a display of communication skills, decision-making ability, result focusing, and ad hoc solutions. Leadership was made easier by the features of the small, rural organization, such as overview, close contact with cooperating partners, and a supportive environment. There was incongruence between demands and described qualifications, and between desired and executed leadership, but nevertheless the organization was running. Leadership demonstrated a “working inadequacy”. Conclusion. Under resource constraints, leadership based on clinical skills favours management by exception which, in the long run, appears to make the leadership less effective. Leadership training which takes into account the prominent features of rural and decentralized primary care is strongly needed.

John Anthony Morgan

John Anthony Morgan (“Tony”) grew up around Cardigan Bay in South Wales before becoming a scholar at Epsom College in Surrey. His love of organ recital music took him to...

A modified electronic key feature examination for undergraduate medical students: validation threats and opportunities

The purpose of our study was the development and validation of a modified electronic key feature exam of clinical decision-making skills for undergraduate medical students. Therefore, the reliability of the test (15 items), the item difficulty level, the item-total correlations and correlations to other measures of knowledge (40 item MC-test and 580 items of German MC-National Licensing Exam, Part II) were calculated. Based on the guidelines provided by the Medical Council of Canada, a modified electronic key feature exam for internal medicine consisting of 15 key features (KFs) was developed for fifth year German medical students. Long menu (LM) and short menu (SM) question formats were used. Acceptance was assessed through a questionnaire. Thirty-seven students from four medical schools voluntarily participated in the study. The reliability of the key feature exam was 0.65 (Cronbach's alpha). The items’ difficulty level scores were between 0.3 and 0.8 and the item-total correlations between 0.0 and 0.4. Correlations between the results of the KF exam and the other measures of knowledge were intermediate (r between 0.44 and 0.47) as well as the learners’ level of acceptance. The modified electronic KF examination is a feasible and reliable evaluation tool that may be implemented for the assessment of clinical undergraduate training.

Clinical undergraduate training and assessment in primary health care: Experiences gained from Crete, Greece

BackgroundPrimary Health Care (PHC) is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on the assessment scale that was developed.Methods284 students' case write-ups from the 6 primary care units (PCUs) where they were allocated for the period 1990 to 1994 were analysed. The demographic data of the students and patients and the number of home visits were studied. Content analysis of the students' write-ups was carried out, using an assessment scale consisting of 10 dichotomous variables, in order to quantify eight (8) primary qualitative criteria.ResultsInternal reliability was estimated by the index KR20 = 0.67. Face and content validity was found to conform to the standards set for the course, while logistic linear regression analysis showed that the quality criteria could be used as an assessment scale.The number of home visits carried out varied between the various different PCUs (p < 0.001) and more were reported in the write-ups that fulfilled criteria related to the biopsychosocial approach (p < 0.05). Nine quantitative criteria were fulfilled in more than 90% of case reports, but laboratory investigations were reported only in 69.0% of case reports. Statistically significant differences between the PCUs were observed in the fulfilment of criteria related to the community approach, patient assessment and information related to the patient's perception of the illness, but not to those related to aspects of clinical patient management. Differences in reporting laboratory investigations (p < 0.001) are explained by the lack of such facilities in some PCUs. Demographic characteristics of the patients or the students' do not affect the criteria.ConclusionThe primary health care course achieved the objectives of introducing students to comprehensive, community oriented care, although there was variation between the PCUs. The assessment scale that was developed to analyse the case-write ups of the students provided data that can be used to evaluate the course.

Trends in Radiological Anatomy Teaching in the U.K. and Ireland

AIM: To determine the prevalence of radiological anatomy teaching in modern medical curricula. MATERIALS AND METHODS: The present paper details a survey carried out amongst 21 medical schools in the U.K. and Ireland to determine the variability of the inclusion of radiological anatomy in their different curricula. RESULTS: In all the institutions surveyed teaching of anatomy as revealed by radiological techniques was delivered by anatomy departments. There was considerable variation, however, in the way in which it was delivered, by whom and in the range of radiological material available. Most anatomy departments had links with radiology departments, though the precise arrangements of these also varied. CONCLUSION: This study highlights the need for standardization between anatomy departments with regard to the content and level of radiological anatomy taught to ensure that an appropriate basis for clinical undergraduate training is provided. Mitchell, B. S. and Williams, J. E. (2002). Clinical Radiology57, 1070–1072.

A short history of Westmead Centre Dental Clinical School.

Westmead Centre is a large teaching hospital of 925 acute treatment beds planned to provide a comprehensive range of general and specialist referral services to the rapidly expanding population of the western suburbs of Sydney. The hospital was conceived in 1968 and opened for patient treatment in 1978. The Dental Clinical School is an integral part of Westmead Centre. The School was planned to provide diagnostic, treatment, recovery, and support facilities. When fully commissioned, it will offer 230 dental chairs, a fully equipped Operating Suite, and extensive laboratory, teaching and research areas. The School is meant to provide clinical undergraduate training for dental students of the University of Sydney and facilities for graduate, postgraduate, and continuing education. At the same time it is to fulfil a general and specialist service role in the Western Metropolitan Health Region. The Dental Clinical School opened for patient treatment in 1980 and accepted its first intake of final year students in 1981. It is anticipated that in 1982 the School will be fully commissioned and making a significant contribution to the dental education and care of the people of New South Wales.