~~~
SPECIAL ARTICLE
An Evaluation of Medical Students’ Practical Experience Upon Qualification Med Teach Downloaded from informahealthcare.com by McMaster University on 10/30/14 For personal use only.
RICHARD WAKEFORD and SARAH ROBERTS Richard Wakeford, BA, is an educational psychologist in the Ofice of the Regius Professor of Physic, Cambridge University School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge CB2 2@ UK. Sarah Roberts, MA, is an applied statistician at the Department of Community Medicine at Addenbrooke’s Hospital. The acquisition of many practical skills-including competence to take initial responsibility for managing serious or life-threatening situations-is rarely assessed in formal medical qualifying examinations in the UK. This paper reports an investigation of two groups of graduands’ experiences of practical procedures and acute conditions. Similar patterns of experience were reported by students undertaking their clinical work in different medical schools, including the lack of opportunity to practise certain procedures. A large proportion felt incompetent to manage emergencies. The study demonstrates how a simple selfreporting technique can provide useful data and identify problems of continuity between two stages of medical education-the undergraduate period and the pre-registration year. It is now generally agreed that undergraduate medical education has two general aims:’ one is concerned with ‘education’ in its broadest sense, and the other with ‘vocational training’-initially for the duties of a preregistration house officer (HO). This is also true for health professionals other than doctors: in addition to possessing the required knowledge, attitudes and intellectual skills, the qualified professional needs to be competent at a wide variety of technical skills. The skills expected of a newly-appointed HO can be specified reasonably succinctly. He or she must be competent in history-taking and the physical examination, skilled in the writing of notes, and practised in the undertaking of certain practical procedures. He or she is also expected to be able to cope when confronted with emergency situations (for example, myocardial infarction). This paper is concerned with these acute conditions and practical procedures. In the United Kingdom, medical schools do not have 140
closely defined educational objectives, nor do they, in general, specify the practical procedures or acute conditions with‘which they expect their graduates to be familiar.’ Moreover, even within a medical school, student experience can be very variable. Qualifying examinations by their nature concentrate upon factual recall, physical examination, history-taking, interpretation of signs, diagnostic problem-solving, and therapeutics: rarely is a student’s competence to undertake practical procedures or emergency management observed. Although some medical schools have formal arrangements for assessing students’ competence in-course ,* many-including Cambridge-do not. It is therefore possible, even commonplace, for medical students to graduate without any careful check having been made upon these important aspects of their training.
A Self-Report A variety of constraints at Cambridge inhibit rapid or radical change to the system of assessment, yet there has been concern as to whether students on the clinical medical course-which is new and shorter than othersreceive sufficient experience of practical procedures and emergency situations to prepare them adequately for HO duties. In the absence of objective data, it was decided to ask students completing the course to report upon their experience and to estimate their own competence.’*‘ With the aid of medical colleagues, two lists were drawn up of practical procedures and acute conditions with which graduates might be expected to be familiar (Tables 1 and 2). Deliberately, these ranged from items with which all concerned believed every student ought to be familiar (for example, venepuncture) to those in which all students would certainly not be personally experienced (for example, liver biopsy). Deliberately also, to maximize co-operation in the study, the lists were kept short. Medical Teacher Vol 4 No 4 1982
Table 1. Reported experience of practical procedures by 1980 examination candidates and their perceptions of their own competence to undertake them. ~~~~
Students’ experience of procedures (per cent) Not seen
Med Teach Downloaded from informahealthcare.com by McMaster University on 10/30/14 For personal use only.
Bladder catheterization (female) Vaginal examination Per rectum examination Subcutaneous injection Intramuscular injection Venepuncture Setting up an IV drip Bone marrow aspiration Lumbar puncture Abdominal paracentesis Pleural fluid aspiration Microscopic examination of urine Biochemical examination of urine Liver biopsy Staining and examining of blood film Repair of episiotomy Estimation of ESR Wound suturing Local anaesthesia Endotracheal intubation Cardiac resuscitation Bladder catheterization (male)
Undertaken only once or twice
Undertaken 3 or more times
c
c
0
c
o
1
13
17
14
30
68
0 0 0 0 2 1 0 0 0 0 0 0 27 38 2 1 23 33 7 3 45 21
0 0 14 9 0 0 66 16 55 59 27
3 0 19 11 0 1 56 49 51 53 11
2
18 14
10 0 28 26 0 0 4 30 12 30 26
98 100 63 70 100 100 4 39 11 16 14
18
9
4
18
17
50
20 33 23 19
79 27
60 22
1 30
7 36
2 1 70 57 0 1 0 0 2 0 4 1 0 0
0 21 2 0 2 29 2
0 21 3 2 7 35 2
0 2 2 2 16 23 4
0 9 0 6 40 27 16
c o
Procedures
Seen but not undertaken
5
23
0 21 21 0 0 4 43 11
Per cent perceiving themselves competent
P*
c
o
o
P*
-
-
71
61
87 C0.05 100 52 63 100 99 1 19
SPECIAL ARTICLE
An Evaluation of Medical Students’ Practical Experience Upon Qualification Med Teach Downloaded from informahealthcare.com by McMaster University on 10/30/14 For personal use only.
RICHARD WAKEFORD and SARAH ROBERTS Richard Wakeford, BA, is an educational psychologist in the Ofice of the Regius Professor of Physic, Cambridge University School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge CB2 2@ UK. Sarah Roberts, MA, is an applied statistician at the Department of Community Medicine at Addenbrooke’s Hospital. The acquisition of many practical skills-including competence to take initial responsibility for managing serious or life-threatening situations-is rarely assessed in formal medical qualifying examinations in the UK. This paper reports an investigation of two groups of graduands’ experiences of practical procedures and acute conditions. Similar patterns of experience were reported by students undertaking their clinical work in different medical schools, including the lack of opportunity to practise certain procedures. A large proportion felt incompetent to manage emergencies. The study demonstrates how a simple selfreporting technique can provide useful data and identify problems of continuity between two stages of medical education-the undergraduate period and the pre-registration year. It is now generally agreed that undergraduate medical education has two general aims:’ one is concerned with ‘education’ in its broadest sense, and the other with ‘vocational training’-initially for the duties of a preregistration house officer (HO). This is also true for health professionals other than doctors: in addition to possessing the required knowledge, attitudes and intellectual skills, the qualified professional needs to be competent at a wide variety of technical skills. The skills expected of a newly-appointed HO can be specified reasonably succinctly. He or she must be competent in history-taking and the physical examination, skilled in the writing of notes, and practised in the undertaking of certain practical procedures. He or she is also expected to be able to cope when confronted with emergency situations (for example, myocardial infarction). This paper is concerned with these acute conditions and practical procedures. In the United Kingdom, medical schools do not have 140
closely defined educational objectives, nor do they, in general, specify the practical procedures or acute conditions with‘which they expect their graduates to be familiar.’ Moreover, even within a medical school, student experience can be very variable. Qualifying examinations by their nature concentrate upon factual recall, physical examination, history-taking, interpretation of signs, diagnostic problem-solving, and therapeutics: rarely is a student’s competence to undertake practical procedures or emergency management observed. Although some medical schools have formal arrangements for assessing students’ competence in-course ,* many-including Cambridge-do not. It is therefore possible, even commonplace, for medical students to graduate without any careful check having been made upon these important aspects of their training.
A Self-Report A variety of constraints at Cambridge inhibit rapid or radical change to the system of assessment, yet there has been concern as to whether students on the clinical medical course-which is new and shorter than othersreceive sufficient experience of practical procedures and emergency situations to prepare them adequately for HO duties. In the absence of objective data, it was decided to ask students completing the course to report upon their experience and to estimate their own competence.’*‘ With the aid of medical colleagues, two lists were drawn up of practical procedures and acute conditions with which graduates might be expected to be familiar (Tables 1 and 2). Deliberately, these ranged from items with which all concerned believed every student ought to be familiar (for example, venepuncture) to those in which all students would certainly not be personally experienced (for example, liver biopsy). Deliberately also, to maximize co-operation in the study, the lists were kept short. Medical Teacher Vol 4 No 4 1982
Table 1. Reported experience of practical procedures by 1980 examination candidates and their perceptions of their own competence to undertake them. ~~~~
Students’ experience of procedures (per cent) Not seen
Med Teach Downloaded from informahealthcare.com by McMaster University on 10/30/14 For personal use only.
Bladder catheterization (female) Vaginal examination Per rectum examination Subcutaneous injection Intramuscular injection Venepuncture Setting up an IV drip Bone marrow aspiration Lumbar puncture Abdominal paracentesis Pleural fluid aspiration Microscopic examination of urine Biochemical examination of urine Liver biopsy Staining and examining of blood film Repair of episiotomy Estimation of ESR Wound suturing Local anaesthesia Endotracheal intubation Cardiac resuscitation Bladder catheterization (male)
Undertaken only once or twice
Undertaken 3 or more times
c
c
0
c
o
1
13
17
14
30
68
0 0 0 0 2 1 0 0 0 0 0 0 27 38 2 1 23 33 7 3 45 21
0 0 14 9 0 0 66 16 55 59 27
3 0 19 11 0 1 56 49 51 53 11
2
18 14
10 0 28 26 0 0 4 30 12 30 26
98 100 63 70 100 100 4 39 11 16 14
18
9
4
18
17
50
20 33 23 19
79 27
60 22
1 30
7 36
2 1 70 57 0 1 0 0 2 0 4 1 0 0
0 21 2 0 2 29 2
0 21 3 2 7 35 2
0 2 2 2 16 23 4
0 9 0 6 40 27 16
c o
Procedures
Seen but not undertaken
5
23
0 21 21 0 0 4 43 11
Per cent perceiving themselves competent
P*
c
o
o
P*
-
-
71
61
87 C0.05 100 52 63 100 99 1 19
