THE WAY WE TEACH...
Behavioural Sciences
Med Teach Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 11/24/14 For personal use only.
B. E. CHALMERS B. E. Chalmers, BA, MA, PH.D,is Senior Lecturer, School of Psychology, University of the Witwatersrand, Jan Smuts Avenue, Johannesburg 2001, South Afica.
This paper describes a new approach to teaching human behavioural science to medical students. Designed to overcome the problems of large student numbers, limited staff resources and a minimum of student-staff contact time, the course follows a grouporientated teaching approach, with students being allocated self-contained work units taking approximately one week to complete and be assessed. Standards achieved by students are as high, and in some cases much higher, than would have been expected following a traditional lecture course. Student feedback has generally been favourable. The traditional approach to teaching social science to medical students at the University of the Witwatersrand has been to use lectures. This has resulted in poor student attendance at classes. In addition, and of greater consequence, some of these courses have earned the reputation of being ‘soft’ and ‘of no real value’. This situation, coupled with a recent re-examination of the teaching goals of the medical school, provided the impetus for redesigning the third-year course in ‘Psychology applied to medicine’. Further stimulus for change was provided by the adoption of a learner-centred, group-orientated course in physiology in the same medical school. This paper describes the student-directed programme in human behavioural science which was introduced to replace the traditional psychology lecture course offered in the third year of study.
Context of the Course During the six-year MB, B.CH curriculum, a total of 32 contact hours in psychology have traditionally been provided for students in the first and third years of study. While assessment of students in their third-year psychology course has sometimes been enforced to encourage student attendance at lectures, marks obtained have not contributed to students’ progress through medical school. The third-year class consists of approximately 200 students with an average age of 21 years. Before entering the third year they have experienced a highly structured, 56
teacher-centred educational system, with lectures, formal laboratory sessions, regular tests and year-end examinations. The third-year teaching techniques present a rnixture of such traditional teaching methods and modern approaches designed along group-orientated, studentcentred lines.
Changes Introduced In 1979 a course entitled ‘Human behavioural science’ (HBS) was instituted in the third year to replace the original psychology course. HBS was divided equally into sociology and psychology, with each section continuing for 10 weeks and being allocated a total of 30 teaching hours. This paper describes the innovations made in the psychology component of the HBS programme during 1979 and 1980. The sociology component, developed and conducted independently of the School of Psychology by the Department of Sociology, retained the lecturing model of instruction combined with prescribed readings and discussions. Table 1. Major goals of the psychology course. 1. To familiarize students with areas of psychology particularly relevant to medicine 2. To familiarize students with sources of psychological information concerning medical topics 3. To improve the status, or more specifically, the lack of status, attributed to psychology by medical students 4. To influence student attitudes to medicine so as to incorporate an awareness of the role of psychological factors in health 5. To encourage students to work together in groups which are mutually dependent. It was hoped that reliance on other group members to the students’ own benefit would provide some insight into the team role frequently required of the qualified doctor 6. To examine the effects of a group-orientated, studentdirected method of teaching, rather than the traditional didactic model.
Medical Teacher Vol 4 No 2 1982
The major goals of the psychology component of the new HBS programme are shown in Table 1.
Med Teach Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 11/24/14 For personal use only.
Teaching Methodr With the exception of the first lecture, which outlined the structure of the HBS course, no formal lectures were given. Instead, a group discussion method of teaching was used. Students were required to meet once a week for a minimum of one hour, in groups of seven to 10 students each. The same groups used in other MB, B.CH courses were maintained for the psychology component of the HBS course. Each week one student in each group was required to present to his group a three-page essay on a set topic. Following the group discussion of this essay the same student was required to prepare a two-page summary of the group discussion of his paper and to submit both essay and group discussion summary for assessment. Assessment
Marks were assigned equally to the paper and to the group discussion summary. Marks obtained by students for this course were included in their overall third-year grade assessments. It was emphasized that failure of the HBS course could mean failure of the third-year MB, B.CH. However, students were informed that it was not considered desirable to fail them in their third year of medicine on the basis of the HBS course. Consequently, students who failed the HBS course work were allowed to rewrite their assignments. Students still not attaining acceptable standards following this procedure have been allowed to write supplementary examinations. Control of the Course It was believed that a relatively structured approach to this aspect of the course was necessary to help overcome the obstacles facing the HBS programme, i.e. the past reputation of psychology courses, the fact that the course was given by a department outside the medical school (both outside the medical faculty and physically off the medical school campus), and the fact that the course was conducted by a staff member whom medical students considered to have low status. A further aspect of the course which was closely controlled was the topics that the students were required to present to their groups. Nine topics were specified for student examination (Table 2). Students in each group were allowed to decide who would present each topic, but topics had to be discussed on the days specified so as to ensure a continuity of subject development and to minimize possible ‘swopping’ and plagiarism of essays. An additional control was instituted by requiring all members of a group to sign each assignment submitted by a member of their group. This control served two purposes; first it went some way to ensuring student attendance at group meetings, and second, it emphasized, as did the group discussion summary, the interdependence of members of a group. As implied in the ‘Statement of goals’ adopted by the medical school‘ such group interaction Medical Teacher Vol 4 No 2 1982
Table 2. Topics selected for group presentation in the psychology course in 1979. Topic
Aspects covered
1. Psychosomatic medicine
The holistic approach as well as traditional psychosomatic disease categories Aetiology and treatment with reference to Simonton’s work’ Based on the writings of Dohrenwend and Dohrenwend’ Normal and abnormal pregnancy as well as cultural influences on the management of pregnancy Concentrating on the writings of Janis‘ as well as on childhood hospitalization Based on the Davis and Harobin book of that title’ describing patients’ experiences in relation 10 medicine The Kuhler-Ross6 outline of the psychology of dying Incorporating neurological, endocrine and immune system mechanisms Attempting to integrate the papers presented for topics 1 to 8
2. Cancer as a psychosomatic disease
3. Life event stresses: their role in somatic illness
4. Psychological aspects of PwnancY 5. Hospitalization and surgery: effects on patients
6. Medical encounters
7. Death and dying: the psychological issues 8. The mechanisms linking psychological events to pathophysiological effects 9. An holistic approach to medicine
and interdependence is a desirable quality to introduce in undergraduate medical courses. Reading Material References were supplied for student use on an overnight lending basis, and multiple copies of 25 journal articles, including some review articles, and 23 books were provided. References were made available because students have an extremely heavy load in their third year, and it was unrealistic to expect them to conduct extensive literature searches. This did not preclude students from reading and referring to other articles, but simply provided a starting point and guide for additional reading. In addition to the general reference list of books and articles, two books were specified as highly recommended: Lipowski, Lipsett and Whybrow’s Psychosomatic medicine’ and Cox’s Stress.’ With few exceptions, the topics selected and their order of discussion proved to be satisfactory. Papers dealing with cancer, pregnancy, hospitalization and surgery and medical encounters were most successfully received. While theoretical papers, such as those on psychosomatic illness, holistic medicine and stress were needed at the start and the end of the course, some confusion arose in 1979 due to overlap between subjects. Paper 8 (Table 2) 57
Table 3. ‘Topics selected for group presentation in the psychology course in 1980. Adult medicine (general)
Adult medicine (male)
Med Teach Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 11/24/14 For personal use only.
Adult medicine (female)
1. Cancer as a psychosomatic illness with special reference to
Simonton’s work’ 2. Psychosomatic medicine: an holistic approach 3. Stress: in general and with reference to the health of executives’ 4. Life event stress with reference to the writings of Dohrenwend and Dohrenwend’ 5. Women and medicine with reference to the writings of Leason and Gray’ 6. Pregnancy and childbirth:
psychological and cultural aspects of normal and abnormal Adolescent medicine
Childhood medicine General medicine
pregnancies 7. The importance of physical appearance and the effects of medical encroachments on
appearance 8. Effects of hospitalization, surgery and handicaps with reference to the work of Janis‘ 9. Medical encounters: based on the Davis and Harobin book of that title’ describing patients’ experiences in relation to medicine 10. The mechanisms
(neurological, endocrine and immune) linking psychological events to pathophysiological effects
on the weakest groups. Papers were marked with detailed comments and returned to students within a week of submission. This provided a means of monitoring groups’ progress and enabled students in the groups to ascertain the standards required of them. In addition, most students who failed on first submission of their work were able to re-do essays during the time allocated to the course. Evaluation of the Course In general, student feedback has been favourable. Students were asked in both 1979 and 1980 to complete questionnaires concerning the course. In 1979, 57 per cent and in 1980, 58 per cent of students agreed that the course had achieved its goals and had resulted in an increased awareness of the patient as a whole person. In addition, when asked in 1980, 58 per cent of students stated that they believed the course would affect their future effectiveness as doctors. In response to questions asked in 1980, satisfaction was expressed by 65 per cent concerning the teaching method adopted, and 83 per cent agreed that the course should have a place in medical training. Compared to the poor student responses to previous courses in psychology for medical students (attendance rate approximately 10 per cent), the increased proportion of students expressing satisfaction with the course was gratifying. Certainly, grades attained by students reflect not only an attempt on the part of the students to ‘pass’ the course but a desire to do well. By comparison, student reactions to the more traditionally orientated sociology component of the HBS course in 1979 were less favourable. Consequently, in 1980 the sociology component of the HBS course followed the same teaching approach as that adopted by psychology, resulting in favourable student responses. Lessons
covering the mechanisms linking psychological events to physiological pathology proved to be an essential component of the course: the provision of evidence supporting a link between psychology and pathology, based on neurological, endocrine and immune system functioning, served to overcome resistance from students who opposed the possible influence of psychological factors in health. While some of the 1979 topics were included in the 1980 course, some changes were made (Table 3). The framework adopted in the 1980 course proved to be an improvement on the 1979 approach as there was less overlap of topics. Running the Course Due to staff shortages in 1979 and 1980, the course was organized and implemented by one lecturer. Attempts to obtain the help of sufficient tutors, whether students or professionals, in running the groups proved unsuccessful. Consequently, as each of the 24 groups met simultaneously, it was not possible for the lecturer to be present at all student discussions. Instead, attention was focussed 58
Medical school courses in the behavioural sciences are frequently staff intensive: l o the course outlined here is suitable for those situations where there are few staff, large student numbers and minimum staff exposure time. The lecturer can ensure that sufficient information is covered by students, and at the same time facilitate stimulating student-orientated learning. A fear expressed during the planning stages of the course, that students would not achieve satisfactory academic standards if left to their own resources, has proved to be largely unfounded. Standards achieved were high, and in some cases much higher than would have been expected following a traditional lecture course. However, it appears that for such standards to be attained assistance in the form of statements of student expectations, available and adequate references, close monitoring of student progress and detailed feedback to students must be provided. The teaching method described resembles, in some respects, the Keller plan. ’’ In both approaches students are allocated self-contained work units taking approxiMedical Teacher Vol 4 No 2 1982
Med Teach Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 11/24/14 For personal use only.
mately one week to complete and be examined. Basic reading material is assigned and students can work individually. As with the Keller plan, our teaching method requires much staff effort and sometimes draws criticism from colleagues. However, a major difference between the two approaches is that with the Keller plan students work at their own pace and cover the entire syllabus themselves, whereas with our approach they do not. Students taking the psychology component of the HBS course have to conform to a weekly timetable and cover only one topic each. Our approach places far more emphasis than the Keller plan on student discussion and interchange. Our course could be improved by having more staff available to guide group discussions, which would also lighten the heavy load placed on a single lecturer. It is our intention to explore this avenue further in future years.
Annual Conference of AMEE The annual conference of the Association for Medical Education in Europe is being held in Cambridge from 20 to 23 September 1982. The event is cosponsored by the Association for the Study of Medical Education, the Cambridge University School of Clinical Medicine and the World Health Organization. The theme of this year's meeting is 'Motivation for Learning'. This conference, which is being held mainly at Churchill College, is to be preceded by a two-day Conference of Deans of European Medical. Schools (AMDE). Associated with the Conference will be a commercial exhibition (drug firms, teaching materials, etc.) and an exhibition of members' activities (teaching models, interactive computer systems, etc). Additional information may be obtained from the conference secretary, Professor R . M. Harden, ASME, 150b Perth Road, Dundee DD1 4EA, Scotland, UK. Reservations must be made by 30 June 1982.
Acknowledgment
I thank Professor C . Beaton, until recently Head, Division of Continuing Medical Education, University of the Witwatersrand, Johannesburg, South Africa, for help in writing this paper. References 'Beaton I;. Mitchell D . The way we teach physiology. Mcd Teach 1979; 1: 71-75
'Simonton CD, Simonton S. Belief systems and the management of the emotional aspects of malignancy. J Transpersonal Psyclhol 1975; 7 : 29-47. 'Dohrenwend BS, Dohrenwend BP. Shessjid lye rucnts: their nature and c&ts. New York: Wiley, 1974. 'Janis IL Psychological strcss. New York: Academic Press, 1958. 'Davis A, Harobin G . Medical encounters: the cxpctitnce of illness and trhahnnl. London: Croom Helm, 1977. 6Kiibler-KossE. On &ath and dying. New York: Macmillan, 1969. 'Lipowskl ZJ, Lipsett DP, Whybrow PC. Psyclrosodic medicine. New York: Oxford University Press, 1977. 'Cox T. .Stmss. London: The Macmillan Press, 1978. 'Leason J . Gray J. Women and medicine. London: Tavistock Publications, 1978. 10Brownstein EJ, Singer P, Dornbush RL, Freedman AM. New concepts in the teaching of behavioural science in the preclinicd curriculum.J Med Educ 1979; 54: 423-425. "Stoward PJ. Self instruction through reading: the Keller plan. Med E d u 1976; 10: 316-326.
Audiovisual Aids for Health Manpower Training The International Green Cross in collaboration with
WHO is producing a series of 24 colour posters for use in the education and training of health workers, especially auxiliaries in developing countries. The first six posters, dealing with the stomach, lungs, liver, eye, ear and teeth, were dispatched at the end of 1980 to the W H O Regional Offces to be distributed to training institutions in each region. The next set of posters will be available shortly. Further information can be obtained from the Regional Offices of WHO. Medical Teacher Vol4 No 2 1982
Cuts in University Funding in UK
Dental Teaching Hospitals The Teachers Committee of the British Dental Association has again drawn attention to the problems that will be caused by the cuts to university funding. They maintain that serious consequences will include:
,
a) An inevitable cut in the special treatment services concentrated in dental teaching hospitals. Achieving the cuts within the time scale demanded will lead to a very uneven distribution of such services, they say. b) Reduction in the number of dental teachers will have serious consequences for the training of dentists, where a close personal teacherlstudent relationship is essential. c) Fewer dental teachers means that there will be an additional work overload on NHS staff remaining in dental teaching hospitals. Only 12 months ago the Nuffield Foundation Committee of Inquiry into dental education, amongst its 35 principal recommendations, made two which would mean a substantial increase in staff establishment. The first maintained that full-time staff should be relieved of the burdens of excessive teaching in order to devote at least one-third of their time to research. The second called on universities to be responsible not only for undergradslate education, but also for the preregistration year, vocational training for general practice, a major part of postgraduate and continuing education, and the education of auxiliaries. 59
Behavioural Sciences
Med Teach Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 11/24/14 For personal use only.
B. E. CHALMERS B. E. Chalmers, BA, MA, PH.D,is Senior Lecturer, School of Psychology, University of the Witwatersrand, Jan Smuts Avenue, Johannesburg 2001, South Afica.
This paper describes a new approach to teaching human behavioural science to medical students. Designed to overcome the problems of large student numbers, limited staff resources and a minimum of student-staff contact time, the course follows a grouporientated teaching approach, with students being allocated self-contained work units taking approximately one week to complete and be assessed. Standards achieved by students are as high, and in some cases much higher, than would have been expected following a traditional lecture course. Student feedback has generally been favourable. The traditional approach to teaching social science to medical students at the University of the Witwatersrand has been to use lectures. This has resulted in poor student attendance at classes. In addition, and of greater consequence, some of these courses have earned the reputation of being ‘soft’ and ‘of no real value’. This situation, coupled with a recent re-examination of the teaching goals of the medical school, provided the impetus for redesigning the third-year course in ‘Psychology applied to medicine’. Further stimulus for change was provided by the adoption of a learner-centred, group-orientated course in physiology in the same medical school. This paper describes the student-directed programme in human behavioural science which was introduced to replace the traditional psychology lecture course offered in the third year of study.
Context of the Course During the six-year MB, B.CH curriculum, a total of 32 contact hours in psychology have traditionally been provided for students in the first and third years of study. While assessment of students in their third-year psychology course has sometimes been enforced to encourage student attendance at lectures, marks obtained have not contributed to students’ progress through medical school. The third-year class consists of approximately 200 students with an average age of 21 years. Before entering the third year they have experienced a highly structured, 56
teacher-centred educational system, with lectures, formal laboratory sessions, regular tests and year-end examinations. The third-year teaching techniques present a rnixture of such traditional teaching methods and modern approaches designed along group-orientated, studentcentred lines.
Changes Introduced In 1979 a course entitled ‘Human behavioural science’ (HBS) was instituted in the third year to replace the original psychology course. HBS was divided equally into sociology and psychology, with each section continuing for 10 weeks and being allocated a total of 30 teaching hours. This paper describes the innovations made in the psychology component of the HBS programme during 1979 and 1980. The sociology component, developed and conducted independently of the School of Psychology by the Department of Sociology, retained the lecturing model of instruction combined with prescribed readings and discussions. Table 1. Major goals of the psychology course. 1. To familiarize students with areas of psychology particularly relevant to medicine 2. To familiarize students with sources of psychological information concerning medical topics 3. To improve the status, or more specifically, the lack of status, attributed to psychology by medical students 4. To influence student attitudes to medicine so as to incorporate an awareness of the role of psychological factors in health 5. To encourage students to work together in groups which are mutually dependent. It was hoped that reliance on other group members to the students’ own benefit would provide some insight into the team role frequently required of the qualified doctor 6. To examine the effects of a group-orientated, studentdirected method of teaching, rather than the traditional didactic model.
Medical Teacher Vol 4 No 2 1982
The major goals of the psychology component of the new HBS programme are shown in Table 1.
Med Teach Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 11/24/14 For personal use only.
Teaching Methodr With the exception of the first lecture, which outlined the structure of the HBS course, no formal lectures were given. Instead, a group discussion method of teaching was used. Students were required to meet once a week for a minimum of one hour, in groups of seven to 10 students each. The same groups used in other MB, B.CH courses were maintained for the psychology component of the HBS course. Each week one student in each group was required to present to his group a three-page essay on a set topic. Following the group discussion of this essay the same student was required to prepare a two-page summary of the group discussion of his paper and to submit both essay and group discussion summary for assessment. Assessment
Marks were assigned equally to the paper and to the group discussion summary. Marks obtained by students for this course were included in their overall third-year grade assessments. It was emphasized that failure of the HBS course could mean failure of the third-year MB, B.CH. However, students were informed that it was not considered desirable to fail them in their third year of medicine on the basis of the HBS course. Consequently, students who failed the HBS course work were allowed to rewrite their assignments. Students still not attaining acceptable standards following this procedure have been allowed to write supplementary examinations. Control of the Course It was believed that a relatively structured approach to this aspect of the course was necessary to help overcome the obstacles facing the HBS programme, i.e. the past reputation of psychology courses, the fact that the course was given by a department outside the medical school (both outside the medical faculty and physically off the medical school campus), and the fact that the course was conducted by a staff member whom medical students considered to have low status. A further aspect of the course which was closely controlled was the topics that the students were required to present to their groups. Nine topics were specified for student examination (Table 2). Students in each group were allowed to decide who would present each topic, but topics had to be discussed on the days specified so as to ensure a continuity of subject development and to minimize possible ‘swopping’ and plagiarism of essays. An additional control was instituted by requiring all members of a group to sign each assignment submitted by a member of their group. This control served two purposes; first it went some way to ensuring student attendance at group meetings, and second, it emphasized, as did the group discussion summary, the interdependence of members of a group. As implied in the ‘Statement of goals’ adopted by the medical school‘ such group interaction Medical Teacher Vol 4 No 2 1982
Table 2. Topics selected for group presentation in the psychology course in 1979. Topic
Aspects covered
1. Psychosomatic medicine
The holistic approach as well as traditional psychosomatic disease categories Aetiology and treatment with reference to Simonton’s work’ Based on the writings of Dohrenwend and Dohrenwend’ Normal and abnormal pregnancy as well as cultural influences on the management of pregnancy Concentrating on the writings of Janis‘ as well as on childhood hospitalization Based on the Davis and Harobin book of that title’ describing patients’ experiences in relation 10 medicine The Kuhler-Ross6 outline of the psychology of dying Incorporating neurological, endocrine and immune system mechanisms Attempting to integrate the papers presented for topics 1 to 8
2. Cancer as a psychosomatic disease
3. Life event stresses: their role in somatic illness
4. Psychological aspects of PwnancY 5. Hospitalization and surgery: effects on patients
6. Medical encounters
7. Death and dying: the psychological issues 8. The mechanisms linking psychological events to pathophysiological effects 9. An holistic approach to medicine
and interdependence is a desirable quality to introduce in undergraduate medical courses. Reading Material References were supplied for student use on an overnight lending basis, and multiple copies of 25 journal articles, including some review articles, and 23 books were provided. References were made available because students have an extremely heavy load in their third year, and it was unrealistic to expect them to conduct extensive literature searches. This did not preclude students from reading and referring to other articles, but simply provided a starting point and guide for additional reading. In addition to the general reference list of books and articles, two books were specified as highly recommended: Lipowski, Lipsett and Whybrow’s Psychosomatic medicine’ and Cox’s Stress.’ With few exceptions, the topics selected and their order of discussion proved to be satisfactory. Papers dealing with cancer, pregnancy, hospitalization and surgery and medical encounters were most successfully received. While theoretical papers, such as those on psychosomatic illness, holistic medicine and stress were needed at the start and the end of the course, some confusion arose in 1979 due to overlap between subjects. Paper 8 (Table 2) 57
Table 3. ‘Topics selected for group presentation in the psychology course in 1980. Adult medicine (general)
Adult medicine (male)
Med Teach Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 11/24/14 For personal use only.
Adult medicine (female)
1. Cancer as a psychosomatic illness with special reference to
Simonton’s work’ 2. Psychosomatic medicine: an holistic approach 3. Stress: in general and with reference to the health of executives’ 4. Life event stress with reference to the writings of Dohrenwend and Dohrenwend’ 5. Women and medicine with reference to the writings of Leason and Gray’ 6. Pregnancy and childbirth:
psychological and cultural aspects of normal and abnormal Adolescent medicine
Childhood medicine General medicine
pregnancies 7. The importance of physical appearance and the effects of medical encroachments on
appearance 8. Effects of hospitalization, surgery and handicaps with reference to the work of Janis‘ 9. Medical encounters: based on the Davis and Harobin book of that title’ describing patients’ experiences in relation to medicine 10. The mechanisms
(neurological, endocrine and immune) linking psychological events to pathophysiological effects
on the weakest groups. Papers were marked with detailed comments and returned to students within a week of submission. This provided a means of monitoring groups’ progress and enabled students in the groups to ascertain the standards required of them. In addition, most students who failed on first submission of their work were able to re-do essays during the time allocated to the course. Evaluation of the Course In general, student feedback has been favourable. Students were asked in both 1979 and 1980 to complete questionnaires concerning the course. In 1979, 57 per cent and in 1980, 58 per cent of students agreed that the course had achieved its goals and had resulted in an increased awareness of the patient as a whole person. In addition, when asked in 1980, 58 per cent of students stated that they believed the course would affect their future effectiveness as doctors. In response to questions asked in 1980, satisfaction was expressed by 65 per cent concerning the teaching method adopted, and 83 per cent agreed that the course should have a place in medical training. Compared to the poor student responses to previous courses in psychology for medical students (attendance rate approximately 10 per cent), the increased proportion of students expressing satisfaction with the course was gratifying. Certainly, grades attained by students reflect not only an attempt on the part of the students to ‘pass’ the course but a desire to do well. By comparison, student reactions to the more traditionally orientated sociology component of the HBS course in 1979 were less favourable. Consequently, in 1980 the sociology component of the HBS course followed the same teaching approach as that adopted by psychology, resulting in favourable student responses. Lessons
covering the mechanisms linking psychological events to physiological pathology proved to be an essential component of the course: the provision of evidence supporting a link between psychology and pathology, based on neurological, endocrine and immune system functioning, served to overcome resistance from students who opposed the possible influence of psychological factors in health. While some of the 1979 topics were included in the 1980 course, some changes were made (Table 3). The framework adopted in the 1980 course proved to be an improvement on the 1979 approach as there was less overlap of topics. Running the Course Due to staff shortages in 1979 and 1980, the course was organized and implemented by one lecturer. Attempts to obtain the help of sufficient tutors, whether students or professionals, in running the groups proved unsuccessful. Consequently, as each of the 24 groups met simultaneously, it was not possible for the lecturer to be present at all student discussions. Instead, attention was focussed 58
Medical school courses in the behavioural sciences are frequently staff intensive: l o the course outlined here is suitable for those situations where there are few staff, large student numbers and minimum staff exposure time. The lecturer can ensure that sufficient information is covered by students, and at the same time facilitate stimulating student-orientated learning. A fear expressed during the planning stages of the course, that students would not achieve satisfactory academic standards if left to their own resources, has proved to be largely unfounded. Standards achieved were high, and in some cases much higher than would have been expected following a traditional lecture course. However, it appears that for such standards to be attained assistance in the form of statements of student expectations, available and adequate references, close monitoring of student progress and detailed feedback to students must be provided. The teaching method described resembles, in some respects, the Keller plan. ’’ In both approaches students are allocated self-contained work units taking approxiMedical Teacher Vol 4 No 2 1982
Med Teach Downloaded from informahealthcare.com by University of Newcastle Upon Tyne on 11/24/14 For personal use only.
mately one week to complete and be examined. Basic reading material is assigned and students can work individually. As with the Keller plan, our teaching method requires much staff effort and sometimes draws criticism from colleagues. However, a major difference between the two approaches is that with the Keller plan students work at their own pace and cover the entire syllabus themselves, whereas with our approach they do not. Students taking the psychology component of the HBS course have to conform to a weekly timetable and cover only one topic each. Our approach places far more emphasis than the Keller plan on student discussion and interchange. Our course could be improved by having more staff available to guide group discussions, which would also lighten the heavy load placed on a single lecturer. It is our intention to explore this avenue further in future years.
Annual Conference of AMEE The annual conference of the Association for Medical Education in Europe is being held in Cambridge from 20 to 23 September 1982. The event is cosponsored by the Association for the Study of Medical Education, the Cambridge University School of Clinical Medicine and the World Health Organization. The theme of this year's meeting is 'Motivation for Learning'. This conference, which is being held mainly at Churchill College, is to be preceded by a two-day Conference of Deans of European Medical. Schools (AMDE). Associated with the Conference will be a commercial exhibition (drug firms, teaching materials, etc.) and an exhibition of members' activities (teaching models, interactive computer systems, etc). Additional information may be obtained from the conference secretary, Professor R . M. Harden, ASME, 150b Perth Road, Dundee DD1 4EA, Scotland, UK. Reservations must be made by 30 June 1982.
Acknowledgment
I thank Professor C . Beaton, until recently Head, Division of Continuing Medical Education, University of the Witwatersrand, Johannesburg, South Africa, for help in writing this paper. References 'Beaton I;. Mitchell D . The way we teach physiology. Mcd Teach 1979; 1: 71-75
'Simonton CD, Simonton S. Belief systems and the management of the emotional aspects of malignancy. J Transpersonal Psyclhol 1975; 7 : 29-47. 'Dohrenwend BS, Dohrenwend BP. Shessjid lye rucnts: their nature and c&ts. New York: Wiley, 1974. 'Janis IL Psychological strcss. New York: Academic Press, 1958. 'Davis A, Harobin G . Medical encounters: the cxpctitnce of illness and trhahnnl. London: Croom Helm, 1977. 6Kiibler-KossE. On &ath and dying. New York: Macmillan, 1969. 'Lipowskl ZJ, Lipsett DP, Whybrow PC. Psyclrosodic medicine. New York: Oxford University Press, 1977. 'Cox T. .Stmss. London: The Macmillan Press, 1978. 'Leason J . Gray J. Women and medicine. London: Tavistock Publications, 1978. 10Brownstein EJ, Singer P, Dornbush RL, Freedman AM. New concepts in the teaching of behavioural science in the preclinicd curriculum.J Med Educ 1979; 54: 423-425. "Stoward PJ. Self instruction through reading: the Keller plan. Med E d u 1976; 10: 316-326.
Audiovisual Aids for Health Manpower Training The International Green Cross in collaboration with
WHO is producing a series of 24 colour posters for use in the education and training of health workers, especially auxiliaries in developing countries. The first six posters, dealing with the stomach, lungs, liver, eye, ear and teeth, were dispatched at the end of 1980 to the W H O Regional Offces to be distributed to training institutions in each region. The next set of posters will be available shortly. Further information can be obtained from the Regional Offices of WHO. Medical Teacher Vol4 No 2 1982
Cuts in University Funding in UK
Dental Teaching Hospitals The Teachers Committee of the British Dental Association has again drawn attention to the problems that will be caused by the cuts to university funding. They maintain that serious consequences will include:
,
a) An inevitable cut in the special treatment services concentrated in dental teaching hospitals. Achieving the cuts within the time scale demanded will lead to a very uneven distribution of such services, they say. b) Reduction in the number of dental teachers will have serious consequences for the training of dentists, where a close personal teacherlstudent relationship is essential. c) Fewer dental teachers means that there will be an additional work overload on NHS staff remaining in dental teaching hospitals. Only 12 months ago the Nuffield Foundation Committee of Inquiry into dental education, amongst its 35 principal recommendations, made two which would mean a substantial increase in staff establishment. The first maintained that full-time staff should be relieved of the burdens of excessive teaching in order to devote at least one-third of their time to research. The second called on universities to be responsible not only for undergradslate education, but also for the preregistration year, vocational training for general practice, a major part of postgraduate and continuing education, and the education of auxiliaries. 59
