This is the first evaluation study we are aware of that has reported on the use of an interactive research study to develop medical students' public health and research skills. It was practical to combine the research and teaching and a majority of the students responded favourably to the exercise. The class was generally successful in raising the profile of public health and research, but still was restricted by the built environment of the tiered lecture theatre which makes small group work difficult.
The poor quality of student flats in Dunedin has been a topic of considerable public interest and has resulted in a report presented to the media that found that some student flats were colder than a refrigerator during winter [15
] as well as other unfavourable media reports [31
]. The results of the student housing and health research have been written up and are in the process of being submitted to a journal (Baker M, Wilson N, Dickson N, Zhang J, Keall M, Crane J, Howden-Chapman P: Medical students have respiratory symptoms associated with poor housing conditions; draft manuscript). The findings were of intrinsic interest to the students and by raising the issue of their exposure to cold indoor temperatures in their accommodation, may have implications for protecting their health.
Evaluating a teaching session using a simple self-completed questionnaire distributed to a large class of medical students at the end of an extended teaching session has important limitations. The response rate of 65% could have been higher and it is possible that those who chose to respond may have differed from the non-responders in important ways (for example, by being more motivated by a desire to record positive or negative views about the teaching experience). This context also means that students inevitably had to provide an immediate and potentially rushed assessment of the teaching. Given those constraints it is surprising that so many students (51%) took the time to write additional comments on the questionnaire.
It is important to also note the potential issues that arise from this form of teaching. In this exercise the students effectively become the research subjects. This raises issues to do with informed consent and whether students felt that they could reasonably opt out of the research. This could become more of a problem if the approach was extended to other forms of health sciences training.
These results support continuation of this type of teaching/research combination, ideally with a switch to use of smaller groups for discussion of the findings. A greater emphasis on small group work is part of the current strategy for change in undergraduate teaching at the University of Otago. This type of teaching is very labour intensive as it requires rapid entry and analysis of questionnaire data and modification of presentation content to incorporate the results. It is therefore important that such teaching is evaluated to ensure its value to students.
If research methods and public health are to be seen as an integral part of the medical curriculum it needs to be integrated into the course. In 2004, no medical school in Australia taught statistics and research skills in an integrated way as part of the rest of their problem based learning (PBL) course [32
]. As Bland mentions, not only does integration prevent marginalisation of the subject, but it also has the advantage of being taught in the context in which students will use it. Problem based learning has been shown to be an effective way of teaching public health [33
] and to be a richer and more engaging approach to the teaching of epidemiology than traditional courses [34
]. This principle suggests that the teaching/research exercise could be further improved by integrating it with the rest of the course.
The benefit-to-cost analysis of this type of teaching also needs to consider the additional benefits in the form of scientific outputs (published findings on the health impact of the built environment). There is also potential for policy changes that might contribute to improved student and public health.
The authors agreed with the students' recommendation that the survey be repeated near the end of the academic year after winter 2008 and a repeat survey was conducted in October, spring-time in the Southern Hemisphere. Findings from these surveys have been compared with student union records of the quality of student flats in Dunedin. These results are also being reported back to the University of Otago administration (of which the Medical School is a part) and are forming part of a community-action plan to improve the quality of student flats.
At the conclusion of the class, the tutors asked if anyone wanted to enrol in a paid summer studentship and work with the tutors to analyse the results and write up the teaching evaluations. The first author volunteered and was able to further reinforce her knowledge of research-based teaching and the impact of housing on health.
Our findings have wider implications for teaching of research and public health skills to medical students and other health sciences students. Many Departments such as ours are no doubt using innovative teaching methods and either not evaluating them, or not reporting them in the published literature. To improve evidence-informed teaching practice, it would be useful if other programmes teaching public health and research skills to medical students also published on these activities.