An audit of undergraduate trauma and orthopaedic surgery teaching was carried out in 24 of the 27 medical schools in Great Britain and major differences were found between the medical schools. The range of time spent in teaching trauma and orthopaedic surgery for undergraduates varied from 3 weeks to 12 weeks and in five out of 27 medical schools trauma and orthopaedic surgery tuition was split between various years of the clinical curriculum. In some schools there were 30 students on a firm and in others only one. The opportunity for undergraduates to give feedback to their teachers, the use of objective assessment at the end of such an appointment by the teachers, varied between medical schools. To avoid some of these very basic differences between our medical schools, the teaching of clinical subjects to undergraduates in medicine should be reviewed nationally and minimum standards set.
OBJECTIVE--To determine whether the time allocated for undergraduate teaching of genitourinary medicine has changed since 1984 and to determine the impact of HIV/AIDS on the teaching of the specialty. METHODS--A self completion questionnaire was sent to the consultant in charge of each department of genitourinary medicine attached to a UK medical school. RESULTS--Replies were received from all twenty seven medical schools. Most schools (24/27) offer a course of lectures accompanied by clinical teaching; however, one medical school does not include teaching of genitourinary medicine in the undergraduate curriculum at all and two others are unable to offer all students clinical tuition. The mean time devoted to lectures is 6.7 hours (range 0-15 hours) made up of 4.8 hours of genitourinary medicine lectures and 1.9 hours of lectures on HIV/AIDS. The mean time allocated for clinic-based teaching of each student is 9.2 hours (range 0-27 hours). On average the time allocated for lecturing and clinical teaching of the speciality has decreased since 1984 although there is considerable variation between schools (time for clinical teaching and lecturing combined ranges from 0-41.0 hours). CONCLUSIONS--The findings of this survey suggest there is considerable variation in both the quantity and quality of undergraduate teaching of genitourinary medicine provided throughout the UK.
International reports recommend the improvement in the amount and quality of training for mental health workers in low and middle income countries. The Scotland-Malawi Mental Health Education Project (SMMHEP) has been established to support the teaching of psychiatry to medical students in the University of Malawi. While anecdotally supportive medical educational initiatives appear of value, little quantitative evidence exists to demonstrate whether such initiatives can deliver comparable educational standards. This study aimed to assess the effectiveness of an undergraduate psychiatry course given by UK psychiatrists in Malawi by studying University of Malawi and Edinburgh University medical students' performance on an MCQ examination paper.
An undergraduate psychiatry course followed by an MCQ exam was delivered by the SMMHEP to 57 Malawi medical students. This same MCQ exam was given to 71 Edinburgh University medical students who subsequently sat their own Edinburgh University examination.
There were no significant differences between Edinburgh students' performance on the Malawi exam and their own Edinburgh University exam. (p = 0.65). This would suggest that the Malawi exam is a comparable standard to the Edinburgh exam. Malawi students marks ranged from 52.4%–84.6%. Importantly 84.4% of Malawi students scored above 60% on their exam which would equate to a hypothetical pass by UK university standards.
The support of an undergraduate course in an African setting by high income country specialists can attain a high percentage pass rate by UK standards. Although didactic teaching has been surpassed by more novel educational methods, in resource poor countries it remains an effective and cost effective method of gaining an important educational standard.
Objective To study medical students' views about the quality of the teaching they receive during their undergraduate training, especially in terms of the hidden curriculum.
Design Semistructured interviews with individual students.
Setting One medical school in the United Kingdom.
Participants 36 undergraduate medical students, across all stages of their training, selected by random and quota sampling, stratified by sex and ethnicity, with the whole medical school population as a sampling frame.
Main outcome measures Medical students' experiences and perceptions of the quality of teaching received during their undergraduate training.
Results Students reported many examples of positive role models and effective, approachable teachers, with valued characteristics perceived according to traditional gendered stereotypes. They also described a hierarchical and competitive atmosphere in the medical school, in which haphazard instruction and teaching by humiliation occur, especially during the clinical training years.
Conclusions Following on from the recent reforms of the manifest curriculum, the hidden curriculum now needs attention to produce the necessary fundamental changes in the culture of undergraduate medical education.
Thirty-eight teaching hospital affiliated accident and emergency departments were surveyed by post to try to find if there had been any change in undergraduate medical student teaching over the past 10 years. Twenty-six departments replied. The results showed that although there has been an improvement in the teaching of A&E medicine to undergraduates in the past few years there are still some medical schools where an A&E attachment is not mandatory. In those departments providing teaching, there is wide variation in course duration and content.
Clinical audit is an important tool to improve patient care and outcomes in health service. A significant proportion of time and economic resources are spent on activities related to clinical audit. Completion of audit cycle is essential to confirm the improvements in healthcare delivery. We aimed this study to evaluate audits carried out within trauma and orthopaedic unit of a teaching hospital over the last 4 years, and establish the proportions which were re-audited as per recommendations.
Data was collected from records of the clinical audit department. All orthopaedic audit projects from 2005 to 2009 were included in this study. The projects were divided in to local, regional and national audits. Data regarding audit lead clinicians, completion and presentation of projects, recommendations and re-audits was recorded.
Out of 61 audits commenced during last four years, 19.7% (12) were abandoned, 72.1% (44) were presented and 8.2 % (5) were still ongoing. The audit cycle was completed in only 29% (13) projects.
Change of junior doctors every 4~6 months is related to fewer re-audits. Active involvement by supervising consultant, reallocation of the project after one trainee has finished, and full support of audit department may increase the ratio of completion of audit cycles, thereby improving the patient care.
Audit of audits; orthopaedic audits; quality of care; audit cycle.
A questionnaire and telephone survey was carried out in April 1991 of all 31 academic departments of general practice in the United Kingdom and Eire; 30 departments responded. The aim of the study was to assess the departments' level of involvement in teaching about audit in the undergraduate curriculum, their role in the development of audit in primary care including involvement with medical audit advisory groups, whether they undertook teaching about audit to other health professionals and whether they were involved in audit related research. Eleven of 27 responding undergraduate departments provided formal teaching about audit and five intended to introduce it in the near future. Respondents expressed concerns about teaching audit to undergraduates, including lack of time in the curriculum, difficulties making the teaching relevant and interesting, and a lack of expertise and knowledge of the subject among the staff. All 29 departments in the UK were represented on medical audit advisory groups, and audit related research was being carried out in 24 undergraduate departments. The role of academic departments of general practice in the development of audit in primary care is discussed.
OBJECTIVE--To assess the feasibility and the validity of an audit using major trauma outcome study methods in an accident and emergency department. DESIGN--Prospective audit of all cases of trauma in patients admitted to a hospital from an accident and emergency department. SETTING--Accident and emergency department in a teaching hospital. PATIENTS--1577 Patients admitted with trauma, of whom 695 met the inclusion criteria for the study--that is, were admitted for more than three days, or admitted to intensive care, or died. 17 Patients were excluded because of failure to trace their notes. OUTCOME MEASURES--Review of case notes with TRISS (trauma score, injury severity score) methodology to compare expected and observed survival. RESULTS--Most (421/678) admissions were due to single orthopaedic injury. Serious injury was uncommon with only 43 patients having injury severity scores greater than 15. The calculated probability of survival matched the observed outcome for most of the seriously injured patients, with only two unexpected deaths. However, 36 of the 61 deaths in the 678 patients occurred in elderly patients with a fractured neck of the femur, and all of these patients had a high probability of survival predicted by TRISS methodology. CONCLUSIONS--Application of TRISS methodology seems to be valid for seriously injured patients except for elderly patients with single orthopaedic injuries, in whom there were major differences between observed and expected outcomes. Using outcome norms from the United States may not be applicable for this group. IMPLICATIONS--Audit of management of major injuries should be carried out by every hospital, and the methodology of the major trauma outcome study is an excellent system for carrying out such audit. The study of all patients admitted with trauma requires appreciable extra resources, but most hospitals should be able to monitor the care of seriously injured patients as their numbers are much fewer.
Assessment has a powerful influence on curriculum delivery. Medical instructors must use tools which conform to educational principles, and audit them as part of curriculum review.
To generate information to support recommendations for improving curriculum delivery.
Pre-clinical and clinical departments in a College of Medicine, Saudi Arabia.
A self-administered questionnaire was used in a cross-sectional survey to see if assessment tools being used met basic standards of validity, reliability and currency, and if feedback to students was adequate. Excluded were cost, feasibility and tool combinations.
Thirty-one (out of 34) courses were evaluated. All 31 respondents used MCQs, especially one-best (28/31) and true/false (13/31). Groups of teachers selected test questions mostly. Pre-clinical departments sourced equally from “new” (10/14) and “used” (10/14) MCQs; clinical departments relied on ‘banked’ MCQs (16/17). Departments decided pass marks (28/31) and chose the College-set 60%; the timing was pre-examination in 13/17 clinical but post-examination in 5/14 pre-clinical departments. Of six essay users, five used model answers but only one did double marking. OSCE was used by 7/17 clinical departments; five provided checklist. Only 3/31 used optical reader. Post-marking review was done by 13/14 pre-clinical but 10/17 clinical departments. Difficulty and discriminating indices were determined by only 4/31 departments. Feedback was provided by 12/14 pre-clinical and 7/17 clinical departments. Only 10/31 course coordinators had copies of examination regulations.
MCQ with single-best answer, if properly constructed and adequately critiqued, is the preferred tool for assessing theory domain. However, there should be fresh questions, item analyses, comparisons with pervious results, optical reader systems and double marking. Departments should use OSCE or OSPE more often. Long essays, true/false, fill-in-the-blank-spaces and more-than-one-correct-answer can be safely abolished. Departments or teams should set test papers and collectively take decisions. Feedback rates should be improved. A Center of Medical Education, including an Examination Center is required. Fruitful future studies can be repeat audit, use of “negative questions” and the number of MCQs per test paper. Comparative audit involving other regional medical schools may be of general interest.
Assessment Technique; Curriculum review; MCQ
Our obstetrics and gynaecology undergraduate teaching module allocates 40–50 final year medical students to eight teaching hospital sites in the West Midlands region. Based on student feedback and concerns relating to the impact of new curriculum changes, we wished to objectively assess whether the educational environment perceived by students varied at different teaching hospital centres, and whether the environment was at an acceptable standard.
A Dundee Ready Education Environment (DREEM) Questionnaire, a measure of educational environment, was administered to 206 students immediately following completion of the teaching module.
The overall mean DREEM score was 139/200 (70%). There were no differences in the education climate between the teaching centres.
Further research on the use of DREEM inventory, with follow up surveys, may be useful for educators to ensure and maintain high quality educational environments despite students being placed at different teaching centres.
Virtual microscopy is being introduced in medical education as an approach for learning how to interpret information in microscopic specimens. It is, however, far from evident how to incorporate its use into existing teaching practice. The aim of the study was to explore the consequences of introducing virtual microscopy tasks into an undergraduate pathology course in an attempt to render the instruction more process-oriented. The research questions were: 1) How is virtual microscopy perceived by students? 2) Does work on virtual microscopy tasks contribute to improvement in performance in microscopic pathology in comparison with attending assistant-led demonstrations only?
During a one-week period, an experimental group completed three sets of virtual microscopy homework assignments in addition to attending demonstrations. A control group attended the demonstrations only. Performance in microscopic pathology was measured by a pre-test and a post-test. Student perceptions of regular instruction and virtual microscopy were collected one month later by administering the Inventory of Intrinsic Motivation and open-ended questions.
The students voiced an appreciation for virtual microscopy for the purposes of the course and for self-study. As for learning gains, the results indicated that learning was speeded up in a subgroup of students consisting of conscientious high achievers.
The enriched instruction model may be suited as such for elective courses following the basic course. However, the instructional model needs further development to be suited for basic courses.
Inquiry-based laboratories are acknowledged as the preferred method of
instruction for development of research skills. Much has been written about
changes in student performance associated with inquiry, but less is known
about how students view the inquiry-based format or whether they perceive a
benefit from this type of instruction. The Student Assessment of Learning
Gains (SALG) survey was used to evaluate and compare student reactions to the
new, inquiry-based laboratories of a lower-division undergraduate curriculum,
from implementation to the present (an interval of 3 yr). Initial student
response to the format and value of the inquiry labs improved over time. The
quality of the graduate teaching assistants and the clarity of the laboratory
manual were important variables influencing student perception. A student's
perception of his/her retention of lab-related skills was strongly associated
with perceptions of gains in those skills. Student responses reflect their
most current laboratory experience and not a cumulative effect of
participation in the core series of courses. Student success in the inquiry
format was not associated with gender or status as a transfer student. The
majority of students believe that their experiences in the lower-division
inquiry labs have prepared them for upper-division course work.
Problem: The first East Anglian audit of hip fracture was conducted in eight hospitals during 1992. There were significant differences between hospitals in 90-day mortality, development of pressure sores, median lengths of hospital stay, and in most other process measures. Only about half the survivors recovered their pre-fracture physical function. A marked decrease in physical function (for 31%) was associated with postoperative complications.
Design: A re-audit was conducted in 1997 as part of a process of continuing quality improvement. This was an interview and record based prospective audit of process and outcome of care with 3 month follow up. Seven hospitals with trauma orthopaedic departments took part in both audits. Results from the 1992 audit and indicator standards for re-audit were circulated to all orthopaedic consultants, care of the elderly consultants, and lead audit facilitators at each hospital.
Key measures for improvement: Processes likely to reduce postoperative complications and improve patient outcomes at 90 days.
Strategy for change: As this was a multi-site audit, the project group had no direct power to bring about changes within individual NHS hospital trusts.
Results: Significant increases were seen in pharmaceutical thromboembolic prophylaxis (from 45% to 81%) and early mobilisation (from 56% to 70%) between 1992 and 1997. There were reduced levels of pneumonia, wound infection, pressure sores, and fatal pulmonary embolism, but no change was recorded in 3 month functional outcomes or mortality.
Lessons learnt: While some hospitals had made improvements in care by 1997, others were failing to maintain their level of good practice. This highlights the need for continuous quality improvement by repeating the audit cycle in order to reach and then improve standards. Rehabilitation and long term support to improve functional outcomes are key areas for future audit and research.
Developing and testing the cognitive skills and abstract thinking of undergraduate medical students are the main objectives of problem based learning. Modified Essay Questions (MEQ) and Multiple Choice Questions (MCQ) may both be designed to test these skills. The objectives of this study were to assess the effectiveness of both forms of questions in testing the different levels of the cognitive skills of undergraduate medical students and to detect any item writing flaws in the questions.
A total of 50 MEQs and 50 MCQs were evaluated. These questions were chosen randomly from various examinations given to different batches of undergraduate medical students taking course MED 411–412 at the Department of Medicine, Qassim University from the years 2005 to 2009. The effectiveness of the questions was determined by two assessors and was defined by the question’s ability to measure higher cognitive skills, as determined by modified Bloom’s taxonomy, and its quality as determined by the presence of item writing flaws. ‘SPSS15’ and ‘Medcalc’ programs were used to tabulate and analyze the data.
The percentage of questions testing the level III (problem solving) cognitive skills of the students was 40% for MEQs and 60% for the MCQs; the remaining questions merely assessed the recall and comprehension. No significant difference was found between MEQ and MCQ in relation to the type of questions (recall; comprehension or problem solving x2 = 5.3, p = 0.07).The agreement between the two assessors was quite high in case of MCQ (kappa=0.609; SE 0.093; 95%CI 0.426 – 0.792) but lower in case of MEQ (kappa=0.195; SE 0.073; 95%CI 0.052 – 0.338). 16% of the MEQs and 12% of the MCQs had item writing flaws.
A well constructed MCQ is superior to MEQ in testing the higher cognitive skills of undergraduate medical students in a problem based learning setup. Constructing an MEQ for assessing the cognitive skills of a student is not a simple task and is more frequently associated with item writing flaws.
Modified essay question; Multiple-choice question; Bloom’s Taxonomy; cognition
Every procedural skill consists of some microskills. One of the effective techniques for teaching a main procedural skill is to deconstruct the skill into a series of microskills and train students on each microskill separately. When we learn microskills, we will learn the main skill also. This model can be beneficial for tuition on procedural skills.
In this study, we propose a stationed-based deconstructed training model for tuition of each microskill, and then we assessed the medical students’ self-perceived abilities.
This quasi-experimental study was conducted in 268 medical students (536 matched pre- and post-questionnaires) at the surgical clerkship stage during five consecutive years in three teaching and learning groups. In this study, we taught each skill in 10 steps (proposed model) to the students. We then evaluated the students’ self-perceived abilities using a pre- and post-self-assessment technique. SPSS v13 software with one-way analysis of variance and paired t-tests were used for data collection and analysis.
Assessment of medical students’ perceived abilities before and after training showed a significant improvement (P < 0.001) in both cognitive and practical domains. There were also significant differences between the three teaching and learning groups (P < 0.001). There were no significant differences for the different years of training regarding the observed improvement.
This study suggests that deconstructing the practical skills into microskills and tuition of those microskills via the separated structured educational stations is effective according to the students’ self-ratings.
clinical skills center; microskills; perceived ability; self-assessment; self-scoring stationed training
Background: Heidelberg Medical School underwent a major curricular change with the implementation of the reform curriculum HeiCuMed (Heidelberg Curriculum Medicinale) in October 2001. It is based on rotational modules with daily cycles of interactive, case-based small-group seminars, PBL tutorials and training of sensomotor and communication skills. For surgical undergraduate training an organisational structure was developed that ensures continuity of medical teachers for student groups and enables their unimpaired engagement for defined periods of time while accounting for the daily clinical routine in a large surgery department of a university hospital. It includes obligatory didactic training, standardising teaching material on the basis of learning objectives and releasing teaching doctors from clinical duties for the duration of a module.
Objective: To compare the effectiveness of the undergraduate surgical reform curriculum with that of the preceding traditional one as reflected by students' evaluations.
Method: The present work analyses student evaluations of the undergraduate surgical training between 1999 and 2008 including three cohorts (~360 students each) in the traditional curriculum and 13 cohorts (~150 students each) in the reform curriculum.
Results: The evaluation of the courses, their organisation, the teaching quality, and the subjective learning was significantly better in HeiCuMed than in the preceding traditional curriculum over the whole study period.
Conclusion: A medical curriculum based on the implementation of interactive didactical methods is more important to successful teaching and the subjective gain of knowledge than knowledge transfer by traditional classroom teaching. The organisational strategy adopted in the surgical training of HeiCuMed has been successful in enabling the maintenance of a complex modern curriculum on a continuously high level within the framework of a busy surgical environment.
Medical education; undergraduate surgery curriculum; evaluation
This paper is an attempt to produce a guide for improving the quality of Multiple Choice Questions (MCQs) used in undergraduate and postgraduate assessment. Multiple Choice Questions type is the most frequently used type of assessment worldwide. Well constructed, context rich MCQs have a high reliability per hour of testing. Avoidance of technical items flaws is essential to improve the validity evidence of MCQs. Technical item flaws are essentially of two types (i) related to testwiseness, (ii) related to irrelevant difficulty. A list of such flaws is presented together with discussion of each flaw and examples to facilitate learning of this paper and to make it learner friendly. This paper was designed to be interactive with self-assessment exercises followed by the key answer with explanations.
Pitfalls; assessment; student
Scholarly achievement is the aim of a pathology institute. In a medical faculty it serves undergraduate, postgraduate teaching, practice and research. Historically, scholarly achievement in these fields has been promoted through the teaching responsibility of the university and hospital. With the increasing volume of work, knowledge and complexity of research, adequate performance in these fields is best obtained by limiting the volume of fixed duties for each individual. At the same time, depth of knowledge is gained by encouraging specialization to complement clinical specialties. This arrangement will guarantee that the teaching and research of the department are disease-oriented, which is the central theme of pathology. With a highly specialized staff there must be a core of intradepartmental conferences common to all staff and those in training. With this form of organization dedicated to the undergraduate and postgraduate teaching, the objectives of scholarly achievement in teaching practice and research will be obtained.
Cultural diversity teaching is increasingly present in both undergraduate and postgraduate training programmes. This study explored the views of stakeholders in medical education about the potential outcomes of cultural diversity teaching and how they thought cultural diversity programmes might be effectively evaluated.
A semi-structured interview was undertaken with 61 stakeholders (including policymakers, diversity teachers, students and users). The data were analysed and themes identified.
Many participants felt that clinical practice was improved through 'cultural diversity teaching' and this was mostly as a result of improved doctor-patient communication. There was a strong view that service users need to participate in the evaluation of outcomes of cultural diversity teaching.
There is a general perception, rather than clear evidence, that cultural diversity teaching can have a positive effect on clinical practice. Cultural diversity teaching needs to be reviewed in undergraduate and postgraduate medicine and better evaluation tools need to be established.
The purpose of this follow-up study was to assess and compare the quantity and quality of dental undergraduate teaching in conscious sedation with comparisons to a previous study conducted in 1998. Questionnaires were designed to collect information about undergraduate sedation education from teaching staff and final-year dental undergraduates at the 15 dental schools in the United Kingdom and Ireland. Staff responses from 9 schools (60%) and student responses from 11 schools (73%) were received. From the students' responses, the mean (range) number of cases observed in inhalational sedation was 7 (0–17) and the mean (range) number performed in inhalational sedation was 4 (0–8). The mean (range) number of cases observed in intravenous sedation was 9 (2–19), and the mean (range) number performed was 5 (0–8). There has been an increase in didactic teaching. There has been a decrease in the observing of inhalational cases, but an increase in the hands-on performance of this type of sedation. There is an increase in the hands-on teaching of intravenous sedation.
Sedation; Education; Dentistry
This paper presents the results of a UK national survey of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training for undergraduate medical students. In all responding medical schools, undergraduates are taught BLS at least once during their course but the assessment and refresher aspects of BLS training are not uniformly covered. There are inconsistencies in ACLS teaching, with some schools providing formal courses, some teaching specific techniques and others providing no ACLS teaching. Most interestingly, of those completing the questionnaire, only 52% considered present undergraduate training adequate to enable junior house officers to provide an effective resuscitation service. We recommend that all aspects of BLS and ACLS training for medical undergraduates be improved and standardized throughout the UK.
determine what standard paediatric medical students would set for
examining their peers and how that would compare with the university standard.
computer marked examination with questionnaire.
students during their final paediatric attachment.
students asked to derive 10, five branch negatively marked multiple
choice questions (MCQs) to a standard that would fail those without
sufficient knowledge. Each 10 were then assessed by another student as
to the degree of difficulty and the relevance to paediatrics. One year
later student peers sat a mock MCQ examination derived from a random 40 questions (unaware that the mock MCQs had been derived by peers).
MEASURES—Comparison of marks obtained in mock and
final MCQ examinations; student perception of the standard in the two
examinations assessed by questionnaire.
derived 439 questions, of which 83% were considered an appropriate
standard by a classmate. One year later 62students sat the mock
examination. Distribution of marks was better in the mock MCQ
examination than the final MCQ examination. Students considered the
mock questions to be a more appropriate standard (72%
v 31%) and the topics more relevant (88%
v 64%) to paediatric medical students.
Questions were of a similar clarity in both examinations (73%
in this study were able to derive an examination of a satisfactory
standard for their peers. Involvement of students in deriving
examination standards may give them a better appreciation of how
standards should be set and maintained.
The structure of trauma meetings has been noted to vary considerably throughout our region. The aim of this study was to assess current practice of trauma meetings on a national level and to propose a structure on the basis of the survey.
MATERIALS AND METHODS
A telephone survey of 120 hospitals in England was performed with a 100% response rate. The on-call duty orthopaedic surgeon at each hospital was contacted and questioned regarding trauma meetings held at that hospital. Details obtained included the frequency of meetings, the presence of medical staff and staff from other disciplines, review of radiographs and educational value.
In total, 107 (89.2%) hospitals conducted regular trauma meetings with a mean duration of 36 min (range, 15–120 min). Teaching of junior medical staff occurred at 89 (83.2%) meetings. Postoperative radiographs were reviewed at 80 (74.8%) hospitals. A radiologist attended in 5 (4.7%) of meetings. The median number of consultants present was 3 (range, 1–10). Other attendees included trauma co-ordinators (34.6%), physiotherapists (30.8%), theatre staff (23.4%), nursing staff (20.6%) and anaesthetists (15.9%).
Trauma meetings assist with the organisation of trauma lists, the review of results and have a valuable educational component. However, in busier orthopaedic units, additional meetings for teaching purposes may be necessary as an adjunct to routine daily trauma meetings.
Trauma meetings; Survey; Telephone survey
Designing and implementing assessment tasks in large-scale undergraduate science courses is a labor-intensive process subject to increasing scrutiny from students and quality assurance authorities alike. Recent pedagogical research has provided conceptual frameworks for teaching introductory undergraduate microbiology, but has yet to define best-practice assessment guidelines. This study assessed the applicability of Biggs’ theory of constructive alignment in designing consistent learning objectives, activities, and assessment items that aligned with the American Society for Microbiology’s concept-based microbiology curriculum in MICR2000, an introductory microbiology course offered at the University of Queensland, Australia. By improving the internal consistency in assessment criteria and increasing the number of assessment items explicitly aligned to the course learning objectives, the teaching team was able to efficiently provide adequate feedback on numerous assessment tasks throughout the semester, which contributed to improved student performance and learning gains. When comparing the constructively aligned 2011 offering of MICR2000 with its 2010 counterpart, students obtained higher marks in both coursework assignments and examinations as the semester progressed. Students also valued the additional feedback provided, as student rankings for course feedback provision increased in 2011 and assessment and feedback was identified as a key strength of MICR2000. By designing MICR2000 using constructive alignment and iterative assessment tasks that followed a common set of learning outcomes, the teaching team was able to effectively deliver detailed and timely feedback in a large introductory microbiology course. This study serves as a case study for how constructive alignment can be integrated into modern teaching practices for large-scale courses.
Clinical audit plays an important role in the drive to improve the quality of patient care and thus forms a cornerstone of clinical governance. Assurance that the quality of patient care has improved requires completion of the audit cycle. A considerable sum of money and time has been spent establishing audit activity in the UK. Failure to close the loop undermines the effectiveness of the audit process and wastes resources.
PATIENTS AND METHODS
We analysed the effectiveness of audit in trauma and orthopaedics at a local hospital by comparing audit projects completed over a 6-year period to criteria set out in the NHS National Audit and Governance report.
Of the 25 audits performed since 1999, half were presented to the relevant parties and only 20% completed the audit cycle. Only two of these were audits against national standards and 28% were not based on any standards at all. Only a third of the audits led by junior doctors resulted in implementation of their action plan compared to 75% implementation for consultant-led and 67% for nurse-led audits.
A remarkably large proportion of audits included in this analysis failed to meet accepted criteria for effective audit. Audits completed by junior doctors were found to be the least likely to complete the cycle. This may relate to the lack of continuity in modern medical training and little incentive to complete the cycle. Supervision by permanent medical staff, principally consultants, and involvement of the audit department may play the biggest role in improving implementation of change.
Medical audit; Orthopaedics