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1.  Using standardized patients to assess communication skills in medical and nursing Students 
BMC Medical Education  2010;10:24.
Background
A number of recent developments in medical and nursing education have highlighted the importance of communication and consultation skills (CCS). Although such skills are taught in all medical and nursing undergraduate curriculums, there is no comprehensive screening or assessment programme of CCS using professionally trained Standardized Patients Educators (SPE's) in Ireland. This study was designed to test the content, process and acceptability of a screening programme in CCS with Irish medical and nursing students using trained SPE's and a previously validated global rating scale for CCS.
Methods
Eight tutors from the Schools of Nursing and Medicine at University College Cork were trained in the use of a validated communication skills and attitudes holistic assessment tool. A total of forty six medical students (Year 2 of 5) and sixty four nursing students (Year 2/3 of 4) were selected to under go individual CCS assessment by the tutors via an SPE led scenario. Immediate formative feedback was provided by the SPE's for the students. Students who did not pass the assessment were referred for remediation CCS learning.
Results
Almost three quarters of medical students (33/46; 72%) and 81% of nursing students (56/64) passed the CCS assessment in both communication and attitudes categories. All nursing students had English as their first language. Nine of thirteen medical students referred for enhanced learning in CCS did not have English as their first language.
Conclusions
A significant proportion of both medical and nursing students required referral for enhanced training in CCS. Medical students requiring enhanced training were more likely not to have English as a first language.
doi:10.1186/1472-6920-10-24
PMCID: PMC2845182  PMID: 20236526
2.  Effectiveness of IV Cannulation Skills Laboratory Training and Its Transfer into Clinical Practice: A Randomized, Controlled Trial 
PLoS ONE  2012;7(3):e32831.
Background
The effectiveness of skills laboratory training is widely recognized. Yet, the transfer of procedural skills acquired in skills laboratories into clinical practice has rarely been investigated. We conducted a prospective, randomised, double-blind, controlled trial to evaluate, if students having trained intravenous (IV) cannulation in a skills laboratory are rated as more professional regarding technical and communication skills compared to students who underwent bedside teaching when assessed objectively by independent video assessors and subjectively by patients.
Methodology and Principal Findings
84 volunteer first-year medical students were randomly assigned to one of two groups. Three drop-outs occurred. The intervention group (IG; n = 41) trained IV cannulation in a skills laboratory receiving instruction after Peyton's ‘Four-Step Approach’. The control group (CG; n = 40) received a bedside teaching session with volunteer students acting as patients. Afterwards, performance of IV cannulation of both groups in a clinical setting with students acting as patients was video-recorded. Two independent, blinded video assessors scored students' performance using binary checklists (BC) and the Integrated Procedural Protocol Instrument (IPPI). Patients assessed students' performance with the Communication Assessment Tool (CAT) and a modified IPPI. IG required significantly shorter time needed for the performance on a patient (IG: 595.4 SD(188.1)s; CG: 692.7 SD(247.8)s; 95%CI 23.5 s to 45.1 s; p = 0.049) and completed significantly more single steps of the procedure correctly (IG: 64% SD(14) for BC items; CG: 53% SD(18); 95%CI 10.25% to 11.75%; p = 0.004). IG also scored significantly better on IPPI ratings (median: IG: 3.1; CG: 3.6; p = 0.015;). Rated by patients, students' performance and patient-physician communication did not significantly differ between groups.
Conclusions
Transfer of IV cannulation-related skills acquired in a skills laboratory is superior to bedside teaching when rated by independent video raters by means of IPPI and BC. It enables students to perform IV cannulation more professionally on volunteer students acting as patients.
doi:10.1371/journal.pone.0032831
PMCID: PMC3299804  PMID: 22427895
3.  Enhancing medical students' communication skills: development and evaluation of an undergraduate training program 
BMC Medical Education  2012;12:16.
Background
There is a relative lack of current research on the effects of specific communication training offered at the beginning of the medical degree program. The newly developed communication training "Basics and Practice in Communication Skills" was pilot tested in 2008 and expanded in the following year at the University Medical Centre Hamburg-Eppendorf in Germany. The goal was to promote and improve the communicative skills of participants and show the usefulness of an early offered intervention on patient-physician communication within the medical curriculum.
Methods
The students participating in the project and a comparison group of students from the standard degree program were surveyed at the beginning and end of the courses. The survey consisted of a self-assessment of their skills as well as a standardised expert rating and an evaluation of the modules by means of a questionnaire.
Results
Students who attended the communication skills course exhibited a considerable increase of communication skills in this newly developed training. It was also observed that students in the intervention group had a greater degree of self-assessed competence following training than the medical students in the comparison group. This finding is also reflected in the results from a standardised objective measure.
Conclusions
The empirical results of the study showed that the training enabled students to acquire specialised competence in communication through the course of a newly developed training program. These findings will be used to establish new communication training at the University Medical Centre Hamburg-Eppendorf.
doi:10.1186/1472-6920-12-16
PMCID: PMC3338375  PMID: 22443807
4.  Is the use of videotape recording superior to verbal feedback alone in the teaching of clinical skills? 
BMC Public Health  2009;9:474.
Background
In recent times, medical schools have committed to developing good communication and history taking skills in students. However, there remains an unresolved question as to which constitutes the best educational method. Our study aims to investigate whether the use of videotape recording is superior to verbal feedback alone in the teaching of clinical skills and the role of student self-assessment on history taking and communication skills.
Methods
A randomized controlled trial was designed. The study was conducted with 52 of the Dokuz Eylul University Faculty of Medicine second year students. All students' performances of communication and history taking skills were assessed twice. Between these assessments, the study group had received both verbal and visual feedback by watching their video recordings on patient interview; the control group received only verbal feedback from the teacher.
Results
Although the self-assessment of the students did not change significantly, assessors' ratings increased significantly for videotaped interviews at the second time.
Conclusions
Feedback based on videotaped interviews is superior to the feedback given solely based on the observation of assessors.
doi:10.1186/1471-2458-9-474
PMCID: PMC2808318  PMID: 20021688
5.  Evaluation of a communication skills seminar for students in a Japanese medical school: a non-randomized controlled study 
Background
Little data exist for the effectiveness of communication skills teaching for medical students in non-English speaking countries. We conducted a non-randomized controlled study to examine if a short intensive seminar for Japanese medical students had any impact on communication skills with patients.
Methods
Throughout the academic year 2001–2002, a total of 105 fifth-year students (18 groups of 5 to 7 students) participated, one group at a time, in a two-day, small group seminar on medical interviewing. Half way through the year, a five-station objective structured clinical examination (OSCE) was conducted for all fifth-year students. We videotaped all the students' interaction with a standardized patient in one OSCE station that was focused on communication skills. Two independent observers rated the videotapes of 50 students who had attended the seminar and 47 who had not. Sixteen core communication skills were measured. Disagreements between raters were resolved by a third observer's rating.
Results
There was a statistically significant difference in proportions of students who were judged as 'acceptable' in one particular skill related to understanding patient's perspectives: asking how the illness or problems affected the patient's life, (53% in the experimental group and 30% in the control group, p = .02). No differences were observed in the other 15 core communication skills, although there was a trend for improvement in the skill for asking the patient's ideas about the illness or problems (60% vs. 40%, p = .054) and one of the relationship building skills; being attentive and empathic nonverbally (87% vs. 72%, p = .064).
Conclusion
The results of this study suggest that a short, intensive small group seminar for Japanese medical students may have had a short-term impact on specific communication skills, pertaining to understanding patient's perspectives.
doi:10.1186/1472-6920-4-24
PMCID: PMC534797  PMID: 15550166
6.  Developing counseling skills through pre-recorded videos and role play: a pre- and post-intervention study in a Pakistani medical school 
Background
Interactive methods like role play, recorded video scenarios and objective structured clinical exam (OSCE) are being regularly used to teach and assess communication skills of medical students in the western world. In developing countries however, they are still in the preliminary phases of execution in most institutes. Our study was conducted in a naïve under resourced setup to assess the impact of such teaching methodologies on the counseling skills of medical students.
Methods
Fifty four 4th year MBBS students were identified to be evaluated for communication skills by trained facilitators in a pre-intervention OSCE. The same group of students was given a demonstration of ideal skill level by means of videos and role playing sessions in addition to real life interaction with patients during hospital and community rotations. A post-intervention evaluation was carried out six months later through OSCE and direct observation through structured checklist (DOS) in hospital and community settings. The combined and individual performance levels of these students were analyzed.
Results
There was a statistically significant difference in the communication skills of students when assessed in the post-intervention OSCE (p = 0.000). Individual post-intervention percentages of study participants displayed improvement as well (n = 45, p = 0.02). No difference was observed between the scores of male and female students when assessed for two specific competencies of antenatal care and breast feeding counseling (p = 0.11). The mean DOS (%) score of 12 randomly selected students was much lower as compared to the post-intervention (%) score but the difference between them was statistically non significant, a result that may have been affected by the small sample size as well as other factors that may come into play in real clinical settings and were not explored in this study (59.41 ± 7.8 against 82.43 ± 22.08, p = 0.88).
Conclusions
Videos and role play in combination with community and clinical exposure are effective modes of teaching counseling skills to medical students. They can be successfully utilized even in a limited resource setup, as demonstrated by our trial.
doi:10.1186/1472-6920-10-7
PMCID: PMC2837024  PMID: 20102626
7.  Benefits of Teaching Medical Students How to Communicate with Patients Having Serious Illness 
Innovative approaches are needed to teach medical students effective and compassionate communication with seriously ill patients. We describe two such educational experiences in the Yale Medical School curriculum for third-year medical students: 1) Communicating Difficult News Workshop and 2) Ward-Based End-of-Life Care Assignment. These two programs address educational needs to teach important clinical communication and assessment skills to medical students that previously were not consistently or explicitly addressed in the curriculum. The two learning programs share a number of educational approaches driven by the learning objectives, the students’ development, and clinical realities. Common educational features include: experiential learning, the Biopsychosocial Model, patient-centered communication, integration into clinical clerkships, structured skill-based learning, self-reflection, and self-care. These shared features ― as well as some differences ― are explored in this paper in order to illustrate key issues in designing and implementing medical student education in these areas.
PMCID: PMC3375674  PMID: 22737055
medical student education; communication skills; end-of-life discussions; communicating bad news; end-of-life care
8.  Consumers as tutors – legitimate teachers? 
Background
The aim of this study was to research the feasibility of training mental health consumers as tutors for 4th year medical students in psychiatry.
Methods
A partnership between a consumer network and an academic unit in Psychological Medicine was formed to jointly develop a training package for consumer tutors and a curriculum in interviewing skills for medical students. Student attitudes to mental health consumers were measured pre and post the program. All tutorial evaluation data was analysed using univariate statistics. Both tutors and students evaluated the teaching program using a 4 point rating scale. The mean scores for teaching and content for both students and tutors were compared using an independent samples t-test.
Results
Consumer tutors were successfully trained and accredited as tutors and able to sustain delivery of tutorials over a 4 year period. The study found that whilst the medical students started with positive attitudes towards consumers prior to the program, there was a general trend towards improved attitude across all measures. Other outcomes for tutors and students (both positive and negative) are described.
Conclusions
Consumer tutors along with professional tutors have a place in the education of medical students, are an untapped resource and deliver largely positive outcomes for students and themselves. Further possible developments are described.
doi:10.1186/1472-6920-4-14
PMCID: PMC524164  PMID: 15377386
9.  An Interprofessional Course Using Human Patient Simulation to Teach Patient Safety and Teamwork Skills 
Objectives. To assess the effectiveness of human patient simulation to teach patient safety, team-building skills, and the value of interprofessional collaboration to pharmacy students.
Design. Five scenarios simulating semi-urgent situations that required interprofessional collaboration were developed. Groups of 10 to 12 health professions students that included 1 to 2 pharmacy students evaluated patients while addressing patient safety hazards.
Assessment. Pharmacy students’ scores on 8 of 30 items on a post-simulation survey of knowledge, skills, and attitudes improved over pre-simulation scores. Students’ scores on 3 of 10 items on a team building and interprofessional communications survey also improved after participating in the simulation exercise. Over 90% of students reported that simulation increased their understanding of professional roles and the importance of interprofessional communication.
Conclusions. Simulation training provided an opportunity to improve pharmacy students’ ability to recognize and react to patient safety concerns and enhanced their interprofessional collaboration and communication skills.
doi:10.5688/ajpe76471
PMCID: PMC3355291  PMID: 22611280
simulation; interprofessional; emergency department; patient safety; team work
10.  Peer Teaching in Paediatrics - Medical Students as Learners and Teachers on a Paediatric Course 
Background: Peer assisted learning is known as an effective educational strategy in medical teaching. We established a peer assisted teaching program by student tutors with a focus on clinical competencies for students during their practical training on paediatric wards. It was the purpose of this study to investigate the effects of a clinical skills training by tutors, residents and consultants on students evaluations of the teaching quality and the effects of a peer teaching program on self assessed clinical competencies by the students.
Methods: Medical student peers in their 6th year were trained by an intensive instruction program for teaching clinical skills by paediatric consultants, doctors and psychologists. 109 students in their 5th year (study group) participated in a peer assisted teaching program for training clinical skills in paediatrics. The skills training by student peer teachers were supervised by paediatric doctors. 45 students (control group) participated in a conventional paediatric skills training by paediatric doctors and consultants. Students from both groups, which were consecutively investigated, completed a questionnaire with an evaluation of the satisfaction with their practical training and a self assessment of their practical competencies.
Results: The paediatric skills training with student peer teachers received significantly better ratings than the conventional skills training by paediatric doctors concerning both the quality of the practical training and the support by the teaching medical staff. Self assessed learning success in practical skills was higher rated in the peer teaching program than in the conventional training.
Conclusions: The peer assisted teaching program of paediatric skills training was rated higher by the students regarding their satisfaction with the teaching quality and their self assessment of the acquired skills. Clinical skills training by student peer teachers have to be supervised by paediatric doctors. Paediatric doctors seem to be more motivated for their own teaching tasks if they are assisted by student peer teachers. More research is needed to investigate the influence of peer teaching on the motivation of paediatric doctors to teach medical students und the academic performance of the student peers.
doi:10.3205/zma000708
PMCID: PMC3140377  PMID: 21818216
Peer assisted learning; clinical skills training in paediatrics; student evaluation; student self assessment
11.  The longitudinal curriculum "social and communicative competencies" within Bologna-reformed undergraduate medical education in Basel 
Background: Within the Bologna reform, a longitudinal curriculum of “social and communicative competencies” (SOKO) was implemented into the new Bachelor-Master structure of undergraduate medical education in Basel (Switzerland).
Project description: The aim of the SOKO curriculum is to enable students to use techniques of patient-centred communication to elicit and provide information to patients in order to involve them as informed partners in decision making processes. The SOKO curriculum consists of 57 lessons for the individual student from the first bachelor year to the first master year. Teaching encompasses lectures and small group learning. Didactic methods include role play, video feedback, and consultations with simulated and real patients. Summative assessment takes place in objective structured clinical examinations (OSCE).
Conclusion: In Basel, a longitudinal SOKO curriculum based on students’ cumulative learning was successfully implemented. Goals and contents were coordinated with the remaining curriculum and are regularly assessed in OSCEs. At present, most of the workload rests on the shoulders of the department of psychosomatic medicine at the university hospital. For the curriculum to be successful in the long-term, sustainable structures need to be instituted at the medical faculty and the university hospital to guarantee high quality teaching and assessment.
doi:10.3205/zma000874
PMCID: PMC3778532  PMID: 24062811
Communication skills; longitudinal curriculum; undergraduate medical education; Bologna process
12.  A Virtual Practice Environment to Develop Communication Skills in Pharmacy Students 
Objective. To develop communication skills in second-year pharmacy students using a virtual practice environment (VPE) and to assess students’ and tutors’ (instructors’) experiences.
Design. A VPE capable of displaying life-sized photographic and video images and representing a pharmacy setting was constructed. Students viewed prescriptions and practiced role-playing with each other and explored the use of nonverbal communication in patient-pharmacist interactions. The VPE experiences were complemented with lectures, reflective journaling, language and learning support, and objective structured clinical examinations (OSCEs).
Assessment. Most students believed the VPE was a useful teaching resource (87%) and agreed that the video component enabled them to contextualize patient problems (73%). While 45% of students questioned the usefulness of watching the role plays between students after they were video recorded, most (90%) identified improvement in their own communication as a result of participating in the tutorials. Most tutors felt comfortable using the technology. Focus group participants found the modified tutorials more engaging and aesthetically positive than in their previous experience.
Conclusion. The VPE provided an effective context for communication skills development classes.
doi:10.5688/ajpe7610202
PMCID: PMC3530064  PMID: 23275667
communication; counseling; virtual environment; simulation; pharmacy students; video; tutorials
13.  Cross-sectional evaluation of a longitudinal consultation skills course at a new UK medical school 
BMC Medical Education  2011;11:55.
Background
Good communication is a crucial element of good clinical care, and it is important to provide appropriate consultation skills teaching in undergraduate medical training to ensure that doctors have the necessary skills to communicate effectively with patients and other key stakeholders. This article aims to provide research evidence of the acceptability of a longitudinal consultation skills strand in an undergraduate medical course, as assessed by a cross-sectional evaluation of students' perceptions of their teaching and learning experiences.
Methods
A structured questionnaire was used to collect student views. The questionnaire comprised two parts: 16 closed questions to evaluate content and process of teaching and 5 open-ended questions. Questionnaires were completed at the end of each consultation skills session across all year groups during the 2006-7 academic year (5 sessions in Year 1, 3 in Year 2, 3 in Year 3, 10 in Year 4 and 10 in Year 5). 2519 questionnaires were returned in total.
Results
Students rated Tutor Facilitation most favourably, followed by Teaching, then Practice & Feedback, with suitability of the Rooms being most poorly rated. All years listed the following as important aspects they had learnt during the session:
• how to structure the consultation
• importance of patient-centredness
• aspects of professionalism (including recognising own limits, being prepared, generally acting professionally).
All years also noted that the sessions had increased their confidence, particularly through practice.
Conclusions
Our results suggest that a longitudinal and integrated approach to teaching consultation skills using a well structured model such as Calgary-Cambridge, facilitates and consolidates learning of desired process skills, increases student confidence, encourages integration of process and content, and reinforces appreciation of patient-centredness and professionalism.
doi:10.1186/1472-6920-11-55
PMCID: PMC3161005  PMID: 21824390
14.  Patient safety and quality improvement education: a cross-sectional study of medical students’ preferences and attitudes 
BMC Medical Education  2013;13:16.
Background
Recent educational initiatives by both the World Health Organization and the American Association of Medical Colleges have endorsed integrating teaching of patient safety and quality improvement (QI) to medical students. Curriculum development should take into account learners’ attitudes and preferences. We surveyed students to assess preferences and attitudes about QI and patient safety education.
Methods
An electronic survey was developed through focus groups, literature review, and local expert opinion and distributed via email to all medical students at a single medical school in the spring of 2012.
Results
A greater proportion of students reported previous exposure to patient safety than to quality improvement topics (79% vs. 47%). More than 80% of students thought patient safety was of the same or greater importance than basic science or clinical skills whereas quality improvement was rated as the same or more important by about 70% of students. Students rated real life examples of quality improvement projects and participation in these projects with actual patients as potentially the most helpful (mean scores 4.2/5 and 3.9/5 respectively). For learning about patient safety, real life examples of mistakes were again rated most highly (mean scores 4.5/5 for MD presented mistakes and 4.1/5 for patient presented mistakes). Students rated QI as very important to their future career regardless of intended specialty (mean score 4.5/5).
Conclusions
Teaching of patient safety and quality improvement to medical students will be best received if it is integrated into clinical education rather than solely taught in pre-clinical lectures or through independent computer modules. Students recognize that these topics are important to their careers as future physicians regardless of intended specialty.
doi:10.1186/1472-6920-13-16
PMCID: PMC3570358  PMID: 23379673
Medical education; Quality improvement; Patient safety; Curriculum development
15.  Identifying Criteria for the Assessment of Pharmacy Students' Communication Skills With Patients 
Objectives
To identify criteria by which patients can assess the communication skills of pharmacy students.
Method
Potential assessment criteria were generated from 2 main sources: a literature review and a focus group discussion. A modified two-round Delphi survey was subsequently conducted with 35 professionals who were actively involved in teaching and assessing communication skills of pharmacy students to determine the importance and reliability of each criterion.
Results
Consensus ratings identified 7 criteria that were important measures of pharmacy students' communication skills and could be reliably assessed by patients.
Conclusions
A modified two-round Delphi consultation survey successfully identified criteria that can be used by patients to assess the communication skills of pharmacy undergraduates. Future work will examine the feasibility of using patients as assessors of communication skills of pharmacy students, preregistration pharmacists, and qualified pharmacists.
PMCID: PMC1913312  PMID: 17619650
communication; assessment; pharmacy students; patient evaluation
16.  Narrative medicine as a means of training medical students toward residency competencies 
Patient education and counseling  2013;91(3):280-286.
Objective
This study sought to explore the perceived influence of narrative medicine training on clinical skill development of fourth-year medical students, focusing on competencies mandated by ACGME and the RCPSC in areas of communication, collaboration, and professionalism.
Methods
Using grounded-theory, three methods of data collection were used to query twelve medical students participating in a one-month narrative medicine elective regarding the process of training and the influence on clinical skills. Iterative thematic analysis and data triangulation occurred.
Results
Response rate was 91% (survey), 50% (focus group) and 25% (follow-up). Five major findings emerged. Students perceive that they: develop and improve specific communication skills; enhance their capacity to collaborate, empathize, and be patient-centered; develop personally and professionally through reflection. They report that the pedagogical approach used in narrative training is critical to its dividends but misunderstood and perceived as counter-culture.
Conclusion/Practice implications
Participating medical students reported that they perceived narrative medicine to be an important, effective, but counter-culture means of enhancing communication, collaboration, and professional development. The authors contend that these skills are integral to medical practice, consistent with core competencies mandated by the ACGME/RCPSC, and difficult to teach. Future research must explore sequelae of training on actual clinical performance.
doi:10.1016/j.pec.2013.01.014
PMCID: PMC3992707  PMID: 23462070
Medical education; Narrative medicine; Communication; Physician/patient relationship; Medical humanities; Qualitative research; Values/attitudes; Competencies
17.  Evaluating Medical Student Communication/Professionalism Skills from a Patient’s Perspective 
Objective: Evaluate medical students’ communication and professionalism skills from the perspective of the ambulatory patient and later compare these skills in their first year of residency. Methods: Students in third year neurology clerkship clinics see patients alone followed by a revisit with an attending neurologist. The patient is then asked to complete a voluntary, anonymous, Likert scale questionnaire rating the student on friendliness, listening to the patient, respecting the patient, using understandable language, and grooming. For students who had completed 1 year of residency these professionalism ratings were compared with those from their residency director. Results: Seven hundred forty-two questionnaires for 165 clerkship students from 2007 to 2009 were analyzed. Eighty-three percent of forms were returned with an average of 5 per student. In 64% of questionnaires, patients rated students very good in all five categories; in 35% patients selected either very good or good ratings; and <1% rated any student fair. No students were rated poor or very poor. Sixty-two percent of patients wrote complimentary comments about the students. From the Class of 2008, 52% of students received “better than their peers” professionalism ratings from their PGY1 residency directors and only one student was rated “below their peers.” Conclusion: This questionnaire allowed patient perceptions of their students’ communication/professionalism skills to be evaluated in a systematic manner. Residency director ratings of professionalism of the same students at the end of their first year of residency confirms continued professional behavior.
doi:10.3389/fneur.2012.00098
PMCID: PMC3379033  PMID: 22723790
professional conduct; medical ethics; medical education
18.  Teaching communication skills to clinical students. 
BMJ : British Medical Journal  1993;306(6888):1322-1327.
Seven years' experience in teaching communication skills to first year clinical students at St Mary's Hospital School of Medicine is described. The first component consists of a day during the introductory clinical course; this is divided into a lecture and small seminar groups and involves behavioural scientists and clinicians from many departments. The second component uses simulated patients and video feedback and takes place in small groups later in the year. Participation of the students through active critical discussion, role play, and interactive video feedback are important aspects in the success of the course. The methods have been refined through evaluation by students and tutors. This article aims to allow others, already running or considering such a course, to develop effective courses within the practical constraints of their own institutions.
Images
PMCID: PMC1677733  PMID: 8518575
19.  Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors' skills and attitudes towards teachers and teaching 
Background
Development of students' teaching skills is increasingly recognised as an important component of UK undergraduate medical curricula and, in consequence, there is renewed interest in the potential benefits of cross-year peer tutoring. Whilst several studies have described the use of cross-year peer tutoring in undergraduate medical courses, its use in the clinical setting is less well reported, particularly the effects of peer tutoring on volunteer tutors' views of teachers and teaching. This study explored the effects of participation in a cross-year peer tutoring programme in clinical examination skills ('OSCE tutor') on volunteer tutors' own skills and on their attitudes towards teachers and teaching.
Methods
Volunteer tutors were final year MBChB students who took part in the programme as part of a Student Selected Component (SSC). Tutees were year 3 MBChB students preparing for their end of year 'OSCE' examination. Pre and post participation questionnaires, including both Likert-type and open response questions, were used. Paired data was compared using the Wilcoxon signed-rank test. All tests were two-tailed with 5% significance level.
Results
Tutors reflected their cohort in terms of gender but were drawn from among the more academically successful final year students. Most had previous teaching experience. They were influenced to participate in 'OSCE tutor' by a desire to improve their own teaching and associated generic skills and by contextual factors relating to the organisation or previous experience of the OSCE tutor programme. Issues relating to longer term career aspirations were less important. After the event, tutors felt that participation had enhanced their skills in various areas, including practical teaching skills, confidence in speaking to groups and communication skills; and that as a result of taking part, they were now more likely to undertake further teacher training and to make teaching a major part of their career. However, whilst a number of students reported that their views of teachers and teaching had changed as a result of participation, this did not translate into significant changes in responses to questions that explored their views of the roles and qualities required of a good clinical teacher.
Conclusion
Findings affirm the benefits to volunteer tutors of cross-year peer tutoring, particularly in terms of skills enhancement and reinforcement of positive attitudes towards future teaching responsibilities, and have implications for the design and organisation of such programmes.
doi:10.1186/1472-6920-7-20
PMCID: PMC1925072  PMID: 17598885
20.  The role of simulation in developing communication and gestural skills in medical students 
BMC Medical Education  2014;14:106.
Background
International studies have shown that laboratory training, particularly through the application of the principles of simulation learning, is an effective means of developing the communication and gestural skills of healthcare professionals. At the Advanced Simulation Center of the University of Genoa we have therefore established the first clinical skill laboratory with medical school students and an interprofessional team of trainers, as the first step towards developing simulation training of both medical and nursing students at our University.
The aim of this study was to assess student satisfaction with laboratory training in an Advanced Simulation Center.
Methods
All of the third-year students of the Medical School (n = 261) were invited to participate in the laboratory sessions at the Advanced Simulation Center. They were divided into groups and attended the Center for one week. The team of trainers included medical doctors and nurses involved in teaching at the University Medicine and Nursing programs. At the end of the week, the students were administered an anonymous questionnaire made up of two sections: the first one was on the content of individual laboratory sessions; the second on the training methods, materials used and the trainers. A five-point Likert scale was used to measure satisfaction.
Results
According to the students all of the topics covered by the laboratory sessions were irreplaceable. Questionnaire results showed a high level of satisfaction with the methods used, the instruments developed, and with the expertise and approachability of the educators. Almost all of the students wanted to participate in similar laboratory activities in the future.
Conclusions
The study highlighted the need to permanently integrate laboratory training sessions into the curriculum of medical students, who found them very useful and stimulating. The limit of this study was that only the teaching staff was interprofessional, and the students were only 3rd Year students of medicine.
In the future, we hope to include also nursing students because they will need to learn how to deal with aspects of their clinical practice that require an interprofessional approach.
doi:10.1186/1472-6920-14-106
PMCID: PMC4039313  PMID: 24885330
Simulation; Education; Communication skills; Gestural skills; Medical students; Nursing students
21.  "That never would have occurred to me": a qualitative study of medical students' views of a cultural competence curriculum 
Background
The evidence is mixed regarding the efficacy of cultural competence curricula in developing learners' knowledge, attitudes and skills. More research is needed to better understand both the strengths and shortcomings of existing curricula from the perspective of learners in order to improve training.
Methods
We conducted three focus groups with medical students in their first year of clinical training to assess their perceptions of the cultural competence curriculum at a public university school of medicine.
Results
Students evaluated the informal curriculum as a more important source of learning about cultural competence than the formal curriculum. In terms of bias in both self and others, the cultural competence curriculum increased awareness, but was less effective in teaching specific interventional skills. Students also noted that the cultural competence curriculum did not always sufficiently help them find a balance between group-specific knowledge and respect for individual differences. Despite some concerns as to whether political correctness characterized the cultural competence curriculum, it was also seen as a way to rehumanize the medical education experience.
Conclusion
Future research needs to pay attention to issues such as perceived relevance, stereotyping, and political correctness in developing cross-cultural training programs.
doi:10.1186/1472-6920-6-31
PMCID: PMC1481591  PMID: 16729888
22.  A curriculum to teach medical students to care for people with disabilities: development and initial implementation 
Background
Lack of knowledge and skills, and negative attitudes towards patients with disabilities, may adversely affect the services available to this group and negatively affect their health outcomes. The objective of this paper is to describe the development and initial implementation of a curriculum for teaching medical students to care for patients with disabilities.
Methods
We followed the six-step approach for developing curricula for medical education: general needs assessment, specific needs assessment, defining goals and objectives, determining the educational strategies, planning the implementation, and developing an evaluation plan.
Results
The curriculum has well defined goals and objectives covering knowledge, attitudes and skills. It employs both traditional and non-traditional teaching strategies. The implementation is planned over the four-year medical school curriculum in collaboration with a number of academic departments and specialized community-based agencies. The curriculum evaluation includes an attitudinal survey which is administered using a controlled design (pre- and post- exposure to the curriculum). The initial implementation of the curriculum has been very successful.
Conclusion
We have developed a longitudinal curriculum to teach medical students to care for people with disabilities. A rigorous evaluation of the impact of the curriculum is needed.
doi:10.1186/1472-6920-9-78
PMCID: PMC2809044  PMID: 20042110
23.  Implementation of the interdisciplinary curriculum Teaching and Assessing Communicative Competence in the fourth academic year of medical studies (CoMeD) 
Introduction: Implementation of a longitudinal curriculum for training in advanced communications skills represents an unmet need in most German medical faculties, especially in the 4rth and 5th years of medical studies. The CoMeD project (communication in medical education Düsseldorf) attempted to establish an interdisciplinary program to teach and to assess communicative competence in the 4th academic year. In this paper, we describe the development of the project and report results of its evaluation by medical students.
Methods: Teaching objectives and lesson formats were developed in a multistage process. A teaching program for simulated patients (SP) was built up and continuous lecturer trainings were estabilshed. Several clinical disciplines co-operated for the purpose of integrating the communication training into the pre-existing clinical teaching curriculum. The CoMeD project was evaluated using feedback-forms after each course.
Results: Until now, six training units for especially challenging communication tasks like “dealing with aggression” or “breaking bad news” were implemented, each unit connected with a preliminary tutorial or e-learning course. An OSCE (objective structured clinical examination) with 4 stations was introduced. The students’ evaluation of the six CoMeD training units showed the top or second-best rating in more than 80% of the answers.
Discussion: Introducing an interdisciplinary communication training and a corresponding OSCE into the 4th year medical curriculum is feasible. Embedding communication teaching in a clinical context and involvement of clinicians as lecturers seem to be important factors for ensuring practical relevance and achieving high acceptance by medical students.
doi:10.3205/zma000776
PMCID: PMC3296104  PMID: 22403591
medical education; communication; curriculum development; simulated patients; medical interview
24.  Can a multisensory teaching approach impart the necessary knowledge, skills, and confidence in final year medical students to manage epistaxis? 
Objective
The purpose of this study is to evaluate the efficacy of a multisensory teaching approach in imparting the knowledge, skills, and confidence to manage epistaxis in a cohort of fourth year medical students.
Methods
One hundred and thirty four fourth year medical students were recruited into the study from Aug 2011 to February 2012 in four groups. Students listened to an audio presentation (PODcast) about epistaxis and viewed a video presentation on the technical skills (VODcast). Following this, students completed a 5-minute Individual Readiness Assessment Test (IRAT) to test knowledge accrued from the PODcast and VODcast. Next, students observed a 10-minute expert demonstration of the technical skills on a human cadaver and spent half an hour practicing these techniques on cadaver simulators with expert guidance. The students’ confidence was assessed with Confidence Level Questionnaires (CLQs) before and after their laboratory session. The skill level of a subset of students was also assessed with a pre- and post-laboratory Objective Structured Assessment of Technical Skills (OSATS).
Results
Eighty two percent of the participants achieved a score of at least 80% on the IRAT. The CLQ instrument was validated in the study. There was a statistically significant improvement between the pre- and post-laboratory CLQ scores (p<0.01) and also between pre- and post-laboratory OSATS scores (p<0.01). Qualitative feedback suggested a student preference for this teaching approach.
Conclusions
This study provides further evidence that a multisensory teaching intervention effectively imparts the necessary knowledge, skill and confidence in fourth year medical students to manage epistaxis.
doi:10.1186/1916-0216-42-51
PMCID: PMC3899690  PMID: 24479815
25.  Standardized Patient-Narrated Web-Based Learning Modules Improve Students’ Communication Skills on a High-stakes Clinical Skills Examination 
Journal of General Internal Medicine  2011;26(11):1374-1377.
BACKGROUND
Use of web-based standardized patient (SP) modules is associated with improved medical student history-taking and physical examination skills on clinical performance examinations (CPX), but a benefit for communication skills has not been shown.
AIM
We describe an innovative web-based SP module using detailed SP and faculty commentary to teach communication skills.
SETTING
A public medical school in 2008–2009.
PARTICIPANTS
Fourth-year medical students.
PROGRAM DESCRIPTION
A 90-minute web-based module with three simulated clinical encounters was narrated by an expert clinician and SP to explain expected history-taking, physical examination, and communication skills behaviors. All 147 students were encouraged to review the module one month before the CPX.
PROGRAM EVALUATION
One hundred and six students (72%) viewed the web-based module. Students who watched the module performed significantly higher on the CPX communication score (+2.67%, p < 0.01) and overall score (+2.12%, p = 0.03), even after controlling for USMLE Step 1 and clerkship summary ratings. Use of the module did not significantly affect history/physical examination scores (+1.89%, p = 0.12).
DISCUSSION
Students who watched an optional web-based SP module prior to the CPX performed higher than those who did not on communication skills. The web-based module appears to be an effective CPX preparatory activity to enhance communication performance.
doi:10.1007/s11606-011-1809-3
PMCID: PMC3208474  PMID: 21769506
medical education; clinical skills; standardized patient; communication

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