Teaching the steps of evidence-based medicine (EBM) to undergraduate as well as postgraduate health care professionals is crucial for implementation of effective, beneficial health care practices and abandonment of ineffective, harmful ones. Stellenbosch University in Cape Town, South Africa, offers a 12-week, completely online module on EBM within the Family Medicine division, to medical specialists in their first year of training. The aim of this study was to formatively evaluate this module; assessing both the mode of delivery; as well as the perceived effectiveness and usefulness thereof.
We used mixed methods to evaluate this module: A document review to assess whether the content of the module reflects important EBM competencies; a survey of the students to determine their experiences of the module; and semi-structured interviews with the tutors to explore their perspectives of the module. Ethics approval was obtained.
The document review indicated that EBM competencies were covered adequately, although critical appraisal only focused on randomised controlled trials and guidelines. Students had a positive attitude towards the module, but felt that they needed more support from the tutors. Tutors felt that students engaged actively in discussions, but experienced difficulties with understanding certain concepts of EBM. Furthermore, they felt that it was challenging explaining these via the online learning platform and saw the need to incorporate more advanced technology to better connect with the students. In their view the key to successful learning of EBM was to keep it relevant and applicable to everyday practice. Tutors also felt that an online module on EBM was advantageous, since doctors from all over the world were able to participate.
Our study has shown that the online module on EBM was effective in increasing EBM knowledge and skills of postgraduate students and was well received by both students and tutors. Students and tutors experienced generic challenges that accompany any educational intervention of EBM (e.g. understanding difficult concepts), but in addition had to deal with challenges unique to the online learning environment. Teachers of EBM should acknowledge these so as to enhance and successfully implement EBM teaching and learning for all students.
Evidence-based medicine; Postgraduate; Online learning; Evaluation
Research training is essential in a modern undergraduate medical curriculum. Our evaluation aimed to (a) gauge students' awareness of research activities, (b) compare students' perceptions of their transferable and research-specific skills competencies, (c) determine students' motivation for research and (d) obtain students' personal views on doing research.
Undergraduate medical students (N=317) completed a research skills questionnaire developed by the Centre for Excellence in Teaching and Learning in Applied Undergraduate Research Skills (CETL-AURS) at Reading University. The questionnaire assessed students' transferable skills, research-specific skills (e.g., study design, data collection and data analysis), research experience and attitude and motivation towards doing research.
The majority of students are motivated to pursue research. Graduate entrants and male students appear to be the most confident regarding their research skills competencies. Although all students recognise the role of research in medical practice, many are unaware of the medical research activities or successes within their university. Of those who report no interest in a career incorporating research, a common perception was that researchers are isolated from patients and clinical practice.
Students have a narrow definition of research and what it entails. An explanation for why research competence does not align more closely with research motivation is derived from students' lack of understanding of the concept of translational research, as well as a lack of awareness of the research activity being undertaken by their teachers and mentors. We plan to address this with specific research awareness initiatives.
undergraduate; research skills; translational research; training; scholarly activity programmes
This study examined whether patient-identified melanomas were more advanced than dermatologist-identified tumors at routine clinic visits, and whether a personal or family history of skin cancer was associated with patterns of detection. A retrospective chart review was performed on melanoma patients (N = 201) in a private dermatology clinic. Variables included age, gender, pattern of detection (i.e., patient or a board certified dermatologist), personal or family history of skin cancer, skin type, and previous sun exposure, as well as tumor location and severity. Dermatologist-diagnosed melanomas were less invasive (P < 0.0005), and more likely present on the chest, back, and legs (P < 0.01). Conversely, patient-identified lesions were more likely to occur on the face, neck and scalp, be associated with younger patients, and a family history of melanoma, but not other types of skin cancer (P < 0.01). In a post-hoc analysis examining these factors as predictors of tumor invasiveness, only diagnostic source was significant. Specifically, dermatologist-identified tumors were significantly less invasive than patient-identified tumors. Although age, family history, and tumor location played roles in the early detection of melanomas, the most important factor was diagnostic source. Thus, board-certified dermatologists play a key role in the early detection of malignant melanoma.
Epidermal growth factor receptor inhibitors (EGFRI) produce various dermatologic side effects in the majority of patients, and guidelines are crucial for the prevention and treatment of these untoward events. The purpose of this panel was to develop evidence-based recommendations for EGFRI-associated dermatologic toxicities.
A multinational, interdisciplinary panel of experts in supportive care in cancer reviewed pertinent studies using established criteria in order to develop first-generation recommendations for EGFRI-associated dermatologic toxicities.
Prophylactic and reactive recommendations for papulopustular (acneiform) rash, hair changes, radiation dermatitis, pruritus, mucositis, xerosis/fissures, and paronychia are presented, as well as general dermatologic recommendations when possible.
Prevention and management of EGFRI-related dermatologic toxicities is critical to maintain patients’ health-related quality of life and dose intensity of antineoplastic regimens. More rigorous investigation of these toxicities is warranted to improve preventive and treatment strategies.
Electronic supplementary material
The online version of this article (doi:10.1007/s00520-011-1197-6) contains supplementary material, which is available to authorized users.
Rash; Xerosis; Paronychia; Pruritus; Radiation dermatitis; Mucositis; EGFR inhibitors; Recommendations
A questionnaire returned by nearly 3,000 dermatologists indicates that about 75 percent of them have discontinued completely the use of x-ray therapy in acne. An additional 11 percent use it in less than 10 percent of their patients who have this disease.
“Hazards” constituted the greatest deterrent to the use of ionizing radiation. Yet the assumption that it can cause skin cancers, in the absence of radiodermatitis, is not proved and its importance as an additive energy to solar radiation is considered to be limited.
About one-third of the respondents expressed belief that better treatments were available for this condition. An equal number were concerned with public resistance to this therapeutic agent, which, however, seems to be more apparent than real. Probably the major roadblock was posed by the dermatologic training centers where teaching was withheld despite a rule of the American Board of Dermatology favoring it. Other factors mentioned with some frequency included ineffectiveness of radiotherapy, lack of equipment, and fiscal and medicolegal considerations.
This study indicates that dermatologic radiation therapy is passing into oblivion.
Skin lesions are extremely common, with 54% of the UK population being affected by skin disease annually. As such, dermatological conditions can be brought to light following admission to hospital for different underlying conditions, with 57% of the dermatological diagnoses made on the hospital wards, unrelated to previous patient history or reasons for admission. The role of the dermatologist is therefore comprehensive and inherently important in the hospital. General practitioners play an integral role in managing skin conditions in the community, with up to 24% of consultations relating to skin disease, referring patients to dermatology mainly for the management of more complex conditions, and diagnosis of certain skin lesions. It is therefore essential to further analyse these roles and to better understand the extent of inpatient and outpatient activity to better plan the provision of dermatological services whether in the community, or in the hospital.
Background and Objectives
The diverse US population requires medical cultural competency education for health providers throughout their pre-professional and professional years. We present a curriculum to train pre-health professional undergraduates by combining classroom education in the humanities and cross-cultural communication skills with volunteer clinical experiences at the University of California, Los Angeles (UCLA) hospital.
The course was open to a maximum of 15 UCLA junior and senior undergraduate students with a pre-health or humanities major and was held in the spring quarters of 2002–2004. The change in students' knowledge of cultural competency was evaluated using the Provider's Guide to Quality and Culture Quiz (QCQ) and through students' written assignments and evaluations.
Trainees displayed a statistically significant improvement in scores on the QCQ. Participants' written assignments and subjective evaluations confirmed an improvement in awareness and a high motivation to continue learning at the graduate level.
This is the first evaluated undergraduate curriculum that integrates interdisciplinary cultural competency training with patient volunteering in the medical field. The didactic, volunteering, and writing components of the course comprise a broadly applicable tool for training future health care providers at other institutions.
Organ transplant recipients (OTRs) have 100-fold increased risk of developing squamous cell carcinomas. Cumulative exposure to ultraviolet radiation is the main risk factor and there is evidence that lack of dermatological surveillance may be responsible for poor levels of knowledge and photoprotection among OTRs.
This study evaluated whether routine consultation in a specialist OTR dermatology clinic improves understanding of skin cancer risk and compliance with photoprotection measures.
A cross-sectional questionnaire-based study was performed in a specialist OTR dermatology clinic at Bart's and the London NHS Trust, London, U.K. The subjects were 399 white-skinned patients under surveillance in a renal transplant clinic, who were sent a postal questionnaire from the renal transplant clinic. The main outcome measures were responses to the questionnaire regarding photoprotective practices and skin cancer risk awareness.
Two hundred and ninety-two of 399 (73%) responded, of whom 89% had previously attended the specialist dermatology clinic. Ninety-six per cent recalled receiving photoprotection advice at least once (85% from dermatologists); 92% reported use of sunscreen; 88% specifically dressed to photoprotect themselves; 96% directly avoided sun exposure during summer; 68% were aware that an increased risk of skin cancer was the reason that extra photoprotective measures were important after a transplant. Photoprotective measures and level of skin cancer awareness were significantly lower in those responders who had never attended the specialist clinic. No obvious bias was identified among nonresponders.
Skin cancer awareness and compliance with photoprotective measures in our patient population is generally greater than previously reported, suggesting that delivery of educational messages regarding skin cancer may be improved if provided in a specialist dermatological setting.
audit; compliance; organ transplant recipients; photoprotection; skin cancer awareness; specialist dermatology clinics
Medical schools have a major challenge in teaching students to choose and prescribe medicines safely and effectively. Problem-based learning based on national essential medicine lists and standard treatment guidelines has been strongly recommended to improve prescribing. In Nepal, pharmacology is taught during the first two years of the undergraduate medical course. At KIST Medical College, Lalitpur the Department of Clinical Pharmacology teaches students to use essential medicines rationally. Small group, activity-based learning is used during practical sessions. In this article the author lists the 10 basic competencies which students should have developed by the end of the pharmacology practical module and also describes a selection of activities with regard to a particular competency used during the practical module and an exercise used to assess these competencies during the practical examination.
Competencies; Nepal; Pharmacology; Small groups
Competency-based education for public health professionals has been recommended by the Institute of Medicine. The Association of Schools of Public Health has developed a set of academic core competencies that it recommends that all Master of Public Health (MPH) students should possess prior to graduation. This article discusses the processes and reasoning used by the workgroup that prepared the epidemiology subset of MPH core competencies that appear in the association's 2006 report. These academic core competencies are complementary to but distinct from the specialist competencies that students should develop in their major field. The authors emphasize the importance of ongoing refinement of the core competency model with participation from both public health academics and public health practitioners.
Most of the many computer resources used in clinical teaching of dermatology and venereology for medical undergraduates are information-oriented and focus mostly on finding a "correct" multiple-choice alternative or free-text answer. We wanted to create an interactive computer program, which facilitates not only factual recall but also clinical reasoning.
Through continuous interaction with students, a new computerised interactive case simulation system, NUDOV, was developed. It is based on authentic cases and contains images of real patients, actors and healthcare providers. The student selects a patient and proposes questions for medical history, examines the skin, and suggests investigations, diagnosis, differential diagnoses and further management. Feedback is given by comparing the user's own suggestions with those of a specialist. In addition, a log file of the student's actions is recorded. The program includes a large number of images, video clips and Internet links. It was evaluated with a student questionnaire and by randomising medical students to conventional teaching (n = 85) or conventional teaching plus NUDOV (n = 31) and comparing the results of the two groups in a final written examination.
The questionnaire showed that 90% of the NUDOV students stated that the program facilitated their learning to a large/very large extent, and 71% reported that extensive working with authentic computerised cases made it easier to understand and learn about diseases and their management. The layout, user-friendliness and feedback concept were judged as good/very good by 87%, 97%, and 100%, respectively. Log files revealed that the students, in general, worked with each case for 60–90 min. However, the intervention group did not score significantly better than the control group in the written examination.
We created a computerised case simulation program allowing students to manage patients in a non-linear format supporting the clinical reasoning process. The student gets feedback through comparison with a specialist, eliminating the need for external scoring or correction. The model also permits discussion of case processing, since all transactions are stored in a log file. The program was highly appreciated by the students, but did not significantly improve their performance in the written final examination.
Chagas disease, an infection caused by the protozoan Trypanosoma cruzi and transmitted by the Reduuvid insect vector, remains a major cause of morbidity in Central and South America over a century after its discovery in 1909. Though major advances in preventing the spread of this disease have been made in recent decades, millions of individuals remain chronically infected due to prior exposure to T. cruzi and are at risk for future complications from the disease. Dermatologic manifestations of acute infection may include localized swelling at the site of inoculation (chagoma), conjunctivitis (Romaña’s sign), and a generalized morbilliform eruption (schizotrypanides). Reactivation of quiescent infection in immunocompromised hosts due to the acquired immunodeficiency syndrome or organ transplantation can present with fever and skin lesions including panniculitis. The wide-spread emigration of chronic carriers of T. cruzi to North America, Europe, and Australia makes it imperative that dermatologists worldwide be familiar with this entity to ensure proper diagnosis and treatment.
We analysed, by a prospective observational study over a 3-year period, the frequency and character of dermatological symptoms and diseases in children admitted to a tertiary general paediatric intensive care unit (PICU) of a university hospital. Skin problems were observed in 42 of 1,800 children admitted. There was a large variability in dermatological diseases in the PICU. In the majority (23/42), the skin problem was a dermatological manifestation of an underlying illness that caused admission to the PICU, e.g. infection, vasculitis or drug reaction. In four of the seven children who died, a direct relation between the dermatological disease and the cause of death could be established. Although the number of patients with relevant dermatological problems was limited, we believe that a skilled paediatric dermatologist is able to contribute to the effectiveness of diagnostic and therapeutic processes in paediatric intensive care patients.
Paediatric intensive care; Iatrogenic; Infection; Purpura
The selection of medical graduates for postgraduate training has often been considered to be unreliable and arbitrary because of the quality of information made available by medical schools to program directors. Many faculties of medicine have changed from reporting graduate performance in percentage grades to using an honours/pass/fail grading system to ensure that clearly established criteria for competence have been met and to encourage excellence and minimize competition. Unfortunately, the honours/pass/fail grading system has not been able to give a clear statement of relative class standing to assist in postgraduate selection. This paper describes a modified honours grading system, which takes into account a student's grade, the relative weighting of a course and the number of honours grades awarded per course. The proposed system was found to rank students in a way similar to that of the traditional percentage grading system, with no significant loss in internal consistency. The modified honours grading system permits faculties that use honours/pass/fail grades to report student performance and class standing, thereby assisting program directors in the selection of medical students for postgraduate training.
Though significant data exist highlighting the extent of health disparities there is limited data specifically on dermatologic health disparities. Melanoma and nonmelanoma skin cancer outcomes are poorer for ethnic minorities, people of low socioeconomic status, less educated, elderly, and uninsured. Recent reports indicate that atopic dermatitis is more prevalent among ethnic minorities; however it is unclear if morbidity is also increased in these populations. Given the current dermatology workforce shortage, the increased patient load may have an adverse effect on dermatologic care access. Additional concerns include the state of dermatologic training, insufficient research involving ethnic minorities, and a lack of investigations of dermatologic health disparities. As the U.S. demographics shift to become more racially diverse, the need to address and reduce dermatologic health disparities will increase.
health disparities; dermatology; education; workforce; atopic dermatitis; skin cancer; research
In the majority of dental schools there are insufficient numbers of clinical patients for all students to receive optimal experience in intravenous sedation. This investigation was carried out to assess whether the signs and symptoms for intravenous sedation taught to the undergraduates were sufficiently objective to ensure that this clinical deficiency was not detrimental to competency of the graduating student. The signs of ptosis, altered speech and blurred vision were used by both experienced dentists and novice students to assess the level of intravenous sedation. Blurred vision was found to be unreliable while altered speech was more accurate than ptosis. The more experienced the operator the earlier the signs were observed.
The “Guidelines for the Teaching of Pain and Anxiety Control in Dentistry” were initially formulated by the American Dental Association in 1971 and revised in 19781 while similar guidelines were accepted by the House of Delegates of the Association of the Canadian Faculties of Dentistry in 19752 Both of these documents outlined the course of instructions necessary for the teaching of all modalities of pain and apprehension control at the undergraduate, postgraduate and continuing education level. Implementation of these guidelines at the undergraduate level has proven to be particularly difficult in the area of intravenous sedation because of the lack of suitable patients. This has resulted in many students graduating, having had little practical experience in sedating a patient with an intravenous drug. It is the hope of educators in this field that lectures, seminars, and demonstrations given to dental students are sufficient to overcome this deficiency.
Since the most critical clinical aspect of intravenous sedation is titrating the amount of drug required without overdosing or underdosing the patient, it was decided to investigate this ability in students with no clinical experience with intravenous diazepam. Although many drugs and techniques are advocated3,4,5 it was decided to limit the study to intravenous diazepam as it may be used alone and has a high therapeutic index.
With the introduction of diazepam to clinical practice the symptomatology of the drug was established and described by clinicians.6,7 Objective methods of measuring recovery from diazepam have been described by several authors8,9,10 but the signs and symptoms used to assess the initial level of sedation have been subjective. This can be attributed to the fact that sedation is an ill-defined clinical effect and can, therefore, only be calibrated by individual arbitary signs. The most frequently used signs for intravenous diazepam sedation are ptosis, also referred to as “the Verrill sign,”11 altered speech and blurred vision.7 This investigation was designed to test the reliability of these signs and to examine the variability of observations between clinicians and students.
Critical appraisal of scientific literature is an integral part of Evidence Based Medicine (EBM). Many medical practitioners have either limited or no formal education in research and are inadequately prepared to critically analyze the quality of research they are reading. This study presents the instructional strategy, students’ evaluation and the feedback of the undergraduate and postgraduate students on teaching critical appraisal of published medical literature to undergraduate and postgraduate students in the Ziauddin Medical University, Karachi, Pakistan.
Two batches of undergraduate medical students of Year-3 (n = 85) and a group of (n = 18) postgraduate students in basic sciences, community health sciences and family medicine.
After 170 hours of teaching of biostatistics, epidemiology and survey methodology in Year-1 & 2, in Year-3 of undergraduate curriculum, six 2-hour structured sessions for critical appraisal of research articles published in peer reviewed journals were held.
All (N=103) students who took the course appeared in the objective structured practical examination (OSPE), where out of 100 they scored 74.3 ± 9.1. The studentds’ feedback on a 5-point Likert’s scale questionnaire showed the mean of overall satisfaction of the students is 3.93, and appreciation of relevance of quantitative subjects to understand medical literature is 4.89. All respondents agreed and strongly agreed the course helped them appreciate the relevance of quantitative subjects to understanding of medical literature
This course should be considered as the first step in the journey of becoming a competent self learner and should be followed by courses on EBM.
Evidence based medicine; critical appraisal skills
The study aimed to review the prescribing knowledge of first-year postgraduate doctors in a medical college in India, using the principles of good prescribing, to suggest strategies to improve rational prescribing, and to recommend what curriculum planners can do to accomplish this objective.
Fifty first-year postgraduate doctors were asked to fill in a structured questionnaire that sought information regarding their undergraduate training in clinical pharmacology and therapeutics, prescribing habits, and commonly consulted drug information sources. Also, the questionnaire assessed any perceived deficiencies in their undergraduate clinical pharmacology teaching and sought feedback regarding improvement in the teaching.
Eighty-eight percent of residents said that they were taught prescription writing in undergraduate pharmacology teaching; 48% of residents rated their prescribing knowledge at graduation as average, 28% good, 4% excellent, 14% poor, and 4% very poor; 58% felt that their undergraduate training did not prepare them to prescribe safely, and 62% felt that their training did not prepare them to prescribe rationally. Fifty-eight percent of residents felt that they had some specific problems with writing a prescription during their internship training, while 92% thought that undergraduate teaching should be improved. Their suggestions for improving teaching methods were recorded.
This study concludes that efforts are needed to develop a curriculum that encompasses important aspects of clinical pharmacology and therapeutics along with incorporation of the useful suggestions given by the residents.
clinical pharmacology and therapeutics; medical education; prescription writing; undergraduate medical curriculum; pharmacovigilance; pharmacoeconomics
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.
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.
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.
Future research needs to pay attention to issues such as perceived relevance, stereotyping, and political correctness in developing cross-cultural training programs.
Objective. To determine the perceptions of junior pharmacy faculty members with US doctor of pharmacy (PharmD) degrees regarding their exposure to residency, fellowship, and graduate school training options in pharmacy school. Perceptions of exposure to career options and research were also sought.
Methods. A mixed-mode survey instrument was developed and sent to assistant professors at US colleges and schools of pharmacy.
Results. Usable responses were received from 735 pharmacy faculty members. Faculty members perceived decreased exposure to and awareness of fellowship and graduate education training as compared to residency training. Awareness of and exposure to academic careers and research-related fields was low from a faculty recruitment perspective.
Conclusions. Ensuring adequate exposure of pharmacy students to career paths and postgraduate training opportunities could increase the number of PharmD graduates who choose academic careers or other pharmacy careers resulting from postgraduate training.
pharmacy faculty members; residency programs; fellowships; graduate education; careers
The objective of the study was to assess the impact of psychological/psychiatric assessment in patients with chronic or intractable dermatological conditions. A diagnostic interview was undertaken in order to pin-point any temporal connection between an adverse life-event and the first appearance of the skin disorder. Following this, the dermatologist's assessment of subsequent changes in the skin disorder were noted. The three main dermatological diagnoses were atopic eczema (10), prurigo (10), and psoriasis (nine). Follow-up was for up to 5 years. A favourable response was noted in 40 out of the 64 patients who participated in the study; this was usually evident within a few weeks and maintained thereafter. Remission was achieved in 12, while 28 showed some improvement. We conclude that this liaison between dermatology and psychiatry proved a valuable adjunct to normal dermatological treatment and was followed by improvement in the majority of patients.
Digital color image analysis is currently considered as a routine procedure in dermatology. In our previous study, a multimodal facial color imaging modality (MFCIM), which provides a conventional, parallel- and cross-polarization, and fluorescent color image, was introduced for objective evaluation of various facial skin lesions. This study introduces a commercial version of MFCIM, DermaVision-PRO, for routine clinical use in dermatology and demonstrates its dermatological feasibility for cross-evaluation of skin lesions.
Sample images of subjects with actinic keratosis or non-melanoma skin cancers were obtained at four different imaging modes. Various image analysis methods were applied to cross-evaluate the skin lesion and, finally, extract valuable diagnostic information. DermaVision-PRO is potentially a useful tool as an objective macroscopic imaging modality for quick prescreening and cross-evaluation of facial skin lesions.
DermaVision-PRO may be utilized as a useful tool for cross-evaluation of widely distributed facial skin lesions and an efficient database management of patient information.
DermaVision-PRO; Actinic keratosis; Cross-evaluation; Multimodal imaging
Postgraduate medical education and training in many specialties, including Clinical Radiology, is undergoing major changes. In part this is to ensure that shorter training periods maximise the learning opportunities but it is also to bring medical education in line with broader educational theory. Learning outcomes need to be defined so that there is no doubt what knowledge, skills, attitudes and behaviours are expected of those in training. Curricula should be developed into competency or outcome based models and should state the aims, objectives, content, outcomes and processes of a training programme. They should include a description of the methods of learning, teaching, feedback and supervision. Assessment systems must be matched to the curriculum and must be fair, reliable and valid. Workplace based assessments including the use of multisource feedback need to be developed and validated for use during radiology training. These should be used in a formative and developmental way, although the overall results from a series of such assessments can be used in a more summative way to determine progress to the next phase of training. Formal standard setting processes need to be established for ‘high stakes’ summative assessments such as examinations. In addition the unique skills required of a radiologist in terms of image interpretation, pattern recognition, deduction and diagnosis need to be evaluated in robust, reliable and valid ways. Through a combination of these methods we can be assured that decisions about trainees’ progression through training is fair and standardised and that we are protecting patients by establishing national standards for training, curricula and assessment methods.
Postgraduate; radiology; training; education
The development of a seamless general practice 'spiral' curriculum, in which topics may be revisited at different levels of intensity and complexity during the learning process, has been discussed in the context of undergraduate-postgraduate co-operation. Although the lifelong curriculum for all doctors contains a number of core competencies that aim to produce a 'stem' doctor, concerns remain about the effects of excessive reductionism. It is therefore essential that the content and delivery of the spiral curriculum ensure that intellectual interest is nurtured, by containing both taught theory and training in a hospital context. The opportunity for generalists to teach core competencies such that general practice is at the centre of the undergraduate curriculum--emphasising working within primary health care teams in teaching and training practices--is an ideal area for undergraduate-postgraduate co-operation. The use of the directly observed measures of performance would bring the undergraduate approach to assessment closer to that used in postgraduate general practice. However, supporting the tutors' network is crucial in undergraduate departments where much can be gained by joint working with postgraduate colleagues.
Outpatient clinics are a key element in dermatology health service provision thus making them an excellent place for intern and medical student rotations. However, this requires that patients are willing to interact with these trainees. This study assessed the attitudes of patients towards interns and medical students rotating in dermatology clinics.
All 112 patients interacting with medical students and interns at dermatology clinics at King Fahad Specialist Hospital in Almadinah Almunawwarah region, Saudi Arabia, from September to November 2009 completed a cross-sectional survey, which assessed their acceptance of these trainees.
Ninety-eight of 112 patient responses were valid. A total of 44 (44.9%) of these 98 patients had a chance to interact with 1–3 medical students or interns during their visit. The majority of the patients preferred the treating physician to be present during history taking by the interns and students. A majority of patients preferred that their physical examination be done by the physician alone (61.2%), whereas others (26.5%) preferred an intern with the physician. Both male and female patients preferred that their health care provider be of the same sex.
The patients in dermatology clinics accept the services of interns and students, while also expecting privacy. Therefore, interns and students should be confident when taking patient histories and performing physical examinations.
Attitude; Dermatology; Medical students