AMEE Berlin 2002 Programme

8J3 Clinical skills training - a new
curriculum between BEME and
reality
Peter Frey
University of Bern, Department of Instructional Media (AUM),
Inselspital 38, CH - 3010 Bern, SWITZERLAND
Clinical skills like history taking and physical
examination are basic skills for clinical reasoning and
the right decisions in patient management. How should
a curriculum be planned and implemented to get the
best evidence medical education? At the Medical
School of Berne Switzerland fundamental changes in
the third year curriculum (first clinical year) allows
the establishment of a new state-of-the art curriculum.
The presentation describes the needs and the change
management, how the goals and objectives were
formulated, the instructional strategies (small group
work, standardization of the training, instruction of
tutors, use of guidelines), the credit system, the use of
information technologies and the barriers of the new
curriculum. Homepage: http://studmed.unibe.ch
8J4 The effects of student gender on
patients’ willingness to be
examined by medical students
William P Metheny*, Roxanne Jamshidi and Kara Pitt
Brown University School of Medicine/Women and Infants
Hospital, 101 Dudley Street, Providence, RI 02905, USA
Gender discrimination by patients can affect the clinical
experiences medical students get. Excluding male
medical students from the gynecologic exam or the
prenatal visit may directly affect their clinical
performance. We hypothesized that patients who were
told the student’s gender (males in particular) prior to
the examination were more likely to reject the student
than patients who were not told the student’s gender in
advance. Our experiment tested this hypothesis by
assigning students to one of two female residents in an
ob/gyn clinic who in asking permission of the patient
would either refer to the student as a medical student
(gender neutral) or identify the student’s gender.
Patients (n=66) did not differ (p> .05) in responding to
the two conditions; however they rejected only males
in the gender specific situation. The way students are
presented to patients can affect patient receptivity to
them.
Wednesday 5 September
- 4.98 -
8J5 Reality shock among medical
students attending first clinical
rotation
I Levi* and T Fischel
Sackler Medical School, 13/2 Tsel Hagivaa, Ramat Gan, ISRAEL
Discrepancy between fantasy that is perceived during
preclinical studies, and reality as met during clinical
rotation may cause difficulties and frustration, a state
that can be defined as “reality shock”. An open
interview was conducted with 40 students attending
their first clinical rotation in an internal medicine
department. Main difficulties described by the students
were their position within the department staff, and their
right to disturb patients while taking their history and
making a physical examination. Significant gaps in
“doctor–patient relationship” as met in real life opposed
to what was learned at school, and gaps in “success
rates” in medical treatment between real life and fantasy
contributed also to “reality shock”. Reality shock is
common in medical students attending their first
clinical experience and can contribute to students’
frustration and burnout. Medical schools should take
this into consideration in planning the preclinical and
clinical curriculum.
8J6 Experiential clinical learning in a
horizontally-integrated, problembased
curriculum
Tim Dornan*, Arno Muijtjens and Henny Boshuizen
Universities of Manchester and Maastricht, 10 Raynham Avenue,
Didsbury, Manchester M20 6BW, UK
The aim of the study was to test whether better
horizontal integration was achievable in the clerkship
phase of a problem-based curriculum. Eight first
clerkship students using a learning portfolio and
attending weekly group tutorials to support selfdirected
reflective clinical learning were compared with
16 historical and 16 contemporary controls. Results
revealed mean agreement with: ‘I was able to see the
types of patients I needed to see’ rose from 3.5 ± 1.1 to
4.4 ± 0.7; 0.1>p>0.05. Historical controls commented
on the inappropriateness of casemix whereas
experimental subjects commented positively about
casemix, and outpatient learning. Mean rating of
outpatient learning rose: 3.6 ± 0.8 to 4.6 ± 0.5 (p=
0.001). Mean rating for inpatient learning was
unchanged. Despite those improvements, learning
remained strongly influenced by the clerkship’s
specialty interest. It was concluded that some measures
of experiential clinical learning improved; other
interventions are needed to help students cross specialty
boundaries.