Untitled - South East Asian Journal of Medical Education

environment. Our results are discussed inthe light of these studies.The majority of graduates agreed thatmost teaching/ learning activities wereuseful in gaining knowledge and skillsnecessary to practice as a house officer. Astudy of Students' perspectives on theeducational environment at the Faculty ofMedical Sciences, Trinidad; where theDREEM questionnaire administered tofinal-year medical students and first-yearmedical interns, the overall studentperceptions were positive with a meanDREEM score of 109.9 ( Bassaw et al.,2003).Traditionally, apprenticeship learning hasbeen relevant for the medical profession(Vleuten et al., 2000), and still theapprentice system of clinical clerkshipremains the cornerstone of clinicalinstruction (Harth et al., 1992). This view isreflected by most graduates who found theclerkship based AHO scheme in Medicineto be useful. Yet a study at the Universityof Antwerp, Belgium concluded thatClinical clerkships do not automaticallyprovide an ideal learning environment formedical students (Remmen et al., 2000).Some teaching/ learning activities such aslabour room activities were found to beenjoyable by many graduates and thisview is reflected in the above study wheredelivery room activities were reportedmost favourably with regard to instructivevalue. The attitude of the consultants wasviewed as prejudiced and temperamentalby some graduates. This view is reiteratedin many studies by comments such as:tutors displayed favouritism, anger, apatronizing attitude, and even victimizedand ridiculed students (Harth et al.,1992).Incidents of humiliation by seniormedical staff occurred when the studentswere repeatedly unable to answer thesame questions or when they werecriticised for an inadequate clinicalexamination (Lempp & Seale, 2004). Theirindividuality was not recognised in thatneither their existing skills nor theexperience were acknowledged by doctors(Seabrook, 2004).This behaviour of consultants was rated asbeing highly stressful by many graduates.Even in other studies relationships withconsultants aroused strong feelings, withstudents describing stressful situationssuch as being humiliated in front of theirpeers (Radcliffe & Lester, 2003). Similaraspects of the teacher−studentrelationship have been reported asstressful, such as being expected to havemedical knowledge which they had notbeen taught and incidents when they wereshouted at or felt humiliated (Lempp &Seale, 2004). This highly negative aspectof stress in teaching through humiliation isa recurring theme.The low ratings for student-nurserelationship in the study are reflected inother studies and several reasonspostulated. In one study, “several incidentswhere nurses and midwives treatedmedical students disrespectfully arereported, and such behaviour may indicatea degree of professional rivalry” (Lempp &Seale, 2004). Another states that“students' relationships with nurses couldalso be difficult, reflecting some of thetensions between the two professions, andthe lack of a formal role for nurses inmedical education” (Lempp & Seale,2004).With regards to assessing final yearclinical training, some graduates perceivedexaminers of long/ short cases to beprejudiced and inconsistent. According toPonnamperuma et al., 2003) thesetraditional forms of assessment have beenexcluded from current assessmentsystems of many institutions. Reiteratingour findings they further state that thesemethods lack standardisation andobjectivity, and suggest variants such asOSCEs and alternatives such as Portfolioassessments as better methods.The MCQ type currently used at the finalyear assessments are true/ falsequestions, which graduates found to testfacts. Swanson (Harth et al., 1992)highlights this deficiency by stating that “intrue/ false questions we are pushedtowards assessing recall of an isolatedfact”, and suggests that “application ofknowledge, integration, synthesis andjudgement questions can better beassessed by one-best-answer questions.As a result, the NBME has completelystopped using true/ false formats on itsexaminations”28South East Asian Journal of Medical EducationInaugural issue