Students and student life

Students are the lifeblood of medical education, and an enthusiastic and energetic group of young people with often strong views on their training. For this issue we have gathered together a range of papers addressing the experience of learning, many taking the student’s perspective. There are also a number of commissioned contributions from students and their teachers giving a wider flavour of contemporary experience. Two important themes run through the papers in this issue: firstly, there is a strong sense of commonality amongst many of the problems faced by students and by teachers across the world and, secondly, the great importance of properly planned and executed research is emphasised for its role in providing good evidence about the effect of teaching. Thomas More, the English cleric and scholar, wrote that the purpose of education is to bring about change. Feedback, to teachers in the form of evaluation, or to learners as a report on progress, is a powerful way of achieving change. Two papers in this month’s issue look closely at differing aspects of the feedback process. Abu-Zidan’s New Zealand based study of student evaluations of surgical seminars suggests that surgical teaching is improving in matters of style such as interactivity between teacher and student, and in providing stimulation. Areas identified by the students in need of further development include making teaching more oriented towards patient care and ensuring that evidence based approaches to clinical practice are included in routine teaching sessions. Amish Parikh and colleagues from the Centre for Research in Education at Toronto were interested in the types of feedback students received in problem based learning (PBL). They argue that whilst feedback about progress in learning is fast becoming a key part of modern medical education, the role played by feedback in PBL has not been widely studied. They sent questionnaires to a sample of final year students from all five of the medical schools in Ontario, including McMaster, and found significant differences between schools in the types and timing of feedback given to students. Definitions and applications of PBL vary around the world, as readers of this journal know well, so it is not surprising that this is also the case in Ontario. Students reported that the most helpful type of feedback was that given by the group tutor on an individual basis, but they also expressed strong preferences for peer and group feedback – unfortunately such methods were not commonly reported. Like feedback, student logbooks are also becoming a popular educational tool at both undergraduate and postgraduate levels. The idea behind many logbooks is that encouraging students to record the patients they see will help them to both reflect on their experiences and measure their progress towards key clinical learning objectives. As anyone involved in routine data collection knows, it can be difficult to be certain that you have captured all of the available data, and that the data you have is completely accurate. A study in Holland, at the Centre for Medical Education in Groningen, investigated how reliably students and doctors completed their logbooks and then measured interobserver agreement, as well as the specificity and sensitivity values for both groups. Students performed less well than doctors in completing their logbooks and in general, under-recorded cases available to them. The authors suggest feedback on the use of the logbook as a necessary step in improving their use. A recent paper in the Lancet, reviewing teaching about professional development in medical schools, called for special attention to be devoted to the informal curriculum and to the role of teachers as role models.1 Two studies from the community, one from New York, United States, and the other from Sheffield, England, look at aspects of relationships within the learning context and touch on both of these very important aspects of learning. Lee Ann Reisenberg and her colleagues used a Q-sort technique to examine the desirable characteristics of teachers in primary care. Teachers who encouraged students to take responsibility at levels appropriate to their experience were ranked highest. The paper also raises questions about differences in expectation between teachers, who in this study valued role modelling doctor-patient relationships, and students, who valued more practical learning experiences during their community attachments. Howe used an extended nominal group technique to examine what students thought of the educational value of their community experience. The very positive effect on learning of an enthusiastic teaching team and the opportunity to deal with the human side of disease emerged as highly valued areas, underlining how important and valuable these often intangible assets are in the curriculum.

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