Can students learn comparable clinical skills in general practice and hospital settings?

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7143.1531a (Published 16 May 1998) Cite this as: BMJ 1998;316:1531

Students are discriminating consumers of educational experience

  1. Sarah Hartley, Clinical lecturer in general practice (s.hartley@ic.ac.uk),
  2. Anita Berlin, Senior lecturer in general practice,
  3. Neil Tolley, Consultant ear, nose, and throat surgeona
  1. a
  2. b
  3. Medical School Buildings, University of Aberdeen, Aberdeen AB25 2ZD
  4. Department of Primary Care and Population Sciences, Whittington Hospital, London N19 5NF
  5. Medical Educational Unit, University of Leeds LS2 9NL

    EDITOR—Murray et al used a randomised crossover trial to study the acquisition of clinical skills in general practice.1 Our experience with the use of randomised trials in medical education has shown that they may be unacceptable to students. In 1996, teaching by general practitioners was introduced into the ear, nose, and throat curriculum of the Imperial College School of Medicine at St Mary's. The aim of such teaching was to give students a grounding in the basic skills of taking a history and examining the ear, nose, and throat. All the general practitioners were trained in teaching skills, and they attended a refresher course in ear, nose, and throat medicine. The students were allocated to the general practitioners for three sessions during the four week course.

    A study was designed to ascertain the most effective form of teaching. After a pilot phase in which all the students were taught by the general practitioners (to ensure that the tutors were experienced in teaching) the students were randomised to either teaching by the general practitioners or the old curriculum. An objective structured clinical examination was planned at the end of every two rotations. After the first rotation the students refused to be randomised to the old curriculum. They explained that unless they were taught by a general practitioner they had no systematic training in ear, nose, and throat examination. They refused to participate and the trial was abandoned. All students now receive training by general practitioners, which remains extremely popular.

    This experience shows that medical students are discriminating consumers of educational experience and will seek out teaching that meets their learning needs. A crossover trial, which ensures …

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