Letters to the Editor

Survey of knowledge of popular children's TV characters among paediatric healthcare professionals

Dear Sir

Communicating with young children still poses considerable difficulty for healthcare professionals. Nevertheless, there has been very little research into communication with young children. It has been shown in the past that social talk with a child patient represents an important first step in establishing a therapeutic relationship (Heszen-Klemens & Lapinska, 1984; Kaplan et al., 1989). The TV viewing habits of pre-school children cover a large aspect of social talk. Experience shows that showing interest in what captures the child's imagination is an extremely helpful way in establishing a rapport (Boggs, 1999). There are also clear indications that patient/parent satisfaction as well as compliance is increased by good communication (Van Duelmen, 1998).

This survey of paediatric healthcare professionals took place at the beginning of 2004 at the Royal Liverpool Children's Hospital. Participants were asked to fill out a questionnaire showing pictures of four currently popular TV characters with a maximum potential score of 20. A total of 187 questionnaires were returned. Fifty-four percent of the participants were paediatric nurses, 19% Specialist Registrars, 16% Consultants and 11% Senior House Officers. Participants with children under the age of five were subsequently excluded leaving 144 questionnaires for analysis. The most striking result of the survey was the difference between nurses and doctors whereby nurses scored on average 3.5 points higher than doctors. Among the doctors the group with the least paediatric exposure (i.e. Senior House Officers) fared worst. This survey raises the question whether juniors who choose to work with young children should be given better training in communication. More research is however needed to establish whether knowledge about children's TV programmes could help healthcare professionals communicate better with their patients.

First aid teaching for undergraduate medical students

Dear Sir

The MBBS curriculum has recently begun to lay emphasis on the need for teaching first aid to undergraduate medical students. A two-week first-aid teaching program for second year students began in our Institute in 1992. The faculty included three surgeons, an anaesthesiologist, a paediatrician, a physician and a nurse tutor. Classes were taken on CPR and Basic Life Support techniques, first aid for medical emergencies including drowning, bites and stings and poisoning, paediatric emergencies, soft tissue and orthopaedic injuries, bandaging techniques, and triage and transport of the injured. Manikins (Resusci-Anne) were employed to demonstrate CPR techniques and each student made to practise individually. Bandaging and splinting techniques were demonstrated and the students practised them on each other. Triage was taught as simulated patient management exercises. A video on paediatric Basic Life Support was shown. Bedside classes on soft tissue injuries and their management were taken in the surgery and emergency wards. Skills acquired were evaluated using a method of role-play. Student feedback was obtained on the utility of the posting.

Of the 305 students included, 300 (98.3%) found the posting as a whole to be useful. Two-hundred-and-ninety-nine (98.03%) students found the adult CPR sessions useful. The session on triage showed improved feedback after simulation exercises were introduced.

The integrated approach, good humour and enthusiasm of the teaching staff were listed as facilitating factors. Lack of time to practise what they had learnt was pointed out as an impediment to full utilization of the posting. Need for a booklet, more exposure to real life situations, another revision later on in the course and a test or examination in the subject were some suggestions made by the students.

First aid teaching is a mandatory component of every undergraduate medical curriculum and must be included in the examination schedule as well. The skills acquired being psychomotor, sufficient time must be given for the students to practise them. Using computer simulations of real life situations would make the lessons more interesting and challenging for the students.

Group study as a tool to teach medical students about coronary heart disease (CHD)

Dear Sir

We decided to employ “group study” as the method of learning. Group work in medical education is now commonly associated with Problem Based Learning. The method described shows how the benefits of group work could be included in a more traditional curriculum. Study materials were obtained by searching websites (www.who.int, www.stanford.edu, www.lipidsonline.org, www.ktl.fi/monica, www.nhlbi.nih.gov/about/Framingham, www.google.com) and made available as handouts.

A brief introduction was given to the class regarding the various studies done on CHD. Then, the whole class was divided into five small groups, each consisting of 8–10 students. Each group was given a handout on one of the five studies chosen: Framingham Heart Study (Group I), MRFIT (Group II), North Karelia Project (Group III), MONICA (Group IV), and Stanford Study (Group V). Then the groups were allowed to review the studies for about 25–30 minutes. Two or three students from each group presented salient features to the whole batch in the plenary session. A pre-test and post-test was administered giving the same questions to each group. Students’ feedback was obtained which included clarity of the objectives, factors facilitating learning, factors hindering learning and suggestions to improve the session.

Results of pre-test and post-test showed that the difference in scores was statistically significant in three out of five groups. Feedback was obtained from 44 students. Objectives of the session were clear (43 students), not clear (1). Factors that facilitated learning were group discussion (36), students' presentation (13), active participation of students (7), good method of learning (3), handouts (2), gave insight about research (2). The hindering factors were afternoon session (6), students' lack of time for preparation and presentation (3) and student presentation fast/not clear (3). Some suggestions were offered to improve the session: make smaller groups (3), break in-between (2) and more handouts (2).

It was found that students were not taking the desired interest when these topics were taught in the form of lecture classes. There is scope for trying innovative approaches, especially in institutions like ours where intake of students is 75 per year and staff:student ratio is good. We were facilitated by the large amount of data available in the various websites and journals. We found that the handouts and the discussion held the attention and interest of the students. This method of group discussion and presentation served as a valuable alternative and an innovative learning experience for the students. This method ensured maximum participation by the students.

Professionalism and medical education

Dear Sir

Professionalism is a hot topic in medical education. I was therefore interested to read the paper by van de Camp et al. (2004). The authors’ systematic search of the literature to clarify what constitutes professionalism revealed a total of 90 different elements, of which altruism, accountability, respect and integrity were the most commonly cited. The elements listed are distinguished by the fact that they are all positive. I would argue that some aspects of medical professionalism, as discussed in the literature of other disciplines such as sociology and history, are in fact negative.

Recent events in the United Kingdom, including the Bristol inquiry, the events at Alder Hey in Liverpool and the conviction of GP Harold Shipman for mass murder, as well as an increasing number of complaints against doctors, have called into question once again whether professionalism is necessarily a good thing. Yet even earlier than these events self-regulation of the profession has been heavily criticized (see for example Freidson, 1988).

The six elements of a profession have been defined as: the presence of skill based on knowledge; provision of training and education; the means of testing for competence; organization of members, adherence to a code of conduct; and the provision of an altruistic service not just for financial reward (Johnson, 1972). The code of conduct is usually defined by the profession itself and deviations from that code policed from within. The public's perception of doctors’ altruism has also been affected by the reduction in hours that doctors are prepared to work, difficulty in finding a GP prepared to do home visits and the notion that doctors receive financial rewards for carrying out immunizations.

In the past the professions were seen as middle-class occupations with status, and this went hand in hand with the paternalism and doctor-centred behaviour of the medical profession. Medical educators are aware that with increasing university fees and the possibility of heavy debts on qualification, doctors are once again likely to be mainly from better-endowed families. Entry to medicine will not be restricted only to those with the necessary academic standard.

I believe that medical students should be aware of the debate surrounding professionalism and what it means, and understand the need for the public (and the patients) to be more involved not only in the regulation of doctors but also in their training.