Letters to the Editor

Student generated questions drive learning in the classroom

Dear Sir

Almost all times, teachers have been empowered with the ‘exciting’ task of ‘questioning’ the students and framing good questions in examinations (Sircar & Tandon 1999). Students, on the other hand, are most often imposed with the chore of giving ‘right’ answers. As teachers, we are entrusted with giving opportunities for students to ‘think actively’ in the classroom. Bombarding with information with no room for thinking and reflecting does not serve the purpose of imparting quality education. Balancing teaching and active learning in the classroom is a challenging task.

Melaka Manipal Medical College, Manipal University, India, offers the Bachelor of Medicine and Bachelor of Surgery (MBBS) program. Students are taught anatomy, physiology and biochemistry in the first year.

The author was involved in taking 12 endocrinology lecture classes of 1 hour duration for a batch of 143 students for about 5 weeks in March-April 2010. After 45 minutes of a lecture, students were asked to write three questions on the topic taught in that particular lecture, after discussing with their peers in each bench. 8–10 minutes were given for this activity. During this time, the author could appreciate active discussion in the classroom. In the subsequent class, three or four students in different rows were asked to read aloud the questions framed by their group and also to provide answers. The entire class was presented with a variety of questions and this in turn served as a platform for the students to refresh their knowledge of the topic. This was continued for all the lecture classes (n = 12) taken by the author. This activity was an enjoyable learning experience for the students as evident from the feedback received. Students responded that this activity helped them to revise the topic taught at the end of the lecture class itself and to forcefully study the same day itself instead of postponing and to prepare for the forthcoming examination. They also commented that framing questions helped them develop their thinking skills and to concentrate in the class. The activity served as a reinforcement of learning and also helped them to summarize the topic by themselves instead of the teacher, at the end of all lectures. It also motivated them to read the topic for the next class as they were required to discuss the questions (framed by them) and answers with the whole class. Framing questions involve revising the topic taught and reinforces students’ learning. It also provides an opportunity for the teacher to give feedback to the students regarding the quality of the questions and also the correctness and completeness of answers. Also the ‘question bank’ developed by the students themselves would be of help in their examinations.

Reem Rachel Abraham

Melaka Manipal Medical College (Manipal Campus)

Manipal

Karnataka

India

Tel.: [phone]

Fax: [phone]

E-mail: [email protected]

A course in basic surgical techniques improves medical student confidence in key skills

Dear Sir

Junior doctors are often required to perform simple surgical techniques in theatre and emergency departments. This requires confidence in employing basic surgical skills. Medical students may be expected to acquire the principles of surgical techniques experientially during clinical attachments. However, high-tension environments, such as the operating theatre, are known to inhibit the learning of motor skills (Pelligrini 2006).

We administered a quantitative questionnaire to 70 UK medical students attending a course on surgical techniques. The questionnaire comprised a series of statements with corresponding 5-point Likert scales (1 = strongly agree, 5 = strongly disagree) assessing student confidence in instrument handling, basic suturing techniques, knot-tying and minor lesion excision. Students were asked to complete the questionnaire prior to, immediately following and three months after the course.

Following the course, students (n = 63) were significantly more confident in instrument handling (p < 0.0001, Wilcoxon Signed Ranks test, W), suturing techniques (p < 0.0001, W), basic knot-tying (p < 0.0001, W) and minor lesion excision (p < 0.0001, W). Three months post-course, students (n = 18) remained significantly more confident (p < 0.05, Mann Whitney test, M) in all four skills than pre-course. At three months, confidence in instrument handling (p = 0.4388, M) and suturing (p = 0.5693, M) were not significantly different than immediately post-course, but confidence in knot-tying (p = 0.0072, M) and minor lesion excision (p < 0.0002, M) were lower. Nearly all participants (56/62; 90%) strongly agreed or agreed that such a course would be useful within the formal undergraduate curriculum.

Our results indicate that confidence in simpler skills appears to be more persistent than technically more demanding, multi-step tasks. The increased confidence in basic surgical techniques, following a course, is associated with greater uptake of opportunities to use the skills (Remmen et al. 1999). In light of recent changes to surgical training and restriction on working hours in the UK, we call for medical schools to consider allocating time for students to formally learn key surgical skills in a controlled environment.

K. Shanmugarajah, J. Shalhoub

S. Mastoridis and P.A. Paraskeva

Division of Surgery

Imperial College London

St Mary's Hospital

London, UK

Email: [email protected]

Web-based training package for HEEADSSS assessment and motivational interviewing techniques: a multi-professional evaluation survey

Dear Sir

Interaction with adolescents in a medical setting is enhanced when healthcare practitioners are trained in counselling techniques such as the HEEADSSS assessment (covering Home, Education, Employment, Eating, Activities, Drugs/alcohol, Smoking, Sex/relationships and Self harm/abuse) and Motivational Interviewing (MI), to improve communication and facilitate discussion of sensitive issues. Adolescent medicine is a developing sub-speciality, with increasing demand for training in these skills.

Recent informal surveys of haemato-oncologists managing adolescents revealed that knowledge and implementation of the techniques is sporadic. Formal training in MI increases confidence in behaviour change counselling (Madson et al. 2009), also improving health risks assessment and the ways in which positive health choices are promoted.

HEEADSSS and MI are relatively new developments in adolescent communication skills and there is little formal training currently available, partly as training can be time consuming to provide (Howells et al. 2006).

With this in mind, a web-based learning package (www.motivationalinterview.webs.com) was created. We trialled this with a multi-professional audience at a national conference of teenage cancer practitioners, with the aim of evaluating whether a web-based interactive package introducing these skills would be welcomed by healthcare practitioners.

Of the 105 evaluation forms distributed, 76 were returned (response rate 72.3%). Respondents were categorised into six groups: nurses (n = 22); doctors (n = 20); researchers (n = 13); social workers (n = 11); other allied healthcare professionals (AHPs, including pharmacists and psychologists; n = 6) and managerial roles (n = 4). The majority of respondents had no prior awareness of the techniques. After experiencing the package, 86% agreed it was a useful introduction, most finding was relevant to their practice (93% of nurses, 80% of doctors and 72% of social workers). 74% stated they would now be willing to incorporate the skills demonstrated into their practice. 64% were interested in further training.

The well-received web-based format facilitates dissemination of information that can be time consuming to provide, and lends itself to self-directed study. Web-based packages such as this are no substitute for ‘real life’ teaching; however, the audience approved of this format as an introduction to new communication skills. It therefore seems suitable that this package could precede formal one-to-one or group training, providing an important pre-session introduction to facilitate further instruction.

The skills introduced by this package provide a solid foundation for encouraging healthy behaviours in adolescents and fostering good relationships with healthcare professionals in adult life, the implications of which are potentially considerable.

Katie M. Knight, Margaret Parr, David Walker

Queen's Medical Centre, Nottingham, UK

Joseph Shalhoub

Imperial College London, London, UK

E-mail: [email protected]