LETTER TO THE EDITOR

The educational benefits of a multihead microscope in an academic hospital

Dear Sir

Some academic pathology institutes harbour a multihead microscope (MHM). This equipment allows several persons to look together at microscopic preparations mounted on glass slides. We want to describe how the MHM provides pathologists and clinicians with the opportunity of working together and to comment on the educational advantages of this tool.

The MHM is composed of tubular arms relating a central pair of oculars to 13 distant ones. Up to 14 persons can sit around the table on which it is fixed and observe a tissue section shown up by one “driver”. In our institution, sixteen different meetings take place around the MHM, on a daily to monthly basis. Their varied purposes include pathological diagnosis as well as quality control review, technicians training, research meetings or clinico-pathological colloquies.

More than half of the MHM's occupation time however is part of pathology post-graduate trainees’ agenda. Through frequent working sessions around the MHM, future pathologists are repeatedly exposed to a variety of microscopic images presented in their clinical context. Daily sessions deal with cases from the laboratory current caseload, whereas more formal teaching sessions are based on a selection of didactic cases.

On the basis of current theories of learning and teaching, and although further studies are needed to document the MHM's educational impact, the conditions for efficient learning are met: physicians with various types and levels of expertise work together in a small group, deal with authentic current patients’ cases, often challenging ones, in a physical configuration favouring deliberation and interaction (Mann 2002). Trainees at every level of pathology knowledge benefit from the MHM all along their training, though participation may evolve from peripheral in their first semesters to more central before certification. In our institution, both surveys and direct observation of sustained attendance (personal unpublished results) support the usefulness of this equipment for this group of learners.

The educational potential of the MHM setting is however influenced by instructors’ skills in facilitating learners participation and role modelling (Pratt 2001). Not only pathology knowledge, but also different professional skills and attitudes such as peer discussion and cooperation, consensus finding, attention to evidence based data and actualization of knowledge are demonstrated around the MHM.

In conclusion, we judge that the essential contribution of a MHM to diagnosis, research and especially education should be recognized by academic institutions and drawn to the attention of funding agencies.

Dr Dominique Sandmeier

Dr Maryse Fiche

Institut Universitaire de Pathologie

Bugnon 25 CHUV

1011 Lausanne, Switzerland

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Email: [email protected]

Students' feedback: should it be anonymous?

Dear Sir

Taking feedback from students is an established tool to upgrade and ensure that the teaching-learning objectives are achieved as per expectations. Responsible feedback from students can be an invaluable component in the teacher's own professional growth and development (Wee 2001). Thus valuing and asking for feedback has recognized benefit to both staff and students (UELT 2004). Hence encouraging students to give feedbacks is a healthy practice in any teaching-learning process.

But are our students mature enough to give unbiased feedbacks? This was the basic research question to proceed with the present study. Two sets of feedbacks were taken from the same student, in the same setting and for the same field study. The feedback form contained seven questions and the choices of answers were given on a four/five point likert scale. The results reflect that the students tend to give better feedback with their names mentioned as compared to anonymous feedbacks to the questions related to their faculty and to the sensitive questions directly directed to them. But the results of anonymous and name feedbacks were also not that discordant that named feedbacks can be ignored completely. In fact, the means of the answers to the questions without names are positively correlated with the means of the answers with their names (Pearsons correlation : 0.985; p < 0.000); although the mean scores are always towards positive feedback with their names.

To conclude, the results show that students' anonymous feedbacks are stricter as compared to their feedback with their names when the questions are related to their faculty and to the sensitive questions directly directed towards them. The positive feedbacks with their names mentioned should be given less importance as compared to their negative remarks. But if the focus of feedback is to critically review each individuals view point, feedbacks with names can still be taken. This reflects that the student's natural tendency is to be as truthful as possible but they are freer when they are asked to give anonymous feedback.

Dr Swaroop Kumar Sahu

Dr MB Soudarssanane

Dr Gautam Roy

Dr K. C. Premrajan

Dr Sonali Sarkar

Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)

Pondicherry 605006

India

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Email: [email protected]

Medical education in first aid and basic life support in the Netherlands

Dear Sir

Adequate education in first aid and Basic Life Support (BLS) should be considered as an essential aspect of the medical curriculum. An evaluation was made, by sending a questionnaire to all 8 medical schools, regarding whether the medical training was performed in accordance with the national Dutch guidelines for medical education stated in the “Blueprint: training of doctors in the Netherlands, objectives of undergraduate medical education”. All medical schools in the Netherlands have accepted the objectives of the Blueprint, and a substantial part of the Blueprint has been legislated in the Individual Health Care Professions Act. The Blueprint has the following structure: (1) a brief description of the profile of the graduating doctor; (2) a review of common general objectives of medical education; (3) a list of problems which every doctor should be able to handle and (4) an overview of clinical pictures and diseases that should be known and skills that should be mastered. According to these objectives, any medical school graduate should be able to perform first aid and basic life support as instructed by the ‘Orange Cross’, the national health care provider for first aid and BLS in the Netherlands (Oranje Kruis 1997; Metz 2001) The response was 100%. Seven out of the eight medical schools train their students in first aid and BLS during the medical curriculum. The persons responsible for education were satisfied with medical training in first aid and BLS and did not mention any large needs to address. However, an average of only 38% of the clinical pictures and diseases and 69% of the skills were mastered at the level defined by the Blueprint. We have demonstrated that there is a wide variety in the content, amount and practical design of first aid and BLS training in medical curricula in the Netherlands. The medical education in the Netherlands does not meet the objectives stated in the “Blueprint”. In our opinion, medical training should include training in emergency care, and this in turn should include first aid and basic life support. These training programmes and regular refresher courses should be mandatory during medical training to maintain the required competency level for first aid and basic life support. We recommend that all aspects of first aid and basic life support training for medical undergraduates be improved and implemented in the Netherlands.

E.C.T.H. Tan

K.D. Hekkert

A.B. van Vugt

J. Biert

Department of General Surgery - Traumatology

Radboud University Nijmegen Medical Centre

Nijmegen

The Netherlands

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Medical students’ confidence in performing motivational interviewing after a brief training session

Dear Sir

Given the increasing burden of ill-health due to modifiable lifestyle behaviours, it is important to provide future doctors with appropriate training in attempting to promote healthy lifestyles amongst their patients. Motivational interviewing (MI) is an effective method of achieving behaviour change but there is little evidence of the impact of teaching MI to medical students (Mounsey et al. 2006). We performed a pilot study to investigate the effects of a single session of training in MI on students’ perceptions of their confidence to counsel a patient about a behaviour change and of its possible use in their future career.

Twenty-five fourth year medical students completed a questionnaire relating to their confidence to counsel patients and their perceptions of the use of MI in their future careers, before and after a two-hour class. During this seminar, the background and technique of MI were explained and demonstrated and students were given the opportunity to practise the skill. Competence to perform MI was examined in an OSCE station.

We found a significant improvement in the students’ perception of their confidence after the session (p < 0.001) and the majority felt that MI was very relevant to their future practice. Students identified features of the skill that they felt made it useful in clinical settings. Some had reservations about the time required to use MI in a consultation. All students passed the OSCE station (mean (SD) score = 65.1 (11.4)%), demonstrating the increased confidence was matched by their competency.

Our findings thus indicate that a single brief training session in MI had a positive effect on students’ confidence to counsel patients about behaviour change. Traditionally medical education is targeted at improving competence, for which there are recognised methods of assessment (Mounsey et al. 2006). However, given the importance of health promotion we feel it is important that students acquire both the skill to perform MI and the confidence to use it in future practice. Anxiety and feelings of being ill-prepared for practice are common amongst medical students (Du Boulay & Medway 1999). We suggest that these fears can be reduced by participation in a single training session, helping to bridge the gap between training and practice.

Mark A. Tully

Andrew E. Gilliland

Margaret E. Cupples

Division of Public Health Medicine and Primary Care Queen's University of Belfast, UK

Email: [email protected]