The use of the Dundee three-circle model to assess quality of medical education

Dear Sir

To achieve an efficient educational system, continuous assessment of the existing system to identify pros and cons is required. An effective way to evaluate the quality of clinical education and to classify learning outcomes is to evaluate trainees based on the Dundee three-circle model (Harden et al. 1999). Therefore, in order to determine the quality of the education which is given to interns during their internship in Shiraz University of medical sciences, we decided to access their performances based on this model, which equates with the three different aspects of physicians’ work. The inner circle shows what the physician is capable of doing or “doing the right thing” (e.g. physical examination). The middle circle shows the way the physician should do the tasks in previous circle or “doing the thing right “(e.g. ethically, with scientific understanding) and finally the last circle which relates to individual intelligences, shows the development of the physician’s personal characteristics or “the right person doing it”. For this purpose a questionnaire based on the Dundee model was designed, by which performances in each circle was assessed. In regard to the inner circle, the results of this study showed that the education was sufficient and interns have learned enough skills to do routine procedures and could manage the patients and communicate with them perfectly. Conversely, regarding the education concerning middle and outer circle, the interns do feel a need for more training and observation. Only approximately half of the interns believe in always applying medical ethics and in seeking academic promotion and responsibility while practicing. Moreover, the interns seem to see themselves more as practitioners rather than teachers and researchers. It seems that they lack motivation for improvement in other areas besides clinical skills and knowledge. Considering our study, we believe that today’s educational system is teaching the interns to be skillful doctors individually, but doesn’t encourage them to seek personal improvement in other areas and does not teach them to work as a group. What’s more, despite the fact that they are capable of doing critical procedures associated with life threatening situations, which only physicians are authorized to perform and almost everyone have done it once already, they are not confident to do it without an attending or a resident observation. It seems that more training and perhaps a hidden curriculum (Hafferty et al. 1994) can be used to boost their moral values and confidence and motivate them.

Declaration of interest: The authors report no conflicts of interest.