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MPharm Programmes: Where are we now?
... Since the 1970s, the RPSGB has played an influential role in the development and direction of pharmacy undergraduate education, through the establishment of a pharmacy degree accreditation process (Wilson et al, 2005). Before 2002 RPSGB accreditation was based upon the meeting of specific requirements outlined in an indicative syllabus. ...
... setting policy for post registration education and revalidation (including registration policy relating to advanced/specialist practice) reviewing education standards and quality assurance systems developing an implementation programme (RPSGB 2006b) Curriculum Practice Wilson et al (2005; conducted the first comprehensive review of teaching, learning and assessment methods of UK Schools of Pharmacy in 2004. Unsurprisingly they found that the RPSGB accreditation process was the main external driver for curriculum design and found little evidence that changes outside the sector of pharmacy were a driver for curriculum development. ...
... Findings from a review of UK schools of Pharmacy in 2004 (Wilson et al, 2005; resonates with our findings. The authors found that formal placements varied across the schools and that students wanted these to be increased. ...
This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge‟ contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study.
... Generally, students are most commonly offered formal professional work placement opportunities in the penultimate year of their undergraduate study, when students are more knowledgeable about practice and their discipline (Case & Jawitz, 2004; Joshua & Fleming, 2002; Reddy & Moores, 2006; Rees, Collett, Crowther, & Mylrea, 1998; Rees, Collett, Mylrea, & Crowther, 1996; Wilson, Jesson, Langley, Clarke, & Hatfiel, 2005). There are a number of studies reporting the benefits of these experiential learning experiences (e.g. Brown et al., 2005; Joshua & Fleming, 2002; McDermott, Caiola, Kuhn, Stritter, & Beza, 1995; Smith, & Hall, 2008; Wilson et al., 2005), but negative features of experiential learning in higher education have rarely been discussed (Auburn, 2007). Also, little is known about the benefits and shortcomings of such experiential learning in the early stages of undergraduate education and training. ...
... Also, little is known about the benefits and shortcomings of such experiential learning in the early stages of undergraduate education and training. A study commissioned by the Pharmacy Practice Research Trust (an independent research charity set up by the Royal Pharmaceutical Society of Great Britain) reported that academic staff in all schools of Pharmacy in the UK encouraged their students to undertake informal work placements in a pharmacy and advised them of the benefits to be gained from the experience (Wilson et al., 2005). Limitations in the development of placements included access to sites, local capacity, resources in terms of staff and funding, and logistics of timetabling (Wilson et al., 2005). ...
... A study commissioned by the Pharmacy Practice Research Trust (an independent research charity set up by the Royal Pharmaceutical Society of Great Britain) reported that academic staff in all schools of Pharmacy in the UK encouraged their students to undertake informal work placements in a pharmacy and advised them of the benefits to be gained from the experience (Wilson et al., 2005). Limitations in the development of placements included access to sites, local capacity, resources in terms of staff and funding, and logistics of timetabling (Wilson et al., 2005). Although most schools in the UK do not formally require their students to take up work placement in a pharmacy, a large proportion of the students generally take up pharmacyrelated jobs during their term break or holiday for a range of reasons from gaining pharmacy experience to financial motivation (Brown et al., 2005). ...
Generally work-based learning opportunities are only offered to students in their penultimate year of
undergraduate study. Little is known about the benefits and shortcomings of such experiential
learning for students in the early stages of their undergraduate education. This is a mixed method
study investigating first year undergraduate pharmacy students’ perceptions of work-based learning
during their vacation. A structured questionnaire was designed to assess students’ views on their
placement experiences and also to help identify suitable participants for the second part of the study
that involved a focus group. Both quantitative and qualitative methods revealed that most students
found work-based learning valuable to them. Subject related competences and personal/social skills
were recorded where some of these skills could not be acquired within the academic setting.
Understanding their professional role and responsibilities and the opportunity to work with other
professionals in a working environment were highlighted as positive features of the placement
experience. The findings from the study suggest that supplemental in-the-field work experiences in
the early stages of students’ university education should be made part of a university curriculum, as
it helps in their academic development and contributes towards preparing them for future work
environments and the job market.
... It is unrealistic to expect a school leaver in the course of a 4-year or even 5-year degree program to acquire sufficient skills that they would be fit-to-practice in all of these distinct areas of pharmacy upon graduation. But it is arguably the responsibility of an educational institution to educate pharmacists for every area of pharmacy, rather than train them for particular job roles or simply to dispense (Florence 2002;Mullen et al. 2003;Florence 2004;Wilson et al. 2005). So, who should decide on what core professional competencies are required for someone to be deemed fit-to-practice as a pharmacist and entitled to PSI registration? ...
... Survey-based studies of undergraduate pharmacy curricula and pharmacy students' attitudes toward their acquisition of a professional identity suggest that in the UK, pharmaceutical sciences still dominate the first 2-3 years of the degree and that students' generally accept this to be a necessary foundation prior to their professional acculturation in the latter stages of their degree (Florence 2004;Wilson et al. 2005;Wilson et al. 2006). However, disadvantages to this approach reported by students and perceived by educators include their use of surface learning techniques to accumulate scientific knowledge and insufficient exposure to pharmacy practice in the early stages of the degree (Florence 2002;McRobbie 2004;Taylor 2007). ...
... Incorporating fitness-to-practice requirements into the new Pharmacy Act has radical implications for the registration, regulation, and sanctioning of pharmacists in Ireland and must be introduced effectively, sensitively, and with a view to preparing future pharmacists for its implementation. While pharmacy training will always, necessarily, be built on a strong scientific background (Florence 2002;Florence 2004), the new fitness-to-practice requirements provide an opportunity to review the balance of practice and science in undergraduate curricula and the teaching methods by which they are delivered McRobbie 2004;Academic Pharmacy Group 2005;Wilson et al. 2005;Jesson et al. 2006;Taylor 2007). Novel teaching and assessment methods such as competency-based assessment, that are more focused on professional acculturation and the training of competent practitioners, may equip Irish pharmacy graduates more thoroughly for the new legal requirements (World Health Organisation 1998; Davies et al. 2002;Merrigan 2002;Goldsmith et al. 2003;Hill et al. 2006;Turner et al. 2006;Taylor 2007;Goldie 2008;Petit & Foriers 2008). ...
Internationally, there is tighter monitoring and enforcement of fitness-to-practice requirements in healthcare, which are being specified within legislation and guidelines. In Ireland, the Pharmacy Act 2007, that was recently published and is being gradually implemented, includes a provision for monitoring fitness-to-practice of pharmacists practicing here. This will mean that upon initial and continued registration by the Council of the Pharmaceutical Society of Ireland, pharmacists must satisfy a fitness-to-practice committee. Two routes by which a pharmacist can be deemed unfit to practice are specified within the Act - on the basis of ill health and through technical incompetence/malice. However, the exact nature of professional, cultural, and technical competencies required to satisfy these new fitness-to-practice requirements remain undecided and a further consultation with all stakeholders is required. Importantly, this consultative process must consider current practice standards and raise awareness of these issues among pharmacists while also considering the current and future undergraduate pharmacy students, i.e. the future pharmacists of Ireland. Radical cultural shifts in monitoring fitness-to-practice, with full professional accountability, must inform changes in the undergraduate curriculum and in assessing students, such that when they graduate, they are thoroughly prepared for ongoing fitness-to-practice scrutiny. Here, different approaches to international pharmacy education that may help pharmacy educators in Ireland prepare their students for the new fitness-to-practice requirements are reviewed and discussed.
... The International Pharmaceutical Federation (FIP) recommends that pharmaco-epidemiology be included as one of the key areas of study in undergraduate pharmacy programs (FIP, 2000). However, in the UK, a recent review of approaches to teaching, learning and assessment in schools of pharmacy (Wilson et al., 2005) identified that research training ranged from formal classes to nothing at all, and that some students felt inadequately prepared for research projects (Wilson et al., 2005). Not surprisingly, researchers have reported that evidence-based practice (EBP) is poorly understood and utilised by some pharmacists (Watson & Bond, 2004) and it has been reported that some pharmacists regard customer feedback and personal experience as EBP (Watson & Bond, 2004). ...
... The International Pharmaceutical Federation (FIP) recommends that pharmaco-epidemiology be included as one of the key areas of study in undergraduate pharmacy programs (FIP, 2000). However, in the UK, a recent review of approaches to teaching, learning and assessment in schools of pharmacy (Wilson et al., 2005) identified that research training ranged from formal classes to nothing at all, and that some students felt inadequately prepared for research projects (Wilson et al., 2005). Not surprisingly, researchers have reported that evidence-based practice (EBP) is poorly understood and utilised by some pharmacists (Watson & Bond, 2004) and it has been reported that some pharmacists regard customer feedback and personal experience as EBP (Watson & Bond, 2004). ...
There is a dearth of research on the undergraduate research training provided to pharmacy students. We aimed to identify and provide examples of effective pedagogy in teaching research and evidence-based practice (EBP) to undergraduate pharmacy students. In conjunction with the professional competency standards for pharmacists, a review of the pharmacy workforce needs and the relevant pedagogical literature, a range of evidence-based approaches for selecting unit content, teaching and assessment strategies was identified. The authors reflect on the evidence and their multidisciplinary experiences in developing curriculum to demonstrate how pharmacy students can be engaged in deep learning rather than surface learning. Effective pedagogy in research training for pharmacy students will ultimately improve the quality of pharmacy education and the use of EBP principles in practice.
... week or block placements (Wilson, K. et al, 2005). Experiential education in pharmacy generally follows initial didactic education in theory and is offered in numerous models throughout the world. ...
... There have been concerns regarding the steady increase in the number of pharmacy graduates in Australia over the last 10 years, and the impact that this may have on preceptors. In 1997, there were six pharmacy university programs with approximately 485 graduates each year; there are currently 21 pharmacy programs graduating approximately 1250 graduates annually (Marriott, J. et al. 2008;Wilson, K. et al, 2005). This influx of students has raised growing concern regarding the availability of sufficient numbers of experienced pharmacists who are willing to supervise and assess the experiential education students. ...
Background: Experiential education is key to students understanding their future practice settings. The quality and success of experiential education rest largely on volunteer preceptors, who are an essential asset to the education of pharmacy students in Australia. This asset needs constant support and nurturing. Aims: This study aims to explore the perceptions of Australian preceptors" and their needs regarding their role in training future generations of pharmacists. Method: Five focus groups of pharmacist preceptors were conducted, audio-taped and transcribed verbatim. Transcripts were thematically analysed to identify major themes related to pharmacy experiential education. Results: Thirty seven pharmacists participated in the focus group interviews, representing diverse demographics and workplace settings. Pharmacists reported enjoying the role of preceptor however, lack of insight into education techniques, increased workload, lack of time and space, and increased stress levels were identified by participants as obstacles to achieving good educational outcomes. Conclusion: Preceptors are role models for novice practitioners, and the relationships between universities and preceptors need to be robust, supportive and relevant to changing professional and health sector environments.
... valuable opportunity (Wilson et al., 2005). Furthermore, previous studies concerning undergraduate Pharmacy assessment suggest that, because of their perception of the importance of the project, students feel very strongly about the extent to which they can exercise choice with regard to research area, and about the training they receive to equip them for the research experience. ...
... Although this enhancement is alluded to in the literature (Wilson et al., 2005), there is little evidence to back this up. However, we find that the project contribution significantly raises the overall assessment profile, providing evidence to support these claims. ...
Undergraduate pharmacy education is undergoing reform, largely driven by changes in the role of the pharmacist. One area of the curriculum coming under particular scrutiny is the final year research project. It has been suggested that such projects should perhaps play a lesser role in undergraduate education because research is not part of the working remit of most pharmacists. If, as a School of Pharmacy, we are to make an informed contribution to any debate, we must be clear about the role the project currently plays, both within our own institution and at a wider level. This project uses a questionnaire-based approach to investigate the MPharm project provision at The Robert Gordon University, Aberdeen, and demonstrates that the grade achieved in this module has a strong positive influence on final degree classification. Furthermore, both staff and students believe that it offers valuable training in both a professional and educational context.
... In the pharmacy arena, two UK reports have confirmed the problem of definition and assessment. A 2004 review of undergraduate education (Wilson et al., 2005, p.10) identified the importance placed upon professionalism and professional attitudes by their respondents, noting that there were " conceptual difficulties in relation to attitudes " . They noted that they were problems at the practical as well as the theoretical level, as most respondents " considered that attitudes were difficult to define and even more difficult to assess " (Wilson et al., 2005, p.46). ...
... A 2004 review of undergraduate education (Wilson et al., 2005, p.10) identified the importance placed upon professionalism and professional attitudes by their respondents, noting that there were " conceptual difficulties in relation to attitudes " . They noted that they were problems at the practical as well as the theoretical level, as most respondents " considered that attitudes were difficult to define and even more difficult to assess " (Wilson et al., 2005, p.46). ...
... In the pharmacy arena, two UK reports have confirmed the problem of definition and assessment. A 2004 review of undergraduate education (Wilson et al., 2005, p.10) identified the importance placed upon professionalism and professional attitudes by their respondents, noting that there were " conceptual difficulties in relation to attitudes " . They noted that they were problems at the practical as well as the theoretical level, as most respondents " considered that attitudes were difficult to define and even more difficult to assess " (Wilson et al., 2005 The report noted that: " a considerable amount of work is required before a universally accepted description of what constitutes assessment of healthcare professionalism is identified " . ...
... A 2004 review of undergraduate education (Wilson et al., 2005, p.10) identified the importance placed upon professionalism and professional attitudes by their respondents, noting that there were " conceptual difficulties in relation to attitudes " . They noted that they were problems at the practical as well as the theoretical level, as most respondents " considered that attitudes were difficult to define and even more difficult to assess " (Wilson et al., 2005 The report noted that: " a considerable amount of work is required before a universally accepted description of what constitutes assessment of healthcare professionalism is identified " . ...
Background: In responding to the debate about the place of professionalism in the student curriculum, it became clear there was no existing consensus as to the definition of professionalism. Aims: The aim of this review was to determine how professionalism is defined and discussed in contemporary pharmacy literature. Method: We searched The Pharmaceutical Journal, MEDLINE, ERIC, PsychINFO, PsychARTICLE, PubMed, Academic Search Complete and Embase. Articles were selected according to their relevance to the research questions. Results: A total of 58 articles published since 1998 were selected for full review. The articles identified 55 different components of professionalism. Conclusion: There remains a lack of consensus around the definition of professionalism, as evidenced by the range of literature and diversity of definitional terms. Many of the character traits relate to complex concepts such as empathy and integrity. The challenge for pharmacy education is in integrating these complex areas into the curriculum.
... Although this review has focused on research projects in US pharmacy programmes, there may be interest in comparing these findings internationally in future work. For instance, one report (albeit using data from a 2004 study) found that all United Kingdom schools of pharmacy required student pharmacists to complete a research project as part of the Master of Pharmacy (MPharm) programme (Wilson et al., 2005). ...
Background: This study explored existing literature on student research projects in United States pharmacy curricula. Methods: In August 2023, searches were conducted in two databases, PubMed and Embase, followed by pharmacy education journals and Google Scholar. Articles were reviewed by two researchers and included if they described or evaluated pharmacy student research projects between 2010 and 2023. Results: Ten articles representing data from six schools were included. Students from most schools had the option to work individually or in groups. The timing of projects in the curriculum varied, with most students working on them from years three through four, though other schools began their projects earlier in the curriculum. Many students presented or published their projects. Conclusion: The similarities and differences for student pharmacist research projects in the United States may affect pharmacy education as colleges of pharmacy review their curricula and determine whether they should also incorporate or revise a research project component in their programmes. Future evaluation may include a systematic review as more literature on student pharmacist research projects becomes available.
... A non-European Union citizen qualifying as a pharmacist in one member state is not automatically eligible to apply for registration as a pharmacist in another member state since legislation applying to mutual recognition of qualifications applies to European Union citizens only. 2 There is some lack of consistency concerning requirements for ''currency of knowledge'' prior to graduation. There is a limited timeframe during which MPharm students must complete their program. ...
Challenges for UK pharmacy education over the coming years are the prevention of easy access to MPharm programs by graduates of other subjects; the possibility of a shortage of employment opportunities for pharmacy graduates; the potential for accelerated progression of pharmacy technicians to pharmacy graduates and the possibility of providing part-time courses in pharmacy. In addition, the requirement to introduce more therapeutics into the courses to cater for the new roles of supplementary and independent prescriber must be faced, at the same time debating the relative weighting of science and practice within the course.
The development of graduate attributes through health professional courses requires the opportunity to engage with learning and teaching activities that reflect the work-based role to which the student aspires. Such activities allow the contextualisation of discipline-specific knowledge, forging a critical understanding of the underpinning theory, and providing a firm foundation for the development of lifelong learning skills. A blended learning approach can be particularly valuable in supporting achievement of the learning outcomes in modules where performance is measured in terms of competency in work-based scenarios. An action research approach was taken to develop and evaluate a cardiovascular risk assessment as the basis for clinically and professionally relevant problem-based learning. Support for this was provided by means of blended learning including a number of online activities. Talking wall focus groups were used to evaluate the student experience, and this was combined with quantitative data regarding student examination performance. Student performance in the cardiovascular section of the examination paper was significantly higher than in other sections. Students reported very favorably on the use of this approach to support not only examination preparation, but also in terms of developing professional identity and enhancing employability skills.
Abstract
Purpose: To explore Jordanian Pharm.D students career choices, perceptions and expectations.
Methods: This observational study was conducted during June 2013 at the University of Jordan. A total of 192 undergraduate Pharm.D students were invited to complete a questionnaire prepared and validated by the research team. The questionnaire investigated student’s demographics, the reasons behind choosing to study Pharm.D, satisfaction with the Pharm.D course, student’s future plans following graduation, and student’s perceptions about the Pharm.D specialty. Data collected were encoded and analyzed by SPSS database for Windows version17.
Results: The majority (93%) of respondents were females, aspired to work as hospital clinical pharmacists (83%) and many (68%) believed that Pharm.D graduates are well respected by the general public. Results indicated that students are unaware of the current Pharm.D salaries and have higher expectations than what is being currently offered in the country.
Conclusions: A generation of Pharm.D students from Jordan reported a future aspiration to work as hospital clinical pharmacists. Students have unrealistic salary expectations compared with the current salaries offered in Jordan. ‘Awareness workshops’ targeting students’ knowledge about the Pharm.D degree is required.
The debate surrounding the science/practice balance in the teaching of undergraduate pharmacy has been played out in the professional literature for years. The objective of this work was to explore the attitudes of pharmacy undergraduates on the practice-science debate.
The study was undertaken as part of a national study of teaching, learning and assessment methods in United Kingdom (UK) schools of pharmacy.
Six focus groups were carried out. The sample was 44 volunteer students from nine UK schools of pharmacy, representing all 4 years of the MPharm programme. Groups were tape recorded and transcribed. Analysis of the transcripts was theme based by topic.
Qualitative data on student attitudes and experiences.
Most students thought that there was too strong an emphasis placed on the science components of the course in the early part of their studies. Later in the course they realised that the majority of the science was necessary; it just had not been apparent to them at the time. There were strongly held attitudes across all 4 years that it would be beneficial to include more practice-related material at the beginning of their studies. This would be beneficial for three reasons: to make the course more interesting, to aid in the contextualisation of the science component and to assist the students in any early placement or vacational work.
Internationally, changes to the role of the pharmacist from a traditional supply function to a more clinical role has resulted in differing educational needs for the pharmacist of the future. Pharmacy will remain a degree built on a strong scientific background, but students advise that the contextualisation and sequencing of material within the degree could make a considerable improvement to their learning. Consulting students helps us to understand the teaching, learning and assessment experience better by giving insights into ways of improving the delivery. In the case of the UK, there are legislative changes impending which may provide an opportunity to review the balance of practice-and science in the curriculum.
267 third-year psychology students from four different UK higher education institutions took part in a study looking at their essay-writing tactics (called 'rules of the game'), cheating behaviours and approaches to studying. The results clearly showed that there was a widespread occurrence of both essay tactics and cheating and that these two types of behaviour correlated positively with each other. The findings relating to approaches to studying showed similar scores for both meaning and reproducing orientations across all four institutions but the correlations with essay tactics and cheating were mostly small. However, 'rules of the game' were found to correlate positively with a deep approach and fear of failure whereas cheating correlated positively with syllabus-boundness and negatively with use of evidence. The authors discuss their findings in relation to the pressures of assessment.
This article describes a new approach to clinical pharmacy practice teaching for undergraduate students using a clinical tutor model at the school of pharmacy and pharmaceutical sciences at the University of Manchester. The results of an evaluation of the first year of the course are also reported T he Government's continuing aim to modernise the National Health Service suggests that a new approach to pharmaceuti- cal education must be developed to produce pharmacists who are able to work within the new NHS framework and to meet the demands that this presents.1,2 The NHS plan3 states: "There will be reforms to the health curricula to give everyone working in the NHS the skills and knowledge to respond effectively to the individual needs of patients. There will be new joint train- ing across professions in communication skills. It will be a precondition of qualification to deliver patient care in the NHS that an individual has demonstrated competence in communication with patients." pharmacy. In contrast, students' exposure to secondary care practitioners has been limited. At the University of Manchester, students visited the hospital setting in the final year of their course and this was often the first exposure they had to pharmacy practice in secondary care. This came at a time when students had already made deci- sions about the branch of the profession in which to undertake their preregistration training. In the light of these facts, and the recent problems of recruitment and reten- tion of pharmacists in secondary care, a need was recognised to increase the rele- vance and profile of hospital-based clinical teaching. It has been suggested that clinical and practice-based topics should have a major role in the four-year pharmacy course and that introducing hospital visits may better prepare graduates for their preregistration year.5 By increasing the exposure of stu- dents to patients at an early stage of their degree, it is hoped that the students' under- standing of patients, their diseases and drug therapy will be enhanced and that their communication skills will be further devel- oped. This should result in graduates beginning their preregistration year with a greater appreciation of pharmaceutical care delivery. It is also hoped that these pharma- cists of the future will be better equipped to meet the changing needs of the health ser- vice, be that in primary or secondary care, a need that has been highlighted previous- ly.3,6 This is particularly important when
Describes an attempt to identify different levels of processing of information among groups of Swedish university students who were asked to read substantial passages of prose. Ss were asked questions about the meaning of the passages and also about how they set about reading the passages, thus allowing for the examination of processes and strategies of learning and the outcomes in terms of what is understood and remembered. It was posited that learning has to be described in terms of its content. From this point differences in what is learned, rather than differences in how much is learned, are described. It was found that in each study a number of categories (levels of outcome) containing basically different conceptions of the content of the learning task could be identified. The corresponding differences in level of processing are described in terms of whether the learner is engaged in surface-level or deep-level processing. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study reports on an attempt to improve the quality of student learning by integrating an Approaches to Learning programme, consisting of 8 workshops, into the first year Psychology curriculum. Written accounts of students' conceptions of learning were collected at the beginning and end of the programme. Content analysis showed that there was a significant shift from naive to more sophisticated conceptions (29% to 60%) in students who had attended more than half the workshops, by the end of the programme. The programme also showed several significant benefits on students' academic performance. Students who attended all the workshops on essay writing and examination taking, obtained higher essay and examination marks than students who did not attend these workshops.
However, when we looked at the effects on academic performance of taking a deep approach and holding a more sophisticated conception of learning, the findings were not so clear cut. Depending on the measure used, there was conflicting evidence about whether examination performance or essay performance benefitted the most. The implications of these results are discussed with particular reference to the role of assessment, in enhancing the quality of student learning.
To avoid many of the disadvantages of the traditional clinical examination we have introduced the structured clinical examination. In this students rotate round a series of stations in the hospital ward. At one station they are asked to carry out a procedure, such as take a history, undertake one aspect of physical examination, or interpret laboratory investigations in the light of a patient's problem, and at the next station they have to answer questions on the findings at the previous station and their interpretation. As they cannot go back to check on omissions multiple-choice questions have a minimal cueing effect. The students may be observed and scored at some stations by examiners using a check list. In the structured clinical examination the variables and complexity of the examination are more easily controlled, its aims can be more clearly defined, and more of the student's knowledge can be tested. The examination is more objective and a marking strategy can be decided in advance. The examination results in improved feed-back to students and staff.