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Medical Teacher
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Letters to the Editor
Online Publication Date: 01 December 2006
To cite this Article: (2006) 'Letters to the Editor', Medical Teacher, 28:8, 744 - 747
To link to this article: DOI: 10.1080/01421590601039901
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Medical Teacher, Vol. 28, No. 8, 2006, pp. 744–747
Letters to the Editor
Problem based learning (PBL) case bank
Dear Sir
There are 41 medical schools in Korea and most of them
have implemented, at least to some degree, PBL programmes
into their respective curricula. However, medical schools
that lack experience of PBL among the staff usually have
difficulty in developing case problems. The solution to this
conundrum is to form a national consortium among the
medical schools.
In April 2004, under the auspices of the Korean Society of
Medical Education, a PBL study group hosted a symposium/
workshop for module development and the members of the
study group agreed to create the PBL Case Bank, which
would be available to all of the participating medical schools
to administer their PBL curricula. Thirty-eight of the 41
medical schools agreed to produce five modules by the end of
2004, and another five by the end of 2006. The annual fees
for participating medical schools amounted to US$500 and
one of the medical schools was designated to collect, control,
classify and compile all of the case modules. Participating
members are allowed to modify any of the pre-existing
modules but are required to indicate the module’s origin.
This is accomplished by coding systems of modules, and
modified problems are reintroduced into the Case Bank for
future use and reference. The ability of participating schools
to modify the case problems according to their needs was
reportedly a great success.
Contrary to expectations, examination of the initial 100
modules has shown that there was virtually no overlap in the
content of the modules that were produced. And even smaller
schools with no prior PBL cases or experience were extremely
enthusiastic about creating and submitting their own case
problems to the bank. In addition, inter-medical school
relations improved significantly as a consequence of imple-
mentation of the PBL Case Bank.
Future plans include an annual meeting for review and
revision of existing PBL modules, to assess their validity,
measure their feedback, and subsequently produce more
updated and effective PBL modules. Other long-term plans
include translation of our modules into English, in an effort
to allow medical schools in less developed countries to
benefit from our wealth of PBL modules.
Ducksun Ahn and Sowon Ahn
Department of Medical Education
College of Medicine, Korea University
126-1 5ga, Anam-dong, Sungbuk-ku
Seoul 136-705, Korea
Implementation of the principles of holistic patient
care at the Nelson R. Mandela School of Medicine:
medical students’ perspectives
Dear Sir
In July 1997 the Nelson R. Mandela School of Medicine,
University of KwaZulu-Natal, adopted a proposal to replace
the traditional, discipline-based six-year programme with
a five-year problem-based learning programme (McLean,
2003). Students acquired knowledge, experience and
skills through small-group discussions, large-group
resource sessions, clinical rounds, research electives, rural-/
community-based medical education electives, family
medicine electives and other methods.
We conducted a qualitative study to assess medical
students’ perceptions as to whether the curriculum has
successfully implemented the principles of holistic patient
care, and whether these principles are being adequately
implemented in their clinical rotations. Email messages were
sent to randomly chosen students, from each level of study,
requesting them to participate in focus-group interviews.
Analysis of data was informed by Burnard’s (1991) method
of analysing interview transcripts in qualitative research.
The protocol was approved by the University’s Bio-Ethics
Forty-seven students participated and eight initial themes
emerged from the focus-group interviews. Initial themes
were then collapsed, by combining similar ones, to derive
the following three major categories:
.Understanding of holistic patient care
‘Holistic medicine as we are taught comprises
a spiritual aspect and religion has a big influence.’
‘Holistic care regards viewing the patient as more
than just a disease entity and involves social,
spiritual and financial aspects.’
.Role of traditional,Chinese and alternative medicines and
circumstances that would necessitate referral to alter native
‘I would refer to an alternative healer if the patient
actually believes in this system because this whole
holistic approach is to treat the patient as a person
not just a symptom.’
.Teaching methods encompassing the principles of holistic
patient care
‘In modules such as Cell Dysfunction and Diseases
of Lifestyle there are aspects of holistic patient
care. For example if you are doing cancer then you
744 ISSN 0142–159X print/ISSN 1466–187X online/06/080744–4 ß2006 Informa UK Ltd.
DOI: 10.1080/01421590601039901
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learn about different effects of cancer on the patient,
such as emotional needs.’
Our students have moved beyond the limitation of viewing
the patient as a disease entity and are now aware of the need
for a complete assessment of the mind, body and spirit
of a patient. They recognize that ‘to heal a person, one must
first be a person’ (Heschel, 1966). To ensure that future
doctors provide patient-centred healthcare, it is important
to introduce the principles of holistic patient care early
in the medical curriculum. However, the problem arises
with the application of these principles in public health
settings. Students expressed the view that there is a gap
between students’ knowledge and tutors’ skills in applying
these principles in the clinics and/or hospitals. Therefore,
what remains is the difficult task of improving on the
reinforcement of these principles during clinical blocks.
Lehlohonolo J. Mathibe & Breminand Maharaj
Department of Therapeutics and Medicines
Nelson R. Mandela School of Medicine,
University of KwaZulu-Natal,
Private Bag X 7, Congella, 4013,
South Africa
BURNARD, P. (1991) A method of analysing interview transcripts
in qualitative research, Nurse Education Today, 11, pp. 461–466.
HESCHEL, A.J. (1966) The Insecurity of Freedom (New York, Noonday
Press/Farrar Struss).
MCLEAN, M.M. (2003) Communicating curriculum reform to students:
advice in hindsight, BMC Medical Education,3,p.4.
Attitudes towards organ donation among medical
Dear Sir
Transplantation medicine has been successful in prolonging
life but the shortage of donor organs is the main obstacle to the
expansion of transplantation programs. The Croatian law on
tissue and organ donation is based on a presumed consent law,
permitting organ and tissue removal unless the donor was
explicitly opposed to organ donation during his or her lifetime.
However, experience from our hospitals and from other
countries has shown that it is advisable to get family consent
for organ retrieval in individual cases (Donor Network
of Croatia, 2005). A previous study showed that the intentions
of health professionals to ask about donation were not as
strong as they should have been and that there is room for
upgrading this element of the organ transplantation system
(Brkljacic et al., 2003). Surveying attitudes of medical students
should provide essential information on perceptions of tissue
and organ donation among doctors-to-be, and help in
planning future educational and training needs.
Undergraduate medical students from Zagreb University
Medical School (n¼276) were surveyed using a question-
naire that included the following parameters: attitudes,
willingness to donate, feelings about making a request for
organ donation, and carrying a donor card. Participants
showed highly positive attitudes toward organ donation
and highly positive willingness to donate different tissues
or organs. Willingness to donate organs of a deceased family
member was still positive, but lower compared with the
willingness to donate one’s own organs to help a person
in need. In a situation where participants should ask for organ
donation, 65% would be able to handle their own negative
emotions, and 47% would feel uncomfortable. Almost 20%
of participants carried a donor card.
This study showed that there is a need for structured
education of medical students in the practical, legal and
ethical aspects of organ donation, but also education of
all healthcare professionals, and professionals from other
vocations ( psychologists, sociologists) in this field.
Gordan Grahovac
, Tihana Brkljacic
, Iva Topic
& Mario Habek
Department of Histology and Embryology,
Department of Anatomy,
Department of Neurology,
Zagreb University Medical School, Croatia
Ivo Pilar Institute of Social Science, Zagreb, Croatia
BRKLJACIC, T., FERIC,I.&RIHTAR, S. (2003) Development and testing
of promotion materials on tissue and organ donation, Croatian Medical
Journal, 44, pp. 225–233.
Donor Network Of Croatia (2005) Available at:
(accessed 27 January 2006).
A novel application of mobile phone cameras in
undergraduate pathology education
Dear Sir
Increasingly resourceful applications have been found for
mobile phones in diverse fields of medicine. These have
ranged from transmitting electrocardiographic records
(Vaisanen et al., 2003) to using short messaging services to
convey laboratory test results (Ferrer-Roca et al., 2004).
Camera phones with Internet access have been used to
transmit images for remote consultation. Surgical wound
snapshots (Tsai et al., 2004); radiological images (Eze et al.,
2005); and funduscopic photographs (Yogesan et al., 2000)
have been broadcast in the past.
We would like to share an unusual application of these
camera phones by undergraduate medical (MBBS) students
that we encountered recently. Part of the MBBS curriculum
in pathology is familiarization with the gross appearance of
various diseases by displaying jar-mounted organ specimens.
The total number of such specimens shown over 18 months
of pathology training is nearly 60. While the primary aim is to
teach gross pathology, these specimen jars are also important
for the purpose of assessment as the more important/classical
Letters to the Editor
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ones form the starting point of oral examinations. A small
number of ‘typical’ specimens such as the small contracted
kidney, Ghon’s focus in the lung and aortic atheroma are
also part of the ‘spotting’ exercise in practical examina-
tions. Unlike postgraduate pathology where the emphasis is
on a range of appearances, undergraduates are character-
istically exposed to the same ‘book-picture’ specimens year
after year.
MBBS students at our institution are now invariably
equipped with personal mobile phones and we have found
that many possess photographs of nearly all the typical
specimens they will encounter in exams. This photography is
usually done covertly at the end of or before the beginning of
teaching sessions when the tutor is not present.
Since no definite guidelines existed on the ethics of the
issue most students had perceived it to be a ‘borderline’
illegal activity. Cellular phones are, however, barred from
examinations and there is no possibility of the images being
used to aid memory in viva voce or the one-minute spotting
station examinations. Therefore the departmental authorities
have tended to consider this intriguing application of
technology by medical students akin to harmless note-taking.
We write this letter to make the point that technological
advancements can initiate subtle changes in the way we
learn. The separate question of how useful gross pathologic
appearances are to the undergraduate in understanding the
pathological basis of disease is of course open to debate.
Prashant Sharma & Vinay Kamal
Department of Pathology,
Maulana Azad Medical College,
Bahadur Shah Zafar Marg,
New Delhi 110002, India
EZE, N., LO, S., BRAY,D.&TOMA, A.G. (2005) The use of camera
mobile phone to assess emergency ENT radiological investigations,
Clinical Otolaryngology, 30, pp. 230–233.
Mobile phone text messaging in the management of diabetes, Journal of
Telemedicine & Telecare, 10, pp. 282–285.
TSAI, H.H., PONG, Y.P., LIANG, C.C., LIN, P.Y. & HSIEH, C.H. (2004)
Teleconsultation by using the mobile camera phone for remote
management of the extremity wound: a pilot study, Annals of Plastic
Surgery, 53, pp. 584–587.
transmission: comparison of advanced mobile phone and facsimile
devices in an urban Emergency Medical Service System, Resuscitation,
57, pp. 179–185.
MCALLISTER, I.L. & TAY-KEARNEY, M.L. (2000) Telemedicine screen-
ing of diabetic retinopathy using a hand-held fundus camera,
Telemedicine Journal, 6, pp. 219–223.
Association of Standardized Patient Educators
Dear Sir
The Association of Standardized Patient Educators (ASPE)
group ( convened its annual
meeting in Chicago. Most of the 280 delegates were based
in Canada and the United States (US). We outline our
reflections on the meeting as United Kingdom (UK) based
delegates and recognize that our views are based on
a relatively small number of all sessions offered, are biased
by our personal interests, and do not represent the status
quo in standardized patient (SP) education but simply our
Although SP terminology is defined in the literature
(Collins & Harden, 1998; Barrows, 1993; Adamo, 2003;
Ker et al., 2005), conversational use does not always have
a shared meaning. In the US, ‘SP’ is used to describe most
situations in which a person takes on the identity of another
for the purposes of creating a healthcare professional
encounter with a patient. This probably reflects the pre-
dominant function that SPs play in assessment in which
consistent performance is required. In the UK, the terms
‘simulated patient’ and ‘role-player’ are more commonly
used with the principal role in teaching and learning with
reference to ‘standardization’ in relation to SP performance
necessary for high-stakes assessments.
In the US, SPs are already widely used in high-stakes
assessments. Recent changes reinforce this assessment
function with medical students undertaking summative
SP-based clinical skills assessments. In the UK, simulated
patients are used in high-stakes assessments and may
contribute to the rating of candidates in contrast to the US
and Canada, where SPs are sometimes the only assessors.
Although the content and process of feedback from
SPs to learners varied, in the US SPs regularly provided
feedback using paper forms (content and communication
processes) that contain ‘professional’ language distant from
patient perspectives. That is, SPs gave feedback as if they
were clinical and/or communication teachers. Although
there are many advantages to this approach, it precludes
feedback from SPs as ‘patients’. This was another
important difference from that in the UK in which
simulated patients are usually called on to provide a
‘patient’ voice delivering feedback on communication and
professionalism and rarely on ‘medical’ content or physical
examination skills.
The title of the association is also of interest. An SP
educator is at minimum responsible for the training of SPs
(performing the role and giving feedback). However,
these SP educators may also be responsible for case writing,
recruitment and administration. It was often unclear
whether these posts were academic, administrative or held
some other status. There are few such designated posts in
the UK.
In the US and Canada, SPs were usually paid, were not
professional actors (exceptions in New York and California),
were offered variable pay rates and sometimes held part-time
contracts. This reflects the diversity of UK-based practice.
Although we recognize that there is variability within
countries, there appeared to be greater differences between
them, which we attribute to different emphases in
The conference was an excellent forum to raise key
issues on all aspects of SPs and simulated patients and,
given there is no parallel group in the UK, ASPE is to
be congratulated on formalizing its activities through
Letters to the Editor
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this professional organization from which there is much
to learn.
Debra Nestel
Senior Lecturer in Communication
Department of Biosurgery and Surgical Technology
Imperial College, London
Karen Barry
Interactive Skills Unit
University of Birmingham
ADAMO, G. (2003) Simulated and standardised patients in OSCEs:
achievements and challenges 1992–2003, Medical Teacher, 25(3),
pp. 262–270.
BARROWS, H.S. (1993) Overview of the uses of standardised patients
for teaching and evaluating clinical skills, Academic Medicine, 68(6),
pp. 443–444.
COLLINS, J.P. & HARDEN, R.M. (1998) AMEE Medical Education Guide
No. 13: Real patients, simulated patients and simulators in clinical
examinations, Medical Teacher, 20(6), pp. 508–521.
BENVIE, S., BRACHER,L.&JACKSON, C. (2005) Twelve tips for
developing and maintaining a SP bank, Medical Teacher, 27(1), pp. 4–9.
Structured, supervised ambulatory medical education
for junior doctors
In Singapore, most of the undergraduate and early post-
graduate training is done at tertiary hospitals, where teaching
and supervision are focused on inpatient care, yet supervised
outpatient teaching is lacking (Chew & Chee, 2005).
In view of the shortfall, a pilot project consisting of a
structured resident outpatient teaching clinic was set up in
January 2005 at our institution. Five to eight new case
referrals were accepted at each session. Residents were
instructed to take sufficient time to clerk each case, followed
by a 15-minute case presentation and case discussion with an
attending hepatologist, who was running a concurrent
outpatient clinic next door. The attending hepatologist
would then meet up with the patients and explain their
medical condition, and manage accordingly.
Teaching was case-based and opportunistic. For instance,
when a resident encountered a patient referred for chronic
active hepatitis B, discussion was focused on the role of HBV
DNA viral load testing, and indications for antivirals.
The emphasis was on rationale and principles, rather than
the correct investigation and management.
Since mid-2005, a standard list of reading materials
consisting of management guidelines for chronic hepatitis B
and C, and fatty liver, were distributed to the residents,
as these were common referral complaints. Extra reading
materials were also given if the need arose. For instance,
an ex-injection drug user was once referred for manage-
ment of chronic hepatitis C, and extra reading material
on this subject was printed for that resident after the clinic
session. To ensure residents obtain a comprehensive history,
a clerking template has also been provided since mid-2005.
From January 2005 till April 2006, 22 residents ran the
Resident Hepatology Clinics. Feedback forms were given to
all and 17 were returned. Median duration since graduation
was 3 (range 1–6) years, and only 1/17 was interested in
further specializing in gastroenterology. A total of 16/17
(94%) felt their interest, knowledge and competence in
hepatology had increased, teaching was above expectations
and the clinic was felt to be an effective and worthwhile
experience. All 17 (100%) felt the clinic was better than any
outpatient clinics run during their previous postings. The
residents particularly appreciated the liberty to assess the
patient first, the case-based teaching, and the opportunity
to observe the interaction between the hepatologist and the
patients. Since results of the feedback are positive, similar
ambulatory clinics are currently being set up for other
Our experience showed that a structured, supervised
format of ambulatory care was welcomed by most residents,
and it should be further evaluated as the educational tool of
choice for junior doctors and medical students.
Chun-Tao Wai, Susan Tan & Dede S. Sutedja
National University Hospital
Singapore, Yong Loo Lin School of Medicine
National University of Singapore
CHEW, C.H. & CHEE, Y.C. (2005) Postgraduate medical education and
specialist training in Singapore, Annals of the Academy of Medicine,
Singapore, 34, pp. 182C–189C.
Letters to the Editor
... 6 To develop effective educational interventions for medical students, it is important to evaluate their existing level of knowledge and comfort with the topic of organ donation. Knowledge and attitude toward organ donation among medical students has been researched extensively, and studies have been conducted worldwide; [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] however, there is limited research regarding medical students in the Arab countries. [24][25][26][27][28][29][30] Students are regarded as a group displaying a high level of social involvement; many of them work as volunteers for different institutions and organizations. ...
... Their knowledge and beliefs concerning transplantation may be among the most important factors affecting individual preferences regarding organ donation. [6][7][8][9][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] The objective of the present study was to understand the awareness and beliefs about organ donation and transplantation among the medical graduate students and to study their attitudes toward organ donation. ...
... 3 Furthermore, as medical students are expected to gain increasing medical knowledge each year of study; they are an important group to empirically assess the effect of increasing knowledge on the subject of organ donation or willingness to donate. Surveys on the attitudes toward organ donation among medical students have been carried out in many countries, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] including some studies in Arab countries. [24][25][26][27][28][29][30] In this study, the knowledge of transplant terminology was fairly good. ...
Full-text available
Kidney transplantation is the most preferred treatment modality for patients with end-stage renal disease (ESRD). This study aims at understanding the awareness, attitudes, and beliefs among the medical and nonmedical students. The study population consisted of 500 medical students and 39 nonmedical controls, who were surveyed using a reliable questionnaire that examined their knowledge and attitudes. A 24-item self-administered questionnaire, which assessed the levels of knowledge, attitude regarding organ donation with dichotomous scale and demographic data were used. Of the 500 medical students who received the questionnaire, 376 (75.2%) with a mean age of 22.1 ± 2.5 years responded; 39% were male, 43.6% were Bahraini, and 32.2% were from Saudi Arabia, 51.3% were in Grades-5 and 6 and 58.8% resided in big cities. The medical students had a highly positive attitude and great willingness toward organ donation. Majority of them (75.3%) knew the treatment of ESRD, and 70.7% recognized correctly that kidney transplantation is the optimal treatment for ESRD. However, only 10.4% knew that it is performed in Bahrain since 1995. A total of 241 participants (64.3%) reported positive attitude toward living kidney donation and 71.8% expressed their agreement to donation after death. More than half (66.8%) believed that their religion permits organ donation, although 56.6% of the participants believed that there is a danger after donating a kidney. When compared to nonmedical students, there was no statistically significant difference in the attitudes toward living kidney donation (P = 0.823) or organ donation after death (P = 0.066).
... Similar studies reported that gender was found to be significant [29,30], whereas in some studies it was found to be insignificant [29][30][31][32][33]. In this study, there was no significant relationship between attitude and the academic year (p-value = 0.605). ...
Full-text available
Background: Organ transplantation is considered as one of the biggest advances in modern medicine. Unfortunately, the need for organ donors is greater than the number of people who donate. The knowledge and attitudes of people toward organ donation are affected by significant factors, such as education and knowledge, and societal factors, such as religion and culture. The aim of this study is to access the knowledge and attitude of medical students toward organ donation in Jeddah, Makkah, and Taif medical colleges in the Kingdom of Saudi Arabia. Methodology: A descriptive, cross-sectional study was carried out via a questionnaire on medical students in the western region of Saudi Arabia (Jeddah, Makkah, and Taif universities), from October to November 2018. Out of 467 participants, only 352 were included and 115 were excluded because the students in the first year in some universities were considered to be in the preparatory year. Results: Most of the participants had poor knowledge (61.1%), on the other hand, 86.1% (n = 303) had an appropriate attitude. There was no significant relationship between the knowledge level and gender or between the knowledge level and university type, whereas a significant relationship was found between the knowledge level and the academic year. A non-significant relationship was found between the attitude level and gender, university type, or the academic year. Conclusion: It was concluded that most of the participants had poor knowledge and most of them had an appropriate attitude about organ donation. Keywords: Knowledge, attitude, students, organ, donation, Saudi.
... Although female gender significantly increases willingness to donate organs it was not found to be effective in the logistic regression analysis (Tables 2 and 3). In some studies conducted with medical students gender was not determined to be significant [35,36], whereas in similar studies conducted with university students [27,37] gender was found to be significant. ...
... This study was performed on 416 high school girls aged between 15 and 18 years of Tehran, Iran. Based on a 5-point Likert scale [6][7][8] and without prior education, the attitude and willingness to donate BM and blood were assessed by an anonymous questionnaire. Attitudes towards tissue donation were assessed by a 5-point Likert scale, with '5' indicating "strongly agree" and '1' depicting "strongly disagree." ...
Full-text available
Background: Tissue donation has been promising in prolonging the lives of people with life-threatening diseases. Objective: To assess the attitude and willingness of high school students towards bone marrow (BM) and blood (as tissue) donation for maintaining a safe and adequate pool. Methods: This cross-sectional study was conducted among the high school girls, aged 15–18 years, who studied in natural sciences, mathematics and humanities. All participants filled a questionnaire consisting of age, religion, education levels and study branch, attitude and willingness towards BM and blood donation according to a Likert scale. Results: Out of 416 students, with the mean±SD age of 16.3±1.2 years, 31% studied in grade I, 27% in grade II (25% natural sciences, 27% mathematics, and 48% humanities), 26% in grade III (30% natural sciences, 34% mathematics, and 36% humanities), and 16% in pre-university level (college) (32% natural sciences, 42% mathematics, and 6% humanities). The students had highly positive attitudes toward BM and blood donation (mean±SD score of 4.2±0.54). The willingness for BM and blood donation was declared respectively, in 87% and 71% of respondents. Moreover, 16% of students wanted to donate only to their relatives and 84% to all persons in need of therapy. There was no significant correlation between the donation willingness and educational levels and study branch; however, these variables significantly correlated with attitude towards tissue donation (p=0.02, p=0.01, respectively). Conclusion: Despite positive attitude towards BM and blood donation, willingness for BM donation is lesser than blood which may be attributed to insufficient information about this type of tissue donation. An organized educational program for high school students in all aspects of tissue donation seems necessary.
... They concluded that an educational program was warranted to address this, as the students medical training should lead to a greater increase in support for organ donation as their understanding of its value increases. Grahovac et al. (2006) further found that educational programs can improve students' attitudes to cadaveric organ donation. In a 2005 survey of 500 medical students in three universities in the United States, Essman and Thornton (2006) found that 99% of those students supported organ donation. ...
Full-text available
There is a worldwide shortage of organs for transplantation. It has been shown that the attitude of healthcare professionals can improve the rates of organ donation, and that educational programs aimed at improving both attitudes and knowledge base of professionals can have positive outcomes. Although there has been research carried out on this topic, there has been none in Ireland. Anatomy dissection can be a stressor to medical students-we investigate the attitudes of Irish students to organ donation and how they change with exposure to anatomy dissection. A questionnaire was administered to first year students in the School of Medicine in University College Dublin, Ireland, three times over a nine-week period at the commencement of classes in an academic year. The attitudes of the students were positive throughout regarding organ donation by a stranger, a family member, or themselves. There was, however, a significant decrease in support for the donation of a family member's organs in a minority of students. Irish students' attitudes to postmortem organ donation are positive and are not changed by exposure to the dissecting room. There is support for the donation of organs, and willingness among students to donate their own organs and support donation by family members.
Full-text available
Health education, research and training rely on the altruistic act of body donation for the supply of cadavers. Organ transplantation and research rely on donated organs. Supply of both is limited, with further restrictions in Australia due to requirements for next‐of‐kin agreement to donation, irrespective of the deceased’s pre‐death consent. Research suggests health workers are less likely to support donation of their own bodies and/or organs, despite recognizing the public good of donation, and that exposure to gross anatomy teaching may negatively affect support for donation. Attitudes to body and organ donation were examined in Australian students studying anatomy. Support for self‐body donation (26.5%) was much lower than support for self‐organ donation (82.5%). Ten percent of participants would not support the election of a family member or member of the public to donate their body, and just over four percent would not support the election of a family member to donate their organs, with one‐to‐two percent not supporting this election by a member of the public. Exposure to gross anatomy teaching was associated with an increased likelihood of consideration of issues about body and organ donation, whether for self, family or the public, and registration as an organ donor. Exposure decreased participants’ willingness to donate their own body, with those who practiced a religion least likely to support body donation. Anatomy courses provide an opportunity to inform future healthcare workers about altruistic donation, albeit with recognition that religious or cultural beliefs may affect willingness to donate.
Transplantation is a successful procedure that prolongs the lives of people suffering from debilitating diseases. The purpose of this study was to assess medical students' attitude toward organ donation. The study population consisted of 262 medical students with a mean age of 22.1 +/- 2.5 years who were surveyed using a reliable questionnaire that examined their attitudes and willingness. All data analyses were performed using Chi-square and analysis of variance tests with SPSS. The medical students had highly positive attitude toward organ donation (mean score 4.34 +/- 0.46) and a great willingness. Participants were more willing to donate their own organs than those of a deceased relative (85% vs 49.2%) to help others more than to develop science (91.2% vs 8.8%). The greatest willingness among students was kidney (84%) donation. There was no correlation between age, gender, education levels, and attitude toward organ donation. These findings necessitate an organized education program of medical students in all aspects of organ and tissue donation.
In the assessment of clinical competence it is important to observe a candidate interacting with a patient. The role of the patient in this encounter will vary depending upon the level of interaction expected between the student and the patient, and whether physical signs are part of the presentation. Patients used in examinations may be real or simulated by a person who has undergone training in order to reproduce a particular scenario. Models or simulators, videotape and audiotape and computers may also be used as patient substitutes. There is a continuum between real patients with no training and simulated patients who have been extensively trained to perform the task: (1) 'real' patients presenting in clinical practice; (2) 'real' patients who have agreed to take part in a clinical examination but who are unrehearsed; (3) 'real' patients who have been rehearsed in what is expected of them; (4) 'real' patients who have been asked to modify, for the purpose of the examination, aspects of their history or presentation; (5) 'real' patients whose medical experience forms the basis for their performance in the examination but whose presentation is substantially modified for the purpose of the examination; (6) simulated patients who are given only an outline of what is expected of them; (7) simulated patients who are given a short brief or scenario with which they become familiar but beyond which they are free to respond as they wish; (8) simulated patients who are briefed extensively and who are thoroughly rehearsed prior to the examination. Simple and sophisticated simulators may be used to assess skills of physical examination and practical procedures. In only a few instances is the choice of patient representation in an examination limited to one approach. Examples where the choice is limited are the use of real patients with physical signs which cannot be simulated, the use of simulated patients in delicate or emotionally difficult areas, and the use of simulators where the use of patients would be inappropriate, for example, cardiopulmonary resuscitation. In many instances, however, there is no one correct approach. The approach adopted should be determined by the local circumstances and the needs of the examination. Factors which should influence the choice of patient representation in an examination are related to: (1) what is being assessed, including the level of abnormality and level of interaction with the patient required; (2) the level of stadardization required, with greater emphasis on standardization needed for high-stakes national examinations; (3) the logistics, including the availability and costs of real patients and trained simulated patients; (4) the context, for example, practice-based or formal examinations of the OSCE type; (5) the level of realism or authenticity required. Practical steps can be taken in the clinical examination to get the maximum value from the patient whether 'real' or simulated.
The author defines the term standardized patient (SP), the umbrella term for both a simulated patient (a well person trained to simulate a patient's illness in a standardized way) and an actual patient (who is trained to present his or her own illness in a standardized way). He first discusses the many values of simulated patients over actual patients as teaching and assessment tools in the classroom and refutes a few myths about the use of SPs. Then he recounts the origin and development of SPs over a three-decade period, beginning with his work as a neurologist at the Los Angeles County Hospital, where he trained a model from the art department to simulate a neurological patient and assist in the assessment of clinical clerks. He then describes additional roles of SPs that have developed, including: (1) their use in the Clinical Practice Examination created at Southern Illinois University School of Medicine and (2) the major use that has come into being over the last 10-15 years; facilitating the comprehensive assessment of clinical competence using multiple stations in examinations such as the objective structured clinical examination. He concludes with information about recent and current work on SPs, who are becoming more and more accepted in the assessment process, and urges skeptics not to make judgments about the value of SPs until they have experienced the technique firsthand and reviewed the literature concerning the extensive and often high-quality research about this assessment tool.
International interest in the teaching and assessment of clinical skills across the professional continuum has fueled extensive use of simulated parents in multiple station events by medical schools and professional organizations devoted to assessment. The author discuss achievements and challenges in the use of the objective structured clinical examination (OSCE) and simulated patient (SP) for medical education and assessment. The author revisits and expands subject put forth as 'technical issues related to logistics' that summarize group discussions of conference attendees in 1992 by Anderson and Kassebaum, editors of the Proceedings of the Association of American Medical Colleges' Consensus Conference on the Use of Standardised Patients in the Teaching and Evaluation of Clinical Skills. The author describes and discusses current terminology; evolving conceptual and practical applications of the OSCE that utilize simulated patients in medical education and high-stakes assessment for licensure and certification; standards of practice in SP case materials development, recruitment, training and quality assurance; operational and research questions for the future in the use of SPs, centralized SP programs and staffing; faculty development in the use of the SP and OSCE; program costs, event space, test and web-based video access and security issues; document and data management of SP programs; development of web-based and online resources and the founding of the Association of Standardized Patient Educators(ASPE), a specialist professional organization.
The Singapore Medical School celebrates its Centenary in 2005. This historical review is presented on Singapore's postgraduate medical education and specialist training programmes. The special informal role of the Alumni Association and its members during the early years and soon after World War II is highlighted. Postgraduate education and specialist training was more formalised only during the challenging years when Singapore became more autonomous and politically independent with the establishment of the Academy of Medicine, the School's postgraduate medical studies, the Singapore Medical Association, specialist societies and, more recently, the College of Family Physicians. Specialist training programmes and the process of specialist accreditation are also outlined. While Singapore has gone far towards developing a comprehensive programme of postgraduate medical education and specialist training, the process is still evolving and can be improved upon. As long as we keep pace with relevant and realistic strategies, the future for postgraduate medical training and specialist training should be assured.
Twelve tips for developing and maintaining a SP bank
  • J S Ker
  • A Dowie
  • J Dowell
  • G Dewar
  • J A Dent
  • J Ramsay
  • S Benvie
  • L Bracher
  • C Jackson
KER, J.S., DOWIE, A., DOWELL, J., DEWAR, G., DENT, J.A., RAMSAY, J., BENVIE, S., BRACHER, L. & JACKSON, C. (2005) Twelve tips for developing and maintaining a SP bank, Medical Teacher, 27(1), pp. 4-9. References CHEW, C.H. & CHEE, Y.C. (2005) Postgraduate medical education and specialist training in Singapore, Annals of the Academy of Medicine, Singapore, 34, pp. 182C-189C.