01.13 The newsletter of the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine, Autumn/Winter 2006

Issues and news on learning and teaching in medicine, dentistry and veterinary medicine

Print: ISSN 1740-8768

Online: ISSN 1479-523X

IN THIS ISSUE:

• CETL updates
• Public health education
• Podcasting in dentistry and veterinary medicine

Other publication formats

This issue is also available as a low resolution PDF document suitable for printing.

Welcome!

The first edition of 01 in 07 brings us a look at the world of podcasting from the perspectives of dentistry in Birmingham and veterinary medicine at the RVC. The use of social software in education is an growing area (often driven by student needs), as witnessed by the BBC coverage of a Glasgow University philosophy lecturers podcast on Kant recently.You can listen to Dr Susan Stuart and her incredibly popular podcasts yourself at podlearn.arts.gla.ac.uk/kant/ .

Imperial College has been using the professional journalist services of Dominic Hartley to broadcast their medilectures, and we also hear from St Georges Medical School about Dr Jonathan Round’s forays into making templates for the creation of virtual patients.

It’s an exciting time in eLearning in our disciplines, and it is easy to get sidetracked into these developments. We balance this with articles looking at the relationship between the undergraduate and postgraduate continuum - a theme we hope to build upon in forthcoming issues.

Don’t forget to make sure you get your miniproject and workshop applications in to us by the deadlines, and if you are going to a conference - why not consider writing it up for 01? We love to receive unsolicited material from you.

Suzanne Hardy
Senior Information Advisor

Contents

• CETL update:Transforming placement learning in health and social care
  Susan J Lea, Director/Professor of Applied Social Psychology, Centre for Excellence in Professional Placement Learning, University of Plymouth
• Conference report:AMEE 2006, Genoa, Italy Dr Anita Laidlaw, Bute Medical School, University of St Andrews
• Podcasts, wikis, videos, and blogs:A case study in dental education
  Giles Perryer, Electronic Learning Manager/Lecturer; Catherine S Lambe, Clinical Scientist/Lecturer; Dr David Attrill, Senior Lecturer/Honorary Consultant; Professor A Damien Walmsley, Professor, Restorative Dentistry School of Dentistry, University of Birmingham
• CETL update: Using human patient simulators in physiology teaching
  Dr Judy Harris, Head of Teaching in Physiology & Co-director of the AIMS CETL, University of Bristol
• Veterinary potcasting
  Brian Cox, Electronic Media Unit; Raymond Macharia,Veterinary Basic Sciences; Nick Short, Electronic Media Unit; Kim Whittlestone, LIVE Centre, Royal Veterinary College
• Undergraduate medical education:What are the implications of changing postgraduate training?
  Dr Helen Graham, Senior Lecturer, Division of Medical Education, King’s College London School of Medicine; Miss Hannah Enguell, 5th year medical student, King’s College London School of Medicine; Dr Jonathan Bath,Year 1 Foundation Doctor, King’s College Hospital, London
• CETL update: LIVE centre
  Birgit Pirklenauer, LIVE Centre, Royal Veterinary College
• CETL update: Assessment and Learning in Practice Settings (ALPS)
  Feedback on health and social care students’ communication skills Trish Walker, CETL Manager
• Spreading the net for Public Health education
  - Facilitating patient autonomy with a new standard of care
  Woody Caan, Professor of Public Health,Anglia Ruskin University
• Creating your own virtual patients
  Dr Jonathan Round, Senior Lecturer in Paediatrics, St. George’s, University of London
• TechDis update
  Dr Simon Ball, Senior Advisor,TechDis
• Medical student as teacher: Inspiring the transition from learner to teacher using the Disney creativity strategy
  Dr Peta Foxall, Lecturer in Clinical Education; Dr Jane McHarg,Teaching Fellow; Dr Michelle McCulley,Teaching Fellow; Dr Jim McGarrick,Teaching Fellow, Institute of Clinical Education, Peninsula College of Medicine & Dentistry, Exeter
• Developing teaching skills in medical students: Peer assisted learning in patient-centred interviewing
  Dr Tanya Tierney, Lecturer in Communication; Dr Debra Nestel, Senior Lecturer in Communication; Dr Frank Harrison, Senior Lecturer in Educational Development, Imperial College London
• Journalism meets medicine on-line
  Dominic Hartley, Imperial College
• Total assessment: Methods in medical education
  David J A Lewis, Blended Learning Coordinator, University of Glamorgan
• Forthcoming educational events and conferences
• Workshop programme
• Educational funding opportunities

CETL update: Transforming placement learning in health and social care

Susan J Lea, Director/Professor of Applied Social Psychology, Centre for Excellence in Professional Placement Learning, University of Plymouth

Placement or practice learning is an essential component of many programmes, but is especially important within those programmes leading to professional registration.The development and dissemination of excellence in placement learning, to the benefit of students, educators and service users, is the primary aim of the Centre for Excellence in Professional Placement Learning (Ceppl).

Learning in the work place is central to the education of all students (1) and is a stated requirement of professional and statutory body accreditation (2). It is vital to producing effective, selfreliant, and competent students who practice safely (3). The development and dissemination of excellence in placement learning, to the benefit of students, educators and service users, is the primary aim of the Ceppl.

The Ceppl is a Centre for Excellence in Teaching and Learning, funded by the HEFCE.

It was awarded in recognition of excellent placement learning in the disciplines of social work, midwifery and the post-registration health professions.

The Ceppl defines placement or practice learning as learning that takes place in the work environment (4). Students on health and social care programmes spend up to 50% of their time in practice, as their programme usually leads to professional registration. While in practice, students often carry some degree of professional responsibility, meaning that they actively contribute to the work context. For this reason, our work is underpinned by an explicitly transformative agenda - both in terms of the students’ own learning, and their potential to transform the health and social care contexts within which they work. We are mindful that education is a socialising experience that helps make the people who make society (5) hence, it can maintain existing order or open up new ways of doing things (6).

Staff within the Ceppl are involved in evaluating existing good practice in various facets of placement learning; in developing generic principles and guidelines that can shared across disciplines; in establishing new, innovative placement opportunities for students; and in encouraging systematic research in placement teaching and learning. All of this work is underpinned by an explicitly transformative agenda - in terms of both the students’ own learning, and their potential to transform the health and social care contexts within which they work.

We are evaluating and enhancing placement learning through:

• The evaluation of key elements of placement learning, and the development of generic principles and guidelines that can be shared across disciplines - teams are working on: preparing staff, supporting students with disabilities, assessment in practice, evaluating interprofessional education, monitoring and enhancing the placement learning context, objective structured clinical examinations, the role of mobile technology, and enhancing library access. Teams include students, service users, practice educators, library and computing personnel, and learning technologists.
• Forging a strong link between research and development - researchers conduct generic research into placement learning, provide a resource for staff, and offer training in various aspects of research.
• The development of new interprofessional placement learning opportunities for students - with traditionally marginalised social groups for whom services are not readily accessible. Students currently work with asylum seekers and refugees, and prisoners. Opportunities for working with migrant workers, young people who are homeless, and carers of people with a chronic illness or disability are being explored.

We would welcome the opportunity to work with others interested in placement learning, to share experience and expertise and ultimately to enhance placement learning. For more information about the Ceppl, please visit our web-site at www.placementlearningcetl.plymouth.ac.uk or e-mail ceppl@plymouth.ac.uk

For more information please contact s.lea@plymouth.ac.uk

References

1. Dearing R (1997), Higher Education in the Learning Society. National Committee of Inquiry into Higher Education. www.leeds.ac.uk/educol/ncihe [Accessed 14/10/2004].
2. Shardlow S & Doel M, Learning to Practise Social Work. London: Jessica Kingsley Publishers.
3. UKCC (1999), Fitness for practice: the UKCC commission for nursing and midwifery education. London: UKCC.
4. Boud D, & Solomon N (2001), Work Based Learning: A New Higher Education. Buckingham: SRHE/Open University Press.
5. Shor I (1992), Empowering Education. Chicago: University of Chicago Press.
6. Dewey J (1966), Democracy and Education. Free P: Collier-MacMillan. Students preparing for practice

Conference report: AMEE 2006 Genoa, Italy

Dr Anita Laidlaw, Bute Medical School, University of St Andrews

Being fairly new to medical teaching, I was extremely pleased to be awarded a Rewarding Excellence in (Medicine) Learning and Teaching award by the MEDEV Subject Centre to allow me to travel to Genoa for my first AMEE meeting.What would it be like? What would the hot topics be? These were the thoughts going through my head as we touched down in Genoa airport. It is impossible for me to cover everything I saw and heard in this review. I will instead, give a couple of my highlights and a brief overview of the hot topics.

Picking up the fairly weighty abstract book at registration confirmed that it was going to be a busy few days. I was intrigued to notice the audience response keypad in the registration pack which was put to good use in the first plenary session. Half of the delegates were also first timers, I wasn’t alone! The next 3 days passed in a whirlwind of posters, short communications, symposiums and plenary sessions. I failed to make it to any of the workshops, which, in hindsight, was a shame.

My first highlight was Brian Hodges talk in plenary 1 entitled Medical education and the maintenance of incompetence. He discussed how various discourses or approaches have been, and are being used in medical education and that each discourse has a focus towards which the medical student is educated. Therefore there are areas that are not focussed on and this can result in incompetencies. The message I took from this is that it is useful to recognise the discourse utilised in your own Medical School as this should enable you to minimise the incompetencies which can arise.

The second highlight was another plenary talk, this time Cees van der Vleuten whose title was Where are we with assessment and where are we going? The emerging theme from this talk was that whilst we now have many assessment methods, we should still continue to develop further tools, especially thinking of appraising in a workplace context. This may require a much more holistic approach than we have seen thus far with assessment technologies.

Hot topics were:

• Interactivity: making learning an interactive, fun, motivating experience in either a physical or virtual environment.

• Technology: audience response systems, virtual patients, computer based assessments and e-portfolios were all being showcased and further developed with the focus on improving the learning experience.

• Integration: Not just of subjects within the curriculum but of teaching styles, learning with assessment, research methodologies and of the global migration of graduate doctors.

So much to think about, lots of information to digest. A couple of the speakers mentioned that we should be thinking of how we should prepare our students, who will be midcareer in 2030, it was clear that many people already are.

For more information please contact ahl1@st-andrews.ac.uk

Podcasts, wikis, videos, and blogs: A case study in dental education

Giles Perryer, Electronic Learning Manager/Lecturer;
Catherine S Lambe, Clinical Scientist/Lecturer;
Dr David Attrill, Senior Lecturer/Honorary Consultant;
Professor A Damien Walmsley, Professor, Restorative Dentistry School of Dentistry, University of Birmingham

Using Web 2.0 technologies allow people who have no programming knowledge to create web pages and share information on the Internet which others may comment on or edit as appropriate.The School of Dentistry at Birmingham has recently introduced the Web 2.0 ethic into its eLearning environment, allowing students to have greater control over what is placed on the site. Student feedback is very positive and has led to further learning and teaching material being created in this manner.The aim of this article is to provide an overview of this approach to eLearning with a view to encourage others to use it in their teaching.

Introduction to Web 2.0

Until recently, almost all internet content has been highly controlled by technically skilled webmasters, administrators, and programmers. A web site would typically be written by those who had permission/instruction to do so, and any contributions by the mainstream users of the site would be limited to the occasional comment in a guest book, and subject to frequent censorship.

In 2003, MySpace allowed aspiring bands to freely upload their music, photographs, and personal information, for advertising to their potential youth audience. Fans too were able to design and create information pages about themselves, link with other fans, and to comment on the music. No specialist programming knowledge was needed, and authoring was done using a regular browser window, such as Internet Explorer.

Soon the sharing of social and personal information by fans became as important to MySpace users as the music itself. Sharing personal information online became known as social networking, with the end-users of the MySpace site in total control of its content. By late 2005, 40 million people were sharing information on MySpace, and currently (2007) there are 140 million.

We now have a generation of young people who regard the internet as their personal territory, accessible and editable with no programming knowledge. They have many online social networks, such as friends, work colleagues, fellow students, and family. Some web sites have specialised in catering for individual social networks, for example Facebook for academic networks. Some sites specialise in sharing specific information genres, such as photographs (Flickr), videos (YouTube), music (MySpace), facts (Wikipedia) and personal diaries (Blogger). There are even sites which allow users to share their favourite web sites (Del.icio.us and CiteULike) - this is known as social bookmarking.

This shift towards control by the users instead of webmasters, and the underlying technologies that enable content creation and information sharing, has become known by the buzzword Web 2.0.

The aim of this article is to provide a brief introduction to the ways that Web 2.0 may be used to engage the imagination and enhance the teaching and learning of our students.

Podcasts

Downloading music to personal mp3 players such as the iPod is now commonplace and a simple way to engage with the learner is by delivering spoken word clips in the form of podcasts.

A podcast is effectively a radio show that can be downloaded onto a personal music player, and listened to by a student in their free time, such as on their journey to and from their work place.

Creating podcasts is relatively easy. Apple computers have a program called GarageBand which automates the entire process. For Windows, there is a free program, Audacity, which may be used for recording and editing sounds and saving them in the correct format (mp3 format). Simply attach a microphone to the recording input on your computer (or use the internal microphone if present) and you are set up to record a podcast interview. Production efficiency is improved if a script is prepared and a rehearsal takes place prior to the recording. They are more interesting if there are two people taking part in a discussion rather than just one person delivering opinions and facts. Podcasts should be kept short and to the point - this is where a script is helpful. From experience 5 to 10 minutes appears to be most the appropriate length.

The easiest and most efficient way to distribute podcasts is by making them available through iTunes, a free Apple program that is almost universally used and understood by students.

The School of Dentistry in Birmingham has made many podcasts available for students (and the public) to download onto their iPod/mp3 player. The School productions are listed on iTunes and subscribers automatically receive new podcasts when they become available. From start to finish a 10 minute podcast will take around 2 hours to script, record and make available on iTunes.

Full instructions on publishing through iTunes are available on Apple’s web site.

Podcasts can also include video, but video podcast players are not as universal as the audio ones: we plan to convert our video based learning objects into video podcasts once a critical mass of our students own a video-enabled player.

Wikis

A wiki is a website that allows visitors themselves to easily add, remove and otherwise edit and change available content directly through the browser window, without any programming knowledge. The ease of interaction and operation makes a wiki an effective tool for collaborative authoring.

The School of Dentistry developed a wiki in-house along the same principles as www.wikipedia.com. Learning topics are initially placed on the site by either staff or students and the pages are further refined by contributions from students. There are many ways for staff to drive the content, such as providing problembased learning scenarios or initiating topic based research. Our first pages were created in supervised tutorial sessions and more recently students are initiating material independently. Students are able to provide their own online learning materials on topics that they feel are poorly covered in the course. Feedback has shown that the students enjoy developing their own content as a group. Contributions can be anonymous if students wish, which creates a safe environment. Our wiki relies on professionalism and mutual trust, and there has been no abuse to date. Information provided by students is not necessarily corrected by staff as it is an open site. The learner has to decide how much they can trust wiki information. If they add to it, they are encouraged to provide references to increase the authenticity.

Videos

Increasingly, students are asking to view videos of operative and laboratory procedures, and this feedback has led to appropriate procedures being routinely filmed. Videos are produced using a hand held camcorder, minimally edited with free proprietary software, and placed on the eLearning site. The videos are catalogued and displayed in a similar manner to popular websites such as YouTube and Google Video. The videos frequently include the addition of formative self assessments to assist the students in their learning. From start to finish a short video will take around 3 hours to script and produce before being placed on the web site. The school currently uses RealPlayer as its video platform. We have found this to be the most time and cost efficient platform for combining video, captioning, slides, and interactive self-assessments into one reusable learning object. Our videos and wiki are currently password protected during this formative period.

Blogs

Blogs (personal web diaries) have not as yet caught the imagination of the undergraduate students but the facility is available. They could potentially be used for reflection and peer support during their course. News from the School of Dentistry is presented as a blog and a postgraduate student has started a research blog.

Summary

Student feedback on most of these developments has been very positive. This is likely to become an expanding area for the future, placing a firm emphasis on student-led learning. The introduction of new technologies has the ability to help students in their learning experience and augment traditional teaching methods.

Further reading

Boulos MN, Maramba I, Wheeler S (2006), Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC Medical Education; 6:41.

For more information please contact d.g.perryer@bham.ac.uk

Resources

Social networking
Music www.last.fm
Photographs www.flickr.com
Video www.youtube.com
www.video-google.co.uk
Myspace www.myspace.com
Facebook www.facebook.com

Social bookmarking
del.icio.us
www.citeulike.org

Podcasting
audacity.sourceforge.net
www.apple.com/itunes
www.apple.com/itunes/store
www.apple.com/garageband
audacity.sourceforge.net
www.real.com
www.dentistry.bham.ac.uk/ecourse/podcast/mp3list.asp

Wikis
www.wikipedia.org

CETL update: Using human patient simulators in physiology teaching

Dr Judy Harris, Head of Teaching in Physiology & Co-director of the AIMS CETL, University of Bristol

We are developing teaching scenarios based on high-fidelity computer-controlled Human patient simulators to enhance our physiology teaching in the first two years of the medical, dental, veterinary science and medical science curricula. The simulators enable us to illustrate many aspects of physiology that cannot be demonstrated in physiology practical classes in which the subjects are usually young, healthy volunteers (i.e. students).The simulator-based teaching is proving very popular, and students have described it as really bringing the material alive.

Computer-controlled human patient simulators (HPS (1)) are already used in several medical schools, including Bristol, for clinical training of medical and health-related professionals. We are now incorporating them into our physiology teaching in the pre-clinical parts of the curriculum.

The AIMS CETL

The simulators are one strand of our HEFCE-funded Applied and Integrated Medical Sciences Centre for Excellence in Teaching and Learning (AIMS CETL) that was established in April 2005. We used around £750k of our capital funding to create two HPS teaching suites each of which accommodates 20-30 students. Some of the evolving teaching scenarios based on the HPS (affectionately known as Stan, or Mr Stan D Ardman) are described below.

Simulated ascent to altitude

This scenario forms part of the first physiology practical class taken by students, in which they investigate the mechanisms responsible for stabilizing arterial oxygen saturation (SaO2). In the first part of the practical they exercise vigorously and measure the resulting changes in their heart and breathing rates, whilst monitoring their SaO2. We then run a simulation session in which students observe Stan’s response to the rather more challenging stimulus of ascent to altitude - an experience that our budget doesn’t enable us to provide annually for 400 first year students. For this, Stan is intubated and provided with air to breathe that has a composition equivalent to that at the top of Mount Everest.

In a subsequent feedback session, comparisons can be drawn between students’ responses to the physiological stress of vigorous exercise and the simulated data at altitude - this triggers discussion about the underlying physiology in each situation, the limitations of homeostatic mechanisms and the physiological adjustments that could have occurred if Stan had acclimatized to altitude over a longer period of time.

Simulated haemorrhage

We are also using Stan in our cardiovascular teaching (2). For many years, in physiology practical classes our students have measured their blood pressure and recorded their ECG under a variety of conditions. Such measurements are valuable for illustrating many aspects of cardiovascular physiology. This practical teaching has now been significantly enhanced by the inclusion of a 45-min scenario in which Stan is bled by progressively decreasing his circulating blood volume (another procedure that we would be reluctant to perform on our students).

The scenario demonstrates the sequential cardiovascular responses of an individual who is involved in a serious road traffic accident immediately after taking part in a routine blood donation session. Real-time waveforms of simulated arterial and central venous blood pressure, ECG, and arterial oxygen saturation are displayed, and cardiac output can be measured.

Other cardiovascular variables (e.g. stroke volume) can then be calculated so the scenario provides a vivid and engaging illustration of Starling’s law of the heart and the baroreceptor reflex being played out in real time. Students are also able to interact with, and observe, Stan - palpating pulses, using a stethoscope to listen to his heart and observing when he loses consciousness, which is simulated by his eyes closing.

It’s important to emphasise that we are not aiming, at this stage of the course, to demonstrate how to treat Stan. We’re using the HPS scenarios to illustrate fundamental principles of physiology. It’s likely, though, that clear clinical relevance within the scenarios is especially effective in engaging the attention of health professionals of the future whether they be doctors, dentists or vets.

Student input and feedback

We routinely evaluate any new scenario by rehearsing it with an audience of student volunteers who then participate in a small focus group session that is led by final year students who are undertaking a research project on the development of the HPS as a physiology teaching tool. This preliminary student feedback enables us to fine-tune each scenario before delivering it to the entire student cohort. The HPS-based scenarios that we’ve developed so far have attracted excellent student feedback, with most students expressing preference for simulator-based teaching over more traditional methods of teaching and learning (3).

Longer term, we plan to disseminate video footage of the scenarios - we have already successfully run one of the scenarios as a large group (n=120) teaching session by streaming video displays of Stan and the waveform display to an adjacent teaching laboratory - and to offer practical physiology workshops and summer schools that will include some HPS-based teaching.

Acknowledgements

Thanks to Dr Eugene Lloyd, Dr Rich Helyer and Prof Stephen Lisney (Department of Physiology, University of Bristol) for their input in developing the scenarios; to Mr Pete Dickens (AIMS CETL) for technical support and to the Higher Education Funding Council of England for funding the AIMS CETL.

For more information please contact judy.harris@bris.ac.uk or go to www.bris.ac.uk/cetl/aims

References

1. Medical Education Technologies Inc, Florida, USA: www.meti.com
2. Lloyd E, Helyer RJ and Harris JR (2006), Human patient simulation in physiology teaching: designing a high fidelity cardiovascular demonstration for first year undergraduates. Proc Physiol Soc 3: PC 63.
3. Harris JR, Lloyd E, Richardson E, Williams M and Helyer RJ (2006), Integration of Human Patient Simulators (HPS) with existing physiology teaching for first year medical, dental, veterinary and medical science undergraduates. Association for Medical Education in Europe Conference Proceedings 2006: 7P19, p135.

Veterinary potcasting

Brian Cox, Electronic Media Unit; Raymond Macharia,Veterinary Basic Sciences; Nick Short, Electronic Media Unit; Kim Whittlestone, LIVE Centre, Royal Veterinary College (RVC)

The RVC is involved in an Academy funded project led by the University of Leicester to investigate the potential of podcasting to enhance traditional approaches to teaching and learning.The IMPALA project (Informal Mobile Podcasting And Learning Adaptation - www.impala.ac.uk) includes initiatives at the University of Leicester, the Royal Veterinary College, Kingston University and the University of Gloucestershire. Each institution is exploring different applications of podcasting ranging from engineering rap lectures to podcast geographical field trips.This article outlines work to develop anatomical potcasts for use by preclinical veterinary students.

Digital audio in education

The rise in popularity of mp3 players (such as Apple’s iPod) for entertainment has provided the potential for the widespread use of digital audio in teaching and learning. These opportunities include capturing lectures, recording interviews or providing technical guides. Most students are now familiar with the concept of downloading music and our initial experience at the RVC suggests that they are happy to mix their favourite music tracks with a digital audio lecture or two!

The early findings from the wider IMPALA project suggests that there are a range of benefits for students in using downloadable mp3 files. They include the fact that regular podcasting helped students to stay organised, brought some informality and fun to their learning, supported their independence but also enabled engagement with materials whilst mobile and situated. Situated learning emphasizes learning presented in authentic contexts and with other people. And of course they can always listen again, any time, anywhere to the files. Most importantly, IMPALA student were able to distinguish between podcasts for entertainment and those for studying.

Potcasting

Like all medical and veterinary schools, the RVC has an anatomical museum with a large number of anatomical pots and specimens. Many of these were produced by staff and students in the past and offer stunning examples of the art of dissection. Sadly, the modern day student has less time or opportunity to spend on these basic skills and must therefore depend on interpreting the work of their predecessors. However, this can be difficult as many of these pots carry little more than the name of the original dissector and perhaps the identity of the principal organs on display.

At the RVC we are now attempting to bring some of the old art of dissection alive with potcasting. We are recording a range of audio files that students can download and listen to whilst they walk around the anatomy museum. These files are in mp3 format and are uploaded to the College VLE from where students can download them using iTunes or save them onto a computer hard drive.

MP3 player: A digital audio player that stores, organises and plays digital music files

Podcasting: Distribution of a multimedia file over the Internet for playback on mobile devices or personal computers

Potcasting: A new term to describe podcasting applied to anatomy museum specimens

The potcast project has been piloted with second year students identifying specimens related to the curriculum that they found difficult to interpret. The anatomist then developed a short script for each pot which was recorded and edited by a member of the e-Media team. In some cases these audio tracks have been enhanced by annotated digital images of the specimen to help students identify key structures. Students then have the opportunity of reviewing a specimen while on the move using the image or listening to the audio track while viewing the real specimens.

Other versions of the potcasting model that are being trialed include a themed overview of a number of different pots. This allows the tutor to highlight related anatomical features in different species or the anatomy relevant to a particular condition or procedure covered later in the course. Video potcasting is also proving an effective way of demonstrating three dimensional features, for example in a dissection.

Other ongoing trials

We are also experimenting with simple and inexpensive methods of capturing audio for teaching and learning purposes to complement the potcasts. Students have been recording anatomy lectures, with the lecturer’s permission, using an Olympus digital Dictaphone. They then convert the lectures into mp3 format using free software such as Audacity and upload it on to the relevant section of the VLE. Whilst the majority of students appear to download and listen to the potcasts on their PC, others report listening to them on their mp3 player on the bus home.

Another example of the use of digital audio involves recording interviews with subject experts about their research work and its relevance to veterinary education. These interviews provide an overview of issues and research relating to wider topics such as tuberculosis, diabetes or milk production and the live question and answer style is designed to engage students and staff directly in the latest developments. In some ways this mirrors past practice in providing audio cassettes but the great attraction of using the web and portable devices is that it makes it easier to produce and distribute the recordings.

Student feedback

Student focus groups and online surveys have indicated that these resources are a popular new medium. Students report that they value the opportunity to review a lecture that they have not fully understood either immediately after the lecture or when revising later. For example one student commented:

It allows me to process information and understand the content of the lecture better as I personally learn and remember information when I hear it rather than when I read it. It has also been useful to be able to go back to parts of a lecture where I’m not sure if I understand something and to hear a concept explained again.

The impact of potcasting is still being evaluated as part of the IMPALA project. However informal feedback from students has been enthusiastic and they have played an active role in identifying specimens to potcast and providing ideas on the most effective ways to distribute the media. This initiative has been well received by anatomists at the College, with several adapting the basic model to support their own teaching.

The future

The technologies described here are simple and cheap to produce. Student assistance has kept the amount of staff time required to a minimum and partly passed the responsibility for the project to the students. The examples we have piloted demonstrate the potential of reinvigorating traditional teaching technologies using modern mp3 player technology.

Potcasting development and research is ongoing and the College is now starting to explore the potential of using this technology to support and encourage student’s independent learning. The RVC is also in discussion with the Hunterian Museum at the Royal College of Surgeons about developing some joint potcasts between the two Colleges. It is hoped that this may encourage our students to visit both museums with a guide in their ear pointing out the lessons to be learnt from comparative anatomy.

For more information please contact
nshort@rvc.ac.uk
www.rvc.ac.uk/emedia

Example of potcasts can be downloaded from www.rvc.ac.uk/review

Audacity can be downloaded from audacity.sourceforge.net

Undergraduate medical education: What are the implications of changing postgraduate training?

Dr Helen Graham, Senior Lecturer, Division of Medical Education, King’s College London School of Medicine; Miss Hannah Enguell, 5th year medical student, King’s College London School of Medicine; Dr Jonathan Bath,Year 1 Foundation Doctor, King’s College Hospital, London

In August 2005, fundamental changes to UK postgraduate training were introduced through the Modernising Medical Careers (MMC) initiative and implemented as the Foundation Programme with the aim of producing better trained doctors and improving patient care.The previously unstructured postgraduate training was replaced by a two-year general training which would form a bridge between medical school and specialist or general practice training.The curriculum was developed by the Academy of Medical Royal Colleges in consultation with NHS staff and other stakeholders, and describes the core competences that should be achieved during the foundation training (MMC 2005).

In the light of these changes, King’s College London School of Medicine through its education committee appointed a skills review group tasked with exploring the implications for the undergraduate curriculum of the new postgraduate training. The group was asked to identify curriculum areas where graduates felt ill-prepared for the Foundation Programme with the aim of adjusting the undergraduate course in the following academic year. In the UK, the General Medical Council (GMC) provides guidance on and monitors undergraduate medical education and the pre-registration year of the Foundation Programme (GMC 2003). The undergraduate course at King’s is based on GMC recommendations and is continuously reviewed and updated to take account of clinical and educational developments. Despite this, some graduates reported feeling under-confident in their skills competencies in the first year Foundation Programme.

Review of the Foundation Programme curriculum

The authors, as members of the skills review group, crosschecked the Foundation Programme skills curriculum against the King’s undergraduate skills curriculum and highlighted possible areas of deficiency. We discussed these in a focus group with King’s graduates who were mid-way through their first year Foundation Programme and highlighted the curriculum skills they considered they had been inadequately prepared for during the undergraduate course. The authors discussed the relevance of these views with key undergraduate and postgraduate educators, including the Director of the South East Thames Foundation School, Undergraduate Dean, and other members of the skills review group, and sought consensus on areas of the undergraduate skills curriculum where there was potential for improvement.

These included:

• The management of acutely ill patients.
• Patient safety issues especially continuity of patient care, risk management and team working.
• Practical prescribing including drug delivery and monitoring, dose calculations, prescription writing skills, use of prescribing formularies, adverse drug reactions, pain control, and safety procedures for controlled drugs.
• Professional development and accountability with emphasis on careers reflection and guidance.
• Communication with non-English speaking patients and use of interpreters.

Recommendations for curriculum change

The skills review group recommended an action plan for curriculum change to the education committee. Working parties were appointed and asked to design new modules or strengthen existing modules for implementation in the following academic year. These included:

• Workshops on care of acutely ill patients and patient safety issues (year 5) .
• Workshops on practical prescribing (years 3 and 5). - Career planning: aptitude tests, reflection on potential careers, and career “taster” special study modules (years 1-5).

Other proposals would involve longer-term planning and wider consultation with faculty and NHS staff before introducing changes. These included:

• A review of therapeutics teaching involving clinicians, pharmacologists, pharmacists, foundation programme doctors, and web-designers to identify potential improvements.
• The design of eLearning modules on prescribing issues which would complement clinical experiences in years 4 and 5.
• The design of a communications training module on use of interpreters for non-English speaking patients.
• A review of Foundation Programme assessment tools and their applicability to undergraduate skills assessment e.g. formative self-assessment of skills.

Since undertaking our review, national reports have highlighted that many medical students feel unprepared for the skilled prescribing needed in their early clinical years and this has led to considerable anxiety about the adequacy of medical student training in prescribing skills (Aronson et al. 2006). We subsequently set up a working party to consider how best to address this problem.

Conclusions

This curriculum review has highlighted the need for medical schools to respond pro-actively to changes in postgraduate training by reviewing their undergraduate programmes and informing faculty about the need for curriculum change. Awaiting recommendations from an MMC review of the Foundation Programme before taking action would have delayed adjustments to the undergraduate course, although these will also inform curriculum change. The timely response by undergraduate teachers to our recommendations led to the implementation of new curriculum modules on the undergraduate medical programme within 12 months of the start of the Foundation Programme and should ensure a more seamless transition from undergraduate to postgraduate training. It will be important to evaluate whether the strengthened curriculum produces doctors who feel better prepared for the Foundation Programme.

The authors acknowledge the advice of the following staff at King’s College London School of Medicine: Professor John Rees, Undergraduate Dean, Dr Jan Welch, Director of South East Thames Foundation School, and the Skills Review Group.

For more information please contact helen.graham@kcl.ac.uk

References

Modernising Medical Careers. (2005). Curriculum for the foundation years in postgraduate education and training.