Medical education
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Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. ⋯ Clinical faculty at Dalhousie have very positive attitudes towards medical communication, and more highly positive attitudes are found in those who have attended a communications workshop. Despite this evidence that faculty appreciate the importance of medical communication skills, many assessed students' training in this curriculum area as poor.
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The script concordance (SC) test was conceived to measure knowledge organization, the presence of links between items of knowledge which allow for interpretation of data in clinical decision making situations. Earlier studies have shown that the SC test has good psychometric qualities and overcomes some of the limitations of simulation clinical testing. This study explores the predictive validity of the test. ⋯ The authors assumed that the richness of knowledge organization, as indicated by SC test scores, would predict part of the performance on the measures of clinical reasoning (SAMP and SOO), but would predict less well performance on the OSCE which measures both clinical skills and clinical reasoning. Data found in the study are coherent with this hypothesis. This is evidence in favour of the construct validity of the SC test. It also indicates that, in the context of certification assessment, if a candidate has shown good organization of clinical knowledge at an early point in training, it can be expected that he/she will show good organization at subsequent measurements of this kind of knowledge. This appears to be true even if the later measures bear on a wider clinical domain.
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To summarize trends over time in the percentage of British medical graduates who subsequently practise in Great Britain in the National Health Service (NHS), in Great Britain outside the NHS, outside Great Britain, or do not practise medicine. ⋯ Medical workforce planning in Great Britain should assume that 15-20% of home-trained doctors will not be working in the NHS within a few years of graduation. Comparing cohorts at the same career stage showed no evidence of increased loss from the NHS in recent times. Although a higher percentage of women than men were not working in medicine at all, recent trends suggest that this percentage is falling.
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The case for being able to respond effectively to cultural and ethnic diversity in health care is attracting increasing debate in medical education. However research exploring the perspectives of learners is lacking. ⋯ The study points to learners' experience of inadequate training but suggests a willingness to learn more. The possible predominance of a "difference" perspective might drive a narrow focus upon learning cultural knowledge at the expense of promoting a balance with self-reflection upon attitudes and developing generic skills. Educators might heed learners' views about how they should be taught successfully.
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Most research into medical communication has had a western setting. It has been undertaken by western researchers and been influential in shaping communication skills curricula. ⋯ We consider the following key aspects of debate on cross-cultural work. (i) To what extent can our understanding of general principles in other cultures be summarized and presented for teaching in a way which does not descend into caricature? Alternatively, can features of other cultures be presented in ways which do not descend into particularity? (ii) Can such paradigms as "patient-centredness" be transferred from culture to culture? Should they be presented across cultures as features of "good" consultations? (iii) What use can be made of the role of interpreters for teaching purposes? What importance does it have to the educator that a doctor may not be a native speaker of the majority language of the culture in which s/he is operating? (iv) Although the language of illness, and particularly metaphors associated with illness, are studied in other cultures, the way in which illness is metaphorized in British English is seldom discussed. What can educators learn and teach from a study of such matters? (v) What are the implications for communication skills teachers of the need to present materials within a culturally diverse environment?