UCD operates a Six-Year undergraduate medical programme which includes a basic science curriculum in Year one. Entrants also require any one school laboratory science. The purpose of this study was to consider how specific school or university basic sciences contribute to enhanced performance on the medical programme and to explore whether six year medical programmes are justifiable.
Quantitative data was collated for all Leaving Certificate (LC) students entering the programme from 2006 to 2009 (n=413). Correlations between entry criteria (LC subjects and points, HPAT scores) and outcome measures (Year and Degree GPA) were analysed and linear regression used to examine the relationship between models of predictor variables and outcome measures. International medical education practice in the UK and Australia was considered alongside student opinion.
Five year programmes are prevalent in the UK with A-Level Chemistry a common entry requirement. Ireland and Australia, having similar broad-based second level exit examinations, still offer a number of six year programmes. An ASTI report in 2012 showed a decline in the availability of Chemistry (-11%) and Physics (-21%) for the LC programme. Student consultation indicated a preference to a medical programme, which offers access to a broader educational experience.
There was no statistically significant difference in the medical programme performance of students with/without prior knowledge in a school science. The presence of Honours Maths was predictive of performance in all years, particular years one to three (p<=.05). Significant but weak correlations found the LC and it’s constituent subjects to be weak predictors of medical programme performance (r values from -0.073 to 0.277). Regression analysis found second level English, Maths and a science subject to be the strongest model to predict programme performance (r2 values from .022 to .17). Performance in the first years of the programme, including performance in the basic science curriculum, was highly indicative of later performance.
Our research suggests that university basic sciences are more predictive than LC sciences of success in later studies. This, alongside the reducing availability of chemistry and physics at second level, justifies the inclusion of basic sciences within medical curricula in Ireland. Advances in medical practice are increasingly based on a foundation in these subjects, with nano biology, advanced therapeutics and radiographic imaging requiring graduates intellectually agile enough to truly understand the diagnostic and therapeutic tools of the future.
A significant challenge faced by families and patients affected by rare diseases is the general lack of awareness among medical professionals of the sheer number of rare diseases that exist and the sometimes devastating impact a rare disease can have on all aspects of a persons life. Many doctors believe that they are unlikely to come across a rare disease in their professional careers and simply to not realise that it is not rare to have a rare disease. The School of Medicine and Medical Science in University College Dublin has developed an innovative educational module that aims to increase awareness of rare diseases among medical students.
We have developed an elective module with contributions from patient organisations, clinicians, academic staff, research scientists and pharmaceutical industry. The module is offered to undergraduate medical students in the final year of their pre-clinical training. The module was designated a grade neutral module which makes no impact on the student’s overall grade that academic year. The method of assessment had to reflect the overall aim of the module, which was to increase awareness of rare diseases among medical students and not examine the level of scientific knowledge of a host of rare disorders. Assessment of the module had two distinct components. The first was a reflective learning journal that had to be completed by the student at regular intervals during the semester. Students also had to prepare an information pamphlet suitable for a medical professional detailing genetic basis, symptoms and treatment of the disorder chosen, as well as resources for further information.
The feedback from the module has been overwhelmingly positive and shows the advantage of using a multidisciplinary approach where the student can hear directly from the patient, learn about the importance of research and advances in treatment of rare disorders and identify resources that will be useful in their future professional careers.
The author would like to acknowledge the contribution made by IPPOSI in facilitating this initiative.
Since 2011, the regulatory environment for medical practitioners requires focused and monitored engagement with Continuing Professional Development throughout the doctor’s career. University medical education in Ireland is now increasingly challenged to move outside the traditional undergraduate education/postgraduate masters’ taught courses and CPD provision which meets professional and health service demands is both a challenge and an opportunity. We describe one such challenge and medical education response.
Ireland’s 2,700 general practitioners (GPs) serve varied communities with complex roles. One such role is care of emergencies which occur in the practice, during domiciliary visits or in the community . Immediate care training is therefore a key CPD component and has been provided to the general practice community by SMMS, UCD since 1991. This paper reports on the 2008-2012 experience of course provision.
A range of cardiac, trauma, paediatric and other emergency care courses are provided, using international standards and a peer led teaching faculty. The model of training is local, multi-disciplinary, adult oriented and participatory rather than assessment based.
In the five year period 1,960 course places were taken up by health professionals; mean 326 places / year, (range 300-476). These included 1081 places filled by General Practitioners, the majority of whom were principals in general practice; many attended more than one course. 664 places were filled by GP trainees, 74 by practice nurses, 12 by public health doctors, and 60 by paramedics /Advanced Paramedics. 95 courses were provided around the country. Special skills courses (such as pre-hospital thrombolysis) and additional courses (such as anaphylaxis training) were tailored to health service needs in certain areas. The mean number of students per course was 21 (range 9-38). Courses were evaluated very positively by participants and continuous refinement of content is led by the relevant evidence base. A close link to the MERIT defibrillation project reflects active and effective implementation of training.
This model may act as a framework for involvement of the university sector in other forms of CPD provision with high relevance to health service need.
A number of educational strategies are available for curriculum planning. Arguably the approach that has been reflected most widely in curriculum reform throughout the world in the past one or two decades has been integration.
The argument about integrated teaching sometimes appears to be polarised. Should there be integrated or discipline-based teaching? This is not what should be asked; rather what is important is to what extent teaching should be integrated or discipline-based. In other words, where should programmes be on the 11 stages of the continuum between fully integrated teaching at one end of the spectrum and subject-based teaching at the other? Supporting integrated services does not mean that everything has to be integrated into one package. In reality, there are many possible permutations.
The Centre for Emergency Medical Science developed a postgraduate 2 year MSc in Emergency Medical Science (EMS) that is delivered at University College Dublin. The course is designed to prepare and assess the ability of those health care professionals/registered practitioners who are regularly involved in pre-hospital emergency care. There was an intentional approach to developing entry criteria that would allow a variety of health care professionals to apply to undertake the programme. This integrated student group have worked in collaboration through each module to form ideas that may improve systems and patient care considering Medical, nursing and EMS perspectives. The integration ladder was used in part during the curriculum development phase to improve the integrated learning opportunities for the students.
A questionnaire of the integration framework within the curriculum was completed by past and present MSc EMS students to assess its effectiveness. The results were extremely positive in respect of the benefits of the integrated learning curriculum and its potential positive impact to patients and systems.
There are many challenges to designing and implementing curriculum change. Gathering a range of opinions on curriculum and teaching/examination methods from those involved in the provision of education when implementing change is essential to inform the process. The Delphi method is a means of gathering opinion and consensus in such a group of stakeholders in a systematic way whilst minimising any effects of group dynamics.
We aimed to systematically question all those involved in the provision of undergraduate psychiatry education using the Delphi method. This information was then used to inform the design and implementation of the new modularised teaching programme.
Using the Delphi method we systematically questioned all participants on two occasions. The first questionnaire was informed by consulting the relevant literature The participants were then questioned on identified topics (curriculum, teaching methods, examination methods etc) and asked to rate these according to importance. In the second questionnaire the results of the first questionnaire were fed back to participants for further feedback. This process ultimately provided a consensus of group opinion.
The Delphi method is a useful tool to systematically gather opinion and reach consensus within a diverse group. This process maximises participant buy in to any changes and minimises any effect of individual influences when gathering opinion. It allows a shift away from an opinion based approach to a more evidence based approach to curriculum design.
To assess students' attitudes towards research; awareness of the importance of research in their future career; awareness of research opportunities; ability to carry out literature appraisals.
Students enrolled in the School of Medicine in UCD during the 2010 academic year were invited to participate in an online anonymous standardised questionnaire. An exemption from ethical approval was granted by UCD. Questions were primarily closed-ended, 5 of which involved a 4-point Likert scale, and students could use free text to answer certain questions such as 'What is your understanding of evidence based medicine?'
Responses were received from 180 students, of whom 16% had previously participated in research. Surprisingly 83% did not feel adequately aware of research opportunities . The projects they were most aware of were Health Resource Board (HRB) scholarships and Student Summer Research Awards (SSRA), and 40% said that they would like to participate in research but did not know how to get involved. The strongest motivating factor to participate in research was the potential benefit for future career prospects, and 36% of students said that an inspiring mentor would most encourage them to do research, ahead of prizes, monetary incentives or academic credits.
The most common disincentive was 'difficulty balancing with academic commitments' (30%), followed by 'lack of awareness of research opportunities' ( 25%). A third of students thought that an intercalated BSc was a good idea, however only 25% were aware that UCD offers this option, and only 11% thought that the medical school provides enough information about it. Two thirds of students felt they understood the term ' critical appraisal' and 23% judged themselves capable of carrying it out. Almost all (88%) students felt they needed more guidance in interpretation of the literature.
Medical students show an interest in participating in research and are aware of its importance, but do not feel they are made appropriately aware of research opportunities. Students are generally unaware of the option of an intercalated degree. Finally, most students do not feel they have the ability to critically appraise literature.
UCD has delivered a Professional Completion Module (PCM) for final year medical students (Final Med) since 2009, incorporating sub-internship (intern shadowing) and practical instruction in relevant intern tasks/knowledge base. We sought to compare its impact on current UCD-trained interns versus those trained elsewhere.
A questionnaire was designed, tested for inter-rater reliability in a subsample, and then administered to current interns in two large Dublin teaching hospitals.
A total of 32 UCD-trained interns and 11 non-UCD-trained interns completed the questionnaire. The questionnaire exhibited good inter-rater reliability. Significantly more UCD (n=30, 94%) than non-UCD trained interns (n=7, 64%) felt they had, during their medical degree course, undertaken a structured period of time where the sole commitment was to spend several hours a day “shadowing” a designated intern, so as to observe their day to day work (Fishers exact p=0.0126).
Among the UCD trained cohort, there was a good recollection of the correct amount of weeks spent in this form of sub-internship i.e. 2 weeks (29 interns, 91%), supporting a contention that this period of time was somehow memorable. Fewer UCD trained interns recognised that they had completed a course in practical issues and tasks as part of PCM, suggesting it was less memorable (22 interns, 69%). During this Final Med period, more UCD (32 interns, 100%) than non-UCD trained interns (7 interns, 64%) had performed a clinical skills procedure, such as taking bloods or inserting an IV cannula or obtaining an ECG (Fishers exact p=0.003). For the two combined intern groups, the highest average usefulness score (out of 10) for each of five options for preparing a prospective intern for the practical day-to-day tasks they will face as an intern, was awarded to the option of spending time in Final Med as a “sub-intern” (7.2/10; 4.1/5 for UCD trained interns, 3.1/5 for non-UCD).
The lowest average usefulness score was for the option of practical teaching delivered earlier than Final Med (5.2/10; 2.4/5 for UCD, 2.8/5 for non-UCD trained interns).
According to current Dublin interns, intern-shadowing is the most useful option for preparing Final Meds for internship.
Graduate attributes describe the comprehensive portfolio of qualities, skills, knowledge and abilities to be developed by students during their studies in a programme. UCD aimed to map both these attributes and the domains outlined by the Irish Medical Council to the undergraduate and graduate entry Medicine programmes. The outcome of this project was a series of maps that clearly demonstrate how the programme’s educational experiences, learning outcomes and assessments support the acquisition of the defined graduate attributes.
Development of a cyclical curriculum review based on four phases: curriculum visioning, mapping the current programme, review of the mapping outcomes, planning curriculum revision.
Phase 1: Curriculum Visioning
Through a review of international frameworks for core competencies and graduate attributes, in parallel with internal school workshops, programme learning outcomes were derived from the graduate attributes.
Phase 2: Mapping the Current Programme
Phase 3: Review of the Mapping Outcomes
Learning outcomes were grouped under a number of themes and experts appointed to review the curriculum map completed during Phase 2. During this process they:
Phase 4: Plan for Revision of Modules
Following feedback from theme experts, module coordinators were invited to revise their modules in terms of the following areas:
We present this plan in order to expose the concept to those who are currently undergoing curriculum mapping and in order to enhance the UCD plan and share best practice.
In their report on the status of medical education in Ireland The Medical Council recommended that there be Greater emphasis on the student as an active participant in learning and not a passive recipient of teaching; Greater opportunities for electives; and encouragement of the “reflective process”.
Medical electives appear to be the least well researched of any aspect of clinical education. One study concluded that students who adopted an active learning approach in reaching their learning goals appeared more successful and “that structuring learning outcomes by a more active learning process might be even more effective” 1. Others have also suggested that it is important to structure electives, clarify the desired learning outcomes and have valid methods of assessment and that students learn most by reflecting on their experiences.
The “Medicine Elective Module” was introduced into the curriculum in UCD in 2009/2010. It is a 10 credit, required module in which students can choose a subject area. The student is required to submit a brief outline of the proposed elective that includes 2-3 goals against which the student’s performance is measured upon completion of the module. Achievement of these goals contained in a Negotiated learning contract and completion of a Reflective portfolio are required to pass this module.
Evaluation of the module by the students indicated that 97% believed it to be a worthwhile experience; 94% believed that it helped them become a self-directed learner and 88% believed that it helped develop their ability to critically reflect on and learn from experiences. While most students students chose to do electives in Dublin hospitals many student have gone to countries outside Ireland for electives – primarily UK/Northern Ireland; USA; Canada; Malaysia/Singapore.
The majority chose Medical Specialities. Interest in the subject area and career goal were the most commonly cited reasons for choice; other reasons included preparation for the long case examination, improvement of knowledge in that subject and quality of teaching. Students considered ability to choose; being more integrated into the team with more responsibility; “no pressure of examinations” and experience in different health systems as the best aspects of this module.
Recognising potential advantages of community-orientated education, and responding to reforms in medical education policy, our medical school developed community focused module (Ní Chróinín et al, The Clinical Teacher, 2012). In partnership, Medicine for the Elderly and General Practice deliver the module in a combination of primary and secondary care settings. As students' perceptions of the educational environment may affect learning outcomes, the Dundee Ready Educational Environment Measure (DREEM), a reliable, validated tool, specific to healthcare education, was used to assess participants' views of the environment in which this module was delivered.
All medical students complete the module in Years 5/6 of the undergraduate MB programme; 155 students undertook the module in 2010. The DREEEM questionnaire comprises 50 statements assessing features of the education climate, using a 5 point Likert-type scale, with an overall maximum score of 200 (150-200 excellent), with separate ranges for individual subscales of the questionnaire.
Response rate was 98/1% (152/155), mean age 23.99 (SD 3.9 years), 58.8% were female, 67.5% Irish. Overall mean score 135.5 (SD 20.1), indicating a generally positive environment. For specific subscales, mean scores with interpretations were: Learning- 31.6/48 (SD 6.1) (more positive perception); Course Organisers 32.1/44 (SD 4.9) (moving in the right direction); Academic Self-Perceptions 21.7/32 (SD 3.9) (more positive feelings); Atmosphere 32.4/48 (SD 5.6) (a more positive attitude); Social Self-Perceptions 17.7/28 (SD 3.6) (not too bad). All areas ranked in the 2nd highest of 4 possible categories. 68.6% of respondees agreed or strongly agreed with statements reflecting positive perceptions of the environment.
Student's perceptions of the educational environment in which the module was delivered were largely positive, although there is room for continued development and improvement. A cooperative care model involving Medicine for the Older Person and General practice, with combined delivery in the community and hospital settings, offers a learning environment that is generally perceived positively by students.
We assess and compare; (1) the attitudes of final year medical students in 2010 to their 1994 counterparts, (2) the attitudes of third year medical students with those of their final year colleagues, (3) the impact of two different teaching modules on students attitudes.
All students completing the year 3 psychiatry preclinical module and the final year clinical clerkship were asked to anonymously complete three well validated attitudinal questionnaires on the first and last day of their module in psychiatry.
These data indicate that Irish medical students have a positive attitude to psychiatry even prior to the start of their clinical training in psychiatry as evidenced by their scores on the ATP-30, SATP and Das and Chandrasena questionnaires. This attitude is significantly more positive now than it was in 1994 (ATP 30: t= 13.4, p< 0.001); ( SATP: t= 6.3, p<0.001). A positive attitudinal change was brought about only by the final year psychiatric clerkship(ATP: t= 10.6, p<0.001); (SATP: t= 8.7835, p<0.001). Those students for whom medicine was not their first degree were less likely to report an interest in psychiatry as a career (r= 0.275, p <0.05).
If we are to address the recruitment difficulties in psychiatry we need to look at innovative and specific ways of translating these positive attitudes into careers in psychiatry.