Letters to the editor

Med Teach Downloaded from informahealthcare.com by University of Stellenbosch on 09/07/13 For personal use only.

(Grant et al. 2002). Students were asked to rate the statements on a six-point Likert scale. Groups were compared using the MannWhitney U test. Statistical significance was set at the p 5 0.05 level. In the intervention group, the answers to all six attitudinal questions favored self-reflective practice compared with the control group responses. The differences in answers for three of these questions reached statistical significance. All three of the questions where significant differences were seen concerned a learners need to make meaning of their experience and increase their self-awareness. Ninety-four percent of participants noted that they would like similar exercises in the future. This study supports the usefulness of incorporating reflective writing and discussion in clinical rotations. The modest format of this exercise would seem to make it relatively easily incorporated into established rotation curricula. Students who experienced this exercise had more positive attitudes toward reflective practice, as measured with a validated questionnaire. We expect that these attitudes will encourage reflective practice in participant students in the future. Scott Dexter, MD, Department of OB/GYN, Albany Medical College, Albany, NY, Email: dexters@mail.amc.edu Karen Mann, PhD, Division of Medical Education, Dalhousie University, Halifax, NS, Canada.

Quite strange what you said earlier that you can just go on and edit what someones written. You could scrub it out and put something else in. Analysis of responses from wiki contributors and non-contributors, using parts of the OLLES questionnaire (Clayton 2007), and thematic analysis of semi-structured interviews with contributors, allowed exploration of attitudes to social and online learning. This identified strong beliefs that learning by sharing experiences is valued, and that scepticism about the wiki related to fears of a consequent loss of either inperson teaching from senior colleagues or protected teaching time away from clinical responsibilities, rather than fundamental failings of the medium. I also feel there is this pressure from the nurses that you know that if youre not actually in teaching then you shouldnt be doing anything else really Junior doctors value collaborative working and case discussion, but their limited IT skills, conflicting clinical and educational demands and scepticism about e-learning appeared to limit the use of the wiki. Implementation of wiki-based PBL is possible and potentially valuable, but ensuring adequate participation may require more intensive facilitation to overcome learner scepticism, reducing the logistical advantages of such an approach. Colin Mitchell, Department of Elderly Medicine, St. Marys Hospital, Praed St, London W2 1NY, UK. E-mail: colin.mitchell2@nhs.net

Reference
Grant AM, Franklin J, Langford P. 2002. The self-reflection and insight scale: A new measure of private self-consciousness. Soc Behav Pers 30:821836.

References

Wiki case-based learning for foundation doctors

Ellaway R, Masters K. 2008. AMEE Guide 32: e-Learning in medical education. Part 1: Learning, teaching and assessment. Med Teach 30(5):455473. Clayton J. 2007. The validation of the online learning environment survey. ICT: Providing choices for learners and learning. Proceedings Ascilite Singapore 2007.

Dear Sir Reviewing recent publications suggests that case-based techniques such as problem-based learning (PBL) remain valued in medical education, and also that on-line teaching methods are being increasingly investigated (Ellaway & Masters 2008). PBL is widely used in UK undergraduate education but less commonly in postgraduate settings for various reasons, including facilitation resources and discontinuity of attendance at weekly sessions problems that could be alleviated using asynchronous online collaboration. This study describes the implementation of a wiki to allow webbased discussion between 26 junior doctors, after a brief face-to-face discussion approximating the PBL model. Analysis of contributed content showed that participation was poor (19% of subjects contributed) and superficial, with no editing of other users contributions. Interestingly, subjects selfrated their IT skills as good (93%) but participants frequently mentioned difficulty using the simple wiki interface, and most were unfamiliar with multi-user collaborative editing.

Medical school lectures as dead as the dodo

Dear Sir

In the past, medical undergraduates would be crammed into dated lecture theatres trying to absorb the words of a dated scholar who would be bombarding them with hundreds of facts and figures, often with no room for discussion on the principles delivered. Over the years, the teaching of medicine has changed significantly with novel methods such as problem-based and team-based learning entering the arena. With the advent of technology, E and M learning are also equal contenders in the much sought after teaching and learning format of the year award if ever one was to exist. Having been educated in the most part without these fancy machineries, Im only now beginning to catch up and realize

20 13
423

Letters to the editor

Med Teach Downloaded from informahealthcare.com by University of Stellenbosch on 09/07/13 For personal use only.

their potential in supplementing the learning process. However, it seems I may have to alter my teaching preference once again. The flipped classroom model relies on students initially studying a particular aspect of the syllabus themselves through some form of technology media provided by the teacher. The class time is then used more actively allowing students to apply what they have learnt through problem-solving or practical means. The Khan Academy has paved the way with this form of teaching and provides videos, interactive challenges and assessments online on an array of mathematical- and science-based topics which students can access and teachers can then use to gauge their students progress and offer support in the class as needed. This flip has been adopted by several institutions across the United States and has even attracted the likes of Bill Gates to its domain (Khan Academy 2010; The Economist 2012). Stanford Medical School recently utilized the flipped teaching model for their core biochemistry course using online presentations initially and then class time for interactive discussions of clinical vignettes highlighting the biochemical basis of various diseases with positive results (Prober 2012). It was David Warlick who once said: We need technology in every classroom and in every student and teachers hand, because it is the pen and paper of our time, and it is the lens through which we experience much of our world. Dr Neel Sharma, Honorary Tutor, Institute of Medical and Health Sciences Education, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong. Email: n.sharma@qmul.ac.uk

References
Khan Academy. 2010. Bill Gates talks about the Khan Academy at Aspen Ideas Festival 2010. Available from http://www.khanacademy.org/ talks-and-interviews/v/bill-gates-talks-about-the-khan-academy-at-aspenideas-festival-2010 The Economist. 2012. Flipping the classroom, September 17, 2012. Available from http://www.economist.com/node/21529062 Prober C. 2012. Lecture halls without lectures A proposal for medical education. NEJM 366:18.

medical students should be able to apply the scientific method and evaluate and integrate evidence critically (General Medical Council 2009). Involvement in research can aid medical students achieve these skills, foster scientific thought and produce doctors that practice evidence-based medicine. Although some opportunities for research exist in the undergraduate medical curricula, such as the option of undertaking an intercalated degree, a recent study found that an astonishing 55% of British medical students had not taken part in any research due to the lack of knowledge about opportunities (Griffin & Hindocha 2011). Involving medical students in clinical audits being undertaken by doctors is a realistic opportunity for students to undertake research. An audit is a systematic review of the quality of medical care and measures the extent of implementation of best practice, as defined by national guidelines, research, or expert opinion. It is an instrumental tool for the practice of evidence-based medicine as it leads to improvements in clinical performance. Participation in clinical audits allows students to learn and be acquainted with current clinical guidelines of the audit topic, to critically evaluate the findings of the audit, and to understand how these findings are used to bring about improvements in healthcare delivery. As participation in a clinical audit is part of the requirements for completion of the Foundation Programme for a junior doctor in the UK, medical students also benefit by familiarising themselves early with the audit cycle process that they will inevitably have to undertake in future. Moreover, the prospect of a publication or presentation at a national conference may encourage students to wholeheartedly participate in audits. With the everincreasing competition for post-graduate jobs, publications and presentations act as discriminatory factors in job selection. As there is never a lack of audits being undertaken in the clinical setting, we urge medical educators and clinicians to involve and recruit medical students to assist in data collection, analysis and write up process of the audits. By encouraging medical student involvement in audits, medical educators will not only equip their students with skills that generate doctors with first-hand experience of evidence-based medicine, but also promote interest in clinical academic careers. Narwani V, Brighton and Sussex Medical School, Audrey Emerton Building, Eastern Road, Brighton, BN2 5BE, UK. E-mail: bsms1501@uni.bsms.ac.uk Nalamada K, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK.

Clinical audits: A realistic research opportunity for medical students

References
Dear Sir The Tomorrows Doctors guidelines, published by the General Medical Council in the UK, states that graduating
General Medical Council. 2009. Tomorrows doctors. London: General Medical Council. Griffin MF, Hindocha S. 2011. Publication practices of medical students at British medical schools: Experience, attitudes and barriers to publish. Med Teach 33(1):e1e8.

424