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Biomedical subjects

Tim J Wilkinson

Publications and source records attributed to Tim J Wilkinson.

At least 19 recordsLinked to original sources
PubMed2006

The impact on students of adverse experiences during medical school.

This study aimed to determine the consequences for, and coping method used by, medical students who experienced adverse experiences during their training. A nationwide questionnaire based census of all current medical students in New Zealand. The response rate was 83% (1384/1660). Two-thirds of students had at least one adverse experience, with humiliation being the most common and having the greatest adverse impact. Unwanted sexual advances, unfair treatment on the basis of gender or race had a lesser impact for most students. Most students took several hours or several days to get over an adverse episode and most commonly they then avoided that person or department. Around one half sought help. Only one-quarter felt it motivated their learning while one-sixth felt it made them consider leaving medical school. The most common perpetrators were senior doctors or nurses. Unwanted sexual advances were most common from other students or from patients. Humiliation is the experience that affected students the most and had a significant adverse effect on learning. There is a disturbing rate of unacceptable practice within medical schools, not all of which is from doctors.

Education, Medical, Undergraduate↗
PubMed2005

Judging a book by its cover: descriptive survey of patients' preferences for doctors' appearance and mode of address.

OBJECTIVE: To document patients' preferred dress styles of their doctors and modes of address. DESIGN: Descriptive survey. SETTING: Inpatients and outpatients at a tertiary level hospital, New Zealand. PARTICIPANTS: 202 inpatients and 249 outpatients, mean age 55.9 (SD 19.3) years. MAIN OUTCOME MEASURES: Ranking of patients' opinions of photographs showing doctors wearing different dress styles. A five point Likert scale was used to measure patient comfort with particular items of appearance. RESULTS: Patients preferred doctors to wear semiformal attire, but the addition of a smiling face was even better. The next most preferred styles were semiformal without a smile, followed by white coat, formal suit, jeans, and casual dress. Patients were more comfortable with conservative items of clothing, such as long sleeves, covered shoes, and dress trousers or skirts than with less conservative items such as facial piercing, short tops, and earrings on men. Many less conservative items such as jeans were still acceptable to most patients. Most patients preferred to be called by their first name, to be introduced to a doctor by full name and title, and to see the doctor's name badge worn at the breast pocket. Older patients had more conservative preferences. CONCLUSIONS: Patients prefer doctors to wear semiformal dress and are most comfortable with conservative items; many less conservative items were, however, acceptable. A smile made a big difference.

Adult↗
PubMed2005

Interns' participation and learning in clinical environments in a New Zealand hospital.

PURPOSE: To explore factors that encourage interns to participate actively within clinical rotations. Encouraging their participation in workplace interactions and activities during their clinical rotations is central to effective development of clinical practice. METHOD: In 2002-03, individual interviews and a focus group were conducted to gather data about interns' experiences in clinical rotations within a New Zealand hospital setting. A model for planning and organizing clinical learning was drafted and refined by iteration with other learners and more experienced peers. RESULTS: The findings resulted in a model for participation in clinical settings where two critical components were identified: the tasks of patient care and engagement with the clinical team. These two components are further divided into two aspects: initiation and maintenance. The outcome of all four factors working well is a reinforcing cycle of activities that promote and encourage effective participation and learning. CONCLUSION: This model could provide a framework and best-practice guide that could be used for faculty development and thereby allow both supervisors and learners to gain confidence and satisfaction.

Focus Groups↗
PubMed2005

Using a diary to quantify learning activities.

BACKGROUND: Diaries of actual learning activities can fill the gap between the planned curriculum and students' opinions and outcomes. We report the development and validity of such a method, estimate sources of variation and model sampling strategies to determine efficient ways to obtain information about a curriculum or about individual students. METHODS: Following development and piloting, the diary was administered to fourth- and fifth-year medical students. Each student was asked to complete a diary on 3 randomly selected days of the academic year. Sources of variance and generalisability were determined using variance components analysis. Validity was explored by comparing activities with what is known about the curriculum, assessment, timetables and the 2 classes of students. RESULTS: Response rate was 83% (287/345). Learning activities varied as expected with timing of assessments, and on weekdays compared with weekends. For most activities, 14 days per student would be needed to obtain generalisable information about an individual student. The variation between days is greater than the variation between students, meaning that sampling for information on a curriculum should include all students and all days of the year but the number of diaries per student could be kept low depending on the desired power to detect any differences. CONCLUSION: Such an evaluation method is feasible and can provide reliable and valid information about study activities. Reasons for good compliance are discussed. Sampling strategies should be tailored to the purpose of the study.

Attitude of Health Personnel↗
PubMed2005

The precision of digital X-ray radiogrammetry compared with DXA in subjects with normal bone density or osteoporosis.

Digital X-ray radiogrammetry (DXR) is a technique to estimate bone mineral density (BMD) that can be available in any area able to take a standard radiograph of the hand. We aimed to establish the precision of this technique and compare this with that obtained by dual energy X-ray absorptiometry (DXA) at the hip and spine. We compared DXA and DXR in 28 women with osteoporosis defined by DXA at the femoral neck and in 28 women with normal BMD. We found that DXR has excellent precision of 0.004 g/cm(2) compared with 0.021 g/cm(2) and 0.015 g/cm(2) obtained by DXA at the hip and spine, respectively. We conclude that DXR measured by the automated Pronosco system has excellent precision.

Absorptiometry, Photon↗
PubMed2004

Family meetings--a qualitative exploration of improving care planning with older people and their families.

OBJECTIVE: To explore the opinions of participants in family meetings to improve the quality of this important rehabilitation tool. DESIGN: Qualitative exploration of opinions and experience from staff, patients and families. SETTING: Tertiary teaching geriatric rehabilitation hospital. PARTICIPANTS: Staff, families and patients who had recently participated in family meetings. METHODS: Focus groups, written surveys and individual semi-structured interviews. RESULTS: Three main themes were identified in the staff focus groups-preparation, staff skills and aftermath. Opinions from family members revealed a high level of satisfaction. The patient interviews revealed a worrying lack of informed consent and lack of clarity of the purpose. All three groups identified an unclear agenda as the underlying reason for unsatisfactory meetings. An unfavourable outcome decision (such as placement in institutional care) also influenced patient opinions on the process. The majority of patients found the family meeting to be helpful. CONCLUSIONS: Family meetings are much appreciated by patients and their families. A model of the family meeting process is proposed to account for our research findings and as a means to improve meetings. Adequate preparation and consent, and skilled facilitation may improve the effectiveness of family meetings while maintaining the patient's sense of autonomy.

Aged↗
PubMed2004

Comprehensive undergraduate medical assessments improve prediction of clinical performance.

OBJECTIVES: This study aimed to compare an essay-style undergraduate medical assessment with modified essay, multiple-choice question (MCQ) and objective structured clinical examination (OSCE) undergraduate medical assessments in predicting students' clinical performance (predictive validity), and to determine the relative contributions of the written (modified essay and MCQ) assessment and OSCE to predictive validity. DESIGN: Before and after cohort study. SETTING: One medical school running a 6-year undergraduate course. PARTICIPANTS: Study participants included 137 Year 5 medical students followed into their trainee intern year. MAIN OUTCOME MEASURES: Aggregated global ratings by senior doctors, junior doctors and nurses as well as comprehensive structured assessments of performance in the trainee intern year. RESULTS: Students' scores in the new examinations predicted performance significantly better than scores in the old examinations, with correlation coefficients increasing from 0.05-0.44 to 0.41-0.81. The OSCE was a stronger predictor of subsequent performance than the written assessments but combining assessments had the strongest predictive validity. CONCLUSION: Using more comprehensive, more reliable and more authentic undergraduate assessment methods substantially increases predictive validity.

Clinical Competence↗
PubMed2004

Are differences between graduates and undergraduates in a medical course due to age or prior degree?

BACKGROUND: The number of medical programmes targeted at graduates is increasing and there are reports of beneficial outcomes. However, many new graduate medical schools have simultaneously changed their admission criteria and curricula. This study aimed to determine whether there were differences between graduates and undergraduates on the same medical course and to establish which differences might be due to having a prior degree, the course itself or age at entry to medical school. METHODS: A questionnaire-based survey was administered to all students in Years 2-5. It included the Study Process Questionnaire, the Achievement Motivation Profile and Likert scale questions on career. RESULTS: Questionnaires were completed by 587 students (response rate 80.3%), of whom 143 had a prior degree. Whilst having a prior degree was associated with many outcomes, for most this disappeared, and the overall predictive ability of the model improved when age was included. Age at entry to medical school brought certainty and motivation about career choice, a prior degree had some effect on approaches to studying and co-operativeness, while the course itself had effects on most outcomes, some of which were positive and some negative. CONCLUSION: Graduates bring a distinct quality to a course but many of these relate to a student's age. Older age at entry may be more important than having a prior degree.

Adolescent↗
PubMed2003

Monitoring medical students' professional attributes: development of an instrument and process.

PURPOSE: To describe and evaluate the implementation of an instrument and process to assess and monitor professional attributes in medical students. METHOD: The instrument was developed following a survey of professional attributes of concern displayed by medical students. This was followed by development and validation, amongst medical faculty staff and students, of the instrument and its supporting process. Evaluation was by recording participation rates by staff and by determining the consistency of the instrument across dimensions and across clerkships. Implementation in practice is described by using a case study based on one school's first year of use amongst all the students. RESULTS: In its first year of use 7,418 forms were distributed to 376 students and 6,621 forms were returned (89%). The instrument's reliability was greatest where staff were diligent in ensuring thorough implementation. The process was able to detect students of concern and provide effective remediation and ongoing monitoring. CONCLUSION: The process that has been developed is sensitive, robust and is able to detect, monitor and remedy attributes traditionally regarded as difficult to define and defend. The strengths of the process lie in (1) clear definitions of acceptable and unacceptable behaviors, (2) reliance on observations by more than one person and over more than a single time period, (3) the ability to provide a longitudinal view of student's progress.

Curriculum↗
PubMed2003

Assessing performance in final year medical students. Can a postgraduate measure be used in an undergraduate setting?

BACKGROUND: The transition between medical school and graduate performance should be a continuum. This study aimed to evaluate an assessment tool developed for practising doctors when applied to undergraduates. METHODS: A 12-item rating form was developed from that used for practising doctors by the Royal Australasian College of Physicians. Over a 2-year period, senior doctors, junior doctors and nurses completed the rating form on final year medical students. Some students completed self-assessments. We performed factor analysis and correlated scores between raters and attachments. Correlating ratings with concurrent traditional assessment results across the year tested construct validity. RESULTS: Ten forms per student were distributed for all 123 students and 856 were returned (70%). Internal consistency was very high. In all, 71.1% of the variance was accounted for by two factors (clinical skills and humanistic). This factor structure is unchanged when restricted to different raters and is the same as that noted previously when rating practising doctors. There were good correlations between raters (including self) and between attachments. Nurse ratings were reliable but nurses rated students significantly lower on humanistic qualities. Correlations with traditional assessments were high when all traditional assessments were combined. Women scored more favourably than men on humanistic qualities. CONCLUSION: A rating instrument for doctors in practice retains the same factor structure and a high degree of reliability and validity for senior medical students. Reliable ratings by nurses have implications for measures of collegiality and teamwork. We believe the instrument could be a useful outcome measure for medical programmes and employers.

Clinical Competence↗
PubMed2003

A needs-based study and examination skills course improves students' performance.

BACKGROUND: Adult learning theory suggests that learning is most effective when related to need, when driven by the learner and when it is flexible. We describe the effect of an educational intervention that was driven by student need, and largely designed by students. METHODS: We undertook a needs assessment of fifth year medical students' study needs. Based on this, we helped them design a course to meet these needs. This was predominantly related to study skills and a practice objective structured clinical examination (OSCE). We evaluated the course by asking for student opinion and by measuring the effect on student performance in a high stakes medical school examination (written examination and OSCE). FINDINGS: Despite the course being run voluntarily and in after-hours sessions, 80-90% of the medical student class attended each session. Student performance on the end of year examinations was significantly enhanced in the year of the intervention, compared with previous years and with students from other schools sitting identical examinations in the same year. INTERPRETATION: Learning activities that are directly based on student needs, that focus on study and examination techniques, and that are largely student-driven, result in effective and valuable outcomes.

Community Participation↗
PubMed2003

Was a breach of examination security unfair in an objective structured clinical examination? A critical incident.

One-third of a class of students was inadvertently given the names of stations immediately prior to an OSCE and two-thirds of the class were not. This provided an opportunity to explore student perceptions of fairness and to explore any effect of this cueing. The subjects were medical students undertaking an end of fifth year multidisciplinary OSCE. OSCE score data from the 20 students who had received the information were compared with those of the 40 students who did not. We also compared their performance on other assessments to determine whether the two groups were comparable. The overall OSCE mark was not significantly different between the two groups. There were significant differences between groups on four stations but this was not in a consistent direction that advantaged one group. There were no significant differences between the two groups in their performance on the other examinations. This inadvertent security breach had no systematic effect on student OSCE station scores. This incident provided a valuable opportunity to admit error, approach it rationally and restore any resulting breach of trust.

Clinical Competence↗
PubMed2003

Objectivity in objective structured clinical examinations: checklists are no substitute for examiner commitment.

PURPOSE: This study explored factors that contribute to objectivity in objective structured clinical examinations (OSCEs). The authors quantified the effect of examiners on interrater reliability and separated this effect from that of station construction, determined the effect of objectification on station reliability and validity, and explored examiner factors that may contribute to interrater reliability. METHOD: Data came from examiners' mark sheets from four annual OSCEs (1997-2000). The OSCEs were conducted identically and simultaneously at three sites, within the University of Otago medical school in New Zealand, with two examiners at each station. The contribution to interrater correlations of station construction and mark sheet compared with examiners' contribution was partitioned out using a random-effects analysis of variance. For one OSCE, a multiple linear regression was used to determine the independent contributions to interrater reliability of the number of checklist items per mark sheet, examiner experience, and examiner involvement in station construction. RESULTS: Station construction and mark sheets contributed 10.1% and examiners contributed 89.9% to the variation in interrater reliability. Following multivariate analysis, the number of items per mark sheet was negatively associated, and examiner involvement in station construction was positively associated, with interrater reliability. Examiner experience in examining or in clinical medicine was not associated with interrater reliability. There was a negative, but nonsignificant, correlation between number of items per mark sheet and that station's correlation with the aggregate OSCE mark. CONCLUSIONS: The contribution of objective mark sheets to objectivity is relatively minor compared with examiners' contribution. Increasing the number of checklist items per mark sheet decreased both reliability and validity. Achieving objectivity requires diligent examiners who are involved in the whole assessment.

Analysis of Variance↗
PubMed2002

Drinking patterns among older people in the community: hidden from medical attention?

AIMS: To determine patterns of alcohol use and misuse among community-dwelling people aged 65 years and over in Christchurch and to assess how often this comes to medical attention. METHODS: A cross-sectional survey of alcohol use and misuse was conducted followed by a self-administered postal survey among non- respondents. General practitioners (GPs) of the respondents completed a self-administered questionnaire on patients' alcohol use and misuse. RESULTS: The response rate was 58% (141/243). The prevalence of hazardous alcohol consumption in the past twelve months (AUDIT cut-off score 8 or more) was 9.9% (95% CI = 4.9-14.9) and the prevalence of lifetime alcohol dependence using DSM-IV diagnostic criteria was 24.8% (95% CI = 17.6-32.0). Men were more likely than women to report lifetime dependency and current hazardous patterns. The response rate among GPs was 77.7% (108/139). None of the GPs identified or diagnosed alcohol problems in the past twelve months among this group and reported a history of alcohol problems in only four (4.0%) patients. Those with current hazardous patterns of alcohol use were twice as likely to be admitted to hospital (RR=2.4; 95% CI 1.2-5.1) but significantly less likely to visit their GPs in the previous twelve months (RR=0.55; 95% CI 0.7-1.1). CONCLUSION: A significant proportion of community-dwelling elderly people reported patterns of alcohol consumption that put them at risk of future damage to physical or mental health. Hazardous drinkers were less likely to visit their GPs and only in a few cases, were GPs aware of such potential problems.

Age Factors↗
PubMed2002

Tolerance of early diet textures as indicators of recovery from dysphagia after stroke.

We undertook this 12-month retrospective cohort study, of 186 teaching hospital inpatients, to determine how tolerance of differing diet textures after a stroke predicts recovery from dysphagia. Outcome measures were insertion of a percutaneous endoscopic gastrostomy (PEG) tube and/or ability to tolerate a normal diet 28 days after the stroke. Likelihood ratios for needing a PEG were highest for intolerance of pureed food. People who tolerated grade 1 fluids (300-600 cP) or thinner, or who tolerated a modified soft diet or better, 7 days after the stroke did not need a PEG. Half (13/26) the people who could not tolerate grade 3 thickened fluids (10,000-12,000 cP) and 52% (13/25) of people who could not tolerate a puree diet 14 days after the stroke needed a PEG. No one who was intolerant of grade 2 thickened fluids (4000-7000 cP) 7 or 14 days after the stroke could tolerate a normal diet and fluids by day 28. If people were tolerating grade 3 thickened fluids at day 7, the proportion tolerating a normal diet at day 28 was 36%. We present similar data for tolerance of differing fluids and diets at each of the measured time points. We suggest a PEG should be considered in people unable to tolerate grade 3 thickened fluids or a puree diet 14 days after their stroke. However, even in these groups, half will recover sufficiently to manage oral feeding.

Adult↗
PubMed2002

The transition out of medical school - a qualitative study of descriptions of borderline trainee interns.

OBJECTIVE: To describe the characteristics of borderline performance in final year medical students (trainee interns), as judged by their supervisors. DESIGN: Qualitative study based on in-depth interviews followed by validation descriptions of borderline trainee interns identified prospectively over 12 months. SETTING: Christchurch School of Medicine, University of Otago, New Zealand. PARTICIPANTS: Fourteen supervisors of trainee interns chosen because of their experience and/or close contact with trainee interns. MAIN OUTCOME MEASURES: Analysis of supervisors' narratives to identify key themes. RESULTS: Borderline trainee intern performance occurs within a transition period from clinical student to doctor and is characterised by difficulty taking on a professional role. This difficulty may be manifest by not getting involved with the health care team, poor time management and occasionally by interpersonal difficulties or not recognising limits. Taking on a professional role requires ability in the clinical task, including diagnostic ability, which is built on a foundation of basic knowledge and clinical skills. These can be influenced by personal factors such as rigidity, motivation and shyness. Personal illness can affect performance at any stage. CONCLUSIONS: The difficulties faced by borderline trainee interns fit a model of transition from competence as a student to performance as an intern. A sensitive marker of such difficulties is poor time management or not getting involved with the patient care team. Such difficulties may reflect more specific problems such as professional socialization, setting priorities, hypothesis generation, assigning probabilities to identified problems, integrating competing issues, recognising limits and learning when to call for assistance.

Clinical Competence↗
PubMed2002

The earlier, the better: the effect of early community contact on the attitudes of medical students to older people.

BACKGROUND: Early clinical contact for medical students is an important curricular innovation. We wished to determine if early contact with older people in the second year of a more vertically integrated medical undergraduate programme influenced attitudes to older people and if any effect was synergistic with the effect of an existing fourth year course. SUBJECTS: Second and fourth-year medical students. METHODS: We used a modified version of the Rosencranz-McNevin semantic differential on ageing to assess attitudes of medical students before and after a one-week early community contact week. Some second-year students were followed into fourth year and the effect on their attitudes of a health care of the elderly course was measured. We compared these data with attitude scores from an earlier cohort of students who had undertaken the fourth-year but not the second-year component. RESULTS: Contact with older people during second-year had a significantly favourable effect on attitudes to older people, especially for students who saw older people in the community rather than in rest homes. The attitudes towards older people of students who had undertaken a fourth-year clinical health care of the elderly attachment were significantly better on two of three subscales than those of fourth-year students who had not seen older people during their second year. CONCLUSION: Contact with older people early in a medical student's training, and within a more vertically integrated programme, has a positive effect on attitudes to older people. This effect may be synergistic with contact later in training.

Aged↗