MEDEV

School of Medical Sciences Education Development

Introduction

This new collaborative project is developing web-based portfolios to support reflective approaches for evidencing the attainment of programme outcomes in undergraduate medicine. The portfolios will be closely integrated with on-line curricula and study guides to become an integral component of managed learning environments for medicine. The project involves The University of Newcastle (lead site), The University of Leeds, The University of Sheffield, The University of Dundee (for consultancy) and is financed for three years through the HEFCE Fund for the Development of Teaching and Learning (FDTL4).

In professional medicine there are ever increasing demands for reflective clinical practice and skills and attitudes appropriate to audit, appraisal and professional revalidation.

These demands are further emphasised by the GMC in the recently revised recommendations for undergraduate medicine: “Students must receive regular and consistent information about their development and progress. Clinical logbooks and personal portfolios, which allow students to identify strengths and weaknesses and to focus their learning appropriately, can provide such information. Using these will emphasise the importance of maintaining a portfolio of evidence of achievement, which will be necessary once they have become doctors and their licence to practise is regularly revalidated,” (Tomorrow’s Doctors, 2002).

Also, there is growing recognition of the need for support for learning across the undergraduatepostgraduate continuum.

As part of the wider teaching/learning and assessment strategies for undergraduate medicine, the use of portfolios has the potential to help address these important challenges.

Furthermore, by incorporating personal development planning, portfolios can also become a vehicle for satisfying the requirements for progress files within Higher Education. This project will draw on the considerable experiences of the project partners in these areas and in networked learning environments to develop on-line portfolios for undergraduate medicine.

An outcomes-based approach

Portfolios have been around for years in medicine in various formats and serving a wide range of different purposes.

One of the key distinguishing features of this project is that the portfolios will be structured largely around defined learning outcomes in order to be integrated with the undergraduate curriculum (see Figure 1).

There has been increasing recognition of the need to define intended learning outcomes in order to ensure that the curriculum is consistently satisfying important outcomes and also to improve the transparency of the curriculum. Students will keep reflective records and evidence the attainment of these learning outcomes in the portfolio.

In medicine these outcomes are greatly influenced by professional requirements, as set out in the GMC document: Good Medical Practice. Therefore, the data from an undergraduate portfolio structured around these outcomes may provide a suitable foundation for a postgraduate portfolio to support CPD.

Also, it is our aim to use portfolios to promote the development of the reflective capabilities of students, giving greater responsibility for managing their own learning and helping them develop the skills for lifelong learning and CPD.

Using internet technologies

Medical students have become increasingly familiar with using webbased systems for their curriculum delivery, study guides, assessment, communications, and other aspects of their education.

The concept of a Networked Learning Environment aims to draw these components together. Likewise, the portfolios in which the learner can record, reflect and plan their educational activities will be integrated within the different learning environments of the consortium partners.

During the project we will also explore the integration of portfolios with other learning environments, including Blackboard and The Bodington System.

Using internet technologies has the advantage of allowing students secure access to their own personalised records from a range of locations. The technology allows the portfolios to be organised in different ways, to be searchable, and to give the user the ability to allow others access to some aspects of their records if desired.

It is also intended that the portfolio will be transportable, for example using emerging interoperability standards to transfer data to other systems.

This will be an important aid to bridging the undergraduatepostgraduate educational continuum.

Also, as it will be a database-driven system, it is intended that the portfolio will be a dynamic living document, rather than being simply a static archive of evidence.

Assessment and appraisal

The portfolio will help students to evidence that they have achieved the curricular outcomes. As well as important clinical knowledge and skills there are also programme outcomes relating to professional attitudes and behaviour which are not readily amenable to traditional methods of assessment.

The portfolio may be a means of assessing these attitudinal outcomes as well as helping nurture reflective and personal development planning skills that are likely to be required throughout a professional career in medicine.

There are many challenges and issues relating to portfolio-based assessment and it is intended that this project will inform on these. Recently the GMC has recommended that medical students should receive regular, structured and constructive appraisal. The portfolio may prove to be a means of preparation, reviewing achievements recorded against the curriculum outcomes, documenting appraisal outcomes, and for recording and monitoring agreed action plans (if this is applicable).

The ultimate aim of the project is to help develop better doctors who will have the necessary skills for life-long learning and continual professional development. It is also a means of satisfying GMC and QAA guidelines. It is intended that the solutions developed will be transferable to subjects other than medicine.

Introduction

The WILeN Project (Web-based Inter-professional Learning Network) is one of the FDTL4 funded projects receiving funding for three years to develop a web-based inter-professional learning environment with additional funding support from the University ofSheffield and in collaboration with Derby University. The network will be extended when associate partners have been identified and have developed a collaborative partnership.

The WILeN project was initiated to address the need identified by the QAA and HEFCE for dentistry, nursing and other subjects allied to medicine to develop a more studentcentred approach to their teaching and promotion of inter-professional education, using on-campus methods and remote modes of access such as virtual learning environments.

The aims of the WILeN project are to develop generic courses for health professionals that can be delivered as inter-professional education, further developing and promoting the means for remote access to learning environments, such as videoconferencing.

WILeN will establish a network across institutions to promote both e-learning and inter-professional education.

Recent appointments

WILeN has recently begun to appoint dedicated staff to the project starting with the e-Technologies and Course Development Officer, Christopher Stokes.

WILeN will benefit from the experience of the iCT Project at Sheffield, which has focussed on establishing the pedagogy associated with introducing video-conferencing as a learning medium, and has a virtual learning environment that is currently supporting a number of courses at the School of Clinical Dentistry.

Prof. Lynn Basford, Head of Nursing at the University of Derby, is a partner of the network and was involved in the project from its inception. Prof. Basford has much to bring to WILeN, as she has chaired the Trent Institute of Inter-professional Practice, Learning and Education (TIPPLE) and has been instrumental in the exploration of new learning models for inter-professional education and the use of new technologies to achieve this.

The experience in inter-professional education is further enhanced by the project directors’ past and present membership of the UK Centre for the Advancement of Interprofessional Education (CAIPE).

Objectives

WILeN’s objectives are:

• to have identified and developed common modules, e.g. ‘health informatics’ across and within the participating subject disciplines in the consortia sites by the end of the first year
• to have established the virtual learning environment (VLE) to deliver the modules by the end of the first year
• to have delivered and evaluated common modules across and within the participating subject disciplines in the consortia sites by the end of the second year  
• to have disseminated and evaluated common module in ‘health informatics’ to at least three nonconsortia sites by the end of year three.

The perceived educational benefits of WILeN are seen as:

• enabling students to attain IT proficiency and accrue the transferable skills necessary for them to operate as independent life-long learners and advance their abilities in the use of subject based web-accessible material 
• enhancing the teaching and learning skills and IT competence of academic staff in the consortium Universities who will understand how to use virtual learning environment based material  
• promoting further collaborative cross-university approaches to innovative subject delivery and skills developments between the consortium institutions.

WILeN has achieved national recognition, with the result of the appointment of WILeN director Dr. Cannavina as a LTSN consultant and invitations to review research and development scholarship papers for international conferences. The WILeN project is being viewed by the project members as being developmental and on completion to have established a sustainable network with the potential for independent growth.

It is envisaged that after the project funding has been expended the existence of an established dedicated web-site will act as a focus for further development, together with further sharing of web-based core courses, materials and video-conferencing across the educational network.

The results of the WILeN project should provide an important contribution to the wider higher education environment and will be disseminated with the support of the LTSN subject centres for Medicine, Dentistry and Veterinary Medicine (LTSN-01), Health Sciences and Practice, the Generic Centre, and CAIPE. Letters of support from these organisations helped to secure the funding for the project.

WILeN’s results will be published in education journals and presented at conferences to update the educational community of its progress as the project evolves.

Introduction

Besides the two projects featured in this month’s newsletter, there are a number of projects that may be of interest. The FDTL4 programme funded 36 other projects, a few of which are listed here.

The institution listed is the lead site, but most of these projects are collaborations involving more than one institution. A list of all FDTL4 projects with contact information is available at:

http://www.ncteam.ac.uk/projects/fdtl/fdtl4/projects.htm

Optimising computer aided and traditional assessment in veterinary education (OCTAVE)

Royal Veterinary College, University of London

This project aims to rationalise veterinary assessment schemes by maximising the use of computer-aided assessment, and developing more structured assessments for practical skills, through objective-structured practical examinations.

This strategy will use academic staff more efficiently, increase assessment reliability, and provide more immediate feedback to undergraduate students.

Incorporating disability equality in clinical practice

University of Bristol

This consortium project will develop a curriculum framework for disability equality training suitable for all health professionals. It will be flexible enough for single or inter-professional learning. Its underpinning philosophy will be the social model of disability and disabled people will have input to its design and delivery.

Developing tomorrow’s leaders in healthcare education

University of Leicester

The aim of the project is to design adevelopment programme for continued leadership development, modelled on an agreed specification for skills and competencies of health and social care education leaders. The framework will include opportunity for initially 30, and overall up to 70 staff, to be equipped with the skills necessary to: manage and enhance the quality of students’ learning experience across the HEI/ NHS/ social care interface, manage change and the development of health and social care education, and work within a well established network to ensure rapid spread of good practice.

A core question bank linked to the learning outcomes for UG medicine

University of Manchester

Manchester will host a ‘Question Bank Unit’ on behalf of five Northern Universities based on QAA/GMC subject benchmarks. Questions will be written at workshops attended by experienced examiners and will be stored in a standard format to ensure ease of sharing.

It will evaluate reliability, accessibility, validity and standards of assessments. The aim is to establish a high quality question bank, improved skills and understanding in setting assessments, and develop an assessment process to share with other relevant faculties.

Interprofessional education for pre-registration students

King's College London

The project's full title is: Interprofessional education for all pre-registration students in the health professions across three HEIs within South East London Workforce Development Confederartion.

This project is a collaboration between King's College London and the Universities of the South Bank and Greenwich and NHS trusts within the South East London Workforce Development Confederation.

Its aim is to delvelop, test, disseminate and evaluate inter-professional education (IPE) in practice for pre-registration health and social care students drawn from in professional greoups.

These are nursing, medicine, dentistry, midwifery, physiotherapy, social work, occupational therapy, pharmacy and dietetics.

Dyslexic students' self managed learning of subject specific terminology

South Bank University

This project is producing self-directed learning programmes to help students with dyslexia to learn to read and to spell problematic subject-specific terminology. These programes will be disseminated, in paper and CD-ROM form, to special needs units and libraries of British universities.

Interprofessional medical training by means of a virtual hospital ward

University of Manchester

The object is to develop web and third generation mobile-phone based interactive case studies, requiring active participation of a team, comprising medical, nursing and pharmacy students. It will specifically examine the areas of prescribing practice, medicines administration and error reporting procedures. This will help to develop and enhance their team working skills.

Advancing the Provision of Pharmacy Law and Ethics Teaching (APPLET)

University of Nottingham

The project aims to make a step change in the scope and content of law and ethics teaching in the pharmacy curriculim to support the pharmacists' changing role from supplier of medicines to clinical practitioner and provision of teaching mostly by non-speciliast, part time teacher practitioners.

Interprofessional teaching and learning in contemporary mental health care

University of York

The project wil design, implement and evaluate a shared learning module for final year, pre-qualifying mental health nursing and social work students. The effectiveness of learning and teaching strategies and materials, designed to develop the knowledge, skills and attitudes required for interprofessional working, will be evaluated and disseminated widely.

Other projects

Royal Veterinary College

University of London

Disability in Veterinary Education - Resources for Sustainable Enhancement (DIVERSE), funded by HEFCE Disability Funding Programme

Aim: to evaluate the extent to which students with particular disabilities will be able to satisfy the requirements of verterinary courses, including work placements, and to identify accommodations to enable them to do so

University of Middlesex. School of Health, Social and Policy Studies

The efectiveness of problem-based learning in promoting evidence based practice, funded by ESRC.

Aim: To contribute to the development of evidence-based education by evaluating the outcomes achieved using two difference approaches/methods of curriculim delivery for continuing professional education.

Introduction

Health Sciences and Practice, LTSN-01 and Social Policy and Social Work (SWAP) are working together on a unique project. The project aims to support the development of interprofessional education in health and social care through identifying scholarship and practice and facilitating debate. Staff from all three centres will be involved in ensuring that the outcomes are relevant and useful for all disciplines.   

The need for and value of interprofessional education is widely recognised, but there are at present many different models of interprofessional education, a range of implementation strategies and stages, and inconsistency across the UK.

The statutory documents for health refer to common learning and the subject benchmarks refer to health care teams and state that, for example, professionally adept graduates should be “capable of giving appropriate input into the multi-disciplinary teams involved in the management of patients”.

Similarly, benchmarking statements for Social Work reflect the knowledge and skills that are required to work effectively with others.

Interprofessional education has been developed for many years for a variety of reasons with a variety of approaches and this highlights the need for greater clarity of what works pedagogically and results in higher quality health and social care.

There is a need for a better understanding of the historical context and future aims of the different disciplines. Initial progress has been made with the publication of “Interprofessional education, Yesterday, Today and Tomorrow” (Hugh Barr 2002) commissioned by LTSN Health Sciences & Practice and available to download from its website (see address (1) in list at end of article). Other preliminary work has identified possible ways forward such as capturing existing practice in case studies available on the LTSN Social Policy and Social Work website (see (2) in list), building capacity in order to get teachers up to speed with CAIPE and the associated Joint Evaluation Team (JET) strengthening evaluation to ensure a sound evidence-base (3).

LTSN Health Sciences and Practice commissioned JET to write their second occasional paper entitled ‘Critical review of Evaluations of Interprofessional Education’ and this can now also be requested online (4). It will be available for downloading shortly.

Project support

LTSN-01 has also supported projects on the development of reflective skills. Some, although not all, interprofessional activities are documented. The evidence base is young, however, and much work is being carried out based solely on intuitive logic. Interprofessional education and related case studies need to be viewed from the perspective of all participants.

A mapping exercise across the disciplines is now essential to establish not only what is going on and where but to identify and disseminate why and how interprofessional learning is working or why it is not.

Interprofessional education in health and social care has developed over the last 25 years or so for a number of reasons, for example to:

• Modify negative attitudes and perceptions (across health professions)
• Remedy failures in trust and communication between professions
• Secure collaboration, for example to improve services
• Reinforce collaborative competence
• Cope with problems that exceed the capacity of any one profession
• Create a more flexible workforce
• Integrate specialist and holistic care
• Enhance job satisfaction and ease stress
• Manage resources.

The above reflect the need for a range of outcomes and therefore a range of processes and structures required for implementation.

The professions involved with health and social care and that are the backbone of the National Health Service, as well as other Public Health and health enhancement strategies, are located within the three LTSN Centres engaged with this proposal.

We will be working together in order to support the academic community who are not only engaged in teaching across the disciplines but are, more importantly, preparing health and social care professionals to practice in interprofessional teams so that clients and patients receive coordinated and seamless health and social care.

Establishing the nature of interprofessional working within the health and social services precedes identifying what kinds of pedagogical approaches might underpin it. The project is underpinned by a genuine belief in the nature of effective learning that ensures:

• That the learners’ experience is central
• Interactive, group based learning;
• Relating collaborative learning to collaborative practice within a coherent rationale
• understanding of interpersonal, group, inter-group, organisational and inter-organisational relations (anxiety and stress result in rigid and defensive behaviour liable to impede collaboration when it is most needed)
• Understanding of processes of professionalisation (strong fences build good neighbours).

Interprofessional education may need to guard against a model that is too inward looking and although the professions remain the key players, patient participation should be written in (UKCC 2001). Here there is a link to the proposed collaborative work on Mental Health Education that also involves a fourth Centre, LTSN Psychology.

We welcome your ideas, experience and involvement. The project will be live on the web early in 2003. Expressions of interest and offers to share experiences and case studies would be happily received by myself, Margaret Sills, or Marion Helme.

Key contacts

Hilary Burgess, LTSN Social Policy and Social Work, H.C.Burgess@bris.ac.uk

Dr Jean McKendree, LTSN-01 Jean.McKendree@newcastle.ac.uk

Dr Marion Helme, Senior Project Development Officer, marion.helme@kcl.ac.uk

Dr Pawel Miklaszewicz, Project Development Officer, pawel.miklaszewicz@kcl.ac.uk

Objectives

• Identify and capture the range of existing interprofessional education practices. 
• Identify priority issues across the disciplines. 
• Identify scholarship in the practice of interprofessional learning.
• Facilitate debate around effective interprofessional learning.  
• Engage constituents in linking up and developing interprofessional education.  
• Link with policy initiatives such as the Department of Health ‘Common Learning’ initiatives and the Welsh National Assembly initiative for interprofessional learning.  
• Build capacity in interprofessional teaching and evaluation where appropriate.  

Introduction

The Resource Discovery and Collaborative Development LTSN-01 mini-project seeks to investigate emerging interoperability standards and to take a pragmatic view of resource discovery with a target audience of teachers and students with a requirement to develop CAL material.

The continuing success of the Resource Discovery Network (RDN), and in the field of medicine BIOME (1) in particular, demonstrates the importance of resource discovery as an activity to support learning and teaching. New technologies and tools to embed the RDN service into virtual learning environments (VLEs) will result in greater emphasis placed upon resource discovery and the collaborative nature of resource development.

An area of resource discovery yet to be fully exploited involves reusable learning objects (RLOs), the building blocks of electronic learning materials. The definitions of RLOs are almost as diverse as the objects themselves but for the purposes of this article RLOs are defined as the smallest components of computer-assisted learning (CAL) packages, single pictures, multiple choice questions (MCQs), digital video clips and so on.

Institutions are investing in developing catalogues of their own RLOs to support their teaching programmes but cost and quality are becoming real issues. Increasingly institutions are looking to share the burden of developing such catalogues and therefore share RLOs. A new challenge to resource discovery is linking diverse and disparate RLO catalogues so that a teacher or student can find just the image or just the MCQ they want.

It is unlikely that institutions will ever use the same content management or database systems but emerging standards (2) may provide a solution to the vexed question of interoperability. Common data exchange formats will ensure that RLOs from one VLE can be incorporated into other VLEs.

The ‘Resource Discovery and Collaborative Development’ LTSN-01 mini-project seeks to investigate emerging interoperability standards and to take a pragmatic view of resource discovery with a target audience of teachers or students with a requirement to develop CAL material.

The project is using the RDF Site Summary (3) (RSS) XML metadata description and syndication format to exchange RLOs between partner institutions. The first public deliverable is an MCQ search portal (4) that searches MCQ RLO catalogues held at five institutions, Birmingham, Newcastle, Nottingham, Dundee and MCQs.com. An advantage of using RSS is that there are many tools (e.g. RSSxpress Lite (5)) in existence for working with data in this format so RLO resource discovery data can be quickly and easily incorporated into VLEs.

The next steps for this project include extending the early success with MCQs to encompass images and other RLOs. There will naturally be issues of intellectual property rights along the way but the main goal of the miniproject is to explore and demonstrate the principle that resource discovery of RLOs can work and can be incorporated into institutional VLEs.

Integration of such an RLO resource discovery system with the RDN as a higher-level resource discovery service is also being explored and issues of controlled vocabularies and metadata schemas are being debated.

Links

(1) BIOME: http://biome.ac.uk/

(2) Standards: http://ltsc.ieee.org/wg12/index.html

(3) RDF site summary: http://web.resource.org/rss/1.0/

(4) MCQ search portal: http://medweb5.bham.ac.uk/databases/interop/mcqs

(5) RSSExpress Lite: http://rssxpress.ukoln.ac.uk/lite/include/

Introduction

This article looks at preliminary results of the LTSN-01 funded evaluation of a pilot outreach course in 4th year restorative dentistry.  

A pilot project to develop dental education in primary care (Elkind and Blinkhorn, 2001) began in September 2001. The objectives are to develop an outreach course for clinical training in fourth year undergraduate restorative dentistry in community clinics; and to assess the organisational, service, and educational implications.

The pilot is run by the University Dental Hospital of Manchester (UDHM) in partnership with the Community Dental Services from Central Manchester Primary Care Trust (PCT) and Salford PCT. In 2001/2 the PCTs provided teaching facilities on two days per week at each of three primary care dental centres. All are in socially deprived areas with poor oral health, and inadequate access to dental services.

Each student spends one day per week in restorative outreach treating adult patients for the academic year. They are supervised by Senior Dental Officers and supported by dental nurses.

The project is funded by the National Dental Development Unit, the Greater Manchester Workforce Development Confederation, and UDHM. LTSN-01 funds the evaluation.

Evaluation

Using an action research approach, monitoring meetings with staff and students enabled problems to be dealt with as they emerged and identified key issues for 2002/3.

The key positive areas of student development highlighted by staff were:

• Improved history taking and treatment planning  
• Increased confidence 
• Good relationships with patients
• Improved/good clinical skills
• Improved speed 
• Reduced need for supervision
• Improved relationship with nurses.

However problems were also identified. These are being addressed in 2002/3 by giving students a better preparation for clinic life through induction and written notes, about clinic procedures, cross infection control, notewriting, time management, and professional attitude. The nurses will have more input into teaching, and the seminar programme will include topics relevant to the clinic environment. For the students, a key issue was meeting requirements. These have been revised for 2002/3.

Questionnaire

One hundred and thirty-nine patients attending the clinics completed a questionnaire in 2002. Asked why they had chosen to attend the clinic, the most frequent replies were the recommendation of family, friend or colleagues (19%), convenience (14%), because they were in pain or required dental treatment (14%), and the availability of free treatment (13%).

Had they not attended the clinic, 39% said they would have gone to a dental practice instead, 10% to another dental clinic, and 16% to the Dental Hospital. However 30% said they would have gone nowhere or did not know where they would have attended.

Some 17% of patients had seen a dentist within the last six months and 33% within the last two years. However 50% had not seen a dentist for more than two years. Asked how they felt about being treated by a dental student, most patients gave a positive response, such as ‘OK’, ‘fine’, ‘very pleased’. A small number said they felt nervous or doubtful.

Some 71% thought the quality of care was excellent and 25% thought it good. Only 4% said they found it fair or poor. Ninety six per cent said they would return to the clinic in future. The main suggestions for improvements were about appointments and waiting times.

Other aspects of the evaluation being analysed include service data, student questionnaires, and patient data. Interviews with the heads of the restorative units are planned. A full report will appear later this year.

What patients said about outreach clinics

• Had they not attended the clinic, 30% said they would have gone nowhere, or did not know where they would have gone.  
• 50% had not seen a dentist for more than two years.  
• 71% of respondents thought the quality of care was excellent and 25% thought it was good.  
• 96% said they would return to the clinic for treatment in future.

Introduction

Using funding from the LTSN-01 subject centre staff from the Royal Veterinary College visited skills labs in medical schools. This article considers their potential for veterinary medicine.

It only takes the first five minutes of avisit to a Medical School skills laboratory to reach the inescapable conclusion that the concept has enormous potential in veterinaryteaching.

This year staff from the Royal Veterinary College and other veterinary schools have had the chance to make exploratory visits to skills laboratories in a number of Medical Schools as the result of a mini-projectgrant from the LTSN-01 subject centre. We saw the teaching of basic skills, such as mannequins for setting up intravenous therapy or practising intubation, or the simple availability of an ECG monitor that students could set up on each other.

There is a considerable amount of more complex technology available. A dummy head and torso that can replicate the heart sounds and pulses of a variety of cardiac complaints was particularly impressive. We also saw larger facilities such as a set of rooms where one student could hold a consultation with an actor patient ”while the rest of the group and a member of staff watched and commented on close circuit TV and provided hints via an ear-piece. 

Adapting the format

The medical schools are clearly using skills labs to teach generic and clinical skills at both basic and more complex levels, and for assessments and the provision of feedback. Moreover they have adapted the format to nursing, undergraduate and postgraduate clinical teaching.

So what are the requirements for developing a skills laboratory in a veterinary school? A list of all the techniques staff might like to see available might be the most obvious start, although targeting the system as an element in selected courses may be more likely to succeed. 

The main points we have considered are:

•A system of requests and planning available to all staff

•Identifying an academic organiser to oversee and promote the unit

•Identifying an organiser to be responsible for the facility and equipment

•Locating equipment for specific tasks and skills

•An appropriate storage, indexing and ordering system for the equipment

•Identifying appropriate rooms

The equipment might seem to be aproblem, but in reality much of it is available in our hospitals already or can be copied from the medical schools. In some areas of deficiency specific veterinary mannequins and teaching aids are becoming available.

Finding appropriate rooms is much more of a problem. Ideal facilities would include space for storage, large and small animal examination, wetlab; and considerable bench space in an inter-linked suite of rooms. A permanent area of this sort provides for timetabled classes and gives students a chance to use the unit int heir own time, but is clearly a large investment at the beginning of a project. It should be possible, however, to start on a smaller scale rotating different classes through a smaller space, and still allowing students to request a particular set of equipment for personal study. 

The greatest challenge in setting up a skills laboratory is not the equipment, facilities and personnel, but the integration of this format into the curriculum. The value of a student setting up an ECG is increased many times when that student has just had a lecture on cardiac lectrophysiology. Not only are they learning a skill, but they are reinforcing the scientific background to it, and hopefully enjoying it because the real clinical relevance is so obvious. 

Benefits of a skills lab

The skills lab is a great basis for assessment, allowing for Objective Structured Clinical or Practical  Examinations (OSCE/OSPE) based ontasks and skills students have undertaken in the facility, and so allowing assessment to drive independent learning.

So, to truly unlock the potential of this sort of teaching we need to carve out a place for it in the curriculum and think of it not as a fixed unit in the course, but as an overarching teaching resource like a library or computer facility. 

A veterinary clinical skills laboratory could be of great value in both horizontal and vertical integration of the curriculum. Rather than teaching skills by rote it allows them to be placed in the context of the scientific and clinical background provided by didactic teaching. The challenge in its development will be two-fold. Firstlyto ind and adapt the equipment and facilities peculiar to veterinary medicine and surgery, and secondly to adapt our courses to gain full advantage from the integration of this facility.

Introduction

The ACETS project is exploring the potential for reusing online teaching and learning materials, which has become a major focus of interest across education. This article explores some of the issues facing the project.  

The possibilities offered by reusing online teaching and learning materials has become a major focus of interest in all areas of education. However, the reuse of other people’s learning resources is not a straightforward matter.

Questions such as: ‘how do I find them’, ‘how do I get access to them’, ‘can I change them’, ‘who owns them’ and ‘how can I find ones that best suit my needs’ raise significant practical and pedagogical issues for all concerned.

The UK’s Joint Information Systems Committee (JISC) has funded a number of projects under its Exchange for Learning (X4L) programme to investigate the many issues raised by a move to a learning object economy.

One such project, ACETS (of which LTSN-01 is a member), is concerned with how we can integrate existing learning objects into biomedical and healthcare teaching and learning. This article will describe some of the issues and approaches of the ACETS project.

The reusable learning object

Reusable learning objects (RLO) have been defined in a number of ways. In ACETS RLOs are considered to be any digital materials which can support teaching and learning such as graphic images, animations, video, audio, text or assessment questions. Some of the key aspects of a learning object approach are outlined in the accompanying diagram (see next page).

A great deal of digital learning content already exists but is locked in to its delivery medium, for example multimedia CD-ROMs.

Other material that has been made available via online repositories is effectively redundant when potential users neither know that it is available for them to use nor have any pedagogical or practical engagement with the utility of such an approach.

ACETS will work with teachers to identify suitable existing RLOs, develop an appropriate cataloguing system (including pedagogical-specific metadata) to facilitate resource discovery and create an electronic repository from which they can be readily accessed and incorporated into their local learning environment.

Creating exemplars

Simply putting together a collection of RLOs might create an effective resource but it does not produce a useful learning activity. This approach has been repeatedly used in the last decade and has been marked by a singular lack of enthusiasm and engagement from the HE community.

Learning activities need to be related to outcomes, they need to have engaging student tasks and they need to have an associated assessment. For this reason a major thrust of ACETS will be to commission experienced teachers in all areas of health-related FE and HE education to identify RLOs and to create ‘wrap-around’ teaching materials to embed them into their teaching practice. In this way the RLOs become central to the teaching and learning process rather than a peripheral resource.

ACETS will evaluate the process of creation, and use of the exemplars of learning activities and examples of best practice will be widely disseminated to the HE and FE communities.

Conclusion

The principle of unlocking and making material available that has educational utility well beyond its original context, has the potential to provide great benefits to teachers, learners and organisations who can reap the rewards of economies of scale and see greater returns on their investment.

Introduction

Discussion can be a valuable tool in increasing levels of attainment among students. This article introduces some of the innovative forms in which discussion can be used in an educational context, and directs the reader to further reading and research.  

Much of what we learn requires understanding descriptions of the world, acquiring knowledge derived from someone else’s experience, and comprehending someone else’s arguments – not only learning based on your own concrete and necessarily limited experiences. What we need is discussion to bring this about effectively (Laurillard. 1993).

Much of the learning students actually do is superficial and short-term, often because of the assessment methods used. Even when we do give feedback, conceptual learning may not be most effectively accomplished by receiving explanations from experts.

Rather, deep learning occurs when learners generate their own explanations to reflect on the differences between what they understand and what is being presented (Chi, et al., 2000).

In order to promote more abstract learning, we need to engage students in conversations aimed at eliciting and resolving different conceptualisations of the students and the teachers or texts.

This is not to say that the students always come to view a domain in exactly the way a lecturer does, but what we need to avoid is the appearance of common understanding, when in fact there are hidden and critical differences.

Discussion and its effects

Abstract learning or generalization does not happen purely by exposure to concrete activities; learners need an initial ‘label’ to hang examples on and this is perhaps most often provided by language. Given this initial framework, students can begin to fit specific experiences into a larger concept (Ohlsson, 1997).

We see this failure to grasp the ‘bigger picture’ when students can read an article and summarise it, but they can’t explain what the article implies for the larger theories in which they sit.

This “missing the forest for the trees” is a very common problem which might be exacerbated by activity-based or problem-based approaches to learning, if due attention is not paid to discussion and assimilation of the knowledge acquired in the process.

An example of this lack of understanding is shown in Turkle (1995). She described a student’s experience with SimLife, a simulation of various ecosystems. She was amazed at the way thirteen-year-old Tim could keep playing even when he had no idea what was driving events.

When his sea urchins become extinct, she asked him why.

Tim: “I don't know, it’s just something that happens.”

ST: “Do you know how to find out why it happened?”  

Tim: “No.”

ST: “Do you mind that you can’t tell why?”  

Tim: “No. I don’t let things like that bother me. It’s not what’s important.”

Unfortunately, the claims of SimLife are that it will teach exactly what is missing from Tim’s learning – the underlying dynamics of environmental systems.

It appears that simply driving the simulation has very little to do with whether the intended lessons are learned. Various studies indicate that what is necessary is discussion to draw out the higher level abstractions illustrated in specific instances (e.g. Tabak and Reiser, 1999).

Innovative Methods

Research indicates that (at least) two attributes potentially crucial to deep learning are promoted by discussion:

(1) abstraction of higher level concepts and

(2) appropriation of domain specific language.

Since it is not always possible to conduct a discussion on every topic with every student, what are some other possible ways to accomplish these benefits?

Vicarious Learning

The Vicarious Learning Project was interested in whether the “vicarious” experience of observing others’ discussions could promote similar benefits. Students were given access to material captured from previous students’ questions and discussions via computer.

Learners who saw other students discussing a topic learned marginally more of the content than students who were presented with the same information as a traditional text.

But, arguably more importantly, when they then engaged in discussions with each other, the Vicarious Learners began using more of the specialized vocabulary and also demonstrated more reflection and critical thinking than the group that saw only the text. Also, their opinion of their peers as a useful learning resource went up significantly as compared to the other group (Lee, Dineen and McKendree, 1998).

Another method that may promote deep learning is to have two students watch a video of a third being tutored on a topic. The two observers then discuss with each other what they have seen, including what they found unsatisfactory about the tutoring session.

Preliminary research indicates that the pair that discuss the tutorial session can sometimes learn more than the one receiving one-on-one tuition (Chi, personal communication). This could be a cost-effective way to deliver some benefits of an expert-novice tutorial to students.

Self-explanation

While talking to oneself doesn’t really seem like discussion, research has found that it actually promotes many of the same results. If we can carry on an internal dialogue, which is a large part of ‘reflection’, learning is more effective.

Indeed, this ‘self-explanation’ hypothesis has been supported in a number of studies (Aleven and Koedinger, 2002; Chi, et al, 1989, 2000; Renkl et al., 1998) that have shown that students who self-explain while reading or solving a problem learn more than those who don’t, even though their self-explanations may be incorrect.

Chi et al (2002) found that when tutors were told not to give explanations or feedback, but simply to prompt students with questions such as, "What do you think about that?” or “Could you explain that sentence?", the students learned just as effectively as students who were given thorough explanations.

And, when taught to ask themselves these questions, students continued to use these strategies on their own (Bielaczyc et al, 1995; Chi et al., 1994).

Task-directed dialogue games

Lee and colleagues (1998) developed a series of Task-Directed Discussion Games based on methods in the Teaching of English as a Foreign Language.

These tasks elicit discussions from students by providing them with a common focus of key concepts taken from the course content that students must use in various ways. Some examples are:

• Scanning: extract a set of main ideas following a presentation of the course content through readings, lectures, or seminars. The students and tutors then select a core set of concepts which will form the basis of other discussions. 
• Ranking: using the selected concepts, have the students rank them according to some criterion (Most Important, Hardest, General to Specific) and justify their choices.
• Defining: write the concepts on cards. A single card is drawn by one of a pair who then has to describe the concept clearly enough for the other to be able to guess what is being described.

These are just a few methods by which discussion, and the important learning that results, can be brought to the forefront of the educational experience without placing undue strain on an individual lecturer.

As students become practiced in focused discussion, they will become more positive and reliant on their peers as learning resources and also will ideally develop skills for internal dialogue that constitute a vital part of becoming a competent and confident reflective practitioner.

Introduction

This article introduces a review carried out into the work of six clinical teams with the aim of identifying core (non-clinical) competencies.  

Last year we published a framework that described the core (non-clinical) competencies of effective interprofessional teams in four key areas: Patient Focus, Team Focus, Interpersonal Understanding and Impact and Quality Assurance. This was the result of an in-depth analysis of the practice of six clinical teams working in the priority health care areas of Cancer Care, Coronary Heart Disease and Elderly Mental Health.

Questionnaire and CD ROM

The competency statements, as performance indicators, have since been incorporated into a questionnaire, which has been piloted with teams in Cancer Care, CHD Rehabilitation and Community Physiotherapy. They were asked to score, using a 1-6 rating scale, both how important they believe a number of performance indicators to be and what their current performance is. The two sets of data form the basis for a review of team performance. To speed up the process of manually processing the data, we have now also produced a CD ROM version of the questionnaire, which turns the ratings into two polygon graphs in the form of a “performance wheel”.

These enable teams to see their strengths and areas for development and to compare them, at a glance, with the importance ratings for each of the four areas. As a result, teams are easily able to identify gaps and discrepancies and agree actions to address specific issues that have been identified. The performance wheels can be printed out and used as the basis for comparison with any future review of the team’s performance. The CD ROM is currently being piloted with teams in CHD Rehabilitation, Vascular Surgery and Physiotherapy. Those involved in curriculum design may find both the competency framework and the comprehensive set of knowledge requirements that underpin the delivery of each of the four competency areas a useful framework to which they can refer.

Case study

Five Physiotherapy sub-teams were asked to relate the competency framework to their work with each other and to their team contribution to the outpatient service. They were asked to review their current strengths and areas for improvement in the service, at both an individual and team level. They found the framework a useful medium for debate and review that resulted in explicit action plans to improve both service delivery and communication between the sub-teams and consequently, team morale.

Observations about the review process:

• It works best with teams of five to eight. Any more than this and the time spent collating, processing and interpreting data detracts from the overall value of using the questionnaire as a medium for debate;
• It is useful to have a facilitator to guide the team through the process to reach a consensus about the collective rating of the team’s current performance and to ensure that actions result from the review

Other applications

In addition to using the questionnaire to review team performance, teams can use any of the following activities:

• Review team working and service Provision 
• Monitor team progress
• Monitor the effect of policy changes by completing the questionnaire before and after the change  
• Identify individual and/or team staff development needs 
• Help with induction for new team members
• Assist in thinking about recruitment of new team members  
• Identify gaps in the team to promote comprehensive patient care
• Inform appraisal discussions and the drawing up of practice development plans

Introduction

Notes from the EASA 2002 (European Academic Software Award) Finals November 23-25 in Sweden. (www.easa-award.net).

In EASA2002 a total of 146 entries were reviewed during summer and early autumn 2002, with the countries of source and disciplines represented listed right. Seven out of the 30 selected entries for the finals in Ronneby, Sweden, were from the medical discipline:

• X-ray files 4: Ionising Radiation (John Stevens, University of Newcastle, UK)  
• Universante.org: Online computer supported collaborative learning of public health concepts between students of different cultural and socio-economic backgrounds. (Bengt Kayser UDREM, CMU, Faculty of Medicine, University of Geneva, CH)  
• Jess: Veterinary Emergency Clinical Case Simulator (Paul Crawford, Sonya Powney, Nick Short Royal Veterinary College, UK)  
• Assessing the periodontium: (N J A Jepson, The Dental School, University of Newcastle, UK)
• 3D Embryo: Interactive 3D animation for the web in medical education (David Örtoft, Hanna Reuterborg Karolinska Institutet, SE)  
• MedicMED Multimedia Education: Internet Campus Medicine - Development of a generic XMLstructure for case-based learning in medicine (Michael Reng, University clinic of Regensburg, Dep. of Internal Medicine I, DE)
• NUDOV: National Educational Software for Dermatology and Venereology (Mona Bäckdahl, Carl- Fredrik Wahlgren, Uno Fors, Samuel Edelbring Dept LIME, Karolinska Institutet, SE)

Medical winners

After a brief presentation for the jurors during the first day, the 30 finalist projects were demonstrated during 30 minutes for two different juror teams the second day. The jurors scored the projects regarding innovation, educational value, design and evaluation and met for ranking and decisions Monday morning.

At the final ceremony during Monday afternoon, November 25, the ten winners were announced to the 400- strong audience and commented on by the chair of the juror committee, Dr Nick Hammond. The winners received the awards – models of a small local sailing boat with the EASA-logo in the main sail – by the Swedish Minister of Education, Thomas Östros.

Two of the winners were in medicine: the student-led 3D Embryo project and the academic-led MedicMED project. All 30 finalists were demonstrated together with commercial and academic software at the subsequent international conference Netlearning2002, details can be found at http://netlearning2002.org.

3D Embryo

The 3D Embryo (1) project has applied 3D-animation and interactive 3D web technology to visualise the early development of a human being, specifically the first four weeks. The subject is hard to understand with traditional tools since time and space aspects are central.

The project leaders are fourth year medical students. Previous experience relevant for this project ranges from design at the University College of Arts, Crafts and Design (Konstfack) and architecture at the Royal Institute of Technology (KTH) to 2D and 3D computer graphics as well as medical research at Karolinska Institutet.

3D Embryo is meant to speed up the process of getting a mental picture of the developing embryo. It is also meant to serve as a common point of discussion for surrounding subjects like molecular biology, pathology, and physiology, both in educational and research communication contexts.

MedicMED

MedicMED (2) developed a generic XML-structure for medical cases (MedicCaseML) based upon international e-learning standards. Using multimedia functionality is an ideal way to train students’ and doctors’ skills in the clinical solving process by simulating the treatment of a virtual patient in various medical cases.

International standards in multimedia education do not allow an adequate mapping of such medical cases. Therefore all available software focussing on case-based learning in medicine today only supports proprietary data formats and demands an authoring-process into a “black box”. The sustainability of the medical author´s work is limited to the sustainability of the chosen software. The chosen software itself strictly defines the didactic concept of presentation and widely fixes the user interface of the medical case.

The structure of MedicMED allows separation of form and content – of presentation information and medical data. MedicCaseML provides all information to parse a medical case into non-specific industry-standard elearning software without any need for proprietary tools. No repeated medical authoring is necessary when changes of didactic presentation or modifications of the graphical userinterface are initiated.

The future and role of EASA

EASA 2002 (3) revealed a lot of good work throughout Europe with not only splendid and innovative ideas but also tedious work to structure and make resources useful and available for students. The quality is steadily increasing and the resources are more and more net based. So far EASA seems to be a forum for good examples (practice) and also for inspiration from other disciplines. At a workshop about European collaboration at the Netlearning2002 the role of common efforts and standards was emphasized. EASA is organised by the European Knowledge Media Association (EKMA) which has suggested it expand its role to reinforce the quality of work between the biannual competitions.

EASA 2004 is planned to be held in Switzerland early autumn 2004. We welcome your work.

Source of entries to EASA awards

The 146 contributions to EASA2002 came from the following countries:

United Kingdom........................52

Sweden ........................................26

Germany......................................18

Austria ........................................14

Switzerland ..................................8

Netherlands ..................................7

France ............................................5

Italy ................................................4

Belgium, Finland, Portugal, Spain ............................2

Bulgaria, Czech Republic, Denmark, Finland, Ireland........1    

Disciplines represented (% of entries received):

Medicine ..............................21.9%

Computer Science ..................11.6

Electronic Learning Environments............................8.9

Arts and humanities ................8.2

Biology, life sciences and chemistry............................7.5

Economics..................................7.5

Education ..................................7.5

Languages and Linguistics ..6.89

Engineering ............................6.25

Physics........................................6.2

Social science ............................4.8

Mathematics..............................2.7

Introduction

Shirley Moore, a student at Dundee University, was one of the jurors at EASA 2002. Here she describes her experiences and impressions of the conference, and the entries she evaluated.

My experience as an EASA student juror began in May 2002, when I was asked if I would like to evaluate some medical software applications. Being an ex-software developer and a current medical student, this sounded right up my street!

The applications I evaluated covered medical ethics, microscopy and ophthalmology, and differed greatly in their aims and approach. I started to appreciate then how difficult it was to judge such varied software.

The quality was generally high and I was surprised to learn that none of the entries I evaluated had made the final. However, one of the evaluation criteriawas accessibility. My main gripe about the software I assessed was that it was not very accessible to the average student.

Three out of the four applications I assessed either required a resolution greater than 600x800 or a DVD drive. Neither the student PCs at my university, nor my personal upgraded 486 PC, could provide these.

For the final, in Sweden, I was part of a four-person, multidisciplinary team. Each team evaluated 12 finalists from across the disciplines represented. This was very hard work. Now, not only were we having to compare different subject areas within one discipline, we had to compare entries from different disciplines that we may have been unfamiliar with. Our jobs were made even harder as the quality of the entries was extremely high.

Personally, my favourite application was the student-led 3D Embryo project. It was a simple idea, but very effective. I certainly wish it had been available during my embryology teaching!

EASA2002 was a great opportunity for me to meet students and academics from other universities and countries and see the range and quality of software available. It was also great to experience the Swedish hospitality!

Introduction

A main aim of LTSN-01 is to disseminate examples of educational approaches used within the community. We hope this ‘sharing of good practice’ will stimulate debate and development regarding innovative teaching methods and the enhancement of student learning. Here we present three papers from around the constituency.

Introduction to the three papers

A common concern within medicine, dentistry and veterinary medicine relates to integration of the pre clinical and clinical curriculum; and what methods may be employed to encourage students to link the basic sciences to clinical material.

What follows are examples from each of the discipline areas describing  strategies designed to address the integration/linkage issue.

The strategies include the introduction of a problem based learning module into the first year of the degree in Dental Surgery at Liverpool University; the  development of a CAL programme in progress at the Royal (Dick) School of Veterinary Studies in Edinburgh and how clinical tutors have been used within a Vocational Studies course for first and second year medical students at Glasgow University.

A problem-based learning module for operative clinical dental skills

University of Liverpool

Involvement in an Operative Technique Course at the beginning of the first year is perceived by undergraduates to be an attractive feature of the Liverpool  degree in Dental Surgery.

In a major curriculum development, dental students joined medical students on a first year course, characterised by a scenario-based, clinically-orientated PBL module, from September 1997. This new course presented an opportunity to develop a further module specifically for dental students that embraced clinical dental skills as a major component but meets the challenge of presenting this component in a PBL format consistent with the other modules.

The module, which extends over a four week period at the end of the first semester in the first year, is devoted entirely to weekly PBL tutorials (of 6-8 students), plenary sessions, selfdirected learning (including sessions in the Resource Laboratory) and practical sessions in the Clinical Dental Skills Laboratory.

Through the clinical scenario, involving a fractured incisor tooth, the student is motivated towards exploring the structure and function of teeth and their supporting tissues and how these influence the methods of restoration with adhesive materials, e.g. the modification of enamel by acidetching to allow bonding of composite resins. In addition, in common with the other PBL modules, the scenario prompts consideration of issues relating to themes of public health and epidemiology; individuals, groups and society; the professional values and growth.

The structure and content of this novel special dental module will make immediately relevant the relationships between operative procedures and the biological principles on which they are based. We conclude that the module will be advantageous as a stimulating introduction to clinical dental skills as, in contrast to the more traditional didactic course, it brings to life the immediate relevance of biological sciences to clinical dental practice.

The virtual dog: Linking basic science teaching with later clinical training

University of Edinburgh

One major challenge in the teaching of Veterinary Medicine is to provide a mechanism which links early basic science teaching with later clinical teaching.

Such a mechanism should allow students in early years to look ahead and place their studies in a clinical context and should allow students in clinical years to review the basic science knowledge which underpins their clinical teaching. A second major challenge within subject areas which are compelled to transmit a large body of factual information, is to encourage students to think for themselves and develop skills of interpretation and evaluation of evidence.

A recent review of teaching in years 3 and 4 achieved some 10-15% cuts in formal didactic teaching. This gives us the opportunity to investigate alternative resources to provide for student centred 'active' learning during some of these vacated slots.

We propose to use the life of an individual ‘virtual’ dog to provide a teaching context in the form of a CAL programme in which the fundamental importance of integrating knowledge in the Veterinary curriculum is emphasised. The CAL programme will be used by early years to provide a clinical context for basic sciences material and by later years to revisit basic sciences knowledge. It will also provide a mechanism for encouraging the integration of Pathology, Clinical Studies and Therapeutics in the third, fourth and final years of the curriculum.

If the initial urinary tract-based project is successful, it is hoped that the principle will be extended to other systems and will eventually contain a range of topics which are linked by the device of the medical history of the virtual dog. The teaching in both the preclinical and clinical years is largely systems-based and many topics will have a system as their focus. The development of the different topics will draw on the expertise of different teachers in the Veterinary curriculum and it is anticipated that these discussions themselves will strengthen the philosophy of integrated teaching.

The initial proposal is to develop a project on the topic of diseases of the urinary tract however each topic will have a common structure:

• The visit to the Vet, the consultation and establishment of a differential diagnosis list where appropriate.
• A review of the relevant basic sciences and pathology material based on the identified organs system(s), in the form of interactive diagrams/ animations/ revision quizzes.
• A diagnosis leading to interactive discussion on relevant therapeutic options and prognosis.

The contribution of general practitioners to medical teaching

University of Glasgow

Around 86 per cent of decisions about health care are made in general practice. Typically, such decisions involve the ability to draw appropriately from a wide body of knowledge and experience to agree what is right for a particular person at a particular time. General practitioners have the requisite attributes of breadth of knowledge, length of experience and flexibility. Can these attributes be brought to bear on aspects of undergraduate medical education?

The current undergraduate medical curriculum at the University of Glasgow includes Vocational Studies in which first and second year medical students spend weekly sessions in groups of eight on a wide range of activities. The learning is experiential and reflective and integrates student learning in communication and clinical skills, working with others in different clinical contexts, understanding patients, people and communities, informatics, evidencebased medicine and ethical, legal and professional issues.

An essential feature of the course is continuity of contact between groups of students and individual tutors, as they address a broad range and sequence of activities. The course is valued by students for its relevance to medical practice and professional development. It is popular with tutors – mainly general practitioners – because it values and utilises the best attributes of the generalist clinician. It may not be possible to teach the art of medicine, but experienced generalist clinicians have much to offer undergraduate students as they attempt to integrate and make sense of their learning.

Introduction

The background behind the establishment of the Jerwood Medical Education Resource Centre at the Royal College of Physicians.

In most medical libraries there is a limited range of specliased books, reports and journals focusing on teaching and training skills. In the medical sections of bookshops, these items are not stocked in any great quantity, and doctors are unlikely to find them reviewed by the major medical journals.

However, a knowledge base in medical education does exist and is ready to be exploited. This is at a time when education issues are at the forfront in providing quality and effective health services. The need to bring this knowledge base together and to keep doctors up-to-date with the latest information in medical education was one of the reasons in establishing the Jerwood Medical Education Resource Centre at the Royal College of Physicians, London.

Framing the collection

Supporting the education work and activities of College Members and Fellows is an important consideration for the resource centre.  Books and reports on educational supervision, assessment of competence and clinical teaching and training form a substantial part of the collection. Nearly all physicians working in the NHS have a teaching or training role, and the intention is to keep them information of the necesary skills, exisitng practices and best evidence in this area.

A look through the 2002 issues of the journal Medical Education shows a diverse range of topics covered. Issues of professionalism, artistic endeavours, stress and pastoral care have all been explored. It is this diversity in what the medical education comunity consider as their knowedge base, which has also helped to shape the resource centre collection. Education is considered to be a social science, and it can be argued that medical education in a broader sense is concerned with the social sciences as applied to medical practice. Books and reports on socilology, politics, psychology and economics with a medical or health care slant are a feature of the resource centre. Knowledge of the requisite skills and methods to teach are impotrant, but equally so are the fundamental barriers that prevent learning and development taking place amongst students and doctors. These barriers include sexism, bullying, racism and so on. Knowledge is a pre-requisite to debate, leading, sometimes, to change.

These issues are, of course, not soley confined to medicine but affect other professional practices. Subsequently books and reports dealing with these isues in other professions have also been acquired to allow doctors to compare and contrast. A good example is the work carried out in the aviation industry on system approaches in preventing accidents and error.

Searching and retrieving

For a long time medical educationalists have relied on the excellant TIMELIT database(1) for identifying publicactions in their field. To complement this, the Resource Centre catalogue has also been made available over the Internet(2). At the moment the technical infrastructure of the catalogue is under development but searches can still be carried out. The catalogue is a holdings database - the references retrieved from a search relate to an item held in the Resource Centre. The catalogue does not claim to be comprehensive in covering the entire medical education knowledge base, but it does contain references to all articles published in major UK journal titles (including Medical Education, Medical Teacher, Education in Primary care) as well as overseas ones (such as Academic Medicine, Teaching and Learning in Medicine and Advances in Health Sciences Education). For journals, coverage goes back to the last three - or four years (when the idea of the Resource Centre was conceived). For books and reports, most items in the Resource Centre tend to be no more than fifteen years old and this is reflected in the catalogue.

Searches can be carried out by author, name, title word(s) or subject. Each reference to an article or book is allocated a number of subject headings. These headings are derived from the British Education Index (BEI), and this should enhance the ability to search effectively for literature from an educational, rather than a medical, perspective. For those used to searching Medline, the BEI terms may be unfamiliar. A useful tip is to enter a suitable word in the title field, open up a catalogue record that nearly matches your requirements, examine what subject headings have been used, and use these headings to carry out a more refined ssearch. Alternatively, a (draft) listing of terms indicating broader, narrower and related subject terms used in the catalogue is available upon request.