Aim: To assess whether there is any advantage to be gained with respect to performance in the first year of postgraduate medical training (internship) by selecting medical school candidates with different educational backgrounds. Specifically, we were interested in comparing the performance ratings of interns who entered medical school with secondary (directly from high school) or tertiary (at least one year of a university degree) level educational backgrounds. Focus: We compared the performance ratings of interns according to the subjects or degree undertaken at a secondary or tertiary level, respectively. The effects of age and gender were also examined to determine their influence on performance ratings. Method: All graduates (N=235) from the University of Newcastle Medical School, Australia who commenced their intern year in the state of New South Wales from 1993 to 1996 inclusive were eligible for the study. The outcome measure was a score derived from a valid and reliable clinical supervisor rating scale. Independent variables were level of previous educational experience (secondary or tertiary entry), and subjects studied by secondary level entrants (predominantly science or equal proportions of humanities and science) and degree undertaken by tertiary level entrants (arts or science or allied health or nursing). Results: The records of 173 (73% of eligible sample) were included in the analyses. There were no significant differences between the mean ratings of interns with respect to previous educational background, subjects studied at secondary school or degree undertaken. Age and gender did not significantly affect performance ratings. Conclusion: These data may be useful for medical schools that are considering a shift in admission policy specifically with respect to requirements for level of educational experience and subject or degree prerequisites. Our data suggest that there may be no disadvantage in admitting students with a broad range of pre-medical school educational backgrounds with respect to performance in the early postgraduate years.

Objectives: To evaluate predictors of success in training programs for Israeli international medical graduates (IMGs) from the former USSR. Subjects: IMGs up to the age of 45 who passed a national licensing examination and a Hebrew knowledge exam were eligible for participation. Intervention: Each IMG participated in one of three programs that offered similar academic activities. In two programs there was a preliminary selection process and one program had supplementary teaching hours. Main outcome measures: Resident's self-evaluation of skills compared with evaluation by department heads. The evaluation included eight clinical skills, a general evaluation, and the passing rate for Phase I of the National Certification Exam. Findings: A total of 176 IMGs, all graduates from medical schools in USSR who immigrated to Israel from 1990 to 1996, and 20 heads of the participating departments completed the questionnaires. The response rate was 64% among the residents and 71% among the department heads. All residents had a similar level of self-esteem regarding clinical skills and considered themselves equal to or better than Israeli-trained residents. The department heads did not concur with this assessment, particularly for residents who participated in the program with no preliminary selection. Participants in the programs with preliminary selection received better evaluations from department heads than those in the program without and had significantly greater success in the written part of the board certification examination (p < 0.05). Discussion and conclusions: Re-training programs for IMGs should include a preliminary process for participant selection. The training program should be implemented in academic departments, in which case supplementary teaching hours are not required.

As its label implies, a pilot study or project is a trial of an idea that may be a new instructional model, innovation, technique, or curriculum reform. Originally it was used for trials of large-scale research designs. Pilot studies and their close relatives, feasibility studies and demonstration projects, have had a varied pattern of use since the 1960s. Kamin et al. (2001) have provided us with an excellent example of how a pilot project can be undertaken to identify the strengths and weaknesses of an instructional model prior to widespread and/or permanent adoption of its use.

In villages without doctors and hospitals in the remote eastern Ugandan district of Pallisa, traditional birth attendants and mothers are solving the most serious health problems through the teaching power of songs and stories. The village's rich oral tradition was enlisted as the principal means not only for transmitting these important health messages, but also for supporting their practice throughout the community. Utilizing existing community traditions such as songs and storytelling offers culturally appropriate ways of enhancing the communications component of the health care system to make it serve the poor majority in a readily comprehensible, credible, affordable, and accessible form. These non-formal active-learning methods are highly compatible with and promotive of the general principles of primary health care, especially for their empowering, participatory and sustainable qualities. It is only a natural extension for health educators to more fully employ the use of the time-honored oral traditions of songs and storytelling as a vehicle for communicating health messages. For students in the health professions, awareness of these proven principles for engaging people at the local levels will contribute to more effective training, strategic program design, and advocacy.

Background: As course directors, we wished to incorporate small group learning into our Evidence-based Medicine course for students to get feedback on the development of a well constructed, researchable clinical question. Scheduling of these groups was problematic. We sought to evaluate computer-mediated communication as an alternative to face-to-face small groups. Methods: Students were randomly assigned to either face-to-face small groups or asynchronous, electronic, small groups. Final examination scores were analyzed with an analysis of variance to determine if there were differences in student performance based on group type. Student survey items were analyzed using Fisher's Exact test to determine if there were differences in student attitudes based on group type. Results: There were no significant differences found in overall student performance. Significant differences in student attitudes were found to exist with respect to: (1) participation in discussions, with face-to-face groups reporting greater participation; (2) putting more thought into comments, with electronic groups reporting more thought put into comments; and (3) difficulty relating to other students in the class, with electronic groups reporting more difficulty. Discussion: We found electronic discussion groups (computer-mediated communication) to be a viable teaching/learning strategy with no adverse effects on student performance or attitudes.

Purpose: (1) to integrate sociobehavioral science concepts into the early curriculum through a continuity ambulatory clinical experience in primary care, and (2) to expose students to a learning environment in which self-awareness and emotional development are nurtured in the context of dealing with the stresses of an early clinical experience. Methods: Second-year students spent half a day twice monthly in a primary care community practice, kept a journal of their experiences, and attended biweekly 60-minute Reflection Groups designed to foster personal awareness and empathic witnessing. Analysis of journal entries and Reflection Group field notes identified stressors occurring during the students' clinical encounters. Results: Three sources of stress are illustrated: the role and responsibility of the physician, death and dying, and racial issues. Reflection Groups provided students with opportunities to identify and describe stressors, to feel less isolated, to begin the process of self-awareness development, and to integrate behavioral and social science concepts into clinical practice. Our program incorporates students' early clinical experience with facilitated opportunities to reflect on the emotional challenges of becoming a physician.

Purpose: We describe and assess the teaching of qualitative methods to postgraduate students using a case study from the Centre of International Child Health, Institute of Child Health, London, which trains mainly health personnel with developing country experience. As the majority of these students are practitioners rather than academics, the teaching focuses on combining theory with practice. We then analyse the results of the assessment of students about this approach and examine lessons learned from this experience. Approach: We present the format of a two-week course and the evaluation of this course by the students of the past four years. We describe the process of conducting a learningby- doing course, giving the day-to-day details of how the course is conducted. We also give examples of how this teaching is done. Results: One indicator of the value of this course is its increasing popularity over the past three years. In 1997 – 1998, 11 students out of 20 took the course. In 1998 – 1999, 16 students out of 21 opted for this qualitative module. In 1999 – 2000, 12 students out of 17 chose this module. Discussion: The lessons learned from this experience include challenges in how to present the teaching within the available time and having realistic expectations concerning course outcomes. We argue that a learning-by-doing approach accomplishes the objectives of having students recognize the value of these methods for health systems research and giving them skills needed to use these methods.

Translating research findings in health education into a publishable manuscript is challenging regardless of whether qualitative or quantitative methods are used. In this paper, we offer practical advice about how to successfully prepare and guide manuscripts based on qualitative research methods, in particular through the peerreviewed journal publication process. Researchers trying to publish qualitative findings may face some unique challenges, given the field's current knowledge of qualitative methods, evaluation criteria, and conventional manuscript styles and length.

Clinical psychologists, like most health professionals, are in essence clinical problem-solvers. However, dealing with mental health problems may necessitate a greater relative reliance upon inductive clinical reasoning during the problem-solving process. To develop a provisional problem formulation mental health professionals may have to make sense of the co-occurrence of complex and poorly delineated problems. Claims have been made, predominantly in the literature on medical education, regarding the utility of problem-based learning (PBL) for achieving aims central to the effective performance of this role. In this article, after characterizing clinical psychology and PBL, we briefly explore the benefits claimed for PBL and assert that the putative cognitive and interpersonal consequences of the approach may be particularly pertinent to mental health practice. Particular emphasis is placed upon the necessity of facilitating effective clinical reasoning, that is, teaching future practitioners how to, rather than what to, think about complex psychopathology. PBL is also considered in the wider context of models of experiential learning and methods for teaching problem-solving. Finally, future research questions are suggested which may provide answers relevant to the facilitation of effective clinical reasoning in all health professions.

Context: Many medical students experience considerable anxiety when starting hospital experiences. Objectives: To investigate the role of gender in this transitional experience. Method: A questionnaire study was conducted in 1992 and 1995 to compare female and male anxieties about clinical situations they anticipated encountering. The 31-item questionnaire listed potential anxiety-provoking situations and requested the respondents' ratings of their reactions (from 1=not anxious to 4=very anxious). Results: Differences in rankings between males and females were consistent between 1992 and 1995. More detailed analysis of 1995 data showed females had significantly higher totals; for 16/31 situations the difference was statistically significantly higher. For 4/31 situations male score was statistically significantly higher. Males ranked clinical situations involving intimate contact with patients significantly higher. Females scored situations involving interactions with consultants significantly higher than other situations and higher than did males. Females compared to males ranked 6/31 situations over five places different. Conclusions: Customisation of clinical introductory courses should be introduced. Earlier community-based clinical experience may help reduce non-productive anxiety.