Introduction: Reflection is an essential tool for the development of professional behaviour. Central to all reflection methods is language, either written or spoken. As the use of language is not easy for all students, especially those learning in a language other than their native tongue, it is essential that teachers use alternative methods to stimulate reflection. Aim: To identify the benefits that speech and language therapy students perceive in an educational approach that combines pictures and drawings as a stimulus for reflecting on professional experiences. Method: During an international course twenty-two students of various nationalities participated in a two-hour session and reflected on professional experiences. To stimulate reflection, drawings and pictures were used. All the students were asked to evaluate this educational approach by responding to five open-ended questions. Their responses were coded and analyzed. Results: Students' comments fell into three categories of perceived benefits: (1) educational approach benefits; (2) personal benefits; and (3) professional benefits. Almost all the students reported that the nature of the reflection exercises helped them verbalize their experiences after the profession-related exercises. Conclusion: This study provides evidence that visualizing as a first step towards verbalizing experiences can foster learning through reflection. It provides students with greater opportunities to verbalize awareness, especially within a group of students who may have difficulty expressing themselves in a non-native language.

Context: Recent studies indicate that medical students may face problems applying clinical skills taught in a skills laboratory setting when they enter their clerkships. This study explores these problems in the context of a developing country, and explores students' suggestions for improving clinical skills training. Methods: Focus groups discussions (FGDs) were organized with students who had just entered their clerkships. Transcripts of FGDs were digested according to the inductive content analysis protocol. Results: Clerkship students said to have encountered significant problems when they had to perform clinical skills on patients for the first time, in particular with respect to invasive clinical procedures. Differences in context between skills laboratory and clinic, inadequate supervision and unpredictable responses by patients were most common reasons given. Students suggested creating opportunities to practice clinical skills on patients before entering the clerkships. Conclusion: Early in their clerkships students may face significant problems when they have to apply skills learned in the skills laboratory on actual patients. Particularly in developing countries, opportunities may exist to follow up on our students' suggestion to arrange for skills training of pre-clinical students in clinical settings.

Humor and laughter in medicine has received much attention in the medical literature. The use of humor by medical students, residents and medical personnel is not uncommon. Laughter can be therapeutic, for patients and practitioners alike. However, when inappropriately directed towards patients humor can be seen as unprofessional, disrespectful and dehumanizing. How physicians interpret their day-to-day professional experiences, and when and how they use humor is influenced by the perspective that is taken, the social distance from the event, culture and context. Some argue that social and physical distance makes it more acceptable to laugh and joke about patients, but not everyone agrees. To laugh with and not at others is the appropriate use of humor in medicine. To cry against the suffering of others and the injustice behind that suffering and not with them in their agony and frustration is the appropriate response to tragedy.

Objectives: This study identifies factors associated with attrition and improvements in body mass index (BMI) in a telephonic health coaching program. Methods: A cohort study design was used with 6,129 employees aged 21-88 years, enrolled in telephonic health coaching sometime during 2002 through 2008. Results: Attrition through 3, 6 and 12 months of follow-up was 13%, 17% and 36%, respectively. Those currently making changes in physical activity or nutrition had the highest BMI (kg/m2), lowest levels of exercise and the poorest overall health at baseline. They were also most likely to continue with health coaching through 12 months. Those not ready to make changes at this time or having maintained an appropriate level of physical activity or nutrition for more than six months were least likely to continue with health coaching through 12 months. They also had the lowest BMI, highest levels of exercise and the best overall health. Among those continuing with health coaching through 12 months, the percent decrease in BMI between baseline and 12 months was: 1.5% for normal weight, 2.7% for overweight, 4.1% for class I & II obesity and 7.2% for class III obesity; 4.3% for high confidence to lose weight, 3.5% for medium confidence to lose weight and 3.1% for low confidence to lose weight; and 3.8% for very good or good general health, 4.5% for average general health and 6.8% for poor/very poor general health. Conclusions: Attrition in the telephonic health coaching program is greatest among those least in need of behavior change. Of those who continued in the program, the greatest decrease in BMI occurred in those in greatest need for behavior change.

Aim: In Turkey and its neighboring countries, few studies have investigated medical students' reactions to ethics education and ethical issues they encounter. The aim of this study was to investigate interns' perceptions of medical ethics education and ethical issues. Background: In students' first three years at the Dokuz Eylul University School of Medicine, various teaching methods are used in ethics education, including problem-based learning, interactive lectures and movies. During the clinical years, the curriculum helps students consider the ethical dimension of their clinical work, and during the internship period a discussion on ethical issues is held. Material and methods: Data were collected through a questionnaire distributed to interns in the 2005-2006 academic year. Its questions asked about interns' perceived adequacy of their ethics education, any interpersonal ethical problems they had witnessed, their approaches to ethical problems, obstacles they believe prevented them from resolving ethical problems and whether they felt themselves ready to deal with ethical problems. 67.2 % of interns were reached and all of them responded. Results: In the assessment of the adequacy of ethics education, the most favorable score was given to educators. Students' most often mentioned ethical problems encountered were between physicians and students and between physicians and patients. Interns believed that difficult personalities on the team and team hierarchy were important obstacles to resolving ethical problems. There were significant differences between the approaches students currently used in dealing with ethical problems and how they anticipated they would approach these problems in their future professional lives. Conclusion: We obtained information about students' perceptions about ethics education and ethical problems which helped us to plan other educational activities. This study may assist other medical schools in preparing an ethics curriculum or help evaluate an existing curriculum.

Background: Faculty development lays the foundation for the quality enhancement in medical education. However, programs are not always based on the needs of the participants, and there is dearth of information on methods to derive faculty's needs. The Medical Education Unit at the University of Dammam, Saudi Arabia, carried out an innovative method to identify and prioritize faculty needs in order to plan future activities. Methods: A questionnaire was designed, pilot-tested and administered to all faculty members (N=200). The respondents rated the perceived importance (high, moderate, low) and their performance (good, average, poor) on twelve competencies described in the literature. The ratings of perceived importance - high/moderate, and self-rated performance- average/poor, were summed up to determine priority rankings for continuing education. The respondents' rating of various continuing education activities, their willingness to participate and commit time, and their suggestions for strengthening faculty development were also analyzed. Results: All the twelve competencies were perceived as 'highly important' by the subjects. They felt most confident in teaching in large and small groups, attitudes and ethical values, and decision making skills. The competencies prioritized as "gaps" were knowing how to develop learning resources, plan curriculum, evaluate courses and conduct research. The prioritized activities were specialized courses, orientation workshops for the new faculty, and training in educational research skills. This implied a multi-phased approach to faculty development. A majority (62.4%) were willing to devote 2.2 hours per week to faculty development. Respondents suggested initiatives that should be undertaken by the Medical Education Unit and the broader institution. Conclusion: We demonstrated a participatory approach to needs assessment by identifying the gaps between "perceived importance" and "self-rated performance", as criteria for determining priorities. Findings also demonstrated the need for adopting a comprehensive approach to faculty development in which both departmental and organizational initiatives are required. Our findings are applicable to the Gulf Region context and our methodology can be applied anywhere.

Objective: This study evaluated the content validity, internal consistency and stability of a questionnaire designed to assess the HIV/AIDS knowledge of young adults. Methods: The questionnaire was administered on two occasions, within two week intervals, to 219 university students in the USA (n=66), Turkey (n=53) and South Africa (n=100). The psychometric instrument contained demographic information questions and 45 knowledge questions regarding the HIV virus, ways of transmitting it, symptoms of HIV/AIDS infection and methods of prevention. Factor analysis was conducted to assess construct validity; Cronbach alphas and Pearson's product moment correlation (r) were calculated to evaluate internal consistency and stability, respectively. Results: The 45 knowledge questions produced a Kaiser-Meyer-Olkin (measure of sampling adequacy) value of 0.8133 and loaded on three factors with an overall Cronbach's alpha of 0.861. The r for the individual knowledge question was greater than 0.50 and the overall knowledge score was "almost perfect" (0.91; p<.001). For participating students from the USA, Turkey and South Africa, their r for the overall knowledge score was 0.80 (p<.001), 0.83 (p<.001) and 0.93 (p<.001), respectively. Conclusions: Our findings revealed that the instrument is highly stable and internally consistent. The availability of this instrument may enhance HIV intervention studies internationally.

Introduction and objective: The cognitive impact of using simulation sessions in midwifery training has not been the subject of previous research. The aim of this study was to compare the effect on students' knowledge of a simulation session versus an image-based lecture, for teaching routine management of normal delivery and resolution of shoulder dystocia to midwives in training. Methods: Sixty students were enrolled three weeks after a "labour and delivery" class, and randomly assigned to two groups. Ten were subsequently excluded as they were not able to attend the whole session and/or did not complete the tests. In the simulation group (n=26), students were divided into pairs and attended a 30-minute hands-on session in the simulation centre. In the lecture group (n=24), students participated in a 30-minute image-based interactive lecture. A ten-question multiple-choice test was taken before (pre-test) and after (post-test) both sessions, to evaluate students' knowledge of labour and delivery and shoulder dystocia. Learner satisfaction was evaluated by adding a six question Likert scale questionnaire to the post-test. Independent t-test, paired samples t-test, and Mann-Whitney test were used for statistical analysis, setting significance at p<0.05. Results: The simulation group showed a significantly higher mean post-test score (6.38 vs. 5.16; p=0.003) and a significantly greater inter-test score progression (p<0.0001). Overall learner satisfaction was also higher in this group (p=0.0001). Conclusions: A significantly higher short-term reinforcement of knowledge and greater learner satisfaction was obtained using simulation sessions compared to image-based lectures when teaching routine management of normal delivery and resolution of shoulder dystocia to midwives in training.

Background: Concerns about poor communication in the medical and other healthcare professions are common in the empirical literature, with studies showing direct relationships between practitioners' effective listening and patients' satisfaction and less risk of litigation. Furthermore, people do not simply listen or not listen, rather they adopt particular listening styles, making the understanding and investigation of practitioner communication a complex topic. The objective of this study was to identify the listening styles of undergraduate health science students enrolled at one Australian university. Methods: A cross-sectional study using a paper-based version of the Listening Styles Profile (LSP-16) was administered to a cohort of students enrolled in undergraduate education programs in eight different health disciplines: emergency health (paramedics), nursing, midwifery, occupational therapy, physiotherapy, nursing/emergency health dual degree, health science and nutrition and dietetics. The LSP-16 is a validated and reliable scale that assesses participants' preferences for each of four distinct listening style constructs. There were 1459 health students eligible for inclusion in the study. Ethics approval was granted. Results: A total of 860 students participated in the study (response rate of 58%), of whom 87.2% (n=750) were female. Across the group, a strong preference was shown for the People Listening Style (LS), which is a listening style characterised by a concern for people's feelings and emotions. Otherwise, an unexpected amount of homogeneity in preferred listening style was found within the group of health science students. Female students reported a slightly stronger preference for the People LS, whereas males reported slightly stronger preferences for the Action LS and Content LS. There were no statistical differences in preference for LS by students' age or year level of undergraduate enrolment. Conclusion: The health professional student participants of this study reported a preference for a range of listening styles, which is appropriate for many healthcare settings. However, a strong preference for the People LS and a moderate preference for the Content LS were evident. This study should be replicated with practicing professionals to establish if the demands of the workplace affect practitioners' listening style(s).

Background and Objective: In medical education, using the World Wide Web is a new approach for building the capacity of faculty. However, there is little information available on medical education researchers' needs and their collective learning outcomes in such on-line environments. Hence, the present study attempted: 1)to identify needs for capacity-building of fellows in a faculty development program on the topic of data analysis; and 2) to describe, analyze and understand the collective learning outcomes of the fellows during this need-based on-line session. Material and Methods: The present research is based on quantitative (on-line survey for needs assessment) and qualitative (contents of e-mails exchanged in listserv discussion) data which were generated during the October 2009 Mentoring and Learning (M-L) Web discussion on the topic of data analysis. The data sources were shared e-mail responses during the process of planning and executing the M-L Web discussion. Content analysis was undertaken and the categories of discussion were presented as a simple non-hierarchical typology which represents the collective learning of the project fellows. Results: We identified the types of learning needs on the topic 'Analysis of Data' to be addressed for faculty development in the field of education research. This need-based M-L Web discussion could then facilitate collective learning on such topics as 'basic concepts in statistics', tests of significance, Likert scale analysis, bivariate correlation, and simple regression analysis and content analysis of qualitative data. Conclusions: Steps like identifying the learning needs for an on-line M-L Web discussion, addressing the immediate needs of learners and creating a flexible reflective learning environment on the M-L Web facilitated the collective learning of the fellows on the topic of data analysis. Our outcomes can be useful in the design of on-line pedagogical strategies for supporting research in medical education.

Background: Problem-based learning (PBL) has over the years become a learning strategy established for teaching students in medicine. In order to use PBL as a teaching tool, faculty must be familiar with PBL and comfortable with the role transition from 'teacher' to 'facilitator'. This transition is critical for the success of PBL. This article describes the faculty development process undertaken in Pakistan at the onset of introduction of PBL in the curriculum. Methods: At the Foundation University Medical College (FUMC), we initiated a faculty development program in PBL. The program consisted of two-day, hands-on facilitator training workshops conducted five times over the year and led by in-house faculty. A total of 180 faculty members completed these workshops. The workshops consisted of interactive sessions on the philosophy of PBL, small group dynamics, the role of the facilitator, an introduction to case design, wrap-up PBL sessions and assessment in PBL. Participants were provided with pre-workshop reading material in the form of 'PBL Handbooks', which contained details of the PBL process and specific responsibilities of the facilitator. Participants were also given a chance to experience the role of the facilitator by facilitating the faculty-learner group through a PBL session and receiving feedback. A retrospective pre-post survey was conducted to gauge changes in participants' perceptions of PBL. Results: The faculty reported a significant increase in their regard for PBL as an instructional paradigm (p=<0.001). They also generally became more interested in empowering students with self-directed learning using PBL as a teaching tool and showed a greater desire to be facilitators (p=<0.001). Conclusion: This evaluation reveals that facilitator training workshops can help not just to improve the facilitation skills of participants but also to stimulate interest amongst faculty to use PBL in the curriculum. Such workshops can be run in Pakistan at minimal cost: the only cost we incurred was for photocopying the reading material. How much difficulty the faculty will actually have serving as facilitator in the PBL process will only become evident when they lead PBL groups over the coming year.

Objective: Describe longitudinal skill development of medical students for the interpreted encounter. Method: Two successive classes of students (n=92 and 100) participated in standardized clinical stations testing general communication skills and skills for working with interpreters at the end of their second year and after completing clinical clerkships during their third year. Performance was rated by standardized patients, interpreters and students using validated scales. Analysis: Analysis of individual matched paired data was performed for each scale item using the Wilcoxon signed-rank test. Pairwise correlation was used to compare global scores of the standardized patient and standardized interpreter with student self-ratings. Results: Over one year students' (n=124-168) performance worsened in behaviors for 'managing the encounter' (per interpreters' ratings) or remained unchanged (per patients' ratings). By patients' ratings, performance scores in general communication remained high. Students rated themselves as significantly improved in five of eight skills for working with interpreters despite a lack of external evidence of improvement from patient or interpreter. Students showed a trend toward underestimating their own global skills at baseline and overestimating them in comparison with the interpreters' global ratings. Discussion: Students' general communication skills remained excellent over one year of training but some skills for working with interpreters worsened. Over time students showed a pattern of overrating their own skills compared with trained observers. Faculty who teach students should focus on specific behaviors that are most likely to decay without reinforcement and practice.

Context: Collaborative engagement between education and health agencies has become requisite since the establishment of school inclusion policies in many developed countries. For the child with healthcare needs in an educational setting, such collaboration is assumed to be necessary to ensure a coordinated and holistic approach. However, it is less clear how this is best achieved. Objectives: This secondary research aimed to answer the questions: what are the reported models of best practice to support the collaboration between education and health staff and what are the implications for training strategies at an undergraduate and postgraduate level to affect these models? Methods: Systematic review of current literature, with narrative summary. Findings: Models of interaction and teamwork are well-described, but not necessarily well-evaluated, in the intersection between schools and health agencies. They include a spectrum from consultative to collaborative and interactive teaming. It is suggested that professionals may not be adequately skilled in, or knowledgeable about, teamwork processes or the unique roles each group can play in collaborations around the health needs of school children. Discussion and Conclusion: There is a need for robust primary research into the questions identified in this paper, as well as a need for educators and health professionals to receive training in inter-professional teamwork and collaboration beyond their traditional domains. It is suggested such training needs to occur at both the undergraduate and postgraduate levels.

Context: There have been recent calls for a renewed worldwide focus on primary health care. The Thai-Australian Health Alliance addresses this call by developing health care management capability in primary health care professionals in rural Thailand. Objectives: This paper describes the history and current activities of the Thai-Australian Health Alliance and its approaches to developing health care management capacity for primary care services through international collaborations in research, education and training over a sustained time period. Methods: The Alliance's approach is described herein as a distributed network of practices with access to shared knowledge through collaboration. Its research and education approaches involve action research, multi-methods projects, and evaluative studies in the context of workshops and field studies. WHO principles underpin this approach, with countries sharing practical experiences and outcomes, encouraging leadership and management resource networks, creating clearing houses/knowledge centres, and harmonising and aligning partners with their country's health systems. Findings: Various evaluations of the Alliance's activities have demonstrated that a capacity building approach that aligns researchers, educators and health practitioners in comparative and reflective activities can be effective in transferring knowledge and skills among a collaboration's partners. Project participants, including primary health care practitioners, health policy makers and academics embraced the need to acquire management skills to sustain primary care units. Participants believe that the approaches described herein were crucial to developing the management skills needed of health care professionals for rural and remote primary health care. The implementation of this initiative was challenged by pre-existing low opinions of the importance of the management role in health care, but with time the Alliance's activities highlighted for all the importance of health care management. Acceptance of its activities and goals are evidenced by the establishment of a Centre of Leadership Expertise in Health Management and the endorsement of the Phitsanulok Declaration by more than 470 primary health care practitioners, academics and policy makers. Discussion and conclusion: Problems with the primary health care delivery system in rural Thailand continue, but the Alliance has successfully implemented a cross cultural strategic collaboration through a continuity of activities to augment practice management capacities in primary care practices.