Context: This paper discusses a key finding arising from a qualitative research project which explored the provision of educational support to clinical teachers who were at least 100 kilometres distant from a university medical school. Objectives: We examined the preferences of clinical teachers in relation to the preferred use of technology as a medium for educational support. Methods: A qualitative approach was used for which 19 participants were interviewed using structured interviews consisting of prepared open-ended questions. Findings: All participants reported that they had a very positive association with the university. However, they overwhelmingly expressed a need to feel more strongly connected to the university and with each other. Discussion: Although a trial of the videoconferencing technology had problems, there was still great potential to connect clinical teachers in a 'Community of Practice'.

Background: In resource-limited countries, health policy makers and practitioners need to know whether healthcare workers have sufficient knowledge of tuberculosis and its management. Objectives: We conducted a study to: (1) measure knowledge changes among healthcare workers who participated in a tuberculosis training programme; and (2) make recommendations about future tuberculosis training for healthcare workers in the KwaZulu-Natal Department of Health. Methods: A cross-sectional study conducted in 2007 measured changes in tuberculosis knowledge of doctors, nurses and other healthcare workers after a training programme based on World Health Organization tuberculosis training modules. Data were collected before and after training using a self-administered, 98-item questionnaire covering eight components. Results: A total of 267 healthcare workers, mean age 40.7 years, answered both pre- and post-training questionnaires. Mean total knowledge scores were low despite significant changes (p<0.001) from a pre-training score of 59.5% to a post-training score of 66.5%. Nurses showed significant improvements in mean total knowledge scores (p<0.001) but had the lowest mean total knowledge score post-training, 63.2%. Doctors had significantly better pre-training (p<0.001) and post-training (p<0.001) mean total knowledge scores compared to nurses. Conclusions: Improvement in healthcare workers' overall knowledge of tuberculosis during a training programme was not clinically significant. Periodic field training and supervision should be considered to ensure tuberculosis knowledge improvements.

Purpose: The purpose of the present study was to validate the use of the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire with medical students. Methods: A sample of 274 medical students in their fourth and fifth years of study (80% response rate) completed the WHOQOLBREF instrument. The four-domain factor structure of the questionnaire was tested using confirmatory factor analysis. A variety of other tests of reliability and validity were conducted. Results: Goodness-of-fit indices from the confirmatory factor analysis were acceptable, and the factor structure of the WHOQOLBREF was confirmed in this sample. Reliability was good, but three of the items showed strong ceiling effects. Conclusion: The WHOQOL-BREF is valid to use with medical students to assess health-related quality of life. Some items, such as those inquiring about pain and medication, may not be suitable for medical students or young people in general. Implications for medical education are presented, including that the WHOQOL-BREF may be a useful inventory for research into the determinants of health-related quality of life of medical students.

Background: Learning of basic clinical skills is introduced in Years 1 and 2 of the MBBS Program at the Aga Khan University, Pakistan, through a structured Clinical Skills Teaching program. Acquisition of competence in performing these skills is assessed through use of the Objective Structured Clinical Examination (OSCE). Self-assessment is defined broadly as the involvement of learners in judging whether or not learner-identified standards have been met. Objective: We compared Year 2 students' self-assessment of clinical skills with examiners' assessment of performance in an OSCE using a standard rating scale. Methods: A self-assessment questionnaire was completed by all Year 2 students immediately after the OSCE. Students assessed their performance at three stations, using a performance rating scale. Examiners observed and evaluated the students during history-taking and physical examination using the same rating scale. Results: There were significant positive correlations between examiners' assessments of performance and students' self-assessed ratings in taking consent, obtaining demographic information, history of presenting problems and summarization. Significant differences were observed in pre-procedural skills, comment on prostate, liver palpation percussion and spleen percussion. Conclusions: Findings highlight the strengths and weaknesses in clinical competence at the end of Year 2 and provide a direction to improve the gaps in the Clinical Skills Teaching program.

Introduction : To graduate good doctors, medical schools should adopt proper student procedures to select among applicant students. When selecting students, many medical colleges focus solely on their academic achievement on high school examinations, which do not reflect all, important attributes of student. For several years, the College of Medicine and Medical Sciences of the Arabian Gulf University has introduced and administered the AGU-MCAT (Arabian Gulf University Medical College Assessment Test) for screening student applicants. This study aimed to assess the ability of the AGU-MCAT to predict students' performance during their first year college study, as an example of one school's multi-dimensional admissions screening process. Methods: The AGU-MCAT is made up of three parts, including a written test on science, a test of students' English language skills and an interview. In the first part, students' science knowledge is tested with 100 multiple choice questions. The English exam assesses students' English reading and listening skills. Lastly, students are interviewed by two faculty members and one senior student to assess their personal qualities. The 138 students who passed the AGU-MCAT in September 2008 and matriculated in the school were studied. Their performance during Year One including their performance on exams in the various disciplines was compared to their achievement on the three AGU-MCAT components. Results: AGU-MCAT's total mark and its science component had the highest linear relationship to students' performance in the various disciplines in Year One, while the strongest predictor of students' performance at the end of Year One was the AGUMCAT's science test (R ² = 45.5%). Students' grades in high school did not predict their achievement in Year One. Conclusion: The AGU-MCAT used to screen applicants to the school also predicts students' performance during their first year of medical school.

Objective: To assess whether the development and implementation of a community health worker (CHW) project in rural Kenya was associated with an increase in knowledge about malaria and the use of insecticide-treated nets (ITNs) in children under five years of age. Methods: A baseline knowledge and behavior questionnaire, adopted from the Kenyan Demographic Health Survey, was conducted in August 2007 by Kenyan health officials in 75 villages. Two CHWs were chosen from each village and trained in appropriate use of ITNs. The CHWs provided educational sessions and ITNs to mothers in their respective villages. A follow-up survey was conducted in March 2008 of all families with children less than five years of age within randomly selected villages. The main questions addressed during the follow-up survey included knowledge about malaria and the practice of correctly using ITNs. Findings: There were 267 surveys compiled for knowledge assessment before the intervention and 340 in the post-intervention analysis with an approximate 99% family participation rate. Of the families surveyed, 81% correctly knew the cause for malaria before the study and 93% after the CHW intervention (p < 0.01). Of those surveyed before the intervention, 70% owned and correctly used mosquito nets compared with 88% after the CHW intervention (p < 0.01). Conclusions: There was a significant increase in knowledge about malaria and use of ITNs after the implementation of the CHW program.

Introduction: Health promotion is a recognized competency in the preparation and education of Addictions Counseling students. This qualitative study explores the value of a reflection assignment in an undergraduate health promotion course at the University of Lethbridge, Canada, towards developing Addictions Counseling students' health promotion competency. Method: In the course, students attempted a health behavior change of their own choosing, reflected on their experiences and completed a reflection paper. Thematic analysis was conducted on students' reflection papers (n=21) and on a transcript of a focus group with four students to generate a description of students' perceived value of the assignment for their learning, personal health, and future health promotion practice in the field of Addictions Counseling. Results: Three themes marked students' perceived increased capacity for healthy behavior and health promotion: (1) facilitating the change process; (2) integrating experiential and theoretical learning about health; and (3) growing as a health promotion practitioner and as a person with expanding capacity for health. Discussion: This reflection assignment shows potential as both a learning process supporting future professional practice and as a tool for promoting health among undergraduate students.

Context: Peer-assisted learning (PAL) is described in the literature and is generally initiated with faculty assistance. The PAL process described here, called Kuppi classes, is exclusively organized and run by the students of the medical school of the University of Ruhuna. Aim: To explore students' experiences with Kuppi classes as a learning process. Methods: A phenomenological research method with focus group discussions and in-depth interviews for data collection was used. Selection of students for the study ensured representation of genders, academic years of study, both Kuppi tutors and tutees, and both those who did and did not pass the prior examination in the medical school on the first attempt. Findings: According to tutee and tutors, Kuppi was developed as a parallel process to fill in gaps in students' understanding and better explain unclear aspects of the formal curriculum. Within the Kuppi, students successfully use informality, familiarity and social bonds with one another to acquire the knowledge required for their examinations. Conclusions: This student-initiated PAL process appears to be succeeding for the students of our school. Some of their experiences may be helpful in implementing a PAL process or even improving the formal teaching processes in medical schools with similar academic, social and cultural environments. The need for a second, student-led curriculum should alert faculty to shortcomings in the formal curriculum and classes.

Introduction: Modern medical education and the requirement for lifelong learning place increasing emphasis on self-directed learning. Studies have not been done on readiness for self-directed learning (SDL) among medical students in Nepal. The present study was carried out to (1) measure and compare readiness for SDL among medical students, and (2) note differences in readiness for SDL according to students' personal characteristics at the beginning and end of the first year of the MBBS course for medical students at the KIST Medical College in Nepal. Methods: The study was done using the Self-directed Learning Readiness Scale. Respondents' agreement with each of forty statements pertinent to self-directed learning readiness using a modified Likert-type scale was noted. The mean total and scores on the subcategories 'self-management', 'desire for learning' and 'self-control' were calculated and compared across subgroups of respondents and in January and August 2010 using appropriate parametric and non-parametric tests (p<0.05). Results: All 100 students participated in January while 90 participated in August. The mean scores varied with certain demographic and background characteristics. The mean total score increased from 152.7 to 157.3 while the self-management score increased significantly from 48.6 to 50.2 from January to August. There were small increases in the mean desire for learning scores from 46.9 to 47.7 and in the self-control scores from 58 to 59 from January to August, but not in other scores. Conclusions: Self-directed learning scores were lower among these Nepalese students than reported elsewhere in the literature. Total scores and self-management scores improved at the end of the first year, but not scores on desire for learning and selfcontrol.

Context: Interprofessional education of pre-licensure students is viewed as an important precursor to developing healthcare professionals who are able to work collaboratively. Objectives: This study conducted a program evaluation of an innovative interprofessional communication skills initiative which incorporated problem-based learning, cooperative learning and standardized patients. Methods: The communication skills session consisted of a three-hour, faculty facilitated, interactive format in which teams of five to eight students met to conduct an interview with a standardized patient and develop an interprofessional care plan. The program evaluation included measures of satisfaction, the Interprofessional Education Perception Scale (IEPS), the Readiness for Interprofessional Learning Scale (RIPLS), focus groups and individual interviews. Findings: A total of 96 students from medical, nursing, physiotherapy, occupational therapy, midwifery, physician assistant and pharmacy programs self-selected to participate in the evaluation. Students rated their satisfaction with the communications skills sessions highly. There were small but statistically significant changes pre- and post-session in the IEPS. Qualitative analyses revealed that students perceived that they had learned about each others' scope of practice and built confidence in their communication skills. The skill of the facilitator and preparation for the experience were perceived to promote the success. Discussion and Conclusion: The demand for experiential events which provide students with the skills required to interact effectively in healthcare teams is likely to continue with the growing awareness of the need for interprofessional education. A learning experience which incorporates standardized patients and feedback from faculty facilitators can promote authentic interprofessional learning, and develop students' confidence to communicate in a team environment.

Context : Drug donations to developing countries may be part of medical relief operations in acute emergencies, development aid in non-emergency situations, or a corporate donations programme. After a number of documented inappropriate drug donations, the World Health Organization developed the 'Guidelines for Drug Donations', with the second and final version published in 1999. Objectives: We reviewed the medical literature on drug donations since the Guidelines publication in 1999. Design: Literature was retrieved from PubMed and other on-line databases as well as from relevant websites providing medical literature for use in developing countries. We considered the following donations to be inappropriate: (i) essential drugs in excessive quantities; (ii) mixed unused drugs (unsorted medicines and free samples); and (iii) drug dumping (large quantities of useless medicines). Results: We retrieved 25 publications dated after 1999, including 20 and 5 from the scientific literature and 'grey' literature (technical reports, working papers), respectively. New information concerned emergencies in East Timor, Mozambique, El Salvador, Gujarat State (India), Aceh (Indonesia) and Sri Lanka. Except for East Timor and Gujarat, inappropriate donations still occurred, accounting for 85%, 37%, 70% and 80% of donations in Mozambique, El Salvador, Aceh and Sri Lanka, respectively. Very little information was found on drug donations in non-emergency situations. Conclusion: There are few recent reports on the compliance of drug donations with the World Health Organization guidelines. For emergency situations, there is still room for improvement. Drug donations in non-emergency situations need to be evaluated. A reform of drug donations policy is needed.