Background: Admission to B. P. Koirala Institute of Health Sciences (BPKIHS), a health sciences university, depends upon a candidate's academic score in prior education and performance in entrance examination. This study analyzes the performance of the first three classes of MBBS (Bachelor's Degree in Medicine and Surgery) students at different levels, who graduated between 1999 and 2001. Objective: To determine whether the premedical performance at different levels has any role in medical performance, and to determine the extent to which the factors predict achievement in the medical program. Methodology: The scores of students at different levels in premedical and medical education, gender and the medium of schooling of 86 medical students were compiled and analyzed. Results: Annual medical performance scores were found to be significantly correlated with each other, but the average MBBS score was not dependent on either high school or entrance examination scores. However, it correlated with intermediate level in science score. Thus, the selection procedure needs to be developed in such a way that the candidates selected by the entrance examination are most likely to perform well in medical school and beyond. Implications: There is a strong need to standardize the entrance selection procedure of MBBS at BPKIHS.

Objectives: Our teaching experience has shown that dealing with the immunological aspects of viral hepatitis poses several difficulties. Therefore, we developed a game to verify whether or not this active-learning exercise could enhance students' learning and arouse their interest in subjects that are basically complex. Methods: Fifteen cards with clinical cases of hepatitis A, B, C, D, and E, and 50 explanatory cards with the description of epidemiological, clinical, and immunological aspects of the hepatites mentioned above. The objective of the game was to match the explanatory cards with the respective clinical case. Pre- and post-tests were used to assess students' grade improvement. Findings: One-hundred-and-forty students participated in the activity. The overall response of the students to the game was very positive: 129 (92.1%) found the game encouraged clinical thinking, and 105 (75%) regarded the game as an important way of consolidating learning. The students' grades significantly improved (p<0.05). Conclusion: Games allow understanding the subject matter through global knowledge. They also foster the student-professor relationship, simplifying the solution to the questions that may arise from a more comprehensive study.

Context: Behavioural studies form an essential component of the Speech and Language Therapy (SLT) undergraduate degree. Aims: This study aimed to produce online teaching material in behavioural studies suitable for undergraduate SLT students, explore students' views on the online material, record their performance when taught through this innovative method and compare their performance to a group taught through the traditional lecture based method. Finally, it aimed to explore the relationship between engagement with the module and performance. Methods: SLT students completed an online health psychology/sociology module and their performance was compared to students who completed a traditional lecture based course. Student evaluations of the online course were also recorded as was their engagement with the online module. Findings: Results suggested that there was no significant difference between students taught through an online medium compared to those taught through ''traditional lectures''. An evaluation survey suggested that students appeared to enjoy the material although there was some reluctance to develop an independent learning style. Conclusion: Online learning has a great deal to offer SLT education. However, material has to be developed that can both engage and motivate learners, thereby enhancing student independent learning.

Context: Task-based learning (TBL) is an educational strategy recommended for the later years of the medical education programme. The TBL programme was adopted for clinical years in the 2000-2001 academic year in Dokuz Eylul University School of Medicine (DEUSM). Objective: The aim of this paper is to describe the TBL programme of DEUSM. Methods: DEUSM outlined 50 clinical tasks for fourth-year students and 37 for fifth-year students. The tasks were grouped into four and five blocks. Interdisciplinary practicals, lectures and patient visits were organised in each task's schedule. The tasks were the focus of learning and each discipline contributed its own learning opportunities to the attached tasks. Formative and summative methods were used to evaluate the programme. Conclusion: Based on the experience and feedback provided by the students and trainers, the authors considered TBL an applicable and advisable approach for the clinical years of medical education.

Context: Students living in university residences experience frail living conditions, being away from their homes and families, the stress of studies, a bizarre routine, and absence of readily available guidance. Their overall health suffers. Objectives: Our study aims at collecting information on health and related problems of the students in university residences and to identify the solutions to ameliorate the prevailing situation. Methods: A qualitative study conducted in five university residences of Nancy, Metz and Strasbourg, France. Findings: The majority of students have complaints about the living conditions in the residences. They mention that they are not in sound health. Stress, depression, fatigue, insomnia, and problems with diet are common. Foreign students suffer more due to culture shock, language, and nostalgia. A tendency for suicides has been observed, especially in girls. Financial problems, too much to study, and relationship break-up are important factors. For their health problems, they generally seek advice from a peer and consume medicines without prescription. Many do not use the ''students' health service'' because of lack of information or difficult access from certain universities or university residences. Conclusion: To solve their problems and to facilitate their social integration, student volunteers ought to be trained in the university residences because a majority prefers to have their peers' advice. Reinforcement of the role of administration of residences, of student-counselors and of the faculty in the university would be another crucial step. More leisure and social activities are imperative. This study itself constitutes the first element of creating awareness regarding the situation of the health of students living in residence halls in France.

Objective: A substantial number of patients with psychiatric disorders consult primary care physicians for comprehensive health care; however, the diagnosis and effective treatment of psychiatric disorders are deficient in primary health care. The aim of this intervention study is to assess the pre- and post-psychiatric training knowledge of primary care physicians. Method: The setting of this study was Buraidah Mental Health Hospital. The research design consisted of a pre- and post-test comparison of physicians' responses (n=70) with a control group (n=40). The instrument includes a Knowledge Test comprised of 50 questions on primary care psychiatry. Results: There were no significant differences between the intervention and control groups with regard to several confounding sociodemographic variables, but physicians' age and duration of medical practice were significantly higher in the control group. There were significant differences between knowledge of intervention and controls prior to psychiatric training and this difference was further highly significant post-psychiatric training. The gain in knowledge of intervention group post-psychiatric training was highly significant as compared to pre-test knowledge but there was no difference in the knowledge of the control group. Conclusion: Psychiatric training courses can enhance physicians' knowledge in clinical psychiatry with possible psychiatric implications, including early diagnosis and better treatment of primary care patients with psychiatric problems.

Context: An ongoing concern of undergraduate medical education regarding oncology has been intensified in Patras Medical School, Greece, aiming at a more comprehensive teaching approach. Objective: A second-step research project was conducted to examine medical students' views of their undergraduate education in oncology, six years after the first investigation, and to assess the impact of the changes on the curriculum. Methods: The same questionnaire used in the previous study was again distributed to 210 different medical students. Findings: Our study revealed that although the quality of education in Oncology has been improved, it has not as yet reached high standards. The improvements over the last six years were mainly attributed to the increased presence of specialized oncology staff and their coordination with other basic and clinical scientists, as well as to the increased focus on research issues. Most of the students suggested putting more emphasis on psychosocial aspects of cancer care and ethical topics. Discussion: Despite the progress made in the curriculum, there is still a need for further improvements in the students' undergraduate education so as to meet current demands. Medical education in Greece still pays lip service to communication and ethical issues while remaining disease-oriented in its approach. Therefore, the target of undergraduate education in Oncology should not only be the provision of updated medical knowledge, but also the development of a proper attitude towards all cancerrelated issues.

Context: Previous studies have shown that students have both positive and negative attitudes towards communication skills training. However, studies in Nepal are lacking. Objectives: The present study was carried out to determine the positive and negative attitudes of student respondents using the previously validated communication skills attitude scale (CSAS) (see Appendix). Methods: The study was carried out among third- and fourth-semester students at the Manipal College of Medical Sciences, Pokhara, Nepal. These students are in the preclinical part of their course and learn the basic science subjects through an integrated, system-based curriculum. Gender, age, nationality of the respondents, occupation of parents, medium of instruction at school, attitude towards communication skills training during the clinical years, and self-rating of communication abilities were recorded. Association of the positive and negative attitudes with these variables was determined using appropriate statistical tests (p<0.05). Findings: A total of 123 students participated in the study; 74 (60.2%) were male, and 104 (84.5%) had studied in English-medium schools. The median positive attitude score was 51 (inter-quartile range 7). Nationality and attitude towards communication skills training during the clinical years showed a significant association. The mean negative attitude scale score was 31.18 (SD=4.96). A significant association was noted with attitude towards communication skills training during the clinical years. Both scales range from 13-65, with higher scores indicating stronger attitudes. Conclusions: Communication skills training should be modified and strengthened. Formal courses during the clinical years are required. Training sessions for the faculty and further studies across different semesters and in different medical colleges in Nepal are needed.

Context & Objective: Norwegian hospitals' trauma teams are seldom exposed to severely injured patients. We developed and implemented a one-day multiprofessional training course for hospital trauma teams in order to improve communication, cooperation and leadership. Methods: Training courses were held in 28 Norwegian hospitals with learning objectives: improved team work, common understanding of treatment priorities and principles, communication skills, and threats to efficient communication. Two trauma teams in each hospital had two consecutive simulations in their hospital's own emergency room, as part of the course. Simulation was based on real cases, with a low-fidelity mannequin as patient. Participants completed questionnaires before and after the training course. Results: A total of 2,860 trauma team members participated in the courses, of which 1,237 took part in the simulation. Independent of hospital size, the participants reported leadership and communication to be major obstacles during their last real trauma team participation. Immediately after the training, all participants reported highly fulfilled educational expectations and a high perception of learning, and taking part in the practical simulation improved the evaluation. Nurses scored their outcome significantly higher than physicians. Participants from minor hospitals reported as great a benefit from the training as personnel from major hospitals. Conclusions: Local team training is a feasible approach and team simulation offers an excellent opportunity to practise demanding and infrequent challenges. The simulation format makes it possible to integrate training on interpersonal skills as well as communication and leadership under stress. Continued requests for such training in Norway support this conclusion.

Context: Although interest exists among medical educators in using writing that reflects on clinical experience to enhance medical students' communication skills, empathy, and overall professionalism, little empirical research documents the value of this approach. This study explored whether students trained in one type of writing would first demonstrate increased awareness of emotional aspects of a clinical encounter in their writing; and second, be evaluated more positively in an OSCE situation by standardized patients. Method: Ninety-two students were assigned to either a point-of-view writing or a clinical reasoning condition as part of a second year doctoring course. At the end of the year, students were evaluated in an OSCE format on 3 cases, and completed a writing assignment about an ER death from cardiac arrest. Student essays were scored according to presence or absence of various themes. A linguistic analysis of the essays was also performed. Point-of-view and clinical reasoning group scores were compared on both measures, as well as on the standardized patient OSCE ratings. Results: Students trained in point-of-view writing demonstrated significantly more awareness of emotional and spiritual aspects of a paper case in a writing assignment than did students trained in clinical reasoning. By contrast, students in the clinical reasoning group were more likely to distance from the scenario. The two groups did not differ on SP OSCE ratings. Conclusion: Training in point-of-view writing can improve medical students' written skills on certain affective dimensions. It is not clear that these skills can translate into clinical behavior.