Introduction: This study explored the views of nursing lecturers concerning the use of patients in nursing education, particularly in light of the development of additional learning opportunities such as clinical simulation. Methods: Focus group interviews involving 19 educators from one school of nursing in the United Kingdom were held. An interview schedule was developed by the study team from the findings of a focused literature review of the area. The focus groups were audio-taped and transcribed into NVivo (version 8) for analysis and identification of emergent themes. Results: Four major categories emerged from the data analysis: clinical placement; patient consent; educator conflict; and developing competency. The themes of clinical placement and patient consent are presented in this paper. Clinical placement revealed two sub-themes: historical custom and practice and safety. Four sub-themes emerged from the theme of patient consent: informed consent; implied consent; capacity to consent; and patients' value of student involvement in their care. Discussion: Educators believed that patients benefit from being cared for by well-qualified nurses and to achieve this it is necessary for patients to participate in clinical training. The predominant view seemed to be one of historical necessity; essentially, it has always been done that way so it has to continue that way. There was an awareness of the need for staff and students to consider the patient's rights and wishes, but the prevailing sentiment seemed to be that informed consent and choice were secondary to patient safety and the need to train student nurses. There is some conflict between the need for educating health professions and the Kantian view of never using the patients as a means to an end. Using patients for nursing education may be ethical as long as the patient is fully informed and involved in the decision-making process.

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Context: Despite being an essential clinical skill, many junior doctors feel unprepared to perform neonatal resuscitation. We introduced a neonatal resuscitation training workshop in 2009 for our final-year medical students. Objectives: We assessed the effectiveness of our workshop in improving knowledge immediately post-training and at the end of the year. Methods: We retrospectively analysed the data of our students who attended the workshops during their Paediatric posting in small groups. The workshop was adapted from the American Academy of Paediatrics (AAP) Neonatal Resuscitation Provider (NRP) programme, and included overview lectures, practical simulation, interactive video scenarios and assessments (pre- and post-tests), which comprised 21 multiple-choice questions covering evaluation, practical actions and theory. We repeated the assessment in the final week of the students' medical training ("final test"). We analysed the data using paired t-test, analysis of variance (ANOVA), linear regression and Friedman's test. Findings: All 56 students attended the workshops. Their mean scores (out of 21) were 11.7 (SD 2.5) (pre-test), 16.2 (SD 1.9) (post-test) and 13.6 (SD 2.3) (final test) (P ≤ 0.001 for all pair- wise comparisons). The workshop's timing (earlier or later in the year) had no relationship with the students' final test scores (P = 0.96). In the final test, 68.5%, 67.4% and 60.6% on average answered correctly questions on practical action, theory and evaluation, respectively (P = 0.03). Discussion and Conclusions: Our workshop produced a modest gain in student knowledge on neonatal resuscitation at the end of their medical course. The students' overall gain in knowledge was below our expectation, and evaluation appeared to be their weakest domain. Further research should evaluate strategies to enhance longer-term knowledge retention with practical performance.

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Introduction: The Brazilian public health system requires competent professionals sensitive to the needs of the population. The Foundation for Advancement of International Medical Education and Research (FAIMER) provides a two-year faculty development programme for health professions educators, aiming to build leadership in education to improve health. A partnership with governmental initiatives and FAIMER was established for meeting these needs. This paper describes the initial process evaluation results of the Brazilian FAIMER Institute Fellowship (FAIMER BR). Methods: Data were analysed for the classes 2007-2010 regarding: application processes; innovation project themes; retrospective post-pre self-ratings of knowledge acquisition; and professional development portfolios. Results: Seventeen of 26 Brazilian states were represented among 98 Fellows, predominantly from public medical schools (75.5%) and schools awarded Ministry of Health grants to align education with public health services (89.8%). One-third (n = 32) of Fellows' innovation projects were related to these grants. Significant increases occurred in all topic subscales on self-report of knowledge acquisition (effect sizes, 1.21-2.77). In the follow up questionnaire, 63% of Fellows reported that their projects were incorporated into the curriculum or institutional policies. The majority reported that the programme deepened their knowledge (98%), provided new ideas about medical education (90%) and provided skills for conflict management (63%). One-half of the Fellows reported sustained benefits from the programme listserv and other communications, including breadth of expertise, establishment of research collaboration and receiving emotional support. Conclusion: Contributors to initial programme success included alignment of curriculum with governmental initiatives, curriculum design merging educational technology, leadership and management skills and central role of an innovation educational project responding to local needs.

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Background: The need to adequately train medical professionals in public health has been recognised internationally. Despite this, public health curricula, particularly in undergraduate medicine, are poorly defined. This study explored the public health disciplines that newly qualified doctors in the United Kingdom (UK) should know. Methods: We developed a 31-item questionnaire covering public health subject areas and expected competencies that medical graduates should know. The questionnaire was then administered to a stratified sample of medically trained individuals across a number of postgraduate schools of public health in the UK. Following administration, a ranking list was developed by subject area and by competency. Results: There was an 85% response rate (69/81). Subject areas ranked highest included epidemiology, health promotion and health protection. Sociology and the history of public health ranked lowest. Competencies perceived as important by the respondents included understanding health inequalities, empowering people about health issues and assessing the effectiveness of healthcare programmes. Discussion: Our study identifies the expected public health subject areas and competencies that newly graduating medical students should know. They provide a context through which to begin addressing concerns over the disparity between these expectations and what is actually taught in medical school, highlighting the continuing need to reframe undergraduate public health education in the UK.

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Introduction: Patients' involvement and their willingness to cooperate in clinical teaching is a vital element of medical education. Clinical teaching at the Faculty of Medicine of Damascus University relies heavily on inpatients at teaching hospitals but also on patients brought to teaching rooms. The purpose of this study was to identify patients' experiences and their attitudes toward the involvement of medical students in clinical consultations within teaching rooms conducted mainly for students' benefit. Methods: In-depth interviews were carried out by a sociologist using an interview guide with 14 patients whose clinical cases were presented to a large group of students in the teaching room at Damascus University teaching hospitals. Data analysis involved content analysis. Findings: Main themes were identified with negative ethical aspects, such as the lack of patient's involvement in decision making and approving to be part of clinical teaching. Risk and benefits were experienced by patients and identified in their experiences. Some felt that they were treated inhumanely and with a lack of dignity. Patients nevertheless felt a responsibility to be part of the teaching process. They expressed their positive attitudes towards involvement in the teaching process to serve medical students as well as the greater community. Discussion: Findings provide perspectives and insights into the current clinical teaching at Damascus University Faculty of Medicine. The findings highlight the need in our institution to carry out medical education involving patients in a more ethical manner. Medical students and their teachers need more training in the ethical involvement of patients in students' learning process, as well as the need to better regulate patients' involvement in education.

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Context: An aim of medical schools is to select the most suitable candidates who are more likely to become good doctors, fulfilling societal expectations. It is imperative to better understand the influence of 'selection' variables on students' academic performance. We conducted a retrospective record review (3R) to examine the predictive power of pre-admission tracks on academic performance in the medical programme at the Universiti Sains Malaysia. Methods: Data were collected on medical graduates' of the university for the years 2003 through 2007. This represented 805 graduates after exclusion of 42 for incomplete and inconsistent data related to the analysis. Results: A total of 95% of the graduates were included in this analysis; 67% were female. Of the 805 graduates, 75% were from the Matriculation course track, 22% from the High School Certificate (HSC) course and 1% from other pre-admission tracks. There was 2% missing information. The majority (79%) were Biology majors and 13% were Physics majors. Graduates from the HSC course and with a Biology background demonstrated a strong correlation with positive academic performance (P < 0.05) compared with other groups. Conclusion: The HSC track and Biology background may be helpful for the medical school in selecting future students.

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Introduction : Moi University College of Health Sciences was established in 1989. It is comprised of the schools of medicine, nursing, public health and dentistry. Since its inception, the college has been in collaboration with Linköping University in Sweden. This collaboration has taken the form of student and staff exchanges, as well as infrastructure and library improvements. This study was carried out to analyse the exchange programme and highlight some of the strengths that the exchange programme brings to the students' academic experience. Methods : A qualitative cross-sectional survey was conducted among the students who participated in the elective/exchange programme in the years 2009, 2010 and 2011. Self-administered questionnaires were completed by the participants. Additional data were obtained from the recommendations and conclusions from the reports that the students wrote after their participation in the exchange programme. Focus group discussions and key informant interviews were also carried out. Results : A total of 46 students participated in the exchange programme: 27 from Moi University and 19 from Linköping University. The disciplines of students reflected the undergraduate courses offered by these universities. The exchange programme's strengths were exposing students to new cultural settings, different healthcare system organisation and influencing future academic and personal lives, as well as making education global. The main challenge facing the exchange programme was language. Discussion : This study shows the exchange programme as a strong pillar of the medical education curriculum, enabling students to get a global perspective on their education, while exposing them to significant cultural and healthcare organisation diversity. There is a need to expand the collaboration so that more students have the opportunity to experience the overseas exchange programme.

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Introduction: In Indonesia, primary healthcare (PHC) centres are among the eligible institutions to provide 'early clinical experiences' (ECE) for pre-clinical medical students. This study explored whether patients of PHC centres would accept third-year pre-clinical students practicing clinical skills with them. Methods: Immediately after being seen by a pre-clinical student - supervised by a general physician - 76 patients of PHC centres participated in a structured, eight-question interview. Interviews were transcribed verbatim and coded to collate and interpret answers to the questions. Results: Most of the patients were satisfied with the clinical performance of their pre-clinical student. Negative comments regarding some students addressed lack of confidence, being nervous, unable to provide satisfactory explanation and education and failure to speak the local language. Some patients suggested more practice for these students in PHC centres. Conclusion: Patients in Indonesian PHC centres generally appreciated health services provided by pre-clinical medical students; no significant objections were recorded. This supports the suitability of these PHC centres to offer ECE for pre-clinical students.

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