SPECIAL ARTICLE
Medical Students’ Perceptions of Teachers’ Attitudes Towards Psychology and Sociology Med Teach Downloaded from informahealthcare.com by Florida International University on 12/31/14 For personal use only.
JANET GALE and RICHARD WAKEFORD Janet Gale, PH.D,Lecturer in Health and Social Welfore, Open University Centre for Continuing Education, Walton Hall, Milton Keynes MK7 6AA and Richard Wakeford, MA, Educational Psychologist, Ofice of the Regius Professor of Physic, Cambridge University School of Clinical Medicine, Addenbrooke ’s Hospital, Hills Road, Cambridge CB2 2QQ. The social and behavioural sciences are increasingly being recognized by educational planners as having a place of considerable importance in undergraduate medical education, yet discussions with teachers of the subjects suggest that many do not feel an integral part of the school as a whole. This study reports upon the views of nearly 4,000 medical students of their teachers’ attitudes towards the topics. It suggests that medical schools vary considerably in the way medical teachers perceive these subjects as having a rightful place in the course. In one new ‘integrated’ medical school, however, the social and behavioural sciences appear to have gained acceptance by teachers throughout the five-year course. The implications for teachers of psychology and sociology are considered.
training in communication4 and facilitating clinical problem-solving skills belong to the latter category.’ These two areas of application of behavioural science to medicine are distinctly different and may well give rise to different problems and perceptions for medical students, psychology and sociology teachers, and doctors. For example, in the first area it might seem that psychology is applied to the patient. But in the second area, it might seem that psychology is being applied, probably critically, to the putative or actual doctor. Behavioural science in the medical curriculum, then, finds itself in a peculiar, dual position; insider and outsider, colleague and critic. Small wonder that discussions with teachers of the behavioural sciences suggest that many feel ‘on the fringe’.’
With a single exception, all medical schools in the British Isles make formal provision for the teaching of psychology and sociology in their undergraduate curricula. ’ Social and behavioural scientists (at least) perceive the subjects as having evident relevance to future doctors, ranging from assisting in the understanding of illness to helping provide the social skills that can be crucial in determining patient behaviour following a general practice consultation.
The Question of Relevance
Application of Behavioural Science to Medicine The ways in which behavioural science is seen by psychologists as relevant to medical practice thus fall into two main areas: first, in diagnosing and treating patients; and second, in having some direct effect on the doctor’s or student’s behaviour in relation to the patient. The former category includes the main work of clinical psychologists, who practise in psychiatric and (occasionally) other departments such as obstetrics and gynaecology’ and in primary health care teams.’ Interview training and Medical Teuher Vol 6 No 3 1984
Psychology itself, as a behavioural social science, or when manifested in either of the two areas identified above, does not fit easily into the medical model that often dominates the learning of medical students. Nichols6 points to the problem: “If medicine is essentially a mechanistic science concerned with reversing the effects of disease and injury by physical means, then psychological care is of marginal relevance”. And so, presumably, the same might be said of the teaching offered by psychologists within the medical curriculum. However, psychologists and sociologists demonstrate very clearly that their discipline and skills have distinct areas of relevance to medical practice and to the medical curriculum. For us, relevance is not in doubt. Our problem is that, the Todd Report notwithstanding, behavioural science teaching and learning can be restricted to the margin if the wider curriculum does not support and reinforce it. That wider curriculum is embodied in its 97
content, its teachers and its examination system. Psychology and sociology in the medical curriculum require a support structure of some kind. In this article, we report on some evidence which indicates that such a structure does not generally seem to emanate from medical teachers and we consider the implications of this. The evidence concerns students’ perceptions of their teachers’ attitudes towards psychology and sociology during the preclinical and clinical years.
Med Teach Downloaded from informahealthcare.com by Florida International University on 12/31/14 For personal use only.
Studying the Medical School Learning Environment One of us (RW) is attempting to monitor and evaluate the new clinical course at Cambridge University.’ Until about twenty years ago, the evaluation of university teaching, such as it was, tended to concentrate upon the ‘product’ of a course-the student emerging from it. In the late 1960s and early 19709, evaluation of the instructional process and the broader environment of the learning milieu has increasingly become regarded as useful and important. Institutions and learning environments can each be seen as having a ‘personality’, which can influence both process and outcome.’
The Medical Schools ’ Environment Questionnaire As one of several complementary educational evaluation activities, it was decided to develop an inventory to measure students’ perceptions of the medical school’s learning environment: it is called the “Medical Schools’ Environment Questionnaire” (MSEQ), and its development and use in a pilot investigation have already been d e ~ c r i b e dIt. ~has eleven ‘dimensions’ which may be used to describe students’ perceptions of their medical school (for example, friendliness, intensiveness, flexibility, vocational versus scientific orientation). The questionnaire, which has two forms, comprises 48 (pre-clinical version) or 49 (clinical version) Likert-type items, with which respondents were expected to indicate their level of agreement or disagreement. A single item in the pre-clinical version, concerned with the ‘scientificvocational’ dimension, asked students to respond to the statement: “Staff generally don’t have much time for subjects like psychology and sociology”. (In the clinical version, only ‘sociology’ was referred to: this was intended to subsume social and behavioural sciences generally, as confusion between ‘psychology’ and ‘psychiatry’ had been found in pilot studies with clinical students. The questionnaire was used in a survey of student attitudes in 25 medical schools throughout the British Isles. In view of the difficulties which many medical schools have reported in implementing the GMC’s recommendations to teach psychology and sociology, the variability in the provision made for them in undergraduate curricula’ and the evident interest on the part of psychologists and sociologists in participating in medical school teaching, the results for this specific item were computed and are presented here. It was thought that they might provide some general impression of the extent to which the subjects are accepted within medical courses and indicate the behaviour of one important variable that impinges upon this acceptance. 98
Students’ Perception of Staff Attitudes Early in the academic year 1981-82, more than 3,800 medical students at 25 medical schools (24 pre-clinical courses, 25 clinical courses) in the UK and Republic of Ireland completed the MSEQ. Students completing the questionnaire were starting the final year of the relevant section of the course. Where possible, the questionnaires were completed at a whole-class lecture (with a standard introduction), but were otherwise despatched by post. The response rate varied substantially between medical schools, and the possibility of bias is thus raised: however, no systematic effect of response rate upon the scores of any individual dimension was discovered, nor on the item under discussion. Moreover, comparison of the data obtained in pilot tests (with small, non-random groups of subjects) and those from the main study shows very great similarity. O n this occasion, the variations in response rate are not thought to give cause for concern. Results Students responded to the items on a five-point scale, from ‘agree’ to ‘disagree’. Mean item ratings were computed, using a scoring system in which ‘2’ indicates total disagreement or agreement, ‘ 1 ’ indicates partial disagreement or agreement and ‘0’means a neutral attitude. The mean rating by students of each medical school is shown in Figure 1: the top distribution is the one that relates to pre-clinical students; the bottom one concerns the responses of clinical students. In this figure, positive and negative refer to the inferred attitudes of the staff. Pre-clinical students gave a broad range of scores, perceiving their teachers as anything from broadly hostile to broadly favourable towards the behavioural sciences. Of the three schools reporting the most positive attitudes (Leicester, University College, Liverpool), one has a new course attempting to integrate all the relevant disciplines (Leicester): another is a multi-faculty one in which psychology has enjoyed high scientific status for many years (University College). The picture reported by clinical students is more consistent and more negative, though it must be remembered *at there was a difference in wording. Nevertheless, one school (Leicester) stands out from the rest, with students reporting a generally favourable staff view towards social science: interestingly, it is the ‘top’ preclinical school, a new one in which efforts are made to integrate social and behavioural considerations throughout the course. Conclusions O n the basis of the evidence presented here, and with appropriate reservations about the nature of the data, it may be concluded that: 0 medical students do not generally perceive their teachers as accepting behavioural science as a necessary and valid component of the medical curriculum; 0 there is nevertheless substantial variation in these Medical Teacher Vol 6 No 3 1984
Respondents
Final year pre-clinical students
Number of schools with students’ mean attitude rating in given range
Med Teach Downloaded from informahealthcare.com by Florida International University on 12/31/14 For personal use only.
Final year clinical students
igure 1. Distribution of mean ratings
of teachers’ attitudes towardr
student perceptions as between medical schools, particularly at the pre-clinical stage; 0 clinical teachers are seen as being more uniform and as having less time for the subject than their pre-clinical colleagues; 0 students in one new medical school that integrates behavioural science into the curriculum quite thoroughly see both their pre-clinical and clinical teachers as ascribing considerable importance to this topic. Those who believe the behavioural sciences to have a major role to play in the basic training of doctors can take comfort from this last fact. Clearly, however, if student perceptions of teachers’ attitudes are anything to go by, the situation at most medical schools leaves much to be desired. Discussion Perceiving the Relevance of Behavioural Science The clear, central factor to emerge from these findings is one that has been addressed by many social and behavioural scientists: the relevance of their subjects to medical practice. At the beginning of this paper we identified two broad areas of relevance and began to suggest that such relevance must also be seen by medical teachers who will form the continuing support structure for the integration of psychology and sociology into medical students’ other learning. The present results imply that either nonbehavioural science teachers in medical schools generally do not see such relevance, or they do not Medical Teacher Vol 6 No 3 1984
behavioural science.
communicate perceived relevance to their students. Putting conspiracy theories aside, we could reasonably conclude that they do not see the relevance of psychology and sociology to the training of medical students. The gloomy corollary is that we cannot reasonably expect medical students to appreciate and value the subjects, given that students tend to respond strongly to the hidden curriculum, picking up messages, however indirect, covert or unintended, about what is actually unimportant and what is important in getting them through their course of studies successfully. l o Demonstrating this Relevance
Our conclusion therefore, must echo the imperatives of other writers, that psychology and sociology teachers in medical education need to negotiate with, and take into consideration, the teachers as well as the students. Gallacher” has recently drawn attention to this necessity and makes some useful suggestions. In principle, the demonstration of relevance must be a practical phenomenon, beginning at the doctors’ central area of concern: the prevention, diagnosis and treatment of disease. The argument that relevance must be demonstrated and the clinical relevance of psychology clearly seen was a central theme of the “Psychology in the Medical Curriculum” symposium at the 1979 British Psychological Society Welsh Branch ‘International Conference on Psychology and Medicine’. Various tactics were suggested: for example, working closely with physicians and surgeons as well as undertaking most independent types of work with patients;” or helping students and 99
practitioners to cope with those situations in which medical technology has failed or is inappropriate. " Such possible roles are important to consider and the present evidence, as well as some presented at the Conference,': points towards the crucial importance of integrating psychology with both the clinical practice of the teachers as well as with the structure of the medical curriculum. It would, perhaps, be useful to consider this proposition further since the attitudinal, professional and value-based barriers that operate in medical education may well also operate in clinical practice.
Med Teach Downloaded from informahealthcare.com by Florida International University on 12/31/14 For personal use only.
Acknowledgementi We thank Colin Coles of Southampton University for helping to develop the questionnaire, to the students for completing them, to Jane Abercrombie for her advice throughout, and to Sally Rose for data-handling. The MSEQ investigation formed part of a programme of curriculum monitoring activities, originally funded by a grant from the Nufield Foundation and subsequently by one from the Marmaduke Sheild Trust.
References 'Basic Medical Education in the British Isles: Report of the G M C Survey. London: Nufield Provincial Hospitals Trust, 1977. *Broome AK. Clinical psychology within obstetrics and gynaecology. Bull Br Psycho1 SOC1980; 33: 357-359. 'Ives G.Psychological treatment in general practice. J R Coil Cm Rat 1979; 29: 343-351. 'Weinmaer J . Integrating psychology with general medicine. Bull Er Pdychol SOC1978; 32: 352-355. 'Weinmaer J. Clinical problem-solving and the role of psychology &aching. (Paper read at the International Conference on Psychology and Medicine, 1979, University College of Swansea, organized by the Welsh Branch of the British Psychological Society). *Nichols KA. Psychological care in general hospitals. E d 1 Er Pychol Soc 1981; 34: 90-94. 'Wakeford RE. An experiment in curriculum evaluation: Monitoring the new, shorter clinical medical course at Cambridge University. Rotgram L a m Educ Techno1 1980; 17: 92-101. 'Moos RH. Evaluating classroom learning environments. Studies Educ Eval 1980; 6 : 239-252. OWakeford RE. Students' perceptions of the medical school learning environment: a pilot study into some differences and similarities between clinical schools in the UK. Assess Eval Higher Educ 1981; 6 : 206217.
"Miller CML, Parlett M. Up to the Mark. London: Society for Research into Higher Education, 1974. "GallacherJ. Letter: Psychology and medicine. Ed1 Er Psycho1 Soc 1982; 35: 471-472. "Cooper J . Psychologists, medical education and msdicalpractice. (Paper read at the International Conference on Psychology and Medicine, 1979, University College of Swansea, organized by the Welsh Branch of the British Psychological Society). "Hopkins S . Psychology in the medical cumidurn-a s t d n t ' s Pcrsprctiuc. (Paper read at the International Conference on Psychology and Medicine, 1979, University College of Swansea, organized by the Welsh Branch of the British Psychological Society). "Stern J. The involvement ofpsychology in a new medical school. (Paper read at the International Conference on Psychology and Medicine, 1979, University College of Swansea, organized by the Welsh Branch of the British Psychological Society).
100
Medical Ethics Intensive Course for Medical and Nursing Teachers This course will be held on 10 to 14 September 1984 at the Imperial College of Science and Technology and will consist of multidisciplinary lectures and seminars on philosophical aspects of medico-moral problems. Subjects include: The Arthur Case; killing and letting die; utilitarian and deontological theories of ethics; life, sentience, human beings and persons; paternalism, professionalism and autonomy; truthtelling; ordinary and extraordinary means; ethics and natural law; justice and allocation of resources; aspects of psychiatric ethics; subjectivity/objectivity; caring and science. Lecturers include Dr Roger Higgs, Director GPU King's College Hospital, Professor Gordon Dunstan, Professor Emeritus, London University, Mr J. R. Bambrough, Fellow St John's College, D. D. Raphael, Emeritus Professor Philosophy, Professor R. M. Hare, Emeritus White's Professor of Moral Philosophy and Dr Raanan Gillon, Editor of the Journal of Medical Ethics. The cost is €115 (nonresidential) and it is approved by the BPMF for study leave. For further information contact John Stanley, Room 314, Sherfield Building, Imperial College, London SW7.
How to Assess Attitudes A short course in Assessment of Attitudes is being held on 10 to 14 September 1984 at the School of Medical Education, The University of New South Wales. Such a course has arisen from the increased awareness in the health professions of the relationship between attitudes and competence. It is designed to: clarify assumptions about attitudes in health care education; explore the factors that influence attitude development; describe methods for attitude assessment and discuss their usefulness. The course is suited to teachers and educational administrators in the health professions. (Enrolment will be limited to 20.) It will be conducted in a workshop format, with plenary presentations, small group tasks and discussions. Tuition fees are $200 and the closing date for applications is 10 August 1984. Registration forms can be obtained from the Coordinator of Academic Programs, School of Medical Education, The University of New South Wales, P O Box 1 Kensington, New South Wales 2033, Australia.
Medical Teacher Vol 6 No 3 1984
Medical Students’ Perceptions of Teachers’ Attitudes Towards Psychology and Sociology Med Teach Downloaded from informahealthcare.com by Florida International University on 12/31/14 For personal use only.
JANET GALE and RICHARD WAKEFORD Janet Gale, PH.D,Lecturer in Health and Social Welfore, Open University Centre for Continuing Education, Walton Hall, Milton Keynes MK7 6AA and Richard Wakeford, MA, Educational Psychologist, Ofice of the Regius Professor of Physic, Cambridge University School of Clinical Medicine, Addenbrooke ’s Hospital, Hills Road, Cambridge CB2 2QQ. The social and behavioural sciences are increasingly being recognized by educational planners as having a place of considerable importance in undergraduate medical education, yet discussions with teachers of the subjects suggest that many do not feel an integral part of the school as a whole. This study reports upon the views of nearly 4,000 medical students of their teachers’ attitudes towards the topics. It suggests that medical schools vary considerably in the way medical teachers perceive these subjects as having a rightful place in the course. In one new ‘integrated’ medical school, however, the social and behavioural sciences appear to have gained acceptance by teachers throughout the five-year course. The implications for teachers of psychology and sociology are considered.
training in communication4 and facilitating clinical problem-solving skills belong to the latter category.’ These two areas of application of behavioural science to medicine are distinctly different and may well give rise to different problems and perceptions for medical students, psychology and sociology teachers, and doctors. For example, in the first area it might seem that psychology is applied to the patient. But in the second area, it might seem that psychology is being applied, probably critically, to the putative or actual doctor. Behavioural science in the medical curriculum, then, finds itself in a peculiar, dual position; insider and outsider, colleague and critic. Small wonder that discussions with teachers of the behavioural sciences suggest that many feel ‘on the fringe’.’
With a single exception, all medical schools in the British Isles make formal provision for the teaching of psychology and sociology in their undergraduate curricula. ’ Social and behavioural scientists (at least) perceive the subjects as having evident relevance to future doctors, ranging from assisting in the understanding of illness to helping provide the social skills that can be crucial in determining patient behaviour following a general practice consultation.
The Question of Relevance
Application of Behavioural Science to Medicine The ways in which behavioural science is seen by psychologists as relevant to medical practice thus fall into two main areas: first, in diagnosing and treating patients; and second, in having some direct effect on the doctor’s or student’s behaviour in relation to the patient. The former category includes the main work of clinical psychologists, who practise in psychiatric and (occasionally) other departments such as obstetrics and gynaecology’ and in primary health care teams.’ Interview training and Medical Teuher Vol 6 No 3 1984
Psychology itself, as a behavioural social science, or when manifested in either of the two areas identified above, does not fit easily into the medical model that often dominates the learning of medical students. Nichols6 points to the problem: “If medicine is essentially a mechanistic science concerned with reversing the effects of disease and injury by physical means, then psychological care is of marginal relevance”. And so, presumably, the same might be said of the teaching offered by psychologists within the medical curriculum. However, psychologists and sociologists demonstrate very clearly that their discipline and skills have distinct areas of relevance to medical practice and to the medical curriculum. For us, relevance is not in doubt. Our problem is that, the Todd Report notwithstanding, behavioural science teaching and learning can be restricted to the margin if the wider curriculum does not support and reinforce it. That wider curriculum is embodied in its 97
content, its teachers and its examination system. Psychology and sociology in the medical curriculum require a support structure of some kind. In this article, we report on some evidence which indicates that such a structure does not generally seem to emanate from medical teachers and we consider the implications of this. The evidence concerns students’ perceptions of their teachers’ attitudes towards psychology and sociology during the preclinical and clinical years.
Med Teach Downloaded from informahealthcare.com by Florida International University on 12/31/14 For personal use only.
Studying the Medical School Learning Environment One of us (RW) is attempting to monitor and evaluate the new clinical course at Cambridge University.’ Until about twenty years ago, the evaluation of university teaching, such as it was, tended to concentrate upon the ‘product’ of a course-the student emerging from it. In the late 1960s and early 19709, evaluation of the instructional process and the broader environment of the learning milieu has increasingly become regarded as useful and important. Institutions and learning environments can each be seen as having a ‘personality’, which can influence both process and outcome.’
The Medical Schools ’ Environment Questionnaire As one of several complementary educational evaluation activities, it was decided to develop an inventory to measure students’ perceptions of the medical school’s learning environment: it is called the “Medical Schools’ Environment Questionnaire” (MSEQ), and its development and use in a pilot investigation have already been d e ~ c r i b e dIt. ~has eleven ‘dimensions’ which may be used to describe students’ perceptions of their medical school (for example, friendliness, intensiveness, flexibility, vocational versus scientific orientation). The questionnaire, which has two forms, comprises 48 (pre-clinical version) or 49 (clinical version) Likert-type items, with which respondents were expected to indicate their level of agreement or disagreement. A single item in the pre-clinical version, concerned with the ‘scientificvocational’ dimension, asked students to respond to the statement: “Staff generally don’t have much time for subjects like psychology and sociology”. (In the clinical version, only ‘sociology’ was referred to: this was intended to subsume social and behavioural sciences generally, as confusion between ‘psychology’ and ‘psychiatry’ had been found in pilot studies with clinical students. The questionnaire was used in a survey of student attitudes in 25 medical schools throughout the British Isles. In view of the difficulties which many medical schools have reported in implementing the GMC’s recommendations to teach psychology and sociology, the variability in the provision made for them in undergraduate curricula’ and the evident interest on the part of psychologists and sociologists in participating in medical school teaching, the results for this specific item were computed and are presented here. It was thought that they might provide some general impression of the extent to which the subjects are accepted within medical courses and indicate the behaviour of one important variable that impinges upon this acceptance. 98
Students’ Perception of Staff Attitudes Early in the academic year 1981-82, more than 3,800 medical students at 25 medical schools (24 pre-clinical courses, 25 clinical courses) in the UK and Republic of Ireland completed the MSEQ. Students completing the questionnaire were starting the final year of the relevant section of the course. Where possible, the questionnaires were completed at a whole-class lecture (with a standard introduction), but were otherwise despatched by post. The response rate varied substantially between medical schools, and the possibility of bias is thus raised: however, no systematic effect of response rate upon the scores of any individual dimension was discovered, nor on the item under discussion. Moreover, comparison of the data obtained in pilot tests (with small, non-random groups of subjects) and those from the main study shows very great similarity. O n this occasion, the variations in response rate are not thought to give cause for concern. Results Students responded to the items on a five-point scale, from ‘agree’ to ‘disagree’. Mean item ratings were computed, using a scoring system in which ‘2’ indicates total disagreement or agreement, ‘ 1 ’ indicates partial disagreement or agreement and ‘0’means a neutral attitude. The mean rating by students of each medical school is shown in Figure 1: the top distribution is the one that relates to pre-clinical students; the bottom one concerns the responses of clinical students. In this figure, positive and negative refer to the inferred attitudes of the staff. Pre-clinical students gave a broad range of scores, perceiving their teachers as anything from broadly hostile to broadly favourable towards the behavioural sciences. Of the three schools reporting the most positive attitudes (Leicester, University College, Liverpool), one has a new course attempting to integrate all the relevant disciplines (Leicester): another is a multi-faculty one in which psychology has enjoyed high scientific status for many years (University College). The picture reported by clinical students is more consistent and more negative, though it must be remembered *at there was a difference in wording. Nevertheless, one school (Leicester) stands out from the rest, with students reporting a generally favourable staff view towards social science: interestingly, it is the ‘top’ preclinical school, a new one in which efforts are made to integrate social and behavioural considerations throughout the course. Conclusions O n the basis of the evidence presented here, and with appropriate reservations about the nature of the data, it may be concluded that: 0 medical students do not generally perceive their teachers as accepting behavioural science as a necessary and valid component of the medical curriculum; 0 there is nevertheless substantial variation in these Medical Teacher Vol 6 No 3 1984
Respondents
Final year pre-clinical students
Number of schools with students’ mean attitude rating in given range
Med Teach Downloaded from informahealthcare.com by Florida International University on 12/31/14 For personal use only.
Final year clinical students
igure 1. Distribution of mean ratings
of teachers’ attitudes towardr
student perceptions as between medical schools, particularly at the pre-clinical stage; 0 clinical teachers are seen as being more uniform and as having less time for the subject than their pre-clinical colleagues; 0 students in one new medical school that integrates behavioural science into the curriculum quite thoroughly see both their pre-clinical and clinical teachers as ascribing considerable importance to this topic. Those who believe the behavioural sciences to have a major role to play in the basic training of doctors can take comfort from this last fact. Clearly, however, if student perceptions of teachers’ attitudes are anything to go by, the situation at most medical schools leaves much to be desired. Discussion Perceiving the Relevance of Behavioural Science The clear, central factor to emerge from these findings is one that has been addressed by many social and behavioural scientists: the relevance of their subjects to medical practice. At the beginning of this paper we identified two broad areas of relevance and began to suggest that such relevance must also be seen by medical teachers who will form the continuing support structure for the integration of psychology and sociology into medical students’ other learning. The present results imply that either nonbehavioural science teachers in medical schools generally do not see such relevance, or they do not Medical Teacher Vol 6 No 3 1984
behavioural science.
communicate perceived relevance to their students. Putting conspiracy theories aside, we could reasonably conclude that they do not see the relevance of psychology and sociology to the training of medical students. The gloomy corollary is that we cannot reasonably expect medical students to appreciate and value the subjects, given that students tend to respond strongly to the hidden curriculum, picking up messages, however indirect, covert or unintended, about what is actually unimportant and what is important in getting them through their course of studies successfully. l o Demonstrating this Relevance
Our conclusion therefore, must echo the imperatives of other writers, that psychology and sociology teachers in medical education need to negotiate with, and take into consideration, the teachers as well as the students. Gallacher” has recently drawn attention to this necessity and makes some useful suggestions. In principle, the demonstration of relevance must be a practical phenomenon, beginning at the doctors’ central area of concern: the prevention, diagnosis and treatment of disease. The argument that relevance must be demonstrated and the clinical relevance of psychology clearly seen was a central theme of the “Psychology in the Medical Curriculum” symposium at the 1979 British Psychological Society Welsh Branch ‘International Conference on Psychology and Medicine’. Various tactics were suggested: for example, working closely with physicians and surgeons as well as undertaking most independent types of work with patients;” or helping students and 99
practitioners to cope with those situations in which medical technology has failed or is inappropriate. " Such possible roles are important to consider and the present evidence, as well as some presented at the Conference,': points towards the crucial importance of integrating psychology with both the clinical practice of the teachers as well as with the structure of the medical curriculum. It would, perhaps, be useful to consider this proposition further since the attitudinal, professional and value-based barriers that operate in medical education may well also operate in clinical practice.
Med Teach Downloaded from informahealthcare.com by Florida International University on 12/31/14 For personal use only.
Acknowledgementi We thank Colin Coles of Southampton University for helping to develop the questionnaire, to the students for completing them, to Jane Abercrombie for her advice throughout, and to Sally Rose for data-handling. The MSEQ investigation formed part of a programme of curriculum monitoring activities, originally funded by a grant from the Nufield Foundation and subsequently by one from the Marmaduke Sheild Trust.
References 'Basic Medical Education in the British Isles: Report of the G M C Survey. London: Nufield Provincial Hospitals Trust, 1977. *Broome AK. Clinical psychology within obstetrics and gynaecology. Bull Br Psycho1 SOC1980; 33: 357-359. 'Ives G.Psychological treatment in general practice. J R Coil Cm Rat 1979; 29: 343-351. 'Weinmaer J . Integrating psychology with general medicine. Bull Er Pdychol SOC1978; 32: 352-355. 'Weinmaer J. Clinical problem-solving and the role of psychology &aching. (Paper read at the International Conference on Psychology and Medicine, 1979, University College of Swansea, organized by the Welsh Branch of the British Psychological Society). *Nichols KA. Psychological care in general hospitals. E d 1 Er Pychol Soc 1981; 34: 90-94. 'Wakeford RE. An experiment in curriculum evaluation: Monitoring the new, shorter clinical medical course at Cambridge University. Rotgram L a m Educ Techno1 1980; 17: 92-101. 'Moos RH. Evaluating classroom learning environments. Studies Educ Eval 1980; 6 : 239-252. OWakeford RE. Students' perceptions of the medical school learning environment: a pilot study into some differences and similarities between clinical schools in the UK. Assess Eval Higher Educ 1981; 6 : 206217.
"Miller CML, Parlett M. Up to the Mark. London: Society for Research into Higher Education, 1974. "GallacherJ. Letter: Psychology and medicine. Ed1 Er Psycho1 Soc 1982; 35: 471-472. "Cooper J . Psychologists, medical education and msdicalpractice. (Paper read at the International Conference on Psychology and Medicine, 1979, University College of Swansea, organized by the Welsh Branch of the British Psychological Society). "Hopkins S . Psychology in the medical cumidurn-a s t d n t ' s Pcrsprctiuc. (Paper read at the International Conference on Psychology and Medicine, 1979, University College of Swansea, organized by the Welsh Branch of the British Psychological Society). "Stern J. The involvement ofpsychology in a new medical school. (Paper read at the International Conference on Psychology and Medicine, 1979, University College of Swansea, organized by the Welsh Branch of the British Psychological Society).
100
Medical Ethics Intensive Course for Medical and Nursing Teachers This course will be held on 10 to 14 September 1984 at the Imperial College of Science and Technology and will consist of multidisciplinary lectures and seminars on philosophical aspects of medico-moral problems. Subjects include: The Arthur Case; killing and letting die; utilitarian and deontological theories of ethics; life, sentience, human beings and persons; paternalism, professionalism and autonomy; truthtelling; ordinary and extraordinary means; ethics and natural law; justice and allocation of resources; aspects of psychiatric ethics; subjectivity/objectivity; caring and science. Lecturers include Dr Roger Higgs, Director GPU King's College Hospital, Professor Gordon Dunstan, Professor Emeritus, London University, Mr J. R. Bambrough, Fellow St John's College, D. D. Raphael, Emeritus Professor Philosophy, Professor R. M. Hare, Emeritus White's Professor of Moral Philosophy and Dr Raanan Gillon, Editor of the Journal of Medical Ethics. The cost is €115 (nonresidential) and it is approved by the BPMF for study leave. For further information contact John Stanley, Room 314, Sherfield Building, Imperial College, London SW7.
How to Assess Attitudes A short course in Assessment of Attitudes is being held on 10 to 14 September 1984 at the School of Medical Education, The University of New South Wales. Such a course has arisen from the increased awareness in the health professions of the relationship between attitudes and competence. It is designed to: clarify assumptions about attitudes in health care education; explore the factors that influence attitude development; describe methods for attitude assessment and discuss their usefulness. The course is suited to teachers and educational administrators in the health professions. (Enrolment will be limited to 20.) It will be conducted in a workshop format, with plenary presentations, small group tasks and discussions. Tuition fees are $200 and the closing date for applications is 10 August 1984. Registration forms can be obtained from the Coordinator of Academic Programs, School of Medical Education, The University of New South Wales, P O Box 1 Kensington, New South Wales 2033, Australia.
Medical Teacher Vol 6 No 3 1984
