IDEAS CAFÉ 2012
TABLE OF CONTENTS 1. Introduction
3
2. Module Structure
4
3. Lectures
8
4. Lecturers
11
5. Critical Thinking Skills (CTS) and Clinical Skills (CS) sessions
14
6. Dissection Lab Sessions
17
7. Objectives
21
8. Examinations
24
9. Projects
29
10. Behavioural Sciences Seminars
32
11. Haematology
34
12. Ethics
38
13. Technical Difficulties
40
14. Conclusion
43
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1. INTRODUCTION “Educationists should build the capacities of the spirit of inquiry, creativity, entrepreneurial and moral leadership among students and become their role model.”
– Abdul Kalam
The new pre-clinical programme is now in its third year and has thoroughly evolved and improved from its first implementation. We students believe that this has been a change for the better and the pre-clinical course is now much more interesting and integrative. As students, we believe that we are a main stakeholder in our own educational process. The Malta Medical Students’ Association (MMSA) under the direction of the Standing Committee on Medical Education (SCOME) has taken initiative to organise an exercise so as to gather as much feedback on the current pre-clinical situation as possible. We believe that improvement does not happen just by gathering complaints; therefore we took this exercise a step further and asked the students to constructively criticise while suggesting ways of improvement. Our aim is to increase communication with the faculty and the lecturers themselves so as to effectively tackle any problems that may be hindering the education process of the students as well as continually strive for a better system. This document contains a number of problems together with suggestions on how these may be tackled. This collection of ideas is very representative of the pre-clinical student body with more than 100 students from both 1st and 2nd year taking part in this exercise. The students are very grateful for your commitment and dedication towards their education, and would greatly appreciate your consideration for the concerns enlisted in this report.
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2. MODULE STRUCTURE The structure of a module highly reflects the planning involved and the outcomes planned for the students. Improving on a module’s structure will automatically improve on the outcome of each and every module. Topics discussed here include timetables, lecture cancellations, secretaries, Virtual Learning Environment (VLE), the sequence of lectures and small group sessions, and the sequence and structure of modules.
Concerns regarding Timetables and Cancellations: The timetable varies a lot from week to week. This might be quite confusing for students since there is no sense of coherency. Some days are highly crammed with lectures while others have a lot of free time especially in between lectures. Moreover the timetable given to students is very crowded and may be confusing. Suggested solutions: The timetable should be more fixed with specific slots on particular days of the week being allocated to a specific module. It would be better to start the day earlier so as to finish earlier. It would also be very helpful if specific sessions are dedicated to revision and questions or difficulties of the students. Students believe that the last few weeks nearer to exams could be dedicated to studying instead of having a few lectures which still result in losing a lot of time especially when it comes to travelling to university and back home. Some suggested that the timetable can be colour coded according to small groups instead of according to sessions. Concerns regarding secretaries: Some students complained that secretaries are not always readily available to students and there were instances when secretaries were out of office during office hours. Some
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also complained that secretaries sometimes took leave without notifying the student representatives who had no one to turn to when lectures were cancelled. Suggested solution: Students suggested that secretaries should be more available especially during office hours. Also, it was suggested that secretaries should take leave in turns and not together so as to make sure that there is always someone available for anything that crops up during that period.
It is also essential that student
representatives are notified beforehand if a secretary will be away so that they can make necessary arrangement a priori.
There should also be better
communication among secretaries and lecturers so as to notify students as early as possible if there are any cancellations. Concerns regarding sequencing of modules: Students strongly believe that the sequencing of some modules makes it very difficult to cope with one subject without having covered another one which gives the essential basic knowledge. The best example is that of MDS1029 – Reproduction which is covered before anatomy of the abdomen and pelvis and before the module dedicated to endocrine physiology. This makes several concepts within this module difficult to understand, both anatomical and physiological ones. Suggested solutions: Modules need to be better sequenced over the course of the preclinical years. It would make more sense to cover thorax and abdomen in the first year, together with other subjects such as haematology which do not require much knowledge beforehand to get a good grasp of. Reproduction could then be done in the second year to avoid the above mentioned issues. Also the upper and lower limb can be left for 2 nd year in exchange of the abdomen and the gastrointestinal system and possibly another module if need be to balance out the two years in terms of ECTSs.
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Whilst we appreciate the difficulty that logistics might present, we feel that it is important to attempt a more logical sequence which will not only be easier on the students, but also make it more efficient and effective for the lecturers. Concerns regarding Module Progression: Students feel that a number of modules being dealt with within a single semester are sometimes unrelated making it difficult to follow the natural progression and understanding of the individual modules. There is also an enormous amount of material being covered in a very strict time-span making it very stressful on students. Suggested solutions: A particularly bold suggestion was that modules are taught one by one, building up from one module to the other, while the former may act as a foundation to establish various concepts and principals. Each module can then be followed by an exam before proceeding to the next one. A final integrative set of examinations can be held to tie everything together, similar to what is done in MDS2020 – Integrated Biomedical Sciences. Whilst this is an ambitious and highly complicated proposal, and one which we appreciate might be difficult to implement in terms of logistics, we do believe it should be explored and possibly implemented to give our medical education a more flowing and logical sequence. This would undoubtedly help students learn with a gradually increasing complexity and natural progression, with lectures and sessions all directed to giving students a complete understanding of a single module before moving on to the next. Concerns regarding MDS1022 – Organisation of the Body: MDS1022 is believed not to be very well structured with topics being included haphazardly. Students feel that a good part of this module is made up of lectures which seem to fit nowhere else in the pre-clinical course. Many students complained that
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there are a lot of unrelated topics grouped together making the module confusing and lacking objectivity. Suggested solutions: Many students suggested that this module should be more like an introductory module. It should be more structured and include introductory topics which are tackled at once and not spread throughout a whole semester (e.g. Embryology). Students felt that an introductory lecture on the Autonomic Nervous System would have been very useful. Some feel that it would have been better if the lectures of this module are split up and integrated within the different modules. In this way they can act as a basis to understanding more complex concepts. Others feel that the only problem was that the module was not tackled in an effective manner and was too unfocused. The module should focus on more fundamental concepts and ideas that would allow students to obtain a clearer idea of other principles explored in separate preclinical modules. An example would be a more thorough exploration of organisation of nerves including nerve anatomy and physiology, dermatomes and myotomes, as many still find it difficult to understand innervation, which is profusely studied in most modules. In general, students feel that this module is a step in the right direction to achieving a basic understanding of general concepts and an insight to the organisation of the body, as the title of the module implies. We believe that the module should be further expanded to deal, not only with abstract principles, but a definite range of concepts such as the nervous system, and possible an overview of body anatomy to truly fit the module’s title.
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Conclusion: The section discussing module structure incorporated a lot of issues involving the course in general. The major suggestions put forward include: -
Increasing student coordination through the class representatives especially regarding timetable changes and secretary availability.
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Better sequencing of modules together with a possible new way of having modules and exams one by one is a brave suggestion being put forward since students believe that this will lighten the workload and improve performance.
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Last but not least, suggestions for improvement on the Organization of the Body module will provide students with stronger foundations to approach the other modules in a more proficient manner.
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3. LECTURES Lectures are one of the main foundations on which any the course is built upon. They are the primary method of conveying information about the particular modules forming the course. Therefore we are to stress how important it is that these are well structured and representative of what is expected out of the student. Concerns regarding Lecture plans: While students are aware that it is impossible for lecturers to cover all the relevant information during the number of lectures assigned, they are rather concerned about the fact that they are never sure what further reading has to be done at home. Suggested solutions: In order to be clearer and feel more at ease, students require that they are advised about any further or extra information they need to research on their own.
Simultaneously, more realistic lecture plans should be set where the
information put forward can be covered well in the lecture span. We suggest that very long lectures are split into multiple ones so as to have more time of delivery. This would make it easier both on the students who need to understand, and on the lecturer who needs to deliver. Concern regarding Lecture Content: The anatomy lectures often do not possess much clinical relevance, resulting in emphasis being made on relatively irrelevant facts. Suggested solution: Instead of the clinical correlations being only limited to CTSs, the clinical relevance should be extended even to gross anatomy lectures so that it would be easier for the students to link the two aspects of anatomy together.
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Concerns regarding PowerPoint Presentations: Although not immediately evident, the slides may contain incorrect or inaccurate information. This means that students find themselves in a dilemma when studying that information as they encounter different versions in their text books and also within the same presentation. Another concern is that many diagrams used do not provide any information or detail as they are not labelled and bare.
This makes it difficult for the students to follow
explanations about a diagram as they are unable to identify the part or area being discussed. Whilst we acknowledge the fact that lecturers are not obliged to make their lecture slides and notes available to the students, we would like to highlight what a great help they are when revising a lecture. We would like to voice our appreciation for this and encourage all lecturers to share such material with students if possible. Suggested solutions: Students suggest that lecturers take the time to go through their presentations prior to a lecture and make any necessary amendments and updates in order to avoid any confusion, while ensuring that the slides are fully comprehensible. Concern regarding Lecture timing: Some lectures are cancelled suddenly due to unforeseen events.
Many students
expressed disappointment that they are often informed very late about this. With regards to the timetable, some students believe that lecture times are too spaced out on most days. In addition, although the benefits of the integrated system are appreciated there is still some fine-tuning to be done. An example would be having the theory lectures, CTS sessions and lab dissections coincide in the same week. However, since there are eight small working groups, it is often the case that some are scheduled
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BEFORE the related lecture. This leads to some groups going unprepared to their dissections or CTS sessions. Suggested solution: Lecturers should have a direct communication system with the class representatives so as to inform them if a lecture will not take place. At the moment this is done via the secretaries but often the lecture is cancelled the day before or on the same day, and the secretary would not have enough time to inform the class. Such suggested communication will be restricted to lecture cancellations. Of course, the secretary would work on the rescheduling as is the norm. Bearing in mind that lecturer availabilities are very specific, it is always better to try and keep the lectures as close together as possible to dedicate more time to studying. The timetable should be planned to avoid the occurrence by making sure that CTS and dissection sessions based on a theory lecture always come AFTER the lecture in question, and if cancellations take place, there should be an appropriate shift in the sequence of lectures such that they follow a comprehensive sequence. It would be ideal if lectures in different modules are synchronised to complement each other. A poignant example which was brought up was that of cardiovascular embryology being covered before general embryology making it much more difficult to understand. Conclusion: Since lectures are such an important tool in delivering information to the student, we would like to maximize their outcome by fine-tuning the lectures and the lecture system. By adjusting some simple matters such as:
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Increasing clinical relevance of lectures
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Having presentations which contain more accurate information
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Having lectures which precede small group sessions
This will make the system more student-friendly and will ensure efficient delivery with a positive result.
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4. LECTURERS Lecturers are a big part of student education. They are role models to the students and their approach towards the subject and the students is a big stakeholder in the actual delivery of knowledge. Evidently lecturers hold high ranking professions and have a lot of know-how to pass on to students; however the students encourage the lecturers that the method of how the lecture is delivered makes a lot of difference in terms of a holistic learning experience. Concerns regarding Information given: A common complaint arose about the fact that some lectures just read directly from their notes or a textbook of their choice. This is not considered healthy by students as they feel that reading from a text book can be done at home without the help of the lecturer. At the same time this method easily loses the student’s interest because it may be seen as a sign of lack of motivation on behalf of the lecturer. As the majority of lectures require that students remain passive for hours on end, many seem to be losing their motivation towards attending lectures and their wish to learn. Therefore, the need for some form of student motivation to tackle this apathy is felt. Suggested solutions: Students understand that it may be necessary that some information is presented in a particular way, but they also feel that together with this, information should contain proper and practical explanations. It would also be more interesting to link information with clinical cases where relevant. The lecturers should consider including more repetition within their very same lecture to emphasise and point out relevance in terms of common case scenarios or simply as a teaching aid. Questioning students at the end of the lecture is also a tool which many lecturers do not make use of. There is no better way for a
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lecturer to recognize whether or not the class has grasped the aims of the lecture. Students also believe that more interaction is needed between students and lecturers during lectures as this would also encourage attention and interest. Concern regarding Lecture length: Some lecturers finish before the end of the one hour period or even purposely go fast to finish early whilst saying that the students should know the information already. On the other hand some lecturers arrive late to the lecture resulting in having to cover only half of the material planned, rescheduling the lecture or last minute elongations. Suggested solutions: If there is extra time at the end of a lecture, it may be used to ask questions and to summarise the lecture, clarifying the important points. This would allow greater understanding and reinforce the crux of the lecture. Also punctuality is very important both from the students and the lecturers, since this ensures that adequate time is available for delivery and understanding. Concerns regarding Lecturer involvement: It was seen that some lecturers were not aware of the year of studies of the students in the class, and therefore not aware of the amount of knowledge the student already knows. Students commented on the lack of effort some lecturers put into the students’ entire experience in the module, resulting in circumstances such as repeat lectures. For example, the same lecture on motility was given thrice in the Gastrointestinal module. Or prior to the examination period, some lecturers were not aware of the structure of their exam module. In the evaluation forms we were asked to fill out after the exams, not all lecturers where included, and students were not able to evaluate all the lecturers equally.
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Suggested solutions: Even though we know that in this course self-directed learning is critical, it is not always possible to have covered certain topics from beforehand due to the course structure and extensiveness. Therefore, lecturers should be more aware of what the students have covered by increasing coordination between lecturers themselves. This would also allow more flow within the same module. All lecturers should be included in the evaluation forms, since constructive feedback is critical for improvement in the quality. Conclusion: The interest of the students in expressing their concerns is simply directed towards having a sounder learning experience. Main points within this section suggest that lecturers should have a more interactive approach, including more clinical relevance, and questioning the students to reinforce learning. While thanking all lecturers for their precious time and contribution to the students’ overall development as prospective doctors, students hope that their concerns and suggestions are considered for the benefit and the improvement of the course.
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5. CRITICAL THINKING SKILLS (CTS) & CLICNICAL SKILLS (CS) SESSIONS CTSs are an invaluable part of our course and many students feel that such sessions provide much more knowledge than lectures. Such methods of self-directed learning and discussions within a small group are essential in our course since they instigate active student participation. Students like the idea that certain tutors start off by giving a small introduction before actually starting a discussion about the given cases. This helps refresh the lecture content and certainly enhances active group participation. A good number of students also pointed out that they loved the fact that certain CTSs were carried out by specialists in the particular field, such as in the case of the cardiovascular module (MDS1004) where cardio-thoracic surgeons were able to give us lots of clinical relevance to support the theoretical input. Concern regarding Tutors: The majority of students encouraged more CTS sessions however the major complaint was that of having particular topic being delivered by different tutors. This results in students invading other groups due to personal preferences at the expense of other students. Moreover since different groups cover different material, some groups might be at a disadvantage with regards to examinable materials covered. Suggested Solutions: Students unanimously agreed that more CTSs would be beneficial as they are an active and effective way of learning. CTSs should be more revision-oriented and relevant to examinable material. To further strengthen these sessions, main objectives of the given CTS should also be provided, while in the last few minutes a general overview of the main points
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covered should be done. The same CTS topic should be taken by one specific tutor in such a way that all students will receive the same information while avoid confusion and overcrowding in certain sessions. Concern regarding CS material: Clinical Skills sessions seem adequate with the exception of lack of resources. An example is that there weren’t enough specula for the CS – Examination of the Female Pelvis, or enough otoscopes for the CS – Examination of the Ear. Other clinical materials such as a urinalysis dipstick would be useful in the CTSs and CSs for the renal module to further increase the clinical correlations. Students also feel that sometimes the best method for learning is through hands-on experience. An example of this was when the students were taken to see an ECG carried out on a class member, making it easier to remember certain details. Students also requested that the surgical aspect of medicine be covered more in the preclinical years. For example, a point was raised that as doctors, suturing will be a standard practice on which students are not trained on specifically. Suggested Solutions: More money should be allotted to obtain materials and resources to be used during small group sessions.
Resources needed include new dissection
specimens to replace the old ones, more mannequins (e.g. the female pelvis), and possibly more clinical instruments for better practice. Due to a more hands-on approach, students will have a more solid clinical basis before the actual clinical years. Students recognized the fact that sometimes the time table is too packed to add more small sessions. It was suggested that mannequins and other resources
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should be made available during a specific period whereby students have the possibility to practice further. Students also think that in collaboration with the MMSA, workshops on specific clinical skills can be held for further improvement of the student’s medical education. Concerns regarding Timing: A small amount of students also pointed out that sometimes lectures are held at Mater Dei Hospital right after or before a small group session which has led to a lot of time being wasted for travelling purposes. A significant amount of students complained that the amount of research required to be well prepared for CTS session removes the critical thinking aspect of the exercise. Furthermore, since preparatory materials are sometimes provided very close to the small group sessions, students might not have enough time to be well prepared for these sessions. Students have complained that sometimes certain cases are not covered in a particular sessions as there would not be enough time to cover all the content of the CTS. Even in CSs, the long introductions often leave little time for actual practice. Suggested Solutions: The majority of students agreed that a list of suggested readings is to do be provided beforehand. This would ensure that the bulk of the content is covered in advance and in a more efficient manner. It has been suggested that when there is no time for the last case(s), the lecturer can send the model answers in order to verify that the students’ work was done in a correct manner, since it is understandable that it is impossible to lengthen a CTS to more than the allocated time-slot.
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Conclusion: Small group sessions provide an excellent environment for students to learn through active participation and hands-on practice. Therefore students encourage this method of teaching with just a bit of tweaking to the system so that preclinical students are better prepared when entering the clinical scene. The most important suggestions offered by the students about this topic include: -
Having objectives for each of these sessions.
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Having the same tutor giving the same session for all the groups.
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Increasing the number of sessions and resources available to students.
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6. DISSECTION LAB SESSIONS The importance of the dissection lab sessions is unanimously recognized. In order to enhance our learning experience during these sessions, the students have pinpointed certain concerns and have offered solutions that can be implemented. Concerns regarding the Dissection Sheets: The majority of the dissection sheets were not very useful. Apart from them not matching the actual specimens they are way too long for a single session. Most of the times these dissection sheets were not even used as the lecturer would pose his own questions and this would make the students get confused. Suggested solutions: The students collectively agreed that there should be a labelled picture (possibly laminated) which is kept next to the respective specimen, depicting the structures that should be observed and analysed. This is since it was noted that certain lecturers tend to point out structures on specimens which are irrelevant to the topic being studied. These flash cards would also help students who individually decide to go to the lab outside allocated session times to practice on specimens. Also as previously mentioned the revision sheets should be updated in order to match the specimens being set-up for the dissection as well as giving a structured way to guide students when working on a specimen. Concerns regarding dissection sessions: Students believe that both video dissection sessions and lectures carry equitable importance. However a number of video dissections were being presented at the expense of a theory lecture. Many students stated that lecturers were not always present in the lab during the dissection session or left very early leaving the students accumulate difficulties, most of
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which remained unanswered. They also agreed that certain groups were getting better explanations than others by the different tutors leading to the switching of groups. Suggested solutions: The students would prefer that video dissections should not replace a theory lecture but these should complement each other. Doing so would mean that the students would understand better the theory explanation with the help of visual aids. Many students agreed that when some lecturers started the session with a brief demonstration they actually understood more than, when they were split into groups immediately. Moreover having all sessions about a particular topic given by the same tutor, would avoid problems of students changing groups and of different groups covering different material. Concerns regarding Dissection Lab: Students said that the cleanliness of the lab, although improved, has still room for improvement. Many people complained of the lab storage cases being in the way, with some students actually tripping over them. Some students also complained about placing their lab coats and bags on the floor. Suggested solutions: Cleanliness should be improved by for example keeping the formalin collecting containers empty. The personnel in charge of the lab should make sure that the floor is cleaned frequently and that liquid soap and hand towels are always available.
Another suggestion was that shelves and coat hangers should be
installed for students to place bags and coats respectively, instead of putting these on the floor.
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Concerns regarding Specimens: Students complained that lab personnel were not always available to help them particularly bring out specimens they need to use, creating difficulties especially if the specimen is rather large and difficult to extract from the container and carry it. It was agreed upon that some specimens were in a poor state and are in a state of degradation. Some lecturers have previously mentioned a plasticisation technique to conserve the specimen, however this has not yet been implemented. Suggested solutions: The technicians should be available to help students with the specimens when needed. Specimens need to be changed especially when it comes to those used in practical exams, a clear example would refer to heart specimens. It was suggested that some specimens should be kept specifically for the exam. This could be done by allotting a larger number of students per anatomy project, and this would allow the department to collect some new specimens which could be conserved and used exclusively for exam purposes. Concerns regarding the Exam: Students found that the major inconvenience was that no lecturers were present to help students in the dissection lab, during the allotted days prior to the dissection exam. Many students complained that the time provided for each specimen during the practical exam was not enough. Due to this students were usually not finished from the specimens after the time ran out. This may have resulted in students lagging behind and wasting precious time from other students who have to wait before moving on to their next station.
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Exam specimens were too close to one another and there was room for cheating with not enough surveillance making students uncomfortable. Pointers should be made larger as they were not that visible especially those indicating structures on images during the practical session in nALR. Students seated at the back where at a greater disadvantage in this regard. It was also mentioned that the weighting of the practical for the respiratory module should be increased. Students also complained that they had never had a practical test before the actual exam and were not acquainted with the system. Suggested solutions It was recommended that at least one lecturer is present to answer questions related to the practical exam when the examination date is nearing. The time allotted to each specimen, should be increased to at least 1 minute per specimen.
Specimens should be labelled clearly so as to properly identify
anatomical structures and orientation convenient for the students bearing in mind that no handling is allowed. The imaging part of the practical exam was deemed to be very fair as students were provided with the adequate training for it and the radiology sessions throughout the semester were also very helpful, however the pointers should be made clearer. Another proposition put forward involved the inclusion of a general revision dissection lecture in the official timetable in which general questions on different specimens could be asked. In this way, students will feel more prepared when confronted with the actual exam.
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Conclusion: Various points were brought forward by the students regarding dissections. The main suggestions included: -
Enhancing the state of certain specimen
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Increasing cleanliness of the lab
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Implementing mock dissection exams
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Ensuring the presence of a lecturer during the week prior to the exam
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Increasing the time allotted to each station during the exam.
Such improvement would surely improve the practical skills of the medical students with regards to anatomical specimens and the dissection lab experience.
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7. OBJECTIVES The role of a set of objectives is to guide actions and anticipate results. They may also act as guidelines for both lecturers and the students. Lecturers use these to prepare their materials and set goals for their lectures while students use them to know what is expected out of them and as a guide to revision. The effort put into stating objectives which are coherent and of quality will be beneficial to both students and lectures. Concerns regarding Missing objectives: MDS 1021: Cell Biology and Biochemistry – students felt that module objectives were unbalanced and that some lecturers did not offer concrete objectives. It may have been the case that some lectures did not follow objectives that were initially set. This was in turn reflected in the setting of exam questions and student performance. MDS 1022: Organization of the Body – This was clearly seen in Neuroscience and Histology. MDS 1023: Introduction to clinical practice 1 MDS 1010: Blood and Body Defence Mechanisms MDS 2027 Nervous System 1 – Misconceptions arose when it was assumed that objectives written for study-unit Nervous System 2 would not be examinable in the first semester but only in the second semester. In general, objectives were not available as from the start of the semester but published later, if so. Also some objectives were not coherent and discrepancies existed especially when different lecturers are taking care of the same topics. Suggested Solutions: Objectives should serve as a guideline to give students an indication of what is expected of them.
This can be reinforced by all the lecturers teaching one
module, to collectively come up with a set of objectives in the beginning of the
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semester. In this way, there will be integration and continuity of the topics in one specific module and students will be able to correlate different aspects together. Moreover, once presented, it would be ideal if all the lecturers based their lecture content on the given objectives. It is also imperative that module objectives are available on eSIMS immediately at the start of the new semester as this would allow students to keep track of what the module will involve and what is expected from them. Concerns regarding Lecture objectives: Students find that although some lecturers give very clear, concise and reliable objectives at the beginning of their lectures, this is not the majority. As a result, students are unable to determine what topics are the most important and clinically useful.
Suggested Solutions: The importance of concise and reliable objectives should be emphasized with each and lecturer participating in all the different modules. It is imperative that lecturers and tutors provide a set of learning objectives to their students for any session that is given, be it a lecture or a small group session. These objectives should also be representative of what the student is expected to know at the end of the lecture and at the end of the module. Objectives should also be realistic and wisely adapted to the level of the students.
Concerns regarding eSIMS objectives: The students find that most of the objectives found on eSIMS are irrelevant to the subject matter and quite different to those which are given to the students by the lecturers. They are not updated regularly, sometimes are inaccurate and are not followed by lecturers, both when it comes to lectures as well as in the case of exams.
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Suggested solutions: Students suggested that given objectives need to be specific and concise, providing more relevant details on the subject. In addition, it was proposed that the very first lecture of any study-unit should be dedicated to naming the essential concepts students need to know and going through the basic objectives of the course so as to avoid any misunderstandings later on throughout the semester. Students should also be given the right to complain if an exam question contained material which does not comply with the objectives given, making objectives more binding in nature.
Ideally objectives would include a reading list of
chapters from recommended books. Conclusion: Having objectives for different modules and specific lectures and small group sessions would enable students to direct their energy towards relevant things.
Resources
related to topics that have to be covered within the different modules are very vast and quite impossible to be covered in their entirety. Therefore setting a guide for the student would not only make his or her life easier but will make learning a more effective process.
Objectives should be specific, direct and concise, reliable and
representative of what is expected, and readily available.
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8. EXAMINATIONS Exams are the main method of assessment to whether individual students have gained enough knowledge and skills so as to progress to the next level of their studies. This topic is always a favourite for discussion especially among stressed medical students who work so hard to make it through those dreadful weeks at the end of each semester. Main complaints were directed towards the bearing of eSIMS objectives on the subject matter, the discrepancy between number of lectures dedicated to a certain topic and their respective weighting in the exam. Concerns regarding Exam balance: The number of exam questions on a particular topic is not proportional to lectures delivered. For instance, with regards to the Nervous System 1 (MDS 2023) module, a lot of emphasis was placed on the importance of the brainstem and the ascending and descending tracts of the spinal cord, however students were barely examined upon this subject matter. In contrast other lectures such as the ‘Molecular basis of Motor Neuron Disease’ and the ‘Vertebral Column’ did not crop up in the exams even though they took up a substantial amount of time in the timetable. Suggested Solutions: The exam should be more balanced with regards to the work put into each subtopic and their weighting in the exam.
This can be achieved by more
communication with different lecturers of the same module and taking into account the semester calendar during setting up of exam questions. Concerns regarding Exam structure: Students feel that short essay questions which are too broad and not very clinicallyoriented should try to be avoided as much as possible. With regards to True-or-False questions, some statements are very ambiguous and
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might be interpreted in multiple ways. For this reason, students feel that negative marking of ‘-1’ mark for each mistake is too harsh. Suggested solutions: Students praised the overall format of exams in that each module has two sections, section A consisting of True-or-False statements and section B consisting of Short Response Questions. While students do understand that learning pure anatomy will surely be of benefit later on in our clinical years, the actual examination should not incorporate pure anatomy questions that are too general. Instead, each short-response question should be broken down into sub-questions (e.g. 1a, 1b, 1c etc‌).
This would help both the students in collecting their
thoughts logically and the lecturers when it comes to correcting. True-or-False statements in most exam papers would be less ambiguous if different sentence structuring was used. By having multiple persons revising the same statements this would surely make the statements clearer. Concerns regarding Invigilators: Of course it is understandable that invigilators must speak amongst themselves to coordinate the smooth running of the exam however students felt that talking amongst the invigilators was too much and was of great disturbance during exams. Many students noticed that in every exam, students were allowed to talk while invigilators collected the exam papers. This obviously led to a time window were some students could share answers. In general students felt that there was not enough surveillance not to allow some students taking advantage. The majority of students saw at least one episode where another student cheated and whilst the invigilators remain oblivious. A general complaint was that exam papers were not given to everyone at the same time and between the first person and the last, there would be at substantial time difference, which might have been very precious during any exam.
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During the exam most students found that the attendance sheet going around, disturbed their concentration and also wasted time from their exam. They feel an alternative for the system of attendance should be found such as signing attendance at the door. Some foreign students complained that English was not used all the time during their exam. Seeing as there are many foreign students in this course, students feel it is essential for invigilators to speak only in English especially when it comes to giving important instructions. Lastly, students felt that it would have helped if invigilators wrote down the start time and finish time on the whiteboard to prevent students from asking how much time there was left in the middle of the exam and disturbing other students. Suggested solutions: There is definitely room for more discipline while exam papers are being collected. If students are caught talking to other students while having their exam paper, disciplinary measures should be taken immediately. Taking less time to collect the papers would probably help keep the class under control too. Not only should invigilators be more observant during the exam but should also check the bathrooms before exams and during exams because some students even found books and large packs of notes inside or in the vicinity of the bathrooms. To keep every aspect of the exam fair, students feel the exam papers should be handed out beforehand facing down and on the invigilators’ signal everyone can start their exam at the same time. Concerns regarding Timetable: Many students argued that the exam timetable was issued very late and locations where not specific.
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Regarding locations, most rooms where reasonable and quite comfortable however, MP401 where most students spent three hours for the cardiovascular exam, had very uncomfortable seating while the benches were also too far away from the bench. Moreover, since the seating was benches, anyone who finished early from the exam and wanted to leave the room had to make the others in the same row to stand up during the exam. Suggested solutions: The timetable should be sent to the students earlier. Furthermore, together with the timetable, a KEY should be included giving further details about the locations of the exams. This is essential since many students, especially international ones, are not familiar with the University grounds. The key should be constructed in a way to explain abbreviations and in which faculty the specific rooms are located. An example: nALR - Anatomy lecture room – Faculty of Medicine and Surgery. Concerns regarding Mock Exams: Mock exams and tests throughout the year are very fruitful and help the students in a number of ways. Students believe that we should have more tests especially in those modules which do not use this opportunity to help the students keep track of their progress. Suggested solutions: Whilst we understand that individual lectures have their own methods, we do believe that mock examinations, tutorials and revision tests aid students dramatically in learning important concepts, especially from their own mistakes. Therefore whilst thanking the several lecturers who took the initiative to prepare such sessions in the best interest of the students, we suggest that more lecturers would do the same.
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Conclusion: Exams are a very sensitive issue and students spend a lot of their time preparing to obtain remarkable results at the end of each semester. Improving the examination system in a number of aspects including invigilation, examination timetables and exam paper set up would mean a lot to each and every student. This would help students maximize their performance both in current exams and within the medical course as a whole.
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9. PROJECTS We are currently being assigned three projects based on anatomy, physiology and pharmacology respectively. Gathering feedback on this topic was aimed at striving for the optimal timing of the assignments as well as finding solutions to problems that the students encountered. Below is a compilation of the students’ complaints followed by suggested solutions. Concerns regarding the Anatomy project: Project title choice – The majority of students felt uncomfortable with the transparency of their grades of “Organisation of the Body” exam – especially as it did not reflect the students’ overall average grade. Dissection projects – Various students complained that it took long to receive their specimen, in some cases even months. Others complained that the specimen they received was cut in a way which rendered it unusable for their project. Some also said that their specimen was not being taken care of with some specimens being left in the fridge as opposed to being stored in formalin. Suggested solutions: It was suggested that the order by which titles are chosen could be determined by an average of all first semester exams. Furthermore, the students’ grades could be made less obvious by assigning actual times to sign for their project title. Concerns regarding Timing: Most students agreed that the deadline for the anatomy project was set too late, resulting in a clash with the physiology project. Furthermore, the pharmacology titles were assigned too late in the year, as second semester exams approached.
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Suggested solutions: A solution would be that the physiology project is assigned for the summer after the first year with the deadline being set for November. This would lift a weight off our shoulders during the scholastic year. The deadline for the anatomy project could be moved up to March. However this being said, the specimen would have to be made available early as mentioned above. Concerns regarding Tutors: Some students encountered significant difficulties when they found out that the tutor they were assigned to was no longer teaching. Whilst some students had a lot of input from their tutors, unfortunately, others were not able achieve significant contact with theirs. Suggested solutions: The students should be forewarned if a tutor is not available. Furthermore, the tutors should be able to handle the amount of students assigned to them. We suggest that tutors are presented with guidelines which have to be followed for the sake of uniformity. Guidelines could also be presented to the students from beforehand in order for them to be more independent of their tutors, in the form of a lecture. This could include how to reference, what plagiarism involves, index composition and the dissection process. Many students felt their only source of reliable information was the help from older students.
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Conclusion: In summary to the above, the most pressing matters are altering the timing and deadlines of the projects – the most feasible of which being moving the physiology project to the summer of first year. We feel that uniform opportunities should be given to all students; hence guidelines for tutors to follow would allow all students equal privileges. Lastly, with more tutor guidance, it would be wise to take these projects as an opportunity to form a publication, in light of our ultimate goals.
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10.
BEHAVIOURAL SCIENCES SEMINAR
The Behavioural Sciences seminars are a huge opportunity for medical students to be trained in skills essential to their future career. A good number of students do not apprehend the importance of fully participating in such seminars. Therefore enhancing such an experience will maximise what the students get out of these workshops. Concerns regarding Material tackled: There seems to be a lack of medically related material being discussed during these seminars. Also, there is a lack of different perspectives given to the students about the multidisciplinary team discussed during the communication skills seminar. Suggested solutions: The seminar should be more medically oriented. For example, it was suggested to include speakers from other professions like nurses and physiotherapists to explain their own perspective to the student about the multidisciplinary teams that exist in our health care system. Concerns regarding Logistics: Students complained about the timing of the first seminar that was held in December, quite close to the first semester exams. Also, the hefty fee for a compulsory seminar is quite a burden on the students. Spending the majority of stipend and smart card to buy books and print notes, it is difficult to keep up with the expenditures. Suggested solutions: To minimize expenses, any material should be provided electronically, to avoid having to pay for photocopies. Students should also be allowed to decide whether they want to sleep at the hotel or not so as to avoid extra fees.
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Concerns regarding Assessment: Students complained that assessment is very subjective, and depends a lot on the individual tutor’s subjective assessment. Furthermore, the final essay can easily be invented and does not always reflect the student’s skills in that particular situation described in the essay. Students complained about not having a grade and feedback on the first seminar before starting the second seminar so they could have a better idea of what the psychologists expect from them during the second seminar. Students argued that the assessment of the intrapersonal skills behavioural sciences seminar is not appropriate as it is tackled too superficially. Suggested solutions: Students would appreciate if assessment is based more on process notes and contribution given within the small group sessions during the seminar to ensure an honest approach by the student. It was suggested that one-on-one session/s with a psychologist would improve assessment of the students’ intrapersonal skills and also allow for more in depth learning. Conclusion: To make the delivery of this weekend more effective, the primary suggestions put forward where to relate the sessions more to our future profession, possibly by including a multidisciplinary team of tutors and to base assessment on the seminar itself, through process notes. Furthermore, the elimination of unnecessary expenses including photocopy and lodging fees would allow for less reserve about the weekend. Such improvements would make it better for the students to gradually apprehend the importance of these seminars and to make the most out of them.
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11.
HAEMATOLOGY
Haematology is not only very interesting but also an essential subject within the medical curriculum. However despite this, year in year out, the majority of students tend to have negative feelings towards it. We attempted to pinpoint the problems in this module so as to improve its learning and assessment outcome. Concerns regarding Reading material: Students commented on the fact that the most updated edition of the textbook itself was only available electronically. Only the outdated version is available in hard copy. Suggested solutions: It would seem that a change in textbook or at least the availability of a separate one approved for study is agreeable. Furthermore, there should be some indication as to what the students actually require from the textbook and how much they should deviate from what is said in class to what is written in the textbook. Concerns regarding Lectures: Several students complained that certain teachers had a rather inappropriate and unprofessional attitude in the classroom. Main complaints included a refusal to take questions after the lecture, minimal interaction in the classroom, lecturers lacking motivation, lack of clarity when the teacher speaks and no form of point reinforcement. Most felt that the lectures themselves had no seeming form. From one lecture to another, there was little or no relation to the subject previously discussed showing the lack of planning. Students felt and complained that having a single lecturer delivering the main lectures
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for the entire study unit is not very healthy. They said that they would have preferred having additional lecturers rather than having the same lecturer for the length of study unit.
Suggested solutions: It should be understood that students will only follow a lesson and be interested if the lecture is delivered in a way that is both exciting and stimulating. If the teachers receive some form of teaching advice and professional assessment, it might make it all the more easier not only for them, but also for students to fully engage into a lesson. Different lecturers for lessons might also present different teaching methods which would also help break the chain of monotony from having a singular teaching method. In order to allow the students the best learning experience possible, the lectures should be structured with one topic leading to the next and reinforcing the essential points by summarizing.
Concerns regarding Tutorials: It appears that different teachers for the tutorials were giving completely different sessions resulting in different class notes of varying competence and detail. Most students felt that this was very unfair and would have rather had fewer lecturers giving the same tutorial. There was not much coordination between the lectures and tutorials. Some tutorials deviated from what was said in lectures (with some over-explaining a subject rather than being specific about a point) and some were given a long time before the actual lecture was delivered.
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Suggested solutions: It would be preferable to keep tutorial teachers giving the same sessions rather than having one session presented by different tutors to different groups. If the lecture quality is increased, tutorials will not need to focus on clarifying and re-explaining the lecture but can take more of a CTS form with more clinical emphasis. Concerns regarding Exams: Students felt that they were not informed properly on what they had to study and the level of detail they had to know for the exam session. Students felt that having an exam consisting solely of eight essays reflected poorly on both the knowledge of the subject and the actual correcting process. This was evident in the class average mark of the exam which was barely above the pass mark. Almost every student commented on how the credit rating for the subunit did not equal the amount of study and effort they needed to put into the study unit. They felt that the study unit should have a higher credit value. Suggested solutions: There definitely needs to be a proper structured set of objectives that should accompany a set plan of lectures and tutorials to ensure continuity between lectures and so that planned tutorials occur after the scheduled lecture dates. This should be accomplished by a meeting for all the teachers of the module at the start of the year. To complement the objectives, a revision lecture can be set to highlight important points to focus on for the exam.
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The exam format is already being altered but should be open to further improvement. An MCQ-based exam would eliminate the subjectivity of exam correction. With regards to the credit rating, it was suggested that there should perhaps be a re-evaluation of the study unit to better reflect the amount of study time. Conclusion: Haematology itself is an intensely interesting subject. The biggest problem with the study unit per se seems to lie within its delivery rather than the content of the subject. If we can find a way to make lecturers see this, and perhaps exploring alternative textbooks, it would certainly ease most of the trouble of this study unit.
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12.
ETHICS
As future doctors, medical students should be aware of the ethical issues that will be encountered during their practicing years. Having an ethics module as part of the medical curriculum is highly advisable and gives a valuable addition to the students’ holistic experience. However, improvement on how the module is currently tackled would make this subject much more enticing for the student. Concerns regarding Practical relevance: Majority of students argued that the lectures were all based upon lists, and there was a lack of practical examples to explain the concepts. Those given were based upon international situations, and generally not applicable to Malta. Some lectures showed no correlation between what was being taught and the actual practice of medicine. The question asked by many students was “Why should I learn a theory, if I do not know how to apply it in my future medical profession?” Suggested solutions: Preferably, the Ethics section of MDS 1023 – Introduction to Clinical Practice 1 should include more applied ethics.
The concept of applying principles and
theories is adopted with current and local situations encountered while practicing the art of medicine. This can be achieved by more CTSs including cases that actually occur in Malta. Better communication is needed between both the lecturers and the students. This can be accomplished by responding to emails on a regular basis and informing the students on what is expected from them. Concerns regarding Exams: Some sections of the Ethics module were found to be extra and unnecessary as none of
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their lecture content was examinable and students were never made aware of this. The material covered in the Introduction to Clinical Practice 2 module was deemed to be sometimes somewhat irrelevant to what we have to study during our pre-clinical years. Suggested solutions: Students appreciate the fact that assessment drives learning, but the lecture content was not reflected in the exam. Thus appropriate objectives should also be set. This module should be made more relevant to what is covered in pre-clinical years, and vague lectures based on endless statistical data should be avoided. Conclusion: Modules that include subjects such as ethics and public health are very relevant and essential for students to obtain a complete picture of what is expected out of them as practicing professionals. Thus, improving on what already exists would surely enhance the outcome of such modules. The main suggestion put forward was to direct the module towards a more clinically-oriented and applicable curriculum.
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13.
TECHNICAL DIFFICULTIES
Below are suggestions on implementing certain facilities to the biomedical sciences department that we think will enhance comfort of both student and lecturer alike and make certain situations more practical. Concerns regarding the Virtual Learning Environment (VLE): The VLE was not explained well to the first years which caused a lot of confusion. It was also ineffective for the first few months of the first semester. Furthermore, not all resources were posted on VLE causing a lot of confusion among the students who had to use multiple sources for sharing resources. Suggested solution: A clear explanation of what VLE is and how it works should be given to first years. Making this session interactive would make it more fruitful. This should also be up and running at the start of first semester. Students believe that having all available resources posted on VLE directly by all lecturers would avoid a lot of confusion and misplacing of resources.
A
suggestion put forward was to give rights to student representatives to add files to the VLE since some lecturers prefer to distribute resources directly after a lecture or tutorial. Concerns regarding Voice Projection: Due to the large number of students within lecture rooms, some have to sit at the back. This means that they are positioned at a distance from the lecturer making it hard for them to hear well as some lecturers do not make use of the microphone. Suggested solution: It was unanimously suggested that without exceptions, all lecturers are to use the
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microphone available as this would mean that all the students are able to hear well without missing out on important information and explanations. Concerns regarding Projectors: A number of lecturers tend to use visual aids for CTS sessions and that many times the projector is not set up beforehand. This means that the lecturer would have to get a projector there and then and this would take up a significant amount of time from the session. Suggested solutions: It was suggested that projectors should be installed in SGT-1 and SGT-2. Students feel that most lecturers tend to feel more confident and deliver their message better with visual aids. Technicians should make sure that projectors in nALR are always ready to be used so as to avoid essential time being wasted. Concerns regarding Electricity: Students have complained that many benches in nALR lack electricity as the plugs do not work. Lately the problem has become aggravated as more rows are lacking electricity supply when most students prefer to type notes on their laptops. Suggested solutions: Apart from ensuring electricity in nALR, more plugs could be included in the corridor outside nALR and throughout the department as many students choose to work and study there. Concerns regarding Lockers: In light of our heavy books and additional material such as lab coats, many students have requested the installation of lockers.
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Suggested solutions: Lockers will be of health benefit to the students as we will not need to carry everything around for the entire day. They could be placed outside the gentlemen’s bathroom and made available for use by all medical students. Conclusion: The main points suggested above include allowing class reps access to VLE in order to have all notes uploaded onto a single source, ensuring that all lecturers use the microphone as well as installing projectors in the SGTs and lockers outside nALR. We believe that such minimal changes will make a substantial difference in the student’s pre-clinical years.
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14.
CONCLUSION
On behalf of all medical students, the MMSA and SCOME would like to thank you for taking the time and initiative to read the report, and for your consideration. We believe that as students we have a lot to give to the development of our own curriculum. We are also very grateful that we have an educational system which recognises student feedback, with helpful lecturers who are eager to help us through the long and winding road which will finally lead us to graduating and becoming practicing doctors. We understand that difficulties crop up along the way and that not all problems are easily avoidable, however we would really appreciate if you would consider our suggestions so as to permit change where appropriate. Once again we thank you for this opportunity and look forward to working hand in hand so as to improve the curriculum which crafts the doctors of tomorrow at the University of Malta. Kind regards, The Standing Committee on Medical Education (SCOME) The Malta Medical Students’ Association (MMSA) Robert Cachia MMSA Medical Education Officer ’11- ‘12 Myranda Attard Ideas Cafe’ Coordinator & Editor 2012
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IDEAS CAFE’ MAY 2012 STANDING COMMITTEE ON MEDICAL EDUCATION scome@mmsa.org.mt MALTA MEDICAL STUDENTS’ ASSOCIATION www.mmsa.org.mt
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