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Lectures versus case discussions: randomised trial of undergraduate psychiatry teaching

  • Meinou Simmons (a1) and Paul Wilkinson (a2)
Abstract
Aims and method

To test whether medical students find case-based discussion of child psychiatry more educationally stimulating and more enjoyable, and whether this leads to greater knowledge acquisition than traditional didactic lectures. Four cohorts of Cambridge medical students (n = 54) were randomised to case-based discussion or traditional didactic lectures for two topics in their psychiatry placements. Enjoyment and stimulation were determined by feedback forms; knowledge acquisition was tested by an end-of-placement exam.

Results

Students in case-based discussion groups scored significantly higher than students in the lecture groups in the extent to which they enjoyed the teaching session (P = 0.006); the extent to which they understood the principles of management of real-life patient problems (P = 0.044); and their interest in looking up further information (P = 0.003). There was no significant difference in exam performance (P = 0.9).

Clinical implications

Medical students find case-based discussion more engaging and enjoyable than didactic lectures, with no reduction in exam performance.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Meinou Simmons (meinou.simmons@gmail.com)
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 Kaufman, DM. ABC of learning and teaching in medicine. Applying educational theory in practice. BMJ 2003; 326: 213–6.
2 Fischer, RL, Jacobs, SL, Herbert, WN. Small-group discussion versus lecture format for Year 3 students in obstetrics and gynaecology. Obstet Gynaecol 2004; 104: 349–53.
3 Costa, M, van Rensburg, L, Rushton, N. Does teaching style matter? A randomised trial of group discussion versus lectures in orthopaedic undergraduate teaching. Med Educ 2007; 41: 214–7.
4 Brown, N, Holsgrove, G, Teeluckdharry, S. Case-based discussion. Adv Psychiatr Treat 2011; 17: 8590.
5 Garralda, E. Teaching child psychiatry to medical students: students' feedback. Psychiatr Bull 1984; 8: 171–2.
6 Altman, D. Practical Statistics for Medical Research. Chapman & Hall, 1991.
7 Rabe-Hesketh, S, Skrondal, A. Multilevel and Longitudinal Modeling using Stata. Statacorp, 2008.
8 Kelly, B, Raphael, B. The evaluation of teaching in undergraduate psychiatric education: students' attitudes to psychiatry and the evaluation of clinical competency. Med Teach 1991: 13: 7787.
9 Bulstrode, C, Gallagher, FA, Pilling, EL, Furniss, D, Proctor, RD. A randomised controlled trial comparing two methods of teaching medical students trauma and orthopaedics: traditional lectures versus the ‘donut round’. Surgeon 2003; 1: 7680.
10 Walton, MJ. The measurement of medical students' attitudes. Br J Med Educ 1967; 1: 330–40.
11 Spiegel, D. Motivating the student in the psychiatry clerkship. J Med Educ 1991; 56: 593–9.
12 Singh, SP, Baxter, H, Standen, P, Duggan, C. Changing the attitudes of ‘tomorrow's doctors’ towards mental illness and psychiatry: a comparison of two teaching methods. Med Educ 1998; 32: 115–20.
13 Miller, G. The assessment of clinical skills/competence/performance. Acad Med 1990; 65: 63–7.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Lectures versus case discussions: randomised trial of undergraduate psychiatry teaching

  • Meinou Simmons (a1) and Paul Wilkinson (a2)
Submit a response

eLetters

Medical students' views of psychiatric teaching methods:

Kamran Ahmed, ST6 Psychiatry, South London & Maudsley Psychiatric training scheme
27 April 2012

We read with interest the paper by Simmons & Wilkinson (The Psychiatrist, April 2012) in which they demonstrated that medical studentsfound cased-based discussion of child psychiatry more enjoyable and engaging than didactic lectures, with no reduction in exam performance. Asthe authors note, there is a dearth of studies comparing students' enjoyment and experience of different teaching methods in psychiatry. We welcome research of this nature as it may help us to improve the undergraduate experience of medical students in psychiatry.

We conducted a survey of two cohorts (n=38) of students' experiences of a 12-week undergraduate psychiatry rotation at a London teaching hospital. The programme consisted of grand rounds, in which students presented a case to the rest of the cohort and were marked by senior psychiatric trainees; web-based scenarios - on-line, problem-based cases with associated questions which students completed themselves then were taught around the topic by junior psychiatric trainees; a series of seminars delivered by consultants and senior trainees; and firm-based clinical teaching including weekly tutorials by consultants.

The survey showed that on a range of 1 (very poor) to 5 (excellent), grand rounds received the highest average rating (4.1), followed by web-based scenarios (3.9), seminars (3.7) and finally firm teaching (3.6). Free text responses showed that incorporating role-play style teaching in to sessions was seen as particularly useful and students wanted more teaching delivered in this way. There was considerable variation in students' experience of firm teaching, with some commenting on the lack ofteaching or poor quality tutorials and others requesting more teaching with junior psychiatric trainees. Clinical teaching by its very nature is difficult to standardise as patients may not attend appointments and clinicians will have differing degrees of aptitude and enthusiasm for teaching, but optimising the student experience is crucial so novel ways of controlling quality must be sought.

The results of this survey will be used to inform changes to this particular teaching programme such as increasing the use of role play teaching and emphasising the importance of structured firm teaching with regular consultant tutorials as well as sessions with junior doctors. The findings could also inform adjustments to psychiatric teaching programmes at other institutions. More studies examining the specific components of undergraduate teaching programmes in psychiatry are required to establish which teaching methods students find most stimulating and which aspects need improvement. Shaping teaching programmes in this way may improve the overall undergraduate experience of psychiatry for students and perhaps even recruitment into the specialty.

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Conflict of interest: None declared

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