Description | Aims | Process | Evaluation | Acknowledgments | Contact

Description

Having learned the basics of medicine and pharmacology, students need to understand how to apply their knowledge in prescribing drugs for patients. Appropriate prescribing of psychoactive drugs is a key part of a medical practitioner's contribution to the prevention of drug abuse and dependence. Until 1998 we did not assess the adequacy of our students knowledge and skills in this area.

One of the difficulties in teaching students about this very important aspect of medical practice is that the knowledge required is skills based, and would, we conjectured, best be learnt experientially. In this project we have produced an interactive video-based tutorial and associated materials that enable medical students to learn how to interact with drug-seeking patients. We evaluated its effectiveness for teaching using interviews with simulated patients in 1996. We have also transferred the tutorial to a computer-aided learning (CAL) format and compared effectiveness of the video and CAL formats in 1997. What we learnt has been incorporated in current teaching practice: currently the video form is used for regular teaching, and students are assessed in a simulated patient setting.

Aims

• To produce an interactive video-based tutorial package that aids the teaching of interpersonal skills specific to interactions with drug-seeking patients
• To evaluate the effectiveness of the video package as a teaching aid using interviews with simulated patients
• To produce a CAL package with similar content to the video package and compare the effectiveness of the two packages
  
  

The objectives for students are:

• to understand the legal and ethical obligations governing prescribing of psychoactive drugs
• to identify patients' drug-seeking behaviour
• to learn appropriate prescribing practices
  
  
  

Process

The video and accompanying tutorial package were gathered from selected general practitioners consulting in Adelaide and based on their experiences with drug-seeking patients. Eight scenarios of three minutes duration were developed, with each scenario followed by questions that elicit from students their opinion on the good and bad aspects of each interaction, and what, if anything, the students would do differently.

The CAL package was produced using digitised video clips (16, 2 minute clips in Quicktime), assembled in a Microsoft Access database. Clips were presented with background information, and multiple choice questions were asked to assess learning.  Incorrect responses lead to extra information being presented.

Evaluation

Fifth year medical students (total 130) at the University of Adelaide received a tutorial either with or without the video, or with the CAL package. Relevant skills were evaluated through simulated patients trained to role play four different scenarios as drug-seeking patients. The students were randomly assigned to one of these scenarios and role played with the simulated patient. Following this consultation the `patients' assessed the students' skills using a check list based on the skills presented in the training video. A research officer also assessed the students from a recording of the consultation. A skills-based short answer question was asked in the end-of-year examinations.

Student opinions about the different tutorial types were obtained. They completed a standard evaluation form about the tutorial they attended, which was evaluated independently (by the Advisory Centre for University Education).

Outcomes
There was no statistically different student preference for any particular format, although the video-based package was marginally preferred. Student performance in simulated patient interviews and in the examination question was not determined by their teaching method. The cost of the CAL package appeared to be less over a 5-year period, taking into account teaching time, providing CAL facilities were available.

The results suggest that clinical skills can be taught effectively via several different methods. Collaboration between institutions in the development of CAL tools should be an efficient teaching strategy with a wide range of applications.

Acknowledgments

This study was funded by the Committee for Drug and Alcohol Education for Medical Students (CADEMS) and was run in conjunction with Professor John Saunders, University of Sydney.

Contact
Dr David Taverner can be contacted on:

Tel: +61 8 303 3905
Fax: +61 8 224 0685
E-mail: dtaverne@medicine.adelaide.edu.au (inactive, 21/8/09)

Adelaide University, Australia 5005