The study shows that students positively evaluated the teaching in all years of the curriculum and were able to identify the skills they thought they had developed, as stated in the curriculum outcomes. These skills increasingly built up on those practiced in earlier years. Tutor facilitation is highly rated by students in all years. This may reflect the care that is given to the selection and training of the facilitators. Consultation skills are integrated into the mainstream curriculum and the scenarios used are congruent with other material that the students are covering at the time. This may contribute to the students' satisfaction with the Teaching.
It is perhaps surprising that the students rate Practice & Feedback less highly than the Tutor facilitation and Teaching. This part of the course involves the active participation of the students and as such is expected to be engaging and effective. Some of the free text comments suggest that this dissatisfaction relates to a desire for more opportunity for practice and feedback. The teaching took place in groups of 10 which limited the opportunity for each individual to be observed interacting with the simulated patient. Further studies are needed to determine the optimal group size and duration of exposure to provide the best learning environment to ensure students get the necessary opportunities to practice and receive individual feedback from the tutor.
The dissatisfaction with the teaching rooms is a local problem which arose because the medical school buildings were incomplete. It is worth noting, however, that the physical environment can have an impact on the students' experiences of learning.
The findings indicate that the learning outcomes were achieved, in that when asked to comment on the most important things they had learnt during the consultation skills sessions, students reported learning skills and knowledge in line with the expected learning outcomes for the session. Although the students were not specifically asked to comment on their perceived self-efficacy (students' confidence in their ability to communicate with patients) and aspects of professionalism (recognising own limits, being prepared, generally acting professionally) they did list these as important outcomes they had learnt. In addition, all years listed structuring the consultation and patient-centredness as amongst the most important aspects of their learning. Relationship building skills such as recognising verbal and non-verbal cues and dealing with emotions were also among the learning outcomes they felt they had achieved from Year 1.
Another important finding is that students in Years 2-5 listed integration of process skills and medical knowledge as a valuable achieved learning outcome which is one of our course's main aims. Core Calgary-Cambridge skills such as giving and receiving feedback when role-playing, balancing the doctor and the patient's agenda, checking the patient's understanding, giving appropriate information with respect to both amount and type and reaching shared decision making were also mentioned as important learning outcomes achieved in the sessions.
The positive learning outcomes achieved by the more advanced students in Years 4 and 5 were also very important. These are the most loaded consultation skills years of the curriculum and require an enormous amount of time and resources. The above findings provide evidence for justifying and maintaining the complexity and intensity of the course in these years. Year 4 and 5 students noted and valued the fact that they had learnt how to communicate risk; to not pre-judge patients or use stereotypes; how to consult with teenagers; how to consult with children and their parents; how to consult with patients with mental health problems; how to cope with triadic consultations; and how to break bad news in different contexts (paediatric, obstetrics and gynaecology, A&E).
The timing of the data collection is both a strength and a weakness of the study. Collecting the feedback at the end of each session enabled students to provide detailed feedback whilst the session was still fresh in their mind; it also enabled collection of feedback about each session individually. In contrast, students might not remember the specifics of each session if the feedback were collected at the end of a rotation or year. Furthermore if feedback was required on each session they had attended in the year they would have to spend considerably more time completing the feedback at that time. An advantage of collecting feedback at the end of the year is that students would have a complete picture of all the teaching they are going to receive that year and would be able to place the individual instances of learning into a wider context.
It is possible that the presence of the Tutor would have influenced the feedback given, with some students feeling that they cannot be as honest as they would like. This was minimised as far as possible by allowing the feedback to be anonymous. Critically, students also complete an annual evaluation of all areas of the MB/BS course in the last third of the year. This evaluation is completed electronically and MB/BS staff receive the feedback anonymously. Whilst this feedback is less specific and does not provide information at an individual session level, it does support the findings of the reported evaluation in terms of the general strengths and weaknesses of the consultation skills teaching identified through the feedback collected at the end of each session.
The cross-sectional nature of the reported study means that we are unable to draw any conclusions directly comparing individual student experience in different year groups as the student proceeds through the course. In the future we hope to investigate how student perceptions of consultation skills training overall from the annual evaluation change over time. Such a longitudinal evaluation of a cohort of students would provide useful information about their experiences of the consultation skills training in the context of what they have learnt in previous years. Whilst questions in evaluation questionnaires are commonly phrased positively, as in the reported study, for the future it would be useful to include some negative statements to see if this has any effect on the student ratings.
There is clearly a need for studies comparing longitudinal and concentrated delivery of consultation skills teaching. In this study, the results suggest that a longitudinal approach to teaching consultation skills allow students to evolve their skills to the point where very sophisticated skills can be learnt. The students develop a clear sense of self-efficacy and feel prepared to deal with difficult communication challenges when they qualify. The current research focuses on subjective reports (student self report) of learning achieved. There is a need to examine whether the student perceptions of what they have learnt match objective assessments of learning. For example, in future work it would be interesting to investigate the relationship between student evaluation of consultation skills sessions and scores on consultation skills stations in the end of module or annual OSCEs (Objective Structured Clinical Examination). This was not possible in the current study as the evaluation data was collected anonymously. Then, the next step would be to find out whether our graduates maintain these complex consultations skills in the clinical environments where they practice and what training they will need in order to continue improving their competence when consulting with patients.