Introduction: Intercalated BScs (iBScs) are an optional part of undergraduate (UG) medicine courses in UK, Eire, Australia, New Zealand, the West Indies, Hong Kong, South Africa and Canada, consisting of advanced study into a particular field of medicine, often combined with research. They potentially improve students' skills and allow exploration of specific areas of interest. They are, however, expensive for institutions and students and delay workforce entry. There is conflicting evidence about their impact. Methods: A mixed-method systematic review (meta-analysis and critical interpretive synthesis) of the biomedical and educational literature, focusing on the impact of iBScs on UG performance, skills, and career choice, and to explore students' and other stakeholders' opinions about iBScs. Results: In the meta-analytic part of this review, we identified five studies which met our predetermined quality criteria. For UG performance, two studies using different methodologies report an improvement in UG performance; one study reported an Odds Ratio [OR] of 3.58 [95% CI 1.47–8.83] and the second reported a significant improvement in finals scores (1.27 points advantage 95% CI 0.52–2.02). One study reported a mixed result, while two studies showed no improvement. Regarding skills and attitudes, one paper suggested iBScs lead to the development of deeper learning styles. With regard to subsequent careers, two studies suggested that for those students undertaking an iBSc there is an increased chance following an academic career [ORs of 3.6(2.3–5.8) to 5.94(3.6–11.5)]. Seven of eight studies (with broader selection criteria) reported that iBSc students were less likely to pursue GP careers (ORs no effect to 0.17 [0.07–0.36]). Meta-analysis of the data was not possible. In the critical interpretative synthesis analysis, we identified 46 articles, from which three themes emerged; firstly, the decision to undertake an iBSc, with students receiving conflicting advice; secondly

Background: Traditionally, paper cases are used as 'riggers' to stimulate learning in problem-based learning (PBL). However, video may be a better medium because it preserves the original language, encourages the active extraction of information, avoids depersonalization of patients and allows direct observation of clinical consultations. In short, it exposes the students to the complexity of actual clinical problems.
Aim: The study aims to find out whether students and facilitators who are accustomed to paper cases would prefer video triggers or paper cases and the reasons for their preference.
Method: After students and facilitators had completed a video PBL tutorial, their responses were measured by a structured questionnaire using a modified Likert scale.
Results: A total of 257 students (92%) and 26 facilitators (100%) responded. The majority of students and facilitators considered that using video triggers could enhance the students' observational powers and clinical reasoning, help them to integrate different information and better understand the cases and motivate them to learn. They found PBL using video triggers more interesting and preferred it to PBL using paper cases.
Conclusion: Video triggers are preferred by both students and facilitators over paper cases in PBL.
[Copyright of Medical Teacher is the property of Informa Healthcare . Full article may be available at the publisher's website:
http://dx.doi.org/10.3109/01421591003686260]

Background: Many doctors experience psychological ill health. Interns are known to be particularly vulnerable.
Aim: To examine the level of depression, anxiety and stress in interns in Hong Kong, as well as the causes and how they cope.
Methods: A questionnaire was designed based on the themes identified in three focus groups of medical graduates of Year 2004 of the University of Hong Kong. The 21-item Depression, Anxiety and Stress Scale (DASS 21) was also administered. All 155 graduates of the same year were invited to participate with a response rate of 63%.
Results: Percentages of respondents with abnormal levels of depression, anxiety and stress were 35.8%, 35.4% and 29.2%, respectively. Frequent calls during night shift, long working hours and heavy workload constituted the most significant stressors. Factor analysis of the stressors showed that seven factors could explain 68% of the total variance: multidisciplinary team working issues, clinical difficulties, job seeking and employment, workload issues, ethical and interpersonal issues, adjustment to job rotation and performance appraisal. Holidays, peers and sleep offered the most significant relief.
Conclusion: Interns experience considerable depression, anxiety and stress. The source of stress is multi-faceted, but workload is the most significant stressor. Peer support groups may relief stress.
[Copyright of Medical Teacher is the property of Informa Healthcare . Full article may be available at the publisher's website: http://dx.doi.org/10.3109/01421590903449894]

Background: Although recent quantitative research suggests that medical students are reluctant to engage in peer physical examination (PPE) of intimate body regions, we do not know why.
Aim: This article explores first-year medical students' anxieties about PPE of intimate body regions at six schools.
Methods: Using the Examining Fellow Students (EFS) questionnaire, we collected qualitative data from students in five countries (UK; Australia; New Zealand; Japan; Hong Kong) between 2005 and 2007.
Results: Our framework analysis of 617 (78.7%) students' qualitative comments yielded three themes: present and future benefits of PPE; possible barriers to PPE; and student stipulations for successful PPE. This article focuses on several sub-themes relating to students' anxieties about PPE of intimate body regions and their associated sexual, gender, cultural and religious concerns. By exploring students' euphemisms about intimate areas, our findings reveal further insights into the relationship between students' anxieties, gender and culture.
Conclusion: First-year students are anxious about examining intimate body regions, so a staged approach starting with manikins is recommended. Further qualitative research is needed employing interviews to explore in depth students' anxieties about examinations of intimate body regions and how their views are shaped by interactions with peers, patients and doctors.
[Copyright of Medical Teacher is the property of Informa Healthcare . Full article may be available at the publisher's website: http://dx.doi.org/10.3109/01421590802578244]

Background: Brainstem death (BSD), defined as the irreversible loss of consciousness, brainstem reflexes and the capacity to breathe, is not an uncommon scenario seen in the day to day practice of medical personnel. Upon the diagnosis of BSD, controversial issues of withdrawing life-supporting treatments and organ procuring for transplantation inevitably arise. This study evaluated the knowledge, acceptance and perception of BSD amongst medical students in Hong Kong.
Methods: A total of 126 medical students completed a self-administered questionnaire. Ten questions were used to assess their knowledge of BSD and this was correlated with their responses in three hypothetical vignettes.
Results: The mean score of the subjects' knowledge was 6.03 out of 10. Less than half (48.8%) of the subjects' knew that BSD is different from persistent vegetative state while 49.2% and 36.3% knew that BSD is accepted as death medically and legally in Hong Kong, respectively. When 'diagnosed' with BSD, 63.7%, 46.8% and 52.4% of the subjects would agree to the withdrawal of life-support from themselves, their most-loved one/family member and a stranger, respectively. Subjects with better knowledge and those who thought that doctors may tend to diagnose BSD to save resources or procure organs for transplantation were more ready to accept the withdrawal of life-support.
Conclusions: We concluded that knowledge of BSD amongst medical students was unsatisfactory and that urgent actions should be taken to remedy the situation. A better knowledge of BSD positively influenced the decision-making on withdrawing life-support and that adequate information regarding the outcome of BSD should be provided. On the other hand, the perception of doctors' intentions behind diagnosing BSD has no direct influence on the decision-making. More emphasis is required on medical education, including a specific emphasis in the undergraduate lecture curriculum and bedside exposure to BSD diagnosis

Introduction: This study investigated the impact of a Master of Family Medicine degree (via distance education) on GPs' career options, and in particular, whether they were more likely to adopt university positions after the course. A secondary aim was to examine whether those who undertook a research project as part of their Masters took up different career options than Masters graduates who undertook a more clinically orientated course.
Methods: A questionnaire survey was posted to all 192 graduates of the Master of Family Medicine degree. Approximately one fifth of these resided overseas, with the majority in Hong Kong.
Results: The response rate was 68%. Graduates stated that they benefited from the course, particularly in the areas of clinical knowledge and improvement in 'academic' skills. Changes in careers, with increases in non-clinical appointments, did occur after the course for both the Research and Clinical Masters graduates.
Discussion: Responses to the survey indicated that graduates benefited in completing the course and changes in their career direction following graduation. However, whether the Masters course provided new skills to enable career change, or the GPs were in the process of change anyway, cannot be determined with certainty. Further studies, including interviews, are required to establish the impact of a distance education higher degree.
Conclusion: The research output of general practice remains behind that of its specialist colleagues. Higher degrees for GPs might encourage them to undertake more academic pursuits, but the precise relationship still remains uncertain.
[Copyright of Medical Teacher is the property of Informa Healthcare . Full article may be available at the publisher's website:
http://dx.doi.org/10.1080/01421590701287905]

Evidence for the use of a patient-centred model for interviewing is well established in the West. There is much less evidence for the application of the model in other cultural settings. This paper describes the impact of a communication skills (CS) course for doctors (n = 32) working in government outpatient clinics in Hong Kong. Emphasis is placed on the cultural relevance of the patient-centred interview (PCI) and educational techniques. Knowledge scores increased immediately after the course and again 8 weeks later (p < 0.001). Participants held favourable attitudes at the outset of the course and these were largely maintained. Qualitative data suggests that the doctors' competence in CS increased. The PCI model was perceived as relevant to the practices of these doctors. Barriers preventing the implementation of this approach related to organizational rather than cultural factors. The educational strategies were well received, suggesting that adult Chinese learners are not dissimilar to their Western counterparts in approaches to learning.
[Copyright of Medical Teacher is the property of Informa Healthcare . Full article may be available at the publisher's website:
http://dx.doi.org/10.1080/01421590020031147]

A four-hour integrated teaching session on clinical decision analysis has been developed and introduced as part of the Life Long Learning Skills course for medical students at The Chinese University of Hong Kong. The feasibility and effectiveness of teaching the principles and practice of clinical decision analysis to final-year undergraduate medical students was evaluated. One hundred and thirty-two students were randomly assigned to medical (intervention) and surgical rotations (control) and were assessed two weeks before and three weeks following a teaching session. The students' performance was assessed in response to 10 A-type multiple choice question items that incorporated various clinical scenarios requiring decision making and interpreting cost-effectiveness ratios and sensitivity analysis graphs. More students in the intervention group improved their overall performance scores compared with those in the control group (23.4% vs. 7.4%; 16.1% difference; 95% confidence interval [CI], 3.8-28.5%; p = 0.01). Improvements were in interpretation of decision making (22.2% difference; 95% CI, 10.1-34.4%; p < 0.001). No improvements were seen for calculating cost-effectiveness ratios or interpreting sensitivity analysis graphs. The overall educational intervention was well received by students and effective in improving students' clinical decision analysis skills under simulated conditions. Practice points Clinical decision-making skill is an important aspect of evidence-based medicine. A randomized controlled trial assessed the effect of teaching clinical decision analysis to undergraduate medical students. An integrated teaching session consisting of three 40-minute lectures on the principles and practice of clinical decision analysis, followed by two 1-hour workshops is effective in undergraduate final-year medical students.
[Copyright of Medical Teacher is the property of Informa Healthcare . Full article may be available at the publisher's website:
http