A questionnaire survey was conducted on the nature of the oral examinations in different disciplines in the medical schools in Sri Lanka. A total of 352 students from Peradeniya and Jaffna medical faculties and pre-registration house officers, including Colombo faculty graduates of the two teaching hospitals, responded to the questionnaire. The results of the survey, which included twelve disciplines, reveal that the time duration of the oral encounter ranged from 10 to 20 minutes. The number of questions asked ranged from five to nine. Detailed analysis of the intellectual level of the questions showed that more than 63% of the questioning was at simple recall level and none at the level of problem-solving. These results show that the oral examination in addition to its inherent weakness of low reliability and objectivity also lacks validity in terms of content sampling. Its predictive validity of professional competence, which requires problem-solving skills, is questionable. Content analysis of the items also revealed that all the abilities tested in the orals could best be tested in a pen-and-paper examination or a structured practical or clinical examination.
In medical education the problem-based approach to learning can be considered as the most significant educational innovation in the past two decades. This paper examines the ways and extent to which health problems have been designed for implementation of problem-based curriculum. Content analysis of curriculum documents of three problem-based schools was carried out in a systematic way from identification of unit of analysis, categorization, sampling, data analysis and interpretation. The comparative study revealed common areas in curriculum organization, arrangement of problems in stages, problem selection criteria, and basic concepts in the early stages of the curriculum. About one-third of the health problems were found to be similar in the schools compared. However, there was no uniformity in the sequence of organ-systems or the health problems. This study provides a framework for the development of problem-based curriculum in three stages with essential concepts identified for the first stage. Criteria for a balanced selection of problems and problem design features which affect the quality of health problems have been identified. These findings could be of value for those who are in the process of developing or revising a problem-based curriculum.
The internship period is a critical phase in the continuum of training provided to medical students. An analysis was made of the tasks the intern medical officers in Sri Lanka are engaged in during their period of training in different clinical disciplines. Data was collected by direct observations by trained observers for a continuous period of 10 days and self-reporting by the interns at the two teaching hospitals and four of the provincial hospitals where interns are posted. The reliability of the data was high. The results indicated the wide differences in the learning experiences of the interns in important aspects of patient care in the different training situations. The non-availability of any guidelines to the consultants with respect to the training intended is another deficiency. The study shows an urgent need to implement a planned and monitored internship programme in the country.
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