nm0309: so with that i shall introduce our next speaker Dr namex who's based at 
the undergraduate er Department of General Practice at namex University he is a 
senior lecturer in medical education and the clinical education lead within er 
the department of general practice and namex is going to talk to us about the 
impact of a special study module on student attitudes namex 
nm0310: thank you right i've cheated slightly because at the time i was er 
invited by namex to give a talk er i was thinking something slightly different 
from what i'm thinking at the moment but i hope that what i will provide you 
with is an attitude to consid-, er er an opportunity to consider er what we 
mean by attitudes and how we might measure them and the means by which i'm 
going to do this is i'm going to describe to you hopefully reasonably briefly a 
course which i developed in conjunction with er a a development 
charity based in namex called Skillshare International and the er the er 
principal aim of the charity er is to work in partnership with people er and 
communities in Africa and India er to promote development and er the means by 
which they do this is partly by recruiting development workers to go and work 
and share their skills hence the name er with people in those communities but 
more recently they've developed er an arm of the charity which looks at 
development education within the U-K and jointly with David Weatherall who was 
at the time the development er education officer at er Skillshare er we devised 
and developed a er course for er students in the special study module section 
of the phase one curriculum er now er what the aim of the course was was to 
develop their understanding of issues around health and international 
development and er David and i were quite open er with the students that we 
obviously brought to this course a set of attitudes beliefs and 
orientation towards development issues and we made those explicit we we made it 
quite clear that we didn't necessarily expect them to agree with us and we were 
very happy to discuss any conflicting or different opinions or attitudes 
towards development issues er in order to help you under sort of stand what we 
did the special study module is a twelve week course it occupies twelve 
consecutive weeks in semester five which in traditional terms is September 
through to December of the third year and we have a day a week and generally 
the pattern of teaching that we adopted was we were giving taught sessions in 
the mornings er and they would have time in the afternoons for self-study and 
to develop their assessment plans and we set out er at the outset we had four 
themes that we wanted to study which sort of kind of drew on the skills and er 
of the people within Skillshare who were able to teach on 
this course and partly address some issues perhaps er to do with er things i 
could bring to it which was issues perhaps more tightly related to becoming a 
doctor which is about disease control treatment and elimination and also er we 
er we found that this was extremely popular module because as you're probably 
all aware issues of globalization are have a high priority in the undergraduate 
student body at the moment er MEDSIN is a very active organization er and is 
promoting very heavily the teaching of these sorts of issues within the 
undergraduate curriculum er and again what Skillshare can bring is to get 
people to think about their skills and so er help them to orientate themselves 
towards er where they're going er in their course er and each theme was taught 
er around sessions er that looked at different aspects of those themes er and 
again the particular aspects we chose depended more on the availa-, the 
interest and availability of the teachers who were going 
to do the sessions and we expected things like looking at the disease control 
of smallpox and malaria to act as paradigm conditions for diseases that are 
prevalent in developing countries right so that's a quick look at what we did 
and er we offered it er to twelve students er of whom six were female and five 
were male the sixth stu-, the s-, the the twelfth student came to our first 
session er and withdrew because she felt that she didn't have enough expertise 
in the area er unfortunately she did so by approaching faculty rather than me 
so i wasn't able to reassure her that we didn't expect her to have expertise 
what i think went wrong is that in our round of introductions at the very start 
of the course er six of the participants had actually lived or er in a 
developing country during all or part of their childhood and seven them seven 
of them had a pa-, parent one or more parent born outside of 
the U-K and in two cases er these were students one from Africa er one from 
Nigeria and one from er Egypt whose parents er were were medically qualified so 
i'm afraid we frightened off the one student who thought that she was er th 
group within a group of experts er as we found out from the assessment process 
er she was sincerely wrong about that although the students did reasonably good 
assessments they certainly didn't display any great expertise even after twelve 
weeks of our [laughter] effective teaching and the process we used was we asked 
them to write an individual essay of two-thousand words on a topic of their own 
choosing er but er we had offered them a menu of different essay titles and in 
fact three of them er wrote essays about breastfeeding and H-I-V transmission 
two about access to self water two about prescribing branded drugs er two about 
education as the key to health and one student wrote an essay about human 
rights and its effect on health and 
another about participation at the second phase of the assessment we divided 
them into two groups and we asked them er to prepare three different 
presentations on the same topic one would be a formal fifteen minute 
presentation very similar to what i'm doing here the second would be a poster 
again similar to the thing you might prepare for a for a conference 
presentation on the theme and the third and most interesting and certainly the 
one they i think they enjoyed the best was what we called a resource poor 
presentation in other words er we invited them to present on the topic er to a 
lay audience using no no resources whatsoever well the topics they chose and 
this may reflect the fact we did quite a lot of teaching about H-I-V at the 
start of the course was on the politics of H-I-V control in Kenya and Uganda er 
and this was the group er doing their little role play both groups 
interestingly chose exactly the 
same tea-, technique because the group that had wanted to talk about access to 
H-I-V treatment in South Africa again had prepared a mini drama er and er th-, 
as i say they certainly enjoyed it w-, i don't know about being resource poor 
because er one group er brought a er an inflatable swimming pool a plastic gun 
and a large amount of props to the presentation [laughter] er i've given 
presentations to audience in Africa and er you're doing pretty well if you've 
got a er a chalkboard to write on right moving on to towards what i'm hoping to 
get to to give you a er er w-, wanting really to develop a discussion er 
hopefully in this half hour slot er but we've we asked them about their view of 
some of the elements within the course er and this slide is is really about oh 
sorry want to go back again er had we got the balance right about teaching 
between er development topics that related to health and global development and 
you know did we did they feel 
that er learning in this special study module which is outside the normal range 
of the curriculum er we were they were learning enough er and we also wanted 
them to reflect on the assessment process and as to whether that had helped er 
to develop their understanding and the last question was really the the counter 
mo-, the counter-question to the one about teaching on development topics now m-
, er we only got ten responses out of the eleven students because er one 
responded by e-mail so this is a caution if you send out e-mail questionnaires 
er i-, if students use a different program to complete them and send them back 
to you to the one you sent them out in you get a garbled response so er his er 
s-, his responses to the free text questions were perfectly er er translatable 
but er the the er the crosses had appeared in the wrong boxes so we didn't know 
what he was actually saying i mean my interpretation of these was that we 
probably had for the students' view got the 
balance about right between teaching on specific health-related issues and 
development issues er and that the course was generally well received er and 
that students er enjoyed it and the informal feedback we got was that they'd 
had a lot of fun doing the course and they felt they'd learned a lot so as it's 
not my job to entertain them but it is my job to educate them i regarded that 
as a success er and they felt that the presentations that they had prepared had 
helped them develop their understanding of the issues they'd chosen to study 
but of course these students had volunteered er they'd specifically opted to 
take this course and because this is a popular topic at the moment in medical 
education it was significantly oversubscribed and some special study modules 
may only have two or three applicants er so to have more students wanting to do 
it than actually did it er is perhaps not er always typical er and then we 
wanted to ask them about their attitudes to 
the course and in in doing this i think we were hoping that we would get some 
kind of handle more generally on their attitudes er to the issues that we 
wanted to talk about so again we felt that er with a couple of exceptions er 
they'd enjoyed the course they felt er challenged to think about deep-, deeply 
about the issues and that they were more motivated er to learn about these 
issues er in the future now it's not it's it's in no way a an objective of ours 
to recruit people who wish to go and work in a developing country either to 
undertake an elective within a developing country er although er we did say 
that students who w-, weren't thinking of doing an e-, elective in a developing 
country would benefit greatly from undertaking our course er but because we 
knew we were dealing with volunteers and it's certainly one of Skillshare's 
objectives to get people to offer their skills and work abroad it's gratifying 
that the majority of them didn't feel 
put off from the no-, from the idea of doing that so that was their attitude to 
the course and moving on to whether their general attitudes had changed as a 
result of the course we asked them had they changed and ten of them said yes 
and one said no er and then when i analysed the free text quest-, the responses 
to the free text question seven of them talked about they felt more aware or 
more knowledgeable about the issues three of them felt they had a better 
understanding and four of them said they had an increased interest in the topic 
for the future but actually very few of them had ac-, responded to the question 
i'd set which is had their attitudes changed er these are the kind of these are 
just a sample of the responses that they made er and i've chosen one from each 
category that i ended up with so possibly understanding that this is a much 
more complex issue than they started is er does represent some sort of 
attitudinal shift and perhaps becoming 
more sympathetic to the plight of refugees and asylum seekers again perhaps an 
attitudinal shift er and if you increase somebody's motivation to go and do 
something then you perhaps can infer that there may have been a change in their 
attitude a positive change in their attitude towards whatever you're asking 
about the student whose attitudes hadn't changed now of course that may not be 
a bad thing 'cause he may have entered the course with exactly the kind of 
attitudes that David and i hoped students would develop during the course and 
all we did was confirm in him in his previous attitudes that were what we were 
interested in so having sort of done this analysis of the course and realized 
that actually i'd absolutely failed in my objective was to measure attitude 
change amongst my students i went away well first of all what does the word 
attitude mean so course i headed across to the dictionary like we all do and 
the first meaning in the dictionary is all to do 
with er body posture so i think i felt that definition wasn't particularly 
helpful to me the second def-, definition is that a state of mind or a feeling 
a disposition and the example the dish-, the dictionary quotes is had a 
positive attitude about work and the second er definition which is probably one 
better understood by teenagers and young people is an arrogant or hostile state 
of mind or disposition now that i find very interesting because it made me 
remember something that Lesley Southgate said when she came to namex to give a 
presentation about poorly performing doctors and what she found is that that 
the s-, the doctors whom that process has identified as poorly performing and 
whom they were having most difficulty in reforming into doctors who would 
perform well in future it was to do with attitude it was not about their 
knowledge on the whole these doctors had good knowledge nor was it 
about their skills they were often quite skillful er surgeons for example where 
obviously skill is very important and they'd identified this was the 
particularly different category of doctor to deal with it also made me remember 
an incident with one of our students who and one of our practice teachers rang 
up and said we're very concerned about this student because er during the 
midpoint assessment er which is the clinical assessment with live patients in 
the doctor's surgery the student possibly a mistaken attempt to create a light-
hearted environment had told a patient female patient getting undressed for not 
a vaginal examination but an abdominal examination go behind the sceen-, 
screens and get your kit off now this was a student who i by chance i actually 
had in my small group and he was a student who'd displayed very great weak-, 
found it very difficult to get him to accept that one of the videotape 
consultations he'd looked 
at there were problems in the behaviour and relationship of the doctor on the 
tape and the patient and he was insisting that okay the doctor wasn't 
clinically very competent but he was polite and therefore he thought this 
doctor was behaving very well with this patient and the entire group eventually 
ended up siding against him and he wouldn't shift his attitude towards this 
performance now one of the advantages of our style of teaching and i suspect 
it's true for all the medical schools represented here is that our general 
practice teachers are pretty good at picking up on these kind of issues and 
generally er they'll they'll refer them to us and we will try and get the 
faculty to take some notice of them often some difficulty to John Cookson's 
credit when i wrote to him about the student and this incident he did call the 
student in and speak to him now the problem is is i've really got no idea 
whether this student i'm sure the student's 
graduated and although he probably said all the right things to John Cookson i 
don't really know whether his attitudes have changed very much so i then 
wondered what have other people done about attitudes so i just did a quick er 
flip through Medical Education using the keyword attitude in the search and 
came up with seventy-four articles where that's the where that is a keyword 
that the author's used to describe the purpose of their work since January 
nineteen-ninety-eight forty-six of which relate to undergraduate medical 
education well twenty-two of these papers essentially are about the students' 
teaching and learning experience so it's nothing to do with their attitudes 
nine of them are about their attitudes towards patients or patient groups 
almost pr-, almost entirely res-, these papers were written by psychiatrists 
who claim people were vulnerable there's one paper by an epidemiologist but 
again that's no surprise that these two groups of specialties in 
medical schools get a bit sensitive about how students perceive their 
speciality eleven of the paysh-, er the papers were about particular issues or 
topics er for example er about the doctor-patient relationship or their 
attitudes towards terminal illnesses er as a topic on which they were being 
taught and four related to something about their personal experiences a 
majority the overwhelming majority of these er papers had assessed student 
attitude by use of questionnaires i guess most of them derived pr-, precisely 
the way i derive questionnaires rather than the way that er Dr namex does and 
many of them depended on scale questions and most of them didn't actually 
attempt to measure change although one of although one or two did so the issues 
that arose then for me is well i'd wanted to measure attitude and i hadn't done 
it well okay we hadn't done a before and after questionnaire but if i'm going 
to measure attitude shift amongst my 
students who take the module next September these are all volunteers who want 
to study this topic so it it may be that they already have all the right 
attitudes and nothing we can do can shift them so do we need control groups and 
and although i didn't look in detail at all the seventy-four papers i didn't 
detect that any of the ones i do look at the abstracts of had actually used 
control groups when they were talking about attitude and this then relates back 
to something that i think is really much more problematic and why i related the 
anecdote i did about the student who said get your kit off is we talk about 
measuring knowledge and skills within a medical education and there's huge vast 
literature about how you do that effectively and reliably and that's actually 
quite relatively easy but how do we measure attitude er i come from namex so 
the example of Peter Green the doctor who sexually assaulted patients in his 
surgery is obviously a 
very live one for us particularly as as he was a partner in one of our teaching 
practices and this is a doctor who's regarded as very outgoing very cultured 
regarded as a very competent general practitioner by all his colleagues and but 
his attitudes towards his patients were about as arrogant as you can get which 
is that i inject them with anaesthetics and i can sexually assault them and of 
course there were concerns about the attitudes of Harold Shipman and because of 
behaviours in previous practices but yet his colleagues regarded him as a 
competent doctor and he wasn't being flagged up by any other mechanisms that we 
generally use to know and we might not use in teaching practice or particular 
practice for teaching because we're concerned about the professional competence 
of the doctors there and yet these were two of the most attitudinally dangerous 
and difficult doctors that we've that have come to light and heaven knows how 
many more 
there are out there that haven't come to light so should we measure whether our 
students have appropriate attitudes when they start and can we assess their 
attitudes during medical education and how do we fine-, define what we mean by 
good and bad attitudes and if it is desirable to assess them how do we prevent 
students from playing the game 'cause you can measure their knowledge and 
that's quite straightforward you can measure their skills and if they haven't 
got skills then they haven't got the skills but it isn't very difficult if 
you're as bright as our students to spot what the socially desirable answer to 
the question might be sorry i'm i'm sorry i've overrun a few minutes so i've 
eaten into your discussion time but i will now shut up and er hopefully that's 
sown some seeds of thought in your minds 
nm0311: can i ask er if you if you if you were to do this again would you 
actually have some sort of measure of attitudes before and after it 
nm0310: 
yes if i had the time 
nm0311: and by what er w-, what would be what method would you use 
nm0310: well if i had the time i'd i'd in September i will probably try to use 
three three groups with the students who come on our module the students who 
expressed a desire to come on our module who don't get a place er and the 
students who had no wish whatsoever to come on our module er now whether i'll 
get we've of-, we're offering this course to eighteen students so whether we'll 
get eighteen students in each group i don't know er and i will design er like 
an instrument or if i if i can't find one that measures attitudes towards er 
issues of global health and development 
nm0312: i think the as you said namex the real problem with er measuring 
attitudes of medical students is they're all too clever to say say you devise a 
question like what is your 
attitude to the asylum seeking problem no one's going to say well i think no-, 
nobody should be able to come to this country at all and they're all going to 
say oh i do sympathize and it's difficult and they're all too clever to give an 
answer which is actually going to be truthful aren't they which i-, it if it's 
a if it's an assessment tool and that's the real problem isn't it how how do 
you measure it 
nm0310: i think that's certainly one of the problems 
nm0312: yeah 
nm0310: yeah 
nf0313: has anybody tried to define good and bad attitude 
nm0312: yeah 
nm0310: er er not that i'm not aware of and i've i've 
nf0313: 'cause surely that's a very subjective call 
nm0310: i mean i think the G-M-C has tomorrow's doctors revisited 
nf0313: mm 
nm0310: er it's pretty obvious what would be regarded by the G-M-C as er the 
appropriate set of attitudes er and i suppose also in the guide to good 
practice as well er what would be consensus about attitude 
is is embedded within them but er but of course the more explicit you make it 
the the the greater the problem of either of those two er how do you stop 
people lying to you when you're asking them 
nf0313: the the thing is with attitudes as well is that flexibility in each 
area i'm just looking at general practice some G-Ps that are happy with 
referring people for abortion say and some G-Ps that will not refer now is that 
a bad attitude or is that a good attitude you can just it's just very woolly in 
certain areas isn't it i just feel if you go in to ha-, to try to create a 
scale 
nm0310: yes and i think in a sense that talking about it is the first step 
because we can agree er obviously as we did in nineteen-sixty-eight 
nf0313: mm 
nm0310: that we would allow doctors to hold both sets of attitudes and both 
would be regarded as socially very acceptable it would be regarded as 
acceptable what was necessary the doctors were honest and explicit 
about their attitudes towards the topic of abortion er it's what you do about 
the the doctors who are not prepared perhaps to be explicit that they think 
patients are a whingeing bunch of losers who shouldn't think of taking up their 
valuable professional time yet we all recognize them yeah 
nm0314: i was er i was just reflecting on this from the point of view as as 
you're saying knowledge and skills are very easy things to assess aren't they 
i'm i'm wondering with the increased culture of if you like political 
correctness and the issues that are being raised around the questionnaire and 
the the issues the gentleman raised here that nobody's going to lie on those 
things whether maybe a questionnaire's the right tool even to assess in this 
day and age when people are so aware of it one of one of the things that 
fascinated me earlier on is when you were is that is that your questionnaires 
themselves seem seem to give you those sorts of answers in 
terms of attitude that reflect on the learning 'cause there was a culture 
around an evaluation that says what did you learn what are the key learning 
issues that you've taken away from today's event and maybe that's why the 
response in terms of attitude is that way as well because very often you're 
saying how do you now feel about working in different environments so perhaps 
the answer to some of that may be about one to one contact but that is a 
resource issue clearly 
nm0310: yeah 
nm0314: yeah 
nm0310: i know that a very different questionnaire and i think 
nm0314: yeah 
nm0310: your suggestions would be ones i would incorporate in writing it er 
yeah 
nf0315: yeah i'm i'm really pleased to see this whole issue about attitude 
coming up because i'm in the middle of doing my well towards the end of 
actually a very big literature search at the 
moment about evalaution and various elements of of communication including er 
professionalism and attitude which we're trying to encapsulate in assessment at 
the moment and doing the full literature review the the results that you've 
just er shown for medical education are reflected elsewhere and i was i was 
trying to find examples of papers whereby external assessors or simulated 
patients had attempted some measure of attitude i found about two papers and 
that worked on the basis of giving somebody a checklist either an external 
examiner or a simulated patient that said er s-, on a scale of one to four one 
bad four very good rate the student's integrity rate the student's altruism on 
a clinical examination i i i found myself reflecting on the the impossibility 
of that task from the point of view of the assessor and it's obviously 
something that you've thought about as well and i wondered if you had any any 
th-, i i i would be really 
interested to know whether you think it's actually possible to externally 
assess er something like a student's integrity 
nm0310: er w-, i think yes i think it is possible but how realistic it is that 
we assess this particularly if we were wanting to make judgements about whether 
the student should progress in their education or not i think that's the big 
difficulty i mean it's interesting what she's saying because the process you 
described in those two papers that have attempted to do this probably is 
actually measuring patient satisfaction 
nf0315: yes 
nm0310: which i think is a rather different set of concepts to what i mean by 
appropriate professional attitudes towards patients themselves 
nf0315: indeed well i think the the well one that i read most recently i can't 
remember the the names of the authors but 
nm0310: mm 
nf0315: i remember reading the paper er they concluded that there's no 
point in having a separate measurement for attitudinal professionalism 
nm0310: mm 
nf0315: 'cause there's so many overlaps with their basic communication 
checklist 
nm0310: mm 
nf0315: i thought what a shame 
nm0310: mm 
nf0315: because every-, everything that you've said in your presentation i 
think highlights a real need 
nm0310: mm 
nf0315: to take this subject very seriously to find some way of dealing with it 
sensibly 
nm0310: mm okay 
nm0316: in in general practice er postgraduate education don't trainers assess 
their registrars for attitude and and surely that's a more realistic 
nf0317: yeah 
nm0316: opportunity to assess them by over a year by talking to patients and by 
observing them and that's when if someone has got an attitude problem or a 
problem with er professionalism then it's going to get flagged up 
nm0310: i'm sure you're right except it's not a field i know about 'cause i my 
background's entirely in undergraduate education i mean i i'd say that i get a 
feel for it in eight weeks of one to one practice based teaching er with 
students er 
nm0312: there's quite sorry 
nm0310: but you can have somebody from the back-, er some postgraduate 
background wants to 
nm0312: it's quite easy to mix up an attitude problem with a communication 
problem as well though isn't it patients may perceive that a registrar's 
attitude is remiss and what it actually is is their ability com-, to 
communicate and their actual internal attitudes are fine but 
nm0318: mm 
nm0312: it's very difficult to assess isn't it 
nf0313: do you thi-, 
nm0310: but is it er i met one of Harold Shipman's patients who thought 
nm0312: that they loved him 
nm0310: 
nm0319: yeah 
nm0310: er doctor he just believed it was right to kill your patients so 
[laughter] albeit er a hard case to make by law but you know bringing it back 
to the sort of real world that we live in you you know we all do have these 
vibes about students i mean even in group teaching you have vibes about 
students and and a student who's sat putting data into his P-D-A during a 
seminar [laughter] now i mean it does annoy me but i er other things about him 
annoyed me er now you know how do i take that forward [laugh] 
nm0319: can i just raise a issue to er attitude i think is extremely difficult 
assess because you're talking about right or wrong some sort of judgement value 
isn't it er to me some people might say collecting a ticket in those er display 
car park that still got time to expire and you take it it's illegal but a lot 
of people do and think well that's okay [laughter] to so i think sometimes 
issue is to me it's more assessing that person what have they got inside what 
nm0310: well 
nm0319: 
what have they got inside that no i know that i might have prejudice because my 
religious my cultural background but i know with my professionalism that won't 
affect my performance er with a patient that to me more important when people 
know inside like Shipman they carry on doing it carry on doing it eventually 
that's why they get caught not because they are not clever enough because they 
lost insight that's what the police always say in in criminal things 
nm0310: yeah it's probably how both Peter Green and Harold Shipman were caught 
i guess because they just didn't believe they were going to get caught and so 
they became careless i mean 
nm0319: so we all know our weakness ou-, ou-, er but once you know you 
nm0310: yeah 
nm0319: got insight it's no wonder you don't make mistake isn't it 
nm0310: yes i mean i-, i-, whether things would have been different you know 
with more robust 
and reliable systems of professional evaluation of your peers and your 
colleagues 'cause within group practice you would hope it's hard to get away 
with i mean to bring it back again to the real world and it might be issues 
like i mean overprescribing just because you want quick simple consultations 
now you know i think that displays remiss political atti-, er professional 
attitudes that need to be tackled because er it's it's underperforming quite 
seriously if your response to every patient is to prescribe them something and 
finish the consultation in two minutes but it's very common behaviour er i mean 
one of the things that's interesting is is that if you sit as i have done on 
finals exam board meetings you have this discussion about students er who are 
failing and usually what ha-, they usually fail because they don't attend and i 
think they usually don't attend either because they're ill which is 
one set of issues or because they're actually they're not motivated to be there 
er and it's remarkable how people who've been around the system for a long time 
have actually spotted these students in the first weeks and okay sits there and 
says yes i knew they were going to be a bad one so there is something about the 
comportment the behaviour the attitude even in a group of a hundred-and-eighty 
students arriving at the medical school people with experience feel they can 
spot students whose attitudes cause concern and when they're called to account 
for various reasons during the course you know that concern is heightened but 
the institution finds it very difficult to do anything with that concern 
nf0313: how easy is it to change people's attitudes or is it the fact that 
you're teaching someone that what they're thinking is wrong even though they 
still think it they should not act in that way i don't know 
nm0310: 
i i mean i [laugh] don't know whether anybody has a response to that question 
er i mean i think it's difficult er because you can change behaviours i mean 
nf0313: it's like your questionnaire you when you were interested in attitudes 
before and attitudes afterwards 
nm0310: mm 
nf0313: would that come from a knowledge point of view 
nm0310: i would think if i wrote the questionnaire carefully enough i probably 
could measure real change in attitudes of students who had become much more 
positive in their views of asylum seekers and refugees or much more positive 
about er developing countries that want to er pr-, you know er produce pate-, 
er patented drugs cheaply so you could say well those are the attitudes shifts 
i want to see as a result of my course er and i'll measure those and i mean i 
can do a control group and i can check whether they haven't changed in my 
control group er so you can do 
that er so you can i think you can change attitude but obviously these are r-, 
relatively insensitive or relatively safe attitudes to change so it's okay to 
say well i now think more positively of asylum seekers because i've met them 
and someone's given me a course about them and explained to me why they're here 
and that's quite safe but how you deal with the much more serious attitudes 
which is basically patients are wasters and i don't like sealing seeing them er 
because it's socially undesirable er to say that and yeah we all know that lots 
of doctors and even students er think it to a greater or lesser degree so 
nf0320: colleges try to measure attitudes er because ti postgraduates er for 
example the M-R-C-G-P examination looks at er and consultation skills and oral 
examinations do you see that those kind of techniques might be wrong for 
undergraduates 
nm0310: 
er i think it's difficult because i would [sigh] i mean if i assess a student 
in as i do quite frequently in cl-, in using the LAP to assess their 
consultation skills i get i feel i get a very good insight into the attitudes 
and i can to some extent i can categorize their attitudes within the c-, the 
category of behaviour and relationship with patients er because i think 
students who have good attitudes towards the professional role as a doctor will 
s-, will score well in that category and s-, and it's unusual for students to 
score badly partly i think because when they're assessed using the LAP as in 
the assessment tool a weak student tends to get rewarded for being polite to a 
patient which is a very different really from what that category should be 
measuring because it should be trying to measure a much more sophisticated view 
of the relationship the pay-, the student develops with the patient so i mean 
you a starting point could well be if you 
had you know well trained assessors is to scrutinize students who scored badly 
in that category because they would be flagged up as giving cause for concern 
but i think you'd need to go on and develop probably more interactive teaching 
programmes with them and you're saying look you've got to you've got to see in 
behaviour and relationship that's the threshold for us focusing on looking at 
what you do with patients and exploring your attitudes perhaps i mean i you 
know psychologists think they can devise questionnaires that spot people who 
are lying in questionnaires so er maybe we could do that but i i don't think 
it's easy but given the the havoc that even doctors just not not the obvious 
criminals but even doctors who just underperform because they have the wrong 
attitudes create through a whole of a professional lifetime er perhaps we 
should be making a more serious attempt to do it 
nm0309: 
namex thanks very much er thank you also for the top slide because that's what 
our next session after coffee is going to address er so we'll be specifically 
looking at that next time and i think er s-, i thought that was absolutely 
fascinating you've raised such an important subject 'cause we think a lot about 
knowledge and skills in medical education during medical school training but we 
don't devote a lot of er time to what is happening to our students' attitudes 
both at the time of entrance and then what happens during their training and 
even what happens in during postgraduate training so thank you very much 
nm0310: thank you 
nm0309: we're now going to move to coffee which will be in seminar room one 
where you had coffee at the beginning and then we'll reassemble at twelve 
o'clock