practical aspects in supporting the st george's graduate entry programme

copy Health Libraries Group 2003

Health Information and Libraries Journal

20

pp179ndash184

179

Blackwell Publishing Ltd

Brief communication

Practical aspects in supporting the St Georgersquos Graduate Entry Programme

Sam Martin St Georgersquos Medical School Cranmer Terrace London UK

Introduction

St Georgersquos Hospital Medical School was founded250 years ago and is a college of the University ofLondon The main campus at Tooting SouthLondon is shared with St Georgersquos HealthcareNHS Trust which is one of the busiest hospitals inthe NHS The School has over 1300 medicalresearch and BSc students In addition nursingradiography and physiotherapy students arejointly taught with Kingston University in ashared Faculty of Health and Social Sciences Twomedical programmes are offered by the School awell-established five-year undergraduate MBBScourse and a new Graduate Entry Programme(GEP)

The Graduate Entry Programme at St Georgersquosis a 4-year fast-track medical course for graduatestudents

1

A key feature of the course is that muchof the learning is problem-based and self-directedThe course is based on the graduate medical pro-grammes running at Flinders University of SouthAustralia the University of Queensland and alsothe University of Sydney

2

At St Georgersquos thecourse is now in its second year with 35 graduatesfor each yearly intake Students have first degreesin Arts Humanities or Sciences and undergo a rig-orous selection procedure including sitting aGAMSAT (Graduate Australian Medical SchoolAdmissions Test) Competition for places is fierceand the course will be doubling its intake to 70 stu-dents from September 2002

Information Services at St Georgersquos comprisethe Library and Computing services which weremerged in 1999 Information Services Staff cur-rently support the GEP course in a variety of waysThe impact of this programme on Library Serviceshas been shown in a previous article in this jour-nal

3

This paper describes these activities and dis-cusses the challenges and problems encountered insupporting the course

The PBL week

GEP students are taught separately from under-graduate MBBS students They are divided intofive groups of seven students each group havingtheir own lsquobase roomrsquo that acts as a teaching anddiscussion room The base rooms each have anetworked PC with Internet access video facilitiesand a small collection of standard medical text-books Each week a clinical problem is presentedvia a series of web pages using Blackboard(Blackboard Inc Washington DC USA) coursewareA tutor facilitates the learning process for eachgroup and much of the learning is student ledproblem based and self directed The tutors role isthat of facilitator acting as a lsquoguide on the sidersquorather than a lsquosage on the stagersquo

4

Students generateissues which become learning goals for the nextsession The walls of the base rooms are coveredwith whiteboards on which learning objectives arewritten Textbooks monographs journals and webresources are employed to provide answers to theissues raised GEP students unlike MBBS under-graduates gain clinical experience early on in theircourse enjoying the opportunity of communityplacements where they can observe clinical practice

Figure 1 shows the timetable for a typical firstyear GEP week Each clinical problem starts on aMonday is resumed on a Thursday finished offthe following Monday Ample time is given forself-directed learning Single-site activities include

Correspondence Sam Martin St Georgersquos Medical School CranmerTerrace London SW17 0RE UK E-mail smartinsghmsacuk

Brief communication



20

pp179ndash184

180

lectures film clinical demonstrations ThelsquoPatient and Doctorrsquo session covers clinical andcommunications skills Community placementsinclude placement at GP practices hospices resi-dential homes etc lsquoPersonal and ProfessionalDevelopmentrsquo includes sessions on ethics man-agement and evidence-based medicine Towardsthe end of the week a subject expert is invited tolead a masterclass answering questions about thetopic of the week This has proved very popularwith students

Information services support

Base room books

The Library has supplied each PBL room with asmall collection of popular student textbooks theselection of which was based on the analysis of theshort-loan collection lending statistics and GEPtutors recommendations Problem-based learningemploys a variety of types of informationparticularly images eg X-rays ultrasoundsECG tissue sections and so most of the booksfinally chosen had good quality illustrations andphotographs Initially GEP staff suggested using a

chained library in each room but this seemed a bitsevere Electronic books were investigated butsuppliers did not have the popular core UKundergraduate medical textbooks available inelectronic format

It was finally decided to barcode and stamp thebooks and list them on a spreadsheet They arehoused in the base rooms and consulted duringfree time and tutorials GEP students take groupresponsibility for the textbooks and would collec-tively have to pay for replacements if books werelost or stolen So far none of the books have beenlost The books are extremely useful in the PBLtutorial where questions can be answered immedi-ately by the group consulting the relevant text-book The presence of textbooks within the roomshas not however reduced the numbers of librarybooks borrowed by GEP students In fact the firstyear GEP students borrow almost three times asmany books as the undergraduates on the 5-yearMBBS course

3

Course books

The content of each clinical problem is developedmonths in advance of the date of its release to the

Figure 1 Typical weekly timetable for year one

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20

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181

students and is updated intermittently by GEPproblem writers The final version is converted tothe definitive web clinical problem and released atthe appropriate time

Bibliographic references for each problem areusually the last to be considered by GEP problemwriters Fortunately many of the recommendedbooks are already in stock and available in ade-quate numbers but there have been occasionswhere we have been unable to buy and process newbooks quickly enough to be on the shelf for thePBL week

As well as buying extra copies of books we aimto add one copy of each recommended book to theshort-loan collection This collection is alreadylimited for space and if the collection expands fur-ther which is likely it will need to be relocated

GEP humanities books

Medicine in literature and medical humanitiesare common module subjects in US medicalcourses

56

and are slowly becoming popular inthe UK to support the lsquoPatient and Doctorrsquo themeof the medical curriculum

7

This part of thecurriculum aims to produce well-rounded doctorsable to communicate and understand ethicaldilemmas

8

As part of the support to both lsquoPatient andDoctorrsquo and lsquoPersonal and Professional Devel-opmentrsquo themes of the curriculum the Library haspurchased a variety of humanities books coveringmedicine in literature The resulting collectionincludes classic novels short stories autobiogra-phy and poetry Titles came from GEP staff andfrom various lsquoMedicine in Literaturersquo sites on theInternet In addition Medical School staff wereasked to donate personal copies of books of relev-ance to this theme to the Library The collectionshould be useful in helping students to addressethics communication and empathy skills in med-icine and will provide a rich learning resource It ishoped that the collection will be used by othercourses as well as by staff and students for recrea-tional reading

Computer aided learning (CAL)

Anatomy Project CD ROMs (Parthenon

Publishing Group) were purchased for use duringdissection classes The CDs were selected byanatomy lecturers with Information Services staffnegotiating licensing issues and advising oncompatibility for web delivery over the MedicalSchool Intranet These CDs are now available overthe Intranet for all students to use onsiteDemonstrations of cross sectional CT vascularanatomy endoscopic images MRI of the brain areavailable as well as tutorials and MCQs Sometutors integrated these CDs into the learningprocess however usage statistics are still lowwhich raises the question as to whether they areworth the effort of installing CD ROMs (webenabled or otherwise) are very unpredictablesometimes difficult to use and the software cancause PCs to crash

Training in the use of the wide variety of CALsoftware is mainly the responsibility of lecturersand the Library does not give any specific trainingin the use of CDs other than showing studentshow to access them

Supporting GEP web delivery

The Graduate Entry Programme uses webtechnology to support the PBL component of thecourse GEP started off using WebCT but recentlyswitched to Blackboard which is the chosencourseware for St Georgersquos partner institution atKingston University The Web element of thecourse gives students access to a variety ofdifferent types of information eg X-rays MRIscans videos of patient interviews etc whichwould normally be difficult to deliver seamlessly ina paper format Many of the images used arederived in-house from various departments suchas Anatomy Radiology and Histopathology

The information is delivered to students inincremental steps that keeps pace with tutorialsThis has been termed lsquoProgressive Deliveryrsquo

9

Information for different years of the course mustbe shielded to prevent for example first-year stu-dents from accessing second-year course materialComputing Services have worked with GEPcourseware developers to administer the serverside of clientdatabase software and have createdopen-source scripts (using Perl CGI and HTML)most appropriate for GEP

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182

Reading lists on the GEP website

Each problem includes a case presentation tutor-ials key topics library resources site activities andobjectives The library resources on the GEPwebsite consists of a page of web resources and apage of recommended reading

Recommended reading lists for each problemare checked for accuracy and converted to a webpage by library staff Journal articles are linked toeither the full text article or the homepage of thejournal website where possible

Initially the HERON service (Higher EducationResources Online)

10

was considered to providefull-text journal references but the cost and thetime taken to clear documents was prohibitive Asmore journals become available in electronic for-mat we hope to be able to provide seamless accessto greater numbers of full-text articles on the site

Web resources on the GEP website

Library staff provide relevant medical resourceson the Internet to support each problem A recentsurvey on the use of the GEP website by studentsproved these pages to be the second most popularpart of the site

Information assistants are trained to search theInternet evaluate sites using BIOME guidelines

11

and construct basic web pages for the GEP courseThey find it an enjoyable activity as well as usefulfor their professional development Sites chosentend to be rich in photographs diagrams or inter-active tutorials The logo of the chosen site is addedto the web page wherever possible to acknowl-edge the site and a brief description is includedA hyperlink provides a link from the logo to theactual website (Fig 2) Most sites are recommendedby library staff with limited input from clinicaltutors The resource pages are updated by informa-tion assistants every year This process is a continuouscommitment and although tedious to do is ess-ential in order to keep the course up to date

Training

All students are issued with network logons ande-mail accounts at the start of their course and haveaccess to a personal file space on the Medical

School server which is backed up regularly GEPstudents have compulsory IT and InformationSkills sessions when they start their course The ITsession introduces students to the School networkand covers basics such as the Intranet e-mailPowerpoint Word and Excel as well as informa-tion about computing services Most students arecompetent in using Microsoft Office and treat theIT session as a refresher course A separate sessionled by the GEP courseware manager covers the useof the GEP website

In the Information Skills session students aregiven a self-directed workbook that includes exer-cises on searching information using the librarycatalogue

and

data-bases Web resources such as the BIOME hub

12

and NeLH

13

are introduced as well as using elec-tronic journals Students were particularly inter-ested in learning more about electronic journalsdatabases and accessing these resources offsiteNext year we hope to collaborate with GEP prob-lem writers to provide an IT and InformationSkills session based on a clinical problem Thisshould make the session more interesting andrelevant for students

During the training sessions the majority of theGEP students seemed confident in using electronicresources to find information Further training inthe use of databases has been offered but has notbeen taken up This has been rather disappointingand we would like to see the Library providingmore specific training at relevant points in theGEP curriculum perhaps to compliment the lsquoPer-sonal and Professional Developmentrsquo themes suchas EBM web page design current awareness

Conclusion

For successful PBL ready access to first-classlibrary and computing facilities is a necessity GEPstudents at St Georgersquos have access to acomprehensive collection of books (over 45 000volumes) and journals (over 1500) as well as threecomputer resource rooms with 120 PCs whichinclude scanners and video equipment Onecomputer room is 24-h access In addition GEPstudents have 24-h access to their base rooms

Although they have their own base rooms GEPstudents still use study areas within the library and

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183

are heavy users of library and computing facilitiesAt the moment this increased use is manageableand has not been noticeable but may become moreapparent when the course doubles its intake fromSeptember 2002

Delivery of course material via the web is a sig-nificant difference between GEP at St Georgersquosand other GEP courses elsewhere The GEPdepartment employs courseware developers webdesigners administrators and PBL tutors Thishas been costly with significant start-up andmaintenance costs for GEP and has been demand-ing of staff time GEP has provided funding forone and a half members of Information Servicesstaff Currently library staff spend approximatelyhalf a day per week in term time creating web-

resource pages and further time is spent in check-ing reading lists ordering materials and makingsome items available as short loans Technicalproblems and negotiating licensing for softwarefor the course (courseware and CD ROMs) hasalso been time consuming

GEP is a driving force in the undergraduateMBBS curriculum development and resourcedevelopment at St Georgersquos The current under-graduate curriculum already has elements of PBLand case-based learning but is facing pressure tobecome more integrated and interactive The GEPcourse will be a significant influence in the curric-ulum renewal for the MBBS course due in 2003and it is anticipated that the undergraduate medicalcurriculum will take on aspects of the GEP course

Figure 2 Example of a library resource page on the GEP website

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184

such as a learning week more CBL and greaterweb support If this occurs the Library can expectmore frequent and intensive use of its facilitiespressurizing space and resources InformationServices may need to reorganize its infrastructureto cope with demand for study areas student sup-port for self-directed learning short loan materialsfor PBLCBL and increased expectation of webdelivery of resources to on-and offsite users

References

1 Graduate Entry Program (GEP)

Aims and Objectives of the Course

Available from httpwwwsghmsacukCoursesgephtm

2 Field M amp Gordon J Australian medical schools admit graduate students from all disciplines Available from httpwwwstudentbmjcomback_issues0990editorials305html

3 Martin S Impact of a graduate entry programme on medical school library service


2003

20

42ndash9

4

Tour a PBL Session

Available from httpwwwgmpusydeduauvguidestudentspbl_tourintrohtml

5 New York University School of Medicine

Medical Humanities

Available from httpendeavormednyuedulit-medindexhtml

6 Yale University

Program for Humanities in Medicine

Available from httpinfomedyaleeduintmedhummedwelcomehtml

7

Broadening your Reading Literature and Medicine

Available from httpwwwnclacuklibrarymedicalmedhumshtml

8 Calman K Literature in the education of the doctor

Lancet

1997

350

1622ndash49 Doeman P amp Key P lsquoProgressive deliveryrsquo of problem-

based learning a staged delivery of developing curriculum Abstract

Technology in Teaching and Learning in Higher Education an International Conference at Samos Island Greece 25ndash27 August 2000

10 HERON (Higher Education Resources On Demand)

Available from httpwwwheronacuk11 BIOME Guidelines Available from httpbiomeacuk

guidelines12 BIOME Available from httpwwwbiomeacuk13 National Electronic Library for Health Available from

httpwwwnelhnhsuk

Brief communication



20

pp179ndash184

180

lectures film clinical demonstrations ThelsquoPatient and Doctorrsquo session covers clinical andcommunications skills Community placementsinclude placement at GP practices hospices resi-dential homes etc lsquoPersonal and ProfessionalDevelopmentrsquo includes sessions on ethics man-agement and evidence-based medicine Towardsthe end of the week a subject expert is invited tolead a masterclass answering questions about thetopic of the week This has proved very popularwith students

Information services support

Base room books

The Library has supplied each PBL room with asmall collection of popular student textbooks theselection of which was based on the analysis of theshort-loan collection lending statistics and GEPtutors recommendations Problem-based learningemploys a variety of types of informationparticularly images eg X-rays ultrasoundsECG tissue sections and so most of the booksfinally chosen had good quality illustrations andphotographs Initially GEP staff suggested using a

chained library in each room but this seemed a bitsevere Electronic books were investigated butsuppliers did not have the popular core UKundergraduate medical textbooks available inelectronic format

It was finally decided to barcode and stamp thebooks and list them on a spreadsheet They arehoused in the base rooms and consulted duringfree time and tutorials GEP students take groupresponsibility for the textbooks and would collec-tively have to pay for replacements if books werelost or stolen So far none of the books have beenlost The books are extremely useful in the PBLtutorial where questions can be answered immedi-ately by the group consulting the relevant text-book The presence of textbooks within the roomshas not however reduced the numbers of librarybooks borrowed by GEP students In fact the firstyear GEP students borrow almost three times asmany books as the undergraduates on the 5-yearMBBS course

3

Course books

The content of each clinical problem is developedmonths in advance of the date of its release to the

Figure 1 Typical weekly timetable for year one

Brief communication



20

pp179ndash184

181






56


7


8









9


Brief communication



20

pp179ndash184

182





10





11


Training




and


12

and NeLH

13



Conclusion



Brief communication



20

pp179ndash184

183






Brief communication



20

pp179ndash184

184


References







2003

20

42ndash9

4

Tour a PBL Session



Medical Humanities


6 Yale University



7




Lancet

1997

350







httpwwwnelhnhsuk

Brief communication



20

pp179ndash184

181






56


7


8









9


Brief communication



20

pp179ndash184

182





10





11


Training




and


12

and NeLH

13



Conclusion



Brief communication



20

pp179ndash184

183






Brief communication



20

pp179ndash184

184


References







2003

20

42ndash9

4

Tour a PBL Session



Medical Humanities


6 Yale University



7




Lancet

1997

350







httpwwwnelhnhsuk

Brief communication



20

pp179ndash184

182





10





11


Training




and


12

and NeLH

13



Conclusion



Brief communication



20

pp179ndash184

183






Brief communication



20

pp179ndash184

184


References







2003

20

42ndash9

4

Tour a PBL Session



Medical Humanities


6 Yale University



7




Lancet

1997

350







httpwwwnelhnhsuk

Brief communication



20

pp179ndash184

183






Brief communication



20

pp179ndash184

184


References







2003

20

42ndash9

4

Tour a PBL Session



Medical Humanities


6 Yale University



7




Lancet

1997

350







httpwwwnelhnhsuk

Brief communication



20

pp179ndash184

184


References







2003

20

42ndash9

4

Tour a PBL Session



Medical Humanities


6 Yale University



7




Lancet

1997

350







httpwwwnelhnhsuk

practical aspects in supporting the st george's graduate entry programme

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