Skip to main content


<?xml version="1.0"?>

<!DOCTYPE TEI.2 SYSTEM "base.dtd">




<title>Teaching Health and Development: Can We Change Attitudes?</title></titleStmt>

<publicationStmt><distributor>BASE and Oxford Text Archive</distributor>


<availability><p>The British Academic Spoken English (BASE) corpus was developed at the

Universities of Warwick and Reading, under the directorship of Hilary Nesi

(Centre for English Language Teacher Education, Warwick) and Paul Thompson

(Department of Applied Linguistics, Reading), with funding from BALEAP,

EURALEX, the British Academy and the Arts and Humanities Research Board. The

original recordings are held at the Universities of Warwick and Reading, and

at the Oxford Text Archive and may be consulted by bona fide researchers

upon written application to any of the holding bodies.

The BASE corpus is freely available to researchers who agree to the

following conditions:</p>

<p>1. The recordings and transcriptions should not be modified in any


<p>2. The recordings and transcriptions should be used for research purposes

only; they should not be reproduced in teaching materials</p>

<p>3. The recordings and transcriptions should not be reproduced in full for

a wider audience/readership, although researchers are free to quote short

passages of text (up to 200 running words from any given speech event)</p>

<p>4. The corpus developers should be informed of all presentations or

publications arising from analysis of the corpus</p><p>

Researchers should acknowledge their use of the corpus using the following

form of words:

The recordings and transcriptions used in this study come from the British

Academic Spoken English (BASE) corpus, which was developed at the

Universities of Warwick and Reading under the directorship of Hilary Nesi

(Warwick) and Paul Thompson (Reading). Corpus development was assisted by

funding from the Universities of Warwick and Reading, BALEAP, EURALEX, the

British Academy and the Arts and Humanities Research Board. </p></availability>




<recording dur="00:34:59" n="6413">


<respStmt><name>BASE team</name>



<langUsage><language id="en">English</language>



<person id="nm0310" role="main speaker" n="n" sex="m"><p>nm0310, main speaker, non-student, male</p></person>

<person id="nm0309" role="participant" n="n" sex="m"><p>nm0309, participant, non-student, male</p></person>

<person id="nm0311" role="participant" n="n" sex="m"><p>nm0311, participant, non-student, male</p></person>

<person id="nm0312" role="participant" n="n" sex="m"><p>nm0312, participant, non-student, male</p></person>

<person id="nf0313" role="participant" n="n" sex="f"><p>nf0313, participant, non-student, female</p></person>

<person id="nm0314" role="participant" n="n" sex="m"><p>nm0314, participant, non-student, male</p></person>

<person id="nf0315" role="participant" n="n" sex="f"><p>nf0315, participant, non-student, female</p></person>

<person id="nm0316" role="participant" n="n" sex="m"><p>nm0316, participant, non-student, male</p></person>

<person id="nf0317" role="participant" n="n" sex="f"><p>nf0317, participant, non-student, female</p></person>

<person id="nm0318" role="participant" n="n" sex="m"><p>nm0318, participant, non-student, male</p></person>

<person id="nm0319" role="participant" n="n" sex="m"><p>nm0319, participant, non-student, male</p></person>

<person id="nf0320" role="participant" n="n" sex="f"><p>nf0320, participant, non-student, female</p></person>

<personGrp id="ss" role="audience" size="m"><p>ss, audience, medium group </p></personGrp>

<personGrp id="sl" role="all" size="m"><p>sl, all, medium group</p></personGrp>

<personGrp role="speakers" size="14"><p>number of speakers: 14</p></personGrp>





<item n="speechevent">Lecture</item>

<item n="acaddept">Primary Health Careand General Practice</item>

<item n="acaddiv">ls</item>

<item n="partlevel">Staff</item>

<item n="module">unknown</item>




<u who="nm0309"><kinesic desc="projector is on showing slide" iterated="n"/> so <pause dur="0.7"/> with that i shall introduce our <pause dur="0.2"/> next speaker <pause dur="0.7"/> Dr <gap reason="name" extent="2 words"/> who's based at the undergraduate <pause dur="0.4"/> # Department of <pause dur="0.3"/> General Practice at <gap reason="name" extent="1 word"/> University <pause dur="0.6"/> he is a senior lecturer in medical education and the clinical <pause dur="0.4"/> education <pause dur="0.4"/> lead within <pause dur="0.3"/> # the department of <pause dur="0.4"/> general practice <pause dur="0.4"/> and <gap reason="name" extent="1 word"/> is going to talk to us about the impact of a special study module <pause dur="0.4"/> on student attitudes <pause dur="0.2"/> <gap reason="name" extent="1 word"/> </u><pause dur="0.5"/> <u who="nm0310" trans="pause"> thank you <pause dur="17.1"/> right i've cheated slightly <pause dur="0.4"/> because at the time i was <pause dur="0.2"/> # invited by <gap reason="name" extent="1 word"/> <pause dur="0.8"/> to give a talk <pause dur="0.3"/> # <pause dur="0.3"/> i was thinking something <pause dur="0.3"/> slightly different from what i'm thinking at the moment <pause dur="1.5"/> but <pause dur="0.2"/> i hope that what i will provide you with is an attitude to <trunc>consid</trunc> # # an opportunity to consider <pause dur="0.6"/> # <pause dur="0.2"/> what we mean by attitudes and how we might measure them <pause dur="0.9"/> and the means by which i'm going to do this is i'm going to <pause dur="0.3"/> describe to you hopefully reasonably briefly <pause dur="0.5"/> a course which i developed in conjunction with <kinesic desc="changes slide" iterated="n"/> # <pause dur="0.8"/> a a development

charity based in <gap reason="name" extent="1 word"/> called Skillshare International <pause dur="1.3"/> and the # <pause dur="0.6"/> the # principal aim of the charity <pause dur="0.5"/> # is to work <pause dur="0.3"/> in partnership with people <pause dur="0.2"/> # and communities in Africa and India <pause dur="0.5"/> # to promote development <pause dur="0.4"/> and # <pause dur="0.4"/> the means by which they do this is <pause dur="0.2"/> partly by recruiting development workers to go <pause dur="0.2"/> and work and share their skills hence the name <pause dur="0.6"/> # <pause dur="0.2"/> with people in those communities <pause dur="0.6"/> but more recently they've developed # <pause dur="1.1"/> an arm of the charity which looks at development education within the U-K <pause dur="0.7"/> and jointly with David Weatherall who was at the time the development # education officer at # Skillshare <pause dur="0.7"/> # we devised and developed a <pause dur="0.2"/> # course for <pause dur="0.5"/> # students in the special study module section of the phase one curriculum <pause dur="0.4"/> # <pause dur="0.7"/><kinesic desc="changes slide" iterated="n"/> now <pause dur="0.9"/> # <pause dur="0.5"/> what the aim of the course was was to develop their understanding of issues around <pause dur="0.2"/> health and international development <pause dur="0.5"/> and # David and i were quite open # with the students that we obviously brought to this course a set of attitudes beliefs and

orientation towards development issues <pause dur="0.5"/> and we made those explicit we we made it quite clear that we didn't <pause dur="0.3"/> necessarily expect them to agree with us and we were very happy to discuss <pause dur="0.4"/> any conflicting or different opinions or attitudes towards development issues <pause dur="1.8"/> # <pause dur="0.3"/> 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 <pause dur="0.6"/> of the third year <pause dur="0.6"/> and we have a day a week and generally the pattern of teaching that we adopted was <pause dur="0.3"/> we were giving taught sessions in the mornings <pause dur="0.4"/> # and they would have time in the afternoons for self-study <pause dur="0.4"/> and to develop their assessment plans <pause dur="1.4"/> <kinesic desc="changes slide" iterated="n"/> and we set out # at the outset we had four themes that we wanted to study which sort of <pause dur="0.3"/> kind of drew on the skills and # <pause dur="0.4"/> of <pause dur="0.3"/> the people within Skillshare who were able to teach on

this course and <pause dur="0.5"/> partly address some issues perhaps <pause dur="0.2"/> # to do with <pause dur="0.4"/> # things i could bring to it which was issues perhaps more <pause dur="0.2"/> tightly related to <pause dur="0.3"/> becoming a doctor which is about disease control <pause dur="0.5"/> treatment and elimination <pause dur="1.8"/> and also <pause dur="0.2"/> # we <pause dur="0.5"/> # <pause dur="0.4"/> we found that this was extremely popular module because as you're probably all aware issues of globalization are <pause dur="0.4"/> have a high priority in the undergraduate <pause dur="0.2"/> student body at the moment # MEDSIN is a <pause dur="0.3"/> very active organization <pause dur="0.5"/> # and is promoting very heavily <pause dur="0.4"/> the teaching of these sorts of issues within the undergraduate curriculum <pause dur="1.5"/> # <pause dur="0.7"/> and again what Skillshare can bring is to get people to think about their skills and so <pause dur="0.3"/> # help them to orientate themselves towards <pause dur="0.4"/> # <pause dur="0.7"/> where they're going <pause dur="0.2"/> # in their course <pause dur="1.1"/> # <pause dur="1.2"/><kinesic desc="changes slide" iterated="n"/> and each theme <pause dur="0.4"/> was taught <pause dur="0.3"/> # around sessions <pause dur="0.4"/> # that looked at different aspects of those themes <pause dur="1.0"/> # <pause dur="0.7"/> and again the particular aspects we chose depended more on the <trunc>availa</trunc> the interest and availability <pause dur="0.4"/> of the teachers who were going

to do the sessions <pause dur="0.3"/> and we expected things like <pause dur="0.2"/> looking at the disease control of smallpox and malaria <pause dur="0.2"/> to act as paradigm <pause dur="0.3"/> conditions for <pause dur="0.3"/> diseases that are prevalent in developing countries <pause dur="2.6"/><kinesic desc="changes slide" iterated="n"/> right so that's a quick look at what we did <pause dur="0.2"/> and <pause dur="0.6"/> # we offered it # to twelve students <pause dur="0.4"/> # of whom six were female and five were male the sixth <trunc>stu</trunc> the <trunc>s</trunc> the the twelfth student <pause dur="0.3"/> came to our first session <pause dur="0.4"/> # and withdrew because she felt <pause dur="0.4"/> that she didn't have enough expertise in the area <pause dur="0.4"/> # unfortunately she did so by approaching faculty rather than me so i wasn't able to reassure her <pause dur="0.4"/> that we didn't expect her to have expertise <pause dur="0.7"/> what i think went wrong <pause dur="0.3"/> is that in our round of introductions at the very start of the course <pause dur="0.4"/> # six of the participants had actually lived or # in a developing <pause dur="0.2"/> country during all or part of their childhood <pause dur="1.4"/> and seven them seven of them had a <trunc>pa</trunc> parent one or more parent born outside of

the U-K <pause dur="0.3"/> and in two cases # these were students one from Africa <pause dur="0.2"/> # one from Nigeria and one from # Egypt <pause dur="0.3"/> whose parents # were were medically qualified <pause dur="0.5"/> so i'm afraid we frightened off the one student who thought <pause dur="0.3"/> that she was <unclear># <trunc>th</trunc></unclear> group within a group of experts # <pause dur="1.0"/><kinesic desc="changes slide" iterated="n"/> as we found out from the assessment process <pause dur="0.3"/> # <pause dur="0.2"/> 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 <pause dur="0.5"/><vocal desc="laughter" iterated="y" n="ss" dur="1"/> effective teaching <pause dur="1.2"/> and the process we used was we asked them to write an individual essay of two-thousand words <pause dur="0.4"/> on a topic of their own choosing <pause dur="0.5"/> # <pause dur="0.3"/> but <pause dur="0.4"/> # we had offered them a menu of different essay titles <pause dur="0.4"/> and in fact three of them <pause dur="1.0"/> # <pause dur="0.2"/> wrote essays about breastfeeding and H-I-V transmission <pause dur="0.6"/> two about access to <unclear>self</unclear> water two about prescribing branded drugs <pause dur="0.4"/> # two about education as the key to health and <pause dur="0.2"/> one student wrote an essay about human rights and its effect on health <pause dur="0.3"/> and

another about participation <pause dur="2.3"/> at the second phase of the assessment we divided them into two groups and we asked them <pause dur="0.3"/> # to prepare three different presentations on the same topic one would be a formal fifteen minute presentation very similar to what i'm <pause dur="0.5"/> doing here <pause dur="0.7"/> the second would be a poster again similar to the thing you might prepare for a for a conference presentation on the theme <pause dur="0.6"/> and the third and most interesting <pause dur="0.2"/> and certainly the one they i think they enjoyed the best <pause dur="0.7"/> was <pause dur="0.4"/> what we called a resource poor presentation in other words <pause dur="0.5"/> # we invited them to present on the topic # to a lay audience using no no resources whatsoever <pause dur="1.0"/><kinesic desc="changes slide" iterated="n"/> well <pause dur="0.9"/> 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 <pause dur="0.3"/> was on the politics of H-I-V control in Kenya and Uganda <pause dur="0.5"/> # and this was the group # doing their little role play both groups interestingly chose exactly the

same <trunc>tea</trunc> <pause dur="0.3"/><kinesic desc="changes slide" iterated="n"/> technique because the group that had wanted to talk about access to H-I-V treatment in South Africa <pause dur="0.7"/> again had prepared a mini drama <pause dur="0.9"/> # <pause dur="0.5"/> and # <pause dur="0.3"/> <trunc>th</trunc> as i say they certainly enjoyed it <trunc>w</trunc> i don't know about being resource poor because # <pause dur="0.4"/> one group # brought a # an inflatable swimming pool <pause dur="0.3"/> a plastic gun <pause dur="0.3"/> and a large amount of props to the presentation <pause dur="0.2"/> <vocal desc="laughter" iterated="y" n="ss" dur="1"/> <shift feature="voice" new="laugh"/># <shift feature="voice" new="normal"/> <pause dur="0.7"/> i've given presentations to audience in Africa and # <pause dur="0.4"/> you're doing pretty well if you've got a <pause dur="0.3"/> # a chalkboard to write on <pause dur="2.5"/><kinesic desc="changes slide" iterated="n"/> right moving on <pause dur="0.5"/> to <pause dur="1.3"/> towards what i'm hoping to get to <pause dur="0.3"/> to give you <pause dur="0.2"/> a <pause dur="0.4"/> # <pause dur="0.8"/> # <pause dur="0.2"/> <trunc>w</trunc> wanting really to develop a discussion # hopefully in this half hour slot <pause dur="1.6"/> # but we've we asked them about their view of some of the elements within the course <pause dur="0.5"/> # <pause dur="0.4"/> and <pause dur="0.5"/> this slide is is really about <pause dur="0.4"/> oh sorry <pause dur="0.2"/> <unclear>want to</unclear> go back again <pause dur="0.3"/> # <pause dur="1.7"/> had we got the balance right about teaching between # <pause dur="0.3"/> development topics that related to health and global development <pause dur="1.7"/> and <pause dur="0.5"/> you know did we did they feel

that # learning in this special study module which is outside the normal range of the curriculum <pause dur="0.5"/> # <pause dur="0.4"/> we were they were learning enough <pause dur="1.9"/> # <pause dur="0.2"/> and <pause dur="0.5"/> we also wanted them to reflect on the assessment process and as to whether that had helped <pause dur="0.6"/> # to develop their understanding <pause dur="3.0"/> and the last question was really the the counter <trunc>mo</trunc> the counter-question to the one about teaching on development topics <pause dur="1.2"/> now <trunc>m</trunc> <pause dur="0.2"/> # <pause dur="0.9"/> we only got ten responses out of the eleven students because # <pause dur="0.2"/> one responded by e-mail so this is a caution if you send out e-mail questionnaires <pause dur="0.5"/> # <pause dur="0.6"/> <trunc>i</trunc> if students use a different program to <pause dur="0.2"/> complete them and send them back to you to the one you sent them out in you get a garbled response so <pause dur="0.4"/> # his <pause dur="0.4"/> # <trunc>s</trunc> his responses to the free text questions were perfectly # <pause dur="0.6"/> # <pause dur="0.3"/> translatable but # the <pause dur="0.3"/> the # <pause dur="1.2"/> the crosses had appeared in the wrong boxes so we didn't know what he was actually saying <pause dur="1.6"/> i mean my interpretation of these was that <pause dur="0.4"/> we probably had for the students' view got the

balance about right between teaching on specific health-related issues and development issues <pause dur="0.7"/> # and that the course was generally <pause dur="0.2"/> well received <pause dur="0.2"/> # <pause dur="0.2"/> and that students # enjoyed it and the informal feedback we got was that they'd had a lot of fun <pause dur="0.6"/> doing the course and they felt they'd learned a lot <pause dur="0.2"/> so as it's not my job to entertain them <pause dur="0.4"/> but it is my job to educate them i <pause dur="0.2"/> regarded that as <pause dur="0.4"/> a success <pause dur="0.6"/> # <pause dur="1.0"/> and they felt that the presentations that they had prepared had helped them develop their understanding of the issues they'd chosen to study <pause dur="1.2"/> but of course <pause dur="0.3"/> these students had volunteered # they'd specifically opted to take this course and because this is a popular topic at the moment <pause dur="0.4"/> in medical education it was significantly oversubscribed and some special study modules <pause dur="0.4"/> may only have two or three applicants <pause dur="0.4"/> # <pause dur="0.4"/> so to have more students wanting to do it than actually did it <pause dur="0.4"/> # is perhaps not <pause dur="0.2"/> # always typical <pause dur="2.0"/> # <pause dur="1.4"/><kinesic desc="changes slide" iterated="n"/> and then we wanted to ask them about their attitudes to

the course and in in doing this i think we were hoping <pause dur="0.5"/> that we would get some kind of handle <pause dur="0.4"/> more generally on their attitudes <pause dur="0.4"/> # to the issues that we wanted to talk about <pause dur="1.7"/> so <pause dur="0.9"/> again we felt that # <pause dur="0.4"/> with a couple of exceptions # <pause dur="0.2"/> they'd enjoyed the course <pause dur="0.2"/> they felt <pause dur="0.4"/> # challenged to think about <trunc>deep</trunc> <pause dur="0.2"/> deeply about the issues <pause dur="1.1"/> and that they were more motivated <pause dur="0.2"/> # to learn about these issues # in the future <pause dur="1.4"/> now it's not <pause dur="0.3"/> 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 <pause dur="0.3"/> to undertake an elective within a developing country <pause dur="0.6"/> # although <pause dur="0.3"/> # we did say that students who <trunc>w</trunc> <pause dur="0.3"/> weren't thinking of doing an <trunc>e</trunc> elective in a developing country would benefit greatly from <pause dur="0.2"/> undertaking our course <pause dur="0.9"/> # <pause dur="1.0"/> but <pause dur="0.2"/> because we knew we were dealing with volunteers and it's certainly one of Skillshare's objectives to get people to <pause dur="0.5"/> offer their skills <pause dur="0.2"/> and work abroad <pause dur="0.4"/> it's <pause dur="0.2"/> gratifying that the majority of them didn't feel

put off from the <trunc>no</trunc> <pause dur="0.2"/> from the idea of doing that <pause dur="1.9"/> so that was their attitude to the course and moving on to whether <pause dur="0.4"/> their general attitudes had changed as a result of the course we asked them <pause dur="1.4"/><kinesic desc="changes slide" iterated="n"/> had they changed and ten of them said yes and one said no <pause dur="1.8"/> # <pause dur="1.4"/> and then when i analysed the free text <pause dur="0.5"/> <trunc>quest</trunc> the responses to the free text question <pause dur="0.7"/> seven of them talked about they felt more aware or more knowledgeable about the issues <pause dur="0.9"/> three of them felt they had a better understanding <pause dur="1.7"/> and four of them said they had an increased interest in the topic for the future <pause dur="1.5"/> but actually very few of them had <pause dur="0.5"/> <trunc>ac</trunc> responded to the question i'd set which is had their attitudes changed <pause dur="2.2"/><kinesic desc="changes slide" iterated="n"/> # <pause dur="0.5"/> these are the kind of these are just a sample of the responses that they made <pause dur="0.5"/> # and i've chosen one <pause dur="0.6"/> from each category <pause dur="0.2"/> that i ended up with <pause dur="2.1"/> so <pause dur="0.8"/> possibly <pause dur="0.4"/> understanding that this is a much more complex issue than they started is # <pause dur="0.2"/> does represent some sort of attitudinal shift <pause dur="1.5"/> and <pause dur="0.5"/> perhaps becoming

more sympathetic to the plight of refugees and asylum seekers again <pause dur="0.5"/> perhaps an attitudinal shift <pause dur="0.8"/> # <pause dur="0.3"/> and <pause dur="0.9"/> if you increase somebody's motivation to go and do something <pause dur="0.4"/> then <pause dur="0.2"/> you perhaps can infer <pause dur="0.2"/> that there may have been a change in their attitude <pause dur="0.2"/> a positive change in their attitude towards <pause dur="0.5"/> whatever you're asking about <pause dur="2.9"/><kinesic desc="changes slide" iterated="n"/> <gap reason="inaudible" extent="1 sec"/> the student whose attitudes hadn't changed <pause dur="0.2"/> now <pause dur="0.8"/> of course that may not be a bad thing <pause dur="0.2"/> 'cause he may have <pause dur="0.2"/> entered the course with exactly the kind of attitudes that David and i <pause dur="0.3"/> hoped students would develop during the course <pause dur="0.3"/> and all we did was confirm in him in his previous attitudes that <pause dur="0.4"/> were what we were interested in <pause dur="2.2"/> 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 <pause dur="0.9"/><kinesic desc="changes slide" iterated="n"/> so <pause dur="0.5"/> course i <unclear>headed across</unclear> to the dictionary like we all do <pause dur="0.9"/> and the first meaning in the dictionary is all to do

with # <pause dur="0.2"/> body posture <pause dur="0.3"/> so i think i felt that definition wasn't particularly helpful to me <pause dur="1.0"/> the second <trunc>def</trunc> definition is that a state of mind or a feeling <pause dur="0.2"/> a disposition <pause dur="0.6"/> and the example the <trunc>dish</trunc> the dictionary quotes is had a positive attitude about work <pause dur="1.7"/> and the second <pause dur="0.2"/> # <pause dur="0.6"/> definition which is probably one better understood by teenagers and young people <pause dur="0.7"/> is an arrogant or hostile state of mind or disposition <pause dur="1.6"/> now <pause dur="0.6"/> that i find very interesting because it <pause dur="0.2"/> made me remember something that Lesley Southgate said when she came to <gap reason="name" extent="1 word"/> to give a presentation about poorly performing doctors <pause dur="1.7"/> and what she found is that <pause dur="0.2"/> that the <trunc>s</trunc> the doctors whom <pause dur="0.5"/> that <pause dur="0.4"/> process has identified as poorly performing <pause dur="0.3"/> and whom they were having most difficulty <pause dur="0.4"/> in reforming <pause dur="0.3"/> into <pause dur="0.7"/> doctors who would perform well in future <pause dur="0.6"/> it was to do with attitude it was not about their knowledge <pause dur="0.3"/> on the whole these doctors had good knowledge <pause dur="0.4"/> nor was it

about their skills they were often quite skillful <pause dur="0.2"/> # surgeons for example where obviously <pause dur="0.2"/> skill is <pause dur="0.2"/> very important <pause dur="1.1"/> and <pause dur="0.6"/> they'd identified <pause dur="0.3"/> this was the particularly different category of doctor to deal with <pause dur="0.6"/> it also made me remember an incident with one of our students <pause dur="0.4"/> who and one of our practice teachers rang up and said we're very concerned about this student <pause dur="0.5"/> because # during the midpoint assessment <pause dur="0.3"/> # which is <pause dur="0.2"/> the clinical assessment with live patients in the doctor's surgery <pause dur="0.4"/> the student <pause dur="0.3"/> possibly a mistaken attempt to <pause dur="0.2"/> create a light-hearted environment had told a patient <pause dur="0.3"/> female patient getting undressed for <pause dur="0.4"/> not a vaginal examination but an abdominal examination <pause dur="0.3"/> go behind the <trunc>sceen</trunc> screens and get your kit off <pause dur="1.0"/> now <pause dur="1.3"/> this was a student who i by chance i actually had <pause dur="0.2"/> in my small group <pause dur="0.6"/> and he was a student who'd displayed very great <trunc>weak</trunc> <pause dur="0.2"/> found it very difficult to get him to accept that one of the videotape consultations he'd looked

at <pause dur="0.4"/> there were problems in the behaviour and relationship of <pause dur="0.2"/> the doctor <pause dur="0.4"/> on the tape and the patient <pause dur="0.4"/> and he was insisting that okay the doctor wasn't clinically very competent <pause dur="0.4"/> but he was polite and therefore he thought this doctor was behaving very well with this patient <pause dur="0.9"/> and the entire group eventually ended up siding against him <pause dur="0.6"/> and he wouldn't shift his <pause dur="0.2"/> attitude <pause dur="0.3"/> towards this performance <pause dur="1.7"/> 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 <pause dur="0.3"/> are pretty good at picking up on these kind of issues <pause dur="0.6"/> and generally <pause dur="0.2"/> # they'll <pause dur="0.2"/> they'll <pause dur="0.3"/> refer them to us and we will try and get the faculty to take some notice of them <pause dur="0.8"/> 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 <pause dur="1.1"/> now <pause dur="0.5"/> the problem is <pause dur="0.5"/> is i've really got no idea whether this student i'm sure the student's

graduated <pause dur="0.5"/> and although he probably said all the right things to John Cookson <pause dur="0.3"/> i don't really know whether his attitudes have changed very much <pause dur="3.4"/><kinesic desc="changes slide" iterated="n"/> so i then <unclear>wondered</unclear> what have other people done <pause dur="0.3"/> about attitudes <pause dur="0.3"/> so i just did a quick <pause dur="0.2"/> # flip through Medical Education <pause dur="0.3"/> using the keyword attitude in the search <pause dur="0.4"/> and came up with seventy-four articles where that's the <pause dur="0.7"/> where that is a keyword that the author's used to describe the purpose of their work <pause dur="0.4"/> since January nineteen-ninety-eight <pause dur="0.4"/> forty-six of which relate to undergraduate medical education <pause dur="1.2"/> well twenty-two of these papers essentially are about the students' teaching and learning experience so it's nothing to do with their attitudes <pause dur="0.9"/> nine of them are about their attitudes towards patients or patient groups almost <trunc>pr</trunc> almost entirely <trunc>res</trunc> these papers were written by psychiatrists who claim people were <pause dur="0.4"/> vulnerable there's one paper by an epidemiologist but again that's no surprise that <pause dur="0.5"/> these two groups of specialties in

medical schools <pause dur="0.3"/> get a bit sensitive about how students perceive their speciality <pause dur="1.1"/> eleven of the <trunc>paysh</trunc> # the papers were about particular issues or topics # for example <pause dur="0.5"/> # <pause dur="0.9"/> about the doctor-patient relationship or their attitudes towards terminal illnesses # <pause dur="0.5"/> as a topic on which they were being taught <pause dur="0.5"/> and four related to something about their personal experiences <pause dur="1.4"/> a majority the overwhelming majority of these # <pause dur="0.2"/> papers had assessed student attitude by use of questionnaires <pause dur="0.3"/> i guess most of them derived <pause dur="0.2"/> <trunc>pr</trunc> precisely the way i derive questionnaires <pause dur="0.4"/> rather than the way that # Dr <gap reason="name" extent="1 word"/> does <pause dur="1.0"/> 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 <pause dur="2.8"/> so <pause dur="0.6"/> the issues that arose then for me is well <pause dur="0.3"/> i'd wanted to measure attitude and i hadn't done it well okay we hadn't done a before and after questionnaire <pause dur="0.5"/> but <pause dur="0.5"/> if i'm going to measure attitude shift amongst my

students <pause dur="0.2"/> who take the module next September <pause dur="1.4"/> these are all volunteers who want to study this topic so it <pause dur="0.2"/> it may be that they already have all the right attitudes and nothing we can do can shift them <pause dur="0.5"/> so <pause dur="0.3"/> do we need control groups and <pause dur="0.2"/> and although i didn't look in detail at all the seventy-four papers <pause dur="0.4"/> 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 <pause dur="2.0"/> and <pause dur="2.4"/> this then relates back to something that i think is really much more <pause dur="0.6"/> problematic and why i <pause dur="0.2"/> related the anecdote i did about the student who said get your kit off <pause dur="1.3"/> is <pause dur="1.2"/> we talk about measuring knowledge and skills <pause dur="0.3"/> within a medical education and there's <pause dur="0.3"/> huge vast literature <pause dur="0.2"/> about how you do that effectively and reliably <pause dur="1.4"/> and that's actually quite relatively easy <pause dur="1.0"/> but how do we measure attitude <pause dur="0.7"/> # <pause dur="1.4"/> i come from <gap reason="name" extent="1 word"/> so <pause dur="0.4"/> the example of Peter Green the doctor who sexually assaulted patients in his surgery is obviously a

very live one for us <pause dur="0.3"/> particularly as as he was a partner in one of our teaching practices <pause dur="1.0"/> and this is a doctor who's regarded as very outgoing very cultured <pause dur="0.5"/> regarded as a very competent general practitioner by all his colleagues <pause dur="1.4"/> and <pause dur="0.4"/> but <pause dur="0.2"/> his attitudes towards his patients <pause dur="0.3"/> were <pause dur="0.2"/> about as arrogant as you can get which is that i inject them with anaesthetics and i can sexually assault them <pause dur="2.0"/> and of course <pause dur="0.5"/> there were concerns about the attitudes of Harold Shipman <pause dur="0.8"/> and because of behaviours in previous practices <pause dur="0.4"/> but yet his colleagues regarded him as a competent doctor and he wasn't being flagged up by any other mechanisms that we generally <pause dur="0.7"/> use to know and we <pause dur="0.2"/> might not use in teaching practice or particular practice for teaching because we're concerned about the professional competence of the doctors there <pause dur="1.4"/> and yet these were two of the most <pause dur="0.4"/> attitudinally dangerous and <pause dur="0.3"/> 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 <pause dur="2.0"/><kinesic desc="changes slide" iterated="n"/> so should we measure whether our students have appropriate attitudes when they start <pause dur="1.6"/> and can we assess their attitudes during medical education <pause dur="2.1"/> and how do we <trunc>fine</trunc> define what we mean by good and bad attitudes <pause dur="1.0"/> and if it is desirable to assess them <pause dur="0.5"/> how do we prevent students from playing the game <pause dur="0.5"/> '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 <pause dur="0.8"/> but it isn't very difficult if you're as bright as our students to spot what the socially desirable answer <pause dur="0.3"/> to the question might be <pause dur="1.4"/> 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 <pause dur="0.7"/> # hopefully that's sown some seeds of thought in your minds </u><pause dur="5.1"/> <u who="nm0311" trans="pause"> can i ask # if you if you if you were to do this again <pause dur="0.6"/> would you actually have some sort of measure of attitudes before and after <unclear>it</unclear> </u><pause dur="0.5"/> <u who="nm0310" trans="pause">

yes if i had the time </u><u who="nm0311" trans="overlap"> and by what # <pause dur="0.2"/> <trunc>w</trunc> what would be <pause dur="0.3"/> what method would you use </u><pause dur="0.9"/> <u who="nm0310" trans="pause"> well if i had the time i'd <pause dur="0.3"/> i'd in September i will <pause dur="0.2"/> probably try to use three <pause dur="0.2"/> three groups with the students who come on our module <pause dur="0.3"/> the students who expressed a desire to come on our module who don't get a place <pause dur="0.5"/> # and the students who had no wish whatsoever to come on our module <pause dur="0.6"/> # now whether i'll get <pause dur="0.4"/> we've <trunc>of</trunc> we're offering this course to eighteen students so whether we'll get <pause dur="0.7"/> eighteen students in each group i don't know <pause dur="0.3"/> # <pause dur="0.2"/> and i will design <pause dur="0.2"/> # like an instrument or if i if i can't find one <pause dur="0.3"/> that measures attitudes towards # <pause dur="0.2"/> issues of global health and development </u><pause dur="1.8"/> <u who="nm0312" trans="pause"> i think the as you said <gap reason="name" extent="1 word"/> the real problem with # 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 <pause dur="0.3"/> no one's going to say well i think <trunc>no</trunc> nobody should be able to come to this country at all and <pause dur="0.3"/> they're all going to say oh i do sympathize and it's difficult and <pause dur="0.3"/> they're all too clever to give an answer which is actually going to be truthful aren't they which <trunc>i</trunc> it if it's a if it's an assessment tool <pause dur="0.6"/> and that's the real problem isn't it how how do you measure it </u><pause dur="0.2"/> <u who="nm0310" trans="pause"> i think that's certainly one of the problems </u><u who="nm0312" trans="overlap"> yeah </u><u who="nm0310" trans="overlap"> yeah </u><pause dur="0.6"/> <u who="nf0313" trans="pause"> has anybody tried to define good and bad attitude </u><u who="nm0312" trans="latching"> yeah </u><pause dur="0.6"/> <u who="nm0310" trans="pause"> # <pause dur="0.3"/> # not that i'm not aware of and i've i've <gap reason="inaudible" extent="1 sec"/> </u><u who="nf0313" trans="overlap"> 'cause surely that's a very subjective <pause dur="1.5"/> call </u> <u who="nm0310" trans="overlap"> i mean i think the G-M-C has <gap reason="inaudible" extent="1 sec"/> tomorrow's doctors revisited </u><pause dur="0.2"/> <u who="nf0313" trans="pause"> mm </u><u who="nm0310" trans="overlap"> # <pause dur="0.5"/> it's pretty obvious what <pause dur="0.3"/> would be regarded by the G-M-C as # the appropriate set of attitudes # <pause dur="0.4"/> and i suppose also in the <pause dur="0.4"/> guide to good practice as well <pause dur="0.2"/> # <pause dur="1.7"/> what would be consensus <unclear>about</unclear> attitude

is is embedded within them <pause dur="0.3"/> but # but of course the more explicit you make it <pause dur="0.4"/> the the the greater the problem of either of those two <pause dur="0.2"/> # how do you stop people lying to you when you're asking them </u><pause dur="0.4"/> <u who="nf0313" trans="pause"> the the thing is with attitudes as well is that <pause dur="0.2"/> flexibility in each area i'm just looking at general practice <pause dur="0.4"/> some G-Ps that <pause dur="0.8"/> are happy with <pause dur="0.2"/> 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 <pause dur="0.4"/> it's <pause dur="0.3"/> just very woolly in certain areas isn't it i just feel <pause dur="0.7"/> if you go in to <trunc>ha</trunc> to try to create a scale </u><pause dur="1.4"/> <u who="nm0310" trans="pause"> yes and i think in a sense that talking about it is the first step <pause dur="0.2"/> because <pause dur="0.5"/> we can agree # obviously as we did in nineteen-sixty-eight </u><u who="nf0313" trans="latching"> mm </u><u who="nm0310" trans="latching"> that we would allow doctors to hold both sets of attitudes and both would be regarded as socially <pause dur="0.3"/> very acceptable it would be regarded as acceptable <pause dur="0.4"/> what was necessary the <pause dur="0.4"/> doctors were honest and explicit

about their attitudes <pause dur="0.3"/> towards the topic of abortion <pause dur="0.6"/> # it's what you do about <pause dur="0.5"/> the the doctors who are not prepared perhaps to be explicit <pause dur="0.4"/> that they think <pause dur="0.2"/> patients are a whingeing bunch of losers who shouldn't think of taking up their valuable <pause dur="0.4"/> professional time <pause dur="1.4"/> yet we all recognize them <pause dur="0.2"/> yeah </u><pause dur="0.4"/> <u who="nm0314" trans="pause"> i was # i was just reflecting on <pause dur="0.7"/> this from the point of view as as you're saying knowledge and skills are very easy things to assess aren't they <pause dur="0.4"/> i'm i'm wondering with the increased <pause dur="0.9"/> culture of <pause dur="0.4"/> if you like political correctness and the issues that are being raised around the questionnaire and the the issues the gentleman raised here <pause dur="0.3"/> that nobody's going to lie on those things <pause dur="0.3"/> whether maybe a questionnaire's the right tool <pause dur="0.3"/> even <pause dur="0.4"/> to assess <pause dur="0.3"/> in this day and age when people are so aware of it <pause dur="0.3"/> one of one of the things that fascinated me <pause dur="0.3"/> earlier on is when you were <pause dur="1.8"/> is that is that your questionnaires themselves seem seem to give you those sorts of answers <pause dur="0.2"/> in

terms of attitude that reflect on the learning <pause dur="0.3"/> 'cause there was a culture <unclear>around an</unclear> evaluation that says <pause dur="0.3"/> what did you learn <pause dur="0.3"/> what are the key learning issues that you've taken away from today's event <pause dur="0.3"/> and maybe that's why the response in terms of attitude is that way as well because very often you're saying <pause dur="0.3"/> how do you now feel <pause dur="0.2"/> about working in different environments so <pause dur="0.2"/> perhaps <pause dur="0.3"/> the answer to some of that may be about <pause dur="0.3"/> one to one contact but that is a resource issue clearly </u><pause dur="0.6"/> <u who="nm0310" trans="pause"> yeah </u><u who="nm0314" trans="latching"> yeah </u><u who="nm0310" trans="overlap"> i know that a <gap reason="inaudible" extent="1 sec"/> very different questionnaire and i think </u><u who="nm0314" trans="overlap"> yeah </u><pause dur="0.2"/> <u who="nm0310" trans="overlap"> your suggestions would be ones i would incorporate in writing it # <pause dur="0.6"/> yeah <kinesic desc="indicates member of audience" iterated="n"/></u><pause dur="0.9"/> <u who="nf0315" trans="pause"> yeah i'm i'm really <pause dur="0.2"/> pleased to see this whole issue about attitude coming up because i'm in the middle of doing my <pause dur="0.3"/> well <pause dur="0.3"/> towards the end of actually a very big literature search at the

moment <pause dur="0.4"/> about evalaution and various elements of of communication including <pause dur="0.4"/> # professionalism and attitude which we're trying to encapsulate in assessment at the moment <pause dur="0.5"/> and doing the full literature review the the results that you've just # shown for medical education <pause dur="0.7"/> are reflected elsewhere and i was i was trying to find examples of papers whereby <pause dur="0.3"/> external assessors or simulated patients had attempted some measure of attitude <pause dur="0.4"/> i found about two papers <pause dur="0.4"/> and that worked on the basis of giving somebody a checklist either an external examiner or a simulated patient <pause dur="0.4"/> that said # <pause dur="0.2"/> <trunc>s</trunc> on a scale of one to four <pause dur="0.6"/> one bad four very good <pause dur="0.4"/> rate the student's integrity <pause dur="0.2"/> rate the student's altruism <pause dur="0.6"/> on a clinical examination <pause dur="0.4"/> i i i found myself reflecting on the the impossibility of that task from the point of view of the assessor <pause dur="0.6"/> and it's obviously something that you've thought about as well and i wondered if you had any <pause dur="0.9"/> any <trunc>th</trunc> i i i would be really

interested to know whether you think it's actually possible to externally assess <pause dur="0.5"/> # something like a student's integrity </u><pause dur="1.7"/> <u who="nm0310" trans="pause"> # <trunc>w</trunc> i think yes i think it is possible but how realistic it is that we assess this particularly if we were wanting to <pause dur="0.4"/> make judgements about <unclear>whether</unclear> the student should progress in their education or not <pause dur="0.5"/> i think that's the big difficulty i mean it's interesting what she's saying because <pause dur="0.6"/> the <pause dur="0.3"/> process you described in those two papers that have attempted to do this probably is actually measuring patient satisfaction </u><pause dur="0.3"/> <u who="nf0315" trans="pause"> yes </u><u who="nm0310" trans="latching"> which i think is a rather different <pause dur="0.4"/> set of concepts to what i mean by <pause dur="0.5"/> appropriate professional attitudes towards patients themselves </u><u who="nf0315" trans="latching"> indeed well i think the the well one that i read most recently i can't remember the the names of the authors but </u><u who="nm0310" trans="overlap"> mm </u><u who="nf0315" trans="overlap"> i remember reading the paper <pause dur="0.5"/> # they concluded that there's no

point in having a separate measurement for attitudinal professionalism </u><u who="nm0310" trans="overlap"> mm </u><u who="nf0315" trans="overlap"> 'cause there's so many overlaps with their basic communication checklist </u><u who="nm0310" trans="overlap"> mm </u><pause dur="0.5"/> <u who="nf0315" trans="pause"> i thought what a shame </u><u who="nm0310" trans="overlap"> mm </u><u who="nf0315" trans="overlap"> because <pause dur="0.3"/> <trunc>every</trunc> everything that you've <pause dur="0.2"/> said in your presentation i think highlights a real need </u><pause dur="0.6"/> <u who="nm0310" trans="pause"> mm </u><u who="nf0315" trans="overlap"> to take this subject very seriously to find some way of dealing with it sensibly </u><pause dur="1.0"/> <u who="nm0310" trans="pause"> mm okay </u><u who="nm0316" trans="overlap"> in in general practice <pause dur="0.2"/> # postgraduate education don't trainers assess <pause dur="0.5"/> their registrars for attitude and and surely that's a more realistic </u><u who="nf0317" trans="latching"> yeah </u><pause dur="0.2"/> <u who="nm0316" trans="pause"> opportunity to assess them <unclear>by</unclear> over a year by talking to patients and by observing them and <pause dur="0.6"/> that's when if someone has got an attitude problem or a problem with # professionalism then it's going to get flagged up </u><pause dur="0.6"/> <u who="nm0310" trans="pause"> i'm sure you're right except it's not a field i know about <pause dur="0.3"/> 'cause i <pause dur="0.2"/> my

background's entirely in <pause dur="0.2"/> undergraduate education i mean i <pause dur="0.2"/> i'd say that i get a feel for it in eight weeks of one to one practice based teaching <pause dur="0.5"/> # with students # </u><pause dur="0.5"/> <u who="nm0312" trans="pause"> there's quite <gap reason="inaudible due to overlap" extent="1 sec"/> sorry </u><u who="nm0310" trans="overlap"> but you can have somebody from the <trunc>back</trunc> # some postgraduate background wants to </u><u who="nm0312" trans="pause"> 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 <pause dur="0.5"/> attitude is remiss and what it actually is is their ability <trunc>com</trunc> to communicate and their actual internal attitudes are fine but </u><u who="nm0318" trans="latching"> mm </u><u who="nm0312" trans="latching"> it's very difficult to assess isn't it </u><pause dur="0.6"/> <u who="nf0313" trans="pause"> do you <trunc>thi</trunc> </u><u who="nm0310" trans="overlap"> but is it # <unclear>i met</unclear> one of Harold Shipman's patients <pause dur="0.6"/> who thought </u><u who="nm0312" trans="overlap"> that they loved him </u><u who="nm0310" trans="overlap"> <gap reason="inaudible due to overlap" extent="1 sec"/> </u><u who="nm0319" trans="overlap"> yeah </u><pause dur="0.9"/> <u who="nm0310" trans="pause"> # <gap reason="inaudible" extent="1 sec"/> doctor he just <pause dur="0.2"/> believed it was right to kill your patients <pause dur="0.3"/> so <pause dur="1.0"/> <vocal desc="laughter" iterated="y" n="ss" dur="1"/> <unclear>albeit</unclear> <pause dur="0.2"/> # <gap reason="inaudible" extent="2 sec"/> a hard case to make by law but <pause dur="0.5"/> you know <pause dur="0.2"/> 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 <pause dur="0.3"/> you have vibes about students and <pause dur="0.4"/> and a student who's sat <pause dur="0.6"/> putting data into his P-D-A <pause dur="0.3"/> during a <pause dur="0.2"/> seminar <vocal desc="laughter" iterated="y" n="ss" dur="1"/> now <pause dur="0.6"/> i mean it does annoy me <pause dur="0.2"/> but <pause dur="0.2"/> i <pause dur="0.4"/> # other things about him annoyed me <pause dur="0.5"/> # <pause dur="0.5"/> now <pause dur="0.3"/> you know how do i take that forward <vocal desc="laugh" iterated="n"/> </u><pause dur="0.8"/> <u who="nm0319" trans="pause"> can i just raise a issue to # <pause dur="0.6"/> attitude i think is extremely difficult assess because <pause dur="0.5"/> you're talking about right or wrong <pause dur="0.6"/> some sort of judgement value isn't it <pause dur="0.4"/> # <pause dur="0.6"/> to me <pause dur="0.7"/> some people might say <pause dur="0.3"/> collecting a ticket <pause dur="0.3"/> in those # <pause dur="0.8"/> display car park that still <pause dur="0.4"/> got time to expire and you take it <pause dur="0.3"/> it's illegal but a lot of people do and think well that's okay <pause dur="1.1"/> <vocal desc="laughter" iterated="y" n="ss" dur="1"/> to so i think sometimes issue is <pause dur="0.2"/> to me it's more assessing that person what have they got inside <pause dur="1.9"/> what </u><u who="nm0310" trans="overlap"> well </u><u who="nm0319" trans="overlap">

what have they got inside that <pause dur="0.2"/> no i know that i might have prejudice <pause dur="0.3"/> because my religious my cultural background <pause dur="0.3"/> but i know with my professionalism that won't affect <pause dur="0.4"/> my performance <pause dur="0.7"/> # with a patient that to me more important when people know inside like Shipman <pause dur="0.2"/> they carry on doing it carry on doing it <pause dur="0.2"/> eventually that's why they get caught <pause dur="0.9"/> not because they are not clever enough <pause dur="0.4"/> because they lost insight <pause dur="0.8"/> that's what the police always say in in criminal things </u><pause dur="1.1"/> <u who="nm0310" trans="pause"> yeah it's probably how both Peter Green and Harold Shipman were caught i guess because <pause dur="0.5"/> they just didn't believe they were going to get caught and so they became careless <pause dur="0.5"/> i mean </u><u who="nm0319" trans="overlap"> so we all know our weakness <trunc>ou</trunc> <trunc>ou</trunc> # but once you know you </u><u who="nm0310" trans="overlap"> yeah </u><u who="nm0319" trans="overlap"> got insight it's no wonder you don't make mistake isn't it </u><pause dur="0.8"/> <u who="nm0310" trans="pause"> yes i mean <trunc>i</trunc> <trunc>i</trunc> whether things would have been different <pause dur="0.2"/> you know <pause dur="0.4"/> with <pause dur="0.6"/> more robust

and reliable systems of professional evaluation of your <pause dur="0.4"/> peers and your colleagues 'cause within group practice <pause dur="0.3"/> you would hope it's hard to get away with <pause dur="0.4"/> i mean to bring it back again to the real world and it might be issues like <pause dur="0.4"/> i mean overprescribing just because you want quick simple consultations now <pause dur="0.5"/> you know i think that displays <pause dur="0.2"/> remiss political <trunc>atti</trunc> # professional attitudes that need <pause dur="0.4"/> to be tackled because <pause dur="0.4"/> # <pause dur="0.4"/> it's it's <pause dur="0.2"/> underperforming quite seriously if your response to every patient is to prescribe them <pause dur="0.3"/> something and finish the consultation in two minutes <pause dur="0.4"/> but it's very common behaviour <pause dur="1.3"/> # i mean one of the things that's interesting is is that <pause dur="0.3"/> if you sit as i have done on finals exam board meetings <pause dur="0.3"/> you have this discussion about students <pause dur="0.4"/> # who are failing <pause dur="0.5"/> and <pause dur="0.4"/> usually what <trunc>ha</trunc> they usually fail because they don't attend and i think they usually don't attend either because they're ill <pause dur="0.3"/> which is

one set of issues or because they're actually they're not motivated to be there <pause dur="0.7"/> # <pause dur="0.4"/> and it's remarkable how people who've been around the system for a long time <pause dur="0.3"/> have actually spotted these students in the first weeks and <gap reason="inaudible" extent="1 sec"/> okay sits there and says yes i knew they were going to be a bad one <pause dur="0.5"/> so there is something about the comportment the behaviour <pause dur="0.3"/> the attitude even in a group of a hundred-and-eighty students arriving at the medical school people with experience <pause dur="0.7"/> feel they can spot students whose attitudes cause concern and when they're called to account <pause dur="0.2"/> for various reasons during the course <pause dur="0.5"/> you know that concern is heightened <pause dur="0.4"/> but the institution finds it very difficult to do anything with that concern </u><pause dur="0.6"/> <u who="nf0313" trans="pause"> how easy is it to change people's attitudes or is it the fact that you're <pause dur="0.5"/> teaching someone that what they're thinking is wrong even though they still think it they should not act in that way <pause dur="0.4"/> <gap reason="inaudible" extent="1 sec"/> i don't know </u><pause dur="0.8"/> <u who="nm0310" trans="pause">

i i mean i <pause dur="0.4"/> <vocal desc="laugh" iterated="n"/> <pause dur="0.4"/> don't know whether anybody has a response to that question # <pause dur="2.1"/> i mean i think it's difficult <pause dur="0.3"/> # <pause dur="0.2"/> because you can change behaviours i mean </u><pause dur="0.7"/> <u who="nf0313" trans="pause"> it's like your questionnaire you <pause dur="0.2"/> when you were interested <unclear>in</unclear> attitudes before and attitudes afterwards </u><u who="nm0310" trans="latching"> mm </u><pause dur="0.3"/> <u who="nf0313" trans="pause"> would that come from a knowledge point of view <pause dur="0.3"/> <gap reason="inaudible" extent="1 sec"/> </u><pause dur="0.7"/> <u who="nm0310" trans="pause"> i would think if i wrote the questionnaire carefully enough i probably could measure real change in attitudes of students who had become <pause dur="0.2"/> much more positive in their views of <pause dur="0.2"/> asylum seekers and refugees or much more positive about # <pause dur="0.3"/> developing countries that want to <pause dur="0.3"/> # <pause dur="0.5"/> <trunc>pr</trunc> you know <pause dur="0.4"/> # produce <trunc>pate</trunc> # patented drugs cheaply <pause dur="0.4"/> so you could say <pause dur="0.2"/> well <pause dur="0.2"/> those are the attitudes shifts i want to see as a result of my course <pause dur="0.4"/> # and i'll measure those and <pause dur="0.2"/> i mean i can do a control group and i can check whether <pause dur="0.3"/> they haven't changed in my control group <pause dur="0.6"/> # <pause dur="0.4"/> so you can do

that <pause dur="0.3"/> # <pause dur="0.2"/> so you can <pause dur="0.2"/> i think you can change attitude <pause dur="0.4"/> but <pause dur="0.3"/> obviously these are <trunc>r</trunc> relatively insensitive or <pause dur="0.2"/> relatively safe attitudes to change so it's okay to say <pause dur="0.3"/> well i now think more positively of asylum seekers because i've met them <pause dur="0.3"/> and someone's given me a course about them and explained to me why they're here <pause dur="0.5"/> and that's quite safe but how you deal with the much more serious <pause dur="0.2"/> attitudes which is <pause dur="0.6"/> basically patients are wasters and i don't like sealing seeing them <pause dur="0.4"/> # because it's socially undesirable <pause dur="0.4"/> # to say that <pause dur="0.2"/> and yeah <pause dur="0.3"/> we all know that <pause dur="0.4"/> lots of doctors and even students <pause dur="0.7"/> # think it <pause dur="1.0"/> to a greater or lesser degree so </u><pause dur="4.3"/> <u who="nf0320" trans="pause"> <gap reason="inaudible" extent="1 sec"/> colleges try to measure attitudes # because <unclear><trunc>ti</trunc></unclear> postgraduates <pause dur="0.6"/> # <pause dur="0.5"/> for example the M-R-C-G-P examination looks at # <gap reason="inaudible" extent="1 sec"/> and consultation skills <pause dur="0.3"/> and oral examinations <pause dur="0.2"/> do you see that those kind of techniques might be wrong for undergraduates <pause dur="0.8"/> <gap reason="inaudible" extent="1 sec"/></u><u who="nm0310" trans="overlap">

# <pause dur="1.9"/> i think it's difficult because i would <pause dur="0.4"/> <vocal desc="sigh" iterated="n"/><pause dur="0.2"/> i mean if i assess a student in <pause dur="0.4"/> as i do quite frequently in <trunc>cl</trunc> in <pause dur="0.2"/> using the LAP to assess their consultation skills i get <pause dur="0.3"/> i feel i get a very <pause dur="0.5"/> good insight into the <pause dur="0.2"/> attitudes and <pause dur="0.3"/> i can to some extent i can categorize their attitudes <pause dur="0.4"/> within the <trunc>c</trunc> the category of behaviour and relationship with patients <pause dur="0.5"/> # because i think students who have good attitudes towards <pause dur="0.5"/> the professional role as a doctor <pause dur="0.4"/> will <trunc>s</trunc> will score well in that category <pause dur="0.4"/> and <trunc>s</trunc> <pause dur="0.2"/> and it's unusual for students to score badly partly i think because when they're assessed using the LAP <pause dur="0.5"/> as in the assessment tool <pause dur="0.5"/> 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 <pause dur="0.5"/> a much more sophisticated view <pause dur="0.3"/> of the relationship the <trunc>pay</trunc> the student develops with the patient <pause dur="1.0"/> so i mean you a starting point could well be if you

had <pause dur="0.4"/> you know <pause dur="0.3"/> well trained assessors is to <pause dur="0.2"/> scrutinize students who scored badly in that category <pause dur="0.2"/> because they would be flagged up as giving cause for concern <pause dur="0.4"/> but i think you'd need to go on and develop probably more interactive teaching programmes with them <pause dur="0.4"/> and you're saying look you've got to you've got to see <pause dur="0.3"/> in behaviour and relationship that's the threshold for us focusing <pause dur="0.5"/> on looking at what you do with patients and exploring your attitudes <pause dur="0.4"/> perhaps i mean i <pause dur="0.2"/> you know <pause dur="0.4"/> psychologists <pause dur="0.3"/> think they can devise questionnaires that spot people who are lying in questionnaires so <pause dur="0.5"/> # maybe we could do that <pause dur="0.5"/> but i i don't think it's easy but <pause dur="0.5"/> given <pause dur="0.2"/> the the havoc <pause dur="0.5"/> that <pause dur="0.2"/> even doctors just not <pause dur="0.4"/> not the obvious criminals but even doctors who just underperform because they have the wrong attitudes <pause dur="0.4"/> create through a whole of a professional lifetime <pause dur="0.4"/> # <pause dur="0.2"/> perhaps we should be making a more serious attempt to do it </u><pause dur="2.6"/> <u who="nm0309" trans="pause">

<gap reason="name" extent="1 word"/> thanks very much <pause dur="5.8"/> <kinesic desc="applause" iterated="y" n="ss" dur="5"/> # <pause dur="0.3"/> thank you also for the <pause dur="0.2"/> top slide because that's <pause dur="0.2"/> what our next session <pause dur="0.4"/> after coffee <pause dur="0.4"/> is going to address <pause dur="0.5"/> # so we'll be specifically looking at that <pause dur="0.5"/> next time <pause dur="0.3"/> and i think <pause dur="0.2"/> # <trunc>s</trunc> i thought that was absolutely fascinating you've raised such an important <pause dur="0.4"/> subject 'cause we think a lot about knowledge <pause dur="0.4"/> and skills in <pause dur="0.3"/> medical education during medical school training <pause dur="0.4"/> but we don't <pause dur="0.6"/> devote a lot of # <pause dur="0.2"/> time to <pause dur="0.4"/> what is happening to our students' attitudes both at the time of entrance and then what happens during their <pause dur="0.2"/> training and even what happens in <pause dur="0.3"/> during postgraduate training so <pause dur="0.4"/> thank you very much </u><u who="nm0310" trans="latching"> thank you </u><pause dur="1.1"/> <u who="nm0309" trans="pause"> we're now going to <pause dur="0.3"/> move to coffee which will be in seminar room one <pause dur="0.3"/> where you had coffee <pause dur="0.3"/> at the beginning and then we'll reassemble at <pause dur="0.4"/> twelve o'clock