Although studies have begun to shed light on medical students' attitudes towards peer physical examination (PPE), they have been conducted at single sites, and have generally not examined changes in medical students' attitudes over time. Employing both cross-sectional and longitudinal designs, the current study examines medical students' attitudes towards PPE at schools from different geographical and cultural regions and assess changes in their attitudes over their first year of medical study. Students at six schools (Peninsula, UK; Durham, UK; Auckland, New Zealand; Flinders, Australia; Sapporo, Japan and Li Ka Shing, Hong Kong) completed the Examining Fellow Students (EFS) questionnaire near the start of their academic year (T1), and students at four schools (Peninsula, Durham, Auckland and Flinders) completed the EFS for a second time, around the end of their academic year (T2). Univariate and multivariate analyses revealed a high level of acceptance for PPE of non-intimate body regions amongst medical students from all schools (greater than 83%, hips, at T1 and 94.5%, hips and upper body, at T2). At T1 and T2, students' willingness to engage in PPE was associated with their gender, ethnicity, religiosity and school. Typically, students least comfortable with PPE at T1 and T2 were female, non-white, religious and studying at Auckland. Although students' attitudes towards PPE were reasonably stable over their first year of study, and after exposure to PPE, we did find some statistically significant differences in attitudes between T1 and T2. Interestingly, attitude changes were consistently predicted by gender, even when controlling for school. While male students' attitudes towards PPE were relatively stable over time, females' attitudes were changeable. In this paper, we discuss our findings in light of existing research and theory, and discuss their implications for educational practice and further research.

Our findings illuminate the interactional and complex nature of PPE, drawing out concerns and ambiguities around relationships, community and rules. We discuss our results in light of Engeström's model of activity theory (AT) and provide recommendations for educational practice and further research based on the principles of AT.

BackgroundE-learning allows delivery of education in many diverse settings and researchers have demonstrated it can be as effective as learning conducted in traditional face-to-face settings. However, there are particular practices and skills needed in the area of providing patient self-management support (SMS), that may not be achievable online. The aim of this study was to compare three approaches in the training of university students regarding the preparation of a Chronic Condition Self-Management Care Plan: 1) traditional face-to-face delivery of SMS training, 2) an e-learning approach and 3) a blended approach (combining e-learning and face-to-face teaching).MethodsGraduate entry physiotherapy students and medical students at Flinders University were recruited. Depending on the cohort, students were either exposed to traditional face-to-face training, e-learning or a blended model. Outcomes were compared between the three groups. We measured adherence to care plan processes in the preparation of an assessment piece using the Flinders Program Chronic Care Self Management tools. A total of 183 care plans were included (102 traditional, 52 blended, 29 e-learning,). All students submitted the Flinders Program Chronic Care Plan for university assessment and these were later assessed for quality by researchers. The submission was also assigned a consumer engagement score and a global competence score as these are integral to successful delivery of SMS and represent the patient perspective.ResultsThe blended group performed significantly better than the traditional group in quality use of the Flinders Program tools: Problem and Goals (P < 0.0001). They also performed significantly better in the total care plan score (P < 0.0001) and engagement score (P < 0.0001). There was no significant difference between the groups for the Partners in Health tool.ConclusionsIn this pilot study, the blended learning model was a more effective method for teaching self-management skills than the traditional group, as assessed in the development of a chronic condition self-management care plan. We anticipate that future research with identical groups of students would yield similar results but in the meantime, academics can have confidence that blended learning is at least as effective as traditional learning methods.

First-year students are anxious about examining intimate body regions, so a staged approach starting with manikins is recommended. Further qualitative research is needed employing interviews to explore in depth students' anxieties about examinations of intimate body regions and how their views are shaped by interactions with peers, patients and doctors.

Self-assessment is an important aspect in the development of lifelong learning skills for medical students, crucial to maintaining a high level of competence in practice. Basic Life Support (BLS) is a skill that all health professionals must acquire and maintain competence in. This paper reports data from a study of 95 first-year graduate entry medical students at Flinders University in Australia, determining how well the students could assess their own BLS performance. These students were videotaped performing a short CPR scenario using a Resusci Anne with SkillReporter (Laerdal, Norway). Using a six-point descriptive ratings scale, students graded themselves twice: once immediately after completing the task, and again after viewing a video of their performance. A single expert assessor viewed all the video recordings and, based on International Liaison Committee on Resuscitation (ILCOR) Guidelines, graded the students using the same scale. The hypothesis was that the intervention of viewing their performance on video would improve the correlation of their ratings with the expert assessor. The results showed that the students' assessments did not agree with the expert assessor either before (weighted kappa = 0.03) or after seeing the video (weighted kappa = 0.002). Possible reasons, including student attitudes and lack of benchmarking, are discussed. Self-assessment skills of students warrant further attention.