The problem based learning (PBL) curriculum at Manchester emphasizes small-group work. This is supported through group assessment where students assess key aspects of their group's function. In the study described here the authors evaluated students' perceptions of both PBL group work and what a group assessment needs to assess. They aimed to produce a description of the cognitive and motivational influences on group process and unpack the ways they contribute to a successful PBL group so that the kinds of skills an effective assessment should assess could be identified. Focus groups and a questionnaire were used to generate the data. The focus group results indicate that students support PBL group work as a method of learning, and that those groups that work cooperatively are perceived as facilitating the most motivating learning environment. The students supported the assessment being summative and felt that it could be simplified to measure: behavioural skills contributing to maximizing motivation of the group process; and cognitive skills relating to the content of the group discussion. The questionnaire results also supported the use of a summative assessment of small-group work that evaluates the domains of group process and the content of the group discussion.

Students perceive a relationship between learning experiences in the final year of a self-directed course and development of confidence for their future role. Whilst further elucidation of the nature of this relationship is required, this provides encouragement to curriculum planners to promote self-direction.

This paper describes a series of communication workshops designed to improve the consultation skills of third-year clinical medical students during their period of attachment in general practice, and to enable them to understand the differences in perspective and attitude existing between doctor and patient and their effect on the process and outcome of the clinical interview. The workshops involve a group of professional actors as simulated patients. The advantages of this method are discussed in terms of increased lay participation in the teaching.

The University of Manchester Medical School has adopted problem-based learning as its main educational method, with a change of emphasis from a biomedical to a biopsychosocial approach. The training of junior medical students in clinical interviewing is intended to reinforce and develop their interpersonal skills. We measured the impact of this new curriculum by assessing two intakes of students covering the period before and after its introduction; a third intake was later added to examine the effect of further curriculum adjustments. 86 students, randomly selected, were videorecorded conducting diagnostic interviews with standardized patients 10 weeks after they had started to learn clinical interviewing. Two instruments were developed--a 23-item communication skills scale and a 13-item information-gathering scale and both showed acceptable inter-rater and test-retest reliability. Communication skills did not differ between years. The total score for information-gathering fell by 13% (95% confidence interval -20 to -6%, P < 0.001) in the first year after introduction of the new educational approach but returned to baseline the following year after further modification of the course. Although the new approach yielded no measurable improvement in the process of communication, assessment 10 weeks after the start of interview training may be too early to permit definitive conclusions. We conclude that it is possible to change to a more patient-centred emphasis in teaching medical interviewing. Some initial loss of information content was rectified by adjustment of the course. Our unfavourable early experience highlights the need to evaluate educational change.