Clinical epidemiology: an experiment in student-directed learning in Western Australia

This paper describes an experiment at the University of Western Australia (UWA) medical curriculum, in which the focus of the 1 week of face-to-face teaching in public health in the 3-year clinical rotation was changed from important health problems affecting whole communities to one emphasizing the use of epidemiological principles to enhance doctors' decision-making. The students are now left to choose the clinical subject matter, and instead of being presented with predetermined readings selected by the teaching staff, the students have assumed responsibility for discovering the latest relevant information on the topics they choose and of presenting this to the class. The teacher now spends much less time in front of the class, providing only mini-tutorials each day on presenting to small groups, and on the skills required to understand the published literature on the aspects of the diagnosis, investigation, management and prognosis of individual patients. The topics chosen by students for exploration differ little, either in terms of the nature of the health problems concerned or the epidemiological principles at issue, from those covered previously when the programme was set entirely by the staff. However, attendance at the course has improved sharply, the short time between mini-tutorials and application of the material they cover has increased the perceived relevance of the teaching, and feedback collected systematically from successive classes of students has been very positive. Any anxiety on the part of the staff at relinquishing control of the curriculum has proved unfounded while the new programme has much to recommend it as a model of self-directed learning.