Occupational Medicine 2006;56:110114

Published online 21 December 2005 doi:10.1093/occmed/kqj006

Medical students evaluation of a teaching

session in occupational medicine: the value of
a workplace visit
Paul Grime1, Sian Williams1 and Sandra Nicholson2
...................................................................................................................................................................................

...................................................................................................................................................................................

Aims

To examine medical students perception of a teaching session in occupational medicine after

changes made in the light of earlier student evaluation, and in particular their views on the inclusion
of a workplace visit.

...................................................................................................................................................................................

Methods

Questionnaire evaluation feedback completed immediately after teaching sessions, triangulated with
a student focus group session conducted by an external facilitator to explore what students valued
most and least and why. Comparison of student evaluations before and after changes introduced in
the light of student evaluations.

...................................................................................................................................................................................

Results

Students perception of the usefulness and relevance of the session significantly improved after the
changes. Students consistently identified the use of case scenarios as helpful but demonstrated
a dichotomy of opinion about the value of a workplace visit. Overall, students valued the brevity
of the session that resulted from removing the workplace visit.

...................................................................................................................................................................................

Conclusions It is possible to enhance students perception of the value of a teaching session by modifying the
session in the light of student-based evaluation.
...................................................................................................................................................................................

Key words

Evaluation; medical students; occupational medicine; undergraduate teaching.

...................................................................................................................................................................................

Introduction
Teaching of occupational medicine is in decline in UK
medical schools, and no school includes a workplace visit
as part of such teaching [1]. Yet the General Medical
Council (GMC) has stated that medical graduates must
understand the areas of sociology relevant to medicine,
including occupation, and must be aware of the significance of health and safety issues and risk assessment in
the health care setting [2].
For the new curriculum at our medical school, we developed an undergraduate occupational medicine teaching programme. This included a workplace visit. We then
1
Occupational Health Unit, Royal Free Hospital, Pond Street, London NW3
2QG, UK.
2
Education Directorate, Barts and the London, Queen Marys School of
Medicine and Dentistry, Medical Sciences Building, Mile End Road, London
E1 4NS, UK.

Correspondence to: Paul Grime, Occupational Health Unit, Royal

Free Hospital, Pond Street, London NW3 2QG, UK. Tel: 144 20 7830 2519;
fax: 144 20 7830 2512; e-mail: paul.grime@royalfree.nhs.uk

used student evaluation to tailor the teaching to students

perceived learning needs. This paper describes the results
of student evaluations before and after changes that were
made in the light of student feedback.
Occupational medicine is taught as a half-day seminar
in the third of 4 weeks of primary care teaching. Other
seminars include ethics, communication and consultation skills, chronic care and clinical reasoning. In addition, students attend general practice attachments and
teaching sessions in community and hospital dermatology. This is the only formal teaching in occupational
medicine that students receive. The session is repeated
nine times throughout the fourth academic year to different groups of 2030 students. Most of the teaching is
delivered by one consultant/honorary senior lecturer in
occupational medicine with support from another, and
a specialist registrar in occupational medicine.
We planned and structured the session with clearly
defined and stated learning objectives. The aim of the
session is to enable students to apply the principles of
occupational medicine to their professional practice as

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Background Undergraduate teaching in occupational medicine in UK medical schools is in decline. We developed a teaching programme for the new curriculum at our medical school, and then used student
evaluation to tailor it to students perceived learning needs.

P. GRIME ET AL.: MEDICAL STUDENTS EVALUATION OF A TEACHING SESSION 111

Box 1. Learning objectives

By the end of this session, students should be able to:

doctors. The specific learning objectives for this session

are shown in Box 1.
We used a variety of teaching activities including student participation in interactive small and large groups.
Students worked in groups of four to six to consider case
studies to illustrate basic concepts in occupational medicine including the hazards of work, work-related illhealth, taking an occupational history and the assessment
of medical fitness for work. We took groups of 812 students to visit a workplace within the hospital: the kitchens,
the carpenters workshop or the boiler house. We asked
students to observe and identify workplace hazards and
control measures and record them on a paper grid. We
prepared multiple choice and extended matching questions, which contributed to the bank of questions used
for the student assessments. The content of our questions
reflected the material included in the teaching session.
We published an interim evaluation of the first six of
the teaching sessions [3]. An external lecturer observed
and commented on the fourth session. We continued to
evaluate and modify the session in the light of observations. The major changes included substituting the workplace visit with pictures of one of the workplaces formerly
visited, curtailing the session from 165 to 120 min, quickening the pace of delivery, reducing the emphasis on the
classification and control of workplace hazards and introducing a didactic element of teaching on occupational
asthma, occupational dermatitis and occupational cancers. These changes were implemented after a student
focus group following the ninth session. The fourth learning objective was altered to reflect this. More minor
changes included integrating the case studies into the
body of the teaching, rather than leaving them to the
end (after the third session) and giving the students

Methods
We designed an evaluation questionnaire (Appendix 1,
available as Supplementary data at Occupational Medicine
Online) for students to complete immediately after the
teaching session. Students were asked to score on a fourpoint scale their perception of the usefulness and relevance of the session and their enjoyment of it, whether
or not they felt that each of the five learning objectives
had been fulfilled, what they had found most useful about
the session and what they would like to change. This
strategy was based on the Kirkpatrick level I evaluation,
i.e. reaction/satisfaction [4] to facilitate sequential analysis and modification of the session.
To enhance the validity of the students evaluations,
the data gained from the questionnaires were triangulated
with the outcome of a student focus group to explore in
more detail what students valued most and least about
the session and why. Students attending the ninth session
were asked to stay at the end of the session to meet with
an external lecturer, who facilitated the focus group.
The MannWhitney U-test (two samples) was used to
compare the mean scores for usefulness, relevance and
enjoyment for Sessions 19 and Sessions 1018. Fischers
Exact test was used to compare the percentage of students who felt that the specific learning objectives had
been met for Sessions 19 and Sessions 1018. The free
text comments about what students found most useful
about the session and what they would like to change
were grouped into themes and compared for frequency
for Sessions 19 and Sessions 1018.

Results
From a year group of 341 students, 205 attended Sessions 19 and 173 completed questionnaires (response
rate 84%). From the next year group of 338 students,
275 attended Sessions 1018 and 214 completed questionnaires (response rate 78%). Eighteen students
attended the focus group.
Table 1 compares students mean scores for usefulness,
relevance and enjoyment for Sessions 19 and Sessions
1018, and Table 2 compares the numbers and percentages of students who felt that the specific learning objectives had been met for Sessions 19 and Sessions 1018.
Some students wrote more than one comment and
some did not write comments. Themes are only included in the Tables 3 and 4 if more than one student

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1. Know what questions to ask in order to take an

appropriate and relevant occupational history
2. Identify factors or patterns in a patients history
that may indicate a work-related contribution to
ill-health
3. Consider a work-related health dilemma and
reach a conclusion with reasons
4. List and rank the principles of workplace hazard
assessment and control. This was changed after
Session 9 to:
List three causative agents and related work activities for occupational asthma, allergic contact
dermatitis and cancer
5. Specify what information is necessary to make
a fully informed assessment of an individuals
medical fitness for work

a handout (after the eighth session). Using the observation that some students read their newspapers during the
session, we began subsequent sessions by asking students
to find stories about work, health or both in their newspapers to illustrate how much these issues are part of
everyday life and therefore relevant for all doctors.

112 OCCUPATIONAL MEDICINE

Table 1. Mean scores for perceived usefulness, relevance and enjoyment, and P value for difference in means between the groups
(score 1 5 disagree, 4 5 agree)

Found session useful

Found session relevant
Enjoyed session

Sessions 19
(n 5 173)

Sessions 1018
(n 5 214)

2.73
2.82
2.68

3.13
3.17
2.82

,0.001
,0.001
0.095

Table 2. Numbers and percentages of students who felt the specific learning objectives had been met and P value for difference
between the groups

1
2
3
4
5

Sessions 1018
(n 5 214)

170
167
156
154
151

213
213
211
211
200

0.329
0.048
0.010
a
0.052

(98.3%)
(96.5%)
(90.2%)
(89.1%)
(87.3%)

(99.5%)
(99.5%)
(98.6%)
(98.6%)
(93.4%)

Comparison not made as Objective 4 was changed after Session 9.

Too long/too slow

Workplace visit
Would like a handout
Nothing
Style of teaching
Case studies
Small-group work
Its just common sense
Longer visit
More on fitness for work
More on taking an occupational
history
More on work-related ill-health
More didactic/factual teaching
rather than principles
Would like a break
More about occupational medicine
as a specialty
More about legal aspects
Include sample examination questions
More cases
More pictures
More on needle-stick injury
More about benefits

Sessions
19

Sessions 1018

25
13
11
10
8
6
5
4
2
2
2

23 (11%)
Not applicable
Not applicable
6 (3%)
9 (4%)
4 (2%)
0 (0%)
0 (0%)
Not applicable
0 (0%)
0 (0%)

(14%)
(7%)
(6%)
(6%)
(5%)
(3%)
(3%)
(2%)
(1%)
(1%)
(1%)

2 (1%)
2 (1%)

2 (1%)
0 (0%)

0 (0%)
0 (0%)

9 (4%)
6 (3%)

0
0
0
0
0
0

4
4
3
3
2
2

(0%)
(0%)
(0%)
(0%)
(0%)
(0%)

(2%)
(2%)
(1.5%)
(1.5%)
(1%)
(1%)

Table 3. What students found most useful about the teaching

Case scenarios
Workplace visit
Taking an occupational history
Learning about work-related
ill-health
Learning about the assessment
of fitness for work
Style of teaching
Learning about risk assessment
Group work/discussion
Structure of teaching
Learning about the role of
occupational physicians
Everything/commendation
Short duration
Handouts
Learning about human
immunodeficiency virus in
relation to health care work
Pictures/slides
No break

Sessions
19

Sessions
1018

36
35
22
13

58 (27%)
Not applicable
15 (7%)
11 (5%)

(21%)
(20%)
(13%)
(7%)

10 (6%)

9 (4%)

8
7
7
5
4

(5%)
(4%)
(4%)
(3%)
(2%)

18
3
5
2
0

(8%)
(1.5%)
(2%)
(1%)
(0%)

3
2
0
0

(2%)
(1%)
(0%)
(0%)

13
22
12
9

(6%)
(10%)
(6%)
(4%)

0 (0%)
0 (0%)

6 (3%)
2 (1%)

commented. Denominators are the total number of questionnaires returned, regardless of whether or not free text
comments were entered. From the 173 questionnaires
from Sessions 19, there were 120 comments on what
was most useful and 94 on something to be changed.

From the 214 questionnaires from Sessions 1018, there

were 134 comments on what was most useful and 77 on
something to be changed.
In the focus group, two main aspects of the session
were discussed frequently: the case histories and the
workplace visit. No negative comments were made concerning the case histories. Students said that they found
the case histories useful because they were well structured
and led them through the learning points in a logical
order but still giving them opportunity to work things
out. Students also thought that an appropriate amount
of time was spent on this area.
Students who liked the workplace visit said they found
it interesting, enjoyed seeing a part of the hospital they
would not normally visit and also considered that they
would retain what they had learnt from the activity
longer. Students who disliked the visit did not perceive
its relevance and stated that they could have learnt about
the occupational hazards by a more didactic teaching
method. These students did not like the practical nature
of the visit; they found it patronizing.
Overall students valued the session, considered that it
was well planned and covered what they thought was
needed for their examination preparation. They commented that it was an interactive session and interesting.
However, students felt that the session could be made
shorter by leaving out the workplace visit and covering
the learning objectives by a more didactic approach.

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Objective
Objective
Objective
Objective
Objective

Sessions 19
(n 5 173)

Table 4. What students said they would most like to be changed

about the teaching

P. GRIME ET AL.: MEDICAL STUDENTS EVALUATION OF A TEACHING SESSION 113

Discussion

Conflicts of interest
None declared.

References
1. Wynn PA, Aw, TC, Williams NR, Harrington M. Teaching
of occupational medicine to undergraduates in UK schools
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2. General
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Tomorrows
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Recommendations on Undergraduate Medical Education.
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4. Kirkpatrick DL. Evaluation. In: Craig RL, ed. Training and
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5. Koh D, Chia KS, Jeyaratnam J, Chia SE, Singh J. Case
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Students perception of the usefulness and relevance of

the teaching session improved significantly following the
introduction of changes made in the light of earlier student evaluations, but there was no statistically significant
change in their reported enjoyment of it. Most students
felt that the specific learning objectives had been met, and
the proportion of those that did, increased with time.
Students consistently valued the use of case scenarios to
illustrate principles of occupational medicine. Others
have also reported the value of case scenarios in delivering
education in occupational medicine, in translating the
principles learnt from teaching into clinical practice
[5,6]. Students reported different learning styles, and
there was a dichotomy of opinion about the value of the
workplace visit. The absence of workplace visits from undergraduate teaching in occupational medicine has been
highlighted as an indication of the decline in commitment
to the subject [1], but in this study students preferred the
teaching session to be shorter, which was made possible
by removing the workplace visit. Workplace visits appear
to have been successfully incorporated into undergraduate teaching elsewhere, although not formally evaluated
[7]. Practical difficulties may preclude the widespread
use of workplace visits in UK medical schools [8].
The content of our teaching programme reflected
what we perceived as important for aspiring doctors to
know. Others may have different priorities although published reports of other undergraduate teaching programmes indicate similar content but various teaching
methods [7,9,10]. The delivery of the teaching session
may have improved with time as the lecturers became
more familiar with the content and structure of the session. This was not accounted for in the analysis. There
are many variables in a Kirkpatrick level I evaluation
(reaction) and the extent to which students perceptions
can be used to evaluate teaching is probably limited. Some
students favour didactic, factual teaching, others prefer
interactional group discussion. Some perceive principles
and concepts as just common sense. The GMC states
that medical graduates must be able to identify their own
learning needs, and that the quality of teaching must be
monitored through a number of different systems, including student feedback and review of teaching by peers [2].
The GMC also states that factual information in the undergraduate curriculum should be kept to the essential
minimum that students need at this stage of medical
education [2].
Students may struggle to see the relevance of subjects
like occupational medicine in the undergraduate curriculum, and it can therefore be challenging to convince
them of its value. Unless subjects are included formally
in the curriculum and tested in examinations, students
may not view them seriously [11]. If medical schools
and medical students can be persuaded of the value of

occupational medicine as an undergraduate subject, it

may be possible to reverse the observed decline in the
teaching of occupational medicine in UK medical
schools. Most work-related health problems are likely to
be managed by non-occupational physicians [11]. In
the light of current political emphasis on issues such as
sickness absence (productivity), access to work, benefits
and pensions, it is important that all doctors have an understanding of the potential for work and health to interact [12,13]. Occupational medicine teaching should
be delivered by specialists in occupational medicine, but
does not need to be sophisticated, specialized or timeconsuming [11].
This study looked only at students perceptions of
teaching (Kirkpatrick level I evaluation), and the effect
of implementing changes they suggested. We did not examine other outcomes, such as learning (knowledge, skills
and attitudesKirkpatrick level II), behaviour (transfer
of knowledge and skillsKirkpatrick level III) and results
(organizational impact of teachingKirkpatrick level IV)
[4], and did not compare students perception of occupational medicine with their perception of other topics.
It would be interesting to observe the effect of undergraduate occupational medicine teaching on career choices.
Further research could examine the consistency between
medical schools in the delivery of occupational medicine
teaching and perhaps evaluate this teaching session in
different settings, for example in other medical schools.
This could lead to the sharing of teaching and learning
resources, thereby enhancing the quality and accessibility
of undergraduate education in occupational medicine
generally.

114 OCCUPATIONAL MEDICINE

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134135.
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medicine to undergraduates. Occup Med (Lond) 2004;
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approach to undergraduate teaching in occupational medicine. Occup Med (Lond) 1995;45:326328.

10. Harrison J, Jefferson RD, Blain PG. Innovations in undergraduate occupational medicine teaching. Occup Med
(Lond) 1996;46:246247.
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enough of a good thing? Occup Med (Lond) 2003;53:
347348.
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Working AgeKey Points from a Guide for Registered Medical
Practitioners IB 204. London: DWP, 2000.
13. Able to WorkReport on the National Employment Panels
Employers Working Group on Disability. London: National
Employment Panel, 2005.

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