Teaching in Family Planning 1965-66

Brit.J. m d . Educ., 1969, 3, 84-93

Teaching in Family Planning 1965-66 P E T E R S I M P S 0 N Orthopaedic Department, Kingston-on-Thames Hospital

In 1966 the Family Planning Association invited the Association for the Study of Medical Education to collaborate in preparing evidence for the General Medical Council on the teaching of all matters relating to family planning. A joint working party was formed. It seemed probable that in no medical school was responsibility for covering the subject firmly laid upon any one department, that most schools could justifiably claim that various teachers and various departments con- tributed to the teaching, and that proof of any need for improvement would come only by demonstrat- ing that the teaching actually received by students was inadequate. Such information could perhaps be obtained from students and therefore the help of the British Medical Students’ Association was invited. This the BMSA gladly gave.

Technique of Inquiry It was decided to study by questionnaire the experience of all final year students in all the medical schools who were taking their qualifying examinations between I April, 1966, and 31 March, 1967. The inquiry was under the overall direction of the Joint Working Party and funds were provided by the FPA and by ASME. The work was done by students with the advice and assistance of Dr Ann Cartwright and the staff of the Institute of Community Studies.

The questionnaires were distributed in bulk from London and addressed to individual students by the BMSA representatives in the schools. The representatives kept a record of the names against the serial numbers on the questionnaires, and the questionnaires were returned individually direct to London in prepaid envelopes. Two weeks after the first return from a particular school follow-up letters were sent in bulk to the representative, together with a list of the serial numbers from whom a reply had not been received. A second follow-up letter with a second questionnaire was ent two weeks later.

The returns were thus anonymous in that the central office and the analysers had no record of the individual students’ names and could iden* them only by number. The representatives could match the numbers with the names but never saw the completed forms. Despite these measures a few students objected to the numbering of questionnaires, which was necessary for the follow-up.

The Questionnaire The questionnaire was divided into three sections. The first section asked whether the student had had teaching from those departments whose instruction might cover matters relating to family planning. The second section asked about the teaching received in six subjects - normal psychosexual development, marital adjustment, sexual difficulties unrelated to marriage, infertility, contraceptive methods, and the social aspects of population control. The third section related to the sex, marital status, and career aims of the student.

Unfortunately, time did not allow of a pilot study, so that the investigation suffered two weak- nesses. Firstly, the response rate was irregular because of the method of distribution, and, second- ly, the coded range of possible answers to one question failed to include one most appropriate response so that many students made no reply. This is further described below.

The Response In all 1,222 replies were received from 22 of the 26 medical schools (Table I). Unfortunately, there was no response from any student in Glasgow and from only seven in Leeds. The replies from Aber- deen were not directly comparable in time with those from the other schools, and Westminster Hospital Medical School was not a member of the Association at the time of the investigation. These four medical schools were therefore excluded from the analysis. It was clear from the number of

Teaching in Family Planning 1965-66 85

Table I. Response

Medical school

Estimated Questionnaires Sent out by ASME data on percentage

returned Amended representatives number of final response (no.) number* (no.) year students (%I

~

Charing Cross 20 20 36 50 40-56 75-86 80-100

71 I 1 0 83 68 46

Guy’s 83 K.C.H. 55 55

62 67 93 66 105 53-85

The London 63 Middlesex 56 56 Royal Free 83 72 99 78 84-92 St Bartholomew’s I06 89 150 86 71-100

St Mary’s 63 62 I08 70 58-89 U.C.H. 41 41 87 74 47-55 St Thomas’s 72 72 92 79 78-91 Belfast 49 48 88 55 Birmingham 43 43 96 45 Bristol 50 50 60 58 83-86 Cardiff 50 50 66 69 72-76 Liverpool 47 47 97 I I 0 43-49 Manchester 30 30 77 39 Newmstle 56 53 77 76 70-73 Sheffield 41 41 47 73 56-87 Oxford 21 21 28 23 75-91 Dundee IS I7 72 24 Edinburgh 123 1x4 I34 85

All schools participating 1,222 1,167 1,266 1,660 70-71

Westminster Leeds 56 Aberdeen 76 Glasgow 131

St George’s 52 52 75 46 69-100

-- -----__-_____-__-------~-- -

* Excluding those with less than 20 months of clinical instruction.

questionnaires that the representatives said they had distributed that in some cases students other than those in this final year had received questionnaires. In order to exclude such students, all those saying they had received less than 20 months of clinical instruction were excluded - there were 55 of these.

Another difficulty was that not all the representatives reported the number of questionnaires sent out, and when they did declare the number it occasionally failed to tally with the numbers (available from an ASME inquiry) known to be attending the medical schools. The ASME data referred to a slightly different period - the number of students taking finals in the year from October I966 - but, taking it as a basis, over of students would seem to have replied from four of the schools.

All the schools included had a return of 40% or higher, except for Dundee with only 24%, which almost led to its exclusion. The distribution and

follow-up demanded a lot of the representatives and the return rate obviously varied with their interest and keeness. Altogether, 1,167 replies were used in the analysis, representing 70% of the final year students in 22 medical schools.

The Students Most of the students had completed between 30 and 40 months of clinical study, over two-fifths were either married or engaged and just over a quarter were women. Only one-fifth had definitely made up their mind about their eventual career, but a quarter put general practice as their first choice, and half hospital or specialist service. These results are given in Table 2. Those who gave hospital or academic or research work as their first or second choice were asked what branch they hoped to specialize in. Obstetrics and gynaecology, medicine, surgery, and paediatrics were the most popular specialties, between 16 and 18% of

Peter Simpson 86

Table 2. The Students

Months of clinical study 20-24 I 3 25-29 18 30-34 32 35-39 34 40 + 3

Married 23 Engaged I9 Single 58

Marital status

Sex Male Female

73 27

State of mind about future career Definitely made up I9 Inclination but not definite 70 Open mind or only negative feelings 1 1

First choice for medical career General practice 27 Hospital or specialist service 56 Academic or research work 5 Public health or industrial medicine 7

Armed forces or colonial medicine 8 Inadequate answer 2

Number of students (-IOO~,)*

* Up to 16 students (I”;) gave inadequate answers to some of these questions. They have been omitted when calculating the percentages.

students mentioning each of them. Seven per cent mentioned psychiatry.

Rather more of the men were married than the women - 257L compared with 19?/,. More women

Table 3. Students’ views on teaching

than men gave both general practice and public health as their first choice of career: 35% of women choosing general practice against 257; of men; 67; of women choosing public health compared with 1% of men.

The Teaching All but 3;; of the 1,167 students said they had had some teaching in infertility, but 1694 had had no teaching in contraceptive methods. Only between one-fifth and three-fifths of the students had received teaching in each of the other four subjects. Those who had had some teaching in each of the subjects were asked whether they thought it was enough. The proportion of positive replies varied from 4 5 O b on marital adjustment to 74q0 on infertility. The students were also asked to grade their teaching on a line marked ‘totally inadequate’ at one end and ‘ideal’ at the other. Replies are shown in Table 3. Infertility and contraceptive methods were felt to be the best taught subjects, but they are probably easier to teach than normal psycho-sexual development, marital adjustment, and sexual difficulties unrelated to marriage.

The opinion of all students on the adequacy of their knowledge was tested by asking the difficult question ‘Do you think your knowledge of this subject adequate professionally, not just for exams 2’ Students naturally have little idea what professional demands will ultimately be made of them. It would be unwise to pay too much attention to expression of their belief that their knowledge is adequate, but perhaps it would be

Sexual Normal di’cultier Social aspects

psychosexual Man.tal unrelated t o Contraceptive population development a4ustment marnage Itfertility methodi control

Grade (70) (04) ( Y o ) (96) (70) ( Y o ) I Totally inadequate 6 I 0 9 3 7 8 2 18 22 29 23 9 15 3 34 39 35 20 26 35 4 31 I 7 25 43 34 26 5 Ideal 7 5 8 25 18 I3

Percentage feeling teaching necessary 95 95 98 99 98 91

Percentage feeling teaching e n o u a 63 45 53 74 59 66

Number of students taught (-100~;) 666 215 470 1,122 980 417

87 Teaching in Family Planning 1965-66

Table 4. Subjects taught and students views' on adequacy of their knowledge

Proportion feeling Proportion of those who Proporticn receivinz their knowledge did not have reaching

teaching professionally adequate who would have liked some (YO) ( 7 3 (%) (no.)

Normal psychosexual

Marital adjustment Sexual difficulties

Infertility

Social aspects of

development 57 37 86 501 19 19 85 952

unrelated to marriage 41 26 87 697 97 73 84 45

Contraceptive methods 84 63 89 187

population control 36 39 73 750

Number of students (-100%) 1,167

even more unwise to ignore the belief of a large number of students that their knowledge of a particular subject is inadequate. Seventy-three per cent of all the students thought their knowledge of infertility adequate, the subject in which 97:/0 had received teaching. In all the other subjects the percentage satisfied with the adequacy of their knowledge was considerably less. Sixty-three per cent thought they had sufficient knowledge of contraceptive methods, but in all the other subjects less than 40% were satisfied with their knowledge, and only 19% thought they knew enough about marital adjustment. They had, of course, very little idea of how much more knowledge on this subject exists than they already pos- sessed.

The picture of the teaching of social aspects of population control is rather different. A slightly higher proportion of students felt their knowledge about this to be professionally adequate than had received any teaching in it, and, whereas more than

Table 5. Departments in which subjects taught

four-fifths of the students who had not had any teaching on each of the other five subjects would have liked some, only three-fifths regretted the lack of teaching in this field (Table 4). Nine- tenths (91 %) of those who had had some teaching on the social aspects of population control thought the teaching necessary, but this proportion was even higher (between 95 and 99%) for the other five subjects. The importance of population control may not be quite so obvious in Britain except during the rush hour. But I would also tentatively mention the view expressed by a few students that these problems are not necessarily the province of the doctor. The part to be played by Church and State was mentioned and particularly the politicians' prior claim to the problem of population control.

Table 5 shows the departments teaching the various subjects : departments of obstetrics and gynaecology did nearly all the teaching of infertility and contraceptive methods and about a

Sexual Normal daficulties Social aspects

psychosexual Marital unrelated to Contraceptive population development a&utment mamage Infertility methods control

(%I (YO) (%) (%I ( O/O ) (70) ~~

97 36 2 2 - 3

Obstetrics and gynaecology 9 43 20 99

I 4 Psychiatry 71 71 84 3 I 0 6 I I I

I - 4 63 8

Social medicine 3 Other 7 6 6 3 3

- Paediatrics 18

Psychology I7 I

taught (-~ooo/b) 62 I 188 438 907 369 Number of students

I,oS7

88 Peter Simpson

Table 6. Type and amount of teaching

S d difficulties Social aspects

psychosexual Marital umelatpd to Contraceptive of pqpulation development adjustment marnage Infertility method control

Normal

(70) (%) (70) (%I (%I (%)

Type of teaching Lectures only 73 47 45 24 44 87 Contact with patients 22 42 48 72 43

inadequate answers 5 11 7 4 I3 7

6 Other, including

~~ ~~

Amount of teaching I lecture/session 32 34 34 28 44 51

or more lectures/sessions 32 20 24 33 16 15 Random’ 4 I2 7 6 5 4 Unspecified I2 18 I7 I2 I 2

2 lectures/sessions 20 16 18 21 23 19

I1

Number of students taught (-1007~) 666 2x5 470 1,122 980 417

third of the teaching of marital adjustment and the social aspects of population control. Normal psychosexual development, marital adjustment, and sexual difficulties unrelated to marriage were taught mainly in the psychiatry department and occasionally in the psychology department. Social medicine departments did just over half the teaching of social aspects of population control. No other department was mentioned by as many as s:/, of students.

The type and amount of teaching in the six subjects is shown in Table 6. Infertility was the only one of the six subjects in which the teaching involved contact with patients for over two-thirds of the students taught. In contraceptive methods less than half of the students had had any practical teaching, but it made them more likely to regard their teaching as ideal - 21% compared with 15% of those having lectures only. In most of the

subjects those students whose teaching involved contact with patients were more confident about their knowledge (Table 7) than those with only ‘theoretical’ teaching and more likely to study infertility, normal psycho-sexual development, marital adjustment, and contraceptive methods by themselves in other ways. Gaps in formal teaching may be easier to repair privately or contact with patients may stimulate students to study further.

Most of the teaching in all six subjects had been given in one or two lectures or sessions. But the relatively high proportion of students who did not answer this question suggests that the range of answers invited may have seemed incomplete, in that there was no opportunity to say a subject had been discussed without it forming the basis for a whole lecture or session.

All students were asked if they had studied the

Table 7. Teaching and students’ feelings about adequacy of their knowledge

Proportion feeling their knowleee professionally adequate in:

Sexual Normal dificulties Social aspects

psychosexual Marital unrelated to Contraceptive population development a4ustment marriage Infertility methodr control (Yo) (no.) (Yo) (no.) Coo) (no.) (73 (no.) (%) (no.) (Yo) (no.)

Teaching involved

73 411 }55 403 contact with patients 57 I43 37 87 49 218 82 782 Other forms of teaching 47 506 35 120 37 240 69 313 67 538 No teaching 23 490 17 926 15 674 16 38 45 182 32 723

Teaching in Famib Planning 1965-66 89

subjects in other ways and the proportion saying that they had ranged from 34% for infertility to 54% for contraceptive methods. Most students, three-quarters, said they studied at least one of the six subjects in some other way. The most common method was by reading - three-fifths of all students mentioned this, a seventh mentioned personal experience, one in 25 mentioned lectures or courses run by the Family Planning Association and one in 50 the Consumer Association’s report on contra- ceptives.

Students who had received some teaching were more likely than others to feel that their knowledge was professionally adequate. Nearly half the students without any teaching about contraceptive methods felt that their knowledge about t h i s was adequate because they had studied it in other ways. Those who had not had any teaching in contraceptive methods were more likely to say they had

studied it in other ways - 78% compared with 57% of those with teaching: but this was not so for the other five subjects.

Differences between Students Career aims did not appear to influence the students’ reactions to the subjects. Sex, however, made a difference; men were more likely than women to feel that their knowledge was adequate professionally about marital adjustment (22% compared with 13%); about sexual difficulties unrelated to marriage (29% as against 19%); and possibly about social aspects of population control (41% as against 33y0). More men than women had studied some of the subjects in other ways - contraceptive methods (54% against 46%); infertility (34% compared with 26%) and sexual difficulties unrelated to marriage, 41% compared with 35%.

More married students than those who were

Table 8. Teaching and students’ feelings about adequacy of their knowledge in different schools

Medical school

Charing Cross Guy’s K.C.H. The London Middlesex Royal Free

mew’s St George’s St Mary’s U.C.H. St Thomas’s Belfast Birmingham Bristol Cardiff Liverpool Manchester Newcastle Sheflield Oxford Dundee Edinburgh

St Barrholo-

All schools

Percentage feeling knowledge professionally adequate: II Percentage with any teaching in:

45 89 69 47 77 26

24 62 45 73 50 69 62 42

57 43 76 88

I2

?3 79

57 -

h s v - r:

-22 UJC

‘C * L...

g+ - I 0 37 18

9 6

14 25 I 0 32 I1 I5 7 18 16

23 15 83

11

21

f4 9

I9 - -

40 62 29 29 38 I7

27 62 26 46 36 79 42 22 6 34 27 51 88

60 f9

I00 99 95 98 95

I 0 0

73 98 98 98

I 0 0 I 0 0 I 0 0

I 0 0 I 0 0 97

I 0 0 I 0 0 I 0 0

98

98

97 - -

I 0 0 99 80 59 68 76

64 63 94 78 81

79 68 98 98

96 96

I 0 0

93

?6 I 0 0

84 -

- II-

-- 25 45 30 59 29 27 26 24 11 45 18 28

1: 11 2 18 26 29 39 14 38 50 33 56 51 rlz 18

% a ‘E 2 :- s-p 02 “9 2: ; s

C c l - -.I

- 55 31 9 I9

I5

16 44

20

21 20 29 35

16 16 39 23 30 41 I9

21

36 26 -

-

h s a

% 4 80 80 71 73 64 70

79 73 75 71 81 69 88 76 64 87 77 75 85

u

2 L

-

?6 77

73 -

-

:- ‘C g 8- g3 $2 U E

75 82 66 55 66 53

54 46 68 7 58 58 65 58 66 68 60 59 68

-

?6 73

63 -

Stud- ents

reply-

-100 10

(no.) ’”<, ,

- 20 71 55 62 56 72

89 52 62 41 72 48 43 50 50 47 30 53 41

I7 114

167

21

- -

Number of students replying too small to give percentages.

Peter Sinipson 90

single or engaged felt their knowledge about marital adjustment was professionally adequate- 317; compared with 20q; of the engaged and 180/, of the single. Many more of the married students said they had studied the subject privately - 57y0 against 359; and 31y0. There was no significant difference between the three groups in the proportion feeling they had adequate professional knowledge of the other five subjects. This included contraception, which had been studied privately more often by the married or engaged students without any gain in professional confidence - a cause for speculation.

Differences between Schools Table 8 shows the proportions of students in the different schools who received teaching in the six subjects and the proportions feeling their knowledge professionally adequate. The only school in which less than 959, of the students said they had been taught about infertility was St Bartholo- mew's - where 22 of the 24 students who had received no teaching had not yet attended their

course in obstetrics and gynaecology. The varia- tion between 95y0 and 100% among the other schools was probably explained by individual students who had missed sessions or forgotten them.

The proportion of students who had received teaching in contraceptive methods was under 90;); in half the schools and lowest at the London Hospital where 61 of the 62 students had completed their clinical appointment in obstetrics and gynaecology. All the London schools appeared to offer relatively little teaching in this field - in only three out of 11 schools was the proportion over 90:~; compared with seven out of 10 schools outside London.

Sheffield stood out with a high proportion of students beins taught about sexual difficulties unrelated to marriage, normal psychosexual development, and marital adjustment - the 837, in the last subject being particularly noticeable. Most of the teaching in Sheffield was done in the psychiatry and psychology departments. Students from Guy's, U.C.H., St George's, Belfast, and

Table 9. Studenrs' views on qualiry of reaching in different schools

Proporticn of students classifyin: reachin: in top three-eighths

Medical school

Sexual Social aspects

psychosexual Marital unrelated to C c n t racep t tve of popula ti on development adjusrmenr marnage Infertility methods control ( O 0 ) (no.) (""1 (no.) ( O 0 ) (no.) (00) (no.) ( O 0 ) (no.) (no.)

Xormal dijjiculries

* Charing-Cross 85 20 40 20

KC.H. The London Middlesex Royal Free St Barthoiomew's St George's St Mary's U.C.H. St Thomas's Belfast Birmingham Bristol Cardiff Liverpool Manchester Newcastle Sheffield Oxford Dundee Edinburgh

47 62 23 26 40 43 74 69 71 69 29 21 34 38 73 52 73 44 22 27 56 59 20 35 41 41 48 21 59 53 53 38

57 72 51 55 43 21 21 24 63 55 40 57 47 32 48 33 70 5 0 49 37 25 28 72 58 48 56 70 30 70 40 53 32 33 46 23 26 78 72 47 5 8 45 3' 36 36 71 45 60 45 41 22 28 32 72 43 48 31 42 26 14 21 78 49 44 34 33 21

50 50 41 49 53 38 22 27 9 4 47 59 46

72 29 57 28 21 39 27 26 75 53 52 50 37 43

*

58 * 36 33 33 39 36 71 41 5 1 * 39 31 26 70 2 0

* 42 89

38 22 33 68 52 39

* Numbers of students replying too small to give percentages.

Teaching in Family Planning 1965-66 91

Edinburgh also had more teaching in these subjects than those at other schools.

Newcastle, Cardiff, Sheffield, Birmingham, and Belfast were the only schools in which at least half the students said they had been taught about the social aspects of population control. They were all schools in which most of the students described the teaching in social medicine as compulsory - but so, too, were Guy’s, The Royal Free, St Bartholomew’s, Bristol, Manchester, and Edin- burgh.

Table 9 shows what the students who had had teaching thought of its quality. University College Hospital and Sheffield scored relatively well on their teaching of normal psychosexual development and Liverpool and Charing Cross on infertility. Two schools in London - Guy’s and K.C.H. - did best on contraceptive methods, but another, The London, worst.

The opportunity to have contact with patients varied greatly (Table 10). Edinburgh students saw

little of the infertile and nothing of those wanting contraceptive advice, while at The London, Man- Chester, and Newcastle less than one student in five met patients seeking contraception. At the Middlesex more students saw patients with problems of normal psychosexual development than patients seeking contraception. U.C.H. topped the list for experience of marital adjustment, sexual difficulties unrelated to marriage, and infertility.

The Tables showing the departments which had supplied the teaching in the individual schools are not reproduced, since they mainly mirror the general picture. The exceptions were these: the paediatric department played a significant part in the teaching of normal psychosexual development at St Thomas’s (260/), St George’s (197/0), Edinburgh (17%) and St Bartholomew’s ( I I ”/;). The part played by the psychiatrists at Guy’s (258;) and St. Bartholomew’s (23%) in the teaching of marital adjustment was notable, as was the

Table 10. Proportion of students having contact with patients as par t of teaching in diyeerent schools

Proportion of students havin: contact m‘th patients as part of teachin: in:

Sexual Normal dificulties Students

psychosexual Manta1 unrelated to Ccntraceptive replying Medical development aa‘pstment marriage Infertility merhods (-100%)

school ( “ c 1 ( O O ) (?id (70) (%I (no.)

Charing Cross Guy’s K.C.H. The London Middlesex Royal Free St Bartholomew’s St George’s St. Mary’s U.C.H. St Thomas’s Belfast Birmingham Bristol Cardiff Liverpool Manchester Newcastle S heffield Oxford Dundee Edinburgh

5 23

6 20

31 I 0 9 27

I9 18 6

2

I0 I2 0

0 4

8 I7 I0 * I5

I0 40 I1 23 9 I3 6 I3 6 25 4 8 7 16

2 3: 16

32 44 I1 31 8 31 0 I4 8 I4 0 2 I2 I 0 3 0 0 I1 I7 27

20 f4 4 29

80 70 78 74 5s 93 54 75 87 98 80 50 98 78 50 85 70 55 95 ?6 24

60 41 45 I9 25 39 33 37 75 63 28

54 23 0 I

20 71 55 62 56 72 89 52 62 41 72 48 43 50 50 47 30 53 41

17 [ I4

21

All schools I2 8 19 69 36 1,167

* Number of students replying too small to give percentages.

92 Peter Simpson

teaching of contraceptive methods by the social medicine department at Sheffield (73%). The social aspects of population control were taught by the obstetricians and gynaecologists at Newcastle (70%) and Edinburgh (11%).

It must be remembered that this report relates to the teaching actually received by individual students, not the teaching offered to them. Stud- ents have been known to miss classes, and even to forget having attended them, perhaps because the content failed to prove memorable. Furthermore, the students concerned were at the end of a five- year course in 1966: their juniors might even then have been receiving a Merent experience, and other curriculum changes may have taken place since.

Some Comments from Students Three hundred and forty-three students took advantage of the space provided for individual comment, telling us of personal difficuity in ans- wering the questionnaire or commenting on their experience of teaching in family planning.

Naturally, there was some comment on the religious delicacy of this topic and a dozen students criticized the attitude of the Roman Catholic Church. Some students had found that members of staff took a hearty jovial rugger-playing attitude to the problem, while other schools were criticized for passing the buck between departments. One student reported that ‘the only teaching we have in our medical school on sex, marital adjustment, etc., is one lecture about the mating habits of cats’. Another found it odd that venereal disease was compulsory when the study of sexual relations was ignored. How to strike the right balance some- where between Victorian prudery and contraceptive slot machines in the college bar was felt to be a difficult problem.

Outside organizations attracted both praise and criticism, and naturally the F.P.A. was most often mentioned in this context. Experience of the As- sociation’s clinics had varied: some students had found themselves as welcome as others had been unpopular. But as one student put it ‘It seems fantastic that we are expected to base our knowledge of contraception on one afternoon spent with a charitable organization in the scruffiest part of

The question of whether the undergraduate course was the proper place for teaching on these

this city’.

conclusions being drawn one way and the other. It all depended on how the individual students saw the purpose of the undergraduate years, but, as one put it, he had learnt so little as a full-time student, he gave little for his chances of learning much more when his education was only a part- time extra.

But certainly the most regular comment of all was the students’ wish to be shown how to fit mechanical contraceptive devices.

Discussion Virtually nothing to do with the human race is totally irrelevant for the future doctor, but, with the limited time available in a pre-qualification course, much selection has to be made. The results of this survey clearly show that the amount of attention given to each of the six topics had varied greatly, and the problem is whether the distribution was to the best advantage of the doctor’s future patients. This also depends on what the doctors learn in their postgraduate education and on their ultimate careers.

A follow-up study of the views of the students after they have had some professional experience, and of the experiences and opinions of the patients, might give a more appropriate evaluation of their teaching.

Taking into account these limitations, it is un- satisfactory that only 19% of students considered their knowledge of marital adjustment adequate professionally at the end of the undergraduate clinical course, even if their postgraduate education proves to be extensive. Only in infertility and contraceptive methods did over ha!f the students think their knowledge sufficient; and it could be argued that many students did not have high demands or expectations, in that only just over a third of them had had teaching on contraceptive methods that involved contact with patients.

It has, of course, to be remembered that these six topics form only one interdisciplinary subject: how much teaching is needed to cover them and when it should be given are points for debate, but, as with much that involves obstetricians and gynaecologists even if the range of problems is not extensive the number of patients involved is very high. For this reason these matters can hardly afford to be treated cursorily.

Students want to be taught about these matters, are pleased when they are taught about them, and - - -

matters came up several times, with-dogmatic are more confident when the; have seen patients

Teaching in Famiry Planning 1965-66 93

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Teaching in Family Planning 1965-66