Medical Education zyxwvutsrqpon 1993, 27, zyxwvutsr 495-502 Audit: teaching medical students in general practice J. M. MORRISON zyxwvuts & F. M. SULLIVAN Department zyxwvutsr of General Practice, University of Glasgow Summary. Audit is being seen as an increasingly important topic for medical students. Many departments of general practice in the UK now incorporate audit as part of their course work. It remains controversial as to whether this is per- ceived to be worthwhile by the students. Following zyxwvut an introductory seminar final-year medical students at the University of Glasgow were asked to perform a case-note review of 10 randomly chosen diabetic patients for a number of process and outcome measures during their practice attachments. Feedback was given in their final teaching session. 128/153 (84%) students completed an evalu- ation of the course on their knowledge and attitudes to audit. Unsurprisingly, 39% found the data collection boring or very boring; however, 60% found the feedback session very interesting or interesting. Both the data collec- tion and the feedback were considered relevant by the majority of students (57% and 70% respectively). Students’ self-reported knowledge also dramatically increased (P < O~OOOl). Key words: *education, medical, undergraduate; family practice/*educ; *medical audit; teaching/ methods; curriculum; Scotland Introduction One of the essential elements of basic medical education is ‘the development of a capacity for self-audit and for participation in the peer review process’ and for this reason audit must become an Correspondence: Dr J. Morrison, Department of General Practice, University of Glasgow, Woodside Health Centre, Barr Street, Glasgow G20 7LR, UK. established part of undergraduate education (Spencer 1992). However, several factors have been identified which have made it difficult to introduce audit into the undergraduate curricu- lum. These include: lack of curricular time; difficulty in making the teaching relevant and interesting; lack of expertise and knowledge among s t a e problem of compartmentalizing audit as a separate topic; negative attitudes in the medical faculty; teaching not linked to the student’s own clinical work; and audit being considered a postgraduate topic. Despite these difficulties, in one study 41% of departments of general practice in the United Kingdom and Eire provided formal teaching in audit. Since the early 1980s the Royal College of General Practitioners has fostered audit through its ‘Quality Initiative’ and other policies (Parry 1990) but despite this the pursuit of audit among grass roots general practitioners has been some- what disappointing. There has been difficulty in reaching agreement about criteria and standards and many published audits have failed to com- plete the audit cycle or to show any improve- ments in patient outcome (Baker 1991). It has been said that a barrier to audit is the narrowness of medical education. Learning without critical appraisal of the subject matter - all too often a tradition in medical education- will not provide the skills required for medical audit in the future (Moss & Smith 1991). It was felt, in view of the increasing import- ance of audit not only in general practice but in all aspects of medical practice, that formal teaching about audit should be provided as part ofthe new curriculum at the University of Glasgow which for the first time included a 4-week attachment in general practice. This study describes the first year ofthe course and the results ofits evaluation. 495