towards revising the group exercise and contextual- ising the glossaries with cases. Students’ knowledge, attitudes and skills in HIV ⁄ STD prevention will be evaluated. Students provide critical feedback on their curriculum and are essential partners in its revision. This endeavour has initiated extensive efforts to revise the entire sexuality curriculum, particularly to include aspects of sexual diversity, such as gay, lesbian, bisexual and transgender health. Correspondence : Dan Ciccarone MD, MPH, Urban Health Study, University of California San Francisco, 3180 18th Street, Suite 302, San Francisco, California 94110, USA. Tel: 00 1 415 514 0275; Fax: 00 1 415 514 3097; E-mail: ciccaron@fcm.ucsf.edu. doi: 10.1111/j.1365-2929.2004.02008.x Medical student peer group utilisation of clinical scenarios A C Vlantis & C A van Hasselt Context and setting Patients are the unit of clinical practice for doctors and consequently medical stu- dents should become adept at evaluating cases. This will be relevant to their daily clinical work. The move towards a problem-based medical education has put an emphasis on the student’s ability to solve a clinical problem that in turn will ensure his ⁄ her competence. Clinical competency includes the ability to integrate basic knowledge, diagnostic skills, problem solving abilities and clinical judgement. Why the idea was necessary The vital need for the medical student to be able to correctly process a clinical case scenario and prioritise the differential diagnoses, investigations and management strategies led us to involve our medical students in the construction and solution of clinical case scenarios. What was done Small group tutorials are the basis of clinical teaching for medical students at the Chinese University of Hong Kong. Twenty groups of 8 final year medical students are taught ear, nose and throat surgery in their 2-week clinical attachment to the department. During this time each group of students is divided into 2 subgroups of 4 students per group. Each subgroup is required to construct and present a short clinical case scenario on a topic relevant to ear, nose and throat surgery, using a PowerPoint format. Students are encouraged to base their case scenarios on patients seen in the wards or outpatient clinics. Students have liberal license and are encouraged to be creative but to remain realistic. They are required to pose a question relating to the case scenario and to give 5 optional answers, 1 of which is correct and 4 incorrect. They are also required to give an explan- ation as to why each answer is either correct or incorrect. One subgroup presents their scenario to the other subgroup, which answers with an expanded explanation to support their reply. The presenting subgroup then presents their definitive explanation for each statement. The subgroups then reverse roles. In this way each subgroup of 4 students constructs and presents a case scenario and answers another. A clinical lecturer supervises the presentations. This format of learning mimics future clinical patterns of thinking and management decision making and resembles an aspect of real life work for the medical student. Evaluation of results The students complete an anonymous feedback questionnaire at the end of their 2-week attachment. So far, students have found the process of case scenario construction to be thought-provoking and have often been led to research around the topic before starting construc- tion. Construction leads to a better understanding of problem solving. Presenting the scenario to their peer group allows them to develop presentation and chairperson skills. The cases often generate a lot of discussion and uncover areas of knowledge deficiency that are usually dealt with by fellow students and, occasionally, by the supervisor. Clinical case scenarios designed by and presented to medical student peer groups raise the level of clinical understanding of patient management. Correspondence : Dr A C Vlantis, Department of Surgery, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. Fax: 00 852 2637 7974; E-mail: lexvlantis@cuhk.edu.hk. doi: 10.1111/j.1365-2929.2004.01999.x Developing clinical skills: a simple and practical tool Ben Lawton & Colin MacDougall Context and setting Student competence in clinical skills is improved by the employment of well organ- ised and strategic learning styles. Evaluation of the objective structured clinical examination (OSCE) has demonstrated the capability of structured checklists to objectively assess many fundamental clinical skills and to pinpoint areas of weakness. Good interrater reliability between expert and non-expert observers with appropriately designed checklists has been demonstrated. We piloted the unsupervised use of structured checklists to facilitate the practice of physical examination by students on a graduate entry medical course during their first clinical rotation. We compared students’ performance following practice with and without structured checklists and evaluated student opinion of the usefulness of the intervention. really good stuff 1198 Ó Blackwell Publishing Ltd MEDICAL EDUCATION 2004; 38: 1181–1202