The patient's role in the assessment of students' communication skills

Patients as Feedback Providers: Exploring Medical Students' Credibility Judgments

Introduction

Patient feedback is becoming ever more important in medical education. Whether students engage with feedback is partly determined by how credible they think the feedback provider is. Despite its importance for feedback engagement, little is known about how medical students judge the credibility of patients. The purpose of this study was therefore to explore how medical students make credibility judgments regarding patients as feedback providers.

Methods

This qualitative study builds upon McCroskey's conceptualization of credibility as a three-dimensional construct comprising: competence, trustworthiness, and goodwill. Since credibility judgments are shaped by the context, we studied students' credibility judgments in both a clinical and non-clinical context. Medical students were interviewed after receiving feedback from patients. Interviews were analyzed through template and causal network analysis.

Results

Students based their credibility judgments of patients on multiple interacting arguments comprising all three dimensions of credibility. In estimating a patient's credibility, students reasoned about aspects of the patient's competence, trustworthiness, and goodwill. In both contexts students perceived elements of an educational alliance between themselves and patients, which could increase credibility. Yet, in the clinical context students reasoned that therapeutic goals of the relationship with patients might impede educational goals of the feedback interaction, which lowered credibility.

Discussion

Students' credibility judgments of patients were a weighing of multiple sometimes conflicting factors, within the context of relationships and their associated goals. Future research should explore how goals and roles can be discussed between students and patients to set the stage for open feedback conversations.

Interpreting the value of feedback: Older adult voices in nursing education

As patients, older adults are often involved informally with the teaching of nursing students in clinical environments. This involvement is recognised as valuable; however, the role of the patient is often passive. In recent years there has been recognition of the value that real people's lives, and health experiences can bring to student education, so much so that many programs now incorporate real patients into the formal education of students. In this educational initiative, older adults, from a Residential Aged Care Campus (RACC), participated as simulated patients in scenario based clinical learning activities, providing feedback to nursing students on the carative aspects of the learning activities. The aim of this study was to contribute toward the body of knowledge in engaging older adults in simulated clinical activities, specifically in the provision of feedback to nursing students. A qualitative interpretive methodology was applied to capture the older adults' experiences of providing feedback as simulated patients. This included the collection of data through participant observation, recording of field notes, collection of a written feedback form and semi-structured interviews with the participants. Thematic analysis was undertaken to identify emergent themes in the data. Findings from this study have emphasised the value of including the patient voice in nursing education. The provision of feedback by older adults during direct care interactions supports and nurtures student awareness of the patient and the caring process of nursing. Unique to this study, was the finding that although the participants received no formal training in the delivery of feedback, all utilised a clear process recognised within the literature. A recommendation linked to this finding is that a feedback training program would be of benefit in reducing some of the feelings of uncertainty expressed by the older adults when giving feedback and better equipping them to deliver constructive feedback.

How does feedback from patients impact upon healthcare student clinical skill development and learning? A systematic review

BACKGROUND

A key feature of health professionals' training, irrespective of discipline, is the acquisition and application of clinical and communication skills. Despite this, little is known about the potential role of patient feedback on this process. This systematic review aimed to answer the question: How does feedback from patients impact upon healthcare student clinical skill development and learning?

DESIGN

Systematic review of published literature.

METHODS

Electronic databases were searched for studies that explored the effects of patient feedback on student learning and were published before March 2016. Eligible articles underwent methodological evaluation using the McMaster University Critical Evaluation Forms and data extraction.

RESULTS

A total of 237 articles were retrieved following searches of electronic databases and hand searches of reference lists. Twelve (7 quantitative, 2 qualitative, 3 mixed methods) studies met the inclusion criteria. Eleven studies reported that patient feedback improved students' clinical skills.

CONCLUSION

Minimal research has explored the impact of patient feedback on student learning. The research to date suggests that direct feedback from patients may be beneficial for the development of students' communication and clinical skills; however, the wide variety of evaluation methods and the lack of validated tools for patients to provide feedback suggest that further exploration is warranted.

How patient educators help students to learn: An exploratory study

INTRODUCTION

Benefits of the active involvement of patients in educating health professionals are well-recognized but little is known about how patient educators facilitate student learning.

METHOD

This exploratory qualitative study investigated the teaching practices and experiences that prepared patient educators for their roles in a longitudinal interprofessional Health Mentors program. Semi-structured interviews were conducted with eleven experienced health mentors. Responses were coded and analyzed for themes related to teaching goals, methods, and prior experiences.

RESULTS

Mentors used a rich variety of teaching methods to teach patient-centeredness and interprofessionalism, categorized as: telling my story, stimulating reflection, sharing perspectives, and problem-solving. As educators they drew on a variety of prior experiences with teaching, facilitation or public speaking and long-term interactions with the health-care system.

CONCLUSIONS

Patient educators use diverse teaching methods, drawing on both individualistic and social perspectives on learning. A peer-support model of training and support would help maintain the authenticity of patients as educators. The study highlights inadequacies of current learning theories to explain how patients help students learn.

Learning to think like a nurse: the development of clinical judgment in nursing students

The purpose of this project was to examine the clinical judgment and reasoning skills of nursing students in high-fidelity simulation. Two levels of students (N = 104), novices and those who are slightly more advanced, participated in individual videotaped simulations. Afterward, interviews were conducted to explore what the student was thinking and feeling during simulation. Five themes emerged from the interviews: thinking like a nurse, assessment, looking for answers, communication, and magical or reflective thinking. There was a clear distinction in the reasoning skills of the novice students compared with students with more clinical experience. Tanner's model of clinical judgment in nursing is used to understand the findings of the study.

Assessing clinical practice of student nurses: Views of teachers, mentors and students

BACKGROUND

Assessment received by students affects the way that they conduct their studies and shapes their interests in clinical placements. It is therefore important that mentors and teachers have high quality assessment strategies to ensure the competence of nursing students.

OBJECTIVES

The objective of this study is to describe the views and experiences of nursing students, nursing teachers, and mentors on the final assessment of nursing students in clinical practice. The study also investigates respondents' views on using a standardized national or European scheme for clinical assessment in the future.

DESIGN

Descriptive survey design with a questionnaire.

SETTINGS

Implemented in five Finnish universities of applied sciences and in five partner hospitals.

PARTICIPANTS

Nursing students (n=276), nursing teachers (n=108) and mentors (n=225).

METHODS

A questionnaire was used to collect data. Survey data were analyzed by using SPSS version 19. Descriptive statistics and cross tabulations were used to characterize the data.

RESULTS

Nursing students felt that they had spent enough time with their mentors during their clinical practice period to ensure that the mentors could assess their behavior. Mentors also evaluated that they had spent enough time with the students. Students and mentors both indicated occasional difficulties with the language used in the competence assessment document. Most of the nursing students and mentors shared the view that it is always necessary for a teacher to be involved in the final assessment discussion.

CONCLUSIONS

The study highlights the importance of assessment skills of mentors and the important role of the teachers. Findings from this study indicate that nursing students' clinical practice assessment already includes many good practices, but we still have some difficulties in ensuring effective measures of competence.

Assessors for communication skills: SPs or healthcare professionals?

INTRODUCTION

The complexity of modern medicine creates more challenges for teaching and assessment of communication skills in undergraduate medical programme. This research was conducted to study the level of communication skills among undergraduate medical students and to determine the difference between simulated patients and clinical instructors' assessment of communication skills.

METHODS

This comparative study was conducted for three months at the Clinical Skills and Simulation Centre of the International Medical University in Malaysia. The modified Calgary-Cambridge checklist was used to assess the communication skills of 50 first year and 50 second year medical students (five-minutes pre-recorded interview videos on the scenario of sore throat). These videos were reviewed and scored by simulated patients (SPs), communication skills instructors (CSIs) and non-communication skills instructors (non-CSIs).

RESULTS

Better performance was observed among the undergraduate medical students, who had formal training in communication skills with a significant difference in overall scores detected among the first and second year medical students (p = 0.0008). A non-significant difference existed between the scores of SPs and CSIs for Year 1 (p = 0.151).

CONCLUSIONS

The SPs could be trained and involved in assessment of communication skills. Formal training in communication skills is necessary in the undergraduate medical programme.

What matters to users of services? An explorative study to promote shared decision making in health care

BACKGROUND

Involving service users and carers in decisions about their health care is a key feature of health-care practice. Professional health and social care students need to develop skills and attributes to best enable this to happen.

AIMS

The aims were to explore service user and carer perceptions of behaviours, attributes and context required to enable shared decision making; to compare these perceptions to those of students and academic staff with a view to utilizing the findings to inform the development of student assessment tools.

METHODS

A mixed methods approach was used including action learning groups (ALG) and an iterative process alongside a modified Delphi survey.

PARTICIPANTS

The ALGs were from an existing service user and carer network. The survey was sent to sixty students, sixty academics and 30 service users from 16 different professional disciplines, spanning four Universities in England.

RESULTS

The collaborative enquiry process and survey identified general agreement that being open and honest, listening, showing respect, giving time and being up to date were important. The qualitative findings identified that individual interpretation was a key factor. An unexpected result was an insight into possible insecurities of students.

CONCLUSIONS

The findings indicate that distilling rich qualitative information into a format for student assessment tools could be problematic as the individual context could be lost, it is therefore proposed that the information could be better used as a learning rather than assessment tool. Several of those involved identified how they valued the process and found it beneficial.

The role of radiotherapy patients in provision of student interpersonal skills feedback

Background

At Queensland University of Technology, student radiation therapists receive regular feedback from clinical staff relating to clinical interpersonal skills. Although this is of great value, there is anecdotal evidence that students communicate differently with patients when under observation.

Purpose

The aim of this pilot was to counter this perceived observer effect by allowing patients to provide students with additional feedback.

Materials and methods

Radiotherapy patients from two departments were provided with anonymous feedback forms relating to aspects of student interpersonal skills. Clinical assessors, mentors and students were also provided with feedback forms, including questions about the role of patient feedback. Patient perceptions of student performance were correlated with staff feedback and assessment scores.

Results

Results indicated that the feedback was valued by both students and patients. Students reported that the additional dimension focused them on communication, set goals for development and increased motivation. These changes derived from both feedback and study participation, suggesting that the questionnaires could be a useful teaching tool. Patients scored more generously than mentors, although there was agreement in relative grading.

Conclusions

The anonymous questionnaire is a convenient and valuable method of gathering patient feedback on students. Future iterations will determine the optimum timing for this method of feedback.

Service user involvement in nurse education: perceptions of mental health nursing students

Increasingly providers of mental health nurse education are required to demonstrate user involvement in all aspects of these programmes including student selection, programme design and student assessment. There has been limited analysis of how nursing students perceive user involvement in nurse education programmes. The aim of this study has been to explore mental health nursing student's perceptions of involving users in all aspects of pre-registration mental health nursing programme. Researchers completed a number of focus group interviews with 12 ex-mental health nursing students who had been recruited by purposeful sampling. Each focus group interview was recorded and analysed using a series of data reduction, data display and verification methods. The study confirms many of the findings reported in earlier user participation in education studies. Three main themes related to user involvement have been identified: the protection of users, enhanced student learning and the added value benefits associated with user involvement.

Australian dust storm: impact on a statewide air medical retrieval service

INTRODUCTION

The Australian dust storm during the week of September 22, 2009, resulted in the grounding of a large portion of the air medical retrieval fleet in Queensland. We sought to determine whether during this event an increase occurred in cases requiring retrieval as a result of the dust storm, and whether the grounding of the retrieval fleet resulted in any adverse outcomes as a result of its inability to respond.

METHODS

A retrospective review of respiratory and injury cases referred to the Queensland Emergency Medical System Coordination Centre from September 8 to October 5, 2009 was conducted. All cases with any respiratory or injury complaints were included. The number of cases, priority for retrieval, and the ability to retrieve these cases within the allocated time were examined and compared with those for a similar time frame in the previous year.

RESULTS

A 62.5% increase in respiratory cases was seen, and 13.3% increase in injury cases during the week of the dust storm event, when compared with the previous year. Neither of these results reached statistical significance, but they demonstrate a practically important difference. For the month surrounding the dust storm event, a 48.5% (P = .04) increase in respiratory cases occurred, but no increase in injury cases when compared with the previous year. Only one urgent case was unable to be air medically retrieved during the study period as a result of grounding of the aircraft because of the dust storm event, but contingency arrangements were made for alternative transport. No adverse events were recorded during the study period.

CONCLUSION

An increased demand on retrieval services was demonstrated during the period of the dust storm event. Despite grounding of the air medical fleet, all cases except one were able to be retrieved within clinically appropriate time frames or by alternative transport methods. Contingency plans need to be developed to cope with the possibility of similar events in the future, to prevent adverse events from occurring.

Experts by experience; the views of service user educators providing feedback on medical students' work based assessments

Assessment tools were designed to provide health and social care students with multi-sourced, interprofessional feedback in practice. This includes feedback from service users. Third year medical students at the University of Leeds were given accesses to 4 assessment tools whilst in practice. Completed assessments were then sent to the university where service users and carers worked with university tutors to give further feedback and comment on the overall development of students. Three service users then took part in a focus group and one provided written feedback. Four key themes were identified from the focus group: • Preparation and support • The design of the tools • The process of using the tools in practice • Feedback. We found that the project provided both challenges and rewards for all involved. The service user educators involved were able to bring a different and valuable perspective to formative feedback. The combination of their personal and professional experiences, along with the preparation they had received, helped bridge the gap between service users in practice and university based tutors. The findings from this study went on to inform a review of the assessment tools and revised versions are now being used.