Parent education classes: teaching junior paediatric doctors and student nurses about normal baby care

Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study

CONTEXT

Factors contributing to the stressful transition from student to doctor include issues with preparedness for practice, adjusting to new status and responsibility, and variable support. Existing transitional interventions provide inconsistent participation, responsibility and legitimacy in the clinical environment. Enhanced support by near peers for new doctors may ease the transition. Irish medical graduates of 2020 commenced work early, creating an unprecedented period of overlap between new graduates and the cohort 1 year ahead.

OBJECTIVE

To explore the experience of commencing practice for these new doctors with this increased near-peer support.

DESIGN

We used interpretive phenomenological analysis as our methodological approach, informed by the cognitive apprenticeship model, to explore the experience of enhanced near-peer support at the transition to practice. Participants recorded audio diaries from their commencement of work, and a semistructured interview was conducted with each, after 3 months, concerning their experience of their overlap with the previous year's interns.

SETTING

University College Cork, one of six medical schools in Ireland.

PARTICIPANTS

Nine newly qualified medical doctors.

MAIN OUTCOME MEASURES

An exploration of their experience of transition to clinical practice, in the context of this enhanced near-peer support, will inform strategies to ease the transition from student to doctor.

RESULTS

Participants felt reassured by having a near-peer in the same role and safe to seek their support. This empowered them to gradually assume increasing responsibility and to challenge themselves to further their learning. Participants perceived that commencing work before the annual change-over of other grades of doctor-in-training enhanced their professional identities and improved patient safety.

CONCLUSIONS

Enhanced near-peer support for new doctors offers a potential solution to the stressful transition to practice. Participants were legitimate members of the community of practice, with the status and responsibility of first-year doctors. Furthermore, this study reinforces the benefit of asynchronous job change-over for doctors-in-training.

Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals

OBJECTIVES

Student assistantships are recommended to prepare medical graduates for clinical practice. Traditionally, assistantships have consisted of longer placements, often up to 15 weeks. However, within the constraints of the final year, medical schools need to carefully balance the time required for specialty placements, assessments and the risk of student burnout. We set out to evaluate the effectiveness of shorter, personalised student assistantships.

DESIGN

An evaluative study on the changes in final year student confidence in preparedness for practice after a 3-week assistantship with defined learning objectives and learning needs assessment.

SETTING

Eight hospitals affiliated with Imperial College School of Medicine.

OUTCOMES

Student confidence in 10 learning outcomes including organising ward rounds, documentation, communication with colleagues, communication with patients and relatives, patient handover, practical procedures, patient management, acute care, prioritisation and out-of-hours clinical work.

RESULTS

Two hundred and twenty final year medical students took part in the student assistantship, of whom 208 completed both the pre-assistantship and post-assistantship confidence rating questionnaires (95% completion rate). After the assistantship, 169 (81%) students expressed increased confidence levels in one or more learning objectives. For each individual learning objective, there was a significant change in the proportion of students who agreed or strongly agreed after the assistantship (p<0.0001).

CONCLUSION

Overall, the focused 3-week, personalised student assistantships led to significant improvement across all learning objectives related to preparedness for practice. The use of the pre-assistantship confidence rating questionnaire allowed students to identify and target areas of learning needs during their assistantship.

Fostering intrinsic motivation in remote undergraduate histopathology education

AIMS

The levels of abstraction, vast vocabulary and high cognitive load present significant challenges in undergraduate histopathology education. Self-determination theory describes three psychological needs which promote intrinsic motivation. This paper describes, evaluates and justifies a remotely conducted, post-COVID-19 histopathology placement designed to foster intrinsic motivation.

METHODS

90 fourth-year medical students took part in combined synchronous and asynchronous remote placements integrating virtual microscopy into complete patient narratives through Google Classroom, culminating in remote, simulated multidisciplinary team meeting sessions allowing participants to vote on 'red flag' signs and symptoms, investigations, histological diagnoses, staging and management of simulated virtual patients. The placement was designed to foster autonomy, competence and relatedness, generating authenticity, transdisciplinary integration and clinical relevance. A postpositivistic evaluation was undertaken with a validated preplacement and postplacement questionnaire capturing quantitative and qualitative data.

RESULTS

There was a significant (p<0.001) improvement in interest, confidence and competence in histopathology. Clinical integration and relevance, access to interactive resources and collaborative learning promoted engagement and sustainability post-COVID-19. Barriers to online engagement included participant lack of confidence and self-awareness in front of peers.

CONCLUSIONS

Fostering autonomy, competence and relatedness in post-COVID-19, remote educational designs can promote intrinsic motivation and authentic educational experiences. Ensuring transdisciplinary clinical integration, the appropriate use of novel technology and a focus on patient narratives can underpin the relevance of undergraduate histopathology education. The presentation of normal and diseased tissue in this way can serve as an important mode for the acquisition and application of clinically relevant knowledge expected of graduates.

How do residents perceive and narrate stories about communication challenges in patient encounters? A narrative study

OBJECTIVE

This article investigated residents' narratives to gain their understandings of which patterns are challenging in doctor-patient conversations.

DESIGN

Qualitative narratological framework.

PARTICIPANTS

We analysed 259 narratives from 138 residents' oral recounts of communication with patients in which they had felt challenged.

RESULTS

The analysis identified an ideal narrative for the doctor-patient encounter with the resident as protagonist pursuing the object of helping the patient with his health problem. Disruptions of this ideal narrative were at play when challenges occurred. Regardless of medical setting, challenges were often related to the establishment of a common object, and the communication actants had to go through negotiations, disagreements or even battles when trying to reach a common object. Challenges also occurred when actants which in the ideal narrative should act as helpers become opponents. We find narratives where patients, relatives and colleagues become opponents.

CONCLUSIONS

Our study showed that communication challenges were the result of disruptions of the perceived ideal narrative. Residents found it especially challenging to establish a common object, and dealing with helpers turned opponents. Patient communication is thus a challenge in the transition phase from student to doctor, and doctor-patient communication is complex in nature and continuously perceived to be so by residents, despite pregraduate training.