Experiential learning

Does medical training in Thailand prepare doctors for work in community hospitals? An analysis of critical incidents

BACKGROUND

Compulsory 3-year public service was implemented in 1967 as a measure to tackle the maldistribution of doctors in Thailand. Currently, therefore, most medical graduates work in rural community hospitals for their first jobs. This research explored doctors' perceptions of preparedness for practice using a critical incident technique.

METHODS

A self-administered critical incident questionnaire was developed. Convenient samples were used, i.e. Family Medicine residents at Ramathibodi Hospital who had worked in a community hospital after graduation before returning to residency training. Participants were asked to write about two incidents that had occurred while working in a community hospital, one in which they felt the knowledge and skills obtained in medical school had prepared them for managing the situation effectively and the other in which they felt ill-prepared. Data were thematically analysed.

RESULTS

Fifty-six critical incidents were reported from 28 participants. There were representatives from both normal and rural tracks of undergraduate training and community hospitals of all sizes and all regions. Doctors felt well-prepared to provide care for patients in emergency situations and as in-patients, but under-prepared for obstetric and paediatric emergencies, out-patient care, and palliative care. Moreover, they felt poorly prepared to deal with difficult patients, hospital administration and quality assurance.

CONCLUSIONS

Long-term solutions are needed to solve the rural doctor shortage. Medical graduates from both normal and rural tracks felt poorly prepared for working effectively in community hospitals. Medical training should prepare doctors for rural work, and they should be supported while in post.

Faculty perceptions regarding community-based medical education: The case of KSA

Objectives

There is great concern about the selection and quality of health college graduates and about their ability to respond to local community health needs. Community-based medical education (CBME) is a means of achieving educational relevance to community needs. In KSA, medical education has rapidly progressed in tandem with huge expansions in community health needs and expectations. This study aimed to assess the perceptions of the faculty members of the colleges of medicine and dentistry towards different concepts reflecting CBME.

Methodology

This analytical, observational and cross-sectional study used a self-administered questionnaire that was given to the faculty members of the colleges of medicine and dentistry at Taibah University, KSA.

Results

As many as 136 faculty members responded, a response rate of 64%. The percentage of agreement was strongest among the faculty members of the college of medicine. The study findings also showed a relationship between different concepts of CBME and faculty teaching experiences by academic positions for applying CBME. There were significant differences in the social, cultural, and ethnic aspects of medical practice.

Conclusion

CBME is a means of achieving educational relevance to community needs and consequently serves as a means of implementing a community-oriented education programme.

Learning opportunities in the clinical setting (LOCS) for medical students: A novel approach

INTRODUCTION

Graduate-entry medical programmes (GEP) have been introduced into many UK universities. Their shortened 4-year programme may restrict exposure to the clinical environment. The GEP at Swansea University has introduced Learning Opportunities in the Clinical Setting (LOCS), a novel approach, allowing students to choose half day sessions from a list which aimed at bringing experiential clinical learning to first and second year students on the course.

METHODS

During the academic years 2007-2008 and 2008-2009, student feedback was collected anonymously online with the options 'very useful', 'useful' or 'not useful' followed by a free text box space to feedback their experience. The text was assessed using qualitative analysis methodology.

RESULTS

A total of 730 LOCS feedback comments were analysed, 422 were recorded as 'very useful' (58%), 276 were 'useful' (38%) and 32 'not useful' (4%). Students' feedback were divided into positive (1330) and negative (152) comments. Positive themes were broadly divided into four categories: Positive Teacher experience, Positive Clinical experience, Relevance to the course and significant Personal Development.

CONCLUSION

The LOCS system provides an efficient method of providing students with a choice of additional learning opportunities which has proved popular and, in the opinion of students, educationally effective.

Factors influencing teaching and learning in the preregistration year

Preregistration training is a transitional period in the career of new medical graduates as they complete their final year of basic medical education in practice settings. This study gathered the views of both preregistration house officers and their educational supervisors on preregistration training in the Mersey Deanery between August 2000 and August 2001.

Translating learning principles into practice: a new strategy for learning clinical skills

AIM

There are data to suggest that medical school may not adequately prepare doctors for practice and that there are deficiencies in undergraduate teaching of skills in history taking, physical examination, diagnosis and management (clinical skills). There is a need to re-evaluate methods by which we can teach clinical skills effectively. This aim of this review was to describe the literature concerning the important principles underpinning effective clinical learning. Subsequently a structured learning tool and teaching process was developed in order to support these principles.

METHOD

The principles of effective clinical learning were derived after a search of the medical education and relevant behavioural science literature. Consequently, a structured learning tool and teaching process was developed in order to potentiate the translation of these principles into practice for medical school training in clinical skills.

RESULTS

Ten principles were derived from the 68 articles referred to in this review. These were: making active decisions, an individual focus to learning, gaining experience, feedback to the learner, reciprocal learning, holistic care, relevant learning, feasibility, cost efficiency and mentoring. A process for history taking, physical examination and management plan was developed for medical students which incorporated these principles.

CONCLUSION

Relevant literature can provide the foundations for teaching and learning methods in medical education. We plan to trial this method and evaluate the impact on student learning outcomes.

Promoting professional knowledge, experiential learning and critical thinking for medical students

It has been recognized internationally that undergraduate medical education must adapt to changing needs, as illustrated by the Tomorrow's Doctors recommendations from the General Medical Council. This paper aims to relate contemporary educational theory to under-graduate medical educational requirements, specifically highlighting conditions (e.g. experiential learning) for: professional knowledge acquisition; critical thinking, problem-solving and clinical problem-solving; and lifelong professional learning. Furthermore, problem-based learning (PBL) is highlighted as potentially providing such conditions. There are lessons from contemporary educational theory for the reform of undergraduate medical education. These include valuing prior knowledge and experience; promoting learner responsibility through facilitating rather than directing learning; encouraging learners to test out and apply new knowledge, and using small-group work to foster explicitly the elusive skills of critical thinking and reflection. Contemporary educational theory contributes valuable insights, but cannot dictate the ultimate 'mix'; at best it provides some principles for reflective analysis of the learning experiences created for tomorrow's doctors.