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Kinston R, Gay S, McKinley RK, Sam S, Yardley S, Lefroy J. How well do UK assistantships equip medical students for graduate practice? Think EPAs. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:173-198. [PMID: 37347459 DOI: 10.1007/s10459-023-10249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved.
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Affiliation(s)
- Ruth Kinston
- School of Medicine, Keele University, Clinical Education Centre, University Hospital of North Midlands, Newcastle Road, Staffordshire, ST4 6QG, UK.
| | - Simon Gay
- University of Leicester School of Medicine, Leicester, UK
- Keele University School of Medicine, Keele, UK
| | | | - Sreya Sam
- Keele University School of Medicine, Keele, UK
| | - Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central & North West London NHS Foundation Trust, London, UK
| | - Janet Lefroy
- School of Medicine and Faculty Lead for the Health Professionals Education Research Theme, Keele University, Keele, UK
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Wilesmith S, Mandrusiak A, Martin R, Lu A, Forbes R. Writing for the role: A qualitative exploration of new graduate physiotherapists' transition to practice of clinical documentation. Physiother Theory Pract 2024:1-13. [PMID: 38415627 DOI: 10.1080/09593985.2024.2315255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 01/07/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION Clinical documentation is an integral component of effective physiotherapy practice. Minimal research has explored how new graduate physiotherapists transition to practice of documentation. OBJECTIVE To understand new graduate physiotherapists' experiences and support needs for transitioning into this professional role, from the perspectives of new graduates and clinical supervisors. METHODS This study utilized the qualitative methodology of reflexive thematic analysis, situated within a critical realist framework and informed by Duchscher's stages of transition theory. Semi-structured interviews of 16 new graduate physiotherapists (less than two years post-graduation) and seven clinical supervisors (of new graduate physiotherapists) were subjected to inductive analysis, where codes were organized into themes and subthemes. RESULTS Three overarching themes were generated with associated subthemes. Variable preparedness for documentation identified that new graduates were equipped with the basics of documentation, yet challenged by unfamiliarity and complexity. Documentation practices evolve over time outlined experiences of new graduates developing a "written voice" and improving documentation efficiency. Workplace support is necessary irrespective of preparedness, discusses: i) opportunities to practice, reflect and refine skills, ii) protected time for documentation, and iii) access to templates and examples. CONCLUSION New graduate physiotherapists enter the workforce with variable levels of preparedness for clinical documentation, and may experience challenges when facing unfamiliar contexts and clinical complexity. Understanding expectations and engaging in opportunities to improve documentation skills were perceived as beneficial for enhancing new graduate practice of clinical documentation across workplace settings. Implications for workplace support to promote safe and effective practice of documentation are discussed.
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Affiliation(s)
- Sarah Wilesmith
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Romany Martin
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Andric Lu
- North West Hospital and Health Service, Queensland Health, Mount Isa, Queensland, Australia
| | - Roma Forbes
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
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Dornan T, Armour D, McCrory R, Kelly M, Speyer F, Gormley G, Maxwell P. Striking fear into students' hearts: Unforeseen consequences of prescribing education. MEDICAL TEACHER 2024:1-11. [PMID: 38301608 DOI: 10.1080/0142159x.2024.2308061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Undergraduate medical education (UGME) has to prepare students to do safety-critical work (notably, to prescribe) immediately after qualifying. Despite hospitals depending on them, medical graduates consistently report feeling unprepared to prescribe and they sometimes harm patients. Research clarifying how to prepare students better could improve healthcare safety. Our aim was to explore how students experienced preparing for one of their commonest prescribing tasks: intravenous fluid therapy (IVFT). METHODS Complexity assumptions guided the research, which used a qualitative methodology oriented towards hermeneutic phenomenology. The study design was an uncontrolled and unplanned complex intervention: judicial review of the iatrogenic death of five children due to hyponatraemia in our region had resulted in the recommendation that students' education in 'the implementation of important clinical guidelines' relevant to fluid and electrolyte balance should be intensified. An opportunity sample of 40 final-year medical students drew and gave audio-recorded commentaries on rich pictures. We completed two template analyses: one of participants' transcribed commentaries on the pictures and one using a novel heuristic to analyse the pictures themselves. We then reconciled the two analyses into a single template. RESULTS There were four themes: affects, teaching and learning, contradictions, and the curriculum as a journey. To explore interconnections between themes, we chose the picture best exemplifying each of the four themes and interpreted the curriculum journey depicted in each of them. These interpretations were grounded in each participant's picture, verbal account of the picture, and the aggregate findings of the template analysis. Participants' experiences were influenced by the situated complexity of IVFT. Layered on top of that, contradictions, overlaps, and gaps within the curriculum introduced extraneous complexity. Confusion and apprehension resulted. CONCLUSIONS After spending five years preparing to prescribe IVFT, participants felt unprepared to do so. We conclude that intensive teaching had not achieved its avowed goal of improving students' preparedness for safe practice. Merton's seminal work on the 'unanticipated consequences of purposive social action' suggests that intensive teaching may even have contributed to their unpreparedness.
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Affiliation(s)
- Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Dakota Armour
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Richard McCrory
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Martina Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Frederick Speyer
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Gerard Gormley
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Peter Maxwell
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
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Godoi A, Casteleyn C, Virk F, McDade-Kumar M, Byrne MHV, Moussa A, Baptiste P, Tombs M. Construction and validation of a medical career readiness inventory. CLINICAL TEACHER 2024:e13733. [PMID: 38233580 DOI: 10.1111/tct.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/09/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Medical students' preparedness for clinical practice is well researched, yet little is known on the extent to which students are being prepared for a medical career. This paper reports the construction of a short medical inventory titled eXploring medical sTudents' caReer reAdiness (XTRA) to measure students' career readiness based on Super's theory of career maturity. APPROACH We designed an instrument consisting of a series of 5-point Likert-scale to identify participants competencies regarding career exploration and planning during their undergraduate studies. The instrument was completed by 348 medical students from 41 universities in the United Kingdom. We examined the validity and reliability of the instrument through Exploratory Factor Analysis, Cronbach's coefficient α and Pearson correlation. EVALUATION Exploratory Factor Analysis revealed that 16 of the 20-items survey were aligned with the exploration stage of Super's theory: Crystallisation (Career goals), Specification (Career pathways) and Implementation (Career accomplishments). The four items that formed two separate statistical factors were specific to a current medical career in the UK. Internal reliability for Super's factor subscales were acceptable (α = 0.71 to α = 0.81). A significant positive relationship was found between students' overall rating of career readiness and the three factors, indicating construct validity. IMPLICATIONS The XTRA Inventory is a short instrument with construct and content validity specifically designed to measure career readiness of medical students. Further work on its psychometric properties will help establish this inventory to be used as a guidance and career counselling tool by medical educators and educational institutions in developing career development programmes.
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Affiliation(s)
- Amanda Godoi
- School of Medicine, Cardiff University, Cardiff, UK
| | | | - Farazi Virk
- Airedale NHS Foundation Trust, Yorkshire, UK
| | - Mia McDade-Kumar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew H V Byrne
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ahmed Moussa
- Faculty of Medicine, Tishreen University, Latakia, Syria
| | | | - Michal Tombs
- School of Medicine, Cardiff University, Cardiff, UK
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Dunin-Borkowska A, Cardoso Pinto AM, Xu J, Bhandari N, Ranasinghe L. Evaluating the Utility of a Near-Peer Situation-Based Course to Prepare Medical Students for the UK Foundation Programme: A Pilot Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:1317-1325. [PMID: 38028371 PMCID: PMC10676640 DOI: 10.2147/amep.s434080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
Background Starting the Foundation Programme can be challenging for many medical graduates, as medical school alone may not adequately prepare them for complex tasks like managing comorbidities or emergencies. Growing evidence supports the role of transition interventions to meet this knowledge gap, however data on the utility of situation-based learning are limited. This pilot study aimed to assess the efficacy of a near-peer case-based course in improving knowledge and preparedness for foundation training in recent medical graduates. Methods Recent Imperial College graduates who attended a "Junior Doctor on Call" course were eligible for inclusion. This transition intervention, designed and delivered by a Foundation Year 1 doctor, covered six patient cases that integrated high-yield clinical concepts and practical tips. An online questionnaire was distributed one week before and after the course to assess perceptions of knowledge, confidence, and preparedness for training. Participants were also invited to attend an online semi-structured after the course. Results Out of 19 attendees, 17 (89.5% response rate) completed the pre-course questionnaire, 14 (73.7% response rate) completed the post-course questionnaire, and 3 completed the interview. 68.75% (n=11) had not previously attended a preparatory course for foundation training. Results demonstrated that 85.7% of participants felt more knowledgeable than before in the key topics covered. Participants also demonstrated an increase in self-rated confidence in commencing work as a junior doctor following the course, with 92.9% of participants stating that they felt more confident. Conclusion This study offers support for short-term situation-based courses in enhancing medical students' knowledge and confidence for foundation training. These findings add to the growing evidence-base encouraging implementation of short-term courses in preparing for practice. However, further research on the utility of such transition interventions is critical to inform the development of evidence-based recommendations for recent medical graduates, educators, and programme directors.
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Affiliation(s)
| | | | - Joshua Xu
- Department of Medicine, Imperial College London, London, UK
| | - Nikhil Bhandari
- Department of Medicine, St George’s Medical School, University of London, London, UK
| | - Lasith Ranasinghe
- Department of Acute Internal Medicine, Homerton Healthcare NHS Foundation Trust, London, UK
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Aggarwal M, Abdelhalim R, Fowler N, Oandasan I. Conceptualizing "Preparedness for Practice": Perspectives of Early-Career Family Physicians. Fam Med 2023; 55:667-676. [PMID: 37643091 PMCID: PMC10741718 DOI: 10.22454/fammed.2023.294689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Competency based medical education (CBME) aims to produce graduates prepared for independent practice. Many equate the outcome of "preparedness for practice" with acquisition of competence. As educators evaluate the outcomes of CBME, being clear on the concept of preparedness for practice will clarify the results that are measured and assessed. This study examined how preparedness for practice is conceptualized in the literature and by family physicians (FPs) in Canada. METHODS This multimethod qualitative descriptive study included (1) rapid review and narrative synthesis, and (2) focus groups with early-career FPs using maximum variation sampling until thematic saturation was reached. Focus groups explored the FPs' conceptualizations of preparedness for practice. Focus groups were audio-recorded, transcribed, and coded before content analysis. RESULTS Thirty-four articles met the inclusion criteria, and 59 early-career FPs participated in the focus groups. We found no consensus on the conceptualization of preparedness for practice in the literature; however, the concept often was described as acquiring competencies for program requirements. In the literature and focus groups, we identified four themes for the conceptualization of preparedness for practice. These themes included competence, self-confidence (self-efficacy, self-concept), capability, and adaptability. CONCLUSIONS Preparedness for practice involves an interplay of dynamic and complex constructs from competence, self-confidence, capability, and adaptability. Preparedness is more than possessing several competencies; it calls for integrating and applying competencies in complex and changing environments. This study aimed to start a discussion on what end point is desirable for residency education and proposed that the end point needs to move beyond competencies.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of TorontoToronto, ONCanada
| | - Reham Abdelhalim
- Institute of Health Policy, Management and Evaluation, University of TorontoToronto, ONCanada
| | - Nancy Fowler
- Department of Family Medicine, McMaster UniversityHamilton, ONCanada
| | - Ivy Oandasan
- Department of Family and Community Medicine, University of TorontoToronto, ONCanada
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Blair M, Mitchell L, Gibson S, Rees CE, Ottrey E, Monrouxe LV, Palermo C. The graduate dietitian experience of employment and employability: A longitudinal qualitative research study from one Australian university. Nutr Diet 2023; 80:377-388. [PMID: 37400363 DOI: 10.1111/1747-0080.12832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/09/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
AIMS Diet-related chronic disease contributes significantly to the global burden of disease. Dietitians are best placed to address this disease burden, yet graduate dietitians may struggle to find employment. This study aimed to explore dietetics graduates' experiences of employment and employability, up to 6-month post-degree completion. METHODS Secondary data analysis of in-depth qualitative interview data and longitudinal audio-diaries was undertaken. An interpretivist approach was employed whereby knowledge was viewed as subjective and multiple realities exist. A total of five entrance interviews, 31 audio-diaries and three exit interviews, from nine graduates were included in the analysis. This comprised 12 h of longitudinal audio data. Thematic analysis was undertaken using a framework analysis method. RESULTS Four key themes were identified: (1) The tumultuous process of applying for jobs demonstrated that graduates struggled with repeated rejections. (2) The uncertain journey to employment indicated that job-seeking was a limbo stage marked by uncertainty. (3) Feeling the pressure showed that graduates experienced pressure from multiple sources. (4) Enhancing employability explained that graduates were not prepared for available employment opportunities, but utilised resources to increase their employability. CONCLUSION Diverse placement experiences may better prepare graduates for available employment opportunities. To enhance employability, it may be beneficial to assist students to develop job-seeking skills, and to engage in networking and volunteering experiences during their education.
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Affiliation(s)
- Merran Blair
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Victoria, Australia
| | - Lana Mitchell
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Simone Gibson
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Charlotte E Rees
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Lynn V Monrouxe
- Waranara (Healthcare Professions Education Research Network), Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Barradell S. Reimagining Preparedness of Health Professional Graduates Through Stewardship. TEACHING AND LEARNING IN MEDICINE 2023; 35:486-495. [PMID: 36520110 DOI: 10.1080/10401334.2022.2148108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/01/2022] [Indexed: 06/17/2023]
Abstract
Issue: Preparing health professional students for practice matters and is an important objective of health professional education. But although health professional courses grow in number and continue to graduate entry-level practitioners annually, there are signs that health professional education is not quite hitting the "purpose" mark. Preparedness is a term encountered often in health professional education, but it is besieged with challenges. Those challenges relate to whether graduates are prepared for their future careers and how preparedness for practice is understood; understandings of preparedness influence what curriculum, teaching, and learning prepares graduates about and for. Evidence: There is a wealth of the literature that suggests that graduates are not prepared for practice or believe they are not. This literature tends to grow rather than diminish, with arguments about preparedness materializing time and again. Preparedness means different things to students, academics, and practitioners and this creates misunderstanding as well as lessening the construct's value to research, education, and practice. What it means to be prepared is in fact not a static construct but changes in response to the needs of individuals and communities and broader societal context. When preparedness is defined as competence in skills or knowledge, graduates will be ill equipped to operate in the chaotic, ambiguous times we now face as competencies tend to oversimplify and reduce the demands of practice. Implications: Preparedness is only one purpose that could be attached to the educational formation of university graduates. It is time we expand our thinking about what is valuable and necessary to learn in order to become health professionals equipped to address the health and social care problems now and to come. Furthermore, continuing to address the challenges of preparedness for practice in the same ways as we have done for decades will not result in change; new and different educational approaches are required to meaningfully reimagine health professional education. We need to value education as a scholarly field in its own right, as much as we do evidence-based healthcare. A concept that prompts us to think and act in these reinvigorated ways is stewardship, which I offer as an expansive way to think about the purposes and desired outcomes of health professional education. Stewardship is an idea that sustains and cares for the professions, and therefore is highly relevant to the preparation of healthcare practitioners.
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Affiliation(s)
- Sarah Barradell
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Large J, Kumar PR, Konda NN, Hashmi Y, Lee JJ. National evaluation of trauma teaching for students (NETTS). Postgrad Med J 2023; 99:624-630. [PMID: 37319162 DOI: 10.1136/postgradmedj-2021-141341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/06/2022] [Indexed: 11/04/2022]
Abstract
Despite the shift towards consultant-led care, many patients with trauma are still seen by junior doctors. Previous research has demonstrated that junior doctors feel unprepared to work in acute care but there is a paucity of recent research in trauma specifically. Thus, a national study is required to investigate the current state of undergraduate trauma teaching and identify specific areas for improvement. Between August and September 2020, a 35-item structured questionnaire was distributed among doctors who graduated from UK medical schools within the last 4 years. The questionnaire retrospectively assessed their experience of trauma teaching at medical school and their confidence to diagnose and manage patients with trauma. 398 responses were recorded from graduates of 39 UK medical schools. With 79.6% reporting only 0-5 hours of bedside trauma teaching and 51.8% reporting less than 20 hours in Accident and Emergency, graduates reported that trauma teaching was deficient compared with other specialties (78.1%). The majority of graduates were not confident in the initial assessment (72.9%) of a patient with trauma and almost all felt that a short course in trauma would be useful (93.7%). 77.4% of students felt that online learning would be beneficial and 92.9% felt that simulation would be useful. There is lack of standardised undergraduate trauma teaching nationally; a formal undergraduate teaching to ensure that new graduates are competent in the management of trauma would be supported by students. It is likely that a blended learning approach, incorporating e-learning with traditional teaching and clinical experience would be well received.
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Affiliation(s)
- Jamie Large
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Prakrit R Kumar
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Lister Hospital, Stevenage, UK
| | - Nagarjun N Konda
- University Hospital Coventry, Coventry, UK
- University of Warwick, Coventry, UK
| | - Yousuf Hashmi
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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Gaxiola-García MA, Villalpando-Casas JDJ, García-Minjares M, Martínez-González A. National examination for medical residency admission: academic performance in a high-stakes test and the need for continuing education. Postgrad Med J 2023; 99:599-604. [PMID: 37319154 DOI: 10.1136/postgradmedj-2022-141607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Performance and selection rate of non-newly graduated physicians in a medical residency admission test as an indicator for the need of continuing education. METHODS A database comprising 153 654 physicians who took a residency admission test in the period 2014-2018 was analysed. Performance and selection rates were assessed in relation to year of graduation and performance in medical school. RESULTS The whole sample scored at a mean of 62.3 (SD ±8.9; range 1.11-91.11). Examinees who took the test in their year of graduation performed better (66.10) than those who took the test after their year of graduation (61.84); p<0.001.Selection rates differed accordingly; 33.9% for newly graduated physicians compared with 24.8% in those who took the test at least 1 year after graduation; p<0.001. An association between selection test performance and medical school grades was established using Pearson's correlation: r=0.40 for newly graduated physicians and r=0.30 for non-newly graduated physicians. There were statistically significant differences in selection rates for every ranking group of grades in medical school based on the χ2 test (p<0.001). The selection rates are decreased years after graduation even for candidates with high grades in medical school. DISCUSSION There is an association between performance in a medical residency admission test and academic variables of the candidates: medical school grades and time elapsed from graduation to test taking. The evidence of decrease in retention of medical knowledge since graduation highlights the pertinence of continuing education interventions.
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Affiliation(s)
| | | | | | - Adrián Martínez-González
- CUAIEED, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
- Public Health Department, Universidad Nacional Autónoma de México, UNAM, Mexico City, Mexico
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Moroni M, Díaz Crescitelli ME, Capuccini J, Pedroni C, Bianco M, Montanari L, Ghirotto L. 'Now I can train myself to be with death': a phenomenological study with young doctors in care homes supported by a palliative care unit during the second wave of the pandemic in Italy. BMJ Open 2023; 13:e065458. [PMID: 37041055 PMCID: PMC10105916 DOI: 10.1136/bmjopen-2022-065458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE During the second wave of the COVID-19 pandemic, one of the organisational strategies established by the Italian National Health System was the special units for continuity of care (SUCCs). In the province of Ravenna, those units enrolled novice doctors to care for elderly patients with COVID-19 in care homes (CHs). The local palliative care (PC) unit decided to offer consultations and support to them. This study aimed to comprehend the experience of young doctors who asked for consultations when facing, during their first early years of practice, complex situations. DESIGN We conducted a qualitative study employing a phenomenological approach and in-depth interviews. PARTICIPANTS We involved 10 young doctors who worked in Italian SUCC during the pandemic and used a PC consultation support service. RESULTS What describes our participants' experience is related to four main themes: (1) reducing distances, (2) perceiving medical futility and improvising, (3) being supported to learn how to be with death and (4) narrowed timing to humanise care. The pandemic was, for our participants, a moment of reflection and critique on the skills acquired during the university course. It was a strong experience of human and professional growth that helped them reshape and deepen their role and skills, incorporating the approach of PC into their professional identity. CONCLUSIONS Integration between specialists and young doctors with an early entry into the workforce during the pandemic in CHs set out a 'shift' to a proactive and creative approach through a new awareness of professional and personal roles in doctor-patient relations. The continuity of care models should be rethought by integrating CHs and PC. Adequate PC training for young doctors (at pregraduate and postgraduate levels) can change doctors' vision and daily practice in assisting patients at the end of life.
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Affiliation(s)
- Matteo Moroni
- S.S.D. Cure Palliative, AUSL della Romagna, Ravenna, Italy
| | | | | | | | - Mattia Bianco
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Luca Ghirotto
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Church HR, Murdoch-Eaton D, Sandars J. Under- and post-graduate training to manage the acutely unwell patient: a scoping review. BMC MEDICAL EDUCATION 2023; 23:146. [PMID: 36869334 PMCID: PMC9983517 DOI: 10.1186/s12909-023-04119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Junior doctors are often the first responders to acutely unwell patients and yet frequently report feeling under-prepared to do so. To understand whether this is consequential of how medical students and doctors are trained to manage acutely unwell patients, a scoping review was conducted using a systematic approach. METHODS The review, informed by the Arksey and O'Malley and PRISMA-ScR guidelines, identified educational interventions targeting the management of acutely unwell adults. Seven major literature databases were searched for journal articles published in English from 2005 to 2022, in addition to the Association of Medical Education in Europe (AMEE) conference proceedings from 2014 to 2022. RESULTS Seventy-three articles and abstracts were eligible for the review, the majority of which were from the UK or USA, and demonstrated that educational interventions were more commonly targeted at medical students than qualified doctors. The majority of studies used simulation, but very few integrated complexities of the clinical environment within scenarios such as multidisciplinary working, distraction-handling techniques and other non-technical skills. A wide range of learning objectives pertaining to acute patient management were stated across studies, but few explicitly cited educational theory underpinning their study. CONCLUSIONS The results of this review encourages future educational initiatives to consider enhancing authenticity within simulation to promote transfer of learning to clinical practice, and use educational theory to augment the sharing of educational approaches within the community of clinical education practice. Additionally, increasing the focus on post-graduate learning, building upon undergraduate educational foundations, is essential to promoting lifelong learning within the ever-changing healthcare environment.
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Affiliation(s)
- Helen R Church
- Faculty of Medicine and Health Sciences, University of Nottingham, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, England, UK.
| | - Deborah Murdoch-Eaton
- Academic Unit of Medical Education, The University of Sheffield, Sheffield, England, UK
| | - John Sandars
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, England, UK
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Javed MQ, Nawabi S, Bhatti UA, Atique S, AlAttas MH, Abulhamael AM, Zahra D, Ali K. How Well Prepared Are Dental Students and New Graduates in Pakistan-A Cross-Sectional National Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1506. [PMID: 36674261 PMCID: PMC9859325 DOI: 10.3390/ijerph20021506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/13/2023]
Abstract
The transition of an undergraduate dental student to an actual practicing dentist is a crucial phase and ensuring the preparedness of graduates for the complexity and demands of contemporary dental practice is a challenging task. This study aimed to evaluate the self-perceived preparedness of undergraduate dental students and house officers in the dental colleges of Pakistan. A cross-sectional national study was planned to collect information from dental students and new graduates in Pakistan. The pre-validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS) was used. A purposive sampling technique was utilized to recruit house officers and undergraduate dental students from 27 dental schools in Pakistan. The data analysis was carried out using the R statistical environment for Windows (R Core Team, 2015). A total of 862 responses with 642 females and 219 males were analyzed in the study. Overall, the clinical skills score was 30.56 ± 9.08 and the score for soft skills was 30.54 ± 10.6. The mean age of the participants was 23.42 ± 1.28. Deficiencies were reported in various soft skills and clinical skills attributes. The results highlighted the strengths and weaknesses of dental students and new graduates in Pakistani dental institutions. The findings may be used to further develop and strengthen the teaching and training of dental students in Pakistan.
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Affiliation(s)
- Muhammad Qasim Javed
- Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Buraidah 52571, Saudi Arabia
| | - Shazia Nawabi
- Department of Medical Education, Rawal Institute of Health Sciences, Islamabad 45550, Pakistan
| | - Usman Anwer Bhatti
- Department of Operative Dentistry, College of Dentistry, Riphah International University, Islamabad 45320, Pakistan
| | - Sundus Atique
- College of Dental Medicine, Qatar University, QU Health, Doha 2713, Qatar
| | - Mustafa Hussein AlAttas
- Department of Conservative Dental Sciences and Endodontics, College of Dentistry, Qassim University, Buraidah 52571, Saudi Arabia
| | - Ayman M. Abulhamael
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia
| | - Daniel Zahra
- Peninsula Medical School, Faculty of Health (Medicine, Dentistry and Human Sciences), Plymouth University, Plymouth PL48AA, UK
| | - Kamran Ali
- College of Dental Medicine, Qatar University, QU Health, Doha 2713, Qatar
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Fung CY, Kearney L, Hatfield E, Martin NM, Halse O, Jensen-Martin J, Hughes E, Sam AH. Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals. BMJ Open 2022; 12:e061842. [PMID: 36549736 PMCID: PMC9791415 DOI: 10.1136/bmjopen-2022-061842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Chee Yeen Fung
- Imperial College School of Medicine, Imperial College London, London, UK
- Directorate of Education and Quality, Health Education England, London, UK
| | - Lesa Kearney
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Emma Hatfield
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Niamh M Martin
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Omid Halse
- Imperial College School of Medicine, Imperial College London, London, UK
| | | | - Elizabeth Hughes
- Directorate of Education and Quality, Health Education England, London, UK
| | - Amir H Sam
- Imperial College School of Medicine, Imperial College London, London, UK
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Tawse J, Demou E. Qualitative study to explore UK medical students' and junior doctors' experiences of occupational stress and mental health during the COVID-19 pandemic. BMJ Open 2022; 12:e065639. [PMID: 36523252 PMCID: PMC9748513 DOI: 10.1136/bmjopen-2022-065639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This qualitative study aimed to explore the occupational experiences of medical students and junior doctors working during the COVID-19 pandemic. In particular, the research sought to identify factors which mediated work stress, barriers to disclosing mental health problems and levels of support medical students and junior doctors received during the pandemic. DESIGN This study was a form of thematic analysis and adopted an inductive, 'bottom-up' approach, in which coded categories were derived from rich, descriptive data. SETTING Semistructured interviews were conducted online with UK-based medical students and junior doctors. Interviews were recorded, and analysis was done by coding salient quotes into themes. PARTICIPANTS The final sample consisted of seven junior doctors and eight medical students, during the summer of 2021. RESULTS High levels of occupational stress were identified, which were exacerbated by COVID-19. A number of organisational difficulties associated with the pandemic compounded participants' experiences of work stress. Participants recognised progress towards promoting and managing mental health within the profession but may still be reluctant to access support services. Barriers to disclosure included fear of stigmatisation, concerns about adding to colleagues' workloads, lack of clarity about career implications and mistrust of occupational health services. CONCLUSIONS While attitudes towards mental health have improved, medical students and junior doctors may avoid seeking help. Given the immense pressures faced by health services, it is imperative that extra measures are implemented to minimise work-stress, encourage help-seeking behaviours and promote supportive work cultures.
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Affiliation(s)
- James Tawse
- University of Glasgow College of Social Sciences, Glasgow, UK
- Staff Advice and Liaison Service, Alder Hey Children's Hospital, Liverpool, UK
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow College of Medical Veterinary and Life Sciences, Glasgow, UK
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16
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Kuehl SE, Spicer JO. Using entrustable professional activities to better prepare students for their postgraduate medical training: A medical student's perspective. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:359-364. [PMID: 36441351 PMCID: PMC9743878 DOI: 10.1007/s40037-022-00731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
THE PROBLEM Medical students graduate underprepared for postgraduate medical training despite years of classroom and clinical training. In this article, a medical student shares her personal perspectives on three factors contributing to this problem in undergraduate medical education: students' peripheral roles in the clinical environment impede learning, students receive inadequate feedback, and assessments do not measure desired learning outcomes. A SOLUTION The authors describe how using entrustable professional activities (EPAs) could address these issues and promote students' clinical engagement by clarifying their roles, providing them with frequent and actionable feedback, and aligning their assessments with authentic work. These factors combined with grading schemes rewarding improvement could contribute to a growth mindset that reprioritizes clinical skill acquisition. The authors explore how medical schools have begun implementing the EPA framework, highlight insights from these efforts, and describe barriers that must be addressed. THE FUTURE Incorporating EPAs into medical school curricula could better prepare students for postgraduate training while also alleviating issues that contribute to student burnout by defining students' roles, improving feedback, and aligning assessments with desired learning outcomes.
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Affiliation(s)
- Sarah E Kuehl
- Emory University School of Medicine and Goizueta Business School, Atlanta, GA, USA.
| | - Jennifer O Spicer
- J. Willis Hurst Internal Medicine Residency Program, Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Gatti CA, Parker-Conway K, Okorie M. COVID-19 pandemic interim Foundation Year 1 post and confidence in core skills and competencies: a longitudinal survey. BMJ Open 2022; 12:e059487. [PMID: 36323477 PMCID: PMC9638744 DOI: 10.1136/bmjopen-2021-059487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES The interim Foundation Year 1 (FiY1) post was created in response to the COVID-19 pandemic to help bolster the workforce and manage increased clinical pressures. This study aimed to assess the impact of the FiY1 post on medical graduates' self-reported confidence in common tasks, core skills, competencies and procedures prior to starting FY1, as a measure of increasing preparedness for practice. SETTING A longitudinal survey was performed at a tertiary teaching hospital in the South East of England. FiY1 posts ran from June to July 2020. PARTICIPANTS Questionnaires were sent to 122 medical graduates from a single medical school (recipients included FiY1s and non-FiY1s) and to 69 FiY1s at a single Teaching Hospital NHS Trust, irrespective of medical school attended. Initial and follow-up questionnaires had 86 and 62 respondents, respectively. Of these, 39 graduates were matched; 26 were FiY1s and 13 non-FiY1s. The 39 matched results were analysed. PRIMARY OUTCOME MEASURES Confidence levels in common FY1 tasks, core procedures and competencies were gathered before and after the FiY1 post through online questionnaires. Change in confidence comparing FiY1s and non-FiY1s was measured and analysed using linear regression. RESULTS On a 5-point scale, the FiY1 post increased overall confidence in starting FY1 by 0.62 (95% CI 0.072 to 1.167, p=0.028). The FiY1 post increased confidence in performing venepuncture by 0.32 (95% CI 0.011 to 0.920, p=0.045), performing intravenous cannulation by 0.48 (95% CI 0.030 to 1.294, p=0.041) and recognising, assessing and initiating the management of the acutely ill patient by 0.32 (95% CI 0.030 to 1.301, p=0.041). CONCLUSIONS The COVID-19 pandemic FiY1 post improved confidence in core skills and competencies. These findings may help guide future educational interventions in conjunction with further larger scale studies, ultimately aiding to bridge the transition gap between being a medical student and a doctor.
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Affiliation(s)
- Cristina Angela Gatti
- Department of Medical Education, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- General Internal Medicine, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Kathryn Parker-Conway
- Department of Medical Education, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Otolaryngology, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Okorie
- Department of Medical Education, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Department of Medicine, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
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Rees CE, Ottrey E, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Understanding Health Care Graduates' Conceptualizations of Transitions: A Longitudinal Qualitative Research Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1049-1056. [PMID: 34879008 DOI: 10.1097/acm.0000000000004554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners' conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa. METHOD The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally. RESULTS The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2). CONCLUSIONS This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders' transition conceptualizations over lengthier durations beyond the new graduate transition.
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Affiliation(s)
- Charlotte E Rees
- C.E. Rees is head of school, School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia, and adjunct professor, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4828-1422
| | - Ella Ottrey
- E. Ottrey is postdoctoral fellow, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-2979-548X
| | - Caitlin Kemp
- C. Kemp is research assistant, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-4056-2230
| | - Tina P Brock
- T.P. Brock is professor of pharmacy education and practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7455-4063
| | - Michelle Leech
- M. Leech is deputy dean and head of medical course, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kayley Lyons
- K. Lyons is Ware fellow for pharmacy education and leadership, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0003-2224-1107
| | - Lynn V Monrouxe
- L.V. Monrouxe is professor for work integrated learning and academic lead of health professions education research, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-4895-1812
| | - Julia Morphet
- J. Morphet is associate professor, Monash Nursing and Midwifery, and affiliate, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7056-6526
| | - Claire Palermo
- C. Palermo is director, Monash Centre for Scholarship in Health Education, and head of education and education research, Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-9423-5067
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Glosser LD, Lombardi CV, Hopper WA, Chen Y, Young AN, Oberneder E, Veria S, Talbot BA, Bodi SM, Matus CD. Impact of educational instruction on medical student performance in simulation patient. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2022; 13:158-170. [PMID: 35752175 PMCID: PMC9911140 DOI: 10.5116/ijme.62a5.96bf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effects, and timing of, a video educational intervention on medical student performance in manikin-based simulation patient encounters. METHODS This prospective mixed-methods study was conducted as part of the University of Toledo College of Medicine and Life Sciences undergraduate medical curriculum. One hundred sixty-six students second-year students participated in two simulations on a single day in September 2021. A 7-minute video intervention outlining the clinical diagnostic approach to pulmonary complaints was implemented. Students were randomized into 32 groups which were divided into two cohorts. One received the video prior to simulation-1 (n=83) and the other between simulation-1 and simulation-2 (n=83). Each simulation was recorded and assessed using a 44-point standardized checklist. Comparative analysis to determine differences in performance scores was performed using independent t-tests and paired t-tests. RESULTS Independent t-tests revealed the video-prior cohort performed better in simulation-1 (t(30)= 2.27, p= .03), however in simulation-2 no significant difference was observed between the cohorts. Paired t-test analysis revealed the video-between cohort had significant improvement from simulation-1 to simulation-2 (t(15)= 3.06, p = .01); no significant difference was found for the video-prior cohort. Less prompting was seen in simulation-2 among both the video-prior (t(15)= -2.83, p= .01) and video-between cohorts (t(15)= -2.18, p= .04). CONCLUSIONS Simulation training, and targeted educational interventions, facilitate medical students to become clinically competent practitioners. Our findings indicate that guided video instruction advances students' clinical performance greater than learning through simulation alone. To confirm these findings, similar investigations in other clinical training exercises should be considered.
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Affiliation(s)
- Logan D. Glosser
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | - Conner V. Lombardi
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | - Wade A. Hopper
- Department of Medical Education, Edward Via College of Osteopathic Medicine, USA
| | - Yixing Chen
- Lloyd A. Jacobs Interprofessional Immersive Simulation Center, USA
| | - Alexander N. Young
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | | | - Sprio Veria
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | - Benjamin A. Talbot
- Department of Medical Education, University of Toledo College of Medicine and Life Sciences, USA
| | - Shirley M. Bodi
- Department of Family Medicine University of Toledo College of Medicine and Life Sciences, USA
| | - Coral D. Matus
- Department of Family Medicine University of Toledo College of Medicine and Life Sciences, USA
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20
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Dheensa S, Feder G. Sharing information about domestic violence and abuse in healthcare: an analysis of English guidance and recommendations for good practice. BMJ Open 2022; 12:e057022. [PMID: 35710255 PMCID: PMC9207756 DOI: 10.1136/bmjopen-2021-057022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Over two million adults experience domestic violence and abuse (DVA) in England and Wales each year. Domestic homicide reviews often show that health services have frequent contact with victims and perpetrators, but healthcare professionals (HCPs) do not share information related to DVA across healthcare settings and with other agencies or services. AIM We aimed to analyse and highlight the commonalities, inconsistencies, gaps and ambiguities in English guidance for HCPs around medical confidentiality, information sharing or DVA specifically. SETTING The English National Health Service. DESIGN AND METHOD We conducted a desk-based review, adopting the READ approach to document analysis. This approach is a method of qualitative health policy research and involves four steps for gathering, and extracting information from, documents. Its four steps are: (1) Ready your materials, (2) Extract data, (3) Analyse data and (4) Distill your findings. Documents were identified by searching websites of national bodies in England that guide and regulate clinical practice and by backwards citation-searching documents we identified initially. RESULTS We found 13 documents that guide practice. The documents provided guidance on (1) sharing information without consent, (2) sharing with or for multiagency risk assessment conferences (MARACs), (3) sharing for formal safeguarding and (4) sharing within the health service. Key findings were that guidance documents for HCPs emphasise that sharing information without consent can happen in only exceptional circumstances; documents are inconsistent, contradictory and ambiguous; and none of the documents, except one safeguarding guide, mention how coercive control can influence patients' free decisions. CONCLUSIONS Guidance for HCPs on sharing information about DVA is numerous, inconsistent, ambiguous and lacking in detail, highlighting a need for coherent recommendations for cross-speciality clinical practice. Recommendations should reflect an understanding of the manifestations, dynamics and effects of DVA, particularly coercive control.
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Affiliation(s)
- Sandi Dheensa
- Domestic Violence and Abuse Health Research Group, Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gene Feder
- Domestic Violence and Abuse Health Research Group, Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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21
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Carr D, Gormley GJ. 'Visiting uncertainty': an immersive primary care simulation to explore decision-making when there is clinical uncertainty. EDUCATION FOR PRIMARY CARE 2022; 33:237-243. [PMID: 35638919 DOI: 10.1080/14739879.2022.2070867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Doctors are required to be able to care for patients in a variety of settings, including the patient's home. Patients requiring urgent care in their own homes are at risk of acute deterioration. However, differentiating acute deterioration from self-limiting conditions in the primary care environment can be challenging, even for GPs who are experienced in managing clinical uncertainty and ambiguity. Preparedness for practice of foundation doctors is directly related to opportunities for experiential learning and medical students face many barriers to obtaining experience of acute care in clinical environments. Simulation has been used in healthcare education as an adjunct to experiential learning in clinical environments since the 1950s. At present, the utilisation of immersive simulation in primary care environments for medical students is uncommon even though many foundation doctors will work in primary care. This article describes how faculty at a UK medical school developed an immersive simulated home visit scenario on an 'Acute Care Course' for medical students during their Assistantship. Debriefing discussions between students, faculty, and simulated participants focused on the cognitive, emotional, and ethical impacts of uncertainty and how this influenced clinical decision-making for medical students. Having an authentic simulated scenario in the primary care environment, where clinical uncertainty and ambiguity are ubiquitous, offered students opportunities in experiential learning in how to make clinical decisions, despite clinical uncertainty and ambiguity, when assessing and caring for acutely unwell patients.
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Affiliation(s)
- Davina Carr
- School of Medicine, Dentistry and Biomedical Sciences, Clinical Skills Education Centre, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Gerard J Gormley
- Queen's University Belfast Faculty of Medicine Health and Life Sciences, Clinical Skills Education Centre, Belfast, United Kingdom of Great Britain and Northern Ireland
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22
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Alsanosi SM. A New Vision of Teaching Clinical Pharmacology and Therapeutics for Undergraduate Medical Students. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:567-575. [PMID: 35656121 PMCID: PMC9153941 DOI: 10.2147/amep.s359704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/21/2022] [Indexed: 06/15/2023]
Abstract
For many years, clinical pharmacology (CP) has been taught at schools of medicine via traditional methods including classic lectures and experimental sessions. The explosion of scientific knowledge and the availability of many treatment options have necessitated the development of new strategies for pharmacology teaching and learning. Applying information learnt in real-life situations has become more important than finding information that is readily available in many places. The newly implemented reformed curriculum at Umm Al Qura University - Faculty of Medicine (UQUMED) is a student-centred, competency-based curriculum with enhanced integration across the disciplines. Teachers and students have a great responsibility in updating the curriculum. The "Use of Medicine" (UofM) vertical module is part of this reformed curriculum that focuses on key principles, a core list of medications, the vertical and horizontal integration of subjects, the knowledge application to real case situations, enhanced critical thinking and self-learning. It emphasizes rational prescribing, safe medical practice and excellence in teaching CP and therapeutics. The adoption of newer and innovative teaching and assessment methods and the training of faculty/staff can help to refresh CP education. One challenge in CP education is that teachers are shifting from acting as information providers to acting as facilitators so that students become life-long learners. The assessment of our reformed curriculum uses several valid reliable tools to evaluate the achieved skills and competencies. This manuscript describes the transformational changes in CP education at UQU up to the development and implementation of the UofM vertical module as part of the reformed UQUMED curriculum. Continuous updates in CP education are critical for rational, safe, and affordable medication prescribing for better patient care.
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Affiliation(s)
- Safaa M Alsanosi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Soares AKF, Sá CHCD, Lima RDS, Barros MDS, Coriolano-Marinus MWDL. Communication in health care from the experiences of Nursing students and teachers: contributions to health literacy. CIENCIA & SAUDE COLETIVA 2022; 27:1753-1762. [PMID: 35544805 DOI: 10.1590/1413-81232022275.21462021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022] Open
Abstract
The object of this study is communication about health in the training processes of nurses and the aim is to analyze the conceptions of teachers and students of an undergraduate nursing course about communication in regard to health based on the construct of health literacy. This is a descriptive, exploratory research, with a qualitative approach. Data were collected through individual narratives of students and semi-structured interviews with teachers at a public university. Data were analysed through inductive coding, supported by the Atlas T.I software, version 8.0 and using the theoretical framework of Health Literacy. The results identified two categories supported by the testimonies of students and teachers: 1) Communication in nursing care and health literacy; 2) Practice in communication skills during graduation. Students and teachers recognized the importance of communication and the relational process with patients in the classroom context. The need for practical and reflective tools is identified so that communication is experienced in a more dialogic and participatory manner, both with patients and in teaching-learning contexts, with the integration of affective, motivational and supportive elements.
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Affiliation(s)
- Adelia Karla Falcão Soares
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Pernambuco. Av. Prof. Moraes Rego 1.235, Cidade Universitária. 50670-901 Recife PE Brasil.
| | | | | | - Mirelly da Silva Barros
- Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal de Pernambuco. Recife PE Brasil
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Soares AKF, Sá CHCD, Lima RDS, Barros MDS, Coriolano-Marinus MWDL. Communication in health care from the experiences of Nursing students and teachers: contributions to health literacy. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022275.21462021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract The object of this study is communication about health in the training processes of nurses and the aim is to analyze the conceptions of teachers and students of an undergraduate nursing course about communication in regard to health based on the construct of health literacy. This is a descriptive, exploratory research, with a qualitative approach. Data were collected through individual narratives of students and semi-structured interviews with teachers at a public university. Data were analysed through inductive coding, supported by the Atlas T.I software, version 8.0 and using the theoretical framework of Health Literacy. The results identified two categories supported by the testimonies of students and teachers: 1) Communication in nursing care and health literacy; 2) Practice in communication skills during graduation. Students and teachers recognized the importance of communication and the relational process with patients in the classroom context. The need for practical and reflective tools is identified so that communication is experienced in a more dialogic and participatory manner, both with patients and in teaching-learning contexts, with the integration of affective, motivational and supportive elements.
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Hayashi M, Nishiya K, Kaneko K. Transition from undergraduates to residents: A SWOT analysis of the expectations and concerns of Japanese medical graduates during the COVID-19 pandemic. PLoS One 2022; 17:e0266284. [PMID: 35353865 PMCID: PMC8967019 DOI: 10.1371/journal.pone.0266284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/17/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Interruptions in undergraduate clinical clerkship during the COVID-19 pandemic have reduced the confidence and preparedness of residents beginning their postgraduate training. We explore the thoughts of new residents about this transition and reflect on the support needed. Methods An exploratory qualitative case study was conducted with 51 residents. All had experienced interruptions in clinical training due to the pandemic and had just started their postgraduate training. Qualitative data were collected through 6 focus groups and 12 individual follow-up interviews. A thematic analysis was undertaken, and the data were categorised using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework. Results Graduates beginning their residency were aware of their professionalism and independence during the transition. They also faced the predicament of needing close supervision while their supervisors managed pandemic conditions. Residents emphasised the importance of developing relationships with colleagues and supervisors during the transition to residency and wanted direct observation and detailed feedback from their supervisors during procedures. Conclusions The experiences of residents were not uniformly negative. In fact, some had developed a positive mindset when entering the clinical field. Medical faculty members reflecting on interactions with new residents and planning future clinical internships could benefit from placing a high value on building relationships among residents, who may expect direct observation and detailed feedback from their supervisors.
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Affiliation(s)
- Mikio Hayashi
- Center for Medical Education, Kansai Medical University, Osaka, Japan
- * E-mail:
| | - Katsumi Nishiya
- Center for Medical Education, Kansai Medical University, Osaka, Japan
| | - Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Osaka, Japan
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Monrouxe LV, Bloomfield JG. Specialty Grand Challenge: Diversity Matters in Healthcare Professions Education Research. Front Med (Lausanne) 2021; 8:765443. [PMID: 34869474 PMCID: PMC8634362 DOI: 10.3389/fmed.2021.765443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lynn V Monrouxe
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jacqueline G Bloomfield
- Faculty of Medicine and Health, School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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Samuriwo R, Bullock A, Webb K, Monrouxe LV. 'Nurses whisper.' Identities in nurses' patient safety narratives of nurse-trainee doctors' interactions. MEDICAL EDUCATION 2021; 55:1394-1406. [PMID: 34060110 DOI: 10.1111/medu.14575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
CONTEXT Nurses are integral to patient safety, but little is known about their narrative constructions of identity in relation to their dyadic interactions with trainee doctors about patient safety and competence during the trajectory of a medical career. AIM We sought to examine how identities are constructed by experienced nurses in their narratives of patient safety encounters with trainee doctors. METHODS Our qualitative study gathered narrative data through semi-structured interviews with nurses of different professional standing (n = 20). Purposive sampling was used to recruit the first eight participants, with the remainder recruited through theoretical sampling. Audio recordings were transcribed verbatim and analysed inductively through a social constructionist framework and deductively using a competence framework. RESULTS We classified seven identities that participants constructed in their narratives of dyadic interactions with trainee doctors in relation to patient safety: nurses as teacher, guardian of patient wellbeing, provider of emotional support, provider of general support, expert advisor, navigator and team player. These identities related to the two key roles of nurses as educators and as practitioners. As they narrated these dyadic interactions, participants constructed identities that positioned trainee doctors in character tropes, suggesting gaps in professional competence: nurses as provider of general support was commonly narrated in the context of perceived deficits of personal or functional capabilities and nurses as team player was mainly associated with concerns (or reassurances) around ethical capabilities. DISCUSSION AND CONCLUSION Our findings are consistent with, and extend the wider literature on the development of professional competence, interprofessional collaboration in health care, and the nature and organisation of nursing work. Nurses' work in ensuring patient safety and support trainee doctors' professional development merits greater formal recognition and legitimation.
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Affiliation(s)
- Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
- Wales Centre for Evidence Based Care, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Katie Webb
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Lynn V Monrouxe
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Quantity and Quality of Physical Medicine and Rehabilitation Clerkships in US Medical Schools. Am J Phys Med Rehabil 2021; 100:1152-1159. [PMID: 33587454 DOI: 10.1097/phm.0000000000001717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to address two underreported issues in undergraduate physical medicine and rehabilitation medical education: quantity and quality of physical medicine and rehabilitation clerkships in US medical schools. DESIGN A multimethod sequential design was used to evaluate the curricula of US medical schools. Quantity (N = 154) of physical medicine and rehabilitation clerkships was assessed by counting the number of required, selective, and elective clerkships in each medical school. Quality (n = 13) was assessed by conducting a thematic analysis on physical medicine and rehabilitation clerkship curricula to identify learning objectives. These objectives were then compared with learning objectives in a model standard. RESULTS Whereas few medical schools required a physical medicine and rehabilitation clerkship, most offered elective rotations in physical medicine and rehabilitation. Most medical schools only included 6 of the 12 model standard learning objectives. Medical schools also included 29 learning objectives not present in the model standard. CONCLUSIONS Physical medicine and rehabilitation clerkships are not underrepresented but are underemphasized, in undergraduate medical schools. Furthermore, these clerkships use inconsistent learning objectives. Thus, findings suggest the need to draw attention to physical medicine and rehabilitation clerkships by offering them as selectives and to develop a list of standardized learning objectives. This exploratory study developed such a groundbreaking list and invites the physical medicine and rehabilitation community to test it.
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Brown MEL, Proudfoot A, Mayat NY, Finn GM. A phenomenological study of new doctors' transition to practice, utilising participant-voiced poetry. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1229-1253. [PMID: 33847851 PMCID: PMC8452574 DOI: 10.1007/s10459-021-10046-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/22/2021] [Indexed: 06/02/2023]
Abstract
Transition to practice can be a turbulent time for new doctors. It has been proposed transition is experienced non-linearly in physical, psychological, cultural and social domains. What is less well known, however, is whether transition within these domains can contribute to the experience of moral injury in new doctors. Further, the lived experience of doctors as they transition to practice is underexplored. Given this, we asked; how do newly qualified doctors experience transition from medical school to practice? One-to-one phenomenological interviews with 7 recently qualified UK doctors were undertaken. Findings were analysed using Ajjawi and Higgs' framework of hermeneutic analysis. Following identification of secondary concepts, participant-voiced research poems were crafted by the research team, re-displaying participant words chronologically to convey meaning and deepen analysis. 4 themes were identified: (1) The nature of transition to practice; (2) The influence of community; (3) The influence of personal beliefs and values; and (4) The impact of unrealistic undergraduate experience. Transition to practice was viewed mostly negatively, with interpersonal support difficult to access given the 4-month nature of rotations. Participants describe relying on strong personal beliefs and values, often rooted in an 'ethic of caring' to cope. Yet, in the fraught landscape of the NHS, an ethic of caring can also prove troublesome and predispose to moral injury as trainees work within a fragmented system misaligned with personal values. The disjointed nature of postgraduate training requires review, with focus on individual resilience redirected to tackle systemic health-service issues.
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Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, York, UK.
| | - Amy Proudfoot
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Nabilah Y Mayat
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, York, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Kennedy E, Bax J, Blanchard P, Drinkwater K, Dysart A, Horan K, Jina R, Leaming A, Lee P, Lepine G, Jackson D, George A. Clients and conditions encountered by final year physiotherapy students in private practice. A retrospective analysis. Physiother Theory Pract 2021; 38:3027-3036. [PMID: 34486929 DOI: 10.1080/09593985.2021.1975340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Currently little is known about the clients and conditions final-year physiotherapy students are exposed to in private practice settings. The aim of this study is to describe the clients and conditions encountered by final-year physiotherapy students during a six-week full-time private practice clinical placement. Client data of conditions were collected over 11 years (2008-2018) from final year physiotherapy students' client reports in a university clinic, Christchurch, New Zealand. Data for anatomical site and pathology were categorized using the Orchards Sports Injury Classification System 10 and descriptive analyses completed. Students saw a mean of 22 (SD 5) unique clients. The anatomical sites most encountered were the shoulder (97.4% of students), lumbar spine (96.3%), knee (95.8%) and ankle (91.2%). The pathologies most encountered were joint sprain (100%), muscle injury (90%), and tendon injury (88.4%). While final year physiotherapy students are exposed to a substantial number of clients encompassing major regions and condition types, this exposure is limited in scope. The findings offer a basis for discussion about what clinical exposure to clients and conditions might best support the transition from physiotherapy student to new graduate in private practice settings.
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Affiliation(s)
- Ewan Kennedy
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jaimee Bax
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Philip Blanchard
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Kayla Drinkwater
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Alexandra Dysart
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Katelin Horan
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Rachel Jina
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Aimee Leaming
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Peter Lee
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Georgia Lepine
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - David Jackson
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Alister George
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
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Ottrey E, Rees CE, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study. MEDICAL EDUCATION 2021; 55:1078-1090. [PMID: 33617656 DOI: 10.1111/medu.14475] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition. METHODS We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally. RESULTS We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3). DISCUSSION This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.
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Affiliation(s)
- Ella Ottrey
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- College of Science, Health, Engineering & Education, Murdoch University, Murdoch, WA, Australia
| | - Caitlin Kemp
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Tina P Brock
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Michelle Leech
- Medicine, Nursing & Health Sciences Medicine Course, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic, Australia
| | - Kayley Lyons
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Lynn V Monrouxe
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Julia Morphet
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia
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Wise HR. Nobody should have been subjected to that experience-students need more support. BMJ 2021; 374:n1339. [PMID: 34340968 DOI: 10.1136/bmj.n1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chesterton P, Chesterton J, Alexanders J. New graduate physiotherapists’ perceived preparedness for clinical practice. A cross-sectional survey. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2021.1958007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Paul Chesterton
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Jennifer Chesterton
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Jenny Alexanders
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
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Padley J, Boyd S, Jones A, Walters L. Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates. Health Sci Rep 2021; 4:e270. [PMID: 33855193 PMCID: PMC8025846 DOI: 10.1002/hsr2.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Work readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined. OBJECTIVE This narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness. METHODS Databases were searched using the terms including "ready," "readiness," "preparedness," "medical graduates," "intern," and "junior doctor." Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes. RESULTS Seventy studies were included in the review. Study participants included final-year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self-report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills-based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness. CONCLUSIONS Different research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.
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Affiliation(s)
- James Padley
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Sarah Boyd
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Alison Jones
- College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Lucie Walters
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
- Adelaide Rural Clinical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Lee A, Abdulhussein D, Fallaha M, Buckeldee O, Morrice R, Leedham-Green K. Whole consultation simulation in undergraduate surgical education: a breast clinic case study. BMC MEDICAL EDUCATION 2021; 21:305. [PMID: 34049545 PMCID: PMC8164306 DOI: 10.1186/s12909-021-02757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Safe and effective clinical outcomes (SECO) clinics enable medical students to integrate clinical knowledge and skills within simulated environments. This realistic format may better prepare students for clinical practice. We aimed to evaluate how simulated surgical clinics based on the SECO framework aligned with students' educational priorities in comparison with didactic tutorials. METHODS We delivered two breast surgery SECO-based simulated clinics to Year 3 students during their surgical attachments at a London teaching hospital. All students attended a didactic breast surgery tutorial the previous week. Pre- and post-session surveys and post-session debriefs were used to explore learning gain, processes, preferences and impacts on motivation to learn. Data were analysed using inductive thematic analysis to categorise student views into themes. RESULTS Seventeen students enrolled in the simulated clinics and debriefs. Students expressed that passing examinations was a key extrinsic motivating factor, although the SECO-based format appeared to shift their motivation for learning towards aspiring to be clinically competent. Self-reported confidence in clinical skills such as history taking and examination improved significantly. Active learning methods were valued. Students expressed a preference for simulated clinics to complement, but not replace, tutorial-based learning. CONCLUSION The SECO-based simulated clinic promoted a shift towards intrinsic motivation for learning by allowing students to recognise the importance of preparing for clinical practice in addition to passing examinations. Integration of surgical simulated clinics into the undergraduate curriculum could facilitate acquisition of clinical skills through active learning, a method highly valued by students.
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Affiliation(s)
- Alice Lee
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK.
| | - Dalia Abdulhussein
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Mohammad Fallaha
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ, UK
| | - Olivia Buckeldee
- Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Rory Morrice
- Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
| | - Kathleen Leedham-Green
- Medical Education Research Unit, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK
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Hawkins N, Younan HC, Fyfe M, Parekh R, McKeown A. Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation. BMC MEDICAL EDUCATION 2021; 21:165. [PMID: 33731104 PMCID: PMC7972243 DOI: 10.1186/s12909-021-02605-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/05/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training. METHODS 30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students' clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes. RESULTS Six key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning 'on the job'. CONCLUSIONS The combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through 'whole task' training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong 'learning while working'.
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Affiliation(s)
- Nichola Hawkins
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK.
| | - Helen-Cara Younan
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Molly Fyfe
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Ravi Parekh
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Andrew McKeown
- University of Buckingham Medical School, Hunter Street, MK18 1EG, Buckingham, UK
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Khanna P, Roberts C, Lane AS. Designing health professional education curricula using systems thinking perspectives. BMC MEDICAL EDUCATION 2021; 21:20. [PMID: 33407403 PMCID: PMC7789213 DOI: 10.1186/s12909-020-02442-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/10/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Medical students navigate complex personal learning pathways from entry into medical school, through an educational program, and into life-long practice. However, many stakeholders have called for substantive reforms in contemporary curricula, citing concerns about the lack of key abilities amongst newly graduated doctors to work in complex healthcare environments. Despite the need for educators to focus on curricula design, there is a paucity of overarching perspectives that allow synthesis of the various curricular elements in a way that lends meaningfulness and appreciation to the students in terms of navigating the immediate program requirements and beyond. Without such guidance, educators risk creating fragmented program designs that can lead to both unintended and unactionable outcomes for students as well as curriculum designers. Using systems thinking, we set out to address this gap by providing an overarching perspective for curriculum designers to appreciate the relationships and the interactions of the various curricular elements that inform and impact student's preparedness for practice. METHODS By framing a curriculum as a complex adaptive system, we used soft systems thinking to develop an initial prototype of a conceptual curricular toolkit, underpinned by an appraisal of relevant literature within health professional education and the broader educational context. The prototype was further refined iteratively after critical reflection by the authors with a diverse range of national and international colleagues via posters, short communications, and workshops at several conferences, and through social media. RESULTS We describe how the 3P-6Cs toolkit captures a learner's personal journey through an educational program into a field of practice by logically linking the three key elements: the personal, the program, and the practice. We demonstrate its application in three examples related to contemporary health profession education curricula. These are: creating integrated educational designs to capture students' developmental continua, conceptualising immersive clinical placements in non-traditional settings, and complexity-consistent evaluation of curricular interventions. CONCLUSION Applying the 3P-6Cs curricular toolkit to problems of curricula (re)design can provide overarching perspectives that enable educators to have a better understanding of how integration of elements within education programs can inform and impact student's preparation for lifelong practice.
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Affiliation(s)
- Priya Khanna
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Chris Roberts
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
| | - Andrew Stuart Lane
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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Beedham W, Wanigasooriya K, Layton GR, Taing Chan L, Darr A, Mittapalli D. The Effectiveness of a Foundation Year 1 Doctor Preparation Course for Final Year Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2021; 8:2382120520984184. [PMID: 33458247 PMCID: PMC7797572 DOI: 10.1177/2382120520984184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/04/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Starting work as a junior doctor can be daunting for any medical student. There are numerous aspects of the hidden curriculum which many students fail to acquire during their training. OBJECTIVES To evaluate the effectiveness of a novel foundation year one (FY1) doctor preparation course focusing on certain core topics, practical tips and components of the hidden curriculum. The primary objective was to improve the confidence level and knowledge of final year medical students transitioning to FY1 doctors. METHOD A 2-day, practical course titled 'Preparation 2 Practice' delivering hands-on, small-group and lecture-based teaching, covering core medical student undergraduate curriculum topics in medicine and surgery. The course content spanned therapeutics, documentation skills and managing acute clinical tasks encountered by FY1 doctors during an on-call shift. A pre- and post-course survey and knowledge assessment were carried out to assess the effectiveness of the course. The assessment was MCQ-based, derived from topics covered within our course. The 20-question test and a short survey were administered electronically. RESULTS Twenty students from a single UK medical school attended the course. 100% participation was observed in the pre- and post-course test and survey. The median post-course test result was 22 (IQR 20.25-23.75) which was higher than the median pre-course test score of 18.75 (IQR 17-21.75). A Wilcoxon sign rank test revealed a statistically significant difference between the pre- and post-course test results (P = .0003). The self-reported confidence score of delegates on starting work as a junior doctor was also significantly higher following the course (P = .004). CONCLUSION The results show a significant improvement in perceived confidence and knowledge on core curriculum topics amongst final year medical students having attended our FY1 doctor preparation course. We conclude that there is scope for similar supplementary courses as an adjunct to the undergraduate medical curriculum.
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Affiliation(s)
- William Beedham
- TMS Collaborative, TMS Trust, Worcestershire, UK
- University of Birmingham Medical School, Birmingham, UK
| | - Kasun Wanigasooriya
- TMS Collaborative, TMS Trust, Worcestershire, UK
- University of Birmingham Medical School, Birmingham, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Georgia R Layton
- TMS Collaborative, TMS Trust, Worcestershire, UK
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ley Taing Chan
- TMS Collaborative, TMS Trust, Worcestershire, UK
- Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Adnan Darr
- TMS Collaborative, TMS Trust, Worcestershire, UK
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham, UK
| | - Devender Mittapalli
- TMS Collaborative, TMS Trust, Worcestershire, UK
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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Gordon L, Rees CE, Jindal-Snape D. Doctors' identity transitions: Choosing to occupy a state of 'betwixt and between'. MEDICAL EDUCATION 2020; 54:1006-1018. [PMID: 32402133 DOI: 10.1111/medu.14219] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 04/26/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT During transitions, doctors engage in identity work to adapt to changes in multiple domains. Accompanied by this are dynamic 'liminal' phases. Definitions of liminality denote a state of being 'betwixt and between' identities. From a social constructionist perspective, being betwixt and between professional identities may either involve a sense of disrupted self, requiring identity work to move through and out of being betwixt and between (ie, temporary liminality), or refer to the experiences of temporary workers (eg, locum doctors) or those in dual roles (eg, clinician-managers) who find themselves perpetually betwixt and between professional identities (ie, perpetual liminality) and use identity work to make themselves contextually relevant. In the health care literature, liminality is conceptualised as a linear process, but this does not align with current notions of transitions that are depicted as multiple, complex and non-linear. METHODS We undertook a longitudinal narrative inquiry study using audio-diaries to explore how doctors experience liminality during trainee-to-trained transitions. In three phases, we: (a) interviewed 20 doctors about his or her trainee-to-trained transitions; (b) collected longitudinal audio-diaries from 17 doctors for 6-9 months, and (c) undertook exit interviews with these 17 doctors. Data were analysed thematically, both cross-sectionally and longitudinally, using identity work theory as an analytical lens. RESULTS All participants experienced liminality. Our analysis enabled us to identify temporary and perpetual liminal experiences. Furthermore, fine-grained analysis of participants' identity talk enabled us to identify points in participants' journeys at which he or she rejected identity grants associated with his or her trained status and instead preferred to remain in and thus occupy liminality (ie, neither trainee nor trained doctor). CONCLUSIONS This paper is the first to explore longitudinally doctors' liminal experiences through trainee-to-trained transitions. Our findings also make conceptual contributions to the health care literature, as well as the wider interdisciplinary liminality literature, by adding further layers to conceptualisations and introducing the notion of occupying liminality.
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Affiliation(s)
- Lisi Gordon
- Centre for Medical Education, School of Medicine, University of Dundee, Dundee, UK
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- College of Science, Health, Engineering and Education (SHEE), Murdoch University, Murdoch, Western Australia, Australia
| | - Divya Jindal-Snape
- Transformative Change: Education and Life Transitions (TCELT) Research Centre, School of Education and Social Work, University of Dundee, Dundee, UK
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Saukko PM, Rousham EK. Diagnosis Between Chaos and Control: Affect and Hospital Clinicians' and Older Adult Patients' Narratives of Urinary Tract Infections. FRONTIERS IN SOCIOLOGY 2020; 5:57. [PMID: 33869463 PMCID: PMC8022813 DOI: 10.3389/fsoc.2020.00057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 07/01/2020] [Indexed: 06/12/2023]
Abstract
Research has observed that older adults are frequently overdiagnosed with urinary tract infection (UTI) and unnecessarily prescribed antibiotics in hospitals. In this article we explore the overlooked affective dimension of experiences of diagnosis and prescribing. Drawing on interviews with doctors, nurses and older adult patients (n = 41) on UTI diagnosis in two UK hospitals and Arthur Frank's work on illness narratives we identified two affective ways of experiencing diagnosis. Some clinicians and older adult patients articulated chaos narratives about being overwhelmed by contradictory evidence and events, doubting the repeated UTI diagnoses and courses of antibiotics but being unable to do anything about their concerns. Other clinicians and patients articulated control narratives about UTIs being frequently diagnosed and antibiotics prescribed to restore patients' health, echoing certainty and security, even if the processes described typically did not follow current guidance. We contend that analyzing the affective dimension offers conceptual insights that push forward sociological discussions on diagnosis as reflective or dogmatic in the context of the contradiction between acute care and chronic illnesses of old age. Our findings contribute practical ideas of why overdiagnosis and overprescribing happen in hospitals and complicate notions of patients pressuring for antibiotics. We also present methodological suggestions for analyzing how participants tell about their experiences in order to explore the typically not directly spoken affective dimension that influences thoughts and actions about diagnosis.
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Affiliation(s)
- Paula M. Saukko
- School of Social Sciences and Humanities, Loughborough University, Loughborough, United Kingdom
| | - Emily Kate Rousham
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
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Perera D, Bolina A. How recently qualified doctors can improve goals-of-care training for medical students. MEDICAL EDUCATION 2020; 54:487. [PMID: 31914205 DOI: 10.1111/medu.14053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Duranka Perera
- Accident and Emergency Department, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Anita Bolina
- Faculty of Medicine, Imperial College London, London, UK
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Corfield L, Williams RA, Lavelle C, Latcham N, Talash K, Machin L. Prepared for practice? UK Foundation doctors' confidence in dealing with ethical issues in the workplace. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105961. [PMID: 32277020 DOI: 10.1136/medethics-2019-105961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
This paper investigates the medical law and ethics (MEL) learning needs of Foundation doctors (FYs) by means of a national survey developed in association with key stakeholders including the General Medical Council and Health Education England. Four hundred sevnty-nine doctors completed the survey. The average self-reported level of preparation in MEL was 63%. When asked to rate how confident they felt in approaching three cases of increasing ethical complexity, more FYs were fully confident in the more complex cases than in the more standard case. There was no apparent relationship with confidence and reported teaching at medical school. The less confident doctors were no more likely to ask for further teaching on the topic than the confident doctors. This suggests that FYs can be vulnerable when facing ethical decisions by being underprepared, not recognising their lack of ability to make a reasoned decision or by being overconfident. Educators need to be aware of this and provide practical MEL training based on trainee experiences and real-world ethics and challenge learners' views. Given the complexities of many ethical decisions, preparedness should not be seen as the ability to make a difficult decision but rather a recognition that such cases are difficult, that doubt is permissible and the solution may well be beyond the relatively inexperienced doctor. Educators and supervisors should therefore be ensuring that this is clear to their trainees. This necessitates an environment in which questions can be asked and uncertainty raised with the expectation of a supportive response.
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Affiliation(s)
| | | | - Claire Lavelle
- GP Trainee, Wirral GP Specialty Training Scheme, Birkenhead, UK
| | - Natalie Latcham
- Department of Medicine, Morecambe Bay Hospitals NHS Trust, Kendal, Cumbria, UK
| | - Khojasta Talash
- Academic Foundation Doctor, Morecambe Bay Hospitals NHS Trust, Kendal, Cumbria, UK
| | - Laura Machin
- School of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
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Sharma PR, Alsaffarini KWB. Preparation for practice and the arguments for standardisation in view of the forthcoming medical licensing exam: A literature review. MEDICAL TEACHER 2020; 42:451-456. [PMID: 31928279 DOI: 10.1080/0142159x.2019.1708291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aims: The aim of this paper is to address whether the introduction of a national licensing exam will improve preparedness for practice. This review will explore and identify the areas in which UK medical graduates are feeling underprepared. In addition, this review will discuss the need for the Medical Licensing Assessment in the UK.Methods: A literature search of several databases was performed in December 2018. Studies which identified the areas in which medical graduates were prepared/unprepared for, and those which explored whether UK medical schools were adequately preparing their graduates for practice, were included. Studies exploring the preparedness of international medical graduates were excluded.Results: Sixteen articles met the final inclusion criteria and are included in this review. All the final studies are cross-sectional and are varied in their use of methods used, with the vast majority using questionnaires to identify the preparedness of medical students and junior doctors.Conclusions: This review conveys that junior doctors are mostly underprepared in emergency work. This can be associated to a lack of exposure to emergency situations during their undergraduate training. Moreover, this review suggests that the preparedness of medical graduates may remain unaffected by the implementation of the MLA.
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Affiliation(s)
- Parivrudh R Sharma
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kareem W B Alsaffarini
- The School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Mat Yudin Z, Ali K, Wan Ahmad WMA, Ahmad A, Khamis MF, Brian Graville Monteiro N'A, Che Ab Aziz ZA, Saub R, Rosli TI, Alias A, Abdul Hamid NF, Harun NA. Self-perceived preparedness of undergraduate dental students in dental public universities in Malaysia: A national study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:163-168. [PMID: 31698535 DOI: 10.1111/eje.12480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 05/05/2023]
Abstract
AIMS To evaluate the self-perceived preparedness of final-year dental undergraduate students in dental public universities in Malaysia. METHODS Final-year dental undergraduate students from six dental public universities in Malaysia were invited to participate in an online study using a validated Dental Undergraduates Preparedness Assessment Scale DU-PAS. RESULTS In total, about 245 students responded to the online questionnaire yielding a response rate of 83.05%. The age range of the respondents was 23-29 years with a mean age of 24.36 (SD 0.797). The total score obtained by the respondents was ranged from 48 to 100 with a mean score of 79.56 (SD 13.495). Weaknesses were reported in several clinical skills, cognitive and behavioural attributes. CONCLUSIONS The preparedness of undergraduate students at six dental institutions in Malaysia was comparable to students from developed countries. The dental undergraduate preparedness assessment scale is a useful tool, and dental institutions may be used for self-assessment as well as to obtain feedback from the supervisors.
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Affiliation(s)
- Zainab Mat Yudin
- School of Dental Sciences, Universiti Sains Malaysia, Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | - Kamran Ali
- University of Plymouth Peninsula Schools of Medicine & Dentistry, Plymouth, UK
| | - Wan Muhamad Amir Wan Ahmad
- School of Dental Sciences, Universiti Sains Malaysia, Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | - Anisa Ahmad
- School of Medical Sciences, Universiti Sains Malaysia, Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Fadhli Khamis
- School of Dental Sciences, Universiti Sains Malaysia, Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | | | | | - Roslan Saub
- Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Tanti Irawati Rosli
- Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Aspalilah Alias
- Faculty of Dentistry, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Nor Faharina Abdul Hamid
- Faculty of Dentistry, Mara University Institute of Technology (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Nor Asilah Harun
- Kulliyyah of Dentistry, International Islamic University Malaysia (IIUM), Kuantan, Pahang, Malaysia
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Sam AH, Fung CY, Wilson RK, Peleva E, Kluth DC, Lupton M, Owen DR, Melville CR, Meeran K. Using prescribing very short answer questions to identify sources of medication errors: a prospective study in two UK medical schools. BMJ Open 2019; 9:e028863. [PMID: 31289084 PMCID: PMC6629393 DOI: 10.1136/bmjopen-2018-028863] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the utility and ability of the novel prescribing very short answer (VSA) question format to identify the sources of undergraduate prescribing errors when compared with the conventional single best answer (SBA) question format and assess the acceptability of machine marking prescribing VSAs. DESIGN A prospective study involving analysis of data generated from a pilot two-part prescribing assessment. SETTING Two UK medical schools. PARTICIPANTS 364 final year medical students took part. Participation was voluntary. There were no other inclusion or exclusion criteria. OUTCOMES (1) Time taken to mark and verify VSA questions (acceptability), (2) differences between VSA and SBA scores, (3) performance in VSA and (4) SBA format across different subject areas and types of prescribing error made in the VSA format. RESULTS 18 200 prescribing VSA questions were marked and verified in 91 min. The median percentage score for the VSA test was significantly lower than the SBA test (28% vs 64%, p<0.0001). Significantly more prescribing errors were detected in the VSA format than the SBA format across all domains, notably in prescribing insulin (96.4% vs 50.3%, p<0.0001), fluids (95.6% vs 55%, p<0.0001) and analgesia (85.7% vs 51%, p<0.0001). Of the incorrect VSA responses, 33.1% were due to the medication prescribed, 6.0% due to the dose, 1.4% due to the route and 4.8% due to the frequency. CONCLUSIONS Prescribing VSA questions represent an efficient tool for providing detailed insight into the sources of significant prescribing errors, which are not identified by SBA questions. This makes the prescribing VSA a valuable formative assessment tool to enhance students' skills in safe prescribing and to potentially reduce prescribing errors.
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Affiliation(s)
- Amir H Sam
- Medical Education Research Unit, Imperial College School of Medicine, Imperial College London, London, UK
| | - Chee Yeen Fung
- Medical Education Research Unit, Imperial College School of Medicine, Imperial College London, London, UK
| | - Rebecca K Wilson
- Medical Education Research Unit, Imperial College School of Medicine, Imperial College London, London, UK
| | - Emilia Peleva
- Medical Education Research Unit, Imperial College School of Medicine, Imperial College London, London, UK
| | - David C Kluth
- Medical Education, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Martin Lupton
- Medical Education Research Unit, Imperial College School of Medicine, Imperial College London, London, UK
| | - David R Owen
- Medical Education Research Unit, Imperial College School of Medicine, Imperial College London, London, UK
| | - Colin R Melville
- Division of Medical Education, School of Medical Sciences, University of Manchester, Manchester, UK
| | - Karim Meeran
- Medical Education Research Unit, Imperial College School of Medicine, Imperial College London, London, UK
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Graham B, Elbeltagi H, Nelmes P, Jenkin A, Smith JE. What difference can a year make? Findings from a survey exploring student, alumni and supervisor experiences of an intercalated degree in emergency care. BMC MEDICAL EDUCATION 2019; 19:188. [PMID: 31170966 PMCID: PMC6554867 DOI: 10.1186/s12909-019-1579-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 04/26/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND One third of UK medical students undertake an intercalated degree, typically in traditional academic disciplines. It is less usual for students to undertake intercalated degrees that are directly aligned to a clinical speciality with longitudinal placements. This cross sectional survey aims to explore the self-reported experiences of students, alumni and supervisors associated with a clinically oriented intercalated degree in emergency care featuring a longitudinal placement in a hospital emergency department over a 9-month academic year. Themes for exploration include student clinical and academic development, effect on career choice, supervisor experience and the effect on host institutions. METHODS Current students, previous alumni, and clinical placement supervisors associated with a single intercalated degree programme in urgent and emergency care since 2005 were identified from records and using social media. Separate online surveys were then developed and distributed to current students/ previous alumni and consultant physician supervisors, between May and August 2016. Results are presented using basic descriptive statistics and selected free text comments. RESULTS Responses were obtained from 37 out of 46 contactable students, and 14 out of 24 supervisors (80 and 63%, respectively). Students self-reported increased confidence in across a range of clinical and procedural competencies. Supervisors rated student competence in clinical, inter-professional and academic writing skills to be commensurate with, or in many cases exceeding, the level expected of a final year medical student. Supervisors reported a range of benefits to their own professional and personal development from supervising students, which included improved teaching and mentoring skills, providing intellectual challenge, and helping with the completion of audits and service improvement projects. CONCLUSIONS Students report the acquisition of a range of clinical, academic, and inter-professional skills following their intercalated BSc year. A positive experience was reported by supervisors, extending to host institutions. Students reported feeling more enthusiastic about emergency medicine careers on completion. However, as students embarking on this degree naturally bring pre-existing interest in the area, it is not possible to attribute causation to these associations. Further investigation is also required to determine the longer term effect of clinically oriented intercalated degrees on career choice.
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Affiliation(s)
- Blair Graham
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Hadir Elbeltagi
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Pam Nelmes
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Annie Jenkin
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
| | - Jason E Smith
- Emergency Department, Derriford Hospital, Plymouth, PL6 8DH England
- Plymouth University, Drake Circus, Plymouth, PL4 8AA England
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Abstract
BACKGROUND Previous research on the transition from student to doctor has indicated that new doctors are 'ill prepared' to start work. Subsequent efforts to improve preparation in the UK have involved increasing practical experience for final-year students through an assistantship period. This study further explored new doctors' experiences of transition in light of recent critiques of preparedness and the first author's own experience of the transition. METHODS A total of 11 Foundation Year 1 (FY1) doctors from West Yorkshire were recruited via e-mail and snowballing methods. Data were collected using semi-structured interviews and analysed thematically, drawing on the knowledge and experience of the authors as a resource. FINDINGS The interviews told a story of new doctors learning through challenge. Challenges were contextual, often occurring out of hours when new doctors were working more independently. These challenges were experienced as stressful at the time, but were also deemed to be necessary for personal and professional development. When aligned with the new doctor's starting job, assistantship was found to be helpful to new doctors becoming familiar with the new work environment and clinical staff; however, assistantship did not provide all of the solutions for the transition, as FY1s will always encounter challenges during this period. … interviews told a story of new doctors learning through challenge … challenges were experienced as stressful at the time, but were also deemed to be necessary for personal and professional development … assistantship was found to be helpful … [but] did not provide all of the solutions CONCLUSION: The transition will always be difficult and new doctors cannot be fully 'prepared' for it. Doctors will not be able to encounter every clinical scenario before starting work, and supported practice is necessary and inevitable. Although assistantship interventions are helpful, there should be equal emphasis on developing effective clinical supervision and addressing barriers to new doctors taking on challenges. Doctors will not be able to encounter every clinical scenario before starting work.
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Abstract
OBJECTIVES To examine what activities constitute the work of Foundation doctors and understand the factors that determine how that work is constructed. DESIGN Cross-sectional mixed methods study. Questionnaire survey of the frequency with which activities specified in curricular documents are performed. Semistructured interviews and focus groups. SETTING Postgraduate medical training in the UK. PARTICIPANTS Doctors in their first 2 years of postgraduate practice (Foundation Programme). Staff who work with Foundation doctors-supervisors, nurses and employers (clinical; non-clinical). RESULTS Survey data from 3697 Foundation doctors identified curricular activities (41/103, 42%) that are carried out routinely (performed at least once or twice per week by >75% of respondents). However, another 30 activities (29%) were carried out rarely (at least once or twice per week by <25% respondents), largely because they are routinely part of nurses', and not doctors', work. Junior doctors indicated their work constituted three roles: 'support' of ward and team, 'independent practitioner' and 'learner'. The support function dominated work, but conflicted with stereotyped expectations of what 'being a doctor' would be. It was, however, valued by the other staff groups. The learner role was felt to be incidental to practice, but was couched in a limited definition of learning that related to new skills, rather than consolidation and practice. Activities and perceived role were shaped by the organisational context, medical hierarchies and through relationships with nurses, which could change unpredictably and cause tension. Training progression did not affect what activities were done, but supported greater autonomy in how they were carried out. CONCLUSIONS New doctors must be fit for multiple roles. Strategies for transition should manage graduates' expectations of real-world work, and encourage teams and organisations to better accommodate graduates. These strategies may help ensure that new doctors can adapt to the variable demands of the evolving multiprofessional workforce.
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Affiliation(s)
- Gillian Vance
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Sharmila Jandial
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
| | - Jon Scott
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
- Northern Foundation School, Health Education England working across North East and North Cumbria, Newcastle Upon Tyne, UK
| | - Bryan Burford
- School of Medical Education, Newcastle University, Newcastle Upon Tyne, UK
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Backhouse A, Malik M. Escape into patient safety: bringing human factors to life for medical students. BMJ Open Qual 2019; 8:e000548. [PMID: 31206043 PMCID: PMC6542456 DOI: 10.1136/bmjoq-2018-000548] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 12/14/2022] Open
Abstract
Background Patient safety is at the core of the General Medical Council (GMC) standards for undergraduate medical education. It is recognised that patient safety and human factors' education is necessary for doctors to practice safely. Teaching patient safety to medical students is difficult. Institutions must develop expertise and build curricula while students must also be able to see the subject as relevant to future practice. Consequently graduates may lack confidence in this area. Method We used gamification (the application of game design principles to education) to create a patient safety simulation for medical students using game elements. Gamification builds motivation and engagement, whilst developing teamwork and communication. We designed an escape room-a team-based game where learners solve a series of clinical and communication-based tasks in order to treat a fictional patient while avoiding 'clinician error'. This is followed up with an after action review where students reflect on their experience and identify learning points. Outcome Students praised the session's interactivity and rated it highly for gaining new knowledge and skills and for increasing confidence to apply patient safety concepts to future work. Conclusion Our findings are in line with existing evidence demonstrating the success of experiential learning interventions for teaching patient safety to medical students. Where the escape room has potential to add value is the use of game elements to engage learners with the experience being recreated despite its simplicity as a simulation. More thorough evaluation of larger pilots is recommended to continue exploring the effectiveness of escape rooms as a teaching method.
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Affiliation(s)
| | - Myra Malik
- Faculty of Medical Leadership and Management, London, UK
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Wells SE, Bullock A, Monrouxe LV. Newly qualified doctors' perceived effects of assistantship alignment with first post: a longitudinal questionnaire study. BMJ Open 2019; 9:e023992. [PMID: 30833316 PMCID: PMC6443063 DOI: 10.1136/bmjopen-2018-023992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Growing evidence supports the role of student assistantships in enhancing graduates' preparedness for practice. However, there is limited evidence concerning the impact of aligning assistantships with graduates' first doctor post. The aims of our study were to determine newly-qualified doctors' views on the value their assistantship experience, effects on anxiety levels, confidence and preparedness for increased responsibilities, exploring change over time and whether effects differ according to assistantship alignment. DESIGN We conducted a longitudinal cross-sectional online questionnaire study examining experiences of aligned and non-aligned assistantships across the transition from medical student to newly-qualified doctor. The questionnaire was distributed to final year medical students within Wales, UK (n=351) and those commencing their first post in Wales, UK (n=150) in June 2015 at Time 1 (T1), and repeated in September 2015 (1 month following transition, T2) and January 2016 (T3). RESULTS Response rates at T1 were 50% (n=251, aligned=139, non-aligned=112), T2 36% (n=179, aligned=83, non-aligned=96) and T3 28% (n=141, aligned=69, non-aligned=72): 15% (n=73, aligned=36, non-aligned=37) completed all questionnaires. Paired longitudinal analysis was undertaken where possible. Significant differences were observed between participants on aligned and non-aligned assistantships in terms of the value they place on their assistantship experiences, their anxiety, confidence levels and preparedness for responsibility. CONCLUSION Although not sustained, aligned assistantships seem to provide graduates with additional benefits during the August transition. Further work is required to establish what it is about the aligned assistantship programme that works and why.
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Affiliation(s)
| | - Alison Bullock
- Department of Social Sciences, Cardiff University, Cardiff, UK
| | - Lynn V Monrouxe
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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