Teaching in the new NHS: the specialised ward based teacher

How to enhance students' learning in a patient-centered longitudinal integrated clerkship: factors associated with students' learning experiences

PURPOSE

Longitudinal integrated clerkships (LICs) have been introduced in medical schools, as learning relationships with clinical faculty or peers are important components of medical education. The purpose of this study was to investigate the characteristics of student-faculty and student-student interactions in the LIC and to identify other factors related to whether students understood and acquired the program's main outcomes.

METHODS

The study was conducted among the 149 third-year students who participated in the LIC in 2019. We divided the students into groups of eight. These groups were organized into corresponding discussion classes, during which students had discussions with clinical faculty members and peers and received feedback. Clinical faculty members and students were matched through an e-portfolio, where records were approved and feedback was given. A course evaluation questionnaire was completed and analysed.

RESULTS

A total of 144 valid questionnaires were returned. Logistic regression analysis showed that relevant feedback in discussion classes (adjusted odds ratio [AOR], 5.071; p<0.001), frequency of e-portfolio feedback (AOR, 1.813; p=0.012), and motivation by e-portfolio feedback (AOR, 1.790; p=0.026) predicted a greater likelihood of understanding the continuity of the patient's medical experience. Relevant feedback from faculty members in discussion classes (AOR, 3.455; p<0.001) and frequency of e-portfolio feedback (AOR, 2.232; p<0.001) also predicted a greater likelihood of understanding the concept of patient-centered care.

CONCLUSION

Student-faculty interactions, including relevant feedback in discusstion classes, frequency of e-portfolio feedback, and motivation by e-portfolio feedback were found to be important factors in the LIC program.

Advances in clinical pharmacy education in Germany: a quasi-experimental single-blinded study to evaluate a patient-centred clinical pharmacy course in psychiatry

BACKGROUND

The pharmacy profession has shifted towards patient-centred care. To meet the new challenges it is necessary to provide students with clinical competencies. A quasi-experimental single-blinded teaching and learning study was carried out using a parallel-group design to evaluate systematically the benefits of clinical teaching in pharmacy education in Germany.

METHODS

A clinical pharmacy course on a psychiatric ward was developed and implemented for small student groups. The learning aims included: the improvement of patient and interdisciplinary communication skills and the identification and management of pharmaceutical care issues. The control group participated only in the preparation lecture, while the intervention group took part in the complete course. The effects were assessed by an objective structured clinical examination (OSCE) and a student satisfaction survey.

RESULTS

The intervention group achieved significantly better overall results on the OSCE assessment (46.20 ± 10.01 vs. 26.58 ± 12.91 of a maximum of 90 points; p < 0.0001).The practical tasks had the greatest effect, as reflected in the outcomes of tasks 1-5 (34.94 ± 9.60 vs. 18.63 ± 10.24 of a maximum of 60 points; p < 0.0001). Students' performance on the theoretical tasks (tasks 6-10) was improved but unsatisfying in both groups considering the maximum score (11.50 ± 4.75 vs. 7.50 ± 4.00 of a maximum of 30 points; p < 0.0001). Of the students, 93% rated the course as practice-orientated, and 90% felt better prepared for patient contact. Many students suggested a permanent implementation and an extension of the course.

CONCLUSIONS

The results suggest that the developed ward-based course provided learning benefits for clinical skills. Students' perception of the course was positive. Implementation into the regular clinical pharmacy curriculum is therefore advisable.

Shedding light into the black box: A prospective longitudinal study identifying the CanMEDS roles of final year medical students' on-ward activities

INTRODUCTION

To our best knowledge, a rigorous prospective analysis of final year medical students' (FY medical students) activity profiles during workplace learning is lacking. The present study investigated the CanMEDS characteristics of all on-ward activities performed by internal medicine FY medical students. We tested the hypotheses that during FY medical student workplace training (I) routine activities are predominantly performed, while supervised, more complex activities are underrepresented with (II) FY medical students performing an insufficient number of autonomous activities and that (III) the CanMEDS roles of the Communicator and the Professional prevail.

METHODS

During the second and the sixth week of their final year trimester at the University of Heidelberg Medical Hospital, N = 34 FY medical students (73% female; mean age 26.4 ± 2.4) were asked to keep a detailed record of all their on-ward activities and to document the duration, mode of action (active versus passive; independent versus supervised), estimated relevance for later practice, and difficulty-level in specially designed activity logbooks. CanMEDS roles were assigned to the documented activities via post-hoc expert consensus.

RESULTS

About 4308 activities lasting a total of 2211.4 h were documented. Drawing blood (20.8%) was the most frequently documented medical activity followed by full admission procedures (9.6%). About 14.9% of the time was spent with non-medical activities. About 82.1% of all medical activities performed went unsupervised. The Communicator (42%), the Professional (38%), and the Collaborator (7%) were assigned as the top three CanMEDS roles.

CONCLUSIONS

The results call for increased efforts in creating more authentic learning experiences for FY medical students shifting towards more complex, supervised tasks, and improved team integration.

Saving Lives audits: do they improve infection prevention and control practice?

Aretrospective audit evaluation was conducted to determine whether the introduction of two clinical skills trainers for four months in a district general hospital improved compliance with infection prevention and control practices. Saving Lives (Department of Health, 2010) peripheral venous cannula and urinary catheter high impact intervention audit data were analysed for six months before, four months during and six months after the clinical skills training was implemented for six control wards and seven intervention wards. Findings showed that although the control wards did not improve compliance significantly over the study period, the intervention wards improved compliance with the high impact intervention care bundles studied and that this practice was sustained for six months after the clinical skills training. The findings suggest that education is required to improve clinical skills surrounding cannulation and catheterisation, which can then be sustained by Saving Lives audits to reduce the risk of infection to patients.

Recognising excellence in medical education: a student-led award scheme

BACKGROUND

The standard of clinical teaching is acknowledged by undergraduate medical students and their clinical teachers as being variable.(1) Furthermore, there is very little recognition by medical schools of the teaching expertise and efforts of clinical teachers.(2)

INNOVATION

In response to these issues, a group of medical students at the University of Birmingham's Medical School have established an awards scheme called Recognising Excellence in Medical Education (REME). This is a student-led award scheme that is supported by the Dean and other senior medical school staff, and by the students' medical society.

METHOD

This research used two focus groups, one comprising REME award winners and one comprising students who voted in the scheme, to discuss opinions regarding the awards, reasons why the students voted, and how clinical teachers feel about receiving the awards.

DISCUSSION

The focus groups revealed that both students and their clinical teachers were very positive about the award scheme and the impact it has had, both personally and within the hospitals or Trusts of the award winners. The REME awards were viewed as motivating and encouraging for clinical teachers, and were particularly prized as teachers were nominated by their students.

The effect of overnight in-house attending coverage on perceptions of care and education on a general medical service

BACKGROUND

An increased emphasis on patient safety has led to calls for closer supervision of medical trainees. It is unclear what effect an increased degree of faculty presence will have on educational and clinical outcomes. The aim of this study was to evaluate resident and attending attitudes and preferences regarding overnight attending supervision.

METHODS

This study was a cross-sectional electronic survey of physicians. Participants were resident and faculty physicians recently on inpatient service rotations after implementation of an overnight attending coverage system.

RESULTS

Of 58 total respondents, most faculty (91%) and resident (92%) physicians reported they were satisfied with the overall quality of care delivered and believed the quality of care delivered overnight improved with an in-house attending system (90% and 85%, respectively). Most resident physicians (82%) believed the educational experience improved with the system of increased attending availability. Nearly all faculty (95%) and resident (97%) physicians preferred the in-house attending system to the traditional system of attendings being available by pager. The implementation of such coverage resulted in increased cost to the hospital for compensating covering hospitalist physicians.

CONCLUSION

In-house attending coverage was acceptable to both residents and faculty, with perceived improvements in quality and educational experience.

Nonphysician medical educators: a literature review and job description resource

PURPOSE

Designing, implementing, and evaluating high-quality, relevant education for physicians is of great importance. The purpose of this study was to describe the historical development of nonphysician medical educators, including health care professionals working in this role, and to develop a job description resource.

METHOD

In 2007, the authors conducted a historical content analysis and literature review to identify resources relevant to the early historical development of nonphysician medical educators. Also in 2007, they carried out a thorough review of the English-language literature, 1950-2007, to describe nonphysician health care professionals working as medical educators. To investigate job descriptions, the authors studied job boards of associations and medical education listservs, July 2006 to November 2007.

RESULTS

Nonphysician educators have participated effectively in physicians' learning for more than 80 years. Their popularity has grown exponentially in the last 15 years, as have the numbers of master's-in-medical-education degree programs. The nonphysician medical educator can provide essential help to the overtaxed physician educator in many facets of the educational process, such as educational theory; curriculum design, validation, and evaluation; clinical instruction; and medical education research. The study of job descriptions yielded 237 distinctly different duties in 17 categories.

CONCLUSIONS

The nonphysician medical educator will never replace the physician educator. However, as team training, interdisciplinary education, and the general competencies become the norm, the need for the nonphysician medical educator will increase. The authors believe the use of nonphysician medical educators offers a way to improve the quality of physician clinical education while controlling costs. They also recommend areas for future research.

'Can you take a student this morning?' Maximising effective teaching by practice nurses

OBJECTIVES

Little is known about the contribution nurses make to medical student learning. This study set out to explore the nature of practice nurse teaching during the general practice clerkship and to investigate ways in which the teacher and learner (the practice nurse and the medical student) can be best supported to maximise learning.

METHODS

Mixed focus groups were conducted with general practitioner educational supervisors and practice nurses. Further focus groups were conducted with students on completion of clerkships.

RESULTS

There is wide variation in the delivery, organisation and expectations of practice nurse teaching. Although there is some evidence of a passive learning experience, the learning dynamic and the student-nurse relationship are regarded highly.

CONCLUSIONS

Time spent with practice nurses is an important part of the clerkship in general practice. The nature of the practice nurse-medical student relationship differs from that of the educational supervisor-medical student relationship and can be built upon to maximise learning during the clerkship. The experience for the practice nurse, medical student and supervisor can be enhanced through formal preparation for delivering teaching.

The nonphysician "medical student educator": a formal addition to the clerkships and key programs at an academic medical center

BACKGROUND

Medical school faculty members face increased clinical and academic demands, leaving less time for teaching, curriculum development, and assessment of learners.

DESCRIPTION

The Keck School of Medicine has hired a dedicated medical student educator for each required clerkship. The medical student educator assists the clerkship director with clinical teaching, curriculum development, student and program evaluation, and administrative functions.

EVALUATION

The program has been well received by both students and faculty. Students believe that the medical student educators add value to their clinical experiences and support both their clinical education and personal and professional development. Preliminary data suggest that student performance has improved, and additional measures of quantitative impact are under way.

CONCLUSIONS

Medical student educators have been a successful addition to the program at the Keck School of Medicine. This strategy should be considered at medical schools that are experiencing resource constraints.

Back to the future: teaching medical students clinical procedures

Over the last decade undergraduate training in clinical procedures has moved from 'learning on patients' towards simulation-based training. Simulation was intended to be an adjunct rather than a replacement for experiential learning and several initiatives have emerged to redress this balance. With these initiatives in mind, we evaluated the impact of our undergraduate skills training programme and considered the need to change our teaching and learning strategy in this area. Outcomes-based data was accrued from the performance-based assessment of 64 medical students in four key procedures. Attitudinal data was gleaned from 130 responses to an electronic questionnaire and student self-efficacy ratings taken immediately before assessment. Students performed best in venepuncture. Performance in the other skills revealed 1 in 3 did not reach competence in i.v. cannulation and more than 1 in 2 were below standard when measuring a BM stix and priming an i.v. giving set. The data on self-efficacy and competence was analysed and a Spearman's Rank Correlation coefficient of 0.36 calculated. Students in final year were poor self-assessors and unaware that their skills often fell below standard. These results suggest a need to increase students' self-awareness and promote ward-based learning. This article considers how these objectives might be achieved.

A comparison of medical students' perceptions of their initial basic clinical training placements in 'new' and established teaching hospitals

This study has examined students' perceptions of the factors influencing learning during initial hospital placements and whether differences in perceived experiences were evident between students attending new and established teaching hospitals. Five focus groups were conducted with Year III students at the University of Birmingham Medical School (UBMS): three with students attending three established teaching hospitals and two with students attached to a new teaching hospital (designated as part of the UBMS expansion programme). Extensive variation in student perception of hospital experiences was evident at the level of teaching hospital, teaching firm and individual teacher. Emergent themes were split into two main categories: 'students' perceptions of teaching and the teaching environment' and 'the new hospital learner'. Themes emerging that related to variation in student experience included the amount of structured teaching, enthusiasm of teachers, grade of teachers, specialty of designated firms and the number of students. The new teaching hospital was generally looked upon favourably by students in comparison to established teaching hospitals. Many of the factors influencing student experience relate to themes grouped under the 'new hospital learner', describing the period of adjustment experienced by students during their first encounter with this new learning environment. Interventions to improve student experience might be aimed at organisations and individuals delivering teaching. However, factors contributing to the student experience, such as the competing demand to teaching of heavy clinical workloads, are outside the scope of medical school intervention. In the absence of fundamental change, mechanisms to equip students with 'survival skills' as self-directed hospital learners should also be considered.

A questionnaire survey of students' perceptions of nurse tutor teaching in a clinical skills learning programme

Changes in medical education and in the environments in which students learn have brought about new ways of learning in undergraduate medical curricula. Amongst these have been the establishment of courses in clinical skills learning to address concerns of deficient skills amongst newly qualified doctors. Curriculum reform at Liverpool, UK, included extensive and early learning of clinical skills. Nurse tutors provide full-time teaching support in a single Clinical Skills Resource Centre. They work alongside medically qualified tutors in delivering a clinical skills learning programme. This study aimed to explore students' opinion of nurses teaching clinical skills and to compare that to their opinion of teaching by medically qualified clinicians. A questionnaire survey was used to gain the views of 206 first-year medical students. Overall, students were strongly supportive in their opinion of nurse tutors. Some small statistically significant differences are probably of little or no educational significance. This role for nurses stresses the importance of interprofessional teachers in undergraduate healthcare education.

The perceptions of final year medical students in rheumatology workshops when delivered by a consultant and a nurse clinical educator

OBJECTIVE

To determine whether final year medical students' perceptions of teaching workshops delivered by a consultant rheumatologist are similar those of the same workshops delivered by an experienced nurse clinical educator (NCE).

METHODS

The design was a semi-randomized post-test intervention study. The consultant and NCE alternated in presenting eight teaching workshops to four groups of six final year medical students. After each of the workshops, students evaluated the feedback by self-completed questionnaires.

RESULTS

Seventy-three questionnaires were available from the consultant workshops and 65 from the NCE ones. There was no difference in the overall scores for the consultant and the NCE. The consultant scored significantly higher on two individual questions, but these differences were lost when we adjusted for multiple testing.

CONCLUSION

We were unable to demonstrate a major difference between the feedback received from medical students in workshops delivered by an enthusiastic consultant and an experienced NCE.

Pre-registration house officer training: a role for nurses in the new Foundation Programme?

PURPOSE

To explore senior nurses' views of pre-registration house officer (PRHO) training, including the scope for their contribution to the new Foundation Programme.

DESIGN

Data reported here are drawn from a larger, national project, which aimed to identify a curriculum for the PRHO year. The project was based in the Education Development Unit, Scottish Council for Postgraduate Medical and Dental Education (SCPMDE), Dundee. As part of the project, 40 semistructured interviews, each lasting about 1 hour, were held with senior nurses. Interviews were fully transcribed and coded in the qualitative software NVivo for further analysis. Codes were studied for emergent themes and categories.

PARTICIPANTS

Senior nurses (10 from each of the 4 postgraduate regions of Scotland), from diverse specialties.

RESULTS

Data suggest considerable cross- regional/specialty consistency. Key emergent themes concerned the process of training as much as the educational outcomes. The nurses focused on the development of outcomes such as communication and teamworking in addition to clinical and practical skills. They guided the PRHOs informally, but were concerned that their own extended roles were detracting from this.

DISCUSSION

Nurses are gaining increasingly advanced professional, clinical and practical skills. Traditionally, experienced nurses guide and support PRHOs, at least informally. Data collected suggested there may be scope for capitalising on their expertise, including formalising aspects of their contribution to the proposed PRHO Foundation Programme. However, this is a potentially sensitive area and more interprofessional dialogue is needed.

Teaching and learning in the clinical setting: a qualitative study of the perceptions of students and teachers

OBJECTIVE

To describe the perceptions of medical students and clinical teachers of teaching and learning in the clinical setting.

DESIGN

Qualitative study of focus groups with undergraduate medical students and semistructured interviews with hospital consultant clinical teachers.

SETTING

The School of Medicine, University of Leeds and the Leeds Teaching Hospitals Trust, UK.

PARTICIPANTS

Fourth year medical students and consultant clinical teachers.

MAIN OUTCOME MEASURES

Analysis of narratives to identify students' perceptions of clinical teaching and consultants' views of their delivery of undergraduate clinical teaching.

RESULTS

Students believed in the importance of consultant teaching and saw consultants as role models. However, they perceived variability in the quality and reliability of teaching between physicians and surgeons. Some traditional teaching venues, especially theatre, are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt under severe pressure from other commitments. They taught in a range of settings and used various teaching strategies, not all of which were perceived to be 'teaching' by students.

CONCLUSIONS

While students and teachers are educational partners, they are not always in agreement about the quality, quantity, style or appropriate setting of clinical teaching. To enable teachers to provide more high quality teaching, there needs to be support, opportunities and incentives to understand curricular developments and acquire teaching skills.