Barriers and future improvements of workplace-based learning in Korean medicine clinical clerkship: perspectives of graduates

BACKGROUND

Workplace-based learning (WPBL) has emerged as an essential practice in healthcare education. However, WPBL is rarely implemented in Korean medicine (KM) due to the passive attitude of teachers and possible violation of medical laws that limit the participation of trainees in medical treatment. In this study, we implemented WPBL in the clinical clerkship of Acupuncture and Moxibustion Medicine at a single College of KM and explored the barriers and future improvements of WPBL.

METHODS

The WPBL was implemented from January to July 2019. During the clerkship, each senior student was assigned an inpatient at the university hospital. WPBL was conducted as follows: patient presentation by the supervisor, interaction with the patient at the bedside, preparation of medical records, oral case presentation, and discussion with feedback. The student performed a physical examination and review of systems as a clinical task. In addition, six doctors of KM who are currently practicing after three years of WPBL were interviewed in September 2022 to investigate the real-world effects and unmet needs of WPBL in their workplaces.

RESULTS

Two major themes identified from the interview were: "the experience of novice doctors of KM with KM practice" and "Current state of KM clinical education." The five subcategories were: "Clinical competency priorities vary according to the KM workplace," "Difficulties faced by doctors of KM immediately after graduation," "WPBL experience of the interviewees," "Necessary but difficult to implement real patient learning," and "Unmet needs for clinical clerkship in KM."

CONCLUSION

It is essential to consider the unique characteristics of KM practice and the duties required in various workplaces for successful WPBL. We anticipate our study to be a starting point for improving the WPBL and addressing the unmet needs in KM clinical education.

Designing feedback processes in the workplace-based learning of undergraduate health professions education: a scoping review

BACKGROUND

Feedback processes are crucial for learning, guiding improvement, and enhancing performance. In workplace-based learning settings, diverse teaching and assessment activities are advocated to be designed and implemented, generating feedback that students use, with proper guidance, to close the gap between current and desired performance levels. Since productive feedback processes rely on observed information regarding a student's performance, it is imperative to establish structured feedback activities within undergraduate workplace-based learning settings. However, these settings are characterized by their unpredictable nature, which can either promote learning or present challenges in offering structured learning opportunities for students. This scoping review maps literature on how feedback processes are organised in undergraduate clinical workplace-based learning settings, providing insight into the design and use of feedback.

METHODS

A scoping review was conducted. Studies were identified from seven databases and ten relevant journals in medical education. The screening process was performed independently in duplicate with the support of the StArt program. Data were organized in a data chart and analyzed using thematic analysis. The feedback loop with a sociocultural perspective was used as a theoretical framework.

RESULTS

The search yielded 4,877 papers, and 61 were included in the review. Two themes were identified in the qualitative analysis: (1) The organization of the feedback processes in workplace-based learning settings, and (2) Sociocultural factors influencing the organization of feedback processes. The literature describes multiple teaching and assessment activities that generate feedback information. Most papers described experiences and perceptions of diverse teaching and assessment feedback activities. Few studies described how feedback processes improve performance. Sociocultural factors such as establishing a feedback culture, enabling stable and trustworthy relationships, and enhancing student feedback agency are crucial for productive feedback processes.

CONCLUSIONS

This review identified concrete ideas regarding how feedback could be organized within the clinical workplace to promote feedback processes. The feedback encounter should be organized to allow follow-up of the feedback, i.e., working on required learning and performance goals at the next occasion. The educational programs should design feedback processes by appropriately planning subsequent tasks and activities. More insight is needed in designing a full-loop feedback process, in which specific attention is needed in effective feedforward practices.

To be or not to be supervisors for medical students in general practice clinical placements: a questionnaire study from Norway

OBJECTIVE

Many countries experience challenges in recruiting and retaining general practitioners (GPs) as supervisors for medical students in clinical placements. We aimed to investigate the opportunities, capacities and limitations of Norwegian GPs to become supervisors.

DESIGN

Web-based cross-sectional questionnaire study.

SETTING

Norwegian general practice.

SUBJECTS

All GPs in Norway, including locums and those on leave, both active supervisors, and GPs who are not presently supervising medical students.

MAIN OUTCOME MEASURES

GPs' terms of salary, office facilities, limiting factors, capacity and needs for becoming or continuing as supervisors.

RESULTS

Among 5145 GPs, 1466 responded (29%), of whom 498 (34%) were active supervisors. Lack of a dedicated student office was the most reported limitation for both active supervisors (75%) and other GPs (81%). A high proportion (67%) of active supervisors reported that they could host more students per year, given financial support for equipped offices and higher salaries. With this kind of support, 48% (n = 461) of the GPs who were not supervisors for medical students were positive about a future supervisor role. By adjusted regression analysis, female GPs had lower likelihood of being supervisors, OR (95% CI) 0.75 (0.59-0.95) than male colleagues. GPs in the North, Mid and West regions had higher odds (OR 3.89, 3.10 and 2.42, respectively) than those in the South-East region. Teaching experience also increased the odds (2.31 (1.74-3.05).

CONCLUSIONS

There seems to be capacity among both active and potential supervisors if increased salaries and financial support for office facilities are made available.

Becoming a doctor: using social constructivism and situated learning to understand the clinical clerkship experiences of undergraduate medical students

BACKGROUND

Despite the emphasis on the uniqueness and educational importance of clinical clerkships in medical education, there is a lack of deep understanding of their educational process and outcomes. Especially due to an inherent trait of clinical clerkships which requires participation in the workplace outside the classroom, it is difficult to fully comprehend their educational potential using traditional learning perspectives such as imbibing outside knowledge. Accordingly, this study aims to explore the experiences of a rotation-based clerkship of medical school students from the perspective of social constructivism of learning, which can empirically examine what and how medical students learn during clinical clerkship in South Korea. By providing an insight into the workings of the clerkship process, this study contributes to a better understanding of how a learning-friendly environment can be cultivated at clinical clerkships.

METHODS

The study utilized a basic qualitative study to understand what and how medical students learn during their clinical clerkships. Semi-structured, in-depth individual interviews were conducted with eight sixth-graders who had experienced a two-year clerkship at Ajou University Medical School. Data were analyzed based on Lave and Wenger's situated learning theory and Wenger's social theory in learning.

RESULTS

We found that the medical students had developed different aspects of their professional identities such as values, functionality, career decisions, sociality, and situating during their clinical clerkships. Further, professional identity was formed through a combination of participation and reification-the processes involved in the negotiation of meaning. This combination was facilitated by the students' first experience and relationships with professors, classmates, and patients. Finally, non-learning occurred in the context of over-participation (learning anxiety and alienation) or over-reification (evaluation and e-portfolio).

CONCLUSIONS

This study revealed five sub-professional identities and their formation process from the learners' perspective, thereby uncovering the unique learning characteristics and advantages of rotated-based clerkship and contributing to a further understanding of how gradual improvements can be made to the traditional clerkship education of medical students.

Abortion education: What are future physicians learning in medical school?

OBJECTIVES

The last nationwide evaluation of abortion education in undergraduate medical schools was conducted by Espey et al. more than 15 years ago. To better understand what medical schools are teaching medical students about abortion care, we conducted a brief assessment of abortion education and training at U.S. medical schools.

STUDY DESIGN

In April 2019, the study team emailed a three-item survey to the obstetrics and gynecology clerkship directors at Association of American Medical Colleges-accredited U.S. allopathic medical schools (n = 143). The multiple-choice survey assessed the availability and type of reproductive health education students had during their preclinical and clinical experiences.

RESULTS

Ninety-one (64%) medical schools responded. Fifty-four (59%) schools reported abortion education as part of their preclinical curriculum, with 26 (29%) dedicating at least one lecture to abortion education. Sixty-seven (74%) institutions provided a clinical abortion experience for students, with 24 (26%) indicating students had to arrange participation on their own. Nine programs (10%) reported offering no formal abortion education.

CONCLUSIONS

While the availability of abortion education has increased since the last nationwide survey in 2005, discrepancies in the education offered persist, and many medical students remain without access to this training.

IMPLICATIONS

Although abortion plays an essential role in women's health services, discrepancies in training opportunities limit abortion education in U.S. medical schools. Gaps in the education of medical students may have downstream effects on the availability of doctors who are trained in providing medically-safe abortions.

Progress testing of an objective structured clinical examination during undergraduate clinical clerkship: a mixed-methods pilot study

BACKGROUND

Progress testing is an assessment method in which an examination reflecting competencies at graduation is regularly administered to students over multiple years, thereby facilitating self-directed learning. However, the significance of the objective structured clinical examination as a progress test in undergraduate education, needs to be determined. This study provides evidence of the role of the objective structured clinical examination for progress testing and optimal scoring methods for assessing students in different academic years.

METHODS

We conducted a sequential explanatory mixed-methods pilot study. Participants were assessed using the Item Rating Scale, the year-adjusted Global Rating Scale, and the Training Level Rating Scale. The characteristics of each scale were compared quantitatively. In addition, the influence of the objective structured clinical examination as a progress test on learning attitudes was examined. Qualitative data from a post-examination questionnaire were analyzed, using content analysis to explore influences on self-directed learning.

RESULTS

Sixth and fifth year clinical students (n = 235) took the objective structured clinical examination progress test. The total Item Rating Scales were recorded (%) as 59.03 ± 5.27 and 52.64 ± 5.08 (p < 0.01); Training Level Rating Scale was 3.94 ± 0.39 vs 3.22 ± 0.42 (p < 0.01); and the year-adjusted Global Rating Scale was 4.25 ± 0.44 vs 4.32 ± 0.52 (no significant difference), for the sixth and fifth year students, respectively. The correlations across stations and the reliability of each station were satisfactory. Four categories were identified in the qualitative analysis: "motivation to learn during the clinical clerkship was promoted," "dissatisfied with being asked about things they had not experienced," "confusion about being unable to use conventional test-taking strategies," and "insufficient understanding of competencies at graduation." The scores indicated significant differences in performance according to training year.

CONCLUSIONS

This study provides evidence that the objective structured clinical examination can be used as a progress testing tool for undergraduate clinical clerkships. Further enhancement of training opportunities and dissemination of performance competency goals in clerkship curricula are required if we intend to promote self-directed learning through progress testing.

"It kinda helped us to be there": students' perspectives on the use of virtual patient software in psychiatry posting

BACKGROUND

At the Faculty of Medicine of the National University of Malaysia, a virtual patient software program, DxR Clinician, was utilised for the teaching of neurocognitive disorder topics during the psychiatry posting of undergraduate medical students in a modified team-based learning (TBL) module. This study aimed to explore medical students' learning experiences with virtual patient.

METHODS

Ten students who previously underwent the learning module were recruited through purposive sampling. The inclusion criteria were: (a) Fourth-year medical students; and (b) Completed psychiatry posting with the new module. Students who dropped out or were unable to participate in data collection were excluded. Two online focus group discussions (FGDs) with five participants each were conducted by an independent facilitator, guided by a questioning route. The data were transcribed verbatim and coded using the thematic analysis approach to identify themes.

RESULTS

Three main themes of their learning experience were identified: (1) fulfilment of the desired pedagogy (2), realism of the clinical case, and (3) ease of use related to technical settings. The pedagogy theme was further divided into the following subthemes: level of entry for students, flexibility of presentation of content, provision of learning guidance, collaboration with peers, provision of feedback, and assessment of performance. The realism theme had two subthemes: how much the virtual patient experience mimicked an actual patient and how much the case scenario reflected real conditions in the Malaysian context. The technical setting theme entailed two subthemes: access to the software and appearance of the user interface. The study findings are considered in the light of learning formats, pedagogical and learning theories, and technological frameworks.

CONCLUSIONS

The findings shed light on both positive and negative aspects of using virtual patients for medical students' psychiatry posting, which opens room for further improvement of their usage in undergraduate psychiatry education.

Nurses' perceptions of preceptorship of undergraduate students in clinical context

BACKGROUND

Nurses' perceptions of preceptorships for undergraduate nursing students are crucial for designing effective and tailor-made strategies to improve nurses' involvement, motivation, commitment, and satisfaction in preceptorships.

OBJECTIVES

The aim of this study was to determine nurses' perceptions of preceptorships for nursing students in two hospitals located in northern Spain.

SETTINGS

This study was conducted in two highly specialized, medium-large, university tertiary care hospitals, including one public and one private hospital, located in northern Spain.

PARTICIPANTS

The participants of this study were clinical nurses in private and public health centers who had been preceptors for at least one year.

METHODS

A descriptive cross-sectional study was carried out between October 2021 and April 2022, with a total sample of 307. The validated "Involvement, Motivation, Satisfaction, Obstacles and Commitment" (IMSOC) questionnaire was used. Descriptive statistics and bivariate analysis were carried out. The variables included sex, age, educational level, preceptorship training, professional experience, work sector, work setting, and type of contract.

RESULTS

The mean global questionnaire score was 115.25 ± 33.86 (95 % CI: 111.62-123), with the highest score obtained for the "Involvement" dimension (29.96; SD: 9.23; 95 % CI: 29.01-34.87). Age showed statistically significant negative correlations with the overall and dimension scores (p < 0.05). Comparisons by work sector and type of contract reflected that nurses working in the private sector and those with permanent contracts had higher motivation and commitment scores.

CONCLUSIONS

Preceptors had positive perceptions of their role in undergraduate nursing students' education. Age, work sector, type of contract and time allocation should be considered when designing strategies to enhance the involvement, motivation, commitment, and satisfaction of nurses in their experiences as preceptors for undergraduate nursing students. Improving the preceptorship experience will benefit both nurses and students by improving preparation, satisfaction, and retention.

Deeper look into feedback practice in an Indonesian context: exploration of factors in undergraduate clinical settings

PURPOSE

The practice of feedback is influenced by the characteristics of students, teachers, and the clinical environment. Most studies on feedback have been conducted in Western settings with different sociocultural backgrounds to Indonesia. This study explores feedback in Indonesian clinical clerkship using a sociocultural lens and aims to provide an exemplar of adaptive practice relevant to non-Western settings.

METHODS

This qualitative study was conducted using an interpretive phenomenology approach. Data were collected through focus groups with students and teachers and interviews with program coordinators. Data were transcribed verbatim and grouped according to data sources, coded, and analyzed thematically.

RESULTS

Themes identified from the focus group discussions and interviews were categorized as student, teacher, and environmental factors. Student factors include dependence on feedback, tendencies to use a group approach, difficulties recognizing social rules, a perceived lack of resilience, and tendencies to doubt praise. Factors related to teachers include a high level of expertise, being extremely busy, having a strong commitment, and being unsure of students' acceptance of feedback. Clinical environment factors influence interactions between teachers and learners and include high power distance and collectivistic values. A safe environment is needed to ensure effective feedback interactions.

CONCLUSION

High power distance, collectivism, and generational characteristics of students likely impact feedback practice in clinical settings. Designing a safe environment is essential for effective feedback practice.

Revisiting Feed Forward: Promoting a Student-Centered Approach to Education Handoffs, Remediation, and Clerkship Success

Issue: Throughout medical school, and especially during clerkships, students experience changing work and learning environments and are exposed to new academic, interpersonal, and professional challenges unique to clinical learning. Given the siloed nature of clinical rotations, students often "fall through the cracks" and may repeatedly struggle through clerkships without support and coaching from which they would otherwise benefit. Many institutions have grappled with creating feed forward processes, that is, educational handoffs in which information is shared among faculty about struggling students with the intention of providing longitudinal support to ensure their success, while protecting students from negative bias that may follow them throughout the remainder of their medical school tenure. Evidence: Here, the authors describe the feed forward processes of four medical schools. Each school's process relies on close collaboration between course directors and deans to identify students and develop intervention plans. Course leadership and administration are typically the primary drivers for long-term follow-up with students. The number of participants in the process varies, with only one school directly involving students. Two schools hold larger, regularly scheduled meetings with up to 12 faculty present in their institution's feed forward process. Across these institutions, students can "graduate" from the feed forward process once they achieve competency in the areas of concern. Implications: The authors believe the most important outcome achieved is the formalization and adherence to a feed forward process. Thus, risk to students in the form of negative bias is mitigated by the flow of information, the extent to which information is available, and permitting students to be part of the process. These exemplars give insight into variable approaches to feed forward systems adopted by medical schools and demonstrate highly visible methodologies by which educational leadership empower students and educators toward a shared goal of student progress and achievement.

Undergraduate Students' and Interns' Perception towards Learning Environment at Dental Clinics, Qassim University, Saudi Arabia

Background

Dental clinical educational environment plays a critical part in the inculcation of skills and enhancement of knowledge for the dental students. The objective was to assess undergraduate dental students' and interns' perceptions towards the clinical learning environment.

Methods

Current cross-sectional study was conducted from December 2020 to February 2021, using the 24-item dental clinical learning environment inventory (DECLEI) on a six point Likert scale. The possible range of cumulative score for DECLEI was from 0 to 100 (interpretation poor to excellent). The inventory was emailed to 111 students and interns at College of Dentistry, Qassim University. The relationship between the independent variables and DECLEI scores was determined by using Pearson correlation test. SPSS version-23 was used for statistical analysis.

Results

Overall response rate was 78.37%. The mean DECLEI score was noted as 67.5 ± 17.98. Among the factors, the highest mean score was documented for the systematic self-evaluation and the lowest mean score was observed for the item related to patients' punctuality for appointments. A factor-wise analysis of three subscales of DECLEI demonstrated the respondents had good perception towards all subscales with the highest mean score (72.3 ± 18.06) for Factor III and lowest mean score (61.3 ± 19.81) for Factor II. Overall, the DECELI was found to be reliable with the Cronbach's Alpha value of 0.94. The Pearson's correlation test showed the weak positive insignificant correlation of mean DECLEI score with gender and categories.

Conclusions

Present study indicated more positive than negative perceptions of the dental students related to their clinical learning environment. The DECLEI helped in recognizing both strengths and shortcomings of the dental clinical learning environment.

Validation of the Korean version of the Reflective Practice Questionnaire in clinical clerkship of Korean medical students

PURPOSE

This study aims to verify whether the Reflective Practice Questionnaire (RPQ) developed by Priddis and Rogers is valid in the Korean context to identify the level of reflection of medical students in clinical practice.

METHODS

A total of 202 third- and fourth-year medical students from seven universities participated in the study. After receiving approval for use from the authors, a survey was conducted on the students through an adaptation process. The original scale consists of 10 factors with 40 items. The Self-efficacy in Clinical Performance Scale (SECP), Korean Self-reflection and Insight Scale (K-SRIS), and Reflection-in-Learning Scale (RinLS) were used to validate the scale. Exploratory factor, confirmatory factor, correlation, and reliability analyses were used for data analysis.

RESULTS

As a result of exploratory factor analysis, 10 subfactors were extracted (Kaiser-Meyer-Olkin=0.856, Bartlett's test: χ 2 =5,044.337, degrees of freedom=780, p<0.001). Among the 40 items, one that showed a high overlapping load for other factors was excluded. As a result of confirmatory factor analysis, the 10-factor structure model was found suitable (χ 2 =1.980, comparative fit index=0.859, Tucker-Lewis index=0.841, root mean square error of approximation=0.070). As a result of the criterion validity test, most of the subfactors of the Korean version of the RPQ (K-RPQ) showed a positive correlation with K-SRIS, RinLS, and SECP. The reliability of 10 subfactors was satisfactory, ranging from 0.666 to 0.919.

CONCLUSION

The K-RPQ was confirmed to be a reliable and valid tool to evaluate the level of reflection among Korean medical students in clinical clerkship. This scale can be used as a tool to provide feedback on each student's level of reflection in clinical clerkship.

Undergraduate rural medical training experiences and uptake of rural practice: a retrospective cohort study in South Australia

BACKGROUND

Rural medical training experiences provided by Rural Clinical Schools (RCS) can encourage future practice in rural locations. However, the factors influencing students' career choices are not well understood. This study explores the influence of undergraduate rural training experiences on graduates' subsequent practice location.

METHODS

This retrospective cohort study included all medical students who completed a full academic year at the University of Adelaide RCS training program between 2013-2018. Details of student characteristics, experiences, and preferences were extracted from the Federation of Rural Australian Medical Educators (FRAME, 2013-2018) survey and linked to graduates' recorded practice location obtained from the Australian Health Practitioner Regulation Agency (AHPRA, January 2021). The rurality of the practice location was defined based on the Modified Monash Model (MMM 3-7) or Australian Statistical Geography Standard (ASGS 2-5). Logistic regression was used to examine associations between student rural training experiences and rural practice location.

RESULTS

A total of 241 medical students (60.1% females; mean age 23.2 ± 1.8 years) completed the FRAME survey (response rate 93.2%). Of these, 91.7% felt well supported, 76.3% had a rural-based clinician mentor, 90.4% reported increased interest in a rural career, and 43.6% preferred a rural practice location after graduation. Practice locations were identified for 234 alumni, and 11.5% were working rurally in 2020 (MMM 3-7; 16.7% according to ASGS 2-5). In adjusted analysis, the odds of working rurally were 3-4 times more likely among those with a rural background or lived the longest in a rural location, 4-12 times more likely among those preferring a rural practice location after graduation, and increased with the student's rural practice self-efficacy score (p-value < 0.05 in all cases). Neither the perceived support, having a rural-based mentor, or the increased interest in a rural career were associated with the practice location.

CONCLUSIONS

These RCS students consistently reported positive experiences and increased interest in rural practice after their rural training. Student reported preference for a rural career and rural practice self-efficacy score were significant predictors of subsequent rural medical practice. Other RCS could use these variables as indirect indicators of the impact of RCS training on the rural health workforce.

Contribution of nursing students to clinical settings: A multi center cross sectional study

AIMS

To describe the contribution of nursing students to clinical settings based on the perceptions of nurse preceptors and to examine whether certain characteristics of nurses' professional activity are associated with a positive perception of nursing students.

BACKGROUND

Most clinical agencies receive many nursing students each year, who acquire clinical competencies under the guidance of a registered nurse preceptor. However, there is limited evidence of the contributions made by nursing students during clinical placements.

METHODS

A multi-center cross-sectional study was carried out between June and December 2019. A convenience sample of Registered Nurses (n = 927) was recruited from four public hospitals in Spain. The Nursing Student Contributions to Clinical Settings' questionnaire was used. In addition, sociodemographic, work and teaching activity variables were collected. Multivariable logistic regression was used to determine the variables associated with positive student contributions.

RESULTS

The nursing student contributions were deemed favorable by 70.7% of the nurse preceptors, mainly because the nursing students are future professionals who know the center, support the development of the nurses' teaching role and constitute a link between the health center and the university. Certain professional characteristics of the Registered Nurses were significantly associated with a positive perception of the contributions of nursing students: having daily coffee breaks (Odds ratio: 2.60; 95% Confidence interval:1.27-5.32), high levels of professional satisfaction (Odds ratio: 2.13; 95% Confidence interval:1.21-3.75) and work in medical-surgical units (Odds ratio: 1.62; 95% Confidence interval: 1.08-2.41). In contrast, nurses with greater work experience (≥ 30 years) (Odds ratio: 0.48; 95% Confidence interval: 0.27-0.85) and who worked at units where 10 or more students perform clinical practice (Odds ratio: 0.57; 95% Confidence interval: 0.36-0.90) were associated with a lower probability of positive perceptions.

CONCLUSIONS

In Spain, the contributions made by nursing students to clinical settings are favorable, both for the nursing profession and for healthcare institutions. Their contributions are influenced by the professional characteristics of the Registered Nurses, as well as the environment and the teaching activity within the units.

Evaluation of the public health clinical rotation in medical school: a qualitative case study design

Public health clinical rotation in the Faculty of Medicine, Universitas Islam Indonesia, was conducted in Puskesmas (community health center). This study aims to evaluate the public health clinical rotation in Puskesmas, part of the clinical clerkship of the Faculty of Medicine, Universitas Islam Indonesia. Several concerns have been highlighted regarding the implementation of clinical rotations in public health in Puskesmas. A briefing session before placement in the village must be coherent with a guidebook. The placement of students in the village was based on community health issues determined by the Puskesmas supervisor. Priority in the curriculum was given to converting the alertness village (Desa Siaga) into a Program Indonesia Sehat-Pendekatan Keluarga (Healthy Indonesia Program-Family Education) program throughout implementation. Moreover, scheduling after four major clinical programs was difficult, and the writing of reports served as a guide for establishing the correct format. Therefore, the objective of the evaluation was to assess knowledge, skill, and psychomotor, and the burden of assignment in Puskesmas was difficult to accomplish a primary task in the community.

Clinical environmental stressors and coping behaviors among undergraduate nursing students in Saudi Arabia: A cross-sectional study

Objectives

This study aimed to explore the level of stress, stressors sources, and coping strategies used among female Saudi undergraduate nursing students during their clinical practice.

Methods

A cross-sectional design was used. Using a convenience sampling technique, female nursing students in Riyadh, Jeddah, and Alahsa who enrolled in clinical courses were recruited from a governmental university from January to May 2022. Data were collected using a self-report questionnaire including socio-demographic characteristics, the Perceived Stress Scale (PSS), and the Coping Behavior Inventory (CBI).

Results

The degree of stress perceived by the 332 participants ranged from 3 to 99 (54.77 ± 0.95). Stress from assignments and workload was the most common type of stressor perceived by nursing students, with a score of 2.61 ± 0.94, followed by stress from the environment, with a score of 1.18 ± 0.47. Meanwhile, the students used staying optimistic as the most adopted strategy, with a score of 2.38 ± 0.95, followed by the transference strategy, a score of 2.36 ± 0.71, and the problem-solving strategy scored 2.35 ± 1.01. The coping strategy of avoidance is positively correlated with all of the stressor types (P < 0.01), while the problem-solving strategy is negatively correlated with stress from peers and daily life (r = -0.126, P < 0.05). Transference is positively correlated with stress from assignments and workload (r = 0.121, P < 0.05), and stress from teachers and nursing staff (r = 0.156, P < 0.01). Lastly, staying optimistic is negatively correlated with stress from taking care of patients (r = -0.149, P < 0.01), and with stress from lack of professional knowledge and skills (r = -0.245, P < 0.01).

Conclusions

These research findings are significant for nursing educators to identify nursing students' main stressors and coping strategies used. Effective countermeasures should be taken to promote a healthy learning environment, decrease the level of stressors and improve students' coping strategies during clinical practice.

Self-assessment scale for the community-based and emergency practice

BACKGROUND

For current medical education, community-based primary care for the elderly is an essential topic. This study aimed to establish a scale of community-based assessment for clinical and emergency practice (C-CEP).

METHODS

A self-assessment scale for C-CEP was developed according to four steps. Initially, we reviewed publications from the societies of the United States, British, and Japan regarding educational goals. In addition, we searched MEDLINE for educational goals regarding attitude, skills, and knowledge. Getting together, we established 23 items as the educational goals of the C-CEP. Second, we collected responses for these 23 items from 5th-grade medical students (n = 195). Third, we conducted an exploratory factor analysis (EFA) using their responses to determine the fundamental structure of the self-assessment scale. Finally, a confirmatory factor analysis (CFA) was performed to assess the fitness of the self-assessment scale developing the EFA, resulting in modification of the items.

RESULTS

In EFA and CFA results, C-CEP Scale consisted of four factors with 15 items: "Attitude and communication in emergency care," Basic clinical skills," "Knowledge of community healthcare," and "Knowledge of evidence-based medicine perseverance." The model fit indices were acceptable (Goodness of Fix Index = 0.928, Adjusted Goodness of Fit Index = 0.900, Comparative Fit Index = 0.979, and Root Mean Square Error of Approximation = 0.045). The values of McDonald's omega as an estimate of scale reliability were more than 0.7 in all four factors. As for test-retest reliability, the intraclass correlation coefficients were ≥ 0.58 for all factors. All four factors of the C-CEP Scale correlated positively with the Medical Professionalism Evaluation Scale subscales.

CONCLUSIONS

We developed a valid and reliable self-assessment scale to assess student competence.

[Analysis of Bullying and Harassment Experienced by Fourth-Year Nursing Students in their Clinical Practice.]

OBJECTIVE

Nursing students, with their inexperience and the frequent challenge of encountering new environments, are a potentially vulnerable group for bullying and harassment in the work setting. The aim of this study was to analyze the bullying and/or harassment experienced by Nursing students during their clinical practice.

METHODS

A descriptive cross-sectional study was carried out at the University of León and the study population was fourth-year nursing students. The measurement instrument was a 24-item questionnaire approved by the University Ethics Committee. The chi-square test, Student's t-test and Mann Whitney U test were used for statistical analysis.

RESULTS

A prevalence of 26.5% (22/83) of students who suffered episodes of bullying and/or harassment was observed; younger students suffered these events from physicians, patients and family members and/or companions to a greater extent. This produced an impact on the psychological well-being of the students, who felt depressed, humiliated and incapable, which negatively affected the level of care provided to patients.

CONCLUSIONS

The overall problem studied presents a lower prevalence than that obtained in other work carried out in the rest of the world; as a consequence, there is an impact on the psychological well-being of the students that affects their level of attention to the tasks they are carrying out and their way of working with others.

General practice-based undergraduate pharmacy longitudinal clerkship: a theoretically underpinned qualitative evaluation

BACKGROUND

A Pharmacy Longitudinal Clerkship (PLC) was designed to develop student pharmacists' (SPs) competence in a general practice setting.

AIM

The aim was to carry out a theoretically underpinned qualitative evaluation of stakeholder perceptions of influences of behavioural determinants on SP development for clinical practice in general practice.

METHOD

General practice-based PLCs were delivered in 2019/20 and 2020/21 for two cohorts of SPs in NHS Highland, Scotland. Qualitative semi-structured interviews were used to explore stakeholder perceptions of influences of behavioural determinants on SP development. Informed written consent was obtained. An interview schedule was developed and piloted using the Theoretical Domains Framework (TDF). Interviews were recorded, transcribed verbatim and analysed using thematic methodology. Ethics approval was granted.

RESULTS

Seven SPs and five general practitioner (GP) tutors were interviewed. Key themes were identified mapped to TDF domains and included: knowledge-utilisation and practical application of knowledge; skills-triangulation of skills under clinical supervision; beliefs about capabilities-confidence building with clinical and patient contact; professional role and identity-elucidation of professional roles within general practice.

CONCLUSION

This evaluation shows benefits of embedding SPs within clinical teams and immersing them in a clinical environment over a prolonged period in a general practice Pharmacy Longitudinal Clerkship. It is expected this will translate into a more confident transition to postgraduate professional clinical practice. Funding should be sought to test alternative PLC arrangements including: multiple full-time longitudinal placement blocks; or ultimately a year-long longitudinal clerkship programme with an IPE element.

A year and a half later: Clinical experiences of intern nursing students in the COVID-19 Pandemic: A constructivist grounded theory

Aims

The aim of this study is to develop a theory to explore the clinical experiences of interns in clinical practice during the COVID-19 pandemic.

Background

The COVID-19 pandemic is a serious public health problem influencing the healthcare systems worldwide. Nursing students were excluded from clinical practice for a long time due to the pandemic. However, the prolonged and uncertain pandemic conditions required the inclusion of fourth-year nursing students in clinical practice.

Design

A qualitative research design based on the Constructivist Grounded Theory approach was used in this study.

Methods

The research data were collected from fourth-year nursing students doing an internship at a university hospital in Turkey. Fourteen nursing students (12 females and 2 males) in the clinical practice during the COVID-19 pandemic with a mean age of 22.64 ± 0.225 were included in the study. In the collection of data, firstly, the purposeful sample selection method, then the theoretical sample selection method was used. On the online interview platform, the data were collected through individual interviews with those agreeing to participate in the study between July 2021 and August 2021 using a semi-structured interview form. The results were analyzed with initial, focused and theoretical coding. The research was reported based on the Consolidated Criteria for Reporting Qualitative Research guide.

Results

A core category and five main categories emerged in the study. The core category is a lonely bird and the main categories are emotions, challenges, coping methods, nursing experiences and solution suggestions.

Conclusions

This research can help create a conceptual framework of clinical practice experiences of intern nursing students during the COVID-19 pandemic. It is thought that intern nursing students need to be supported by reliable authorities before and during the internship. Intern students stated that they experienced many emotions together and felt alone. Our study results revealed that intern nurses need more psychological support, especially during the pandemic period. A remarkable finding of the research is that interns now think of themselves as professional nurses. For interns to develop effective coping methods, intensive and regular training should be organized in cooperation with the hospital and school administration.

Experiences of French medical students during their clerkship in adolescent psychiatry: a qualitative study

The epidemiology of adolescent psychiatric disorders and the relational complexity of their management make exposure to adolescent psychiatry essential during medical school. However, some clinical particularities can complicate the students' learning experiences. Our work aimed to explore the experience of being a medical student during clerkships in adolescent psychiatry. Following the Interpretative Phenomenological Analysis qualitative approach, 20 semi-structured face-to-face interviews were conducted with medical students at the end of their clerkship in adolescent psychiatry. Three super-ordered themes emerged to describe their experience: in-depth self-exploration calling on emotions, thoughts and experiences; changes in the view of adolescent mental health; better understanding of the role and meaning of adolescent psychiatric care and how to approach it. Identification between students and patients could result from time-related factors (the end of adolescent brain remodeling, long, demanding studies, and financial and material dependence). In addition, the predominant use of non-analytical clinical reasoning processes-less valued in the rest of the graduate curriculum-poses a challenge for students. Indeed, for a student to find his or her place in adolescent psychiatry requires the student to reinvent him or herself, because the codes are different (no gown, less well-defined tasks, etc.). Finally, the excess prevalence of mental disorders among medical students requires increased vigilance on the part of tutors. For all these reasons, close, attentive tutoring seems essential to support students, while these clerkships afford a real opportunity for students to broaden their interpersonal skills.

Clinical clerkship students' preferences and satisfaction regarding online lectures during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has caused an unprecedented disruption in medical education. Students and lecturers had to adapt to online education. The current study aimed to investigate the level of satisfaction and future preference for online lectures among clinical clerkship students and elucidated the factors that affect these outcomes.

METHODS

We selected a sample of 114 medical students undergoing clinical clerkship during the COVID-19 pandemic. We conducted onsite lectures before the pandemic and online lectures after the outbreak. A survey was conducted, and the sample included students and 17 lecturers. The average scores of total satisfaction and future preference related to online lectures were computed.

RESULTS

Students' scores on total satisfaction with online lectures and their future preference were higher than those for onsite lectures. Scores on the ease of debating dimension were low and those on accessibility of lectures in online lectures were higher than those in onsite lectures. There was no difference between the two groups in the scores on the comprehensibility and ease of asking questions dimensions. Results of the multiple regression analysis revealed that accessibility determined total satisfaction, and future preference was determined by comprehensibility as well as accessibility. Contrary to students' future preferences, lecturers favored onsite lectures to online ones.

CONCLUSION

Online lectures are an acceptable mode of teaching during the COVID-19 pandemic for students undergoing clinical clerkship. Online lectures are expected to become more pervasive to avoid the spread of COVID-19.

Experience of Indonesian medical students of ethical issues during their clinical clerkship in a rural setting

Although ethics is an essential part of medical education, little attention has been paid to ethics education during the clerkship phase, where medical students observe how physicians make decisions regarding various ethical problems. Specific nuances and cultural contexts such as working in a rural setting can determine ethical issues raised. This phenomenology study aimed to explore ethical issues experienced by Indonesian students during clinical clerkship in a rural setting. In-depth interviews were used to explore students’ experiences. Participants were ten students, selected on gender and clerkship year variations. Data saturation was reached after eight interviews, followed by two additional interviews. Thematic analysis was used in this study, and trustworthiness was ensured through data and investigator triangulation, member checking, and audit trail.

Three main themes found in this study were limited facilities and resources, healthcare financing and consent issues, as well as unprofessional behavior of healthcare providers. Many ethical issues related to substandard care were associated to limited resources and complexities within the healthcare system in the rural setting. Early exposure to recurrent ethical problems in healthcare can help students prepare for their future career as a physician in a rural setting.

Student satisfaction level, clinical learning environment, and tutor participation in primary care clinical placements: An observational study

BACKGROUND

Competence evaluations in the clinical setting represent approximately 50% of the nurse training process. Factors, such as perceived learning environment and clinical nurse participation, may influence nursing student satisfaction during clinical placements.

OBJECTIVE

To evaluate the relationship between the levels of nursing student satisfaction with clinical placements, the clinical learning environment, and the level of nurse tutor participation.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

We included 61 nursing students and 45 clinical nurses from 35 primary care centres assigned to the Universitat Jaume I.

VARIABLES AND DATA COLLECTION

We assessed the overall level of student satisfaction with clinical placements, students' perception of the learning environment, tutors' level of participation, and socio-demographic variables.

DATA ANALYSIS

We performed a descriptive analysis of the study sample, as well as correlation and simple linear regression analyses. Questionnaire results were analysed depending on the nature of the variables.

RESULTS

The students' perception of the learning environment was 4.39 ± 0.48 points out of 5. The overall satisfaction level was 8.89 ± 1.22 points out of 10. Tutor participation level in students learning was 3.91 ± 0.58 points out of 5.

CONCLUSIONS

Both student perception of the learning environment in the clinical setting and their overall level of satisfaction with clinical placements in the primary care centres were considered high. Tutors were participative, but poorly satisfied.

Psychiatry curriculum: How does it affect medical students' attitude toward psychiatry?

The purpose of this study was to identify the attitude of South Korean medical school students towards psychiatry and to analyze how lectures and clinical clerkship in psychiatry effect changes in students' attitudes. A total of 100 medical school students were recruited as subjects in the study, 86 of whom completed psychiatry lectures and underwent psychiatry clerkship from March 2015 to August 2018. The participating students completed a survey, which included demographic data, specialty choice, and attitude towards psychiatry. Subjects who completed lectures and clinical clerkship in psychiatry showed positive changes in attitude towards psychiatry in the following items: "Among mental health professionals, psychiatrists have the most authority and influence" (p = 0.002), "Psychiatrists frequently abuse their legal power to hospitalize patients against their will" (p < 0.001), and "Many people who could not obtain a residency position in other specialties eventually enter psychiatry" (p = 0.028). However, negative changes in attitude towards psychiatry were shown in the following item: "On average, psychiatrists make as much money as most other doctors" (p = 0.008). Also, specific medical school factors scored positively overall. Although it was not statistically significant, the questionnaire item "During my psychiatry rotation, psychiatry residents were good role models" was more positively observed by students after completion of psychiatry lectures and clerkship. After each curriculum, certain attitudes toward psychiatry were positively changed, but others either remained unchanged or were negatively changed. By using these study results to revise the current curriculum, medical school students' attitude towards psychiatry can be improved.

An innovative General Practice based Pharmacy Longitudinal Clerkship: using theory to characterise its development, implementation and initial evaluation

BACKGROUND

Longitudinal Integrated Clerkships exist in undergraduate medicine courses. A pilot Pharmacy Longitudinal Clerkship (pPLC) was funded to investigate delivery of this model of clinical education for student pharmacists.

OBJECTIVE(S)

To investigate the development, implementation and initial evaluation of a pPLC.

METHODS

The 11-week pPLC was delivered to two students in two GP practices in Scotland. Mixed theory-based methods were used to gather information on the pPLC structures and processes required and qualitative semi-structured Theoretical Domains Framework (TDF) based interviews explored outcomes with key stakeholders. Informed written consent was obtained. Interviews were audio-recorded, transcribed verbatim and analysed thematically. University Ethics approval was granted.

RESULTS

Data were generated on resources and processes required for a pPLC including funds budgeted for and actually spent on staffing, student travel/subsistence and student clinical 'Kit Bags', learning outcomes, curriculum and training timetable, GP Practice/University contracts. Interviews were completed with the two students, three linked GP clinical supervisors and two Regional Tutors involved. The seven themes were identified and mapped to seven TDF domains including: increased levels of student confidence, and increased student enthusiasm for a career in pharmacy, need for definition of the role of the Regional Tutor for the PLC and GP positivity towards the expected outcomes of clerkship model versus traditional placements.

CONCLUSION

Findings are limited by the small number of participants and settings, but evaluation was positive and the work garnered information on requirements for resources and processes. This will inform 'roll out' of the PLC.

Dundee Ready Education Environment Measure of Dentistry: Analysis of Dental Students' Perception about Educational Environment in College of Dentistry, Mustaqbal University

INTRODUCTION

Evaluation of the educational environment is an important element which can be used to improve our curriculum. The aims and objectives of this cross-sectional study were to identify the student's perception about educational environment in College of Dentistry, Mustaqbal University. As the educational environment has a significant impact on the learning and academic performance of the students, the present study will help us identify areas of improvement and refining the dental curriculum.

MATERIALS AND METHODS

A total of 120 students of year 4, 5, 6, and interns, both male and female, responded to the Dundee Ready Education Environment Measure (DREEM) in the 1^st month of the second semester, 2021. This scale measures the student's perceptions of the educational environment overall and for five domains: learning, teaching, academic self-perception, atmosphere, and social self-perception.

RESULTS

A total of 92 students responded and were generally positive about their learning environment, with a total DREEM score of 130.87 ± 32.73/200. The lowest score for Domain 5 (social self-perception) and the highest score for Domain 1 (student's perception of learning.) were noted.

CONCLUSION

Students' perception of educational environment of College of Dentistry, Mustaqbal University, was more positive than negative. This study provided a valuable insight of how students perceive their course and identified several weak areas that need to be worked upon, hence helping in improvement of the curriculum.

Temporal changes in medical student perceptions of their clinical skills and needs using a repeated self-assessment instrument

BACKGROUND

Medical student needs in clinical skill training may change over time, but data on this topic are limited. This study uses repeated self-assessments on clinical rotations during medical school to evaluate students' perceptions of their clinical skill growth.

METHODS

A self-assessment rating was completed by students during each clinical rotation as they progressed through their core clinical rotation year. The instrument consisted of questions on 5 clinical skill categories where students rated their performance as "below", "at" or "above" expected, and open-ended questions on strengths and challenges. We evaluated changes in self-ratings between the first (n=136) and third (n=118) quarters by matched-pair analysis of the shift in responses between time points using a Sign Test. We also identified the main themes from the students' responses to open-ended questions.

RESULTS

We found 22.4 % and 13.3 % of students increased their self-assessment ratings on "Oral Presentation Skills" and on "Differential Diagnosis", respectively. In contrast, perceived ability to communicate with patients saw the largest negative shifts. "Patient Interaction" was the most commonly identified area of strength and "Knowledge and Organization" was most frequently cited as a barrier.

CONCLUSIONS

Students demonstrated a positive shift in perceived competence in some core clinical skills that are not strongly emphasized in the preclinical curriculum, likely reflecting increased exposure over time. However, their perceived competence in communication skills declined. This may reflect initial over-estimation or true decline due to competing needs/interests. These patterns of change can inform the design of longitudinal curricula that anticipate and address students' needs during clinical rotations, such as placing increased emphasis on presentation skills and differential diagnosis earlier in the curriculum, and adding more emphasis to communication skills in later phases.

The impact of longitudinal integrated clerkships on patient care: a qualitative systematic review

BACKGROUND

Longitudinal Integrated Clerkships (LIC) are a relatively novel type of clinical placement model within medical education, particularly within the UK. The research on LICs primarily focuses on the impact of the model on students, tutors, communities, and organisations. The impact of LICs on patients has not yet been adequately synthesised. This systematic review aims to fill this gap by examining empirical evidence regarding the impact of LICs on patient care using quality-of-care measures, namely, health process measures and outcome measures.

METHODS

A systematic search was conducted in MEDLINE, PsycINFO, Academic Search Premier, Education Research Complete, CINAHL Complete, ERIC, Web of Science, and Scopus. Two reviewers independently conducted the screening process for study selection. Results across studies were analysed and summarised by thematic analysis.

RESULTS

The reviewers screened 1632 records. Seven studies met the inclusion criteria following a full-text review, from which four themes were created. Three themes describe health process measures, including: 1) Advocacy within healthcare system, 2) Provision of supplementary and personalised care, and 3) Providing companionship with care. One theme described a health outcome measure: Therapeutic Alliance.

CONCLUSION

Current evidence demonstrates an overall beneficial impact of LICs on patient health processes and outcome measures. However, the available evidence is weak and limited. Further research is required to illuminate the true impact of LICs on patient health.

"Rhythm of the Night": Medical student reflections on overnight trauma call

INTRODUCTION

On their surgical clerkship, students reflected on their experience on a traditional overnight call. We explored whether perceived learning experiences differ between students who identify surgical specialties as their career compared to those who do not.

METHODS

Medical students participated in traditional call at a Level 1 Trauma Center and submitted guided reflections. Reflections were coded using thematic analysis. We used Epistemic Network Analysis to compare codes based on matched specialty.

RESULTS

418 students submitted reflections between 2016 and 2019.95% learned something on call they could not have during daily services. Students who matched in surgical specialties connected more call learning experiences to formation of student agency through individualized teaching experiences and awareness of stamina.

CONCLUSIONS

Most students found participation in overnight call valuable, and professed increased awareness of their skills and future residency duties. Results indicate students who matched in surgical specialties had more formative experiences on call.

Nursing students' evaluation of clinical practice placements using the Clinical Learning Environment, Supervision and Nurse Teacher scale - A systematic review

OBJECTIVES

To review undergraduate nursing students' perceptions of the quality of their clinical placement experiences by means of surveys conducted using the Clinical Learning Environment Supervision and Nurse Teacher questionnaire.

DESIGN

Systematic review of English language studies published between 2014 and 2020, in any clinical setting, utilising data collected in the decade 2010 to 2020.

DATA SOURCES

Structured searches were conducted in CinahlPlus, Ovid Medline, Scopus, PubMed and Google Scholar.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses framed the review.

RESULTS

A total of 111 records were screened, after which 21 studies met criteria for inclusion. Studies were centred on students in Sweden and in 15 other countries. Students' ratings of 'Experience' were positive across five scale subdimensions with means 3.0-3.95 of a possible 5 (overall mean 75.4%). 'Satisfaction' across seven studies was rated highly (mean 4.16 of 5) 83.2% agreement. The highest rated subdimension was Supervisory relationship, with the Role of the Nurse Teacher rated lower and inconsistently. The underlying elements are discussed.

CONCLUSION

Although students' Experience and Satisfaction were rated highly averaging over 75%, there is still room for improvement. Further research is needed to examine how students perceive various components of 'satisfaction' within clinical learning environments because this can be seen as the primary measure of program quality. Research using experimental and observational study designs is needed to compare ways of preparing clinical teachers and reporting measurable learning outcomes for models of supervision that are applicable in varied clinical learning environments.

Virtual Advanced Electives in Urology: A Survey of Student Perceptions

OBJECTIVE

To gather medical student perceptions and learner preferences regarding virtual advanced electives.

DESIGN

An 8-question survey regarding perceived usefulness and preferred structure of virtual advanced electives as well as miscellaneous suggestions and concerns.

SETTING

University of Iowa in Iowa City, IA, a tertiary care center, as well as social media.

PARTICIPANTS

Eighty-four self-identified academic staff and medical students taking part in the upcoming 2021 residency match, of which 74 of 84 (88%) identified as applicants for the 2021 residency application cycle.

RESULTS

Preferred structure of electives is 2 weeks or less, lasting 5 hours or less per day. Desired structural components in over 30% of responses included networking with a program, didactics, departmental conferences, and operating room interaction. Primary objectives in over 30% of responses included sharing program information, networking, getting to know the residents, and assessing fit.

CONCLUSIONS

Virtual advanced electives may provide a viable replacement for away rotations. If pursued, student perceptions and preferences of virtual advanced electives should guide the creation of these educational offerings.

Feasibility of clinical performance assessment of medical students on a virtual sub-internship in the United States

We aimed to determine whether it was feasible to assess medical students as they completed a virtual sub-internship. Six students (out of 31 who completed an in-person sub-internship) participated in a 2-week virtual sub-internship, caring for patients remotely. Residents and attendings assessed those 6 students in 15 domains using the same assessment measures from the in-person sub-internship. Raters marked “unable to assess” in 75/390 responses (19%) for the virtual sub-internship versus 88/3,405 (2.6%) for the in-person sub-internship (P=0.01), most frequently for the virtual sub-internship in the domains of the physical examination (21, 81%), rapport with patients (18, 69%), and compassion (11, 42%). Students received complete assessments in most areas. Scores were higher for the in-person than the virtual sub-internship (4.67 vs. 4.45, P<0.01) for students who completed both. Students uniformly rated the virtual clerkship positively. Students can be assessed in many domains in the context of a virtual sub-internship.

"I would do something if I could!": experiences and reflections from ethics teachers on how to respond when hearing alarming cases from medical students

BACKGROUND

Previous studies show that teachers can feel disturbed by alarming cases brought up by students during their teaching activities. Teachers may feel uncertain about how to deal with these cases, as they might feel responsible to take action to prevent further harm. This study aims to explore how ethics teachers in medical schools would respond to a student report of unethical or unprofessional behaviour during the clinical training phase (clerkship) that is alarming and potentially harmful for patients or students themselves.

METHODS

This study used qualitative methods with purposive sampling. We conducted in-depth interviews with 17 teachers from 10 medical schools in Indonesia. We asked if they had heard any alarming and harmful cases from students and provided two cases as examples.

RESULTS

Four teachers shared their own cases, which they perceived as disturbing and alarming. The cases included power abuse, fraud and deception, violation of patient's rights and autonomy, and sexual harassment. Regarding teachers' responses in general, we found three main themes: (1) being assertive, (2) being careful, (3) barriers and facilitators. Most teachers were convinced of the need to take action despite numerous barriers, which they identified, leading to doubts and concerns in taking action. Our study shows that formal education in ethics might not necessarily influence how teachers respond to alarming cases, and that their responses are mainly influenced by how they perceive their role and responsibility as teachers.

CONCLUSIONS

Our study suggests that teachers should carefully consider the risks and consequences before taking action upon alarming cases to prevent further harm, and that support from higher authorities might be crucial, especially in the Indonesian context. Our study also shows that taking action as a group might be appropriate in certain cases, while personal approaches might be more appropriate in other cases. Most importantly, school leaders and administrators should develop effective organisational culture and support students and teachers for their ethical responsibility commitment.

One-on-one mentoring for final year medical students during the neurosurgery rotation

BACKGROUND

Medical students show varying clinical practical skills when entering their final year clinical clerkship, which is the final period to acquire and improve practical skills prior to their residency. We developed a one-on-one mentoring program to allow individually tailored teaching of clinical practical skills to support final year students with varying skill sets during their neurosurgical clinical clerkship.

METHODS

Each participating student (n = 23) was paired with a mentor. At the beginning students were asked about their expectations, teaching preferences and surgical interest. Regular meetings and evaluations of clinical practical skills were scheduled every 2 weeks together with fixed rotations that could be individually adjusted. The one-on-one meetings and evaluations with the mentor gave each student the chance for individually tailored teaching. After completion of the program each student evaluated their experience.

RESULTS

The mentoring program was well received by participating students and acquisition or improvement of clinical practical skills was achieved by most students. A varying practical skill level and interest in the field of surgery was seen.

CONCLUSIONS

A neurosurgical one-on-one mentoring program is well received by final year medical students and allows for individually tailored learning of clinical practical skills.

Agreement between medical students' peer assessments and faculty assessments in advanced resuscitation skills examinations in South Korea

PURPOSE

In medical education, peer assessment is considered to be an effective learning strategy. Although several studies have examined agreement between peer and faculty assessments regarding basic life support (BLS), few studies have done so for advanced resuscitation skills (ARS) such as intubation and defibrillation. Therefore, this study aimed to determine the degree of agreement between medical students' and faculty assessments of ARS examinations.

METHODS

This retrospective explorative study was conducted during the emergency medicine (EM) clinical clerkship of fourth-year medical students from April to July 2020. A faculty assessor (FA) and a peer assessor (PA) assessed each examinee's resuscitation skills (including BLS, intubation, and defibrillation) using a checklist that consisted of 20 binary items (performed or not performed) and 1 global proficiency rating using a 5-point Likert scale. The prior examinee assessed the next examinee after feedback and training as a PA. All 54 students participated in peer assessment. The assessments of 44 FA/PA pairs were analyzed using the intraclass correlation coefficient (ICC) and Gwet's first-order agreement coefficient.

RESULTS

The PA scores were higher than the FA scores (mean±standard deviation, 20.2±2.5 [FA] vs. 22.3±2.4 [PA]; P<0.001). The agreement was poor to moderate for the overall checklist (ICC, 0.55; 95% confidence interval [CI], 0.31 to 0.73; P<0.01), BLS (ICC, 0.19; 95% CI, -0.11 to 0.46; P<0.10), intubation (ICC, 0.51; 95% CI, 0.26 to 0.70; P<0.01), and defibrillation (ICC, 0.49; 95% CI, 0.23 to 0.68; P<0.01).

CONCLUSION

Senior medical students showed unreliable agreement in ARS assessments compared to faculty assessments. If a peer assessment is planned in skills education, comprehensive preparation and sufficient assessor training should be provided in advance.

Visual arts in the clinical clerkship: a pilot cluster-randomized, controlled trial

BACKGROUND

Arts exposure is associated with positive psychological constructs. To date, no randomized, controlled studies have integrated art into clinical medical education or measured its effects on positive psychological constructs or educational outcomes. In this study, we assessed the possibility and potential benefits of integrating visual arts education into a required internal medicine (IM) clinical clerkship.

METHODS

We conducted a controlled trial in an academic healthcare system with an affiliated art museum. IM students were assigned to one of three interventions: museum-based arts (n = 11), hospital-based arts (n = 10), or hospital-based conventional education (n = 13). Arts groups explored empathy, resilience, and compassion in works of art during facilitator-guided discussions. We assessed pre- and post-intervention measures of empathy, mindfulness, tolerance of ambiguity, and grit and tracked National Board of Medical Examiners IM shelf exam performance to capture changes in educational outcomes. Focus group discussions with participants in the arts-based interventions were performed at the study's conclusion.

RESULTS

Arts education was successfully integrated into a busy clinical clerkship in both hospital and art museum settings. Focus group participants reported increased implicit bias cognizance and time for reflection, but no significant differences in psychometric or educational outcomes were identified. While most students felt positively toward the experience; some experienced distress from missed clinical time.

CONCLUSIONS

This pilot study demonstrates the feasibility of integrating visual arts education into the clerkship. Although observable quantitative differences in measures of positive psychological constructs and educational outcomes were not found, qualitative assessment suggested benefits as well as the feasibility of bringing fine arts instruction into the clinical space. A larger, multi-center study is warranted.

Suspending Medical Student Clerkships Due to COVID-19

Medical schools around the world have been grappling with how to adapt undergraduate medical curricula in the face of the COVID-19 pandemic. Our institution made the decision to suspend all clinical clerkships the day before the Association of American Medical Colleges (AAMC) recommended to US medical schools a similar suspension of "medical student participation in any activities that involved patient contact." This manuscript describes the rapid evolution in our decision-making as we weighed various information, values, and priorities in the face of the emerging public health crisis. We discuss how a compromised learning environment and concerns about student, patient, and the public health led to the suspension. We also consider next steps as we move forward in this uncertain time.

Medical students' perspectives on recommencing clinical rotations during coronavirus disease 2019 at one institution in South Korea

PURPOSE

Clinical rotations of medical students across the world have inevitably been affected due to the coronavirus disease 2019 (COVID-19) pandemic. The aims of this study were to explore medical students' perception on the school's response and management of clinical rotation during the COVID-19 pandemic and on how it had affected the quality of their education.

METHODS

An online questionnaire was distributed to third year medical students at one institution whose clinical rotations re-started during the pandemic. The questions asked about the students' satisfaction with the school's policy and feelings of safety, and the impact of COVID-19 on clinical learning.

RESULTS

The students' perception on the school's response to the pandemic was mixed. Re-commencement of the clinical rotations and procurement of personal protective equipment was positive but a third of students still felt unsafe. The decreased number of hospital patients did not seem to have impacted their overall clinical education with praise on the role of the supervising physicians. Seventy-six-point seven percent of students conferred the positive educational opportunities on medical professionalism presented to them only as the clinical rotation during the ongoing pandemic.

CONCLUSION

Our observations on the re-commencement of clerkship during this pandemic may help equip medical institutions on future public health crisis.

The relationship between personality dimensions, spirituality, coping strategies and clinical clerkship satisfaction among intern nursing students: a cross-sectional study

Background

The clinical clerkship is a crucial stage in nursing training, yet a dissatisfaction at this stage may cause a nurse to quit in future. This study aimed to investigate the relationship among personality dimensions, spirituality, coping strategies and clinical clerkship satisfaction among intern nursing students.

Methods

This was a correlational, cross-sectional study. A total of 293 Iranian nursing students, who were fulfilling their clinical clerkship at university-affiliated hospitals in Tehran, were selected using cluster random sampling. All participants were provided with standard questionnaires including personality dimensions (NEO_FFI), spirituality, coping strategies (WoCQ), and satisfaction with clinical clerkship. Data were analyzed using Pearson correlation and hierarchical multiple regression.

Results

The results showed that spirituality (β = 0.32, p < 0.001), problem-focused coping (β = 0.26, p < 0.001) and extraversion (of personality dimensions, β = 0.22, p < 0.001) played significant roles in predicting clinical clerkship satisfaction among intern nursing students. Regression analysis showed openness (β = 0.14, p < 0.01), extraversion (β = 0.16, p < 0.01), and spirituality (β = 0.23, p < 0.001) could significantly predict problem-focused coping style among intern nursing students. However, personality dimensions and spirituality were not good predictors for emotion-focused coping among these students (p > 0.05).

Conclusion

Personality dimensions, coping strategies and, in particular, spirituality are good predictors of clinical clerkship satisfaction among intern nursing students. Therefore, paying attention to spiritual needs in nursing students, improving their problem solving skills in dealing with clinical stress and training extraversion characteristics can be effective in enhancing their satisfaction with clinical clerkship.

Voluntary assignments during the pediatric clerkship to enhance the clinical experiences of medical students in the United States

PURPOSE

Pediatric clerkships that utilize off-campus clinical sites ensure clinical comparability by requiring completion of patient-focused tasks. Some tasks may not be attainable (especially off-campus); thus, they are not assigned. The objective of this study was to evaluate the feasibility of providing a voluntary assignment list to third-year medical students in their pediatric clerkship.

METHODS

This is a retrospective single-center cross-sectional analysis of voluntary assignment completion during the 2019–2020 academic year. Third-year medical students were provided a voluntary assignment list (observe a procedure, use an interpreter phone to obtain a pediatric history, ask a preceptor to critique a clinical note, and follow-up on a patient after the rotation ends). Descriptive statistics were used to assess the timing and distribution of voluntary assignment completion.

RESULTS

In total, 132 subjects (77 on the main campus, 55 off-campus) were included. Eighteen (13.6%) main-campus and 16 (12.1%) off-campus students completed at least 1 voluntary assignment. The following voluntary assignments were completed: observe a procedure (15, 11.4%), use an interpreter phone (26, 19.7%), ask a preceptor to critique a clinical note (12, 9.1%), and follow-up on a patient after the rotation ends (7, 5.3%). Off-campus students completed the assignments more often (29.1%) than on-campus students (23.4%)

CONCLUSION

Our clerkship values specific patient-focused tasks that may enhance student development, but are not attainable at all clinical sites. When provided a voluntary assignment list, 34 out of 132 students (25.8%) completed them. Clerkships that utilize off-campus sites should consider this approach to optimize the pediatric educational experience.

Effects of clinical clerkship in education for physical and occupational therapy students: a multifaceted examination using objective indices

OBJECTIVES

This study aimed to determine the effects of clinical clerkship in physical and occupational therapy students' education on their stress, sleep, and technical skill acquisition.

METHODS

We compared responses to the Brief Job Stress Questionnaire and the Athens Insomnia Scale, and students' clinical training grades between a traditional clinical training group (n=48) and a clinical clerkship group (n=48).

RESULTS

Compared with the traditional group, the clinical clerkship group showed significantly higher scores on the Brief Job Stress Questionnaire for quantitative and qualitative burden, and significantly lower scores for the extent of control over tasks, irritability, fatigue, depression, and physical ailment. Scores for vitality and supervisor support were also significantly higher in the clinical clerkship group than the traditional group. The median Athens Insomnia Scale score was significantly lower in the clinical clerkship group. Clinical training grades for fundamental attitude and treatment techniques were significantly higher in the clinical clerkship group than in the traditional group.

CONCLUSIONS

Students that experienced clinical clerkship perceived quantitative and qualitative burdens, which may be attributable to the level of interaction with patients during training. Their perception of low control over tasks may be because their supervisors described tasks specifically. However, the clinical clerkship group showed lower mental and physical stress than the traditional group. These students perceived they had supervisor support, which may be attributable to increased communication with their supervisor. Clinical clerkship was also linked to better sleep status than traditional training. Continuing clinical clerkship is necessary to develop students' technical clinical skills.

Do clerkship schemes effectively improve pharmacy students' understanding of and attitudes regarding pharmaceutical care?--a pre-post study in China Pharmaceutical University

BACKGROUND

Clerkship is potentially an effective measure of improving the pharmacy students' understanding of and attitudes toward pharmaceutical care. This research aimed to validate whether clerkship schemes in China effectively improve pharmacy students' understanding of and attitudes toward PC, and discuss on how to improve the clerkship schemes for better quality.

METHODS

A pre-post and self-administrated questionnaire survey among three continuous years of students was conducted to measure Chinese fifth-year clinical pharmacy students' differences in understanding of pharmaceutical care and attitudes toward pharmaceutical care before and after their clerkship schemes. Statistical analysis was conducted on the retrieved data.

RESULTS

602 respondents completed the post-part survey (drop rate = 1.8%). Correct rates of all statements regarding students' understanding of pharmaceutical care were generally increased, but the rates of respondents holding correct understanding of the primary goal of pharmaceutical care (71.9 to 85.0%), the necessity of drug information support in pharmaceutical care (77.1 to 87.5%) and the patients' role and duty when receiving pharmaceutical care (66.1 to 70.6%) were unsatisfactory before the clerkship and the improvement was not significant. Most statements regarding students' attitudes toward pharmaceutical care were improved in general. However, rates of respondents holding negative attitudes toward students performing pharmaceutical care during their clerkship (3.7 to 7.5%) and choosing pharmaceutical care provider as their career after clerkship schemes (10.8 to 14.8%) had increased after the clerkship schemes.

CONCLUSION

Clerkship generally improves clinical pharmacy students' understanding of and attitudes toward pharmaceutical care, yet adjustments are also required in some contents of the clerkship for further improvements in its outcomes.

How do German medical students perceive role models during clinical placements ("Famulatur")? An empirical study

BACKGROUND

Studies have demonstrated the importance of role models in medical education. Medical students in Germany participate in clinical placements ("Famulatur") that last 4 months in total and represent the first real-world setting where students encounter possible role models in their clinical education. These placements are an extracurricular activity, however, and regarded as the "black box" of medical education. This study aimed to evaluate whether and how students experience role models during clinical placements, the qualities associated with potential role models and whether role model-related learning gains are relevant.

METHODS

We recruited 96 students (mean age: 23.83 years; 75% female) in their 5th to 9th semesters at the Faculty of Medicine at the University of Ulm, Germany, who were participating in a clinical placement between July and October 2015. Participants completed a questionnaire at the beginning of a 5-day working week to record sociodemographic and other information and another one at the end of the week to assess various aspects of their experiences. On each of the 5 days, they completed a structured questionnaire to record their perceived role models and self-assessed learning gains.

RESULTS

Role models and role modelling play an important role in clinical placements. The positive function of medical staff as role models predominated (88.4%) across all specialties. Junior doctors were the most frequently perceived role models (28.5%), followed by consultants (25.1%) and nursing staff (22.4%). The most commonly perceived positive quality was the interaction with students (16.5%), followed by team behaviour (13.6%), interaction with patients (13.6%) and professional expertise (13.4%). Students also had various kinds of learning gains such as knowledge or skills.

CONCLUSIONS

Although these clinical placements are extracurricular activities in Germany and their content is not regulated, they are home to a relevant amount of role modelling. Students experience the various medical professions in different roles and in a range of tasks and interactions. Defining basic learning objectives could help to increase the relevance of these placements for the medical curriculum in Germany and transfer the associated learning gains from the hidden to the open curriculum.

Medical students' satisfaction with clinical clerkship and its relationship with professional self-concept

PURPOSE

Medical students construct their identity as a student physician through clinical clerkship. However, there is a lack of research on the effect of clinical clerkship on professional self-concept formation. The aim of this study is to analyze and ascertain the relationship between medical students' satisfaction with clinical clerkship and professional self-concept.

METHODS

This investigation studied 84 third- and fourth-year medical students enrolled in the Ajou University School of Medicine and Graduate School of Medicine. Study measures tools included satisfaction with clinical clerkship and professional self-concept measurement. For data analyses, a descriptive analysis of the research variable characteristics was applied, gender differences in variables by years of medical school were analyzed with t-tests, and correlation analysis was used to check for relationships between variables.

RESULTS

We found no statistically significant differences between satisfaction with clinical clerkship with respect to medical school year and gender. While professional self-concept did not show significant differences by year of medical school, we observed statistically significant differences by gender with respect to the subscales of professional practice and communication factor. In addition, satisfaction with clinical clerkship and professional self-concept demonstrated statistically significant positive correlation. The present research was able to confirm that there exists a correlation between medical students' clinical clerkship experience and professional self-concept formation.

CONCLUSION

Our study outcomes shows that provision of positive assistance as a measure to enhance satisfaction with clinical clerkship via the curriculum and environmental improvement is envisaged to lead to medical students' professional self-concept formation.

Burnout syndrome in nursing students: An observational study

BACKGROUND

Academic burnout appears attributable to work and academic overload and may negatively affect learning and care quality during clinical clerkship.

OBJECTIVES

To evaluate the presence of burnout syndrome in nursing students and to detect the main stressors that occur during clinical clerkship.

DESIGN

Observational, descriptive and cross-sectional study carried out between January and July 2017.

SETTINGS AND PARTICIPANTS

Second-, third- and fourth-year nursing students at Jaume I University (Universitat Jaume I) (Spain) (n = 126).

METHODS

The KEZKAK questionnaire and the Maslach Burnout Inventory Student Survey were used when carrying out the data collection; sociodemographic and clinical clerkship variables were also collected. Descriptive and bivariate analyses of these instruments' variables were performed.

RESULTS

No student manifested high levels of depersonalisation or low personal accomplishment. Moreover, depersonalisation was found to increase as the academic year progressed (p = 0.027). The most stressful factors were Helplessness and Uncertainty (m = 3.61, sd = 0.345) and Confusion of Medication (m = 2.50, sd = 0.754). The female subsample showed higher stress levels due to multiple factors, such as Lack of Competence (p = 0.001) and Having to Give Bad News (p = 0.01).

CONCLUSION

This study found that its sample did not meet the criteria indicating the presence of burnout syndrome. In addition, the main stressors affecting nursing students during clinical clerkship were identified.

Nursing Degree students' perception about their clinical practice environment: a phenomenological study

AIM

To explore the perception of fourth-year nursing students of the healthcare environment where their training process in clinical practices takes place.

METHODS

Phenomenological qualitative study based on the hermeneutical philosophy of Gádamer that included the development of focus groups and semi-structured interviews in a sample of fourth-year nursing students from the University of Almería. The collection period was in February 2016. The information obtained was transcribed and analyzed by inductive strategies in search of emerging categories.

RESULTS

The analysis revealed two main categories: (1) influence of the clinical environment on the healthcare and teaching performance of nurses and on student learning and (2) training and job prospects for the future professionals. Each of them showed two subcategories with their corresponding codes. The information collected showed the experiences and perceptions of Nursing students regarding the healthcare environment where their training process in clinical practices takes place.

CONCLUSIONS

This study enabled us to discover the perception of fourth-year nursing students of the environment where their training process in clinical practices takes place. Knowledge of this phenomenon helps to identify deficits in students' clinical learning and to adapt university curricula to their training needs in order to guarantee their success as professionals facing future clinical-labour demands.

The implementation and evaluation of an e-Learning training module for objective structured clinical examination raters in Canada

Improving the reliability and consistency of objective structured clinical examination (OSCE) raters' marking poses a continual challenge in medical education. The purpose of this study was to evaluate an e-Learning training module for OSCE raters who participated in the assessment of third-year medical students at the University of Ottawa, Canada. The effects of online training and those of traditional in-person (face-to-face) orientation were compared. Of the 90 physicians recruited as raters for this OSCE, 60 consented to participate (67.7%) in the study in March 2017. Of the 60 participants, 55 rated students during the OSCE, while the remaining 5 were back-up raters. The number of raters in the online training group was 41, while that in the traditional in-person training group was 19. Of those with prior OSCE experience (n= 18) who participated in the online group, 13 (68%) reported that they preferred this format to the in-person orientation. The total average time needed to complete the online module was 15 minutes. Furthermore, 89% of the participants felt the module provided clarity in the rater training process. There was no significant difference in the number of missing ratings based on the type of orientation that raters received. Our study indicates that online OSCE rater training is comparable to traditional face-to-face orientation.

The application rate for urology specialty compared with other specialties from 2007 to 2014 in Korea: is it influenced by social interest manifested by internet trends?

BACKGROUND

Reduced clinical exposure to urology at the undergraduate or internship level is the main explanation for the marked decrease in applicants to urology residencies. This manuscript was to access the application rate for urology specialty compared with that of other specialties and to investigate the relationship between the decreasing trend in urology applications and social interest using internet trend tests.

METHODS

We reviewed data collected by the Korean Hospital Association from 2007 to 2014. We assessed internet trends using Naver Trend for domestic social interest and Google Trends for international social interest (2007 to 2014). Trend tests and Spearman correlations were used for statistical analyses.

RESULTS

Among the all specialties, the application rates to obstetrics and gynecology, emergency medicine, and occupational medicine are significantly increasing (p = 0.015, 0.012, and 0.048, respectively). Application to other specialties is mostly decreasing. The decreasing trend is highest for urology (beta = - 12.21 and p < 0.001). The application rate and domestic social interest revealed by Naver trends were significantly correlated (r = 0.786 and p = 0.021). No correlation was found between Naver trends and Google trends (r = - 0.19 and p = 0.651).

CONCLUSIONS

The rate of application to urology specialty is decreasing the fastest, and this trend is related to domestic social interest. An attempt should be made to increase the number of urologic applicants.

Predictors of nurses' level of participation in student care: A multivariable analysis

OBJECTIVE

To determine the association and predictive nature of certain socio-demographic, education, work and research variables on nurses' participation level in the clinical care of students.

DESIGN

A cross-sectional analytical study using a validated questionnaire between February and June 2014.

SETTING AND PARTICIPANTS

A consecutive sample of 117 nurses who worked in public health centres in the province of Castellón (Spain) in 2014. The nurses who had never mentored students and the questionnaires that were <50% complete were excluded.

METHODS

A descriptive analysis of the sample and an association analysis between variables were performed. The questionnaire and its dimensions were performed with a logistic regression and the maximum likelihood method, which used a complementary log-log link method. The concordance index was calculated using contingency tables.

RESULTS

The mean age was 42.56 years, and the overall mean questionnaire score was 122.84 (SD = 18.69; 95% CI: 119.415-126.26). Across the sample, 58.1% (n = 68) of the nurses obtained an Excellent score, followed by Adequate in 41% (n = 48). Overall, the predictive variables were age, mentoring of students in the last 5 years and previous training to mentor students.

CONCLUSION

The main predictive variable for greater participation in the mentorship of students was previous training in mentoring. This study also reflected on other variables that could influence nurses' participation in student mentoring.