Medical Education最新文献

Using cross-cultural dialogue pieces from this issue, Nyoni outlines factors to consider when trying to balance voices between south and north.

Introduction: Research shows that medical students are graduating with inadequate teaching on diverse patients and insufficient experience of working with diverse patient groups. The inclusion of patients from diverse groups is necessary in healthcare teaching to ensure medical students are adequately prepared for practice. In this study, we explored the perspectives of General Practitioner (GP) tutors on the recruitment of diverse volunteer patients for medical student primary clinical care placements. In particular, we focused on the current representation of diverse volunteer patients, barriers affecting their inclusion and recommendations to help with this.

Methods: Focus groups were carried out with GP tutors involved in the recruitment of volunteer patients from one region in the United Kingdom. Transcripts were analysed using Thematic Analysis.

Results: Participants acknowledged the importance of ensuring that medical students have clinical experience in assessing and managing patients from diverse populations, but most did not actively think about the diversity of the patients they were recruiting. Instead, recruitment was driven by the need to cover the curriculum and teaching requirements. To ensure that students' learning was not diminished and recognising time was a significant factor, participants automatically discounted certain patients from being a volunteer patient. They acknowledged that they did not feel comfortable identifying patients based on their demographics and were more likely to invite patients who had been volunteer patients before.

Discussion: Suggested solutions to overcome the factors affecting the recruitment of diverse patients are presented. Patient populations will continue to become more diverse, and therefore, medical schools must prepare their students for this and encourage GP tutors to make a conscious effort to recruit diverse patient volunteers for teaching.

Purpose: Student-led clinics generate a range of benefits to multiple stakeholder groups. Students receive important educational opportunities to advance in their training. Patients with limited access to care may access effective care or a higher amount of effective care and so reduce burden on the health care system. The financial viability of student-led clinics run by universities is uncertain, and establishing this is complicated by the range of stakeholder costs and benefits that may be involved. This systematic review aimed to synthesise evidence related to the costs and benefits of student-led clinics and report the methods that have been used to measure these costs and benefits.

Method: We conducted a systematic search of MEDLINE All, PsychInfo, CINAHL, A+ Education (Informit), ERIC (ProQuest) and ProQuest Education databases for studies that reported the costs and/or economic benefits of student-led clinics from inception through August 2023. Studies were screened for eligibility, and data were extracted including study characteristics, student-led clinic description and economic outcomes. A narrative synthesis was undertaken due to the heterogeneity of studies.

Results: Of 349 potentially eligible studies, 24 were included. Nine studies (38%) used an outcome description-monetised approach; four used partial economic evaluation (17%); four employed cost description (17%); two used cost approximation (8%); two used cost analyses (8%); and one was a full economic analysis (4%). Studies examined costs or benefits, from the perspective of a range of stakeholders, but few examined both. Only six studies (25%) had established the clinical effectiveness of their service. Student clinics generate costs for universities in supplying supervision, capital and consumables. Benefits are shared by patients, students, universities and the broader health system, however, economic evaluations to date have largely ignored or not monetised/valued these benefits.

Conclusions: Student-led clinics involve many different stakeholders, each of whom may incur costs and reap benefits. This complicates how we can go about trying to establish the economic efficiency and viability of student-led clinics. Measurement of both costs and benefits is needed to understand the efficiency of student-led clinics in comparison to alternatives. Without the full picture, decision-makers may make decisions that are ill-informed and lead to a loss of benefit for society.

Introduction: Increasingly, medical training aims to develop physicians who are competent collaborators. Although interprofessional interactions are inevitable elements of medical trainees' workplace learning experiences, the existing literature lacks a cohesive model to conceptualise the learning potential residing in these interactions.

Methods: We conducted a critical review of the health professions and related educational literatures to generate an empirically and theoretically informed description of medical trainees' workplace interactions with other health professionals, including learning mechanisms and outcomes. Informed by Teunissen's conceptualisation of workplace learning, we highlight the individual, social and situated dimensions of learning from interprofessional workplace interactions.

Results: Workplace interactions between medical trainees and other health professionals tend to be brief, spontaneous, informal and often implicit without the predefined educational goals and roles that structure trainees' relationships with physician supervisors. Yet they hold potential for developing trainees' knowledge and skills germane to the work of a physician as well as building their capacity for collaboration. Our review identified a spectrum of learning theories helpful for examining what and how trainees learn from these interactions. Self-regulated learning theories focus attention on how learning depends on trainees interpreting and judging the cues offered by other health professionals. Sociocultural frameworks including the zone of proximal development and legitimate peripheral participation emphasise the ways other health professionals support trainees in performing tasks at the border of their abilities and facilitate trainees' participation in clinical work. Both the landscapes of practice theory and cultural historical activity theory highlight the influence of surrounding social, cultural and material environments. These theories are unified into cohesive model and demonstrated through an illustrative example.

Conclusion: Interprofessional workplace interactions harbour a range of learning opportunities for medical trainees. Capitalising on their potential can contribute to training collaborative practice-ready physicians alongside traditional intra-professional interactions between physicians and merits future research.