The clinical teacher最新文献

Background: Medical migration is now more frequent, and raises complex issues concerning the standards of practice and transitions required for doctors. The challenges faced by international medical graduates have been acknowledged through the proliferation of orientation programmes designed within hospitals. This paper discusses and evaluates a pilot orientation programme for doctors in Victoria, Australia, called Transition in Practice.

Methods: Drawing on theories of active reflection and situated learning, the programme entailed fortnightly meetings for new international medical graduates at a metropolitan hospital in Victoria. The programme comprised a series of informal discussion sessions where doctors were facilitated to actively reflect on everyday practical challenges in their hospital work. Local medical and non-medical staff were invited to each session. Data comprised doctors' reflections about new insights gathered at the conclusion of each session.

Results: Thematic analysis of 55 evaluation cards revealed that participants benefited from the programme by learning directly from invited staff members' descriptions of their roles and their specific areas of practice. Participants gained increased awareness of the differences between their past and present work environments, and greater insight into the complexities of the local system. Participating doctors became actively involved in their own orientation process, generating new topics for future discussions.

Conclusion: This programme successfully integrated experiences and views of both international medical graduates and local hospital staff to generate a greater understanding of each other and of the workplace. The programme used simple, inexpensive methods that tapped into the resources that both international medical graduates and local staff bring to the workplace.

Background: The Lancashire Gujarat Health Users Forum has organised several successful 'Health Mela' events in Preston, where medical students actively volunteered in health-promotion activities. The participating students enjoyed these events, but we were keen to assess whether students derived any benefit from it in developing their clinical skills.

Methods: A focus group of 12 medical students with varied experience was set up following one such event and a semi-structured interview was conducted. Their experiences were analysed qualitatively and grouped into various themes.

Results: The students found that the 'Health Mela' was very useful to increase their clinical skills and communication skills. It also improved their understanding of preventative medicine, which is not well covered in their curriculum. In addition, these events developed teamworking and leadership skills. Students were also very pleased because they could use their personal skills creatively in the planning and smooth running of the 'Health Mela'.

Discussion: We believe that medical students should be encouraged to form groups to engage in health-promotional activities in the community. This will no doubt be beneficial to the community, but in addition will also improve the students' knowledge and skills, which will help them to be successful doctors in the future.

Background: With vertical integration, registrars and medical students attend the same educational workshops. It is not known whether these learners have similar or different learning styles related to their level of education within the medical training schema. This study aims to collect information about learning styles with a view to changing teaching strategies. If a significant difference is demonstrated this will impact on required approaches to teaching.

Methods: The VARK learning inventory questionnaire was administered to 36 general practice registrars and 20 medical students. The learning styles were compared as individuals and then related to their level of education within the medical training schema.

Results: Students had a greater preference for multimodal learning compared with registrars (62.5 per cent versus 33.3 per cent, respectively). More than half of the registrars preferred uni or bimodal learning modalities, compared with one-third of the medical students.

Discussion: The present workshop format based on visual and aural material will not match the learning needs of most learners. This small study has shown that the majority of medical students and registrars could have their learning preferences better met by the addition of written material to the workshop series. Surprisingly, a significantly larger number of medical students than registrars appeared to be broadly multimodal in their learning style, and this warrants further research.

Background: Keele Medical School's new curriculum includes a 5-week course to extend medical students' consultation skills beyond those historically required for competent inductive diagnosis.

Context: Clinical reasoning is a core skill for the practice of medicine, and is known to have implications for patient safety, yet historically it has not been explicitly taught. Rather, it has been assumed that these skills will be learned by accumulating a body of knowledge and by observing expert clinicians. This course aims to assist students to develop their own clinical reasoning skills and promote their greater understanding of, and potential to benefit from, the clinical reasoning skills of others. The course takes place in the fourth or penultimate year, and is integrated with students' clinical placements, giving them opportunities to practise and quickly embed their learning.

Innovation: This course emphasises that clinical reasoning extends beyond initial diagnosis into all other aspects of clinical practice, particularly clinical management. It offers students a variety of challenging and interesting opportunities to engage with clinical reasoning across a wide range of clinical practice. It addresses bias through metacognition and increased self-awareness, considers some of the complexities of prescribing and non-pharmacological interventions, and promotes pragmatic evidence-based practice, information management within the consultation and the maximising of patient adherence. This article describes clinical reasoning-based classroom and community teaching.

Implications: Early evaluation suggests that students value the course and benefit from it.

Background: A doctor performs 160 000-300 000 interviews during a lifetime career, thus making the medical interview the most common procedure in clinical medicine. It is reported that 60-80 per cent of diagnosis is based on history taking, yet there is little published data advising on the best method for medical students to initially attain and further refine these core skills during their medical degree.

Methods: Medical students interviewed two patients: using an open interview first, based on the Calgary-Cambridge approach, and then using a structured pro forma. The students' medical data were assessed by a senior lecturer, and their communication skills were assessed by a behavioural scientist and by the patients.

Results: An exact Wilcoxon paired signed rank test was conducted to determine whether there was a difference between the open interview and pro forma methods for history taking and communication skills. The test yielded p-values of 0.0017 and 0.069, respectively, with the pro forma method providing a statistically significantly higher history-taking score and communication score than the open interview method. Subjectively, patients reported the pro forma method as being preferable.

Conclusion: Medical students in the early years of training benefit from a structured history-taking pro forma to assist them gather an accurate data set without compromising their interpersonal and communication skills.

Background: Front-line teachers seek guidance and tools to instruct and remediate clinical reasoning, but effective professional development methods to accomplish these goals have not been reported.

Methods: A 2-hour workshop was developed to empower front-line clinician educators to teach and remediate clinical reasoning by understanding the cognitive steps in the clinical reasoning process which can be leveraged in clinical settings. The workshop has been given 19 times over 6 years and uses interactive didactic presentations, facilitated discussion and dyad exercises, followed by small group analysis of trainee cases, where the diagnosis and remediation of clinical reasoning issues are practised.

Results: The quality and organisation of the session and the participants' intentions to change their teaching practice were rated higher than faculty development seminars in the same academic years. Participants cited the four-step model, technology analogies and the opportunity to analyse cases with peers as highly effective elements of the workshop.

Discussion: Similarly structured faculty development seminars may help bring insights from clinical reasoning theory to bedside and classroom instruction.