The clinical teacher最新文献

Background: It has long been acknowledged that health professionals who retrain as doctors make a significant contribution to the medical profession. Having a background as a health professional sets this group apart from the other medical students, including mature students. It is therefore important to understand more about how health professionals adapt to their role as medical students.

Methods: A qualitative approach was adopted, in which interviews were conducted with 12 of the possible 30 medical students who met the inclusion criterion: namely that they were or had been registered health professionals.

Findings: The most common driver to retrain was a desire to seek a fresh challenge, and they described their previous roles as limited; however, returning to student status after life as an autonomous health professional was initially very uncomfortable. Once they loosened their grip on their previous role and embraced life as a medical student the students eventually realised that, irrespective of their previous health profession, they had a set of core professional abilities that they could bring to their role as a doctor.

Discussion: There has been considerable focus on the support required for mature students, graduate students and students from disadvantaged backgrounds. Little attention has been afforded to the experience of health professionals as medical students. This category of individual already possesses a wealth of experience, knowledge and attitudes relevant to health care work. This experience should be built upon so that the transition from 'expert' to 'novice' is as comfortable as possible for all parties. Health professionals who retrain as doctors make a significant contribution to the medical profession.

Background: This study explored graduate-entry medical students' experiences of health-advice requests from their family and friends.

Methods: This was a descriptive thematic analysis study involving a convenience sample of medical students from the University of Warwick 4-year MB ChB graduate-entry medicine programme. Each participating student attended a one-to-one semi-structured interview. Audio recordings of the interviews were transcribed verbatim and analysed thematically. Data saturation of the main themes was achieved following 14 interviews.

Findings: Of the 14 students, eight (57%) were males and six (43%) were females. Students were asked to advise on a range of human and veterinary health issues. They were prepared to offer advice on health issues that they felt competent to manage: for example, first-aid scenarios that a 'reasonable layperson' or a first-aider would be able to help with. The nature of health advice given by students became increasingly complex as they progressed through their degree programme; however, they generally refrained from giving advice on complex health issues and chose to refer the individual to seek help from competent professionals instead.

Discussion: Previous research highlighted inappropriate advice could delay individuals seeking help from competent professionals, resulting in adverse clinical outcomes; however, we recommend that students should not be discouraged to act as good Samaritans. Instead, educators could help them to explore the professionalism and ethical issues raised by these requests, and the practical ways of handling these requests sensitively through discussion of case scenarios with acceptable and inappropriate behaviours. This study explored graduate-entry medical students' experiences of health-advice requests from their family and friends.

Background: In undergraduate dental or medical programmes clinical time with exposure to patients is limited. A priority for all those involved in the delivery of a clinical programme is to ensure that this time is used effectively and to maximum potential. Patient non-attendance is a reality, and developing organised activities to provide alternative learning opportunities is important.

Methods: We have developed a range of close-contact teaching and learning activities (CCTLs) for dental students to productively use patient non-attendance time. CCTLs are short, skills-based tasks that are directly observed and have structured assessment criteria. Used formatively, they are performed in the clinical environment utilising the materials, equipment and clinical staff usually available during the clinical session.

Findings: The CCTLs have proved particularly useful for early-stage clinical students, by developing understanding and skills, reinforcing protocols and promoting the role of the wider dental team in teaching. Students have welcomed these activities and engagement has been high. In addition to improving skills, they have proved helpful in familiarising students with direct observation, and have inspired peer collaboration and feedback.

Discussion: The CCTLs have promoted opportunities for students to receive direct feedback, which may be difficult to deliver if a patient were present. Empowering students to lead on their own learning requirements also promotes the ethos of lifelong learning that will be fundamental to future professional development. Investment of resources to develop these activities has proved worthwhile, as we have found that CCTLs can complement and maximise the potential of clinical attachments. Patient non-attendance is a reality, and developing organised activities to provide alternative learning opportunities is important.

Background: Near-peer teaching and electronic learning (e-learning) are two effective modern teaching styles. Near-peer sessions provide a supportive learning environment that benefits both the students and the tutor. E-learning resources are flexible and easily distributed. Careful construction and regular editing can ensure that students receive all of the essential material. The aim of this study is to compare the efficacy of e-learning and near-peer teaching during the pre-clinical medical curriculum.

Methods: Thirty-nine second-year medical students were consented and randomised into two groups. Each group received teaching on electrocardiogram (ECG) interpretation from a predefined syllabus. Eighteen students completed an e-learning module and 21 students attended a near-peer tutorial. Students were asked to complete a multiple-choice exam, scored out of 50. Each student rated their confidence in ECG interpretation before and after their allocated teaching session.

Results: The near-peer group (84%) demonstrated a significantly higher performance than the e-learning group (74.5%) on the final assessment (p = 0.002). Prior to the teaching, the students' mean confidence scores were 3/10 in both the near-peer and e-learning groups (0, poor; 10, excellent). These increased to 6/10 in both cases following the teaching session.

Discussion: Both teaching styles were well received by students and improved their confidence in ECG interpretation. Near-peer teaching led to superior scores in our final assessment. Given the congested nature of the modern medical curriculum, direct comparison of the efficacy of these methods may aid course design. The aim of this study is to compare the efficacy of e-learning and near-peer teaching.

Background: An increasing emphasis on accountability led to the development of the Intercollegiate Surgical Curriculum Project (ISCP) in the UK. A major feature of ISCP was a focus on competence with the institution of formative assessments to aid learning and provide portfolio evidence. Case-based discussions (CBDs) are one of the main formative assessments used at all stages of training. The aim of this study was to review the use of CBDs by surgical trainees to determine if and when they are useful, and whether they are perceived as being used correctly.

Methods: Semi-structured interviews were carried out with both higher and core surgical trainees. Inductive reasoning principles were used to analyse and interpret the responses to open questions. Common themes were determined and thematic analysis was carried out.

Results: Forty-two surgical trainees (21 core and 21 higher trainees) were interviewed. Core trainees felt that CBDs were more likely to be used correctly, and both groups thought that they were a positive feature of training. Few stated that they were used to shape training needs. Positive themes identified included the provision of feedback, identifying learning portfolio evidence and encouraging reflection. Negative themes included a 'tick-box' mentality and that the value was diminished by a lack of engagement with the process from trainers. Case-based discussions are one of the main formative assessments used at all stages of training

Conclusion: Trainees regarded CBDs as a positive feature allowing the discussion of complicated cases, and encouraging higher thinking and reflection; however, concerns were raised regarding their implementation, which has led to a diminishing of their value.

Background: Communication in emergency departments (EDs), often between several health professionals and patients and relatives, is a major cause of patient complaint and error; however, communication-skills teaching for medical students largely focuses on individual clinician-patient interactions.

Context: We developed and implemented an evidence-informed online resource, Communication for Health in Emergency Contexts (CHEC; http://www.chec.meu.medicine.unimelb.edu.au/resources) to raise medical students' awareness of the challenges of communication in the ED, and to provide students with communication strategies for addressing these challenges. The foundation of the CHEC resource was the findings and data from a large research project conducted at five emergency departments in Australia over the period 2006-2009. From this, we developed ED scenarios and teaching vignettes using authentic communication data. The project included a nationwide medical curriculum scoping phase, involving interviews with medical students and educators, on ED communication curriculum needs in order to inform the educational activities.

Innovation: The CHEC resource provides students with the opportunity to follow real-life scenarios through all stages of the ED journey, whereas insights from ED medical and nursing staff provide learning opportunities about interprofessional communication for medical students. Evaluation suggests that students find the resource useful, and that the resource has been successfully embedded in medical and junior doctor training on communication and quality and safety.

Implications: The CHEC resource enhances the capacity of busy clinical educators to raise students' awareness of the communication needs of emergency health care by focusing on communication in high-stress, time-pressured settings using a web format. The CHEC resource provides students with the opportunity to follow real-life scenarios through all stages of the ED journey.