The clinical teacher最新文献

Background: Digital rectal examination (DRE) is an integral part of physical examination. The teaching and practising of DRE should start early in medical school for mastering the skills to perform DRE by the time of graduation. In recent years it has been observed that medical students are reluctant to learn and practise DRE because of a perception of the reduced importance of DRE as compared with other modalities of investigation. We evaluated the knowledge and attitude of medical students and interns towards the teaching and practising of DRE.

Methods: We conducted a cross-sectional survey of four medical institutions in Karachi, Pakistan.

Results: Of the 398 participants included in the study, almost half were medical students. Almost all (98%) of the participants appreciated the importance of DRE. Only half of the participants reported having been formally taught about DRE before reaching the final year of medical school. Only 16 per cent reported the use of manikins as an aide to demonstrate and practise DRE. The median number of times respondents had performed DRE was one. Patients' refusal to grant consent was the most common reason given for not performing DRE. Students are reluctant to learn and practise DRE because of a perception of its reduced importance

Conclusion: Teaching sessions on DRE using manikins are suggested to begin early in medical school. It is also suggested that a minimum number of DREs should be performed under supervision before the completion of the internship.

Background: Prescribing medicines is one of the most common interventions in health care, so even a small percentage of prescribing errors can affect many patients. Many of these errors are prevented by the intervention of pharmacists. Research has identified gaps in medical education and training that contribute to these errors. More effective learning opportunities for prescribing at undergraduate level will help to improve the preparation of junior doctors for their role.

Context: Traditionally, doctors have acquired their prescribing skills through an apprenticeship model. Given the complexity of current health care and increasing polypharmacy, a more systematic approach to safe prescribing is required. The pharmacist can have a key role in education and the practice of safe prescribing.

Innovation: Final-year students at the University of Dundee Medical School are invited to undertake sessions to rehearse safe prescribing practices using an objective structured clinical examination (OSCE) format. This helps to recreate the time pressures of practice with a focus on the elements of safe prescribing for patients. On a simulated ward, students rehearse six situations that represent the basis of commonly reported prescribing errors. Each scenario has four prescribing related tasks, one of which is feedback from a pharmacist. An evaluation of this approach and students' self-reported learning indicated that it was a useful way of enhancing awareness of errors and of increasing confidence. The pharmacist can have a key role in education and the practice of safe prescribing

Implications: There are several benefits for students in having pharmacists design and facilitate the OSCE clinical scenarios, which include the immediate learning of accurate prescribing as well as the advisory role that the pharmacists play.

Background: Structured debriefing is an essential part of effective learning from simulation. The advocacy-inquiry method (AIM) is a newer debriefing model where the facilitator seeks to understand the student's underlying rationale for their decisions.

Methods: We surveyed two cohorts of 21 final-year medical students who had experienced AIM debriefing during a simulation programme across two semesters. Data were collected on students' prior experience of debriefing, their perceptions of being involved in AIM, and which aspects of the curriculum they felt AIM addressed best.

Results: The age ranged from 22 to 31 years; 74 per cent (n = 31) were female. Fifty-seven per cent (n = 24) of the group had prior experience of simulation and 88 per cent of these (n = 21) had experienced dedicated debriefing time, mainly using Pendleton's guidelines. Ninety-one per cent (n = 38) of the students felt that the area covered best using AIM was clinical assessment. Seventy-one per cent of students (n = 30) felt that they were encouraged to 'explore and challenge [their] underlying thoughts, attitudes and beliefs' during the debriefing. Only two students (5%) agreed with the statement that they felt uncomfortable during the debriefing exercise. Students in the second semester were less likely to want the lead clinician to 'just tell me what to do' (p = 0.009). Students perceive AIM as an acceptable method of debriefing

Discussion: Our findings demonstrate that students perceive AIM as an acceptable method of debriefing. We suggest that the second cohort's attitudes towards being 'told what to do' are the result of maturing learning styles throughout their final year. The direct questioning involved is acceptable to the majority of students and we encourage the use of AIM debriefing in an undergraduate setting.

Background: For educators, an awareness of the impact of dyslexia on learners in the clinical workplace is vital: first, to be able to identify whether dyslexia may underlie certain traits and behaviours; and second, to be able to provide appropriate advice and support when dyslexia is identified. We reviewed the primary research evidence concerning the effects of dyslexia on clinicians (in or after training) in the workplace, and adaptive strategies ('workarounds') that are presently in use.

Methods: A systematic search of literature was undertaken, followed by a narrative review of studies selected as meeting the inclusion criteria. The review used a priori research questions and focused on studies based on primary research evidence.

Results: The review identified five key studies on qualified doctors or nurses with dyslexia. The impact of dyslexia on doctors can include: writing and calculating prescriptions, writing patient notes, and prioritising and making referrals. Strategies to minimise the effects of dyslexia include the use of adaptive technologies, the need for more time for mentors and supervisors, and an awareness of 'enabling' and 'disabling' environments. An awareness of the impact of dyslexia on learners in the clinical workplace is vital

Discussion: The difficulties associated with dyslexia are varied and may be unexpected. Medical educators must therefore be aware of dyslexia and its impact. When supporting a trainee with dyslexia, there is guidance available but educators may struggle to identify strategies and resources that are evidence based, so further research is required.

Background: Traditional journal club models based on didactic presentation sessions followed by group discussion have many limitations. To overcome some of these shortcomings, a virtual journal club (VJC) using social media and e-mail was developed. The aim of this study was to report the initial experience of this novel multimodal e-learning platform to facilitate journal club discussion and promote the development of critical appraisal skills.

Methods: Journal articles were discussed monthly via e-mail and social media. After a 3-week period of discussion, all comments were collated and group-generated critical appraisal summaries were fed back to participants. In addition, letters to the journal editors based on the group appraisal were submitted. A questionnaire survey to evaluate the VJC concept was also conducted.

Findings: After eight cycles of the VJC, the mean trainee participation rate was 29.6 per cent (range 21.1-42.1%). Senior trainees (≥4 years of postgraduate experience) were more likely to participate than more junior trainees (75.0 versus 21.1%; p = 0.005). The majority of participants thought that the VJC was educationally valuable, easy to participate in, helpful in keeping up to date with recent papers and useful in developing critical appraisal skills. Barriers to participation were lack of time, motivation and lack of experience in critical appraisal. In addition, the group-generated critical appraisal summaries derived from VJC discussions led to eight published 'letters to the editor'. Traditional journal club models based on didactic presentation sessions followed by group discussion have many limitations

Conclusion: This novel VJC model is a feasible and popular method of delivering a journal club in the postgraduate setting.

Background and context: Training in 'non-technical skills', i.e. social (communication and teamwork) and cognitive (analytical and personal behaviour) skills, in health care have been of great interest over the last decade. Whereas the majority of publications focus on 'whether' such education can be successful, they overlook 'how' they enhance skills. We designed and piloted a theoretically robust teaching package that addresses non-technical skills in the context of medicine safety through simulation-based interprofessional learning: the Training In Non-technical Skills to Enhance Levels of Medicines Safety (TINSELS) programme.

Innovation: A modified Delphi process was completed to identify learning outcomes, and multi-professional teams were recruited through local publicity. The faculty staff developed a three-session simulation-based intervention: firstly, a simulated ward encounter with multiple medicine-related activities; secondly, an extended debriefing and facilitated discussion; and finally, a 'chamber of horrors', where interprofessional teams identified potential sources of error. Each session was completed in the simulation suite with between six and nine participants, lasted approximately 90 minutes and took place over 2 weeks. Full details of the course will be presented to facilitate dissemination. Training in 'non-technical skills' in health care have been of great interest over the last decade

Implications: Feedback was collected on a Likert scale after the course (1, strongly disagree; 5, strongly agree). Mean scores were all greater than 4, with qualitative feedback noting the fidelity of the authentic interprofessional groups. A previously validated safety attitudes questionnaire found changes in attitudes towards handover of care and perceptions of safety in the workplace. An original, simulation-based, multi-professional training programme has been developed with learning and assessment materials available for widespread replication.

Background: This article describes an innovative method of learning clinical skills. A care bundle is defined as a small set of evidence-based interventions that, when implemented together, results in significantly better patient outcomes than when implemented individually. Care bundles improve the consistency of standards of care delivered, and hence reduce harm.

Context: In 2007 The Scottish Clinical Skills Strategy identified the use of simulation-based education to ensure all health care staff can deliver a consistently high standard of clinical skills practice throughout the National Health Service in Scotland (NHS Scotland).

Innovation: Clinical skills bundles were developed to underpin a number of evidence-based care bundles. Grouping the clinical skills together and learning them as a clinical skills bundle may improve the reliability of skills delivery for each care bundle. Three groups were recruited and asked to identify a consensus of the essential technical and non-technical skills for clinical skills bundle for a central venous catheter (CVC) maintenance care bundle. As a pilot, six clinical skills bundle workshops were held for junior doctors, nursing and medical students, and clinical skills educators. The aims of the workshops were to introduce the concepts of clinical skills bundles and to give participants a chance to practice the underpinning clinical skills bundle for a care bundle using simulation. The majority of participants rated the workshop as excellent or good. Self-reported learning included refreshing their clinical skills in a different context. Care bundles improve the consistency of standards of care delivered

Implication: Learning skills together as a bundle may enhance the reliability of clinical skills performance for care bundles, and may also reinforce the use of care bundles.