The clinical teacher最新文献

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.

Background: The importance of a collaborative approach to patient care in improving safety and outcomes has been highlighted by medical regulatory organisations. The World Health Organization has advocated that future health care professionals should be 'collaborative practice ready', and there is a global drive to incorporate interprofessional learning into health education. Interprofessional learning promotes the development of effective teamworking skills and improves the understanding of roles in the multidisciplinary team. This article outlines the development of a practice-based interprofessional learning initiative on a stroke unit. The World Health Organization has advocated that future health care professionals should be 'collaborative practice ready'

Methods: A half-day seminar was developed by King's College London in conjunction with an interprofessional clinical team from the Stroke Unit at St Thomas' Hospital. Students were assigned discipline-specific supervisors who allocated them to care for a patient within the confines of their usual professional role. They were asked to present the patient to a mixed-discipline group of students within the seminar from the perspective of their individual disciplines. This was followed by supervisor-led group discussions concerning the care of the patient and interprofessional working.

Results: Sixty-seven students from different disciplines participated in nine seminars over a 2-year period. Thematic analysis of participants' comments revealed an improvement in the students' awareness of: the varying roles and responsibilities of professionals; how differing disciplines share functions; and the importance of effective communication. All students stated that they would recommend the seminar to other students.

Discussion: Effective interprofessional learning programmes are imperative to promote collaborative practice amongst health care professionals. Stroke units are ideal learning environments for practice-based interprofessional education.

Background: Evidence suggests that medical graduates are underprepared to work as junior doctors. To ease transition in the UK, the General Medical Council (GMC) recommended the introduction of a student 'assistantship'. This is a period of training where final-year students take on duties of a foundation doctor under supervision. This study explored the experiences of the first cohort of students and junior doctors participating in the assistantship in one UK medical school in 2012.

Methods: All 248 students and their supervisors were asked to complete an online feedback questionnaire. All students who went on to work locally were also invited to participate in focus groups as recent graduates. Evidence suggests that medical graduates are underprepared to work as junior doctors

Results: Questionnaire response rates were 49 per cent for students and 43 per cent for supervisors. Fifteen new graduates participated in focus groups. Aspects of the assistantship considered important to participants frequently mapped to areas specified by the GMC and the locally identified learning outcomes. Additional themes identified included the importance of having meaningful responsibility for patient care, a placement in a general medical or surgical ward and receiving effective feedback.

Discussion: The assistantship seems to have been highly valued by students, but could be improved by ensuring that all students are given relevant placements and clinical responsibility.

Background: Many students feel unprepared for clinical practice after completing their medical school training. There is evidence that a brief shadowing period improves student confidence and patient safety, but there is currently little evidence on the impact of a longer shadowing period. A 10-week student assistantship (SA) for final-year students was implemented for Year 5 undergraduates at the University of Bristol in 2011. This study investigated the impact of the SA on student confidence.

Methods: All final-year medical students at the University of Bristol in the academic year 2012-13 (n = 248) were contacted with an online questionnaire at the start of the SA. They were asked about confidence in a range of domains. Further questionnaires were sent at the end of the SA, and again once the students had qualified as foundation doctors. Descriptive statistical analysis was performed. Many students feel unprepared for clinical practice

Results: A total of 37 students responded to the pre-assistantship questionnaire, 62 to the post-assistantship questionnaire, and 13 to the questionnaire sent once students had qualified. Self-assessed confidence improved in all areas when the pre- and post-assistantship scores were compared, in particular prescribing, assessing and managing unwell patients, and aspects of death and dying.

Discussion: Our findings suggest that a prolonged assistantship period improves knowledge and skills in a range of domains relevant to becoming a junior doctor, and could be considered within medical schools as a way to address established areas of poor confidence in new graduates. Larger studies are needed to provide more robust evidence for these initial findings.

Background and purpose: The selection of medical students to the foundation programme has undergone several changes since its introduction in 2005, with the latest being the introduction of the Situational Judgement Test (SJT) in 2013. The SJT, a 2-hour exam that uses a multiple-choice format to assess an individual's judgement when presented with clinically related scenarios, now accounts for 50 per cent of the application process. The remaining 50 per cent is made up of the Educational Performance Measure (EPM) score, which includes the medical student's performance at medical school, allocated by points attributed according to decile ranking. Coming out of its pilot year, there is little research into the results of the SJT. This project aims to discover whether there is a correlation between high-performing students who succeeded at medical school (i.e. by decile ranking) and those who scored high in the SJT. This project aims to discover whether there is a correlation between high- performing students and those whoscored high in the SJT METHOD: A survey was circulated to fifth-year medical students across the UK applying to the foundation programme in 2013, and who had sat the pilot year of the SJT. Students were asked to enter numerical values for their EPM and SJT scores.

Results: A total of 239 students from 12 UK medical schools responded to the questionnaire. In addition to their EPM, academic and SJT scores, all participants provided data on gender, duration of course (i.e. 4 or 5 years) and whether or not additional resources were used for the SJT. There was no correlation between the SJT and the academic scores (Spearman's = 0.0458; probability of any relationship = 0.4865).