A review of standardized patients in clinical education: Implications for speech-language pathology programs

The use of standardized patients has been reported as a viable addition to traditional models of professional practice education in medicine, nursing and allied health programs. Educational programs rely on the inclusion of work-integrated learning components in order to graduate competent practitioners. Allied health programs world-wide have reported increasing difficulty in attaining sufficient traditional placements for students within the workplace. In response to this, allied health professionals are challenged to be innovative and problem-solving in the development and maintenance of clinical education placements and to consider potential alternative learning opportunities for students. Whilst there is a bank of literature describing the use of standardized patients in medicine and nursing, reports of its use in speech-language pathology clinical education are limited. Therefore, this paper aims to (1) provide a review of literature reporting on the use of standardized patients within medical and allied health professions with particular reference to use in speech-language pathology, (2) discuss methodological and practical issues involved in establishing and maintaining a standardized patient program and (3) identify future directions for research and clinical programs using standardized patients to build foundation clinical skills such as communication, interpersonal interaction and interviewing.

Integrated case learning: teaching clinical reasoning

Learning how to 'think like doctors' can be difficult for undergraduate medical students in their early clinical years. Our model of collaborative Integrated Case Learning (ICL) and simulated clinical reasoning aims to address these issues. Taking a socio-cultural perspective, this study investigates the reflective learning interactions and practices of clinical thinking that emerged in the ICL environment. We also explore how third year medical students perceived their ICL experiences in relation to the clinical situations encountered in the hospital setting. The context for the inquiry is a rural Clinical School in North West Victoria, Australia. We used a qualitative case study methodology following eight third-year medical students over an academic year. Individual and group interviews were conducted, together with observations and document/artefact analysis. Data was analysed using content and narrative methods. The ICL program was well received. Findings suggest that the group-based, simulated clinical reasoning process appears to help undergraduate medical students to rehearse, articulate and question their clinical decision-making pathways. We argue that the ICL process offers a professionally challenging, but supportive group learning 'space' for students to practise what it might mean to 'think', 'talk' and 'perform' like doctors in real settings. The ICL environment also appears to create a connective bridge between the 'classroom' and clinical practice.

Learning from lives together: medical and social work students' experiences of learning from people with disabilities in the community

The study aims to evaluate an interprofessional community-based learning event, focussing on disability. The learning opportunity was based on the Leicester Model of Interprofessional Education, organised around the experiences and perceptions of service users and their carers. Programme participants were drawn from medicine and social work education in Leicester, UK, bringing together diverse traditions in the care of people with disabilities. Small student groups (3-4 students) worked from one of the eight community rehabilitation hospitals through a programme of contact with people with disabilities in hospital, at home or in other community settings. The evaluation, in March 2005, used a mixed methods approach, incorporating questionnaire surveys, focus group interviews with students and feedback from service users. Responses were collated and analysed using quantitative and qualitative measures. Fifty social work and 100 medical students completed the first combined delivery of the module. The findings indicated that the merging of social work and medical perspectives appear to create some tensions, although overall the student experience was found to be beneficial. Service users (16 responses) valued the process. They were not concerned at the prospect of meeting a number of students at home or elsewhere and were pleased to think of themselves as educators. Problems and obstacles still anticipated include changing the mindset of clinicians and practising social workers to enable them to support students from each other's disciplines in practice learning. The generally positive outcomes highlight that disability focussed joint learning offers a meaningful platform for interprofessional education in a practice environment.

The use of objective structured self-assessment and peer-feedback (OSSP) for learning communication skills: evaluation using a controlled trial

Feedback is essential to guide students towards expected performance goals. The usefulness of teacher feedback on improving communication skills (CS) has been well documented. It has been proposed that self-assessment and peer-feedback has an equally important role to play in enhancing learning. This is the focus of this study. Objectively structured self-assessment and peer feedback (OSSP) was incorporated into small group CS teaching sessions of a group of semester one medical students who were learning CS for the first time, to minimise the influence of previous educational interventions. A control group matched for academic performance, gender and age was used to enable parallel evaluation of the innovation. A reflective log containing closed and open ended questions was used for OSSP. Facilitators and simulated patients provided feedback to students in both groups during CS learning as per routine practice. Student perceptions on OSSP and acceptability as a learning method were explored using a questionnaire. CS were assessed in both groups using objective structured clinical examination (OSCE) as per routine practice and assessors were blinded as to which group the student belonged. Mean total score and scores for specific areas of interview skills were significantly higher in the experimental group. Analysis of the questionnaire data showed that students gained fresh insights into specific areas such as empathy, addressing patients' concerns and interview style during OSSP which clearly corroborated the specific differences in scores. The free text comments were highly encouraging as to acceptability of OSSP, in spite of 67% being never exposed to formal self- and peer-assessment during pre-university studies. OSSP promotes effective CS learning and learner acceptability is high.

What makes a great clinical teacher in pediatrics? Lessons learned from the literature

Great clinical teachers occupy a unique and powerful role in the education of medical students. Their noncognitive and cognitive actions and behaviors influence future student behaviors and career choices and, most importantly, result in a future generation of physicians who are equipped to care for children. Although we continue to have difficulty defining the critical characteristics of a great clinical teacher, identifying such a teacher is easy: they are the ones to whom students and residents flock. If we return to a teacher we each remember as having made the clinical experience memorable and inspired us to work a little harder, it is the person, not necessarily the content, that we remember. Although some have advocated that great teaching is innate, many of the skills and strategies can, in fact, be learned and developed. Over the next several issues we will explore in greater detail the skills and strategies developed by COMSEP that can be quickly and efficiently assimilated into daily practice and help make a good clinical teacher great.

Perspective: authentic patient perspectives in simulations for procedural and surgical skills

In this article, the authors consider the role of the patient in simulation-based training and assessment of clinical procedural skills. In recent years, there has been a progressive shift of emphasis from teacher-centered to student-centered education, resulting in a redefinition of approaches to medical education. Traditional models of transmission of information from an expert to a novice have been supplanted by a more student-centered approach. However, medical education is not a matter for teacher and student alone. At the center is always the patient, around whom everything must ultimately rotate. A further shift is occurring. The patient is becoming the focal point of medical teaching and learning. It is argued that this shift is necessary and that simulation in its widest sense can be used to support this process. However, sensitivity to what we are simulating is essential, especially when simulations purport to address patient perspectives. The essay first reviews the history of medical education "centeredness," then outlines ways in which real and simulated patients are currently involved in medical education. Patient-focused simulation (PFS) is described as a means of offering patients' perspectives during the acquisition of clinical procedural and surgical skills. The authors draw on their experiences of developing PFS and preliminary work to "authenticate" simulations from patient perspectives. The essay concludes with speculation on the value of a "complementarity" model that acknowledges the authentic and equal perspectives of patients, students, clinicians, and teachers.

Research in medical education: pratical impact on medical training and future challenges

Medical education research has changed over the years from merely descriptive studies towards justification or curriculum comparison studies and, nowadays, towards a slow introduction of more clarification studies. In clarification studies quantitative and qualitative methods are used to explain why or how educational interventions work or do not work. This shift is described in this paper. In addition, it is explained how research into workplace learning and assessment has impacted developments in educational practice. Finally, it is argued that the participation of teachers within the medical domain in conducting and disseminating research should be cherished, because they play a crucial role in ensuring that medical education research is applied in educational practice.

How to objectively classify residents based on their psychomotor laparoscopic skills?

In minimally invasive surgery (MIS), a surgeon needs to acquire a certain level of basic psychomotor MIS skills to perform surgery safely. Evaluation of those skills is a major impediment. Although various assessment methods have been introduced, none of them came as a superior. Three aspects of assessing psychomotor MIS skills are discussed here: (i) advantages and disadvantages of currently available assessment methods, (ii) methods to objectively classify residents according to their level of psychomotor skills, and (iii) factors that influence psychomotor MIS skills. Motion analysis has a potential to be the means to deal with assessment of psychomotor skills. Together with classification methods (e.g. linear discriminant analysis), motion analysis provides an aid in deciding whether a resident is ready to move to the next level of training. Presence of factors that influence psychomotor MIS skills results in a high need for standardisation of valid tasks and setups used for the assessment of MIS skills.

Education beyond competencies: a participative approach to professional development

OBJECTIVES

New curricula for UK medical training emphasise work-based learning and assessment of competencies. It is debatable whether competency-orientated training is sufficient to prepare doctors for consultant clinical, managerial and professional roles. This article describes a novel approach to postgraduate medical education in palliative medicine for a small group of consultants and specialty trainees. The aim of the study was to extend learning beyond the behaviourist focus of competencies by sharing experience and knowledge through discussion of professional practice.

METHODS

Seven doctors met weekly for a 2-hour specialty education session. Participative action research was conducted over four cycles in 2008. Qualitative analysis of semi-structured group discussions and interviews, together with participants' comments, modified the programme's structure and content.

RESULTS

Participants developed a framework for discussion of educational subjects based on the specialty curriculum. Thematic analysis suggested that they valued others' experience and found learning through discussion with colleagues supportive and stimulating. Early preference for 'free-flowing' discussion was modified by recognition that structure in planning, preparation and summarising enhanced learning. The framework changed from a learner-led approach to one of collaboration with clearer roles for consultants and trainees.

CONCLUSIONS

It is important that doctors' education encompasses opportunities to share and develop expertise with experienced colleagues. The group developed an education programme for small-group learning based on social constructivist principles and learning within a community of practice. This was facilitated by the context for learning in palliative medicine and may be applicable to other specialties with small groups of trainees.

Why medical students choose not to carry out an intercalated BSc: a questionnaire study

BACKGROUND

At some medical schools, students can opt to undertake a 1 year intercalated degree, usually a BSc, in addition to their medical course. Over the last few years the numbers of students who have opted to undertake an intercalated degree have been steadily decreasing despite the advantages in securing foundation posts. The aim of this study was to find out why medical students opted not to take an intercalated degree.

METHODS

All 4th and 5th year medical students (n = 343) who had elected not to take an intercalated degree were personally handed a questionnaire.

RESULTS

293 completed questionnaires were returned (response rate 85%). The most common reason students opted not to intercalate was because they did not want to have another year of study (69.6%) or incur more debt (51.9%). Only 45 (15.3%) students said they had enough information to inform their decision: reported take up of information provision was poor.

CONCLUSIONS

Our findings indicate that the benefits of intercalating need to be better defined and presented to students in a way that they can make a more informed decision.

Using standardized patients to assess communication skills in medical and nursing students

BACKGROUND

A number of recent developments in medical and nursing education have highlighted the importance of communication and consultation skills (CCS). Although such skills are taught in all medical and nursing undergraduate curriculums, there is no comprehensive screening or assessment programme of CCS using professionally trained Standardized Patients Educators (SPE's) in Ireland. This study was designed to test the content, process and acceptability of a screening programme in CCS with Irish medical and nursing students using trained SPE's and a previously validated global rating scale for CCS.

METHODS

Eight tutors from the Schools of Nursing and Medicine at University College Cork were trained in the use of a validated communication skills and attitudes holistic assessment tool. A total of forty six medical students (Year 2 of 5) and sixty four nursing students (Year 2/3 of 4) were selected to under go individual CCS assessment by the tutors via an SPE led scenario. Immediate formative feedback was provided by the SPE's for the students. Students who did not pass the assessment were referred for remediation CCS learning.

RESULTS

Almost three quarters of medical students (33/46; 72%) and 81% of nursing students (56/64) passed the CCS assessment in both communication and attitudes categories. All nursing students had English as their first language. Nine of thirteen medical students referred for enhanced learning in CCS did not have English as their first language.

CONCLUSIONS

A significant proportion of both medical and nursing students required referral for enhanced training in CCS. Medical students requiring enhanced training were more likely not to have English as a first language.

Establishing a distributed campus: making sense of disruptions to a doctor community

CONTEXT

In August 2004, the Northern Medical Program (NMP), a distributed campus of the Faculty of Medicine at the University of British Columbia, Canada, admitted its first students. Situated at the University of Northern British Columbia in Prince George, the NMP created new opportunities, challenges, stresses and changes for the approximately 180 local specialists and family doctors. This study examines the initial impacts of the NMP on doctors practising in its host community.

METHODS

Qualitative interview methods were used. A purposive sample was drawn from: (i) doctors who had involvement with the NMP, and (ii) doctors who were not involved with the NMP. Data were collected from May to September 2007 using a semi-structured interview guide. Interviews were audiotaped, transcribed and checked by participants. Analysis involved identifying, coding and categorising key emergent themes until saturation.

RESULTS

Prior to the implementation of the NMP, doctors in Prince George had formed cohesive networks, in the face of adverse conditions, that functioned effectively as a form of social capital. The introduction of new doctors and resources through the NMP disrupted this sense of community cohesiveness. Over time, however, the NMP has created new mechanisms by which doctors interact and develop partnerships.

DISCUSSION

The study confirms the value of a social capital framework for understanding a medical community's adaptation to change. At this early point, it appears the NMP has created new mechanisms by which doctors can interact and develop the partnerships and relationships necessary to renew a sense of community cohesion.

Postgraduate training and career choices: an analysis of the National Physicians Survey in Japan

OBJECTIVES

This study analyses and discusses recent changes in young Japanese doctors' career paths, in terms of their distribution in different types of facilities and specialties, following changes to the postgraduate clinical training system in 2004.

METHODS

Data from the National Survey of Physicians, Dentists and Pharmacists conducted by Japan's Ministry of Health, Labour and Welfare were used for this study.

RESULTS

After the introduction of the new postgraduate training system, 2 years of clinical training became mandatory and a doctor-to-facility matching system was introduced. Since then, more young doctors have migrated from academic hospitals to non-academic hospitals. The number of first-year doctors at non-academic hospitals increased, whereas the number at academic hospitals decreased. In terms of the distribution of doctors per specialty, the decreasing tendency of doctors to choose internal medicine and surgery has accelerated. These results illustrate the significant changes that have affected young doctors' career paths since the new system was introduced.

CONCLUSIONS

Designing and providing desirable postgraduate clinical training and achieving appropriate doctor distribution are important policy issues. Appropriate policy interventions regarding a mechanism to ensure the appropriate distribution of doctors should be established and attention should be paid to expanding doctors' choices and increasing patient satisfaction and general cost-effectiveness.

Increased authenticity in practical assessment using emergency case OSCE stations

In case of an emergency, a fast and structured patient management is crucial for patient's outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. However, traditional OSCE stations examine isolated skills or components of a clinical algorithm and thereby lack a valid representation of clinical reality. We developed emergency case OSCE stations (ECOS), where students have to manage complete emergency situations from initial assessment to medical treatment and consideration of further procedures. Our aim was to increase the authenticity and validity in the assessment of students' capability to cope with emergency patients. 45 students participated in a 10-station OSCE with 6 ECOS and 4 traditional OSCE stations. They were assessed using a case-specific checklist. An inter-station and post-OSCE-questionnaire was completed by each student to evaluate both ECOS and traditional OSCE. In this study, we were able to demonstrate that ECOS are feasible as time-limited OSCE stations. There was a high acceptance on both students and examiners side. They rated ECOS to be more realistic in comparison to the traditional OSCE scenarios. The reliability estimated via Crohnbach's alpha for the 6 ECOS is high (0.793). ECOS offer a feasible alternative to the traditional OSCE stations with adequate reliability to assess students' capabilities to cope with an acute emergency in a realistic encounter.

Introducing gross pathology to undergraduate medical students in the dissecting room

Pathology and anatomy are both sciences that contribute to the foundations of a successful medical career. In the past decade, medical education has undergone profound changes with the development of a core curriculum combined with student selected components. There has been a shift from discipline-based teaching towards problem-based learning. Both anatomy and pathology are perceived to have suffered from this educational shift. The challenge is to introduce methods of learning for these subjects into an integrated student-centered curriculum. The purpose of this study was to determine the prevalence of pathology in 12 donor cadavers in the dissecting room of the Bute Medical School, University of St Andrews. All of the cadavers had multiple pathologies (between three to four conditions) ranging from common to rare disorders. A number of prostheses and surgical interventions were also noted. This small study confirms that cadaveric dissection provides an excellent opportunity for the integration of anatomy, pathology, and clinical medicine into the early clinical training of undergraduate medical students. The identification of disease in a cadaver provides an excellent introduction to the gross features of a disease process, but does not substitute for the detailed study of a process later in the curriculum.

Do educational interventions improve prescribing by medical students and junior doctors? A systematic review

Our aim was to review systematically the literature on educational interventions to improve prescribing by medical students and junior doctors. MEDLINE, EMBASE, Educational Resource Information Center, British Education Index, PsycINFO, CINAHL, TIMELIT, Cochrane Trials Database and grey literature were searched. Inclusion criteria were: educational interventions to improve medical student and/or junior doctors' prescribing, in primary or secondary care settings, and published after 1990. After screening 3189 records, we retrieved 11 controlled and four 'before-and-after' trials. Ten controlled trials showed improvements in the scores of the intervention group on written scenarios or clinical examination stations, but one study in junior doctors showed no effect on real-life prescription errors. Only one intervention [the World Health Organization (WHO) Good Prescribing Guide, in six randomized trials] had been tested in a variety of international settings and across a range of students at different levels. All four 'before-and-after' trials reported significant improvements in written tests or clinical stations. However, most studies tested only small numbers of participants and were affected by a range of methodological flaws. There is only moderate evidence in the literature to inform medical schools about how to prepare medical students for the challenges of prescribing. The WHO Good Prescribing Guide is the only model that has been widely used and shown to improve prescribing. Although it is based on sound principles, there is a need for further development. Robust methods of assessment are required to show clearly whether particular teaching interventions are successful.

Evaluation of a clinical examination skills training course in an undergraduate pharmacy programme

Objective

To introduce and evaluate a short clinical examination skills course in a BPharm programme. The study objectives were to assess needs, explore attitudes, record perceived competence requirements and assess the value of physical examination skills learning.

Setting

BPharm programme in Auckland, New Zealand. Participants were students enrolled in years 3 and 4 of the programme (2003).

Method

The design was a longitudinal, dual cohort, educational intervention evaluation using a self-completed questionnaire. An examination skills component was added to the fourth year of the pharmacy programme. Year 3 and 4 students were recruited, and completed the questionnaire at two points. Year 3 students were sampled one year before and soon after the skills sessions. Year 4 students were sampled after the sessions and 18 months later (once registered). The questionnaire sought their attitudes towards clinical skills training and practical relevance for future practice, and evaluated their learning experience.

Key findings

Response rates at the four points were 42–67%. Year 3 students identified a similar set of appropriate skills to those actually taught in year 4. Overall, attitudes to introducing examination skills learning were positive at all points. At follow-up, both cohorts agreed more strongly that examination skills training should be core (significantly for registered pharmacists versus year 3, P < 0.006). Measuring manual blood pressure was deemed the most difficult skill. All taught skills were used in practice except for respiratory rate; most used were body mass index (BMI), temperature and peak flow measurement.

Conclusions

There was a close correlation between what was offered in the course, what students felt they needed to learn and what was relevant in practice. Once registered, pharmacists were aware of their limitations and level of competence in relation to clinical skills. The small changes in attitudinal scores appear to reflect maturity and experience. The study design allowed us to adapt the educational component to student need. Health professional educators need to be aware of and respond to changes in professional scopes of practice.

An exploration of student nurses' thoughts and experiences of using a video-recording to assess their performance of cardiopulmonary resuscitation (CPR) during a mock objective structured clinical examination (OSCE)

Cardiopulmonary resuscitation (CPR) is an essential skill taught within undergraduate nursing programmes. At the author's institution, students must pass the CPR objective structured clinical examination (OSCE) before progressing to second year. However, some students have difficulties developing competence in CPR and evidence suggests that resuscitation skills may only be retained for several months. This has implications for practice as nurses are required to be competent in CPR. Therefore, further opportunities for students to develop these skills are necessary. An action research project was conducted with six students who were assessed by an examiner at a video-recorded mock OSCE. Students self-assessed their skills using the video and a checklist. Semi-structured interviews were conducted to compare checklist scores, and explore students' thoughts and experiences of the OSCE. The findings indicate that students may need to repeat this exercise by comparing their previous and current performances to develop both their self-assessment and CPR skills. Although there were some differences between the examiner's and student's checklist scores, all students reported the benefits of participating in this project, e.g. discussion and identification of knowledge and skills deficits, thus emphasising the benefits of formative assessments to prepare students for summative assessments and ultimately clinical practice.

Flexner's global influence: medical education accreditation in countries that train physicians who pursue residency in the United States

BACKGROUND

Abraham Flexner's report on medical education, published 100 years ago, remains influential in the United States today, although its international impact is unclear. In addition to global variability in content and delivery of medical education programs, systems of quality assurance oversight are not universal, and there are variations in the scope of the reviews, protocols, and standards used.

METHOD

The authors used the process and elements of medical school evaluation that Flexner regarded as important for ensuring quality to create a framework for describing aspects of the accreditation systems used in the 10 countries that supply the greatest numbers of international medical graduates (IMGs) to the United States.

RESULTS

Of these 10 countries, most have an accreditation system, although the review in some is voluntary. Globally, there is variability in the use of Flexner's system. Prerequisite entrance requirements vary according to the degree offered. Faculty involvement in research is frequently encouraged but seldom required. Almost all standards mention the need for adequate facilities for experiential learning in the basic sciences. Three accrediting organizations require that clinical facilities be under the direct control of the medical school, and seven indicate that affiliation agreements are acceptable. All accreditation plans use predetermined standards and external evaluation.

CONCLUSIONS

Data describing accreditation of the medical education programs of IMGs currently seeking to enter graduate training in the United States contribute to a better understanding of medical education practices around the world and can supplement other information available to graduate medical education program directors who select IMGs for their training programs.

Early experiences of the mini-PAT (Peer Assessment Tool) amongst hospital pharmacists in South East London

Objectives

The aim was to describe early experience of use of the mini-PAT (Peer Assessment Tool) amongst general-level pharmacists working in secondary care, and to capture their views about the method of assessment.

Methods

General-level pharmacists who had completed two rounds of the mini-PAT assessment in their first year post-qualification were asked to complete a semi-structured questionnaire, assessing the usefulness and acceptability of the assessment method.

Key findings

The pharmacists found the assessment method useful and acceptable, with many citing that they found it useful to see how they were doing in relation to their peers. To further improve the assessment method, the general-level pharmacists suggested that any verbatim comments made should have the relevant assessor's name next to it, so the context of the comment can be understood.

Conclusions

Early experience suggests that the mini-PAT is a useful formative assessment tool for use amongst GLPs.

Development of a training curriculum for microsurgery

Recent changes in healthcare necessitate revision of the current apprenticeship model of surgical training. Current methods of assessment such as examinations and logbooks are not criteria-based, so are subjective and lack validity and reliability. The objective feedback of technical skills is crucial to the structured learning of surgical skills. We review current publications about training and methods of assessment in microsurgery. Searches on PubMed using keywords (microsurgery, training, assessment, simulation, and skill) were used to retrieve relevant articles, and further cross-referencing was done to obtain more information. New methods of assessment that are objective include checklists, global rating scales (GRS), and dexterity analysis, which give feedback of technical skills during training. Vital (living), non-vital, prosthetic, and virtual reality simulation models can be used to train surgeons to a proficient level outside the operating theatre before they operate on real patients. After reviewing the current evidence we propose a curriculum for microsurgical training that starts outside the operating theatre. The surgical community should follow the example of other high-risk industries such as aviation, where continuous assessment on simulators is a part of training, but further research is necessary before such methods can be used for summative assessment and revalidation.

The objective structured public health examination: a study of reliability using multi-level analysis

BACKGROUND

Introduced in 2006, the objective structured public health examination (OSPHE) is a part of the examination for the UK Membership of the Faculty of Public Health. Designed to simulate real work in public health, the same five generic competencies were assessed simultaneously in each of six stations in 1 h 48 min. This study estimates the examination reliability of the OSPHE.

METHODS

Data from all 198 candidates, 54 questions, 39 examiners over 9 test days in 2006 were analysed for reliability and sources of error using multilevel cross-classified analysis and generalisability theory.

RESULTS

A reliability co-efficient of 0.85 was estimated (95% confidence interval 0.82-0.88). Little variance was accounted for by questions or examiners. Twelve questions would increase reliability to 0.92. More than one examiner per question has negligible impact on reliability.

CONCLUSION

Multilevel modelling estimates examination reliability which is more rigorous than Cronbach's alpha. Traditional generalisability methods based on the analysis of variance (ANOVA) are unable to do this. The reliability of this examination compares favourably with the literature despite having just six test stations and under 2 h per candidate. Other specialties could consider the use of parallel testing of the same key competencies at all stations within simulated workplace events.

Interprofessional educator ambassadors: An empirical study of motivation and added value

BACKGROUND

Interprofessional education (IPE) is being led by a driving force of teaches who advocate for the importance of this learning within health and social care professional curriculum. Many of these leaders have additional uni professional teaching responsibilities.

AIMS

This study aimed to explore the impact of leading an IPE curriculum on teachers, who were at the forefront of establishing a new IPE curriculum in the east midlands, UK.

METHODS

The prospective study used the principles of grounded theory to analyse the educator's experiences. The study included teachers who work from academic university posts and those who teach from within practice. These IPE leaders were identified through their involvement in the design and delivery of the local IPE initiatives. They were invited to share their experiences at either a mixed-discipline focus group, a one-to-one interview or by completing a postal/e questionnaire. During analysis the views from each data set were triangulated.

RESULTS

A total of 58 educators shared their experiences. All benefitted from being part of the planning and teaching teams. They were driven by a strong belief that IPE had the potential to improve patient care and that future healthcare practice would remain team based. Engagement had brought additional benefits to their teaching and career development in particular through forming new relationships with colleagues from other caring professions. They were concerned about educators teaching interprofessional student groups with little prior experience of IPE.

CONCLUSION

The data suggest educators who take on a leading developmental role in designing and delivering an interprofessional curriculum benefit personally and professionally through working relationships with colleagues in other professions and through teaching wider networks of students. These new insights strengthen personal practice and research and in turn have the potential to influence and improve the quality of faculty teaching.

A qualitative study of student responses to body painting

One hundred and thirty-three preclinical medical students participated in 24 focus groups over the period 2007-2009 at Durham University. Focus groups were conducted to ascertain whether or not medical students found body painting anatomical structures to be an educationally beneficial learning activity. Data were analyzed using a grounded theory approach. Five principal themes emerged: (1) body painting as a fun learning activity, (2) body painting promoting retention of knowledge, (3) factors contributing to the memorability of body painting, (4) removal from comfort zone, and (5) the impact of body painting on students' future clinical practice. Students perceive body painting to be a fun learning activity, which aids their retention of the anatomical knowledge acquired during the session. Sensory factors, such as visual stimuli, especially color, and the tactile nature of the activity, promote recall. Students' preference for painting a peer or being painted is often dependent upon their learning style, but there are educational benefits for both roles. The moderate amounts of undressing involved encouraging students to consider issues surrounding body image; this informs their attitudes towards future patients. Body painting is a useful adjunct to traditional anatomy and clinical skills teaching. The fun element involved in the delivery of this teaching defuses the often formal academic context, which in turn promotes a positive learning environment.

Developing self-assessment skills amongst doctors in Nepal

BACKGROUND

Accurate self-assessment is essential to direct life-long learning. Most research on self-assessment is from the West. This study takes place in Kathmandu, Nepal.

AIM

To develop tools to aid the development of self-assessment skills in Nepali doctors.

METHODS

Fifteen doctors were asked to complete three self-assessment tasks per month over a 6-month period; one mini-clinical evaluation exercise, one clinical case review and one significant event analysis. Self-assessment was compared with mentor assessment for each task. Changes over time for each individual were noted. Results were analyzed using SPSS 10.0. Self and tutor scores were compared using Pearson's correlation coefficient. Reliability of the tools was assessed using Cronbach's Alpha. Participants completed a qualitative questionnaire regarding each tool.

RESULTS

All three tools had high content and face validity, as well as reliability. The use of the "intra individual" approach, with multiple assessments over time demonstrated that most doctors were able to accurately self-assess in some areas. Feedback from a senior tutor was vital. Doctors appreciated feedback that was immediate, specific and delivered in a safe environment. Even where self-assessment was less accurate, the process itself helped to develop awareness of key learning issues.

CONCLUSIONS

These self-assessment tools are feasible, reliable and valid for the hospital setting in Nepal.

Assessment and feedback to facilitate self-directed learning in clinical practice of Midwifery students

BACKGROUND

Clinical workplaces are hectic and dynamic learning environments, which require students to take charge of their own learning. Competency development during clinical internships is a continuous process that is facilitated and guided by feedback. Limited feedback, lack of supervision and problematic assessment of clinical competencies make the development of learning instruments to support self-directed learning necessary.

AIMS

To explore students' perceptions about a newly introduced integrated feedback and assessment instrument to support self-directed learning in clinical practice. Students collected feedback from clinical supervisors and wrote it on a competency-based format. This feedback was used for self-assessment, which had to be completed before the final assessment.

METHODS

Four focus group discussions were conducted with second and last year Midwifery students. Focus groups were audiotaped, transcribed verbatim and analysed in a thematic way using ATLAS.ti for qualitative data analysis.

RESULTS

The analysis of the transcripts suggested that integrating feedback and assessment supports participation and active involvement in learning by collecting, writing, asking, reading and rereading feedback. Under the condition of training and dedicated time, these learning activities stimulate reflection and facilitate the development of strategies for improvement. The integration supports self-assessment and formative assessment but the value for summative assessment is contested. The quality of feedback and empowerment by motivated supervisors are essential to maximise the learning effects.

CONCLUSIONS

The integrated Midwifery Assessment and Feedback Instrument is a valuable tool for supporting formative learning and assessment in clinical practice, but its effect on students' self-directed learning depends on the feedback and support from supervisors.

Assessment of a peer review process among interns at an Australian hospital

Purpose. This study considered how a peer review process could work in an Australian public hospital setting. Method. Up to 229 medical personnel completed an online performance assessment of 52 Junior Medical Officers (JMOs) during the last quarter of 2008. Results. Results indicated that the registrar was the most suitable person to assess interns, although other professionals, including interns themselves, were identified as capable of playing a role in a more holistic appraisal system. Significant sex differences were also found, which may be worthy of further study. Also, the affirmative rather than the formative aspect of the assessment results suggested that the criteria and questions posed in peer review be re-examined. Conclusion. A peer review process was able to be readily implemented in a large institution, and respondents were positive towards peer review generally as a valuable tool in the development of junior medical staff. What is known about the topic? The literature generally concurs that peer review is a useful tool in professional development and can provide a rounded view from diverse sources about a peer’s professional performance. It has been implemented in at least one Canadian medical facility as a mandatory process. What does this paper add? Our study identifies who is considered the most suitable peer(s) to assess interns, various substantive issues about peer review and about the process itself, and raises questions about the voluntary v. mandatory nature of peer review. It is the first study to trial peer review amongst interns in an Australian hospital. What are the implications for practitioners? That peer review is a suitable tool in professional development and generally supported in our study, suggesting that it could be implemented into Australian healthcare practice. However, education about the nature and value of peer review would be required amongst healthcare professionals, and the use of peer review could imply greater managerial engagement in medical practice. Peer review is a more effective assessment tool than that currently employed in many Australian hospitals.

The current state of undergraduate medical education in New Zealand

The two medical schools in New Zealand (NZ) are responding to the challenges of increasing healthcare demands and a worldwide doctor shortage, despite an environment of relatively scarce resource. Admissions to medical school are being increased and curricula examined and modified so that graduates are able to meet the healthcare needs of all New Zealanders. Affirmative pathways are in place for people of Maori, Pacific and rural origin to enter medical programmes and aim towards a broad demographic representation in future doctors. Additionally, there is a strong focus on Maori (indigenous) health in curricula. Medical undergraduate programmes have common learning outcomes and assessment but there are different pathways to achieve these, delivered at geographically dispersed sites. The final (Trainee Intern) year of the programme is an apprenticeship year which serves as a 'work hardening' year, but remains under the auspices of the respective universities. One of the greatest challenges that NZ faces with respect to healthcare is the long-term retention of high quality, local medical graduates, whose services are in high demand internationally.

Teaching for clinical reasoning - helping students make the conceptual links

BACKGROUND

Dental educators complain that students struggle to apply what they have learnt theoretically in the clinical context. This paper is premised on the assumption that there is a relationship between conceptual thinking and clinical reasoning.

AIMS

The paper provides a theoretical framework for understanding the relationship between conceptual learning and clinical reasoning.

METHOD

A review of current literature is used to explain the way in which conceptual understanding influences clinical reasoning and the transfer of theoretical understandings to the clinical context.

RESULTS

The paper argues that the connections made between concepts are what is significant about conceptual understanding. From this point of departure the paper describes teaching strategies that facilitate the kinds of learning opportunities that students need in order to develop conceptual understanding and to be able to transfer knowledge from theoretical to clinical contexts. Along with a variety of teaching strategies, the value of concept maps is discussed. The paper provides a framework for understanding the difficulties that students have in developing conceptual networks appropriate for later clinical reasoning.

CONCLUSION

In explaining how students learn for clinical application, the paper provides a theoretical framework that can inform how dental educators facilitate the conceptual learning, and later clinical reasoning, of their students.

Empathy in Iranian medical students: A preliminary psychometric analysis and differences by gender and year of medical school

BACKGROUND

It has been well documented that effective empathic communication in the context of patient care is associated with improved health care outcomes. However, the emphasis given to empathy in medical education in Iran is limited, and the state of such teaching is unknown in many countries.

AIMS

To determine the psychometric properties of an Iranian translation of the Jefferson Scale of Physician Empathy (JSPE) among medical students, and to examine the differences on mean empathy scores by gender and the different years of medical school.

METHOD

A cross-sectional study was conducted among medical students. Data analysis was based on 181 questionnaires. Principal component analysis (PCA) with Varimax rotation was used to identify the number and composition of components constituting the developed constructs.

RESULTS

The PCA yielded three factors: Compassionate care, perspective-taking, and the ability to walk in the patient's shoes. No statistically significant differences in the empathy means scores were found by gender and the different years of medical school.

CONCLUSIONS

The Persian version of JSPE is a psychometrically sound instrument to measure empathy. Cultural backgrounds and pedagogical practice may influence medical students' attitudes towards empathy. Some recommendations are made, and the study limitations are discussed.

The gross anatomy course: an analysis of its importance

The gross anatomy dissection course is a cost-intensive piece of undergraduate medical education that students and professionals alike describe as very important within the overall medical curriculum. We sought to understand more explicitly students' valuation of gross anatomy as an "important" course and so developed a quantitative longitudinal questionnaire. Medical students (n = 124) enrolled in the winter term 2006/2007 gross anatomy course at the Ulm University Faculty of Medicine were surveyed anonymously prior to, in the middle of, and at the end of the dissection course. Subgroups of students expressing rising or falling opinions of course value were identified and correlated with student opinions about the course's ability to convey professional competencies. Five-point Likert scales were used for each survey item, which included such standardized instruments as the NeoFFI, BSI, and FBM. The study confirmed that medical students believe dissection to be valuable. Students indicated that participation in the course facilitated acquisition of anatomy knowledge as well as skills related to teamwork, coping with stress, and, to a lesser extent, time management. Students also noted that they developed less empathy than expected beforehand. Significant subgroup differences were observed relative to the competencies of teamwork, stress coping strategies, and empathy, as well as in students' stress levels associated with having to take a dissection course. Our study builds on previous work that has shown dissection courses help students develop professional competencies. The increase in professionalism might be a reason for the generally high value students place on the gross anatomy dissection course.