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Burgis-Kasthala S, Bain-Donohue S, Tailby E, Stonestreet K, Moore M. How the training pathways and capacity of rural physicians inform their scope of practice: A qualitative study examining the experiences of Australian and international medical graduates in South-East New South Wales, Australia. Aust J Rural Health 2024; 32:394-405. [PMID: 38504461 DOI: 10.1111/ajr.13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 02/19/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Current strategies to address shortages of rural doctors focus on developing a pipeline for rural generalist practice. Limited research has explored how doctors' professional journey engenders the skills required to practice rurally. OBJECTIVE This paper analyses how rural general practitioners' clinical pathway informs their scope of practice and future retention. DESIGN Qualitative thematic analysis using semi-structured telephone interviews. Twenty-one general practitioners appointed in their local health district of Murrumbidgee and Southern New South Wales, Australia, within the past 10 years. Participants comprised 10 Australian medical graduates (AMG) and 11 international medical graduates (IMG). FINDINGS AMGs and IMGs contrasted how their pathway into rural practice, and capacity to work rurally, informed their scope of practice. Australian medical graduates' familiarity with rural areas was consolidated through congruous experiences, including at rural clinical schools. Paradoxically, the fluency of their training limited the amount of unsupervised experience and confidence AMGs gained. Together with a focus on work-life balance, this limited many to providing mainstream general practice, precluding extending their scope of practice. International medical graduates described disseminated experiences, often unsupervised in high-volume contexts. However, a lack of professional opportunities prevented them from extending their scope of practice. DISCUSSION IMG and AMG motivation and pathway for working rurally differ. Respective cohorts have concerns regarding requisite skills and knowledge for rural practice, which incorporates opportunity and recognition. Entry points for training should be variable to allow consideration of life stage, prior skill development and extension of scope of practice. CONCLUSION Doctors' scope of practice is informed by their pathways into rural practice. Australian medical graduates may not gain adequate competence during expedited training programs to confidently undertake extended clinical activities. International medical graduates, however lacked the opportunities and support, to utilise their expertise in rural practice. Complementarily utilising the expertise and commitment of both AMGs and IMGs may synergistically address workforce shortages.
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Affiliation(s)
- Sarath Burgis-Kasthala
- Rural Clinical School, Australia National University, Canberra, Australian Capital Territory, Australia
- ScotGEM, University of St Andrews, North Haugh, St Andrews, UK
- ScotGEM, University of Dundee, Nethergate, Dundee, UK
| | - Suzanne Bain-Donohue
- Rural Clinical School, Australia National University, Canberra, Australian Capital Territory, Australia
| | - Ellen Tailby
- Rural Clinical School, Australia National University, Canberra, Australian Capital Territory, Australia
| | - Kathryn Stonestreet
- Rural Clinical School, Australia National University, Canberra, Australian Capital Territory, Australia
| | - Malcolm Moore
- Rural Clinical School, Australia National University, Canberra, Australian Capital Territory, Australia
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Wong WJ, Lee RF, Chong LY, Lee SWH, Lau WM. Work readiness of pharmacy graduates: An exploratory study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100389. [PMID: 38204886 PMCID: PMC10776422 DOI: 10.1016/j.rcsop.2023.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024] Open
Abstract
Introduction The recent global pandemic of Covid-19 caused various disruptions. Among them were face-to-face teaching and learning activities being switched to virtual sessions in accordance with health authorities recommendations. The impact of these changes on work readiness of pharmacy graduates is unknown. Aim This study aims to determine the impact of pharmacy graduate's work readiness, particularly those that had their studies disrupted from the pandemic. Methods Practicing pharmacists with supervisory experience were interviewed on their opinions on work readiness of early career and intern pharmacists. Specifically, they were asked to comment on work readiness of pharmacy graduates who had their later stage of pharmacy education impacted by the pandemic. Data was transcribed verbatim and thematically analysed. This was also supplemented with quantitative data from graduating students in 2020 and 2021 using the Work Readiness Scale. Results Qualitative feedback showed four themes related to workforce readiness: work competence, social intelligence, personal characteristics, and organizational acumen. Preceptors interviewed noted differences in communication abilities when interacting with patients. However, this improved with time. Quantitative data collected from graduates via the validated Work-Readiness Scale also showed a more positive agreement towards perceived work readiness. These graduates were comfortable with using technology as they had used these extensively in their learning during the pandemic and thus was comfortable in adopting digital health tools in their practice. Conclusion Although graduates reported to be work ready, there were gaps in communication skills and confidence levels when interacting with patients, as reported by supervising preceptors. Graduates also described this sense of 'missing out' from not having the opportunity to attend face-to-face activities like their originally planned hospital placements and how it impacted their choice of career. As pharmacists continue to play vital roles as members of the broader healthcare workforce, both in clinical and nonclinical settings, learnings from this study should be considered in designing educational activities to train and develop the workforce of the future.
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Affiliation(s)
| | | | | | | | - Wee Ming Lau
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
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Choi H, Oh J, Kim CK, Ryu H, Ryu Y. Residents need competence not confidence: A retrospective evaluation of the new competency education program for Korean neurology residents. PLoS One 2023; 18:e0290503. [PMID: 37796843 PMCID: PMC10553350 DOI: 10.1371/journal.pone.0290503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023] Open
Abstract
The objective of our study was to scrutinize the learning experiences of Korean neurology residents, with an emphasis on the implications of the novel competency-based curriculum implemented in 2021. We hypothesized that this revised curriculum could modulate residents' cognitive conduct, primarily the manifestation of overconfidence, in distinctive ways across different stages of training. Our investigative framework was three-fold. Initially, we began with a qualitative inquiry involving in-depth interviews with a purposively selected cohort of eight residents from four training sites. This approach facilitated comprehensive insight into their perceptions of their competence and confidence across the continuum of a four-year residency program. Subsequently, we incorporated the K-NEPA13 assessment instrument, administered to the residents and their overseeing supervisors. This stage aimed to dissect potential cognitive biases, particularly overconfidence and consistency, within the resident population. The final study involved a comprehensive survey administered to a group of 97 Korean neurology residents, allowing us to consolidate and validate our preceding findings. Our findings revealed that junior residents portrayed heightened confidence in their clinical capabilities compared to their senior peers. Intriguingly, junior residents also displayed a stronger inclination towards reevaluating their clinical judgments, a behavior we hypothesize is stimulated by the recently introduced competency-based curriculum. We identified cognitive divergence between junior and senior residents, with the latter group favoring more consistent and linear cause-and-effect reasoning, while the former demonstrated receptiveness to introspection and reconsideration. We speculate this adaptability might be engendered by the supervisor assignment protocol intrinsic to the new curriculum. Our study highlights the essentiality of incorporating cognitive behaviors when devising medical education strategies. Acknowledging and addressing these diverse cognitive biases, and instilling a spirit of adaptability, can nurture a culture that persists in continuous learning and self-reflection among trainee doctors.
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Affiliation(s)
- Hojin Choi
- Department of Neurology, Hanyang University, Seoul, Republic of Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chi Kyung Kim
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Hokyoung Ryu
- Graduate School of Innovation & Technology Management, Hanyang University, Seoul, Republic of Korea
| | - Youngji Ryu
- School of Psychology, Korea University, Seoul, Republic of Korea
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Graham P, Padley J, Williams S, Gonzalez-Chica D, Isaac V, Walters L. Australian rural medical students' perceived readiness for work as a junior doctor: A cross-sectional national survey. Aust J Rural Health 2023; 31:999-1007. [PMID: 37650537 DOI: 10.1111/ajr.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVE To report self-perceived readiness for work as a junior doctor in a national cohort of rural clinical school students. DESIGN Cross-sectional study using a self-report questionnaire. Independent variables included 14 individual readiness items related to clinical and professional tasks, sociodemographic data and reported experience of rural clinical school (RCS) training. Participants were 668 medical students (55.3% females) completing a full academic year in rural Australia. Multivariable analysis explored factors associated with overall readiness for work as a junior doctor. FINDINGS 86% agreed that RCS experience prepared them to undertake the roles and responsibilities of a junior doctor. Self-ratings for specific clinical and professional tasks varied from a mean score of 5.9-8.0 out of 10, and 13 of the 14 items were associated with the outcome (p-value <0.001, except for performing spirometry). Lowest readiness scores were seen for some aspects including raising concerns about a colleague (mean score 6.1) or responding to workplace bullying (mean score 6.0). Aspects of the RCS experience that were strongly associated with overall readiness included: feeling a valued team-member (OR 9.28, 95%CI 2.43-35.39), feeling well-supported academically (OR 6.64, 95%CI 3.39-13.00), having opportunity for unsupervised but supported clinical practice (OR 4.67, 95%CI 1.45-15.00), having a rural mentor (OR 3.38, 95%CI 1.89-6.06) and having a previous health professional qualification (OR 2.7, 95%CI 1.32-5.54). DISCUSSION Most RCS students felt ready for work as a junior doctor. Important aspects of RCS experience are likely to include students feeling integrated within the clinical team and having opportunities for authentic clinical roles. There remains a significant challenge for medical school curricula to address professional areas where graduates felt less prepared.
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Affiliation(s)
- Patrick Graham
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
| | - James Padley
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Susan Williams
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
| | - David Gonzalez-Chica
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Vivian Isaac
- Discipline of Rural and Remote Health, Flinders University, Adelaide, South Australia, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, South Australia, Australia
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Homberg A, Narciß E, Thiesbonenkamp-Maag J, Schüttpelz-Brauns K. Experience-based learning during the final year - quantitative content analyses of students' self-reports. MEDICAL TEACHER 2023; 45:542-549. [PMID: 36370418 DOI: 10.1080/0142159x.2022.2144187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The final year offers students the opportunity to explore their future role as a physician in different environments. Learning success depends in large part on how students experience these assignments. The aim of this study is to analyze students' self-reported experiences to derive factors that promote experience-based learning in the transition phase during the final year of medical school in order to optimally prepare students for professional practice. METHOD Data were collected from 2013 to 2019 via written survey after each assignment in the final year. Students were asked to report their pleasant and unpleasant experiences in free-text fields. The text material was analyzed using quantitative content analysis. RESULTS The authors included 1762 questionnaires for analysis. They formed 12 main categories from the text material, equally covering pleasant and unpleasant experiences. Supervisors and teamwork played a central role in both questions, responsibility and working areas frequently led to positive experiences, and working conditions to negative ones. CONCLUSION This study confirms the great importance of supervision. Above all, successful collaboration serves as a door opener into a feeling of security which students need to take on responsibility. The authors adapted Dornan's model of experience-based learning to the transition phase to help medical schools establish tailored conditions for students' successful entry into professional practice.
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Affiliation(s)
- A Homberg
- Department of Medical Education Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - E Narciß
- Competence Center for final-year education, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Thiesbonenkamp-Maag
- Department of Medical Education Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - K Schüttpelz-Brauns
- Department of Medical Education Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Baker J, Weis N, Boysen T, Bestle M, Andersen A, Morcke A, Bremholm L. The clinical task force: Improving quality of medical students' internship. Heliyon 2023; 9:e13419. [PMID: 36820021 PMCID: PMC9937950 DOI: 10.1016/j.heliyon.2023.e13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Background Up to 40% of young medical doctors feel that the internships prepared them insufficiently for the clinical work. This study investigated whether a Clinical Task Force (CTF) could improve internship quality. Methods The CTF visited internship departments with a triple-targeted approach: first, departments pre-filled a self-evaluating questionnaire; secondly, CTF visited departments to discuss the self-evaluation and previous student evaluations; and thirdly, CTF and departments agreed on several quality-improving focus points to work on after the meeting. Focus points were followed-up after three and 12 months. The impact on internship quality was assessed with departments' student evaluation scores, number of completed focus points, and the effect of completed focus points on a range of learning parameters. The CTF learned several things along the way, that potentially could affect the quality of internships. A shortlist of these was provided to illustrate unmeasurable benefits. Results The CTF met with 53 out of 60 eligible departments. The CTF and departments agreed upon 197 focus points of which 64% were completed. The three most frequent categories of focus points were Introduction of the students, The departments' evaluation percentage, and The departments' function as an educational site. The mean student evaluation scores did not change significantly, but the individual evaluation parameters changed significantly in two categories. It decreased in the category regarding the students' satisfaction with the clinical lecturers and the scheduled teaching and increased in the category regarding the percentage of students evaluating the department. Conclusion The CTF's triple-targeted approach did not increase the mean student evaluation score significantly. For departments that completed the agreed focus points, one category increased and another decreased. However, the unmeasurable benefits illustrated that CTF was a good viable linking element between the faculty, departments, and students with the potential of improving other aspects of the quality of internships.
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Affiliation(s)
- J.J. Baker
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Corresponding author.
| | - N. Weis
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark
| | - T. Boysen
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Gastrounit, Division of Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - M.H. Bestle
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital, North Zealand, Copenhagen, Denmark
| | - A.G. Andersen
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A.M. Morcke
- Centre for Educational Development, Aarhus University, Aarhus, Denmark
| | - L. Bremholm
- Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Surgery, Zealand University Hospital, University of Copenhagen, Koege, Copenhagen Denmark
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Meiklejohn S, Anderson A, Brock T, Kumar A, Maddock B, Wright C, Walker L, Kent F. The utility of an interprofessional education framework and its impacts upon perceived readiness of graduates for collaborative practice. A multimethod evaluation using the context, input, process, product (CIPP) model. NURSE EDUCATION TODAY 2023; 121:105707. [PMID: 36640451 DOI: 10.1016/j.nedt.2023.105707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/13/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Frameworks in higher education can support strategic curriculum change in complex systems. The impact of these frameworks in achieving their stated purpose is less known. An interprofessional education (IPE) framework and related multi-activity curriculum designed to develop health profession graduates with the requisite skills for collaborative care, was introduced in a large university, across eleven health professions. OBJECTIVE To determine the utility of an interprofessional framework and impact upon perceived work readiness for collaborative practice. METHOD A multimethod design using the context, input, process, product (CIPP) evaluation model was selected taking a social constructivist theoretical stance. Data collection included staffing allocation to IPE, curriculum audit, and reflections from representatives of all health professions courses offered at the institution. Data was analyzed using framework analysis. PARTICIPANTS Interviews or focus groups were undertaken with academic Faculty (n = 13), recent graduates (n = 24) and clinical supervisors/employers of recent graduates (n = 17). RESULTS The framework assisted the systematic implementation of interprofessional curriculum across the different health courses at the university. Collaborative work-ready learning outcomes were identified in graduates where targeted curriculum had been implemented across all four domains of the framework. Gaps identified in framework implementation were consistent with gaps identified in graduate knowledge and skills related to collaborative practice. The combination of formal university-based IPE and informal workplace learning as part of clinical placements contributed to achieving the desired learning outcomes. CONCLUSIONS These findings offer insights into the use of shared frameworks to drive specific learning activities related to collaborative practice.
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Affiliation(s)
- Sarah Meiklejohn
- Monash University (Monash Centre for Scholarship in Health Education), Melbourne, Victoria, Australia
| | - Amanda Anderson
- Monash University (Department of Nutrition, Dietetics and Food), Melbourne, Victoria, Australia
| | - Tina Brock
- Monash University (Faculty of Pharmacy and Pharmaceutical Sciences), Melbourne, Victoria, Australia
| | - Arunaz Kumar
- Monash University (Faculty of Medicine, Nursing and Health Sciences), Melbourne, Victoria, Australia
| | - Bronwyn Maddock
- Monash University (Faculty of Medicine, Nursing and Health Sciences), Melbourne, Victoria, Australia
| | - Caroline Wright
- Monash University (Department of Medical Imaging and Radiation Sciences), Melbourne, Victoria, Australia
| | - Lorraine Walker
- Monash University (School of Nursing and Midwifery), Melbourne, Victoria, Australia
| | - Fiona Kent
- Monash University (Faculty of Medicine, Nursing and Health Sciences), Melbourne, Victoria, Australia.
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Work readiness attributes: Comparative views of clinical supervisors and final year sonography students. SONOGRAPHY 2021. [DOI: 10.1002/sono.12274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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