Adapting the forms of yesterday to the functions of today and the needs of tomorrow: a genealogical case study of clinical teaching units in Canada

Nurses' perceptions regarding the establishment of clinical education and training units in public hospitals in the North-West Province: a qualitative study

BACKGROUND

A Clinical Education and Training Unit is defined as a unit in which the clinical orientation, teaching, learning, and assessment, mentoring and support of student nurses are coordinated to achieve the outcomes of their learning programmes in the health establishment. In South Africa, Clinical Education and Training Unit was developed to reconstruct and revitalise nursing education and training. The clinical education is crucial to enable nursing students to put what they learn in the classroom into practice as they direct patient care, practise therapeutic communication, hone technical skills, demonstrate caring behaviours, investigate ethical dilemmas, and take on the roles of nurses. The clinical teaching unit is one of the models that show potential in advancing clinical education. Since the proposed clinical education and teaching model concluded that Clinical Education and Training Units should be established in 2012, to the researcher's knowledge, no research study has been conducted to explore and describe the nurses' perceptions regarding the establishment of Clinical Education and Training Units, particularly in the North-West Province. This has resulted in the scarcity of literature on their perceptions. Thus, the researcher believed that it was essential to explore and describe the perceptions of professional nurses regarding the establishment of Clinical Education and Training Units in the North-West Province of South Africa, so that their perceptions may be known and understood.

AIM

The study aimed to explore and describe the perceptions of professional nurses regarding the establishment of Clinical Education and Training Units in public hospitals in the North-West Province.

METHODS

A qualitative-exploratory-descriptive and contextual research design was used. This method was used because it is known to unearth a wide range of views, opinions, thoughts, and feelings of the participants thus enabling a deeper understanding concerning perceptions of professional nurses regarding the establishment of Clinical Education and Training Units at the hospitals of interest. Participants were recruited using pamphlets and flyers. A non-probability convenience and purposive sampling techniques were used to select participants based on an inclusion criterion. From 09 September 2023 to 07 December 2023, the researcher used face-to-face group discussions to collect data and it was analysed using six steps of inductive thematic data analysis as outlined by Braun and Clarke.

RESULTS

Four focus groups discussions were conducted with a total of 19 participants who were professional nurses. Responses were categorised into three domains: advantages of the Clinical Education and Training Unit, challenges of the Clinical Education and Training Unit, and recommendations for the Clinical Education and Training Unit. Subsequently, a total of three main themes with eight sub-themes were determined for advantages of the Clinical Education and Training Unit, two themes with six subthemes for challenges of the Clinical Education and Training Unit, and one theme with two sub-themes for recommendations for the Clinical Education and Training Unit respectively.

CONCLUSION

The need to establish functional Clinical Education and Training Units is therefore very important not only to student nurses but also to health care professionals. Most of the participants emphasised that if Clinical Education and Training Units were fully established they would be beneficial in developing health care professionals, especially in terms of in-service training where nursing standards are emphasised as outlined by the South African Nursing Council. The research study results might contribute to the full establishment of CETUs in the hospitals of the North- West Province, South Africa.

TRIAL REGISTRATION

not applicable to the study.

Residents and staff perceptions of a pediatric clinical teaching unit in a large tertiary care center in Saudi Arabia

BACKGROUND

The clinical teaching unit (CTU) is a commonly used model of patient care and teaching. Despite being a common model of care, very few studies have looked at its impact on the education of trainees. In addition, it is a relatively new structure for pediatric inpatient care in Saudi Arabia. The purpose of this study was to compare postgraduate trainees (residents) and staff perceptions of the old and the new (the CTU) inpatient team structures, and to evaluate the impact of the CTU on residents' education.

METHODS

An online survey was sent to nurses, pediatric residents, and attending physicians who worked under both structures. Questions for residents were adopted from the National training survey of the General Medical Council, United Kingdom.

RESULTS

A total of 147 pediatric healthcare workers completed the survey (97 nurses, 39 residents, and 11 attending physicians), most of whom worked in both the old and new inpatient team structures. More than 97% of residents reported being supervised by their attending on a daily basis in the CTU structure as compared with 15% in the old structure. A higher proportion of residents favored the old structure in terms of the opportunity it provided to develop their leadership skills. Eighty-seven percent of nurses believed the CTU had improved patient safety of pediatric inpatients. Overall, 82% of residents, 91% of nurses, and 100% of attending physicians favoured the CTU structure over the old inpatient model.

CONCLUSIONS

Our study shows that pediatric residents and staff perceived the CTU structure as superior to the old inpatient team structure, especially in terms of patient safety. Although the CTU seemed to have a positive impact on residents' education, this must be further examined especially with respect to its impact on residents' leadership skills.

Clinical teaching unit design: a realist systematic review protocol of evidence-based practices for clinical education and health service delivery

INTRODUCTION

The clinical teaching unit (CTU) has emerged as a near-ubiquitous model of clinical education across Canadian and international medical schools since it was first proposed over 50 years ago. However, while healthcare has changed dramatically over this period, the CTU model has remained largely unchanged. We thus aimed to systematically review principles of CTU design that contribute to improved outcomes in clinical education and health service delivery.

METHODS AND ANALYSIS

We will perform a realist systematic review in accordance with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) II protocol for realist reviews. Databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews and Cumulative Index of Nursing and Allied Health Literature (CINAHL), were searched to find primary research articles published from 1993 to 2019 involving CTUs or other teaching wards, and outcomes related to either trainee education or health service delivery. Two reviewers will independently screen studies in a two-stage process. Retrieved titles and/or abstracts of studies will be screened in the first stage, with full texts reviewed in the second stage. Selected articles meeting inclusion criteria will undergo data abstraction using a standardised, pre-piloted form for assessment of study quality and knowledge synthesis.

ETHICS AND DISSEMINATION

This review will generate higher quality evidence on the design of CTUs as a model for both clinical education and health service delivery. In addition, further knowledge translation efforts may be necessary to ensure that known best practices in CTU design become common practice.

The Big D(eal): professional identity through discursive constructions of 'patient'

CONTEXT

Professional identity formation has become a key focus for medical education. Who one becomes as a physician is contingent upon learning to conceptualise who the other is as a patient, yet, at a time when influential ideologies such as patient-centred care have become espoused values, there has been little empirical investigation into assumptions of 'patient' that trainees take up as they progress through their training.

METHODS

Our team employed a critical discourse analysis approach to transcripts originally produced from a micro-ethnography of medical student learning on an acute care in-patient paediatric ward. The dataset included 20 case presentations and 14 sign-over rounds taken from a 3-week observation period. We paid specific attention to how trainees used language to talk about, refer to and categorise patients.

RESULTS

Identified discourses included patient-as-disease-category, patient-as-educational-commodity and patient-as-marginalised-actor. These discourses conceptualise 'patient' as an entity that is principally biomedical, useful for clinical learning and spoken for and about. Medical student participation in these discourses contributes to an identity that allows them to move further into the professional medical world they are joining.

CONCLUSIONS

We contend that as learners participate in these discourses, they are also performatively produced by them. By making these discourses visible, we can consider how to minimise unintended effects such discourses may cause. Our findings, although limited, offer a glimpse of the effects that those assumptions may have as we look to align better the formation of professional medical identity with the ideals of patient-centred care and socially responsible health care systems.