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Patel P, Hancock J, Rogers M, Pollard SR. Improving uncertainty tolerance in medical students: A scoping review. MEDICAL EDUCATION 2022; 56:1163-1173. [PMID: 35797009 PMCID: PMC9796811 DOI: 10.1111/medu.14873] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Uncertainty is an inevitable part of medical practice. An ability to tolerate uncertainty is viewed as a key competency across many health-care systems. Poor uncertainty tolerance (UT) has been linked to negative outcomes including reduced psychological well-being in medical students. A variety of medical education interventions have been developed with the intention of increasing medical students' UT. However, there is no synthesis of these studies available to inform education and research practice. Our aim was to conduct a scoping review of medical education interventions that evaluate their impact on UT. METHODS Medline, PsycInfo, Embase and ERIC databases were searched for articles published from inception to December 2020. An extensive supplementary search was conducted and both quantitative and qualitative evaluations were included. For each intervention, we categorised the stimulus of uncertainty (ambiguity, complexity and/or probability) and mapped the students' reported cognitive, behavioural, and/or emotional response(s) to uncertainty onto an existing conceptual framework. RESULTS Twenty-two of 24 included studies reported a positive impact on medical student UT in at least one domain (cognitive, behavioural or emotional). Interventions included problem based learning-based curricula, medical humanities, simulation, reflection and assessment. We found in four studies that a negative response in the emotional domain was reported despite positive responses also being reported in the cognitive and/or behavioural domains. CONCLUSION We identified a range of medical education interventions which report a positive impact on medical student UT. Further research is required to understand why a single intervention may stimulate a negative emotional response alongside a positive cognitive or behavioural response. In turn, this could support stakeholders such as policymakers and institutions to adapt the medical curriculum to better prepare their medical students for practice by enhancing their UT.
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Affiliation(s)
- Priya Patel
- College of Medicine and HealthUniversity of ExeterExeterUK
| | - Jason Hancock
- College of Medicine and HealthUniversity of ExeterExeterUK
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Corfield L, Williams RA, Lavelle C, Latcham N, Talash K, Machin L. Prepared for practice? UK Foundation doctors' confidence in dealing with ethical issues in the workplace. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2019-105961. [PMID: 32277020 DOI: 10.1136/medethics-2019-105961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 06/11/2023]
Abstract
This paper investigates the medical law and ethics (MEL) learning needs of Foundation doctors (FYs) by means of a national survey developed in association with key stakeholders including the General Medical Council and Health Education England. Four hundred sevnty-nine doctors completed the survey. The average self-reported level of preparation in MEL was 63%. When asked to rate how confident they felt in approaching three cases of increasing ethical complexity, more FYs were fully confident in the more complex cases than in the more standard case. There was no apparent relationship with confidence and reported teaching at medical school. The less confident doctors were no more likely to ask for further teaching on the topic than the confident doctors. This suggests that FYs can be vulnerable when facing ethical decisions by being underprepared, not recognising their lack of ability to make a reasoned decision or by being overconfident. Educators need to be aware of this and provide practical MEL training based on trainee experiences and real-world ethics and challenge learners' views. Given the complexities of many ethical decisions, preparedness should not be seen as the ability to make a difficult decision but rather a recognition that such cases are difficult, that doubt is permissible and the solution may well be beyond the relatively inexperienced doctor. Educators and supervisors should therefore be ensuring that this is clear to their trainees. This necessitates an environment in which questions can be asked and uncertainty raised with the expectation of a supportive response.
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Affiliation(s)
| | | | - Claire Lavelle
- GP Trainee, Wirral GP Specialty Training Scheme, Birkenhead, UK
| | - Natalie Latcham
- Department of Medicine, Morecambe Bay Hospitals NHS Trust, Kendal, Cumbria, UK
| | - Khojasta Talash
- Academic Foundation Doctor, Morecambe Bay Hospitals NHS Trust, Kendal, Cumbria, UK
| | - Laura Machin
- School of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
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Machin LL, Latcham N, Lavelle C, Williams RA, Corfield L. Exploring the perceived medical ethics and law training needs of UK foundation doctors. MEDICAL TEACHER 2020; 42:92-100. [PMID: 31558083 DOI: 10.1080/0142159x.2019.1665636] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Foundation doctors (FDs) encounter a wide range of ethical and legal issues during their first two years of work. Despite ethics being a key part of most modern undergraduate curricula, FDs can struggle with the issues they see. This study is based on results from an on-line survey answered by 479 UK FDs regarding their medical law and ethics learning needs, and their undergraduate training in this area. Over two-thirds stated they would wish to receive MEL training as an FD on self-discharge against medical advice (∼71%), sedating patients (∼70%), decision making in emergency medicine (∼67%), and withholding and withdrawing treatment (∼66%). Over half of all respondents want MEL training during their Foundation Programme on DNACPR orders (∼63%), dealing with patients with suicidal intent (∼59%), Mental Health Act (∼55%), Deprivation of Liberty Safeguards (∼54%), and end of life care (∼53%). We therefore propose a minimum curriculum for ethics and law training for FDs based on these topics, as well as cases brought by the FDs themselves.
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Affiliation(s)
- L L Machin
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - N Latcham
- University Hospitals of Morecambe Bay Foundation Trust, Lancaster, UK
| | - C Lavelle
- Wirral GP Specialty Training Scheme, Birkenhead, UK
| | - R A Williams
- Lancaster University Management School, Lancaster University, Lancaster, UK
| | - L Corfield
- Keele Medical School, Keele University, Staffordshire, UK
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Parmar H, Schafheutle E, Willis S, Silkstone V. Does curriculum reform influence perceived preparedness for practice of graduates? A comparison of two cohorts. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:156-164. [PMID: 31368607 DOI: 10.1111/ijpp.12569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Using performance standards (PS) set by the General Pharmaceutical Council (GPhC), this study compared the views of two consecutive cohorts of MPharm graduates from one pharmacy school, pre- and postcurriculum reform on preparedness for practice (PFP). METHODS Preparedness was investigated using the GPhC's 76 PS, grouped into three domains of practice: professional activity, interpersonal skills and ability to provide an effective pharmaceutical service. Respondents were asked to (dis)agree with how they perceived the MPharm had sufficiently prepared them to meet each of the 76 PS. Differences in mean score between the two cohorts were analysed via the independent-samples t-test. Regression analysis was used to determine whether the year of graduation was a predictor of PFP once other variables were controlled for. KEY FINDINGS A response rate of 30.1 and 42.4% was achieved for the 2014 and 2015 cohort, respectively. Significantly more respondents of the 2015 cohort (postcurricular reform) felt prepared for practice than respondents of the 2014 cohort (precurricular reform), for all domains of preregistration performance standards. Multiple regression analysis demonstrated that year of graduation was the independent variable that made the strongest unique contribution to explaining PFP (β = 0.527, P ≤ 0.005). CONCLUSIONS Overall findings of this study suggest that increasing adoption of undergraduate active learning opportunities and integrating learning of core subjects may enhance the overall feeling of preparedness for practice.
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Affiliation(s)
- Harsha Parmar
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Ellen Schafheutle
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Sarah Willis
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Victoria Silkstone
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Lertrattananon D, Limsawart W, Dellow A, Pugsley H. Does medical training in Thailand prepare doctors for work in community hospitals? An analysis of critical incidents. HUMAN RESOURCES FOR HEALTH 2019; 17:62. [PMID: 31357987 PMCID: PMC6664783 DOI: 10.1186/s12960-019-0399-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Compulsory 3-year public service was implemented in 1967 as a measure to tackle the maldistribution of doctors in Thailand. Currently, therefore, most medical graduates work in rural community hospitals for their first jobs. This research explored doctors' perceptions of preparedness for practice using a critical incident technique. METHODS A self-administered critical incident questionnaire was developed. Convenient samples were used, i.e. Family Medicine residents at Ramathibodi Hospital who had worked in a community hospital after graduation before returning to residency training. Participants were asked to write about two incidents that had occurred while working in a community hospital, one in which they felt the knowledge and skills obtained in medical school had prepared them for managing the situation effectively and the other in which they felt ill-prepared. Data were thematically analysed. RESULTS Fifty-six critical incidents were reported from 28 participants. There were representatives from both normal and rural tracks of undergraduate training and community hospitals of all sizes and all regions. Doctors felt well-prepared to provide care for patients in emergency situations and as in-patients, but under-prepared for obstetric and paediatric emergencies, out-patient care, and palliative care. Moreover, they felt poorly prepared to deal with difficult patients, hospital administration and quality assurance. CONCLUSIONS Long-term solutions are needed to solve the rural doctor shortage. Medical graduates from both normal and rural tracks felt poorly prepared for working effectively in community hospitals. Medical training should prepare doctors for rural work, and they should be supported while in post.
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Affiliation(s)
- Dumrongrat Lertrattananon
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Wirun Limsawart
- Society and Health Institute, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Helen Pugsley
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, United Kingdom
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Miles S, Kellett J, Leinster SJ. Medical graduates' preparedness to practice: a comparison of undergraduate medical school training. BMC MEDICAL EDUCATION 2017; 17:33. [PMID: 28166769 PMCID: PMC5295184 DOI: 10.1186/s12909-017-0859-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/11/2017] [Indexed: 05/05/2023]
Abstract
BACKGROUND There is evidence that newly qualified doctors do not feel prepared to start work. This study examined views of first year Foundation doctors (F1s) regarding how prepared they felt by their undergraduate medical education for skills required during the first Foundation training year in relation to their type of training. METHOD One-hundred and eighty two F1s completed a questionnaire during their first rotation of Foundation training. Analysis was conducted by type of medical school training: Problem-Based Learning (PBL), Traditional or Reformed. RESULTS F1s from medical schools with a PBL curriculum felt better prepared for tasks associated with communication and team working, and paperwork than graduates from the other medical school types; but the majority of F1s from all three groups felt well prepared for most areas of practice. Less than half of graduates in all three groups felt well prepared to deal with a patient with neurological/visual problems; write referral letters; understand drug interactions; manage pain; and cope with uncertainty. F1s also indicated that lack of induction or support on starting work was affecting their ability to work in some areas. CONCLUSIONS Whilst F1s from medical schools with a PBL curriculum did feel better prepared in multiple areas compared to graduates from the other medical school types, specific areas of unpreparedness related to undergraduate and postgraduate medical training were identified across all F1s. These areas need attention to ensure F1s are optimally prepared for starting work.
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Affiliation(s)
- Susan Miles
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Joanne Kellett
- Clinical Research and Trials Unit, Norwich Medical School, Norfolk and Norwich University Hospital, University of East Anglia, Norwich, NR4 7TJ UK
| | - Sam J. Leinster
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
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Lutz G, Roling G, Berger B, Edelhäuser F, Scheffer C. Reflective practice and its role in facilitating creative responses to dilemmas within clinical communication - a qualitative analysis. BMC MEDICAL EDUCATION 2016; 16:301. [PMID: 27881123 PMCID: PMC5121969 DOI: 10.1186/s12909-016-0823-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/14/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND Good communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students' experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students' ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency. METHODS Thematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity. RESULTS Reflection on real difficult clinical communication situations appears to increase medical students' ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer. CONCLUSIONS Reflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students' overall communicative competency.
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Affiliation(s)
- Gabriele Lutz
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
- Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Gudrun Roling
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
| | - Bettina Berger
- Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Witten, Germany
| | - Friedrich Edelhäuser
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
- Department of Early Rehabilitation, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Christian Scheffer
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department for Health, Faculty of Medicine, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
- Department of Internal Medicine, Clinical Education Ward for Integrative Medicine (CEWIM), Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
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Illing JC, Morrow GM, Rothwell nee Kergon CR, Burford BC, Baldauf BK, Davies CL, Peile EB, Spencer JA, Johnson N, Allen M, Morrison J. Perceptions of UK medical graduates' preparedness for practice: a multi-centre qualitative study reflecting the importance of learning on the job. BMC MEDICAL EDUCATION 2013; 13:34. [PMID: 23446055 PMCID: PMC3599362 DOI: 10.1186/1472-6920-13-34] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 02/19/2013] [Indexed: 05/05/2023]
Abstract
BACKGROUND There is evidence that graduates of different medical schools vary in their preparedness for their first post. In 2003 Goldacre et al. reported that over 40% of UK medical graduates did not feel prepared and found large differences between graduates of different schools. A follow-up survey showed that levels of preparedness had increased yet there was still wide variation. This study aimed to examine whether medical graduates from three diverse UK medical schools were prepared for practice. METHODS This was a qualitative study using a constructivist grounded theory approach. Prospective and cross-sectional data were collected from the three medical schools.A sample of 60 medical graduates (20 from each school) was targeted. They were interviewed three times: at the end of medical school (n = 65) and after four (n = 55) and 12 months (n = 46) as a Year 1 Foundation Programme doctor. Triangulated data were collected from clinicians via interviews across the three sites (n = 92). In addition three focus groups were conducted with senior clinicians who assess learning portfolios. The focus was on identifying areas of preparedness for practice and any areas of lack of preparedness. RESULTS Although selected for being diverse, we did not find substantial differences between the schools. The same themes were identified at each site. Junior doctors felt prepared in terms of communication skills, clinical and practical skills and team working. They felt less prepared for areas of practice that are based on experiential learning in clinical practice: ward work, being on call, management of acute clinical situations, prescribing, clinical prioritisation and time management and dealing with paperwork. CONCLUSIONS Our data highlighted the importance of students learning on the job, having a role in the team in supervised practice to enable them to learn about the duties and responsibilities of a new doctor in advance of starting work.
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Affiliation(s)
- Jan C Illing
- Centre for Medical Education Research, Durham University, Burdon House, Leazes Road, Durham DH1 1TA, UK
| | - Gill M Morrow
- Centre for Medical Education Research, Durham University, Burdon House, Leazes Road, Durham DH1 1TA, UK
| | | | - Bryan C Burford
- Centre for Medical Education Research, Durham University, Burdon House, Leazes Road, Durham DH1 1TA, UK
| | - Beate K Baldauf
- Warwick Institute for Employment Research, The University of Warwick, Coventry CV4 7AL, UK
| | - Carol L Davies
- Institute of Clinical Education, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK
| | - Ed B Peile
- Institute of Clinical Education, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK
| | - John A Spencer
- School of Medical Sciences Education Development, Newcastle University, Framlington Place, Newcastle upon Tyne NE2 4HH, UK
| | - Neil Johnson
- Institute of Clinical Education, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK
| | - Maggie Allen
- Institute of Clinical Education, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, UK
| | - Jill Morrison
- College of Medical, Veterinary and Life Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK
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van den Eertwegh V, van Dulmen S, van Dalen J, Scherpbier AJJA, van der Vleuten CPM. Learning in context: identifying gaps in research on the transfer of medical communication skills to the clinical workplace. PATIENT EDUCATION AND COUNSELING 2013; 90:184-92. [PMID: 22796303 DOI: 10.1016/j.pec.2012.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 05/23/2012] [Accepted: 06/06/2012] [Indexed: 05/22/2023]
Abstract
OBJECTIVE In order to reduce the inconsistencies of findings and the apparent low transfer of communication skills from training to medical practice, this narrative review identifies some main gaps in research on medical communication skills training and presents insights from theories on learning and transfer to broaden the view for future research. METHODS Relevant literature was identified using Pubmed, GoogleScholar, Cochrane database, and Web of Science; and analyzed using an iterative procedure. RESULTS Research findings on the effectiveness of medical communication training still show inconsistencies and variability. Contemporary theories on learning based on a constructivist paradigm offer the following insights: acquisition of knowledge and skills should be viewed as an ongoing process of exchange between the learner and his environment, so called lifelong learning. This process can neither be atomized nor separated from the context in which it occurs. Four contemporary approaches are presented as examples. CONCLUSION The following shift in focus for future research is proposed: beyond isolated single factor effectiveness studies toward constructivist, non-reductionistic studies integrating the context. PRACTICE IMPLICATIONS Future research should investigate how constructivist approaches can be used in the medical context to increase effective learning and transition of communication skills.
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Langewitz W. [Physician-patient communication in medical education: can it be learned?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 55:1176-82. [PMID: 22936486 DOI: 10.1007/s00103-012-1533-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Based on a review of recent key articles, this paper demonstrates that many elements of physician-patient communication can be learned successfully during medical education. Methods of assessment and definition of success depend largely on the definition of teaching goals, which are usually based on the principles of a more egalitarian and non-paternalistic physician-patient communication. In this article another approach is suggested. Teaching objectives in patient-physician communication can also be deduced from the needs of clinical medicine, resulting in the following goals: students are able to gather relevant data from patients' history, they explicitly structure the consultation and the way they give information, they know how to respond to patients' emotions. The Objective Standardised Clinical Examination (OSCE) is discussed with its strengths and weaknesses. The inclusion of video-based feedback is presented as a teaching tool to improve students' self-reflection. Workplace-based assessment and Mini-CEX are promising educational tools that require a well-trained faculty, not only in the teaching and practice of communication but also in the art of giving constructive and yet honest feedback.
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Affiliation(s)
- W Langewitz
- Psychosomatik - Innere Medizin, Universitätsspital Basel, Hebelstr. 2, 4031, Basel, Schweiz.
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Morrow G, Johnson N, Burford B, Rothwell C, Spencer J, Peile E, Davies C, Allen M, Baldauf B, Morrison J, Illing J. Preparedness for practice: the perceptions of medical graduates and clinical teams. MEDICAL TEACHER 2012; 34:123-35. [PMID: 22288990 DOI: 10.3109/0142159x.2012.643260] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Earlier research indicated that medical graduates feel unprepared to start work, and that this varies with medical school. AIMS To examine the extent to which graduates from different UK medical schools differed in their perceptions of preparedness for practice, and compare their perceptions with those of clinical team members. METHOD An anonymous questionnaire assessing perceptions of 53 aspects of preparedness was devised, and administered to the graduating cohorts of three medical schools: Newcastle (systems-based, integrated curriculum); Warwick (graduate-entry) and Glasgow (problem-based learning). In addition, a triangulating questionnaire was cascaded via ward managers to doctors, nurses and pharmacists who worked with new graduates in their first posts. RESULTS The response rate for the cohort questionnaire was 69% (479/698). The overall mean preparedness score was 3.5 (on a five-point scale), with no significant difference between schools. On individual items, there were large differences within each site, but smaller differences between sites. Graduates felt most prepared for aspects of working with patients and colleagues, history taking and examination. They felt least prepared for completing a cremation form, some aspects of prescribing, complex practical procedures and for applying knowledge of alternative and complementary therapies, and of the NHS. A total of 80 clinical team questionnaires were completed, similarly showing substantial variation within each site, but smaller differences between sites. CONCLUSIONS New doctors feel relatively unprepared for a number of aspects of practice, a perception shared by their colleagues. Although medical school has some effect on preparedness, greater differences are common across sites. Differences may reflect hidden influences common to all the schools, unintended consequences of national curriculum guidance or common traits in the graduate populations sampled. Further research is needed to identify the causes.
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Affiliation(s)
- Gill Morrow
- Medical Education Research Group, School of Medicine and Health, Durham University, UK.
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Bearman M, Lawson M, Jones A. Participation and progression: new medical graduates entering professional practice. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2011; 16:627-642. [PMID: 21359857 DOI: 10.1007/s10459-011-9284-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 02/15/2011] [Indexed: 05/30/2023]
Abstract
The first year of practice after medical school is considered to be an essential part of becoming a medical practitioner in Australia. Previous qualitative investigations have investigated a number of significant aspects of this early stage of professional development. This qualitative study explores experiences and developing professional identities during internship. Thirty interns and six intern supervisors were interviewed from three different Australian states. Grounded theory techniques were used to develop three key themes: internship-as-participation, internship-as-progression, and conflicts, parallels, disturbances and outliers. Key findings were: the important balance between support from colleagues and development through taking independent responsibility; and the strength of the view of internship as part of a 'natural progression', an inevitable evolution through the stages of medical training.
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Affiliation(s)
- Margaret Bearman
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Notting Hill, VIC, Australia.
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Harreiter J, Wiener H, Plass H, Kautzky-Willer A. Perspectives on gender-specific medicine, course and learning style preferences in medical education: a study among students at the Medical University of Vienna. Wien Med Wochenschr 2011; 161:149-54. [DOI: 10.1007/s10354-011-0866-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 01/05/2011] [Indexed: 11/28/2022]
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Bleakley A, Brennan N. Does undergraduate curriculum design make a difference to readiness to practice as a junior doctor? MEDICAL TEACHER 2011; 33:459-67. [PMID: 21609175 DOI: 10.3109/0142159x.2010.540267] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Undergraduate medicine curricula can be designed to enable smoother transition to work as a junior doctor. Evaluations should improve curriculum design. AIM To compare a graduate cohort from one medical school with a cohort from other medical schools in the same Foundation Year 1 (FY1) programme in terms of retrospective perceptions of readiness for practice. METHOD A Likert-scale questionnaire measured self-perception of readiness to practice, including general capabilities and specific clinical skills. RESULTS Response rate was 74% (n = 146). The Peninsula Medical School cohort reported readiness for practice at a significantly higher level than the comparison cohort in 14 out of 58 items (24%), particularly for 'coping with uncertainty'. In only one item (2%) does the comparison cohort report at a significantly higher level. CONCLUSIONS Significant differences between cohorts may be explained by undergraduate curriculum design, where the opportunity for early, structured work-based, experiential learning as students, with patient contact at the core of the experience, may promote smoother transition to work as a junior doctor. Evaluation informs continuous quality improvement of the curriculum.
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Affiliation(s)
- Alan Bleakley
- Peninsula Medical School, University of Plymouth, UK.
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Teunissen PW, Westerman M. Opportunity or threat: the ambiguity of the consequences of transitions in medical education. MEDICAL EDUCATION 2011; 45:51-9. [PMID: 21155868 DOI: 10.1111/j.1365-2923.2010.03755.x] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVES The alleged medical education continuum is interrupted by a number of major transitions. After starting medical school, the first transition students encounter is that from non-clinical to clinical training. The second transition is that of graduated student to junior doctor or specialist trainee, and the third concerns the specialist trainee's transition to medical specialist. As a first step towards a better understanding of the effects of transitions, this paper provides a critical overview of how these transitions have been conceptualised in the medical education domain. The findings are complemented with perspectives from the fields of transitional psychology and organisational socialisation. The transition into medical school is not reviewed. METHODS Using the term 'transition', six leading medical education journals were searched for relevant articles. A snowballing technique on the reference lists of the 44 relevant articles yielded 29 additional publications. Studies were reviewed and categorised as representing objectifying, clarifying, or descriptive and/or justifying research. RESULTS When students enter clinical training, they need to relearn what they thought they knew and they must learn new things in a more self-directed way. As junior doctors or specialist trainees, their main challenges involve handling the many responsibilities that accompany the delivery of patient care while simultaneously learning from the process of providing that care. As medical specialists, new non-medical tasks and decisions on how to delegate responsibilities become issues. CONCLUSIONS Research on transitions has objectified the challenges students and doctors face. Clarifying studies often lack conceptual frameworks that could help us to gain deeper insight into the observed phenomena. Psychology offers valuable theoretical perspectives that are applicable to medical education transitions. To transform a transition from a threat to a learning opportunity, medical education should assist students and doctors in developing the coping skills they need to effectively deal with the challenges presented by new environments.
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Affiliation(s)
- Pim W Teunissen
- Department of Educational Research and Development, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
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Brennan N, Corrigan O, Allard J, Archer J, Barnes R, Bleakley A, Collett T, de Bere SR. The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors. MEDICAL EDUCATION 2010; 44:449-58. [PMID: 20518984 DOI: 10.1111/j.1365-2923.2009.03604.x] [Citation(s) in RCA: 233] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
CONTEXT Medical education in the UK has recently undergone radical reform. Tomorrow's Doctors has prescribed undergraduate curriculum change and the Foundation Programme has overhauled postgraduate education. OBJECTIVES This study explored the experiences of junior doctors during their first year of clinical practice. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. METHODS The study used qualitative methods comprising of semi-structured interviews and audio diary recordings with newly qualified doctors based at the Peninsula Foundation School in the UK. Purposive sampling was used and 31 of 186 newly qualified doctors self-selected from five hospital sites. All 31 participants were interviewed once and 17 were interviewed twice during the year. Ten of the participants also kept audio diaries. Interview and audio diary data were transcribed verbatim and thematically analysed with the aid of a qualitative data analysis software package. RESULTS The findings show that, despite recent curriculum reforms, most participants still found the transition stressful. Dealing with their newly gained responsibility, managing uncertainty, working in multi-professional teams, experiencing the sudden death of patients and feeling unsupported were important themes. However, the stress of transition was reduced by the level of clinical experience gained in the undergraduate years. CONCLUSIONS Medical schools need to ensure that students are provided with early exposure to clinical environments which allow for continuing 'meaningful' contact with patients and increasing opportunities to 'act up' to the role of junior doctor, even as students. Patient safety guidelines present a major challenge to achieving this, although with adequate supervision the two aims are not mutually exclusive. Further support and supervision should be made available to junior doctors in situations where they are dealing with the death of a patient and on surgical placements.
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Affiliation(s)
- Nicola Brennan
- Institute of Clinical Education, Peninsula Medical School, University of Plymouth, Plymouth, UK.
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Hoppe A, Persson E, Birgegård G. Medical interns' view of their undergraduate medical education in Uppsala: an alumnus study with clear attitude differences between women and men. MEDICAL TEACHER 2009; 31:426-32. [PMID: 19811130 DOI: 10.1080/01421590802216266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND An alumni study of graduates from the medical school in Uppsala, was performed to give input into an ongoing reform process. AIMS This study aimed to investigate how medical interns view their undergraduate medical education and the extent to which they felt that the curriculum prepared them for their current positions. METHODS A web-based questionnaire was sent out via mail in 2005 to all past graduates who had qualified in Uppsala in 2003. RESULTS Replies were obtained from 69 of 102 students (68%). The most apparent suggested change of the education was increased integration of preclinical and clinical teaching. Correlations were found between student satisfaction with the medical school and perceived teacher attitude, encouragement to reflect, and the graduates' perception of having sufficient practical abilities. Significant gender differences were found regarding perceived clinical ability and concerning feedback and encouragement from the teachers. CONCLUSIONS Our results suggest more direct feedback from the teachers and more integration between basic sciences and clinical education. Female and male students may have different needs. A key question is therefore to encourage teachers to learn about gender since female and male students should equally experience respectful encounters with teachers and doctors acting as role models.
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Affiliation(s)
- Astrid Hoppe
- Educational Unit, Study Programme in Medicine, Kunskapscentrum, Uppsala University, Uppsala, Sweden.
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Premadasa IG, Shehab D, Al-Jarallah KF, Thalib L. Frequency and confidence in performing clinical skills among medical interns in Kuwait. MEDICAL TEACHER 2008; 30:e60-e65. [PMID: 18484443 DOI: 10.1080/01421590801915652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Several investigations suggest inadequate emphasis of basic clinical procedures during internship training. Many trainees had reported lack of competence, while some expressed confidence to manage conditions although not sufficiently experienced. AIMS This study aimed at ascertaining the perceptions of new medical graduates regarding the performance of core clinical skills during training and confidence of performing them later. It also aimed at determining any gender variability in the confidence in performing selected clinical skills in Obstetrics & Gynaecology. METHODS Interns trained during 2005/06 responded anonymously to a questionnaire that listed 48 core clinical skills. The 124 subjects eligible for the study comprised graduates from Kuwait (64), other Gulf Cooperation Council countries (29), Ireland (27) and Egypt. They indicated whether they felt confident to perform the skills in future, and the number of times they had performed them during training. We received 91 completed questionnaires. RESULTS The majority felt confident in performing routine skills (basic ECG and X-ray interpretations, insertion of intravenous line, inserting urethral catheter and nasogastric feeding). Approximately two thirds had performed generic skills related to emergency resuscitation, with a half of them confident in performing them in the future. A third felt confident in performing artificial ventilation and endotracheal intubation. The confidence to perform common skills in Obstetrics & Gynaecology varied, with no significant gender variation. Approximately a fifth was confident in performing lumbar puncture, needle aspiration of joints, insertion of thoracic drainage, insertion of central venous catheter, venous cut-down and indirect laryngoscopy. A small proportion reported confidence in performing different clinical procedures although they had not undertaken them during training. CONCLUSIONS Substantial proportions of trainees lacked confidence in performing emergency resuscitative measures and some routine clinical skills. Training needs to be closely monitored and interns who are not competent identified early for taking remedial measures.
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Hirsh DA, Ogur B, Thibault GE, Cox M. "Continuity" as an organizing principle for clinical education reform. N Engl J Med 2007; 356:858-66. [PMID: 17314348 DOI: 10.1056/nejmsb061660] [Citation(s) in RCA: 319] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lueddeke GR, Anderson FH, Carr NJ, Mitchell BS, Taylor MES. Looking 'back to the future': alumni perceptions of a UK undergraduate medical programme. MEDICAL TEACHER 2006; 28:654-6. [PMID: 17594560 DOI: 10.1080/01421590600627425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The five year Bachelor of Medicine (BM5) programme of the University of Southampton commenced in 1971. In keeping with other medical schools, the Southampton BM5 programme has been involved in a number of incremental curriculum reforms over the years. Complementing the School's annual pre-registration house officer (PRHO) questionnaire, this study of alumni cohorts (2000-2003) sought to investigate further how past graduates view their medical education and whether there are emerging priorities in medical practice. Findings confirm that alumni rate the BM5 highly and generally value the BM5 aims. Considering the impact of the social context on individual well-being and patient care, increased emphasis may need to be placed on preventive medicine, including greater alignment of several curriculum areas with clinical practice.
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Affiliation(s)
- G R Lueddeke
- School of Medicine, University of Southampton, UK.
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O'Neill P, Duplock A, Willis S. Using clinical experience in discussion within problem-based learning groups. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2006; 11:349-63. [PMID: 16937238 DOI: 10.1007/s10459-006-9014-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 04/27/2006] [Indexed: 05/11/2023]
Abstract
A key principle in problem-based learning (PBL) is the student linking learning from different sources to enrich understanding. We have explored how medical students based in a clinical environment use clinical experience within PBL groups. We recorded the discussion of 12 third-year groups, which were meeting for the second time on a PBL case, where students report back on the learning objectives. Discussions covering five separate PBL paper cases were recorded. Analysis of the transcripts was based on constant comparative method using a coding framework. The range of discussion segments of clinical experience was 2-15, with 9 of 12 groups having at least five separate segments. Our initial coding framework covered 10 categories, of which the most common were: a specific patient encounter (19%); an experience in the community (15%); and a personal health experience (15%). Students often used emotive phrases with 37 examples in the clinical experience segments compared with 9 from the longer non-clinical discussion. Most clinical descriptions triggered further discussion with almost half leading to some related medical topic. The discussion segments were subsequently coded into; 'confirming' (40); 'extending' (40); and 'disconfirming' (16) the understanding of the group for that topic. Discussion of clinical experience encouraged students to connect to the affective aspects of learning. It helped students to bridge between the tutorial and real clinical contexts. A clinical experience was often a powerful pivotal point, which confirmed, extended or refuted what was being discussed.
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Affiliation(s)
- Paul O'Neill
- The Medical School, The University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PL, UK. p.a.o'
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Watmough S, Taylor D, Garden A. Educational supervisors evaluate the preparedness of graduates from a reformed UK curriculum to work as pre-registration house officers (PRHOs): a qualitative study. MEDICAL EDUCATION 2006; 40:995-1001. [PMID: 16987190 DOI: 10.1111/j.1365-2929.2006.02563.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
INTRODUCTION In 1996 the University of Liverpool introduced an integrated problem-based learning (PBL) medical curriculum incorporating the recommendations of Tomorrow's Doctors. This paper investigates whether the PRHO (pre-registration house officer) educational supervisors who supervise Liverpool graduates believe that the reformed curriculum is producing house officers who have the competencies outlined by the General Medical Council. METHODS Forty-one interviews were arranged with a sample of educational supervisors in the Mersey Deanery area to ascertain their views on the competencies of Liverpool PRHOs. The interviews were tape-recorded, transcribed and analysed. RESULTS The supervisors felt that the PRHOs had been well prepared to work as PRHOs, and compared with traditional graduates they were actually better prepared for the job of PRHO. They saw the PRHOs as competent communicators with improved clinical skills, who had good attitudes, were aware of limitations, were team workers, good at history-taking and examination and had different approaches to finding information. There was a very confusing picture regarding basic knowledge, with some consultants expressing concerns, despite saying they had adequate knowledge to work as PRHOs. It emerged that there was little consensus about the knowledge base of the traditional or PBL graduates or what knowledge level was needed at this stage. DISCUSSION Educational supervisors believe that the reformed curriculum in Liverpool is producing competent PRHOs who have been better prepared for the role of PRHO than previous graduates. It could be that uncertainty over knowledge base may be the price paid for reducing the factual burden and improving preparedness for professional practice.
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Affiliation(s)
- Simon Watmough
- School of Medical Education, University of Liverpool, UK.
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Abstract
WHAT IS ALREADY KNOWN IN THIS AREA • The acquisition of clinical reasoning skills from novice to advanced student has been described and compared with experienced clinicians Research from the field of cognitive psychology suggests that development of such skills depends upon organizing packages of information into coherent structures which are quickly accessible from memory. These are called 'instance scripts?. Various strategies are employed in reasoning, starting with step-by-step analysis by novices, moving towards categorisation processes in-advanced practitioners (e.g. pattern recognition). WHAT THIS WORK ADDS • This work suggests a reference framework for reasoning skills and expertise development from novice to experienced practitioner within primary care. It extends ideas from existing Studies using medical students into postgraduate professional development, encompassing various transitions from newly qualified doctor to training registrar, and from new principal towards the experienced practitioner. • Within these transitory stages, reasoning strategies are highlighted, including potential problem areas and appropriate educational implications. The role of follow up mechanisms for GP registrars is suggested to enable validation of illness vectors in the natural history of disease and recovery. Extension of training schemes to provide for expertise development in primary care is proposed as the logical context where such skills can be improved. SUGGESTIONS FOR FUTURE RESEARCH • Current research in medical education in the UK appears to be heavily concentrated upon skills and competency assessment. These are more easily measured than cognitive skills. However, the impact of early clinical contact in UK medical schools upon cognitive skills could be compared with other countries where clinical contact is still delayed. Early patient contact may shift acquisition of some cognitive skills back in the proposed framework. • In addition to this, the impact of the foundation programme upon doctors subsequently entering primary care will provide the biggest stimulus for research, assuming that cognitive attributes, such as decision-making skills, are assessed alongside practical competencies.
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Lohfeld L, Neville A, Norman G. PBL in undergraduate medical education: a qualitative study of the views of Canadian residents. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2005; 10:189-214. [PMID: 16193401 DOI: 10.1007/s10459-005-1293-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Accepted: 01/27/2005] [Indexed: 05/04/2023]
Abstract
BACKGROUND AND OBJECTIVES At McMaster University, the birthplace of problem-based learning (PBL), administrators and curriculum planners have begun the process of renewing the undergraduate MD curriculum. One step has been to conduct an environmental scan that includes input from medical residents. METHODS Individual interviews with 17 medical residents and fellows currently enrolled at McMaster University and are graduates of six Canadian medical schools. RESULTS PBL appears to be well known even by graduates of non-PBL Canadian medical schools. Tutors are key to a successful PBL program, should be knowledgeable about the content area under study and able to effectively facilitate groups. Tutorial problems should be realistic, up-to-date, and challenge students to investigate more than the medical aspects of the case in question. Students need to be prepared, willing to participate in peer teaching, and supportive of the group learning process. PBL programs can be improved if they incorporate elements of traditional medical programs (e.g., mini-lectures, clear learning objectives, and unbiased evaluation of student progress) while retaining the essence of student-generated learning. CONCLUSIONS Medical residents are an underutilized source of information about undergraduate medical programs. According to our participants, more emphasis on faculty development and upgrading health care problems will improve PBL-based undergraduate medical education.
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Affiliation(s)
- Lynne Lohfeld
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Building T-13, Room 117A, L8S 4B1, Ontario, Hamilton, Canada.
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Lempp H, Seabrook M, Cochrane M, Rees J. The transition from medical student to doctor: perceptions of final year students and preregistration house officers related to expected learning outcomes. Int J Clin Pract 2005; 59:324-9. [PMID: 15857330 DOI: 10.1111/j.1742-1241.2005.00438.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In this prospective qualitative study over 12 months, we evaluated the educational and clinical effectiveness of a new final year undergraduate programme in a London medical school (Guy's, King's and St Thomas'). A stratified sample of 17/360 final year students were interviewed four times, and the content was assessed against 32 amalgamated learning outcomes identified in 1997 in The New Doctor. At the beginning of the preregistration year, eight of the learning outcomes were already met, 10 partly, eight remained to be attained and for six, insufficient evidence existed. Preregistration house officers who have been through the final year student house officer programme expressed competence in many of the outcomes of the General Medical Council's New Doctor. The study identified areas such as prescribing where further developments are needed and will help in planning the new foundation programme.
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Affiliation(s)
- H Lempp
- Division of Medical Education, Sherman Education Centre, Thomas Guy House, Guy's Hospital, London SE1 9RT, UK
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Brown J, Ryland I, Chapman T, Graham D. Comparison of aspects of preregistration house officer training from traditional and new medical curricula. ACTA ACUST UNITED AC 2004; 65:745-7. [PMID: 15624451 DOI: 10.12968/hosp.2004.65.12.745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As medical graduates from the new (problem-based learning) curriculum at University of Liverpool undertook their first post in the postgraduate clinical setting, this study investigated whether their views of preregistration training in the Mersey Deanery differed from the last cohort of preregistration house officers who had graduated from the traditional lecture-based medical curriculum at University of Liverpool.
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Affiliation(s)
- Jeremy Brown
- Mersey Deanery and Centre for Health Research and Evaluation, Edge Hill College, Faculty of Health, Ormskirk, Lancashire L39 4QP
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Morrison J. Effect of the undergraduate curriculum on the preparedness of pre-registration house officers. MEDICAL EDUCATION 2003; 37:1060-1061. [PMID: 14984107 DOI: 10.1046/j.1365-2923.2003.01705.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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