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Zickuhr L, Kolfenbach J, Bolster MB. Applying Educational Theory to Optimize Trainee Education in the Ambulatory Virtual Care Environment. MEDICAL SCIENCE EDUCATOR 2021; 31:1715-1722. [PMID: 34422453 PMCID: PMC8370462 DOI: 10.1007/s40670-021-01365-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 05/10/2023]
Abstract
Virtual care (VC) encounters have become an essential part of outpatient clinical care. The theory of situated learning and legitimate peripheral participation posits that medical trainees learn best when they participate in authentic patient care experiences and engage effectively with their preceptors, members of the health care team, and the clinical learning environment. This theory can provide a framework from which to approach teaching in the VC setting, whereby preceptors may capitalize on the unique learning and assessment opportunities provided during VC encounters and optimize educational experiences for trainees as well as clinical outcomes for patients. In this monograph, we propose an approach grounded in situated learning and legitimate peripheral participation for teaching in the VC environment, particularly during real-time video visits.
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Affiliation(s)
- Lisa Zickuhr
- Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
| | - Jason Kolfenbach
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO USA
| | - Marcy B. Bolster
- Department of Medicine, Massachusetts General Hospital, Boston, MA USA
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Allan R, McAleer S. Parallel consulting method: student and tutor evaluation in general practice. EDUCATION FOR PRIMARY CARE 2021; 32:308-310. [PMID: 33847234 DOI: 10.1080/14739879.2021.1908174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The parallel consulting method (PCM) is widely used by general practitioners (GPs) for teaching medical students. Studies have described individual aspects of bedside teaching in community settings, including the logistics of using the PCM, but there has been no evaluation of it as a teaching method. This study aimed to evaluate the PCM and whether it helped students develop consultation, clinical and clinical reasoning skills. The study was based at the Oxford University Primary Care Department. Penultimate clinical year students (n = 63) were recruited to take part in this mixed methods study. Students completed a questionnaire with closed and open-ended questions rating the PCM. A focus group explored questionnaire themes. GP tutors completed a questionnaire about the PCM and the logistics of delivering it. Three tutors took part in semi-structured interviews. The PCM helped develop students' consulting, and clinical reasoning skills. Teaching was improved when tutors were unrushed and had increased time to provide feedback and teaching. Delivery logistics of the PCM impacted on whether tutors were rushed and found it difficult to teach. Most benefit was derived when students were well briefed with sufficient debriefing time following a consultation. The following steps are recommended for effective delivery of the PCM teaching model: ensure tutors are appropriately trained; comprehensively brief the student about how to gain the most out of the learning experience; plan the logistics; ensure appropriate review and debriefing following consultation; review clinical cases after the session teaching on any outstanding aspects.
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Affiliation(s)
- Rachel Allan
- Department of Primary Care, University of Oxford, Oxford, UK
| | - Sean McAleer
- Centre for Medical Education, University of Dundee, Dundee, UK
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Oberhelman S, Boswell C, Jensen T, Swartz D, Bruhl E, O’Brien M, Angstman K. Student experiences and satisfaction with a novel clerkship patient scheduling. MEDICAL EDUCATION ONLINE 2020; 25:1742963. [PMID: 32174268 PMCID: PMC7144222 DOI: 10.1080/10872981.2020.1742963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/14/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
Background: Outpatient primary care clerkships are an important part of medical students' education.Traditional clerkships usually partner a student with a single preceptor in that physician's clinic. However, it can be quite difficult for the preceptor to balance the educational needs of the students, the expectations of the patients and the organizational demands of the clinic practice.Objective: An innovative scheduling model (named "Patients as Teachers" [PAT] clinic) was developed as part of our third-year Family Medicine clerkship. The goal was to increase the students' opportunities for independence and improve their satisfaction without negatively impacting the flow of the clinic or patient satisfaction.Design: The third-year medical students spent part of their clerkship working in the PAT clinic and part of the time working with an individual preceptor in that preceptor's clinic in the traditional, usual fashion (PAU clinic-precepting as usual). The students completed patient-logs regarding the patients they saw and their level of participation. They also completed a voluntary survey regarding their experiences.Results: Students performed more independent interviews (90.3 vs 59.0%) and independent exams (96.2 vs 63.3%) in the PAT clinic than while working with their traditional preceptor (both p<0.01). Students were highly satisfied with the experience with 89.5% stating they would recommend it and 87.7% finding the PAT clinic to be an equal or superior experience to the PAU experience.Conclusions: Using a combination of time in the PAT clinic and time with a one on one preceptor in the usual fashion was successful in increasing opportunities for student autonomy and achieving a high level of student satisfaction in our third-year Family Medicine clerkship. Additional opportunities for innovative scheduling could be considered for meeting a variety of clerkship and clinic needs.
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Affiliation(s)
- Sara Oberhelman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chris Boswell
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Teresa Jensen
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel Swartz
- Department of Family Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, VA, US
| | - Elliot Bruhl
- Southeast Alaska Regional Health Consortium, Juneau, AK, US
| | - Marcia O’Brien
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kurt Angstman
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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Hayes V, Bing-You R, Varaklis K, Trowbridge R, Kemp H, McKelvy D. The research contributions of predominantly North American Family Medicine educators to medical learner feedback: a descriptive analysis following a scoping review. EDUCATION FOR PRIMARY CARE 2018; 29:144-150. [PMID: 29366382 DOI: 10.1080/14739879.2018.1424566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVES In 2016, we performed a scoping review as a means of mapping what is known in the literature about feedback to medical learners. In this descriptive analysis, we explore a subset of the results to assess the contributions of predominantly North American family medicine educators to the feedback literature. METHODS Nineteen articles extracted from our original scoping review plus six articles identified from an additional search of the journal Family Medicine are described in-depth. RESULTS The proportion of articles involving family medicine educators identified in our scoping review is small (n=19/650, 3%) and the total remains low (25) after including additional articles (n=6) from a Family Medicine search. They encompass a broad range of feedback methods and content areas. They primarily originated in the United States (n=19) and Canada (n=3) within Family Medicine Departments (n=20) and encompass a variety of scientific and educational research methodologies. CONCLUSIONS The contributions of predominantly North American Family Medicine educators to the literature on feedback to learners are sparse in number and employ a variety of focus areas and methodological approaches. More studies are needed to assess for areas of education research where family physicians could make valuable contributions.
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Beach RA. Strategies to maximise teaching in your next ambulatory clinic. CLINICAL TEACHER 2017; 14:85-89. [DOI: 10.1111/tct.12638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Renée A Beach
- Division of Dermatology; Department of Medicine; Women's College Hospital; affiliate of the University of Toronto; Faculty of Medicine; Toronto Canada
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Chen HC, O'Sullivan P, Teherani A, Fogh S, Kobashi B, ten Cate O. Sequencing learning experiences to engage different level learners in the workplace: An interview study with excellent clinical teachers. MEDICAL TEACHER 2015; 37:1090-1097. [PMID: 25693794 DOI: 10.3109/0142159x.2015.1009431] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE Learning in the clinical workplace can appear to rely on opportunistic teaching. The cognitive apprenticeship model describes assigning tasks based on learner rather than just workplace needs. This study aimed to determine how excellent clinical teachers select clinical learning experiences to support the workplace participation and development of different level learners. METHODS Using a constructivist grounded theory approach, we conducted semi-structured interviews with medical school faculty identified as excellent clinical teachers teaching multiple levels of learners. We explored their approach to teach different level learners and their perceived role in promoting learner development. We performed thematic analysis of the interview transcripts using open and axial coding. RESULTS We interviewed 19 clinical teachers and identified three themes related to their teaching approach: sequencing of learning experiences, selection of learning activities and teacher responsibilities. All teachers used sequencing as a teaching strategy by varying content, complexity and expectations by learner level. The teachers initially selected learning activities based on learner level and adjusted for individual competencies over time. They identified teacher responsibilities for learner education and patient safety, and used sequencing to promote both. CONCLUSIONS Excellent clinical teachers described strategies for matching available learning opportunities to learners' developmental levels to safely engage learners and improve learning in the clinical workplace.
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Affiliation(s)
| | | | | | | | | | - Olle ten Cate
- b University Medical Center Utrecht , The Netherlands
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Gonzalo JD, Heist BS, Duffy BL, Dyrbye L, Fagan MJ, Ferenchick G, Harrell H, Hemmer PA, Kernan WN, Kogan JR, Rafferty C, Wong R, Elnicki DM. The art of bedside rounds: a multi-center qualitative study of strategies used by experienced bedside teachers. J Gen Intern Med 2013; 28:412-20. [PMID: 23129164 PMCID: PMC3579967 DOI: 10.1007/s11606-012-2259-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 09/05/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Medical educators believe bedside rounds are effective for the delivery of patient-centered care, and are necessary in helping trainees acquire competence in clinical care. Although recommendations for bedside rounds have been reported, a recent, systematic assessment of strategies used by current-day bedside teachers was needed to advance knowledge of this teaching method. OBJECTIVE To identify and understand bedside teachers' 1) preparatory steps, 2) patient selection, and 3) role allocation during the process of bedside rounds. DESIGN A qualitative inductive thematic analysis using transcripts from audio-recorded, semi-structured telephone interviews. PARTICIPANTS Internal medicine physicians (n = 34) who perform bedside rounds from ten academic US institutions (2010-2011). APPROACH A purposive sampling strategy was utilized to identify physicians who were active inpatient attending physicians and met specific inclusion criteria for "bedside rounds." A total of 34 interviews were completed, and each was recorded and transcribed verbatim. A thematic analysis extracted key themes pertaining to the three objectives. KEY RESULTS Most respondents (51 %) were associate or full professors, with an average of 14 years of academic experience. Attending physicians prepared using trainee-specific, patient-specific and disease-specific information, while also mentally preparing for bedside rounds. They sought trainee buy-in and learning objectives, reviewed expectations and methods to ensure patient comfort, and provided early guidance with bedside encounters. Patients were selected if they required immediate care, were new to the service, or had a high educational value, while patients were deferred if unavailable, unwilling, or unable to communicate. The team members' roles during bedside rounds varied, with trainees being given graduated autonomy with increased experience. CONCLUSIONS Bedside teachers' methods for preparation, patient selection, and role allocation during bedside rounds enhance trainees' education within the workplace. Strategies used by experienced bedside teachers can be used for faculty development efforts aimed at promoting this activity.
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Affiliation(s)
- Jed D Gonzalo
- Pennsylvania State University College of Medicine, Hershey, PA, USA.
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Gierk B, Harendza S. Patient selection for bedside teaching: inclusion and exclusion criteria used by teachers. MEDICAL EDUCATION 2012; 46:228-233. [PMID: 22239336 DOI: 10.1111/j.1365-2923.2011.04054.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CONTEXT Bedside teaching encounters on hospital wards offer medical students opportunities to learn key medical and interpersonal skills. Although many aspects of bedside teaching have been studied, not much is known about the selection process used by medical teachers to find patients for these encounters. Patient selection could have a substantial impact on medical students' clinical experiences. Therefore, we studied the ways in which medical teachers select patients for bedside teaching and tried to determine the factors that affect patient selection. METHODS Using a qualitative research approach, we interviewed 15 teachers from three departments within the Medical Faculty at Hamburg University on how they choose patients for bedside teaching encounters. We extracted selection criteria from the transcripts of the audio-recorded interviews and identified other factors that influenced selection. RESULTS One main category and two minor categories of factors relevant to patient selection were identified: educational; bio-psycho-social, and structural. Medical teachers look primarily for patients who have diseases that fit their conceptions of the learning objectives of the lessons in question. The two minor categories influence their choice of patients in different ways. By finding a balance between these categories, they decide which patients are eligible for participation. As a result of these selection criteria, some patients are more likely to become involved in clinical teaching, whereas others may be omitted. CONCLUSIONS Patient selection for bedside teaching is based on several criteria. Non-representative patient selection may narrow the learning experiences of medical students. Curriculum planners need to be aware that specific aspects of medical care may be neglected as a result of the exclusion of some patients. Teacher training and additional teaching formats should be provided to ensure that these are covered.
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Affiliation(s)
- Benjamin Gierk
- Department of Internal Medicine, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany
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Carmody D, Tregonning A, Nathan E, Newnham JP. Patient perceptions of medical students' involvement in their obstetrics and gynaecology health care. Aust N Z J Obstet Gynaecol 2011; 51:553-8. [PMID: 21981308 DOI: 10.1111/j.1479-828x.2011.01362.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine perceptions held by patients of the involvement of medical students in their obstetrics and gynaecology health care. STUDY DESIGN This study evaluated patients' perceptions of medical students involved in their care at a tertiary women's hospital. A questionnaire was used to collect patients' perceptions of the student's professional skills, their attitude to and level of comfort in the patient and student interaction. RESULTS Ninety-five percent of patients approached participated in this study. Results demonstrated a high level of patient satisfaction with student involvement in care. Most patients believed students should be part of the hospital team and were prepared to have a student involved in the future. Satisfaction levels were higher for patients for whom English was their first language, women under 40 years of age and those receiving care in assessment and in-patient settings. Patient comfort in student participation was greater for those seen by a female student and those who had previously had a student involved in their care or previously attended the hospital. CONCLUSION Patient perceptions of students' involvement in their obstetrics and gynaecology care are mainly positive. Satisfaction levels differ with the gender of the student, the age of the patient, the location of care and for those for whom English is their first language. Attention must be paid to informing patients of the presence and possible level of interaction of students in their care.
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Affiliation(s)
- Dianne Carmody
- School of Women's and Infants' Health, The University of Western Australia Women and Infants Research Foundation, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, WA 6008, Australia.
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Myung SJ, Kang SH, Kim YS, Lee EB, Shin JS, Shin HY, Park WB. The use of standardized patients to teach medical students clinical skills in ambulatory care settings. MEDICAL TEACHER 2010; 32:e467-e470. [PMID: 21039087 DOI: 10.3109/0142159x.2010.507713] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Ambulatory medicine is being increasingly emphasized in undergraduate medical education. Because of the limited availability of real patients, we introduced a standardized patient (SP) encounter program in an ambulatory care setting. AIMS This study was undertaken to assess the usefulness of SPs for teaching undergraduate students clinical skills in ambulatory settings. METHOD Third-year medical students met two different SPs, who presented common authentic problems, during internal medicine clerkship. Each SP encounter of 30 min was followed by SP and a tutor's feedback, using a video recording of the SP encounter. We surveyed students for program evaluation purposes at the end of their three-year internal medicine clerkships (from 2006 to 2008). RESULTS Most students found that the consecutive SP sessions were instructive and helpful. Video recordings of clinical encounters allowed students to reflect on their behavior and receive feedback from tutors. However, students identified several weaknesses of these SP encounters. For example, pre-exposure to the SP scenario reduced tension of the experience and inconsistent feedback from tutors caused confusion. CONCLUSIONS SP encounters in an ambulatory care setting, followed by tutor's feedback based on a video recording, can be used for teaching basic clinical ambulatory care skills.
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Affiliation(s)
- Sun Jung Myung
- Seoul National University College of Medicine, Republic of Korea
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O'Leary KJ, Chadha V, Fleming VM, Martin GJ, Baker DW. Medical subinternship: student experience on a resident uncovered hospitalist service. TEACHING AND LEARNING IN MEDICINE 2008; 20:18-21. [PMID: 18444180 DOI: 10.1080/10401330701797974] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Studies demonstrating the value of hospitalists to medical student education have been performed in traditional resident covered ward service settings (RCWS). PURPOSE To compare medical subinterns' experiences on an RCWS to that on a resident uncovered hospitalist service (RUHS). METHODS We assessed students' overall experience and knowledge learned on the two services using a 5-point Likert scale. We also assessed learning environment characteristics, workload, and time spent at the hospital on each service. RESULTS The mean rating for knowledge learned was higher on the RCWS. Subinterns rated the two services equivalent on measures of educational value of patient problems, faculty assessment, supervision, and number and value of teaching sessions. The RCWS received higher ratings on variety of patient problems and frequency of intellectual discussion. CONCLUSIONS The RCWS provided a superior learning experience for subinterns. Academic medical centers should take these findings into consideration before placing medical students on an RUHS.
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Affiliation(s)
- Kevin J O'Leary
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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