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Liu CI, Tang KP, Wang YC, Chiu CH. Impacts of early clinical exposure on undergraduate student professionalism-a qualitative study. BMC MEDICAL EDUCATION 2022; 22:435. [PMID: 35668444 PMCID: PMC9172165 DOI: 10.1186/s12909-022-03505-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/27/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Early clinical exposure (ECE), or authentic human contact in a social or clinical context during preclinical training, has been adopted by many medical schools. This study aims to investigate how medical students' sense of professionalism changed after ECE intervention, with the aim of informing curriculum design to enhance student awareness of the importance of medical professionalism. METHOD Focus groups of ECE students were held to collect data for the study. All participants read interview guidelines before starting. During the focus groups, the students discussed their medical obligations as perceived throughout the course, which offered a choice between four different ECE tracks. They were then asked to report their understanding of the situations they encountered during the course and reflect on their implications. RESULTS Six focus groups of 22 students in total from a medical school in northern Taiwan were held shortly after the students completed an ECE course in September 2019. From their responses, 10 categories relating to medical professionalism were deduced categorized under 5 major dimensions. An additional 8 sub-dimensions on attitudes and 2 sub-dimensions on personal well-being were also identified as new categories separate from but related to medical professionalism. After the ECE intervention, about 59% of participants redefined their understanding of medical professionalism. CONCLUSION ECE and intensive interaction with key stakeholders, including patients and their families, help students in the early stages of medical education form and cultivate a sense of medical professionalism. However, the relationship between participants' personalities, motivations, and clinical activities requires further investigation.
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Affiliation(s)
- Chun-i Liu
- Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Kung-pei Tang
- Department of Early Childhood and Family Education, College of Education, National Taipei University of Education, Taipei, Taiwan
| | - Yun-chu Wang
- Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chiung-hsuan Chiu
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
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Welch Bacon CE, Cavallario JM, Walker SE, Bay RC, Van Lunen BL. Characteristics of Patient Encounters for Athletic Training Students during Clinical Education: A Report from the AATE Research Network. J Athl Train 2022; 57:640-649. [PMID: 35045182 DOI: 10.4085/1062-6050-526-21] [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: 11/09/2022]
Abstract
CONTEXT To enhance the quality of patient care, athletic training students (ATSs) should experience a wide variety of clinical practice settings, interact with diverse patient populations, and engage with patients that have a wide variety of conditions. It is unclear in what ways, if any, ATSs have diverse opportunities during clinical experiences. OBJECTIVE To describe the characteristics of patient encounters (PEs) ATSs engage in during clinical experiences. DESIGN Multi-site, panel design. SETTING 12 professional athletic training programs (ATPs; 5 Bachelor, 7 Master's). PATIENTS OR OTHER PARTICIPANTS 363 ATSs from the ATPs that used E*Value software to document PEs during clinical experiences participated in this study. MAIN OUTCOME MEASURES During each PE, ATSs were asked to log the clinical site at which the PE occurred (college/university, secondary school, clinic, other), the procedures performed during the patient encounter (e.g., knee evaluation, lower leg flexibility/ROM, cryotherapy), and the diagnoses, with ICD-10 code, of the patient (e.g., S83.512A Knee Sprain, ACL). RESULTS 30,630 PEs were entered by 363 ATSs across unique 278 clinical settings. More than 80% of PEs occurred at college/university and secondary school settings. More than half of diagnoses recorded were designated as lower body region. Examination and evaluation procedures and application of therapeutic modality procedures contributed approximately 27% of procedures each. CONCLUSIONS It is surprising that ATSs are not gaining experience in all clinical practice settings in which athletic trainers commonly practice, and our data suggest that students may be consigned to working with more frequently occurring injuries which may not prepare them for the realities of autonomous clinical practice. These findings suggest that directed efforts are needed to ensure ATSs are provided opportunities to engage with h diverse patient populations with a variety of conditions in an array of clinical site types during clinical experiences.
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Affiliation(s)
- Cailee E Welch Bacon
- Associate Professor, Department of Interdisciplinary Health Sciences & School of Osteopathic Medicine in Arizona, A.T. Still University
| | - Julie M Cavallario
- Graduate Program Director, Athletic Training Programs, Old Dominion University
| | | | - R Curtis Bay
- Professor, Department of Interdisciplinary Health Sciences, A.T. Still University
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Shibli-Rahhal A, Brenneman A, McVancel M, Rosenbaum M. A Practical Approach to Integrating Communication Skills and Early Clinical Experience into the Preclinical Medical School Curriculum. MEDICAL SCIENCE EDUCATOR 2019; 29:947-957. [PMID: 34457571 PMCID: PMC8368819 DOI: 10.1007/s40670-019-00779-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Effective integration of early clinical experiences (ECE) with preclinical curricula is challenging, given the limited knowledge-base of students and the unpredictability of clinical environments. Integration of ECE with communication skills (CS) training presents an attractive opportunity since CSs apply to all types of clinical encounters and are independent of students' medical knowledge. We present an ECE program that integrates formal CS training with the realities of clinical practice. METHODS Five ECE sessions occur throughout the first year of medical school, each focusing on a specific set of CSs previously introduced in class. Students actively observe preceptors use these skills, briefly practice them, write a critical analysis on each experience, and discuss these in small groups. To identify the perceived usefulness and impact of the ECE on students' CS learning, we analyzed the critical analyses and post intervention evaluations from students and preceptors. Descriptive analyses used SAS for Windows. Thematic content analysis using constant comparison was used to review and code narrative data, and the most commonly referred to impacts, strengths, and limitations of ECE were identified. RESULTS Analysis of the students' critical analyses identified the following main themes: (1) integration between ECE and formal CS teaching, (2) importance of effective CS to the delivery of good patient care, and (3) adaptability of CS to specific clinical contexts. Preceptors did not perceive the program as an added burden. CONCLUSIONS ECE with focused goals, critical analyses, and small group debriefing can be used to effectively teach and reinforce formal classroom CS training.
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Affiliation(s)
- Amal Shibli-Rahhal
- Department of Internal Medicine, University of Iowa Carver College of Medicine, 1216H MERF, 375 Newton Rd, Iowa City, IA 52242-2600 USA
| | - Anthony Brenneman
- Physician Assistant Program, University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Megan McVancel
- University of Iowa Carver College of Medicine, Iowa City, IA USA
| | - Marcy Rosenbaum
- Office of Consultation and Research in Medical Education and Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA
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Englar RE. Tracking Veterinary Students' Acquisition of Communication Skills and Clinical Communication Confidence by Comparing Student Performance in the First and Twenty-Seventh Standardized Client Encounters. JOURNAL OF VETERINARY MEDICAL EDUCATION 2018; 46:235-257. [PMID: 30285598 DOI: 10.3138/jvme.0917-117r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The American Veterinary Medical Association's Council on Education mandates that veterinary students graduate with competence in clinical communication. Communication competence facilitates the successful transition of students into clinical practice by improving veterinary client satisfaction and reducing the risk of litigation. Curricular experimentation with communications training has led to innovative approaches to this content area, including the adoption of standardized patients from human health care education. Although the use of standardized clients (SCs) is time and resource intensive, their use by veterinary educators has allowed students to work through authentic cases in a safe learning environment in which learner goals drive training. Despite the increasing popularity of SC-based communications curricula, outcomes assessment studies that track the resultant student growth are lacking. Ninety students in the inaugural class of 2018 at Midwestern University College of Veterinary Medicine participated in 27 SC encounters over eight consecutive quarters. Students' use of Calgary-Cambridge Guide communication skills was compared in the first and twenty-seventh encounters. On the basis of SC evaluations of student performance, students increased their use of all communication skills in the final encounter compared with baseline. Students were also more likely to take a comprehensive patient history, build rapport, and retain the client. Mean scores for pre- and post-encounter communication confidence, as self-reported by students, also increased. These findings support that a SC-rich curriculum facilitates student acquisition of communication skills and promotes confidence when students approach entry-level clinical tasks such as history taking.
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von Below B, Rödjer S, Mattsson B, Hange D, Wahlqvist M. What factors motivate junior doctors to engage as clinical tutors? A qualitative study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:151-157. [PMID: 29860243 PMCID: PMC6129157 DOI: 10.5116/ijme.5b07.d108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The study aimed to explore and identify factors motivating junior doctors to engage as long-term clinical tutors in undergraduate medical education. METHODS In this qualitative study, twenty-seven participants were recruited among junior doctors attending preparatory tutor courses at the Sahlgrenska Academy, University of Gothenburg, and the Primary Healthcare system, West Sweden. They were asked to respond to open-ended questions and write a short account of their needs as clinical tutors for medical students. A qualitative content analysis was performed. RESULTS A main theme emerged: "Let me develop my skills in a supportive workplace, provide feedback and merits, and I will continue tutoring". Participants described suitable personality as fundamental, and the need to develop professional skills, both as clinical tutors and physicians. Tutor education was an important source of knowledge and stimulation. A workplace environment, supporting learning and the tutor's role, was considered important, including having an adequate time frame. A clear and well-prepared assignment was regarded essential. Junior doctors requested feedback and merits in their work as long-term tutors. Clinical tutorship was considered an optional task. CONCLUSIONS In this exploratory study, motivating factors of junior doctors' engagement as future long-term tutors were identified. It is important to form a process where junior doctors can build up professional competence as clinical tutors and physicians. To ensure a sustainable tutorship in the future, we suggest that universities and healthcare authorities acknowledge and further study these motivating factors.
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Affiliation(s)
- Bernhard von Below
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Stig Rödjer
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Bengt Mattsson
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Mats Wahlqvist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
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Hatton AL, Mandrusiak A. A Single Clinical Experience in a Nursing Home Improves Physiotherapy Students' Attitudes Towards, and Confidence to Communicate With, Older People. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2018. [DOI: 10.1080/02703181.2018.1449164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Anna Lucy Hatton
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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Cavallario JM, Van Lunen BL, Hoch JM, Hoch M, Manspeaker SA, Pribesh SL. Athletic Training Student Core Competency Implementation During Patient Encounters. J Athl Train 2018; 53:282-291. [PMID: 29420058 DOI: 10.4085/1062-6050-314-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Health care research evidence suggests that early patient encounters (PEs), as well as the purposeful implementation of professional core competencies (CCs), for athletic training students (ATSs) may be beneficial to their ability to provide care. However, no investigators have related facets of the clinical education experience with CC implementation as a form of summative assessment of the clinical experience. OBJECTIVE To determine the relationship between the frequency and length of PEs, as well as the student's role and clinical site during PEs, and the students' perceived CC implementation during these encounters. DESIGN Cross-sectional study. SETTING Professional athletic training program, National Collegiate Athletic Association Division I institution. PATIENTS OR OTHER PARTICIPANTS We purposefully recruited 1 athletic training program that used E*Value software; 40 participants (31 females, 9 males) enrolled in the professional phase (12 first year, 14 second year, 14 third year) participated. INTERVENTION(S) Participants viewed a 20-minute recorded CC educational module followed by educational handouts, which were also posted online for reference throughout the semester. The E*Value software was used to track PEs, including the type of encounter (ie, actual patient, practice encounter, didactic practice scenario), the type of site where the encounter occurred (university, high school), and the participant's role (observed, assisted, performed), as well as responses to an added block of questions indicating which, if any, of the CCs were implemented during the PE. MAIN OUTCOME MEASURE(S) Variables per patient were PE length (minutes), participant role, site at which the encounter occurred, and whether any of the 6 CCs were implemented ( yes/ no). Variables per participant were average encounter length (minutes), encounter frequency, modal role, clinical site assignment, and the number of times each CC was implemented. Separate 1-way analyses of variance were used to examine the relationships between role or clinical site and implementation of total number of CCs. Multiple linear regressions were used to determine how the average length and frequency of PEs were related to the average and total number of implemented CCs. Binary logistic regression models indicated how the length of each encounter, role of the participant, and type of clinical site related to the implementation of each CC. RESULTS The roles of participants during PEs were related to their ability to implement the total number of CCs ( F = 103.48, P < .001). Those who observed were likely to implement fewer total CCs than those who assisted (M diff = -0.29, P < .001); those who assisted were likely to implement more total CCs than those who performed (M diff = 0.32, P < .001). Frequency of encounters was the only significant variable in the model examining all independent variables with CC implementation ( b4,32 = 3.34, t = 9.46, P < .001). CONCLUSIONS The role of the student, namely assisting during PEs, and the volume of PEs should be considered priorities for students to promote greater CC implementation.
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Affiliation(s)
- Julie M Cavallario
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA
| | - Bonnie L Van Lunen
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA
| | | | | | | | - Shana L Pribesh
- School of Physical Therapy and Athletic Training, Old Dominion University, Norfolk, VA
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Park S, Khan NF, Hampshire M, Knox R, Malpass A, Thomas J, Anagnostelis B, Newman M, Bower P, Rosenthal J, Murray E, Iliffe S, Heneghan C, Band A, Georgieva Z. A BEME systematic review of UK undergraduate medical education in the general practice setting: BEME Guide No. 32. MEDICAL TEACHER 2015; 37:611-630. [PMID: 25945945 DOI: 10.3109/0142159x.2015.1032918] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND General practice is increasingly used as a learning environment in undergraduate medical education in the UK. AIM The aim of this project was to identify, summarise and synthesise research about undergraduate medical education in general practice in the UK. METHODS We systematically identified studies of undergraduate medical education within a general practice setting in the UK from 1990 onwards. All papers were summarised in a descriptive report and categorised into two in-depth syntheses: a quantitative and a qualitative in-depth review. RESULTS 169 papers were identified, representing research from 26 UK medical schools. The in-depth review of quantitative papers (n = 7) showed that medical students learned clinical skills as well or better in general practice settings. Students receive more teaching, and clerk and examine more patients in the general practice setting than in hospital. Patient satisfaction and enablement are similar whether a student is present or not in a consultation, however, patients experience lower relational empathy. Two main thematic groups emerged from the qualitative in-depth review (n = 10): the interpersonal interactions within the teaching consultation and the socio-cultural spaces of learning which shape these interactions. The GP has a role as a broker of the interactions between patients and students. General practice is a socio-cultural and developmental learning space for students, who need to negotiate the competing cultures between hospital and general practice. Lastly, patients are transient members of the learning community, and their role requires careful facilitation. CONCLUSIONS General practice is as good, if not better, than hospital delivery of teaching of clinical skills. Our meta-ethnography has produced rich understandings of the complex relationships shaping possibilities for student and patient active participation in learning.
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AlHaqwi AI, Taha WS. Promoting excellence in teaching and learning in clinical education. J Taibah Univ Med Sci 2015. [DOI: 10.1016/j.jtumed.2015.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Application of Educational Theory and Evidence in Support of an Integrated Model of Clinical Education. ACTA ACUST UNITED AC 2014. [DOI: 10.1097/00001416-201400001-00005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yardley S, Brosnan C, Richardson J, Hays R. Authentic early experience in Medical Education: a socio-cultural analysis identifying important variables in learning interactions within workplaces. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2013; 18:873-891. [PMID: 23212811 DOI: 10.1007/s10459-012-9428-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 07/02/2012] [Indexed: 06/01/2023]
Abstract
This paper addresses the question 'what are the variables influencing social interactions and learning during Authentic Early Experience (AEE)?' AEE is a complex educational intervention for new medical students. Following critique of the existing literature, multiple qualitative methods were used to create a study framework conceptually orientated to a socio-cultural perspective. Study participants were recruited from three groups at one UK medical school: students, workplace supervisors, and medical school faculty. A series of intersecting spectra identified in the data describe dyadic variables that make explicit the parameters within which social interactions are conducted in this setting. Four of the spectra describe social processes related to being in workplaces and developing the ability to manage interactions during authentic early experiences. These are: (1) legitimacy expressed through invited participation or exclusion; (2) finding a role-a spectrum from student identity to doctor mindset; (3) personal perspectives and discomfort in transition from lay to medical; and, (4) taking responsibility for 'risk'-moving from aversion to management through graded progression of responsibility. Four further spectra describe educational consequences of social interactions. These spectra identify how the reality of learning is shaped through social interactions and are (1) generic-specific objectives, (2) parallel-integrated-learning, (3) context specific-transferable learning and (4) performing or simulating-reality. Attention to these variables is important if educators are to maximise constructive learning from AEE. Application of each of the spectra could assist workplace supervisors to maximise the positive learning potential of specific workplaces.
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Affiliation(s)
- Sarah Yardley
- Research Institute of Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, UK,
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Abstract
This Guide provides an overview of educational theory relevant to learning from experience. It considers experience gained in clinical workplaces from early medical student days through qualification to continuing professional development. Three key assumptions underpin the Guide: learning is 'situated'; it can be viewed either as an individual or a collective process; and the learning relevant to this Guide is triggered by authentic practice-based experiences. We first provide an overview of the guiding principles of experiential learning and significant historical contributions to its development as a theoretical perspective. We then discuss socio-cultural perspectives on experiential learning, highlighting their key tenets and drawing together common threads between theories. The second part of the Guide provides examples of learning from experience in practice to show how theoretical stances apply to clinical workplaces. Early experience, student clerkships and residency training are discussed in turn. We end with a summary of the current state of understanding.
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von Below B, Rödjer S, Wahlqvist M, Billhult A. "I couldn't do this with opposition from my colleagues": a qualitative study of physicians' experiences as clinical tutors. BMC MEDICAL EDUCATION 2011; 11:79. [PMID: 21975057 PMCID: PMC3212900 DOI: 10.1186/1472-6920-11-79] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 10/05/2011] [Indexed: 05/26/2023]
Abstract
BACKGROUND Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors. METHODS Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method. RESULTS In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: (a) Pleasure and stimulation. Informants appreciated tutorship and meeting both students and fellow tutors, (b) Disappointment and stagnation. Occasionally, tutors were frustrated and expressed negative feelings, (c) Demands and duty. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, (d) Impact of workplace relations. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and (e) Multitasking difficulties. Combining several duties with those of a tutorship was often reported as difficult. CONCLUSIONS It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system.
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Affiliation(s)
- Bernhard von Below
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Floda Primary Health Care Center, Southern Älvsborg County, Rurik Holms väg, S-448 30 Floda, Sweden
- Research and Development Unit, Primary Health Care, Southern Älvsborg County, Sven Eriksonsplatsen 4, plan 2, S-503 38 Borås, Sweden
| | - Stig Rödjer
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Section of Hematology, Department of Medicine, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Mats Wahlqvist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
| | - Annika Billhult
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Research and Development Unit, Primary Health Care, Southern Älvsborg County, Sven Eriksonsplatsen 4, plan 2, S-503 38 Borås, Sweden
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Maudsley G. Mixing it but not mixed-up: mixed methods research in medical education (a critical narrative review). MEDICAL TEACHER 2011; 33:e92-104. [PMID: 21275539 DOI: 10.3109/0142159x.2011.542523] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Some important research questions in medical education and health services research need 'mixed methods research' (particularly synthesizing quantitative and qualitative findings). The approach is not new, but should be more explicitly reported. AIM The broad search question here, of a disjointed literature, was thus: What is mixed methods research - how should it relate to medical education research?, focused on explicit acknowledgement of 'mixing'. METHODS Literature searching focused on Web of Knowledge supplemented by other databases across disciplines. FINDINGS Five main messages emerged: - Thinking quantitative and qualitative, not quantitative versus qualitative - Appreciating that mixed methods research blends different knowledge claims, enquiry strategies, and methods - Using a 'horses for courses' [whatever works] approach to the question, and clarifying the mix - Appreciating how medical education research competes with the 'evidence-based' movement, health services research, and the 'RCT' - Being more explicit about the role of mixed methods in medical education research, and the required expertise CONCLUSION Mixed methods research is valuable, yet the literature relevant to medical education is fragmented and poorly indexed. The required time, effort, expertise, and techniques deserve better recognition. More write-ups should explicitly discuss the 'mixing' (particularly of findings), rather than report separate components.
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Affiliation(s)
- Gillian Maudsley
- Division of Public Health, Whelan Building, Quadrangle, The University of Liverpool, Liverpool L69 3GB, UK.
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Başak O, Yaphe J, Spiegel W, Wilm S, Carelli F, Metsemakers JFM. Early clinical exposure in medical curricula across Europe: An overview. Eur J Gen Pract 2009; 15:4-10. [DOI: 10.1080/13814780902745930] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Strengths and weaknesses of simulated and real patients in the teaching of skills to medical students: a review. Simul Healthc 2009; 3:161-9. [PMID: 19088660 DOI: 10.1097/sih.0b013e318182fc56] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of this review was to identify the strengths and weaknesses of the roles of real and simulated patients in undergraduate medical education. The literature was reviewed in relation to four patient roles: real patients as educational "resource" (passive role), real patients as teachers (active role), and simulated patients as educational resource and teachers. Each of the four patient roles was found to have specific advantages and disadvantages from the perspectives of teachers, students, and patients. For example, advantages of real patients as educational resource were patient-centered learning and high patient satisfaction. Disadvantages were their limited availability and the variability in learning experiences among students. Despite the considerable amount of literature we found, many gaps in knowledge about patient roles in medical education remain and should be addressed by future studies.
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von Below B, Hellquist G, Rödjer S, Gunnarsson R, Björkelund C, Wahlqvist M. Medical students' and facilitators' experiences of an Early Professional Contact course: active and motivated students, strained facilitators. BMC MEDICAL EDUCATION 2008; 8:56. [PMID: 19055727 PMCID: PMC2614986 DOI: 10.1186/1472-6920-8-56] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 12/02/2008] [Indexed: 05/11/2023]
Abstract
BACKGROUND Today, medical students are introduced to patient contact, communication skills, and clinical examination in the preclinical years of the curriculum with the purpose of gaining clinical experience. These courses are often evaluated from the student perspective. Reports with an additional emphasis on the facilitator perspective are scarce. According to constructive alignment, an influential concept from research in higher education, the learning climate between students and teachers is also of great importance. In this paper, we approach the learning climate by studying both students' and facilitators' course experiences.In 2001, a new "Early Professional Contact" longitudinal strand through term 1-4, was introduced at the Sahlgrenska Academy, University of Gothenburg, Sweden. General practitioners and hospital specialists were facilitators.The aim of this study was to assess and analyse students' and clinical facilitators' experiences of the Early Professional Contact course and to illuminate facilitators' working conditions. METHODS Inspired by a Swedish adaptation of the Course Experience Questionnaire, an Early Professional Contact Questionnaire was constructed. In 2003, on the completion of the first longitudinal strand, a student and facilitator version was distributed to 86 students and 21 facilitators. In the analysis, both Chi-square and the Mann-Whitney tests were used. RESULTS Sixty students (70%) and 15 facilitators (71%) completed the questionnaire. Both students and facilitators were satisfied with the course. Students reported gaining iiration for their future work as doctors along with increased confidence in meeting patients. They also reported increased motivation for biomedical studies. Differences in attitudes between facilitators and students were found. Facilitators experienced a greater workload, less reasonable demands and less support, than students. CONCLUSION In this project, a new Early Professional Contact course was analysed from both student and facilitator perspectives. The students experienced the course as providing them with a valuable introduction to the physician's professional role in clinical practice. In contrast, course facilitators often experienced a heavy workload and lack of support, despite thorough preparatory education. A possible conflict between the clinical facilitator's task as educator and member of the workplace is suggested. More research is needed on how doctors combine their professional tasks with work as facilitators.
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Affiliation(s)
- Bernhard von Below
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Floda Primary Health Care Center, Southern Älvsborg County, Rurik Holms väg, S-448 30 Floda, Sweden
- Research and Development Unit, Primary Health Care, Southern Älvsborg County, Sven Eriksonsplatsen 4, plan 2, S-503 38 Borås, Sweden
| | - Gunilla Hellquist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
| | - Stig Rödjer
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Section of Hematology, Department of Medicine, Sahlgrenska University Hospital, S-413 45 Gothenburg, Sweden
| | - Ronny Gunnarsson
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
- Research and Development Unit, Primary Health Care, Southern Älvsborg County, Sven Eriksonsplatsen 4, plan 2, S-503 38 Borås, Sweden
| | - Cecilia Björkelund
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
| | - Mats Wahlqvist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, PO Box 454, SE-405 30 Gothenburg, Sweden
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Ottenheijm RPG, Zwietering PJ, Scherpbie AJJA, Metsemakers JFM. Early student-patient contacts in general practice: an approach based on educational principles. MEDICAL TEACHER 2008; 30:802-8. [PMID: 18608956 DOI: 10.1080/01421590802047265] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Clinical teaching and learning is generally seen as an educationally sound approach, but the clinical environment does not always offer optimal conditions to facilitate students' learning processes. AIMS To show how insights on constructing a good learning environment for student-patient contacts in real practice can be translated into an undergraduate clinical general practice programme in Year 3 and to study its feasibility. METHOD Literature search, yielding starting points for the development of the new programme and questionnaire evaluation of the programme. RESULTS Six starting points for a good learning environment for early student-patient contacts: continuing exposure to patients,transformation of experience into knowledge, active role of students, supervision and feedback, time and space for teaching and teacher training were translated into a the new programme. The evaluation showed that the programme was feasible and well received by students and GPs, although some improvements are possible. CONCLUSION In a curriculum with clear goals for early student-patient contacts, it is feasible to implement an early clinical programme in general practice based on educational principles.
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Affiliation(s)
- Ramon P G Ottenheijm
- Department of General Practice, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
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