Perspective: the case for subspecialty clinical learning in early medical education-moving from case-based to patient-based learning

Developing a national collaborative of medical educators who lead clinical skills courses

BACKGROUND

The majority of US medical schools now have pre-clerkship clinical skills (PCCS) courses. Course directors for these often logistically complicated courses may be in different medical specialties and, historically, have had few formal opportunities for communication and collaboration with their counterparts at other institutions. As such, we hypothesized that leaders of PCCS courses would benefit from a national network.

SUMMARY

In this paper, we outline the methodology used to form a national collaborative from grass roots interest. Over three years, a self-identified eleven-person task force with national representation has created an organization for PCCS course directors from US medical schools called Directors Of Clinical Skills courses (DOCS) that meets annually.

CONCLUSIONS

Through iterative presentations at regional and national medical education meetings, we have produced an inventory of educational issues for those developing, administering, and evaluating PCCS courses. Further development of this nascent organization is ongoing. Our process is generalizable.

Assessment and feedback to facilitate self-directed learning in clinical practice of Midwifery students

BACKGROUND

Clinical workplaces are hectic and dynamic learning environments, which require students to take charge of their own learning. Competency development during clinical internships is a continuous process that is facilitated and guided by feedback. Limited feedback, lack of supervision and problematic assessment of clinical competencies make the development of learning instruments to support self-directed learning necessary.

AIMS

To explore students' perceptions about a newly introduced integrated feedback and assessment instrument to support self-directed learning in clinical practice. Students collected feedback from clinical supervisors and wrote it on a competency-based format. This feedback was used for self-assessment, which had to be completed before the final assessment.

METHODS

Four focus group discussions were conducted with second and last year Midwifery students. Focus groups were audiotaped, transcribed verbatim and analysed in a thematic way using ATLAS.ti for qualitative data analysis.

RESULTS

The analysis of the transcripts suggested that integrating feedback and assessment supports participation and active involvement in learning by collecting, writing, asking, reading and rereading feedback. Under the condition of training and dedicated time, these learning activities stimulate reflection and facilitate the development of strategies for improvement. The integration supports self-assessment and formative assessment but the value for summative assessment is contested. The quality of feedback and empowerment by motivated supervisors are essential to maximise the learning effects.

CONCLUSIONS

The integrated Midwifery Assessment and Feedback Instrument is a valuable tool for supporting formative learning and assessment in clinical practice, but its effect on students' self-directed learning depends on the feedback and support from supervisors.

2008 ACLPS panel discussion on resident education in clinical pathology

A curriculum in clinical pathology (CP) was developed under the auspices of the Academy of Clinical Laboratory Physicians and Scientists (ACLPS) in 2006. At the 2008 ACLPS meeting in Philadelphia, PA, a panel was convened to address the current challenges in resident education and how to overcome them. Current challenges include the heterogeneity of the discipline (which requires analytical, medical, and managerial knowledge), the diverse repertoire of clinical laboratory testing, and the need to better integrate the resident into the work flow of the laboratory, especially with respect to clinical consultation. Recommendations of the panel include the incorporation of active learning, clinical consultation, and competency assessment into CP resident training. A summary of the panel discussion is presented herein.