Consultant attitudes to undertaking undergraduate teaching duties: perspectives from hospitals serving a large medical school

The Clinical Teaching Fellow role: exploring expectations and experiences

BACKGROUND

Many UK junior doctors are now taking a year out of the traditional training pathway, usually before specialty training, and some choose to work as a clinical teaching fellow (CTF). CTFs primarily have responsibility for delivering hospital-based teaching to undergraduate medical students. Only a very small amount of literature is available regarding CTF posts, none of which has explored why doctors choose to undertake the role and their expectations of the job. This study aimed to explore the expectations and experiences of CTFs employed at NHS hospital Trusts in the West Midlands.

METHODS

CTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 took part in a survey and a focus group.

RESULTS

Twenty-eight CTFs participated in the survey and ten participated in the focus group. In the survey, participants reported choosing a CTF role due to an interest in teaching, wanting time out of training, and being unsure of which specialty to choose. Expectations for the year in post were directly related to reasons for choosing the role with participants expecting to develop teaching skills, and have a break from usual clinical work and rotations. The focus group identified five main themes relating to experiences starting their job, time pressures and challenges faced in post, how CTF jobs differed between Trusts, and future career plans. Broadly, participants reported enjoying their year in a post at a mid-year point but identified particular challenges such as difficulties in starting the role and facing time pressures in their day-to-day work.

CONCLUSION

This study has provided a valuable insight into the CTF role and why doctors choose a CTF post and some of the challenges experienced, adding to the sparse amount of literature. Understanding post holders' experiences may contribute to optimisation of the role. Those employing CTFs should consider ensuring a formal handover process is in place between outgoing and incoming CTFs, having a lead person at their Trust responsible for evaluating changes suggested by CTFs, and the balance of contractual duties and personal development time.

Radiographers' perspectives on clinical supervision of students in Ireland

INTRODUCTION

Optimising clinical education in radiography is crucial to ensure competent graduates provide safe and effective patient care. Radiographers play a vital role in student supervision undertaken in the complex clinical environment. A greater understanding of factors influencing their ability to undertake this role effectively is needed. The study aimed to explore radiographers' attitudes and perceptions of confidence in undertaking clinical supervision and perceived barriers in a 'real-life' clinical department.

METHODS

The lens of Bandura's social-cognitive theory was utilised to assist the exploration of the desired constructs. An anonymous online survey was developed and circulated among qualified radiographers in Ireland. Descriptive (frequencies and percentages) and inferential statistical testing was undertaken. Thematic analysis was conducted on optional free-text comments.

RESULTS

217 responses were received. Although most radiographers reported a positive attitude (73.3%), a significant minority reported not being confident across survey items related to the tasks required (ranging from 20.7%-29.1%). Time pressures from clinical workload, perceived lack of organisational support, and lack of guidance on expectations were highlighted challenges.

CONCLUSION

The survey has enabled first-hand identification of some challenges radiographers encounter in undertaking students' clinical supervision. Radiographers must be supported to optimise the clinical learning environment where both students and educators are valued.

IMPLICATIONS FOR PRACTICE

The findings highlight impact on educational support, practice, policy and future research. Effective clinical supervision is dependent on collaborative engagement and support being evident at all levels, including the clinical department, academic and healthcare institutions, and national organisations.

Twelve tips for medical students to enhance clinical skills learning during disrupted placements

Disruption to healthcare settings can present a significant challenge to traditional, face-to-face models of learning in medical education. Reductions in undergraduate medical students' clinical exposure, whether due to periods of increased healthcare demand, localised service changes or infectious disease outbreaks, are likely to result in fewer opportunities to develop key clinical and practical skills. Proficiency in these skills is often essential to progression and future practice, creating a broad incentive for students to develop techniques to maintain and refine their clinical skills during disrupted placements. These tips, based on our experiences as senior medical students, are intended to help students on disrupted placements to engage in reflective practice, discover ways to facilitate further opportunities for clinical skills learning, and to make the most of clinical skills learning opportunities that they do receive.

Medical student learner neglect in the clinical learning environment: Applying Glaser's theoretical model

INTRODUCTION

Learner neglect is a relatively new concept in education, and no suitable framework for its exploration has been devised. The aim of this study was to determine whether an existing framework, Glaser's framework of child neglect, could be applied to learner neglect in clinical learning environments. This was a retrospective analysis of data obtained as part of a related study.

METHOD

Six focus groups were conducted with medical students in their early clinical years to explore their views of what experiences in medical education were challenging and why they presented a challenge. The transcript data were analysed using inductive content analysis, within an interpretivist approach in the development of categories. The identified categories were cross referenced with Glaser's framework categories replacing the carer with the teacher and the child with the learner.

RESULTS

Glaser's classifications of teacher (parent) behaviours were all identified in the negative aspects of medical learner clinical education including emotional unavailability/unresponsiveness, acting in a hostile manner, inappropriate inconsistent developmental interaction, failure to recognise individuality and failure to promote social adaption. Physical unavailability was identified as an additional category and is included in our proposed framework of learner neglect.

DISCUSSION

Adapting Glaser's framework was useful in considering learner neglect. Medical schools have a role in ensuring learning experiences are positive across contexts and to make explicit to teachers any behaviours that may appear as learner neglect. Applying this framework has the potential to make more explicit any subtle undermining teacher behaviours. Once explicit, there is a greater likelihood that behaviours may be reappraised both by the teacher and learner and modified to promote a more effective clinical learning experience.

Factors affecting consultant attitudes to undertaking undergraduate medical student teaching in the UK: a systematic review

OBJECTIVE

This systematic review aimed to explore consultant attitudes towards teaching undergraduate medical students in the UK.

DESIGN

Systematic review.

METHODOLOGY

Standard systematic review methodology was followed. MEDLINE, EMBASE and OpenGrey were searched from inception to August 2019 to identify studies exploring senior doctors' attitudes towards teaching undergraduate medical students. Two reviewers independently carried out key methodological steps including study screening/selection, quality assessment and data extraction. A narrative synthesis was undertaken.

RESULTS

Five studies were included in the review dating 2003-2015. Two studies used questionnaires, and three used focus groups/semistructured interviews. Key findings identified across all studies were consultants generally found teaching undergraduate medical students enjoyable, and consultants identified time constraints as a barrier to teaching. Other findings were consultants feeling there was a lack of recognition for time spent teaching, and a lack of training/guidance regarding teaching students.

CONCLUSIONS

This is the first systematic review to explore senior hospital doctors' attitudes towards teaching undergraduate medical students. Despite these five studies spanning 12 years, the same attitudes and issues regarding teaching are identified by all, suggesting lack of time particularly is a persistent problem regarding consultant-based teaching. An anecdotal impression is that consultants are no longer as enthusiastic about teaching as they once were, but it is evident over the 12 years of these studies that enjoyment levels, and presumably enthusiasm, have not changed significantly.

Osler Centenary Papers: William Osler in medical education

William Osler combined many excellent characteristics of a clinical educator being a scientific scholar, a motivational speaker and writer and a proficient physician. As we celebrate his life a century on, many of his educational ideals are as pertinent today as they were in those Victorian times. Osler's contributions to modern medicine go beyond his legacy of quotable aphorisms to a doctor, educator and leader whose proponent use of bedside teaching, careful clinical methods, and clinicopathological correlation was a great inspiration for students and junior doctors. He was also a great advocate of patient-centred care-listening to and closely observing his patients, an important message for modern medicine as the reliance on investigations strains modern healthcare systems. This review of Osler's contribution to medical education summarises his development as an educator and provides reflection on his influences to modern clinical education.

A study of clinical teachers' attitude to teaching and perceived learning needs in a medical college in Nigeria

BACKGROUND AND PURPOSE

Debates on medical educational reform initiatives in Nigeria have gradually shifted from access to medical colleges to improving learning quality. Understandably, clinical teachers are being encouraged to acquire basic teaching pedagogical knowledge through learning activities. Considering the fact that the concept of faculty development for medical teachers' is still evolving in Sub-Saharan Africa, this study aims to explore clinical teachers' attitude to teaching and perceptions of continuing education in teaching knowledge and skills in a medical college in Nigeria.

METHODS

Using a mixed-method research approach, quantitative data were collected from a sample of teachers through survey questionnaires, and qualitative data were obtained through face-to-face individual semi-structured interviews of teachers from the same institution.

RESULTS

Sixty-one survey questionnaires (response rate of 88%) and 10 interviews were completed and analyzed. Findings revealed that teachers' derived satisfaction from teaching and maintain a strong commitment to teaching. Bedside teachings (64%) and lectures (21%) were reported to be the most frequent mode of teaching. Although four out of every five respondents (80%) reported not having previous training in teaching, a large proportion (97%) self-assessed their teaching abilities to be average or above average, with most indicating that the experience of teaching observed during undergraduate medical training may be sufficient preparation for their teaching roles. The majority of the teachers' were of the opinion that there is a need to improve their individual teaching skill. However, in the absence of formal faculty development programs in the college, most of the teachers indicated that their teaching skills are currently being improved through sporadic informal community of practice involving interested colleagues and modeling identified good teachers.

CONCLUSION

A catalyst of learning by teachers' may come from their belief and self-rating of teaching ability. In this under-resourced context, explicit classifications of existing informal learning opportunities coupled with greater institutional support could improve teaching and teachers' development.

Needs Assessment for an American College of Surgeons Certificate in Applied Surgical Education Leadership (CASEL)

OBJECTIVE

Surgeon educators in departments of surgery play key roles in leading and advancing surgical education. Their activities include ensuring sound curricula and evaluation systems, monitoring education resources, overseeing faculty development, and providing mentorship. For more than 25 years, the American College of Surgeons (ACS) has offered a comprehensive "Surgeons as Educators" (SAE) course to address fundamental topics in surgical education. This study aims to identify future career needs of SAE graduates to inform the development of an American College of Surgeons Certificate in Applied Surgical Education Leadership program.

DESIGN

An IRB exempt, anonymous electronic survey was developed to determine educational roles, career aspirations, and needs of SAE Graduates.

SETTING AND PARTICIPANTS

Participants included all 763 1993-2016 SAE graduates.

RESULTS

One hundred and thirty-five responses were received from 600 (22.5%) graduates with valid email addresses. Sixty (45%) respondents completed the SAE Course > 5 years prior to the study (M5YRS) and 75 (55%) within the last 5 years (L5YRS). L5YRS respondents were less likely to be full professors (8% vs. 44%) or to serve as program directors (32% vs. 57%), and more likely to be associate program directors (25% vs. 17%) or clerkship directors (40% vs. 18%). High percentages of both L5YRS and M5YRS reported not pursuing additional educational opportunities post-SAE due to time and fiscal constraints. One-fifth of respondents were unaware of additional opportunities and 19% of M5YRS versus 6% of L5YRS stated that existing programs did not meet their needs. Overall improving skills as educational leaders, developing faculty development programs, and conducting educational research were noted as priorities for future development. Differences were observed between the L5YRS and M5YRS groups. The dominant preferences for course format were full-time face-to-face (41%) or a combination of full-time face-to-face with online modules (24%). The most important considerations in deciding to pursue a certificate course were course content, and interest in advancing career and time constraints.

CONCLUSIONS

An SAE graduate survey has confirmed the need for additional formal training in surgical education leadership in order to permit surgeon educators meet the demands of the changing landscape of surgical education. The needs of early career faculty may differ from those of more senior surgeon educators.

The paediatric change laboratory: optimising postgraduate learning in the outpatient clinic

BACKGROUND

This study aimed to analyse and redesign the outpatient clinic in a paediatric department. The study was a joint collaboration with the doctors of the department (paediatric residents and specialists) using the Change Laboratory intervention method as a means to model and implement change in the outpatient clinic. This study was motivated by a perceived failure to integrate the activities of the outpatient clinic, patient care and training of residents. The ultimate goal of the intervention was to create improved care for patients through resident learning and development.

METHODS

We combined the Change Laboratory intervention with an already established innovative process for residents, 3-h meetings. The Change Laboratory intervention method consists of a well-defined theory (Cultural-historical activity theory) and concrete actions where participants construct a new theoretical model of the activity, which in this case was paediatric doctors' workplace learning modelled in order to improve medical social practice. The notion of expansive learning was used during the intervention in conjunction with thematic analysis of data in order to fuel the process of analysis and intervention.

RESULTS

The activity system of the outpatient clinic can meaningfully be analysed in terms of the objects of patient care and training residents. The Change Laboratory sessions resulted in a joint action plan for the outpatient clinic structured around three themes: (1) Before: Preparation, expectations, and introduction; (2) During: Structural context and resources; (3) After: Follow-up and feedback. The participants found the Change Laboratory method to be a successful way of sharing reflections on how to optimise the organisation of work and training with patient care in mind.

CONCLUSIONS

The Change Laboratory approach outlined in this study succeeded to change practices and to help medical doctors redesigning their work. Participating doctors must be motivated to uncover inherent contradictions in their medical activity systems of which care and learning are both part. Facilitators must be willing to spend time analysing both historical paediatric practice, current data on practice, and steer clear of organisational issues that might hamper a transformative learning environment. To ensure long-term success, economical and organisational resources, participant buy-in and department leadership support play a major role.

WATCH: Warwick Assessment insTrument for Clinical teacHing: Development and testing

OBJECTIVE

Medical education and teaching skills are core competencies included in the generic curriculum for specialty training. To support the development of these skills, there is need for a validated instrument. This study aims to develop and test an instrument to measure the attributes of specialty trainees as effective teachers.

METHODS

The study was conducted in two phases. In first phase, the content of the instrument was generated from the literature and tested using the Delphi technique. In second phase, the instrument was field tested for validity and reliability using factor analysis and generalizability study. Feasibility was calculated by the time taken to complete the instrument. Acceptability and educational impact were determined by qualitative analysis of written feedback. Attributes of specialty trainees were assessed by clinical supervisors, peers, and students.

RESULTS

The Delphi study produced consensus on 15 statements which formed the basis of the instrument. In field study, a total of 415 instruments were completed. Factor analysis demonstrated a three-factor solution ('learning-teaching milieu', 'teaching skills', and 'learner-orientated'). A generalizability coefficient was 0.92. Mean time to complete the instrument was five minutes. Feedback indicated that it was an acceptable and useful method of assessment.

CONCLUSION

This new instrument provides valid, reliable, feasible, and acceptable assessment of clinical teaching.

A survey of the practice and experience of clinical educators in UK secondary care

BACKGROUND

Experiences and attitudes of clinical trainers of undergraduate medical students and postgraduate medical trainees in secondary care have received limited attention. Anecdotally, clinical teaching is becoming increasingly restricted by clinical service pressures, thereby presenting a risk to the quality of training provision.

METHODS

To explore the commitment, experience and attitudes of clinical teachers and trainers of undergraduate medical students and postgraduate trainees, respectively, amongst secondary care providers across a UK Healthcare Workforce Deanery, an invitation to complete a study-specific, on-line survey, comprising predominantly yes/no response and 5-point Likert scale statements with some open questions, was sent to all registered secondary care trainers/supervisors working in the East Midlands Strategic Health Authority. The survey was open between February and June 2012, with two reminders to complete. Responses were anonymised and the frequency of responses to questions was analysed. Data were analysed for the whole study population and for the relationship between frequency of responses and gender.

RESULTS

The majority of teachers/trainers considered that they were well prepared and fulfilled their clinical teaching responsibilities. Many reported having restricted time for preparation and delivery and that teaching activities were often completed in their own time. Despite reported poor support and low incentives, many respondents felt valued for their clinical teaching by their Medical Schools and the Deanery, but less so by hospital Trusts.

CONCLUSIONS

Respondents indicated that some faculty like and enjoy clinical teaching despite lack of allocated time, resources and recognition. The majority indicated that they feel confident and competent in their clinical teaching roles. Insufficient dedicated time due to competing clinical service pressures was reported as the major barrier to clinical teaching provision.

Recognising excellence in medical education: a student-led award scheme

BACKGROUND

The standard of clinical teaching is acknowledged by undergraduate medical students and their clinical teachers as being variable.(1) Furthermore, there is very little recognition by medical schools of the teaching expertise and efforts of clinical teachers.(2)

INNOVATION

In response to these issues, a group of medical students at the University of Birmingham's Medical School have established an awards scheme called Recognising Excellence in Medical Education (REME). This is a student-led award scheme that is supported by the Dean and other senior medical school staff, and by the students' medical society.

METHOD

This research used two focus groups, one comprising REME award winners and one comprising students who voted in the scheme, to discuss opinions regarding the awards, reasons why the students voted, and how clinical teachers feel about receiving the awards.

DISCUSSION

The focus groups revealed that both students and their clinical teachers were very positive about the award scheme and the impact it has had, both personally and within the hospitals or Trusts of the award winners. The REME awards were viewed as motivating and encouraging for clinical teachers, and were particularly prized as teachers were nominated by their students.

'I enjoy teaching but...': Paediatricians' attitudes to teaching medical students and junior doctors

AIM

To explore consultant paediatricians' attitudes, motivations, and barriers to training medical students and junior doctors.

METHODS

Qualitative research involving 24 paediatricians (with a diversity of specialties, experience, age, gender, teaching activity and employment status) from a tertiary paediatric hospital and clinical school in Sydney, Australia. Participants were engaged in semi-structured focus group discussions which explored their attitudes to teaching medical students and junior doctors, their role and experience of teaching, their training in medical education, perceived barriers to teaching, and possible solutions to these barriers. Data from the transcriptions of the focus group discussions were coded using the constant comparative method and analysed for themes using NVivo 7 software. Differences in responses between participants were explored.

RESULTS

All participants reported enjoying teaching. However, a number of factors which occurred at the consultant, learner and institution level affected the enjoyment or challenge of teaching. Consultant factors included time commitments, knowledge of and confidence in the learner's course, and comfort with teaching. Learner factors included level of knowledge, attendance, interest and enthusiasm, and cultural changes. Institution factors included acknowledgement of teaching contribution, communication, teaching support and resources, and attitude to teaching. These factors and the consultant's relationship with the learner and institution impacted on their ownership, involvement, and commitment to teaching.

CONCLUSIONS

Consultant paediatricians identified challenges to their involvement and commitment to teaching. Actions to address these challenges and improve the relationship between the consultant and the learner and the consultant and the institution may enhance the consultant's commitment to teaching.

Assessing the assessment: are senior summative OSCEs measuring advanced knowledge, skills, and attitudes?

PURPOSE

The authors investigated adaptation of Bloom's and Simpson's taxonomies for the medical (student) setting, and using the adapted taxonomies to determine whether a summative objective structured clinical examination (OSCE) used at their medical school was assessing higher-order knowledge, skills, and attitudes.

METHOD

Two faculty members (including H.M.H.) adapted the taxonomies and used them to categorize (knowledge, skills, or attitudes) and rank (by level within the taxonomies) every item on every OSCE station checklist. Interrater reliability was moderate to high.

RESULTS

Although there was a range of domains and levels within and across stations, on average every OSCE station was assessing learning behaviors at a lower level than expectations articulated in the school's goals for medical students' education.

CONCLUSIONS

The adapted taxonomies were useful for assessing the domains and levels of behaviors measured on the summative OSCE, and they can also be used to modify existing checklists or to create new assessment instruments that meet the expectations articulated in a school's goals for medical students' education.

More students, less capacity? An assessment of the competing demands on academic medical staff

CONTEXT

Medical student numbers in England have increased by more than 60% over the last decade. The capacity of universities and the National Health Service (NHS) to deliver education and training to these expanded cohorts is not clear.

METHODS

We carried out an interview study in three English medical schools, involving 60 academic, administrative, clinical and managerial staff, sampled across disciplines.

RESULTS

Given the expansion in medical student numbers, capacity in medical schools must increase. This requirement has become even more immediate in light of the shift towards more resource-intensive curricula. However, the aims of the Research Assessment Exercise and NHS policies are at odds with attempts to build teaching capacity. Although monies have been made available to recruit new staff and to backfill clinical time spent teaching, the success of these strategies is questioned by interviewees. Other initiatives, such as the new consultant contract and educational quality assurance processes, have the potential to promote the importance of teaching but are presently perceived as being inadequate so to do. As was consistently expressed by interviewees, within the competing triad of research, service delivery and teaching, the latter is perceived as taking a poor third place.

CONCLUSIONS

That research, service delivery and education are in competition will come as no surprise to UK academic staff. However, our results show a striking uniformity of opinion. We would question whether existing NHS and higher education policies enable medical schools and health care organisations to deliver education of the highest quality to the enlarged student population.

How can we prepare medical students for theatre-based learning?

CONTEXT

The quality of medical undergraduate operating theatre-based teaching is variable. Preparation prior to attending theatre may support student learning. Identifying and agreeing key skills, competences and objectives for theatre-based teaching may contribute to this process of preparation.

METHODS

We carried out a cross-sectional survey of consultant surgeons and students using a forced choice questionnaire containing 16 skills and competences classified as 'essential', 'desirable' or 'not appropriate', and a choice of 6 different teaching methods, scored for perceived effectiveness on a 5-point Likert scale. Questionnaire content was based on the findings from an earlier qualitative study.

RESULTS

Comparative data analyses (Mann- Whitney and Kruskal-Wallis tests) were carried out using SPSS Version 14. A total of 42 consultant surgeons and 46 students completed the questionnaire (46% and 100% response rates, respectively). Knowledge of standard theatre etiquette and protocols, ability to scrub up adequately, ability to adhere to sterile procedures, awareness of risks to self, staff and patients, and appreciation of the need for careful peri-operative monitoring were considered 'essential' by the majority. Student and consultant responses differed significantly on 5 items, with students generally considering more practical skills and competences to be essential. Differences between students on medical and surgical attachments were also identified.

CONCLUSIONS

Consultant surgeons and medical students agree on many aspects of the important learning points for theatre-based teaching. Compared with their teachers, students, particularly those on attachment to surgical specialties, are more ambitious - perhaps overly so - in the level of practical skills and risk awareness they expect to gain in theatre.

A comparison of medical students' perceptions of their initial basic clinical training placements in 'new' and established teaching hospitals

This study has examined students' perceptions of the factors influencing learning during initial hospital placements and whether differences in perceived experiences were evident between students attending new and established teaching hospitals. Five focus groups were conducted with Year III students at the University of Birmingham Medical School (UBMS): three with students attending three established teaching hospitals and two with students attached to a new teaching hospital (designated as part of the UBMS expansion programme). Extensive variation in student perception of hospital experiences was evident at the level of teaching hospital, teaching firm and individual teacher. Emergent themes were split into two main categories: 'students' perceptions of teaching and the teaching environment' and 'the new hospital learner'. Themes emerging that related to variation in student experience included the amount of structured teaching, enthusiasm of teachers, grade of teachers, specialty of designated firms and the number of students. The new teaching hospital was generally looked upon favourably by students in comparison to established teaching hospitals. Many of the factors influencing student experience relate to themes grouped under the 'new hospital learner', describing the period of adjustment experienced by students during their first encounter with this new learning environment. Interventions to improve student experience might be aimed at organisations and individuals delivering teaching. However, factors contributing to the student experience, such as the competing demand to teaching of heavy clinical workloads, are outside the scope of medical school intervention. In the absence of fundamental change, mechanisms to equip students with 'survival skills' as self-directed hospital learners should also be considered.