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Zhao Y, Mbuthia D, Gathara D, Nzinga J, Tweheyo R, English M. 'We were treated like we are nobody': a mixed-methods study of medical doctors' internship experiences in Kenya and Uganda. BMJ Glob Health 2023; 8:e013398. [PMID: 37940204 PMCID: PMC10632815 DOI: 10.1136/bmjgh-2023-013398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/21/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVE Medical interns are an important workforce providing first-line healthcare services in hospitals. The internship year is important for doctors as they transition from theoretical learning with minimal hands-on work under supervision to clinical practice roles with considerable responsibility. However, this transition is considered stressful and commonly leads to burn-out due to challenging working conditions and an ongoing need for learning and assessment, which is worse in countries with resource constraints. In this study, we provide an overview of medical doctors' internship experiences in Kenya and Uganda. METHODS Using a convergent mixed-methods approach, we collected data from a survey of 854 medical interns and junior doctors and semistructured interviews with 54 junior doctors and 14 consultants. Data collection and analysis were guided by major themes identified from a previous global scoping review (well-being, educational environment and working environment and condition), using descriptive analysis and thematic analysis respectively for quantitative and qualitative data. FINDINGS Most medical interns are satisfied with their job but many reported suffering from stress, depression and burn-out, and working unreasonable hours due to staff shortages. They are also being affected by the challenging working environment characterised by a lack of adequate resources and a poor safety climate. Although the survey data suggested that most interns were satisfied with the supervision received, interviews revealed nuances where many interns faced challenging scenarios, for example, poor supervision, insufficient support due to consultants not being available or being 'treated like we are nobody'. CONCLUSION We highlight challenges experienced by Kenyan and Ugandan medical interns spanning from burn-out, stress, challenging working environment, inadequate support and poor quality of supervision. We recommend that regulators, educators and hospital administrators should improve the resource availability and capacity of internship hospitals, prioritise individual doctors' well-being and provide standardised supervision, support systems and conducive learning environments.
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Affiliation(s)
- Yingxi Zhao
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Raymond Tweheyo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- Centre for Health Systems Research and Development (CHSRD), The University of Free State, Bloemfontein, South Africa
| | - Mike English
- NDM Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Ottrey E, Rees CE, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Exploring health care graduates' conceptualisations of preparedness for practice: A longitudinal qualitative research study. MEDICAL EDUCATION 2021; 55:1078-1090. [PMID: 33617656 DOI: 10.1111/medu.14475] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Although preparedness for practice (P4P) has been variously described, little shared understanding exists about what P4P is across the health professions. How P4P is conceptualised matters, because this shapes how stakeholders think, talk about and act towards it. Further, multiple understandings can result in diverse expectations for graduate performance. This study therefore explores health care learners' solicited and unsolicited conceptualisations of P4P over their early graduate transition. METHODS We conducted longitudinal qualitative research including individual and group entrance interviews (phase 1: n = 35), longitudinal audio-diaries (phase 2: n = 30), and individual and group exit interviews (phase 3: n = 22) with learners from four disciplines (dietetics, medicine, nursing and pharmacy). We employed framework analysis to interrogate data cross-sectionally and longitudinally. RESULTS We found 13 conceptualisations of P4P (eg knowledge, confidence), broadly similar across the disciplines. We found some conceptualisations dominant in both solicited and unsolicited talk (eg skills), some dominant only in solicited talk (eg competence) and others dominant only in unsolicited talk (eg experience). Although most conceptualisations appeared relatively stable across time, some appeared to dominate at certain time points only (eg employability and skills in phases 1 and 2, and competence in phase 3). DISCUSSION This novel study extends previous uniprofessional work by illustrating a broader array of conceptualisations, differences between professions, solicited versus unsolicited talk and longitudinal cohort patterns. We encourage health care educators to discuss these different P4P understandings in graduate transition interventions. Further research is needed to explore other stakeholders' conceptualisations, and over a duration beyond the early graduate transition.
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Affiliation(s)
- Ella Ottrey
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- College of Science, Health, Engineering & Education, Murdoch University, Murdoch, WA, Australia
| | - Caitlin Kemp
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Tina P Brock
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Michelle Leech
- Medicine, Nursing & Health Sciences Medicine Course, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic, Australia
| | - Kayley Lyons
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Vic., Australia
| | - Lynn V Monrouxe
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Julia Morphet
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Monash Nursing & Midwifery, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Vic., Australia
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Clayton, Vic., Australia
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Padley J, Boyd S, Jones A, Walters L. Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates. Health Sci Rep 2021; 4:e270. [PMID: 33855193 PMCID: PMC8025846 DOI: 10.1002/hsr2.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Work readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined. OBJECTIVE This narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness. METHODS Databases were searched using the terms including "ready," "readiness," "preparedness," "medical graduates," "intern," and "junior doctor." Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes. RESULTS Seventy studies were included in the review. Study participants included final-year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self-report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills-based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness. CONCLUSIONS Different research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.
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Affiliation(s)
- James Padley
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Sarah Boyd
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Alison Jones
- College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Lucie Walters
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
- Adelaide Rural Clinical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Simelane T, Ryan DJ, Stoyanov S, Bennett D, McEntee M, Maher MM, O'Tuathaigh CMP, O'Connor OJ. Bridging the divide between medical school and clinical practice: identification of six key learning outcomes for an undergraduate preparatory course in radiology. Insights Imaging 2021; 12:17. [PMID: 33576894 PMCID: PMC7881064 DOI: 10.1186/s13244-021-00971-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/19/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There exists a significant divide between what is learnt in medical school and subsequently what is required to practice medicine effectively. Despite multiple strategies to remedy this discordance, the problem persists. Here, we describe the identification of a comprehensive set of learning outcomes for a preparation for practice course in radiology. METHODS Assessment of interns' readiness to interact with the radiology department was conducted using a national survey of both interns and radiologists. In parallel, group concept mapping (GCM) which involves a combination of qualitative and quantitative techniques was used to identify the shared understanding of participants from a diverse range of medical specialties regarding what topics should be included in an intern preparatory course for interacting with the radiology department. RESULTS The survey demonstrated that most interns and radiologists felt that undergraduate medical training did not prepare interns to interact with the radiology department. GCM identified six learning outcomes that should be targeted when designing a preparatory module: requesting investigations; clinical decision support; radiology department IT and communication; adverse reactions and risks; interpretation of radiology results and urgent imaging. The thematic clusters from the group concept mapping corroborated the deficiencies identified in the national survey. CONCLUSION We have identified six key learning outcomes that should be included in a preparation for practice module in radiology. Future courses targeting these thematic clusters may facilitate a smoother transition from theory to practice for newly graduated doctors.
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Affiliation(s)
| | - David J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Slavi Stoyanov
- Open University of the Netherlands, 177, Valkenburgerweg, 6401 DL, Heerlen, The Netherlands
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Mark McEntee
- Department of Radiography, School of Medicine, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
| | - Colm M P O'Tuathaigh
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland
- Department of Radiology, School of Medicine, University College Cork, Cork, Ireland
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Zhao Y, Musitia P, Boga M, Gathara D, Nicodemo C, English M. Tools for measuring medical internship experience: a scoping review. HUMAN RESOURCES FOR HEALTH 2021; 19:10. [PMID: 33446218 PMCID: PMC7809831 DOI: 10.1186/s12960-021-00554-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 01/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Appropriate and well-resourced medical internship training is important to ensure psychological health and well-being of doctors in training and also to recruit and retain these doctors. However, most reviews focused on clinical competency of medical interns instead of the non-clinical aspects of training. In this scoping review, we aim to review what tools exist to measure medical internship experience and summarize the major domains assessed. METHOD The authors searched MEDLINE, Embase, PsycINFO, ERIC, and the Cochrane Library for peer-reviewed studies that provided quantitative data on medical intern's (house officer, foundation year doctor, etc.) internship experience and published between 2000 and 2019. Three reviewers screened studies for eligibility with inclusion criteria. Data including tools used, key themes examined, and psychometric properties within the study population were charted, collated, and summarized. Tools that were used in multiple studies, and tools with internal validity or reliability assessed directed in their intern population were reported. RESULTS The authors identified 92 studies that were included in the analysis. The majority of studies were conducted in the US (n = 30, 32.6%) and the UK (n = 20, 21.7%), and only 14 studies (15.2%) were conducted in low- and middle-income countries. Major themes examined for internship experience included well-being, educational environment, and work condition and environment. For measuring well-being, standardized tools like the Maslach Burnout Inventory (for measuring burnout), Patient Health Questionnaire-9 (depression), General Health Questionnaire-12 or 30 (psychological distress) and Perceived Stress Scale (stress) were used multiple times. For educational environment and work condition and environment, there is a lack of widely used tools for interns that have undergone psychometric testing in this population other than the Postgraduate Hospital Educational Environment Measure, which has been used in four different countries. CONCLUSIONS There are a large number of tools designed for measuring medical internship experience. International comparability of results from future studies would benefit if tools that have been more widely used are employed in studies on medical interns with further testing of their psychometric properties in different contexts.
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Affiliation(s)
- Yingxi Zhao
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, United Kingdom.
| | - Peris Musitia
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | | | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Catia Nicodemo
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Mike English
- Oxford Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, S Parks Rd, Oxford, OX1 3SY, United Kingdom
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
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Prozesky DR, Molwantwa MC, Nkomazana O, Kebaetse MB. Intern preparedness for the CanMEDS roles and the Dunning-Kruger effect: a survey. BMC MEDICAL EDUCATION 2019; 19:422. [PMID: 31727028 PMCID: PMC6854771 DOI: 10.1186/s12909-019-1836-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/03/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether the first cohort of graduates from a new undergraduate medical programme in Botswana were adequately prepared for internship. METHODS The authors surveyed 27 interns and 13 intern supervisors on site, who rated intern preparedness for 44 tasks using a previously validated instrument. Tasks were grouped according to the seven roles of the physician in the CanMEDS framework and Cronbach α values confirmed internal consistency. To determine the direction of differences between intern and supervisor ratings for tasks Likert scale ratings were treated as interval data and mean scores calculated. Rating frequencies for each role were compared using the χ2 statistic. Reasons for differences between intern and supervisor ratings were explored by determining correlations between scores using the Spearman ρ statistic, and analysing qualitative data generated by the questionnaire. RESULTS Preparedness for all seven roles and the majority of tasks was found to be between 'Fairly well prepared' and 'Well prepared'. The ratings for four roles (Medical expert, Communicator, Collaborator, Professional) differed statistically, but not for the three others (Leader, Health advocate, Scholar). Interns rated their proficiency higher than their supervisors for the tasks in six roles; for the 'Professional' role intern ratings were mostly lower. Correlations between intern and supervisors scores were only significant for three roles (Medical expert, Communicator, Collaborator). Qualitative data provided further insights into the reasons for these associations. CONCLUSIONS Intern preparedness for tasks and roles varied but was generally satisfactory. Based on the analysis of the data seeming discrepancies in between interns and supervisor ratings were investigated and explanations are offered. For three roles the data indicate that their component tasks are understood in the same way by interns and supervisors, but not for the other roles. The Dunning-Kruger effect offers a plausible explanation for higher intern scores for tasks in six of the roles. For the 'Professional' role differences between interns' internal, individual understanding and supervisors' external, group understanding may explain lower intern scores. The fact that respondents may understand the tasks they rate differently has implications for all research of this nature.
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Affiliation(s)
| | | | - Oathokwa Nkomazana
- Faculty of Medicine, University of Botswana, Private Bag UB, 0022 Gaborone, Botswana
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Walzak A, Butler D, Bates J, Farrell L, Law SFB, Pratt DD. Working in the dead of night: exploring the transition to after-hours duty. MEDICAL EDUCATION 2019; 53:296-305. [PMID: 30474125 DOI: 10.1111/medu.13762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/20/2017] [Accepted: 09/10/2018] [Indexed: 05/24/2023]
Abstract
CONTEXT Transitions, although often difficult, represent integral components of medical training. New postgraduate trainees (first-year residents) find themselves in an especially challenging transition as they are expected to fulfil both learning and service expectations concurrently. Workplace learning theory has been suggested as a lens through which to understand this unique educational, yet service-oriented, role. This tension may be further amplified overnight when residents are on-call with little to no support. OBJECTIVES The aims of this study were to explore the transition from medical student to resident with respect to the on-call experience, and to provide theory-based suggestions to enhance learning during this unique transition. METHODS We conducted an interpretivist qualitative study by interviewing eight medical students and 10 first-year residents from six different specialty training programmes across four academic sites. Each semi-structured interview was transcribed verbatim and anonymised. Resident interview transcripts were initially coded for major themes, after which medical student interview transcripts were coded for consistencies and discrepancies. RESULTS Four interrelated themes were identified in students' and residents' descriptions of on-call experiences: (i) shift in responsibility; (ii) supervisory support; (iii) contextual conditions, and (iv) clarity of expectations. Generally, students were not able to anticipate the challenges they would face as residents on-call, and residents perceived the transition as sudden with little emphasis placed on learning. CONCLUSIONS First-year residents face multiple challenges during on-call, which may prevent optimal learning in this setting. These challenges are amplified by the large gap between the respective roles of medical students and residents. We identified promoters of and barriers to effective learning in this environment and, by using workplace learning theory, provide recommendations for how we might be able to enhance medical students' preparation for and first-year residents' learning during experiences of being on-call.
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Affiliation(s)
- Alison Walzak
- Department of Internal Medicine, Faculty of Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Deborah Butler
- Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanna Bates
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Farrell
- Department of Internal Medicine, Faculty of Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Sai Fai Bosco Law
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Daniel D Pratt
- Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
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Smink GM, Jeffe DB, Hayashi RJ, Al-Hammadi N, Fehr JJ. Pediatric-Oncology Simulation Training for Resident Education. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:155-160. [PMID: 31485338 DOI: 10.1136/bmjstel-2018-000347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Introduction We sought to evaluate pediatric oncology simulations intended to improve pediatric residents' skills and comfort in caring for children with cancer. Method In a non-randomized trial, controls (the first three rotations) received a standard set of lectures, and the intervention arm received these lectures plus five simulation-training scenarios-fever/neutropenia, a new leukemia diagnosis, end-of-life care discussion, tumor lysis syndrome, and a mediastinal mass. All residents were tested after the rotation on the first three scenarios; management skills were evaluated independently by two raters. Before and after training, all residents completed an emotional-appraisal questionnaire evaluating each scenario as a perceived challenge or threat. Analysis of variance (ANOVA) measured differences by study arm in skills-checklist assessments and appraisals; repeated-measures ANOVA measured changes in emotional-appraisal scores. Results Forty-two residents (9 control, 33 intervention) participated. Inter-rater agreement for skills-checklist scores using average-measures intraclass correlation was high (0.847), and overall mean scores were significantly higher for the intervention than control group across both raters (P = 0.005). For all residents, perceived challenge increased in the end-of-life simulation, and perceived threat decreased in all three test scenarios. The intervention group, regardless of training year, evaluated the teaching scenarios favorably and felt that challenging oncology situations were addressed, skills were enhanced, and the simulations should be offered to other residents. Conclusions It was feasible to introduce residents to difficult pediatric oncology scenarios using simulation. The intervention group performed more skills than controls when tested, and perceive threat declined in all residents after their pediatric oncology rotation.
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Affiliation(s)
- Gayle M Smink
- Assistant Professor of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Donna B Jeffe
- Professor of Medicine and director of the Health Behavior, Communication, and Outreach Core, Department of Medicine, and director of the Medical Education Research Unit, Office of Education, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Robert J Hayashi
- Professor of Pediatrics, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Noor Al-Hammadi
- statistical data analyst, Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - James J Fehr
- Professor of Anesthesiology and Pediatrics, Departments of Anesthesiology and Pediatrics, Washington University School of Medicine, and medical director of the Saigh Pediatric Simulation Center at St. Louis Children's Hospital, St. Louis, Missouri, USA
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Kennedy KM, Wilkinson A. A Student Selected Component (or Special Study Module) in Forensic and Legal Medicine: Design, delivery, assessment and evaluation of an optional module as an addition to the medical undergraduate core curriculum. J Forensic Leg Med 2017; 53:62-67. [PMID: 29182913 DOI: 10.1016/j.jflm.2017.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/28/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
The General Medical Council (United Kingdom) advocates development of non-core curriculum Student Selected Components and their inclusion in all undergraduate medical school curricula. This article describes a rationale for the design, delivery, assessment and evaluation of Student Selected Components in Forensic and Legal Medicine. Reference is made to the available evidence based literature pertinent to the delivery of undergraduate medical education in the subject area. A Student Selected Component represents an opportunity to highlight the importance of the legal aspects of medical practice, to raise the profile of the discipline of Forensic and Legal Medicine amongst undergraduate medical students and to introduce students to the possibility of a future career in the area. The authors refer to their experiences of design, delivery, assessment and evaluation of Student Selected Components in Forensic and Legal Medicine at their respective Universities in the Republic of Ireland (Galway) and in the United Kingdom (Oxford).
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Affiliation(s)
- Kieran M Kennedy
- SAOLTA University Healthcare Group, Health Service Executive West, Galway, Ireland; School of Medicine, National University of Ireland, Galway, Ireland.
| | - Andrew Wilkinson
- Oxford Medico-Legal, Headington, Oxford, OX3 0BU, United Kingdom; The Faculty of Forensic and Legal Medicine of the Royal College of Physicians of London, London, United Kingdom; University of Oxford, Oxford, United Kingdom; School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
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Al Sinawi H, Al Alawi M, Al Qubtan A, Al Lawati J, Al Habsi A, Jose S. Perception of Preparedness for Clinical Work Among New Residents: A Cross-sectional Study from Oman. Oman Med J 2017; 32:201-206. [PMID: 28584600 DOI: 10.5001/omj.2017.38] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To evaluate new residents' perceptions of their own preparedness for clinical practice and examine the associated factors. METHODS This is a cross-sectional study conducted on August 20-23, 2016. New residents accepted for postgraduate training by Oman Medical Specialty Board were asked to complete the Preparation for Hospital Practice Questionnaire (PHPQ). Data was analyzed using the Statistical Package for the Social Sciences version 22. RESULTS A total of 160 residents were invited to participate in this study. Out of 160, 140 residents participated (87.5%), 70.7% were female and 59.3% were graduates from Sultan Qaboos University (SQU). Ninety-nine percent of the graduates were either 'well prepared' or 'fairly well prepared' for hospital practice. Male residents scored higher in the confidence scale, while residents who did a post-internship general practice placement scored higher in understanding science. Graduates from Oman Medical College felt more prepared compared to graduates from SQU. CONCLUSIONS Most of the new residents were well prepared to clinical work. Factors such as place of undergraduate study, training, and duration of internship significantly influenced the residents' perception of preparedness. Addressing these factors will enhance residents' preparedness for clinical work.
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Affiliation(s)
- Hamed Al Sinawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed Al Alawi
- Department of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ali Al Qubtan
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Jaber Al Lawati
- Psychiatry Residency Training Program, Oman Medical Specialty Board, Muscat, Oman
| | - Assad Al Habsi
- College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Sachin Jose
- Department of Research, Oman Medical Specialty Board, Muscat, Oman
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Beane A, Padeniya A, De Silva AP, Stephens T, De Alwis S, Mahipala PG, Sigera PC, Munasinghe S, Weeratunga P, Ranasinghe D, Deshani EM, Weerasinghe T, Thilakasiri K, Jayasinghe K, Dondorp AM, Haniffa R. Closing the theory to practice gap for newly qualified doctors: evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice. Postgrad Med J 2017; 93:592-596. [PMID: 28500246 DOI: 10.1136/postgradmedj-2016-134718] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/28/2017] [Accepted: 04/02/2017] [Indexed: 11/04/2022]
Abstract
PURPOSE The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to practice gap' of doctors preparing for their internship. This paper evaluates the impact of a 2-day peer-delivered Acute Care Skills Training (ACST) course as part of the GIP. STUDY DESIGN The ACST course was developed by an interprofessional faculty, including newly graduated doctors awaiting internship (pre-intern), focusing on the recognition and management of common medical and surgical emergencies. Course delivery was entirely by pre-intern doctors to their peers. Knowledge was evaluated by a pre- and post-course multiple choice test. Participants' confidence (post-course) and 12 acute care skills (pre- and post-course) were assessed using Likert scale-based questions. A subset of participants provided feedback on the peer learning experience. RESULTS Seventeen courses were delivered by a faculty consisting of eight peer trainers over 4 months, training 320 participants. The mean (SD) multiple choice questionnaire score was 71.03 (13.19) pre-course compared with 77.98 (7.7) post-course (p<0.05). Increased overall confidence in managing ward emergencies was reported by 97.2% (n=283) of respondents. Participants rated their post-course skills to be significantly higher (p<0.05) than pre-course in all 12 assessed skills. Extended feedback on the peer learning experience was overwhelmingly positive and 96.5% would recommend the course to a colleague. CONCLUSIONS A peer-delivered ACST course was extremely well received and can improve newly qualified medical graduates' knowledge, skills and confidence in managing medical and surgical emergencies. This peer-based model may have utility beyond pre-interns and beyond Sri Lanka.
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Affiliation(s)
- A Beane
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.,University of Oxford, Oxford, United Kingdom
| | - A Padeniya
- Lady Ridgeway Hospital, Colombo, Sri Lanka.,Faculty of Medicine, University of Rajarata, Anuradhapura, Sri Lanka.,Government Medical Officers Association, Colombo, Sri Lanka
| | - A P De Silva
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka.,Intensive Care National Audit and Research Centre, London, UK
| | - T Stephens
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Critical Care Research Team, Royal London Hospital, London, UK.,William Harvey Institute, Queen Mary University of London, London, UK
| | - S De Alwis
- Education, Training and Research Unit, Ministry of Health, Colombo, Sri Lanka
| | - P G Mahipala
- Director General of Health Services, Ministry of Health, Colombo, Sri Lanka
| | - P C Sigera
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka
| | - S Munasinghe
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka
| | - P Weeratunga
- National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - D Ranasinghe
- Government Medical Officers Association, Colombo, Sri Lanka
| | - E M Deshani
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | - T Weerasinghe
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | - K Thilakasiri
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
| | - Kas Jayasinghe
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - A M Dondorp
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.,University of Oxford, Oxford, United Kingdom
| | - R Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.,University of Oxford, Oxford, United Kingdom.,National Intensive Care Surveillance, Ministry of Health, Colombo, Sri Lanka
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12
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Yu TC, Webster CS, Weller JM. Simulation in the medical undergraduate curriculum to promote interprofessional collaboration for acute care: a systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2016; 2:90-96. [DOI: 10.1136/bmjstel-2016-000103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/16/2016] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
This literature review summarises interprofessional, simulation-based interventions in the context of preparing undergraduate and prelicensure healthcare students for the management of acutely unstable patients. There was a particular focus on the impact of such interventions on medical students. The review sought to identify the range of described interprofessional education (IPE) learning outcomes, types of learners, methods used to evaluate intervention effectiveness and study conclusions. We systematically compiled this information and generated review findings through narrative summary. A total of 18 articles fulfilled the review criteria. The diversity of IPE interventions described suggests a developing field where the opportunities provided by simulation are still being explored. With significant heterogeneity among the studies, comparison between them was unfeasible, but each study provided a unique narrative on the complex interplay between intervention, curriculum, learning activities, learners and facilitators. Together, the narratives provided in these studies reflect positively on undergraduate simulation-based interventions to promote interprofessional collaboration in acute care settings, and provide the basis for recommendations for future IPE design and delivery, and areas requiring further research.
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Rogers GD, McConnell HW, Jones de Rooy N, Ellem F, Lombard M. A randomised controlled trial of extended immersion in multi-method continuing simulation to prepare senior medical students for practice as junior doctors. BMC MEDICAL EDUCATION 2014; 14:90. [PMID: 24886098 PMCID: PMC4016660 DOI: 10.1186/1472-6920-14-90] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/25/2014] [Indexed: 05/03/2023]
Abstract
BACKGROUND Many commencing junior doctors worldwide feel ill-prepared to deal with their new responsibilities, particularly prescribing. Simulation has been widely utilised in medical education, but the use of extended multi-method simulation to emulate the junior doctor experience has rarely been reported. METHODS A randomised controlled trial compared students who underwent two, week-long, extended simulations, several months apart (Intervention), with students who attended related workshops and seminars alone (Control), for a range of outcome measures. RESULTS Eighty-four third year students in a graduate-entry medical program were randomised, and 82 completed the study. At the end of the first week, Intervention students scored a mean of 75% on a prescribing test, compared with 70% for Control students (P = 0.02) and Intervention teams initiated cardiac compressions a mean of 29.1 seconds into a resuscitation test scenario, compared with 70.1 seconds for Control teams (P < 0.01). At the beginning of the second week, an average of nine months later, a significant difference was maintained in relation to the prescribing test only (78% vs 70%, P < 0.01).At the end of the second week, significant Intervention vs Control differences were seen on knowledge and reasoning tests, a further prescribing test (71% vs 63% [P < 0.01]) and a paediatric resuscitation scenario test (252 seconds to initiation of fluid resuscitation vs 339 seconds [P = 0.05]). CONCLUSIONS The study demonstrated long-term retention of improved prescribing skills, and an immediate effect on knowledge acquisition, reasoning and resuscitation skills, from contextualising learning activities through extended multi-method simulation.
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Affiliation(s)
- Gary D Rogers
- School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
- Health Institute for the Development of Education and Scholarship, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Harry W McConnell
- School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
| | | | - Fiona Ellem
- School of Pharmacy, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Marise Lombard
- School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
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14
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Scicluna HA, Grimm MC, Jones PD, Pilotto LS, McNeil HP. Improving the transition from medical school to internship - evaluation of a preparation for internship course. BMC MEDICAL EDUCATION 2014; 14:23. [PMID: 24485072 PMCID: PMC3913947 DOI: 10.1186/1472-6920-14-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/30/2014] [Indexed: 05/21/2023]
Abstract
BACKGROUND This study evaluates the impact of a new 'Preparation for Internship' (PRINT) course, which was developed to facilitate the transition of University of New South Wales (UNSW) medical graduates from Medical School to Internship. METHODS During a period of major curricular reform, the 2007 (old program) and 2009 (new program) cohorts of UNSW final year students completed the Clinical Capability Questionnaire (CCQ) prior to and after undertaking the PRINT course. Clinical supervisors' ratings and self-ratings of UNSW 2009 medical graduates were obtained from the Hospital-based Prevocational Progress Review Form. RESULTS Prior to PRINT, students from both cohorts perceived they had good clinical skills, with lower ratings for capability in procedural skills, operational management, and administrative tasks. After completing PRINT, students from both cohorts perceived significant improvement in their capability in procedural skills, operational management, and administrative tasks. Although PRINT also improved student-perceived capability in confidence, interpersonal skills and collaboration in both cohorts, curriculum reform to a new outcomes-based program was far more influential in improving self-perceptions in these facets of preparedness for hospital practice than PRINT. CONCLUSIONS The PRINT course was most effective in improving students' perceptions of their capability in procedural skills, operational management and administrative tasks, indicating that student-to-intern transition courses should be clinically orientated, address relevant skills, use experiential learning, and focus on practical tasks. Other aspects that are important in preparation of medical students for hospital practice cannot be addressed in a PRINT course, but major improvements are achievable by program-wide curriculum reform.
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Affiliation(s)
- Helen A Scicluna
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Michael C Grimm
- St George Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Philip D Jones
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Louis S Pilotto
- Rural Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - H Patrick McNeil
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia
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15
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Hill AG, Srinivasa S, Hawken SJ, Barrow M, Farrell SE, Hattie J, Yu TC. Impact of a Resident-as-Teacher Workshop on Teaching Behavior of Interns and Learning Outcomes of Medical Students. J Grad Med Educ 2012; 4:34-41. [PMID: 23451304 PMCID: PMC3312530 DOI: 10.4300/jgme-d-11-00062.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 09/13/2011] [Accepted: 09/20/2011] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residents and interns are recognized as important clinical teachers and mentors. Resident-as-teacher training programs are known to improve resident attitudes and perceptions toward teaching, as well as their theoretical knowledge, skills, and teaching behavior. The effect of resident-as-teacher programs on learning outcomes of medical students, however, remains unknown. An intervention cohort study was conducted to prospectively investigate the effects of a teacher-training workshop on teaching behavior of participating interns and on the clerkship learning outcomes of instructed fourth-year medical students. METHODS The House Officer-as-Teacher Training Workshop was implemented in November 2009 over 1.5 days and attended by all 34 interns from one teaching hospital. Subsequently, between February and August 2010, 124 fourth-year medical students rated the observable teaching behavior of interns during 6-week general surgery clerkships at this intervention hospital as well as at 2 comparable hospitals serving as control sites. Ratings were collected using an anonymous 15-item Intern Clinical Teaching Effectiveness Instrument. Student achievement of clerkship learning outcomes during this period was evaluated using a validated and centralized objective structured clinical examination. RESULTS Medical students completed 101 intern clinical teaching effectiveness instruments. Intern teaching behavior at the intervention hospital was found to be significantly more positive, compared with observed behavior at the control hospitals. Objective structured clinical examination results, however, did not demonstrate any significant intersite differences in student achievement of general surgery clerkship learning outcomes. CONCLUSIONS The House Officer-as-Teacher Training Workshop noticeably improved teaching behavior of surgical interns during general surgery clerkships. This improvement did not, however, translate into improved achievement of clerkship learning outcomes by medical students during the study period.
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Eze BI, Oguego NC, Uche JN, Shiwoebi JO, Mba CN. Assessing the knowledge and skills in clinical ophthalmology of medical interns: survey results from enugu, South-eastern Nigeria. Middle East Afr J Ophthalmol 2012; 19:135-40. [PMID: 22346129 PMCID: PMC3277012 DOI: 10.4103/0974-9233.92130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To compare the skills and knowledge of clinical ophthalmology among medical interns in Enugu, Nigeria, to the recommendations of the International Council of Ophthalmology (ICO). MATERIALS AND METHODS A questionnaire-based cross-sectional survey was conducted of Medical Interns attending the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital, from April 2010 to June 2010. Data on cohort demographics, undergraduate ophthalmology exposure, clinical skills and diagnostic competencies were collected and analyzed. Statistical significance was indicated by P < 0.05. RESULTS The cohort comprised 81 males and 48 females (sex ratio = 1.7 : 1), aged 21-35 years (mean: 26.8 ± 2.4 years). The gender difference was significant (P < 0.05). The response rate was 88.7%. The duration of undergraduate ophthalmology exposure ranged from 1 to 4 weeks. Exposure was often adequate in cornea/external eye (95.3%), lens/cataract (95.3%) and glaucoma (92.2%); but not in vitreo-retinal disease (47.3%), neuro-ophthalmology (45.7%) and refractive surgery (0.0). The majority were competent at visual acuity testing (97.7%) and visual field examination (93.0%). There was lower competency at anterior chamber assessment (49.6%) and slit-lamp examination (39.5%). The majority could confidently diagnose conjunctivitis (96.1%) and cataract (90.7%), but not strabismus (42.6%) or macular degeneration (20.2%). CONCLUSIONS Medical interns in Enugu displayed gaps in their undergraduate ophthalmology exposure, clinical knowledge and skills. This has implications for stakeholders in medical education and eye care delivery. Review of the curriculum, provision of training resources and compliance with ICO guidelines could address the deficiencies.
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Affiliation(s)
- Boniface I. Eze
- Department of Ophthalmology, University of Nigeria Teaching Hospital (UNTH), PMB 01139, Ituku-Ozalla, Enugu, Nigeria
| | - Ngozi C. Oguego
- Department of Ophthalmology, Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria
| | - Judith N. Uche
- Department of Ophthalmology, University of Nigeria Teaching Hospital (UNTH), PMB 01139, Ituku-Ozalla, Enugu, Nigeria
| | - Jude O. Shiwoebi
- Department of Ophthalmology, University of Nigeria Teaching Hospital (UNTH), PMB 01139, Ituku-Ozalla, Enugu, Nigeria
| | - Chibuike N. Mba
- Department of Ophthalmology, University of Nigeria Teaching Hospital (UNTH), PMB 01139, Ituku-Ozalla, Enugu, Nigeria
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Tallentire VR, Smith SE, Skinner J, Cameron HS. Understanding the behaviour of newly qualified doctors in acute care contexts. MEDICAL EDUCATION 2011; 45:995-1005. [PMID: 21916939 DOI: 10.1111/j.1365-2923.2011.04024.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
CONTEXT A particularly onerous aspect of the transition from medical student to practising doctor concerns the necessity to be able to rapidly identify acutely unwell patients and initiate appropriate resuscitation. These are skills in which many graduates feel poorly prepared and are considered by some to be best learned on the job. This constructivist study investigated the factors that influence the behaviour of junior doctors in this context and initiated the development of a framework that promotes understanding of this important area. METHODS Focus groups involving 36 clinicians with a variety of clinical experience were conducted and analysed using a qualitative, grounded theory approach. The complex relationships between emergent themes guided the development of a framework that was refined and validated by further interviews with participants. RESULTS Six main themes, grouped under three broad headings, emerged from the data: 'transferring knowledge into practice' and 'decision making and uncertainty' (cognitive challenges); 'acts and omissions' and 'identity and expectations' (roles and responsibilities), and, finally, 'the medical hierarchy' and 'performing under stress' (environmental factors). The framework presented within this paper illustrates the complex relationships between these factors. CONCLUSIONS Although the potential of metacognitive strategies to reduce medical error is acknowledged, the framework promotes looking beyond the individual to consider the contributions to patient safety of identity issues, role uncertainty and the hierarchical clinical environment. A more distributed approach to situation awareness may help junior doctors to better tolerate complexity and uncertainty. The efficacy of simulation as an educational strategy may be improved by finding ways to recreate the hierarchical and stressful environment in which junior doctors practise. Junior doctors should be aware of the impact of affect and emotion on behaviour, and clinical supervisors should strive to ensure that roles and responsibilities are explicitly discussed.
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18
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Evaluation models and items of clinical competence for the hospital physicians in internal medicine. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Preston-Shoot M, McKimm J. Towards effective outcomes in teaching, learning and assessment of law in medical education. MEDICAL EDUCATION 2011; 45:339-346. [PMID: 21401681 DOI: 10.1111/j.1365-2923.2010.03882.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
CONTEXT Law is slowly emerging as a core subject area in medical education, alongside content on the ethical responsibilities of doctors to protect and promote patient health and well-being. Curriculum statements have begun to advise on core content and methods for organising teaching and assessment. However, no comprehensive overview of approaches to the delivery of this law curriculum has been undertaken. OBJECTIVES This paper reports an assessment of the nature and strength of the published evidence base for the teaching, learning and assessment of law in medical education. It also provides a thematic content overview from the best available literature on the teaching of law to medical students and on the assessment of their legal knowledge and skills. METHODS A systematic review of the evidence base was completed. Detailed scrutiny resulted in the inclusion of 31 empirical sources and 11 conceptual papers. The quality of the included material was assessed. RESULTS Significant gaps exist in the evidence base. Empirical studies of the teaching of law are characterised by insufficient sample sizes and a focus on individual study programmes. They rely on measures of student satisfaction and on evaluating short-term outcomes rather than assessing whether knowledge is retained and whether learning impacts on patient outcomes. Studies reveal a lack of coordination between pre- or non-clinical and clinical medico-legal education. Although evidence on the development of students' knowledge is available, much learning is distant from the practice in which its application would be tested. Law learning in clinical placements appears to be opportunistic rather than structured. CONCLUSIONS The place of law in the curriculum remains uncertain and should be more clearly identified. A more robust knowledge base is needed to realise the aspirations behind curriculum statements on law and to enable medical students to develop sufficient legal literacy to manage challenging practice encounters. Further research is needed into effective methods of teaching, learning and assessing legal knowledge and skills during and following initial medical education.
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Nardi R, Mathieu G, Berti F, Filannino C, Greco A, Nozzoli C, Mazzone A. Modelli di valutazione della clinical competence del medico specialista internista ospedaliero. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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21
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Chong A, Weiland TJ, Mackinlay C, Jelinek GA. The capacity of Australian ED to absorb the projected increase in intern numbers. Emerg Med Australas 2010; 22:100-7. [DOI: 10.1111/j.1742-6723.2010.01268.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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