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Pinidiyapathirage J, Heffernan R, Carrigan B, Walters S, Fuller L, Brumpton K. Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists' experiences across continents. BMC MEDICAL EDUCATION 2023; 23:974. [PMID: 38115001 PMCID: PMC10731800 DOI: 10.1186/s12909-023-04949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Many health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC. METHODS The study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed 'Secrets to success'. The session was recorded with the participants' consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified. RESULTS Thirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed. DISCUSSION This PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC.
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Affiliation(s)
- Janani Pinidiyapathirage
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia.
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia.
| | - Robert Heffernan
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia
| | - Brendan Carrigan
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia
| | - Sherrilyn Walters
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia
| | - Lara Fuller
- Rural Community Clinical School, School of Medicine, Deakin University, Geelong, Australia
| | - Kay Brumpton
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia
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Parekh R, Maini A, Golding B, Kumar S. Community-engaged medical education: helping to address child health and social inequality. Arch Dis Child Educ Pract Ed 2022; 107:397-401. [PMID: 34593557 DOI: 10.1136/archdischild-2021-322024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022]
Abstract
Medical education has a key role in helping to address child health and social inequality. In this paper we describe the rationale for developing a community-engaged approach to education, whereby medical schools partner with local communities. This symbiotic relationship enables medical students to experience authentic learning through working with communities to address local health and social priorities. Case studies of how such approaches have been implemented are described, with key takeaway points for paediatric healthcare professionals wanting to develop community-engaged educational initiatives.
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Affiliation(s)
- Ravi Parekh
- Medical Education Innovation and Research Centre, School of Public Health, Imperial College London, London, UK
| | - Arti Maini
- Medical Education Innovation and Research Centre, School of Public Health, Imperial College London, London, UK
| | - Bethany Golding
- Medical Education Innovation and Research Centre, School of Public Health, Imperial College London, London, UK
| | - Sonia Kumar
- Medical Education Innovation and Research Centre, School of Public Health, Imperial College London, London, UK
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O'Regan A, O'Doherty J, Green J, Hyde S. Symbiotic relationships through longitudinal integrated clerkships in general practice. BMC MEDICAL EDUCATION 2022; 22:64. [PMID: 35081951 PMCID: PMC8793267 DOI: 10.1186/s12909-022-03119-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/12/2022] [Indexed: 06/02/2023]
Abstract
BACKGROUND Longitudinal integrated clerkships (LICs) are an innovation in medical education that are often successfully implemented in general practice contexts. The aim of this study was to explore the experiences and perspectives of general practitioner (GP)-tutors on the impact of LICs on their practices, patients and the wider community. METHODS GPs affiliated with the University of Limerick School of Medicine- LIC were invited to participate in in-depth interviews. Semi-structured interviews were conducted in person and over the phone and were based on a topic guide. The guide and approach to analysis were informed by symbiosis in medical education as a conceptual lens. Data were recorded, transcribed and analysed using an inductive thematic approach. RESULTS Twenty-two GPs participated. Two main themes were identified from interviews: 'roles and relationships' and 'patient-centred physicians'. Five subthemes were identified which were: 'GP-role model', 'community of learning', and 'mentorship', 'student doctors' and 'serving the community'. CONCLUSION LICs have the potential to develop more patient-centred future doctors, who have a greater understanding of how medicine is practised in the community. The LIC model appears to have a positive impact on all stakeholders but their success hinges on having adequate support for GPs and resourcing for the practices.
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Affiliation(s)
- Andrew O'Regan
- School of Medicine, Health Research Institute, Faculty of Education and Health Sciences University of Limerick, Limerick, Ireland
| | - Jane O'Doherty
- School of Medicine, Health Research Institute, Faculty of Education and Health Sciences University of Limerick, Limerick, Ireland
| | - James Green
- School of Allied Health, Health Research Institute,, Faculty of Education and Health Sciences University of Limerick, Limerick, Ireland
| | - Sarah Hyde
- School of Medicine, Health Research Institute, Faculty of Education and Health Sciences University of Limerick, Limerick, Ireland.
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Kanakis K, Young L, Reeve C, Hays R, Gupta TS, Malau-Aduli B. How does GP training impact rural and remote underserved communities? Exploring community and professional perceptions. BMC Health Serv Res 2020; 20:812. [PMID: 32867750 PMCID: PMC7457499 DOI: 10.1186/s12913-020-05684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 08/23/2020] [Indexed: 11/15/2022] Open
Abstract
Background Substantial government funding has been invested to support the training of General Practitioners (GPs) in Australia to serve rural communities. However, there is little data on the impact of this expanded training on smaller communities, particularly for smaller rural and more remote communities. Improved understanding of the impact of training on underserved communities will assist in addressing this gap and inform ongoing investment by governments and communities. Method A purposive sample of GP supervisors, GP registrars, practice managers and health services staff, and community members (n = 40) from previously identified areas of workforce need in rural and remote North-West Queensland were recruited for this qualitative study. Participants had lived in their communities for periods ranging from a few months to 63 years (Median = 12 years). Semi-structured interviews and a focus group were conducted to explore how establishing GP training placements impacts underserved communities from a health workforce, health outcomes, economic and social perspective. The data were then analysed using thematic analysis. Results Participants reported they perceived GP training to improve communities’ health services and health status (accessibility, continuity of care, GP workforce, health status, quality of health care and sustainable health care), some social factors (community connectedness and relationships), cultural factors (values and identity), financial factors (economy and employment) and education (rural pathway). Further, benefits to the registrars (breadth of training, community-specific knowledge, quality of training, and relationships with the community) were reported that also contributed to community development. Conclusion GP training and supervision is possible in smaller and more remote underserved communities and is perceived positively. Training GP registrars in smaller, more remote communities, matches their training more closely with the comprehensive primary care services needed by these communities.
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Bartlett M, Couper I, Poncelet A, Worley P. The do's, don'ts and don't knows of establishing a sustainable longitudinal integrated clerkship. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:5-19. [PMID: 31953655 PMCID: PMC7012799 DOI: 10.1007/s40037-019-00558-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program. METHOD All four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do's, Don'ts and Don't Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline. RESULTS The final set of 18 Do's, Don'ts and Don't Knows is presented with an appraisal of the evidence for each one. CONCLUSION Implementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don't Knows, in particular the question of how cost-effectiveness is best measured.
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Affiliation(s)
- Maggie Bartlett
- Education in General Practice, Dundee University School of Medicine, Dundee, UK.
| | - Ian Couper
- Faculty of Medicine and Health Sciences, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ann Poncelet
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Paul Worley
- Department of Health, GPO Box 9848, 2601, Canberra, Australian Capital Territory, Australia
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van Schalkwyk S, Couper I, Blitz J, Kent A, de Villiers M. Twelve tips for distributed health professions training. MEDICAL TEACHER 2020; 42:30-35. [PMID: 30696315 DOI: 10.1080/0142159x.2018.1542121] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Increasing numbers of health professions students are being trained in healthcare facilities that are geographically removed from central academic hospitals. Consequently, studies have evaluated this distributed training, assessed the impact that it has on student learning as well as on the facilities where the training occurs, and explored factors that enable and constrain successful clinical training at such sites. The 12 tips presented in this article have been developed from a longitudinal project that has focused on developing a framework for effective distributed health professions training through an extensive review of the literature and a national consultative process. These 12 tips should, therefore, have applicability across multiple contexts. The purpose of this article is to assist people in implementing, adapting, upscaling, maintaining, and evaluating the distributed training of students in the health professions.
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Affiliation(s)
- Susan van Schalkwyk
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - Athol Kent
- Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
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Kato D, Wakabayashi H, Takamura A, Takemura YC. Identifying the learning objectives of clinical clerkship in community health in Japan: Focus group. J Gen Fam Med 2019; 21:3-8. [PMID: 32161694 PMCID: PMC7060287 DOI: 10.1002/jgf2.289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 11/19/2019] [Indexed: 11/08/2022] Open
Abstract
Background The value of medical education in the community has been increasingly and globally recognized. In 2015, the World Federation for Medical Education emphasized the importance of medical education in various settings in their standard. Similarly, in Japan, the Model Core Curriculum for Medical Education in Japan (MCCMEJ) is revised in 2016. However, both the learning objectives of such clerkships and their concrete strategies in Japan are not clearly established. In this study, the authors identified the learning objectives of clinical clerkship in community health reflecting the perspectives of medical professionals and community inhabitants. Methods They held six focus groups that included physicians, other medical professionals, and inhabitants (n = 35) who were involved in a clinical clerkship in community health at three prefectures in Japan from 2017 to 2018. Further, they recorded, transcribed, and thematically analyzed the discussion using MCCMEJ as conceptual frameworks. Results The learning objectives comprised of 13 domains. The following four domains were not found in "Basic Qualities and Capacities for Physicians" in MCCMEJ: "future-oriented systematic view," "organic integration of knowledge/skill," "understanding of the community," and "awareness as an individual physician." Conclusion With the community inhabitants' participation, the study results reflect the community needs in Japan. The authors hope that the outcome of this study will be useful to further improve clinical clerkship in community health.
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Affiliation(s)
- Daisuke Kato
- Department of Family Medicine Mie University Graduate School of Medicine Mie Japan
| | - Hideki Wakabayashi
- Department of Community Medicine Kameyama, Mie University School of Medicine Mie Japan
| | - Akiteru Takamura
- Department of Medical Education Kanazawa Medical University Ishikawa Japan
| | - Yousuke C Takemura
- Department of Family Medicine Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
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Molwantwa MC, van Schalkwyk S, Prozesky DR, Kebaetse MB, Mogodi MS. Enhancing learning in longitudinal clinical placements in community primary care clinics: undergraduate medical students' voices. EDUCATION FOR PRIMARY CARE 2019; 30:301-308. [PMID: 31362601 DOI: 10.1080/14739879.2019.1644540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Longitudinal clinical placements are increasingly adopted by medical training institutions. However, there seems to be little evidence regarding their implementation in primary care settings in the developing world. This paper explored medical students' perceptions of their learning experiences in longitudinal placements in primary care clinics. The Manchester clinical placement index (MCPI) survey was offered to second-year medical students at the University of Botswana to determine perceptions of their 16 weeks clinical placement in primary care clinics. The MCPI provided data on eight aspects of clinical placements which were analysed to gain insight into students learning experiences while on placement. The eight items in the tool were grouped into four themes, namely, teaching and learning, learning environment, relationships and organisation of placements. Students cited the feedback they received whilst on placement and the learning environment in primary care clinics as aspects of clinical placements which could be improved to enhance their learning experience. For an enriched learning experience in primary care settings in a developing world context, there are critical aspects to be considered. Based on the students' perspective we suggest an approach of how learning in such placements could be enhanced.
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Affiliation(s)
- Mmoloki C Molwantwa
- Department of Medical Education, Faculty of Medicine, University of Botswana , Gaborone , Botswana
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa
| | - Detlef R Prozesky
- Department of Medical Education, Faculty of Medicine, University of Botswana , Gaborone , Botswana
| | - Masego B Kebaetse
- Department of Medical Education, Faculty of Medicine, University of Botswana , Gaborone , Botswana
| | - Mpho S Mogodi
- Department of Medical Education, Faculty of Medicine, University of Botswana , Gaborone , Botswana
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Prideaux D, Ash J, Broadley S, Crotty B, Hart W, Searle J, Watson J, Wing L, Worley P. Leasing a medical curriculum: What's it worth? MEDICAL TEACHER 2019; 41:697-702. [PMID: 30736709 DOI: 10.1080/0142159x.2018.1563290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction: The early part of this century saw an unprecedented growth in number and size of Australian medical schools. There was some partnering of the new schools with existing programs. Griffith, Deakin and Curtin Universities leased an established curriculum from Flinders University. Nature and rationale for curriculum leasing: The new schools had short startup times and leasing a curriculum enabled them to appoint key staff, develop facilities and meet accreditation requirements in a timely way. However, the lease arrangements were costly and the curriculum was largely determined before the Dean and key staff appointments. Outcomes of leasing: There was differential adoption of the leased curriculum. The first two years of the courses at Flinders were transferred with little change. The final two years of predominantly clinical studies were developed differently. This is explained through Michael Fullan's work on context in educational change. The context of the clinical years of the courses involved negotiations with local health services and other schools using those health services. The advantage of the leasing arrangements was that the new schools could proceed through early development and accreditation, while having time and opportunity to negotiate a clinical curriculum that engaged local health services and fulfilled the new schools' missions.
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Affiliation(s)
- David Prideaux
- a Prideaux Centre for Research in Health Professions Education Flinders University , Adelaide , Australia
| | - Julie Ash
- a Prideaux Centre for Research in Health Professions Education Flinders University , Adelaide , Australia
| | - Simon Broadley
- b School of Medicine , Griffith University, Gold Coast , Australia
| | - Brendan Crotty
- c Faculty of Health , Deakin University , Geelong , Australia
| | | | - Judy Searle
- b School of Medicine , Griffith University, Gold Coast , Australia
| | - Jon Watson
- e School of Medicine , Deakin University , Geelong , Australia
| | - Lindon Wing
- f School of Medicine , Flinders University , Adelaide , Australia
| | - Paul Worley
- f School of Medicine , Flinders University , Adelaide , Australia
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Prideaux D. The global-local tension in medical education: turning 'think global, act local' on its head? MEDICAL EDUCATION 2019; 53:25-31. [PMID: 29974492 DOI: 10.1111/medu.13630] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/19/2018] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Medical education has not been immune from forces for globalisation in the contemporary world. At the same time the social accountability of medical schools in addressing local health priorities has been emphasised. This paper explores the global-local tension in medical education through a careful selection of key overview papers. GLOBALISATION Globalisation in medical education has taken two main forms: economic and altruistic. The former includes licensing curricula, recruiting internationally and establishing 'offshore' schools or campuses. Altruistic collaborations focus on the spread of learning and educational innovations. Both forms bring benefits but have been subject to critique for their differential impact and focus on educational inputs rather than outputs. SOCIAL ACCOUNTABILITY Social accountability requires medical schools to direct their activities to local priorities and to serving local health systems. Adoption of the principles of social accountability compels all medical schools to ask questions of their educational programmes and graduate outcomes. However, these are globally interdependent questions and are the intent of some well-known social accountability collaborations. It is naïve to think that adoption of a social accountability agenda by all medical schools would necessarily reduce global health inequity. A recent Australian example shows that workforce maldistribution, for example, is resistant to even high-level intervention. CONCLUSIONS It is yet too early to fully accept that 'think global, act local can be turned on its head'. There is much research to be carried out, particularly on the outcomes and impacts of medical education. Establishing cause and effect is a challenge, as is determining whether globalisation or localisation can contribute to greater global health equity. If we are ever to resolve the global-local tension in medical education, we need more evidence on the outcomes of what we do, whether globally or locally inspired.
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Affiliation(s)
- David Prideaux
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
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Somporn P, Ash J, Walters L. Stakeholder views of rural community-based medical education: a narrative review of the international literature. MEDICAL EDUCATION 2018; 52:791-802. [PMID: 29603320 DOI: 10.1111/medu.13580] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/02/2018] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. OBJECTIVES The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. METHODS This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. RESULTS Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. CONCLUSIONS Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature.
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Affiliation(s)
- Praphun Somporn
- Hatyai Medical Education Centre, Hatyai Hospital, Hat Yai, Songkhla, Thailand
| | - Julie Ash
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
| | - Lucie Walters
- Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
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12
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Structuring Medical Education for Workforce Transformation: Continuity, Symbiosis and Longitudinal Integrated Clerkships. EDUCATION SCIENCES 2017. [DOI: 10.3390/educsci7020058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Green-Thompson LP, McInerney P, Woollard B. The social accountability of doctors: a relationship based framework for understanding emergent community concepts of caring. BMC Health Serv Res 2017; 17:269. [PMID: 28403860 PMCID: PMC5389126 DOI: 10.1186/s12913-017-2239-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 04/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social accountability is defined as the responsibility of institutions to respond to the health priorities of a community. There is an international movement towards the education of health professionals who are accountable to communities. There is little evidence of how communities experience or articulate this accountability. METHODS In this grounded theory study eight community based focus group discussions were conducted in rural and urban South Africa to explore community members' perceptions of the social accountability of doctors. The discussions were conducted across one urban and two rural provinces. Group discussions were recorded and transcribed verbatim. RESULTS Initial coding was done and three main themes emerged following data analysis: the consultation as a place of love and respect (participants have an expectation of care yet are often engaged with disregard); relationships of people and systems (participants reflect on their health priorities and the links with the social determinants of health) and Ubuntu as engagement of the community (reflected in their expectation of Ubuntu based relationships as well as part of the education system). These themes were related through a framework which integrates three levels of relationship: a central community of reciprocal relationships with the doctor-patient relationship as core; a level in which the systems of health and education interact and together with social determinants of health mediate the insertion of communities into a broader discourse. An ubuntu framing in which the tensions between vulnerability and power interact and reflect rights and responsibility. The space between these concepts is important for social accountability. CONCLUSION Social accountability has been a concept better articulated by academics and centralized agencies. Communities bring a richer dimension to social accountability through their understanding of being human and caring. This study also creates the connection between ubuntu and social accountability and their mutual transformative capacity as agents for social justice.
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Affiliation(s)
- Lionel P Green-Thompson
- Faculty of Health Sciences, University of the Witwatersrand, PV Tobias Health Sciences Building, 5 York Road, Parktown, 2193, Johannesburg, South Africa.
| | - Patricia McInerney
- Faculty of Health Sciences, University of the Witwatersrand, PV Tobias Health Sciences Building, 5 York Road, Parktown, 2193, Johannesburg, South Africa
| | - Bob Woollard
- Department of Family Practice, University of British Columbia, Vancouver, Canada
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Liu AC, Liu M, Dannaway J, Schoo A. Are Australian medical students being taught to teach? CLINICAL TEACHER 2017; 14:330-335. [PMID: 28084007 DOI: 10.1111/tct.12591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The current global trend of growth in medical training is increasing the demand for the teaching and supervision of medical students and junior doctors. If well trained and supported, junior doctors and medical students represent an important teaching resource. Unfortunately, there is limited evidence available on whether Australian medical students are equipped with teaching skills. This study aimed to gain insight into the type and amount of teaching-skills training and peer-to-peer teaching present in Australian medical schools. METHODS A survey of Australian medical schools was conducted between May and December 2014. An online 22-item questionnaire was sent to all 19 Australian medical schools. RESULTS The response rate to the questionnaire was 100 per cent. Eleven Australian medical schools reported offering a teaching-skills programme, of which five were described as compulsory formal programmes. Eight schools did not offer such a programme, citing time restraints and other subjects taking higher priority. Formal peer-to-peer teaching opportunities were described by 17 schools, with 13 offering this electively. Two schools reported that they did not offer such opportunities because of time restraints, the belief that the quality of expert teaching is superior and because of a lack of staffing. The demand for the teaching and supervision of medical students and junior doctors is increasing CONCLUSIONS: Despite the increasing number of medical students and subsequently junior doctors in Australia, a minority of Australian medical schools report including a formal, compulsory teaching-skills programme. These results may imply a lost opportunity to use the positive effects of teaching-skills programmes, and are in line with studies from other countries.
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Affiliation(s)
- Amy C Liu
- St Vincent's Hospital, Sydney, Australia
| | | | | | - Adrian Schoo
- School of Medicine, Flinders Rural Health South Australia, Flinders University, Adelaide, Australia
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Worley P, Couper I, Strasser R, Graves L, Cummings BA, Woodman R, Stagg P, Hirsh D. A typology of longitudinal integrated clerkships. MEDICAL EDUCATION 2016; 50:922-32. [PMID: 27562892 DOI: 10.1111/medu.13084] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/14/2015] [Accepted: 03/14/2016] [Indexed: 05/13/2023]
Abstract
CONTEXT Longitudinal integrated clerkships (LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time-limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution-specific studies. OBJECTIVES This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. METHODS Data on all LIC and LIC-like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student-years of LIC-like curricula. RESULTS Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC-like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. CONCLUSIONS Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context.
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Affiliation(s)
- Paul Worley
- Prideaux Centre for Research in Health Professions Education, School of Medicine, Flinders University, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Lisa Graves
- Department of Family and Community Medicine, School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Beth-Ann Cummings
- Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatics, Flinders University, Adelaide, South Australia, Australia
| | - Pamela Stagg
- Centre for Remote Health, School of Medicine, Flinders University, Darwin, Australia
| | - David Hirsh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Seymour-Walsh A, Worley P, Vnuk A, Grantham H. Is the common approach to teaching ALS skills cost-effective? Resuscitation 2016. [DOI: 10.1016/j.resuscitation.2016.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Connolly M, Sweet L, Campbell D. What is the impact of longitudinal rural medical student clerkships on clinical supervisors and hospitals? Aust J Rural Health 2014; 22:179-88. [DOI: 10.1111/ajr.12097] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marnie Connolly
- East Gippsland Regional Clinical School; School of Rural Health; Monash University; Bairnsdale Victoria Australia
| | - Linda Sweet
- School of Nursing and Midwifery; Flinders University; Adelaide South Australia Australia
| | - David Campbell
- East Gippsland Regional Clinical School; School of Rural Health; Monash University; Bairnsdale Victoria Australia
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Perkins D, Daly M. What is the evidence for clinical placements in underserved areas? MEDICAL EDUCATION 2013; 47:958-960. [PMID: 24016164 DOI: 10.1111/medu.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Berryman C, Sweet L, Wearne S, Greenhill J. Developing Symbiotic Clinical Educators: Using Program Logic to Evaluate a Clinical Education Course. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/1035719x1301300206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Developing health professional clinical educators able to meet the shifting health care requirements of this century is a current government priority. To change practices in the clinic, those who teach need to change and that is best achieved by specific curricula designed for faculty development. Principles revealed during an investigation of a successful community-based medical education program underpin the Master of Clinical Education (MCE) course, a new faculty development curriculum. After six years, it is timely to evaluate whether the educational goals of the MCE course are being met. The MCE faculty employed an independent research officer to conduct the study. A two-phase approach used semi-structured interviews and content analysis to develop and assess outcomes against an outcomes logic model. The program achieved all short-term goals: understanding the symbiotic model; commitment to self as teacher; and changes in the way to give feedback. It achieved two of three medium-term goals: belief of transformation; and relationship development. One medium-term goal was not met: developing a sense of community. This evaluation of the MCE course shows the program develops clinicians as committed educators and also as change agents who see building relationships as the key to operating effectively within complex health services and systems.
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Affiliation(s)
- Carolyn Berryman
- Sansom Institute for Health Research at the University of South Australia, Adelaide
| | - Linda Sweet
- School of Nursing and Midwifery tat Flinders University, Adelaide
| | - Susan Wearne
- Research and Development at General Practice Education and Training Ltd, Canberra
| | - Jennene Greenhill
- Rural Clinical School in the School of Medicine at Flinders University, Adelaide
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Hirsh D, Worley P. Better learning, better doctors, better community: how transforming clinical education can help repair society. MEDICAL EDUCATION 2013; 47:942-9. [PMID: 23931543 DOI: 10.1111/medu.12278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- David Hirsh
- Department of Internal Medicine, Cambridge Health Alliance, Harvard Medical School, 1493 CambridgeStreet, Cambridge, MA 02139, USA.
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Greenhill J, Poncelet AN. Transformative learning through longitudinal integrated clerkships. MEDICAL EDUCATION 2013; 47:336-9. [PMID: 23488752 DOI: 10.1111/medu.12139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Jennene Greenhill
- Rural Clinical School, Flinders University, PO Box 852, Renmark, South Australia 5341, Australia.
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Sweet LP, Glover P. An exploration of the midwifery continuity of care program at one Australian University as a symbiotic clinical education model. NURSE EDUCATION TODAY 2013; 33:262-267. [PMID: 22196076 DOI: 10.1016/j.nedt.2011.11.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/10/2011] [Accepted: 11/18/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This discussion paper analyses a midwifery Continuity of Care program at an Australian University with the symbiotic clinical education model, to identify strengths and weakness, and identify ways in which this new pedagogical approach can be improved. BACKGROUND In 2002 a major change in Australian midwifery curricula was the introduction of a pedagogical innovation known as the Continuity of Care experience. This innovation contributes a significant portion of clinical experience for midwifery students. It is intended as a way to give midwifery students the opportunity to provide continuity of care in partnership with women, through their pregnancy and childbirth, thus imitating a model of continuity of care and continuity of carer. METHODS A qualitative study was conducted in 2008/9 as part of an Australian Learning and Teaching Council Associate Fellowship. Evidence and findings from this project (reported elsewhere) are used in this paper to illustrate the evaluation of midwifery Continuity of Care experience program at an Australian university with the symbiotic clinical education model. FINDINGS Strengths of the current Continuity of Care experience are the strong focus on relationships between midwifery students and women, and early clinical exposure to professional practice. Improved facilitation through the development of stronger relationships with clinicians will improve learning, and result in improved access to authentic supported learning and increased provision of formative feedback. This paper presents a timely review of the Continuity of Care experience for midwifery student learning and highlights the potential of applying the symbiotic clinical education model to enhance learning. CONCLUSION Applying the symbiotic clinical education framework to evidence gathered about the Continuity of Care experience in Australian midwifery education highlights strengths and weaknesses which may be used to guide curricula and pedagogical improvements.
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Affiliation(s)
- Linda P Sweet
- Flinders University Rural Clinical School, GPO Box 2100, Adelaide, SA 5001, Australia.
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Pront L, Kelton M, Munt R, Hutton A. Living and learning in a rural environment: a nursing student perspective. NURSE EDUCATION TODAY 2013; 33:281-285. [PMID: 22732124 DOI: 10.1016/j.nedt.2012.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 05/20/2012] [Accepted: 05/24/2012] [Indexed: 06/01/2023]
Abstract
UNLABELLED This study investigates the influences on nursing student learning who live and learn in the same rural environment. BACKGROUND A declining health workforce has been identified both globally and in Australia, the effects of which have become significantly apparent in the rural nursing sector. In support of rural educational programs the literature portrays rural clinical practice experiences as significant to student learning. However, there is little available research on what influences learning for the nursing student who studies in their own rural community. RESEARCH AIMS AND DESIGN The aim of this study was to understand what influences student learning in the rural clinical environment. Through a multiple case study design five nursing students and two clinical preceptors from a rural clinical venue were interviewed. The interviews were transcribed and thematically analysed to identify factors that influenced student learning outcomes. RESEARCH FINDINGS The most significant influence on nursing student learning in the rural clinical environment was found to include the environment itself, the complex relationships unique to living and studying in a rural community along with the capacity to link theory to practice. The rural environment influences those in it, the demands placed on them, the relationships they form, the ability to promote learning and the time to teach and learn.
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Affiliation(s)
- Leeanne Pront
- School of Nursing and Midwifery, Flinders University, Renmark, SA 5341, Australia.
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Walters L, Greenhill J, Richards J, Ward H, Campbell N, Ash J, Schuwirth LWT. Outcomes of longitudinal integrated clinical placements for students, clinicians and society. MEDICAL EDUCATION 2012; 46:1028-41. [PMID: 23078680 DOI: 10.1111/j.1365-2923.2012.04331.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
CONTEXT Longitudinal integrated clerkships (LICs) have been widely implemented in both rural and urban contexts, as is now evident in the wealth of studies published internationally. This narrative literature review aims to summarise current evidence regarding the outcomes of LICs for student, clinician and community stakeholders. METHODS Recent literature was examined for original research articles pertaining to outcomes of LICs. RESULTS Students in LICs achieve academic results equivalent to and in some cases better than those of their counterparts who receive clinical education in block rotations. Students in LICs are reported to have well-developed patient-centred communication skills, demonstrate understanding of the psychosocial contributions to medicine, and report more preparedness in higher-order clinical and cognitive skills in comparison with students in traditional block rotations (TBRs). Students in LICs take on increased responsibility with patients and describe having more confidence in dealing with ethical dilemmas. Continuity of supervision reportedly facilitates incremental knowledge acquisition, and supervisors provide incrementally progressive feedback. Despite early disorientation regarding the organising of their learning, students feel well supported by the continuity of student-preceptor relationships and value the contributions made by these. Students in LICs living and working in rural areas are positively influenced towards primary care and rural career choices. DISCUSSION A sound body of knowledge in the field of LIC research suggests it is time to move beyond descriptive or exploratory research that is designed to justify this new educational approach by comparing academic results. As the attributes of LIC alumni are better understood, it is important to conduct explanatory research to develop a more complete understanding of these findings and a foundation for new theoretical frameworks that underpin educational change. CONCLUSIONS Longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to TBRs in medical education.
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Affiliation(s)
- Lucie Walters
- Flinders University Rural Clinical School, Faculty of Health Sciences, Flinders University, Mount Gambier, South Australia, Australia.
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Murray RB, Larkins S, Russell H, Ewen S, Prideaux D. Medical schools as agents of change: socially accountable medical education. Med J Aust 2012; 196:653. [PMID: 22676883 DOI: 10.5694/mja11.11473] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medical education reform can make an important contribution to the future health care of populations. Social accountability in medical education was defined by the World Health Organization in 1995, and an international movement for change is gathering momentum. While change can be enabled with policy levers, such as funding tied to achieving equity outcomes and systems of accreditation, medical schools and students themselves can lead the transformation agenda. An international movement for change and coalitions of medical schools with an interest in socially accountable medical education provide a "community of practice" that can drive change from within.
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Affiliation(s)
- Richard B Murray
- School of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
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Hirsh D, Gaufberg E, Ogur B, Cohen P, Krupat E, Cox M, Pelletier S, Bor D. Educational outcomes of the Harvard Medical School-Cambridge integrated clerkship: a way forward for medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2012; 87:643-50. [PMID: 22450189 DOI: 10.1097/acm.0b013e31824d9821] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The authors report data from the Harvard Medical School-Cambridge Integrated Clerkship (CIC), a model of medical education in which students' entire third year consists of a longitudinal, integrated curriculum. The authors compare the knowledge, skills, and attitudes of students completing the CIC with those of students completing traditional third-year clerkships. METHOD The authors compared 27 students completing the first three years of the CIC (2004-2007) with 45 students completing clerkships at other Harvard teaching hospitals during the same period. At baseline, no significant between-group differences existed (Medical College Admission Test and Step 1 scores, second-year objective structured clinical examination [OSCE] performance, attitudes toward patient-centered care, and plans for future practice) in any year. The authors compared students' National Board of Medical Examiners Subject and Step 2 Clinical Knowledge scores, OSCE performance, perceptions of the learning environment, and attitudes toward patient-centeredness. RESULTS CIC students performed as well as or better than their traditionally trained peers on measures of content knowledge and clinical skills. CIC students expressed higher satisfaction with the learning environment, more confidence in dealing with numerous domains of patient care, and a stronger sense of patient-centeredness. CONCLUSIONS CIC students are at least as well as and in several ways better prepared than their peers. CIC students also demonstrate richer perspectives on the course of illness, more insight into social determinants of illness and recovery, and increased commitment to patients. These data suggest that longitudinal integrated clerkships offer students important intellectual, professional, and personal benefits.
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Affiliation(s)
- David Hirsh
- Department of Medicine, Harvard Medical School, Massachusetts, USA.
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27
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Ash JK, Walters LK, Prideaux DJ, Wilson IG. The context of clinical teaching and learning in Australia. Med J Aust 2012; 196:475. [DOI: 10.5694/mja10.11488] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 08/29/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Julie K Ash
- Health Professional Education, School of Medicine, Flinders University, Adelaide, SA
| | - Lucie K Walters
- Health Professional Education, School of Medicine, Flinders University, Adelaide, SA
| | - David J Prideaux
- Health Professional Education, School of Medicine, Flinders University, Adelaide, SA
| | - Ian G Wilson
- Medical Education Unit, University of Western Sydney, Sydney, NSW
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Bolte K, Bennett P, Moore M. ENRICHing the rural clinical experience for undergraduate health science students: A short report on inter-professional education in Broken Hill. Aust J Rural Health 2012; 20:42-3. [DOI: 10.1111/j.1440-1584.2011.01251.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hirsh D, Walters L, Poncelet AN. Better learning, better doctors, better delivery system: possibilities from a case study of longitudinal integrated clerkships. MEDICAL TEACHER 2012; 34:548-54. [PMID: 22746961 DOI: 10.3109/0142159x.2012.696745] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Interest in longitudinal integrated clerkships (LICs) as an alternative to traditional block rotations is growing worldwide. Leaders in medical education and those who seek physician workforce development believe that "educational continuity" affords benefits to medical students and benefits for under-resourced settings. The model has been recognized as effective for advancing student learning of science and clinical practice, enhancing the development of students' professional role, and supporting workforce goals such as retaining students for primary care and rural and remote practice. Education leaders have created multiple models of LICs to address these and other educational and health system imperatives. This article compares three successful longitudinal integrated clinical education programs with attention to the case for change, the principles that underpin the educational design, the structure of the models, and outcome data from these educational redesign efforts. By translating principles of the learning sciences into educational redesign efforts, LICs address the call to improve medical student learning and potential and advance the systems in which they will work as doctors.
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Walters L, Hirsh D. Teaching in general practice: considering conceptual lenses. MEDICAL EDUCATION 2011; 45:660-662. [PMID: 21649697 DOI: 10.1111/j.1365-2923.2011.04008.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Lucie Walters
- Flinders University Rural Clinical School, Faculty of Health Sciences, Flinders University, Mount Gambier, South Australia, Australia
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Walters L, Prideaux D, Worley P, Greenhill J. Demonstrating the value of longitudinal integrated placements to general practice preceptors. MEDICAL EDUCATION 2011; 45:455-63. [PMID: 21486321 DOI: 10.1111/j.1365-2923.2010.03901.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
CONTEXT This paper aims to consider why general practitioners (GPs) teach, in particular by defining the longitudinal supervisory relationships between rural clinician-preceptors and students. METHODS A total of 41 individual semi-structured interviews were conducted with GPs, practice managers and students. All interviews were audiotaped, transcribed and analysed for emergent themes. RESULTS In this study preceptors identified many ways in which precepting added value to their roles. However, themes relating to the doctor-student relationship were central to GP preceptors' experiences. These developed in chronological order and resulted in changes in the triangular relationship between doctor, patient and student in the consultation. DISCUSSION Interpretive findings identify that the motivators for precepting represent a group of constantly changing interconnected factors that contribute to the defining of preceptors as central members of their professional community of practice. This critical finding challenges the simplistic organisational concept that universities can recruit and retain GPs by offering increased rewards. This paper introduces four clinical preceptor models, which involve the roles of, respectively: the student-observer; the teacher-healer; the doctor-orchestrator, and the doctor-advisor. Symbiosis between student learning and patient care was found to occur in the doctor-orchestrator model. CONCLUSIONS The evolution of doctor-student relationships in long-term student placements explains how students become more useful over the academic year and sheds light on how GPs are changed through precepting as part of the complex process by which they come to recognise themselves as central members of the rural generalist community.
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Affiliation(s)
- Lucie Walters
- Flinders University Rural Clinical School, Faculty of Health Sciences, Flinders University, South Australia, Australia.
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McKimm J, Wilkinson T, Poole P, Bagg W. The current state of undergraduate medical education in New Zealand. MEDICAL TEACHER 2010; 32:456-60. [PMID: 20515371 DOI: 10.3109/0142159x.2010.486427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The two medical schools in New Zealand (NZ) are responding to the challenges of increasing healthcare demands and a worldwide doctor shortage, despite an environment of relatively scarce resource. Admissions to medical school are being increased and curricula examined and modified so that graduates are able to meet the healthcare needs of all New Zealanders. Affirmative pathways are in place for people of Maori, Pacific and rural origin to enter medical programmes and aim towards a broad demographic representation in future doctors. Additionally, there is a strong focus on Maori (indigenous) health in curricula. Medical undergraduate programmes have common learning outcomes and assessment but there are different pathways to achieve these, delivered at geographically dispersed sites. The final (Trainee Intern) year of the programme is an apprenticeship year which serves as a 'work hardening' year, but remains under the auspices of the respective universities. One of the greatest challenges that NZ faces with respect to healthcare is the long-term retention of high quality, local medical graduates, whose services are in high demand internationally.
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Sarikaya O, Civaner M, Vatansever K. Exposure of medical students to pharmaceutical marketing in primary care settings: frequent and influential. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2009; 14:713-724. [PMID: 19184498 DOI: 10.1007/s10459-009-9153-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 01/08/2009] [Indexed: 05/27/2023]
Abstract
It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician-pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.
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Affiliation(s)
- Ozlem Sarikaya
- Department of Medical Education, Marmara University School of Medicine, Haydarpasa, 34668, Uskudar, Istanbul, Turkey.
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Walters L, Prideaux D, Worley P, Greenhill J, Rolfe H. What do general practitioners do differently when consulting with a medical student? MEDICAL EDUCATION 2009; 43:268-73. [PMID: 19250354 DOI: 10.1111/j.1365-2923.2008.03276.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVES The practice of having medical students see patients in a general practice setting, in their own consulting rooms, prior to the GP preceptor joining the consultation does not increase general practitioner (GP) consultation time. How do GPs meet the needs of both patient and student without extending consultation time? This study sought to quantify and compare GP consultation activities with and without students. METHODS This was a prospective cohort study of 523 videotaped consultations. Consultations were analysed in 15-second intervals using a modified Davis observation code to define GP activity. Estimated marginal means were calculated using mixed model analysis accounting for confounding factors. RESULTS In comparison with consulting alone, GPs precepting a student spent 37 seconds less time examining patients (P = 0.001), 41 seconds less on patient management, and 1 minute, 31 seconds less on clerical and other activities (P < 0.001). This created time for GPs to take a history from both the student and patient (39 seconds longer; P = 0.002) and to teach students (1 minute, 10 seconds; P < 0.001). DISCUSSION General practitioner activity in the consultation changes significantly when precepting a student; GPs spend longer exploring the history in order to unpack the student's clinical reasoning, verify the patient's story and resynthesise the information. They spend less time on examination, management and clerical activities and presumably delegate or defer these activities. Conclusions This organising of clinical activities in order to meet the needs of both patient and student is likely to require different processing skills to solo consulting.
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Affiliation(s)
- Lucie Walters
- Flinders University, Rural Clinical School, Flinders University, South Australia, Australia.
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Abstract
Australia is a young country in medical education terms. Traditionally courses followed a 6-year British model with a pre-clinical/clinical divide. There is no national licensing system. After graduation there are two postgraduate years followed by specialist training. From the mid-1990s there has been considerable expansion and innovation in medical education. There are now 19 medical schools with a mix of 4-, 5- and 6-year courses. The creation of rural clinical schools has fostered new clinical placements and community-based programmes. Indigenous health is a priority. There is a nationally accepted curriculum framework in Indigenous health for all medical schools. Clinical teaching remains as a significant challenge especially with the increasing number of medical schools and students. There are also important issues in aligning a teaching hospital-based system with the health services of the future. Medical education research is a developing discipline. There is an emerging national recognition of research and schemes to promote young researchers. The Medical Schools Outcomes Database project is providing an important impetus to career choice and outcomes research. While the period of expansion may have ceased, Australian medical education still faces considerable challenges posed by a new health care reform agenda.
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