Becoming ‘ward smart’ medical students

Is it worth it? A comparison study of medical students' aspirations for gaining the Health Care Certificate following employment as Healthcare Assistants

BACKGROUND

Medical students seek early patient contact but their curriculum starts with scientific knowledge. We integrated the Healthcare Assistant (HCA) course into semester one for early patient-facing clinical contact. This study compares students' aspirations for this learning with the realities of employed work as HCAs.

METHODS

This sequential mixed-methods study used pre-post-scored questionnaire data, followed by post-course focus groups, and interviews a year later. The quantitative data were analysed using SPSS and the qualitative data using thematic analysis.

RESULTS

The learning was highly valued with early perceptions challenged. The learning both accelerated and advanced their medical skills. Their naivety of nurses' work within team-based practice quickly eroded; they symbiotically linked their clinical and non-clinical learning; they acclimatised to the hospital environment while future gazing in preparation for clinical learning. Early anxieties for starting employment were overcome, building resilience.

CONCLUSIONS

HCA training offers a practical patient-facing set of competencies on which to build medical capability. Student text-book scientific knowledge was validated through their experiences with recognition of the importance of empathetic patient-centred care. They quickly learnt and absorbed ward function; experienced good and poor teamworking; highly valued the nursing role; and experienced the every-day stresses of being a front-line practitioner.

Praxis-Informed Pointers: A Student Guide for Optimizing Clinical Learning in a Resource-Constrained Setting

Issue: Health professions education (HPE) is intimately linked with teaching and learning in the clinical environment. While the value of authentic clinical experiences is acknowledged, whether learning actually occurs is to a large extent dependent on students' behaviors and attitudes. The kinds of student behaviors and attitudes that are necessary to optimize learning in the clinical environment thus becomes relevant. Evidence: Tips and recommendations to maximize clinical learning in a variety of settings have been well documented. There is, however, a dearth of literature which takes a narrative-based praxis approach focused on resource-constrained environments. We developed this praxis-orientated article as a means to translate the available literature and theory into a simple, practical guide, focused on optimizing clinical learning from a student perspective, remaining cognizant of the particular challenges present in a resource-constrained setting. Implications: Based on the resource-constrained environments our students are exposed to, we outline the following six key aspects: student-driven learning, integration into the community of practice, student engagement, empathy, interprofessional learning opportunities, and feedback for learning. These aspects provide useful pointers for students in general. Furthermore, exploration into what strategies students may utilize in resource-constrained clinical contexts is addressed.

Surgical Nursing Students' Perception of Feedback in Clinical Education: A Mixed-method Study

BACKGROUND

Feedback is a critical component of education but may not always be delivered in a useful manner. This study assessed surgical nursing students' perception of the feedback they received on a clinical rotation.

METHODS

This is a sequential mixed-method study. The first stage surveyed surgical nursing students in surgical units about the feedback they received. In the second stage, participants' experiences receiving feedback were explored in interviews, and analyzed by a conventional content analysis approach.

RESULTS

The majority of nurses found that feedback was not helpful, citing a lack of constructive feedback. Negative feedback was often delivered in a public setting. Comments were frequently based on secondary information rather than direct observation.

DISCUSSION

Feedback to nurses on the surgical unit is not perceived by students as constructive. Clinical teachers did not appear to be aware of the educational effect of the feedback on the learning process of students. In addition, the setting for feedback often undermined its effectiveness. Staff development on effective feedback for teachers on the surgical unit is recommended.

Healthcare support worker assistantships should form a mandatory part of medical school curricula: A perspective from UK medical students

This personal view, regarding the value of healthcare support worker (HCSW) assistantships, is based on our experiences as medical students entering our final year, having both worked as HCSW's during the COVID-19 pandemic, and from SC's experience as a HCSW before and throughout medical school. HCSW's provide a large proportion of the basic care patients receive on the wards, in clinics and primary care. The proximity to patients attracts individuals with excellent communication skills and bedside manner, and means they are well-positioned to assist in the management of both the general wellbeing of patients and equally, to recognise the signs of a deteriorating patient making them a versatile and invaluable member of the multidisciplinary team (MDT). This piece aims to highlight the value of our time spent working as a HCSWs, thus promoting the formation of a mandatory assistantship for medical students, like that seen in Germany. Through this, essential communication skills, empathy, 'ward smarts' and an appreciation for the wider MDT can be gained in a way that typical clinical attachments and classroom teaching do not replicate.

"From doing to knowing": medical students' experiences of working as Healthcare Assistants

There is growing recognition that doctors need to deliver person-centered care. More evidence is needed on how to best equip students in an already busy curriculum. Providing medical students with the opportunity to work as Healthcare Assistants (HCAs) can help them develop the desired skills. This study examined medical students' experiences of working as HCAs and perceived impact on their future practice. Adopting an Interpretative Phenomenological Analysis approach, we analyzed narratives from two focus groups of 13 'Year 0' and 'Year 1' medical students, who had completed an HCA project. This project allowed participants to experience a new dimension of patient care whereby learning by "doing" evolved to a deeper level of "knowing" patients, the HCA role and the wider team. Four major themes were identified: seeing the doctor: gaining new perspectives; building confidence: learning from and about patients; understanding the overall patient experience: providing personal care; finding "the person behind the patient": exploring beyond the diagnosis. This study suggests that working as an HCA enables participants to develop sustainable skills that equip them for their future role as doctors able to deliver person-centered care as part of an interprofessional team. Recommendations for inclusion of this type of intervention into the medical curriculum are discussed.

Qualitative exploration of medical student experiences during the Covid-19 pandemic: implications for medical education

BACKGROUND

During the Covid-19 pandemic medical students were offered paid roles as medical student healthcare assistants. Anecdotal reports suggested that students found this experience rich for learning. Previous studies have explored alternative models of student service, however this defined medical student support role is novel.

METHODS

Individual semi-structured interviews were recorded with 20 medical students at a UK medical school exploring their experiences of placement learning and experiences of working as healthcare assistants. Responses were analysed qualitatively using a framework approach. The framework was developed into a model describing key findings and their relationships.

RESULTS

Interviews yielded data that broadly covered aspects of (1) Medical students' experiences of clinical placement learning (2) Medical students' experiences of working as medical student healthcare assistants (3) Learning resulting from working as a healthcare assistant (4) Hierarchies and professional barriers in the clinical environment (5) Influences on professional identity. Participants described barriers and facilitators of clinical learning and how assuming a healthcare assistant role impacted on learning and socialisation within the multidisciplinary team. Students became increasingly socialised within the healthcare team, contributing directly to patient care; the resulting social capital opened new opportunities for learning, team working and enhanced students' interprofessional identity. Students described the impact of these experiences on their aspirations for their future practice.

CONCLUSIONS

Changes to work patterns in healthcare and delivery models of medical education have eroded opportunities for students to contribute to healthcare delivery and be embedded within a team. This is impacting negatively on student learning and socialisation and we suggest that medical curricula have much to learn from nursing and allied health professional training. Longitudinal embedment with a multidisciplinary team, where students have a defined role and work directly with patients may not only add value to clinical service, but also overcome current barriers to effective placement learning and interprofessional identity formation for medical students.

Twelve tips to promote a feedback culture with a growth mind-set: Swinging the feedback pendulum from recipes to relationships

Feedback in medical education has traditionally showcased techniques and skills of giving feedback, and models used in staff development have focused on feedback providers (teachers) not receivers (learners). More recent definitions have questioned this approach, arguing that the impact of feedback lies in learner acceptance and assimilation of feedback with improvement in practice and professional growth. Over the last decade, research findings have emphasized that feedback conversations are complex interpersonal interactions influenced by a multitude of sociocultural factors. However, feedback culture is a concept that is challenging to define, thus strategies to enhance culture are difficult to pin down. In this twelve tips paper, we have attempted to define elements that constitute a feedback culture from four different perspectives and describe distinct strategies that can be used to foster a learning culture with a growth mind-set.

Bedside teaching: everybody's but nobody's responsibility

Evidence shows dwindling levels of bedside teaching for medical students in the UK, especially in district general hospitals. Lack of individual responsibility has resulted in disengagement in teaching. Based on a quality improvement project (QIP) at a District General Hospital, we suggest some ways this could be addressed. We suggest here that harnessing support from the medical education lead, incentivizing teaching, allocating student-junior doctor groups to harbor personal responsibility, providing a supportive framework, and educating about barriers to teaching can all be used to develop an effective teaching program.