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Huang M, Yang H, Guo J, Fu X, Chen W, Li B, Zhou S, Xia T, Peng S, Wen L, Ma X, Zhang Y, Zeng J. Faculty standardized patients versus traditional teaching method to improve clinical competence among traditional Chinese medicine students: a prospective randomized controlled trial. BMC MEDICAL EDUCATION 2024; 24:793. [PMID: 39049066 PMCID: PMC11267817 DOI: 10.1186/s12909-024-05779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Standardized patients (SPs) simulation training models have been widely used in various fields, the study of using SPs in Traditional Chinese medicine (TCM) is still a new filed. Previous studies have demonstrated the effectiveness of occupational SP for TCM (OSP-TCM), which has an increasingly problem of high time and financial costs. The faculty SPs for TCM (FSP-TCM) simulation training model may provide a better alternative. This study aims to test and determine whether FSP-TCM simulations are more cost-effective than OSP-TCM and traditional educational models to improve the clinical competence of TCM students. METHODS This study was a single-blind, prospective, randomized controlled trial conducted between February 2023 and October 2023. The participants were randomized into FSP-TCM group, OSP-TCM group and traditionally taught group (TT group) in the ratio of 1:1:1. The duration of this training program was 12 weeks (36 credit hours). Formative and summative assessments were integrated to evaluate the effectiveness of teaching and learning. Three distinct questionnaires were utilized to collect feedback from students, SPs, and teachers at the conclusion of the course. Additionally, analysis of cost comparisons between OSP-TCM and FSP-TCM were performed in the study. RESULTS The study comprised a total of 90 students, with no dropouts during the research. In the formative evaluation, students assigned to both the FSP-TCM and OSP-TCM groups demonstrated higher overall scores compared to those in the TT group. Notably, their performance in "physical examination" (Pa = 0.01, Pb = 0.04, Pc = 0.93) and "comprehensive ability" (Pa = 0.01, Pb = 0.006, Pc = 0.96) significantly exceeded that of the TT group. In the summary evaluation, both SP-TCM groups students outperforms TT group in the online systematic knowledge test (Pa = 0.019, Pb = 0.04, Pc = 0.97), the application of TCM technology (Pa = 0.01, Pb = 0.03, Pc = 0.93) and real-time assessment (Pa= 0.003, Pb = 0.01, Pc = 0.93). The feedback questionnaire demonstrated that both SP-TCM groups showed higher levels of agreement for this course in "satisfaction with the course" (Pa = 0.03; Pb = 0.02) and "enhanced TCM clinical skills" (Pa = 0.02; Pb = 0.03) than TT group. The SP questionnaire showed that more FSPs than OSPs in "provided professional feedback" (FSPs: strongly agree 30%, agree 50% vs. OSPs: strongly agree 20%, agree 40%. P = 0.69), and in "gave hints" during the course (FSPs: strongly agree 10%, agree 30% vs. OSPs: strongly agree 0%, agree 10%. P = 0.42). It is noteworthy that FSP-TCM was significantly lower than the OSP-TCM in overall expense (FSP-TCM $7590.00 vs. OSP-TCM $17415.60), and teachers have a positive attitude towards the FSP-TCM. CONCLUSION FSP-TCM training mode showed greater effectiveness than traditional teaching method in improving clinical competence among TCM students. It was feasible, practical, and cost-effective, and may serve as an alternative method to OSP-TCM simulation.
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Affiliation(s)
- Meilan Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Han Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Jing Guo
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Xiaoxu Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Wangshu Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Bin Li
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Shan Zhou
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Ting Xia
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Sihan Peng
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China
| | - Lijuan Wen
- Clinical Skill Center, Clinical Medical School of Chengdu University of Traditional Chinese Medicine, No. 37 Shierqiao Road, Chengdu, 610072, China
| | - Xiao Ma
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China.
| | - Yi Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China.
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China.
| | - Jinhao Zeng
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shierqiao Road, Chengdu, 610072, China.
- Clinical Medical School, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Avenue, Chengdu, 611137, China.
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Dornan T, Armour D, McCrory R, Kelly M, Speyer F, Gormley G, Maxwell P. Striking fear into students' hearts: Unforeseen consequences of prescribing education. MEDICAL TEACHER 2024:1-11. [PMID: 38301608 DOI: 10.1080/0142159x.2024.2308061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Undergraduate medical education (UGME) has to prepare students to do safety-critical work (notably, to prescribe) immediately after qualifying. Despite hospitals depending on them, medical graduates consistently report feeling unprepared to prescribe and they sometimes harm patients. Research clarifying how to prepare students better could improve healthcare safety. Our aim was to explore how students experienced preparing for one of their commonest prescribing tasks: intravenous fluid therapy (IVFT). METHODS Complexity assumptions guided the research, which used a qualitative methodology oriented towards hermeneutic phenomenology. The study design was an uncontrolled and unplanned complex intervention: judicial review of the iatrogenic death of five children due to hyponatraemia in our region had resulted in the recommendation that students' education in 'the implementation of important clinical guidelines' relevant to fluid and electrolyte balance should be intensified. An opportunity sample of 40 final-year medical students drew and gave audio-recorded commentaries on rich pictures. We completed two template analyses: one of participants' transcribed commentaries on the pictures and one using a novel heuristic to analyse the pictures themselves. We then reconciled the two analyses into a single template. RESULTS There were four themes: affects, teaching and learning, contradictions, and the curriculum as a journey. To explore interconnections between themes, we chose the picture best exemplifying each of the four themes and interpreted the curriculum journey depicted in each of them. These interpretations were grounded in each participant's picture, verbal account of the picture, and the aggregate findings of the template analysis. Participants' experiences were influenced by the situated complexity of IVFT. Layered on top of that, contradictions, overlaps, and gaps within the curriculum introduced extraneous complexity. Confusion and apprehension resulted. CONCLUSIONS After spending five years preparing to prescribe IVFT, participants felt unprepared to do so. We conclude that intensive teaching had not achieved its avowed goal of improving students' preparedness for safe practice. Merton's seminal work on the 'unanticipated consequences of purposive social action' suggests that intensive teaching may even have contributed to their unpreparedness.
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Affiliation(s)
- Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Dakota Armour
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Richard McCrory
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Martina Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Frederick Speyer
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Gerard Gormley
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Peter Maxwell
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
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Dejene D, Ayalew F, Yigzaw T, Woretaw A, Versluis M, Stekelenburg J. Assessment of clinical competence of graduating medical students and associated factors in Ethiopia. BMC MEDICAL EDUCATION 2024; 24:17. [PMID: 38172922 PMCID: PMC10765545 DOI: 10.1186/s12909-023-04939-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Ethiopia has scaled up medical education to improve access to healthcare which presented challenges to maintaining training quality. We conducted a study to assess the clinical competence of graduating medical students and the associated factors. METHODS AND MATERIALS A pretest assessment of a quasi-experimental study was conducted in 10 medical schools with a sample size of 240 students. We randomly selected 24 students per school. Clinical competence was assessed in a 12-station objective structured clinical examination. The clinical learning environment (CLE), simulation training, and practice exposure were self-rated. Mean scores for clinical competence, and satisfaction in the CLE and simulation training were calculated. Proportions of students with practice exposure, and who agreed on CLE and simulation items were done. Independent t-tests were used to look at competence differences among subgroups. Bivariate and multiple linear regression models were fitted for the outcome variable: competence score. A 95% statistical confidence interval and p-value < 0.05 were used for making statistical decisions. A 75% cut-off score was used to compare competence scores. RESULTS Graduating medical students had a mean competence score of 72%. Low scores were reported in performing manual vacuum aspiration (62%), lumbar puncture (64%), and managing childbirth (66%). Female students (73%) had a significantly higher competence score than males (70%). Higher cumulative grade point average (CGPA), positive appraisal of the CLE, and conducting more clinical procedures were associated with greater competence scores. Nearly half of the students were not satisfied with the clinical practice particularly due to the large student number and issues affecting the performance assessment. About two-thirds of the students were not satisfied with the sufficiency of models and equipment, and the quality of feedback during simulation training. Nearly one-third of the students never performed lumbar puncture, manual vacuum aspiration, and venipuncture. CONCLUSIONS Medical students had suboptimal clinical competence. A better clinical learning environment, higher cumulative GPA, and more practice exposure are associated with higher scores. There is a need to improve student clinical practice and simulation training. Strengthening school accreditation and graduates' licensing examinations is also a way forward.
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Affiliation(s)
- Daniel Dejene
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, Netherlands.
- Jhpiego Ethiopia, P.O. Box:2881, code, 1250, Addis Ababa, Ethiopia.
| | - Firew Ayalew
- Jhpiego Ethiopia, P.O. Box:2881, code, 1250, Addis Ababa, Ethiopia
| | - Tegbar Yigzaw
- Jhpiego Ethiopia, P.O. Box:2881, code, 1250, Addis Ababa, Ethiopia
| | | | - Marco Versluis
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen/University of Groningen, Groningen, Netherlands
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Mattick K, Goulding A, Carrieri D, Brennan N, Burford B, Vance G, Dornan T. Constraints and affordances for UK doctors-in-training to exercise agency: A dialogical analysis. MEDICAL EDUCATION 2023; 57:1198-1209. [PMID: 37293699 DOI: 10.1111/medu.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/09/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The goal of medical education is to develop clinicians who have sufficient agency (capacity to act) to practise effectively in clinical workplaces and to learn from work throughout their careers. Little research has focused on experiences of organisational structures and the role of these in constraining or affording agency. The aim of this study was to identify priorities for organisational change, by identifying and analysing key moments of agency described by doctors-in-training. METHODS This was a secondary qualitative analysis of data from a large national mixed methods research programme, which examined the work and wellbeing of UK doctors-in-training. Using a dialogical approach, we identified 56 key moments of agency within the transcripts of 22 semi-structured interviews with doctors based across the UK in their first year after graduation. By analysing action within the key moments from a sociocultural theoretical perspective, we identified tangible changes that healthcare organisations can make to afford agency. RESULTS When talking about team working, participants gave specific descriptions of agency (or lack thereof) and used adversarial metaphors, but when talking about the wider healthcare system, their dialogue was disengaged and they appeared resigned to having no agency to shape the agenda. Organisational changes that could afford greater agency to doctors-in-training were improving induction, smoothing peaks and troughs of responsibility and providing a means of timely feedback on patient care. CONCLUSIONS Our findings identified some organisational changes needed for doctors-in-training to practise effectively and learn from work. The findings also highlight a need to improve workplace-based team dynamics and empower trainees to influence policy. By targeting change, healthcare organisations can better support doctors-in-training, which will ultimately benefit patients.
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Affiliation(s)
- Karen Mattick
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Anna Goulding
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Daniele Carrieri
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research, Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Bryan Burford
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Gillian Vance
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Fábry S, Rózsa S, Hargittay C, Kristóf P, Szélvári Á, Vörös K, Torzsa P, Németh E, Dornan T, Eőry A. Evaluating real-patient learning in medical education - Hungarian validation of the Manchester Clinical Placement Index. Front Med (Lausanne) 2023; 10:1265804. [PMID: 38162882 PMCID: PMC10756501 DOI: 10.3389/fmed.2023.1265804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction The Manchester Clinical Placement Index (MCPI) is an instrument to measure medical undergraduates' real-patient learning in communities of practice both in hospital and in GP placements. Its suitability to evaluate the quality of placement learning environments has been validated in an English-language context; however, there is a lack of evidence for its applicability in other languages. Our aim was to thoroughly explore the factor structure and the key psychometric properties of the Hungarian language version. Methods MCPI is an 8-item, mixed-method instrument which evaluates the quality of clinical placements as represented by the leadership, reception, supportiveness, facilities and organization of the placement (learning environment) as well as instruction, observation and feedback (training) on 7-point Likert scales with options for free-text comments on the strengths and weaknesses of the given placement on any of the items. We collected data online from medical students in their preclinical (1st, 2nd) as well as clinical years (4th, 5th) in a cross-sectional design in the academic years 2019-2020 and 2021-2022, by the end of their clinical placements. Our sample comprises data from 748 medical students. Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. Results Although a bifactor model gave the best model fit (RMSEA = 0.024, CFI = 0.999, and TLI = 0.998), a high explained common variance (ECV = 0.82) and reliability coefficients (ωH = 0.87) for the general factor suggested that the Hungarian version of the MCPI could be considered unidimensional. Individual application of either of the subscales was not supported statistically due to their low reliabilities. Discussion The Hungarian language version of MCPI proved to be a valid unidimensional instrument to measure the quality of undergraduate medical placements. The previously reported subscales were not robust enough, in the Hungarian context, to distinguish, statistically, the quality of learning environments from the training provided within those environments. This does not, however, preclude formative use of the subscales for quality improvement purposes.
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Affiliation(s)
- Szabolcs Fábry
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Sándor Rózsa
- Department of Personality and Health Psychology, Károli Gáspár University of the Reformed Church, Budapest, Hungary
| | - Csenge Hargittay
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Kristóf
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Szélvári
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztián Vörös
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Endre Németh
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Timothy Dornan
- Centre for Medical Education, Queen’s University Belfast, Belfast, United Kingdom
| | - Ajándék Eőry
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
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Dornan T, Armour D, Bennett D, Gillespie H, Reid H. Reluctant heroes: New doctors negotiating their identities dialogically on social media. MEDICAL EDUCATION 2023; 57:1079-1091. [PMID: 37218311 DOI: 10.1111/medu.15109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Ensuring that students transition smoothly into the identity of a doctor is a perpetual challenge for medical curricula. Developing professional identity, according to cultural-historical activity theory, requires negotiation of dialectic tensions between individual agency and the structuring influence of institutions. We posed the research question: How do medical interns, other clinicians and institutions dialogically construct their interacting identities? METHODS Our qualitative methodology was rooted in dialogism, Bakhtin's cultural-historical theory that accounts for how language mediates learning and identity. Reasoning that the COVID pandemic would accentuate and expose pre-existing tensions, we monitored feeds into the Twitter microblogging platform during medical students' accelerated entry to practice; identified relevant posts from graduating students, other clinicians and institutional representatives; and kept an audit trail of chains of dialogue. Sullivan's dialogic methodology and Gee's heuristics guided a reflexive, linguistic analysis. RESULTS There was a gradient of power and affect. Institutional representatives used metaphors of heroism to celebrate 'their graduates', implicitly according a heroic identity to themselves as well. Interns, meanwhile, identified themselves as incapable, vulnerable and fearful because the institutions from which they had graduated had not taught them to practise. Senior doctors' posts were ambivalent: Some identified with institutions, maintaining hierarchical distance between themselves and interns; others, along with residents, acknowledged interns' distress, expressing empathy, support and encouragement, which constructed an identity of collegial solidarity. CONCLUSIONS The dialogue exposed hierarchical distance between institutions and the graduates they educated, which constructed mutually contradictory identities. Powerful institutions strengthened their identities by projecting positive affects onto interns who, by contrast, had fragile identities and sometimes strongly negative affects. We speculate that this polarisation may be contributing to the poor morale of doctors in training and propose that, to maintain the vitality of medical education, institutions should seek to reconcile their projected identities with the lived identities of graduates.
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Affiliation(s)
- Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Gillespie H, Reid H, Conn R, Dornan T. Pre-prescribing: Creating a zone of proximal development where medical students can safely fail. MEDICAL TEACHER 2022; 44:1385-1391. [PMID: 35820063 DOI: 10.1080/0142159x.2022.2098100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Prescribing is a common task, often performed by junior clinicians, with potential for significant harm. Despite this, it is common for medical students to qualify having only prescribed in simulated scenarios or assessments. We implemented an alternative: students were given pens with purple ink, which permitted them to write prescriptions for real patients. We set out to understand how this intervention, pre-prescribing, created a zone of proximal development (ZPD) for learners. METHODS An anonymous, mixed methods, evaluation questionnaire was distributed to all final-year medical students at one university in the United Kingdom. Analysis was guided by Experience Based Learning theory. RESULTS Two hundred and eighteen students made 386 free-text comments. Most participants reported that pre- helped them become capable doctors (Strongly Agree n = 96, 45%; Agree: n = 110, 50%). Pre-prescribing created a ZPD in which participants could use the tools of practice in authentic contexts under conditions that made it safe to fail. CONCLUSIONS This research shows how a theoretically informed intervention can create conditions to enhance learning. It encourages educators to identify aspects of routine practice that could be delegated, or co-performed, by learners. With appropriate support, educators can create 'safe-fails' which allow learners to participate safely in authentic, risky, and indeterminate situations they will be expected to navigate as newly qualified clinicians.
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Affiliation(s)
- Hannah Gillespie
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
- School of Health Professions Education, Maastricht University, The Netherlands
| | - Helen Reid
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Richard Conn
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
- School of Health Professions Education, Maastricht University, The Netherlands
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Conn RL, Speyer F, Davison GL, Dornan T. Experience-based learning: an alternative approach to teaching medical students on paediatric placements. Arch Dis Child Educ Pract Ed 2022; 108:210-213. [PMID: 35470241 DOI: 10.1136/archdischild-2021-322077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 04/05/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Richard L Conn
- Centre for Medical Education, Queen's University Belfast, Belfast, UK .,Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Frederick Speyer
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Gail Lindsey Davison
- Centre for Medical Education, Queen's University Belfast, Belfast, UK.,Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Dornan T, Gillespie H, Findlay-White F, Lee C, Reid H, Conn R. Situation, Me, Act, and Check (SMAC): A toolkit that helps students learn to Act Wisely in practice. CLINICAL TEACHER 2021; 19:8-16. [PMID: 34964549 PMCID: PMC9303680 DOI: 10.1111/tct.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Hannah Gillespie
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | | | - Ciara Lee
- Department of General Practice and Rural Health, Faculty of Medicine, University of Otago, Dunedin, New Zealand
| | - Helen Reid
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Richard Conn
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
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Brown NL, Moshtael SA, Rogers M, Mohamed I, Smith B, Rimmer CT, Hamad A, Yan A. A review of the clinical assistant workforce at a district general hospital during the COVID-19 pandemic. Future Healthc J 2021; 8:e638-e643. [PMID: 34888457 DOI: 10.7861/fhj.2021-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction In April 2020, a new workforce of clinical assistants (CAs), comprising predominantly of medical students, began work at Northampton General Hospital. Clinical-years students had a role similar to final-year student assistants; pre-clinical students were offered a healthcare assistant role. This research aimed to evaluate both CAs' and clinicians' perceptions of this programme. Methods Separate questionnaires were developed for CAs and clinicians, assessing the scheme's successes and failures. Data analysis was carried out using MS Excel and SPSS. Results and discussion Forty-nine CAs and 60 clinicians responded. CAs of all years were completing the higher-level role. They were perceived to improve continuity of care (74% CA agreement; 88% clinician agreement), reduce clinician workload (90% clinician agreement) and felt significantly more confident with practical and administrative tasks. Sixty-eight per cent of CAs and 72% of clinicians believed the role should be available to students before their final year.
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Affiliation(s)
| | | | | | | | | | | | - Adeel Hamad
- Northampton General Hospital, Northampton, UK
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Dornan T, Lee C, Findlay-White F, Gillespie H, Conn R. Acting wisely in complex clinical situations: 'Mutual safety' for clinicians as well as patients. MEDICAL TEACHER 2021; 43:1419-1429. [PMID: 34372748 DOI: 10.1080/0142159x.2021.1951693] [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] [Indexed: 06/13/2023]
Abstract
PURPOSE The hope that reliably testing clinicians' competencies would improve patient safety is unfulfilled and clinicians' psychosocial safety is deteriorating. Our purpose was to conceptualise 'mutual safety', which could increase benefit as well as reduce harm. METHODS A cultural-historical analysis of how medical education has positioned the patient as an object of benefit guided implementation research into how mutual safety could be achieved. RESULTS Educating doctors to abide by moral principles and use rigorous habits of mind and scientific technologies made medicine a profession. Doctors' complex attributes addressed patients' complex diseases and personal circumstances, from which doctors benefited too. The patient safety movement drove reforms, which reorientated medical education from complexity to simplicity: clinicians' competencies should be standardised and measurable, and clinicians whose 'incompetence' caused harm remediated. Applying simple standards to an increasingly complex, and therefore inescapably risky, practice could, however, explain clinicians' declining psychosocial health. We conducted a formative intervention to examine how 'acting wisely' could help clinicians benefit patients amidst complexity. We chose the everyday task of insulin therapy, where benefit and harm are precariously balanced. 247 students, doctors, and pharmacists used a thought tool to plan how best to perform this risky task, given their current clinical capabilities, and in the sometimes-hostile clinical milieus where they practised. Analysis of 1000 commitments to behaviour change and 600 learning points showed that addressing complexity called for a skills-set that defied standardisation. Clinicians gained confidence, intrinsic motivation, satisfaction, capability, and a sense of legitimacy from finding new ways of benefiting patients. CONCLUSION Medical education needs urgently to acknowledge the complexity of practice and synergise doctors' and patients' safety. We have shown how this is possible.
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Affiliation(s)
- Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
- Educational Development and Research, Maastricht University, Maastricht, Netherlands
| | - Ciara Lee
- University of Otago Faculty of Medicine, Department of General Practice and Rural Health, Dunedin, New Zealand
| | - Florence Findlay-White
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Hannah Gillespie
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
| | - Richard Conn
- Centre for Medical Education, Queen's University Belfast, Belfast, United Kingdom of Great Britain and Northern Ireland
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Mustafa OG, Alsheikh G. A diagnostic formulation of undergraduate medical education in the UK. BMJ 2021; 372:n161. [PMID: 33472815 DOI: 10.1136/bmj.n161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Omar G Mustafa
- Department of Diabetes, King's College Hospital, London SE5 9RS, UK
| | - Ghanim Alsheikh
- WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, UK
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Melville C. Reforming medical education: we must retain innovative training solutions developed in response to covid-19. BMJ 2021; 372:n165. [PMID: 33468456 DOI: 10.1136/bmj.n165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wass V. A crisis is an opportunity riding a dangerous wind. ( Chinese proverb). EDUCATION FOR PRIMARY CARE 2020; 31:331. [DOI: 10.1080/14739879.2020.1852607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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