Improving the transition from medical school to internship - evaluation of a preparation for internship course

Understanding learners' experiences across three major transitions in undergraduate medical education

BACKGROUND

Medical students in the United States undergo three significant transitions as they progress from pre-clinical to clinical rotations, to acting interns, and ultimately to first-year resident. However, there is limited understanding of whether the factors and strategies that impact these transitions remain consistent or are unique to each individual transition.

METHODS

Qualitative data was collected from three Nominal Group Technique (NGT) sessions held separately for third-year students (M3), fourth-year students (M4), and first-year residents (PGY-1). The participants were asked to share their perceptions on their most recent medical school transition. These responses were independently coded into thematic categories.

RESULTS

The NGT session with M3 students (n = 9) identified 67 transition factors and 64 coping strategies. The M4 (n = 8) session identified 33 transition factors and 72 strategies to manage their transition. The PGY-1 (n = 5) session identified 28 factors and 25 strategies. The coping strategies for each session were categorized into seven themes and the transition factors were assigned to ten thematic categories.

CONCLUSION

Just as each transition is unique, so too are the number and variety of factors and strategies to manage each transition. Despite these differences, the themes of "Professional socialization" and "Prioritization, efficiency, and delegation" emerged as impactful in all three transitions.

Internship Preparatory Clinical Course: A Timed-Station Approach to Bridging the Theory-to-Practice Gap

BACKGROUND

Medical students' transition to internship has a discernible gap in structured preparation, particularly in practical skill application. We introduced the internship preparatory clinical course (IPCC) to address this gap.  Methods: The course was conducted at the clinical skills and simulation center at King Saud University Medical City and included a total of eight skills distributed across four stations. It employs a timed-station methodology, inspired by the Observed Structured Clinical Examination, but innovatively adapted as a teaching method. Participants were exposed to various stations, such as suturing techniques, interactive mannequins for anatomical structure demonstration, real ultrasound machines on simulated patients, IV cannulation, and urinary catheterization. To facilitate active learning, participants received course materials a day prior, equipped with QR codes for quick reference. Instructors emphasized on-the-spot review, fostering an environment where learners actively engage. Toward the end of the course, after internship a follow-up survey was administered to obtain feedback, achieving a response rate of 83% (n=45/54).

RESULTS

Feedback from the course was overwhelmingly positive, with 91.1% (n=41/45) rating the course as 7 and above out of 10. Participants expressed a higher degree of confidence in providing wound care (Median: 8, IQR: 2) and inserting or removing a Foley catheter (Median: 8, IQR: 4). Lower confidence was observed in stoma examination and care (Median: 5, IQR: 4). During their internships, participants reported that 100% (n=45/45) utilized suturing skills, 48.9% (n=22/45) performed focused assessment with sonography in trauma (FAST) examinations, and 62.2% (n=28/45) attempted nasogastric tube insertions. Additionally, 88.9% (n=40/45) performed wound examinations, 77.8% (n=35/45) provided wound care and dressing, 37.8% (n=17/45) performed abscess drainage, 51.1% (n=23/45) removed and 37.8% (n=17/45) inserted a Foley catheter, and 20% (n=9/45) provided stoma care.

CONCLUSION

The IPCC effectively addresses the existing gap in medical education, bridging the theory-to-practice divide. The innovative use of the timed-station approach emphasizes the importance of active learning. Our results signify the importance of simulation training, as most interns acknowledge the positive impact of the course on their internship. We recommend preparing pre-interns for internships by giving special consideration to the procedural aspects as most associated with medical errors. The timed-station approach can improve cost-effectiveness and enhance responsibility-driven learning.

Assessment of clinical competence of graduating medical students and associated factors in Ethiopia

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.

Perceived Preparedness of Internal Medicine Interns for Residency and the Value of Transition to Residency Courses

The popularity of Transition to Residency (TTR) courses has been increasing in U.S. medical schools. Yet there is limited data on interns' perceived preparation for residency and the value of nonsurgical TTR courses and their common components. Research has shown that TTR courses increase medical knowledge, clinical skills, and an increase in confidence in participants, but still, incoming residents do not feel prepared for the start of residency. Currently, there are only a few single institution studies researching interns' perceived value of TTR courses. This quantitative study surveyed internal medicine interns at five residency programs to find their preparation for residency, their preparedness in TTR competencies, and the perceived value of common TTR components. Data show that IM interns still feel unprepared for residency. The data also indicate that individuals who engage in TTR courses feel more prepared in TTR competencies compared to those who do not participate in TTR courses. Finally, internal medicine interns found the common TTR components valuable.

How is transition to medical practice shaped by a novel transitional role? A mixed-methods study

OBJECTIVES

This study considered a novel 'interim' transitional role for new doctors (termed 'FiY1', interim Foundation Year 1), bridging medical school and Foundation Programme (FP). Research questions considered effects on doctors' well-being and perceived preparedness, and influences on their experience of transition. While FiY1 was introduced in response to the COVID-19 pandemic, findings have wider and ongoing relevance.

DESIGN

A sequential mixed-methods study involved two questionnaire phases, followed by semi-structured interviews. In phase 1, questionnaires were distributed to doctors in FiY1 posts, and in phase 2, to all new FP doctors, including those who had not undertaken FiY1.

SETTING AND PARTICIPANTS

Participants were newly qualified doctors from UK medical schools, working in UK hospitals in 2020. 77% (n=668) of all participants across all phases had undertaken FiY1 before starting FP in August. The remainder started FP in August with varying experience beforehand.

OUTCOME MEASURES

Questionnaires measured preparedness for practice, stress, anxiety, depression, burnout, identity, and tolerance of ambiguity. Interviews explored participants' experiences in more depth.

RESULTS

Analysis of questionnaires (phase 1 n=441 FiY1s, phase 2 n=477 FiY1s, 196 non-FiY1s) indicated that FiY1s felt more prepared than non-FiY1 colleagues for starting FP in August (β=2.71, 95% CI=2.21 to 3.22, p<0.0001), which persisted to October (β=1.85, CI=1.28 to 2.41, p<0.0001). Likelihood of feeling prepared increased with FiY1 duration (OR=1.02, CI=1.00 to 1.03, p=0.0097). Despite challenges to well-being during FiY1, no later detriment was apparent. Thematic analysis of interview data (n=22) identified different ways, structural and interpersonal, in which the FiY1 role enhanced doctors' emerging independence supported by systems and colleagues, providing 'supported autonomy'.

CONCLUSIONS

An explicitly transitional role can benefit doctors as they move from medical school to independent practice. We suggest that the features of supported autonomy are those of institutionalised liminality-a structured role 'betwixt and between' education and practice-and this lens may provide a guide to optimising the design of such posts.

Understanding intention and use of digital elements in higher education teaching

Digital elements are being increasingly used in higher education teaching, but the intention and their actual use vary depending on the lecturers. We used the reasoned action approach to understand the beliefs and intentions behind the use of digital elements in this context. We conducted a quantitative survey in which university lecturers shared their intention concerning the use of digital learning elements and indicated their actual use. The results confirm the influence of attitude, perceived norms, and perceived behavioral control on the intention to use digital learning elements. However, we also identified an intention-behavior gap: Only one-time effort to become familiar with digital elements has a significant impact on actual usage. We conclude that, above all, teachers must first be given the opportunity to become familiar with digital learning elements to be able to use them effectively. Understanding why such an intention-behavior gap exists should be the aim of future studies.

Assessment of Medical Students Burnout during COVID-19 Pandemic

This study estimated the prevalence of burnout and its determinants among medical students at Jazan University during the COVID-19 pandemic. A total of 444 medical students completed an online survey containing the Maslach burnout inventory. The prevalence of burnout was 54.5%. Burnout reached its peak during the fourth year whereas it was the lowest in the internship year. Being a resident in mountain areas, being delayed in college-level, being divorced, and having divorced parents were all associated with an increased risk of burnout. During their time at medical school, students generally showed a trend of consistently high scores in the personal accomplishment subscale, a decreasing trend in the emotional exhaustion subscale, and an increasing trend in the depersonalization subscale. The most important predictive factor was having separated parents. Perceived study satisfaction appeared to be a significant protective factor in a dose-response manner. These findings suggest that burnout among medical students during the COVID-19 pandemic is a concern that should be monitored and prevented.

An Exploratory Study of a Novel Approach to Improve Readiness for a Rural Family Medicine Residency

BACKGROUND AND OBJECTIVES

Transitioning from medical school to residency is challenging, especially in rural training programs where a comprehensive scope of practice is needed to address rural health disparities. Oregon Health & Science University partnered with Cascades East Family Medicine Residency in Klamath Falls, Oregon to create an integrated fourth-year medical student experience (Oregon Family medicine Integrated Rural Student Training (Oregon FIRST). Participants may then enter this residency to complete their training with the intention to practice in rural underresourced settings.

METHODS

In this exploratory study, we conducted key informant interviews with 9 of ten Oregon FIRST participants to determine how Oregon FIRST contributed both to their readiness for residency training and their choice to practice in rural underserved locations. Interviews were conducted between June 10, 2020 and July 8, 2020. We analyzed field notes taken during interviews for emergent themes using classical content analysis.

RESULTS

Emergent themes included logistical ease, relationship development, key curricular elements, and commitment to rural practice. Overwhelmingly, Oregon FIRST participants reported the experience had many challenging and demanding components because they served as subinterns for their entire fourth year of medical school, but this prepared them very well for internship. When asked if they would choose to enroll in Oregon FIRST again, given what they now know about physician training and patient care, all nine (100%) said they would.

CONCLUSIONS

This study demonstrated that Oregon FIRST students felt better prepared for the rigors of residency and are committed to practicing in rural areas.

Student’s confidence in mental health practice before and after psychiatry rotation: a follow up study

ABSTRACT Objectives The primary objective was to measure the effect of psychiatry rotation in students self-confidence (SC) for managing mental health (MH) issues. Methods An eighteen questions version of “Preparation for Hospital Practice Questionnaire” (PHPQ) adapted for MH was applied before, after and six months later the psychiatry rotation. Sociodemographic and experience with mental illness was measured as confounding factors. Results Hundred and ten students were recruited and four factors were identified: “Diagnosis elaboration and basic care” (F1), “Crisis management and prevention” (F2), “External sickness determinants” (F3) and “Personal distress with clinics” (F4). Cronbach Alpha ranged from 0.71 to 0.90. Previous MH training were not frequent (9.09%), and associated with better SC in F2 (after p < 0.05, 6m p = 0.03). Previous mental disorder was frequent (42.16%), and associated with more SC on F2 (p < 0.01) and F3 (p = 0.03) before course, but only on F3 after (p < 0.01) and not 6 months later. Male gender had more SC in F4 (p < 0.01) before course, but after course and 6m later female gender became more SC in F1 (after p = 0.02, 6m p = 0.01) and equivalent in F4. All factors had higher scores after and 6 months later (p < 0.001). The class considered that an interview script is very important for their SC, and improves assistance (mean > 9.0/10.0). Conclusion Obligatory rotation in MH improved SC in students. Previous training and gender were related with long lasting effects in SC.

Final-year medical students' competence profiles according to the modified requirement tracking questionnaire

BACKGROUND

Undergraduate medical education is supposed to equip medical students with basic competences to select any specialty of their choice for postgraduate training. Medical specialties are characterized by a great diversity of their daily work routines and require different sets of competence facets. This study examines the self-assessed competence profiles of final-year undergraduate medical students and their specialty choice for postgraduate training. Students' profiles, who wish to choose anaesthesiology, internal medicine, or paediatrics, are compared with the physicians' competence profiles from these three disciplines.

METHODS

In this study, 148 volunteer final-year undergraduate medical students completed the modified requirement-tracking (R-Track) questionnaire for self-assessment of their competence profiles. The R-Track questionnaire contains 63 competence facets assigned to six areas of competence: "Mental abilities", "Sensory abilities", "Psychomotor & multitasking abilities", "Social interactive competences", "Motivation", and "Personality traits". The expression of the different competence facets had to be assessed on a 5-point Likert scale (1: "very low" to 5: "very high"). Additionally, socio-demographic data and the participants' first choice of a medical speciality for postgraduate education were collected. We used analysis of variance (ANOVA) for mean score comparison of subgroups and least significant difference (LSD) tests for post hoc analysis.

RESULTS

The competence area with the highest rating was "Motivation" (3.70 ± 0.47) while "Psychomotor & multitasking abilities" received the lowest rating (3.34 ± 0.68). Individual facets of competence ranked from "In need of harmony" (4.36 ± 0.72), followed by "Tactfulness" (4.26 ± 0.64), and "Cooperation/Agreeableness" (4.24 ± 0.53) to "Risk orientation" (2.90 ± 0.92), "Mathematical reasoning" (2.87 ± 1.25), and "Sanctioning" (2.26 ± 0.93). The students' competence profiles showed 100 % congruence with physicians' competence profiles of the postgraduate specialty of their choice for internal medicine, 33.3 % for paediatrics, and 0 % for anaesthesiology.

CONCLUSIONS

Undergraduate medical students could define their competence profiles with the modified R-Track questionnaire and compare them with the profile of their desired specialty for postgraduate training to discover possible learning gaps or to detect good specialty matches. A combination of students' competence self-assessment with an external assessment of students' facets of competence could provide curricular planners with useful information how to design learning opportunities for specific facets of competence.

Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates

CONTEXT

Work readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined.

OBJECTIVE

This narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness.

METHODS

Databases were searched using the terms including "ready," "readiness," "preparedness," "medical graduates," "intern," and "junior doctor." Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes.

RESULTS

Seventy studies were included in the review. Study participants included final-year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self-report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills-based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness.

CONCLUSIONS

Different research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.

Accomplishing CAPE Domain 3 During APPE Rotations: Student Perceptions

INTRODUCTION

The purpose of this study is to examine student perceptions of accomplishment among 6 subdomains of Center for Advancement of Pharmacy Education (CAPE) Domain 3 "Approach to Practice and Care" outcomes in Advanced Pharmacy Practice Experiences (APPE) across distinct geographical regions.

METHODS

An 18-item electronic survey was distributed to 88 student pharmacists at a private university completing APPEs in 5 distinct regions and 2 concentrated learning experiences during their penultimate rotation. The survey assessed whether students had at least 1 opportunity to achieve Domain 3 outcomes. Students were prompted to report a percentage of perceived successful accomplishment of outcomes if they stated they had at least 1 opportunity for achievement.

RESULTS

Survey response rate was 52% (n = 46). Respondents reported a median accomplishment of at least 85% for each question. For 2 questions, respondents reported a median accomplishment of 99%. Students perceived successful accomplishment for most of the questions related to communication outcomes, while the lowest completion percentages were noted in outcomes related to patient advocacy (85%) and problem solving (88%). Student perceptions of accomplishment among the 6 subdomains were similar across regions and concentrated learning experiences.

CONCLUSIONS

Students felt confident in accomplishing the outcomes associated with CAPE Domain 3. Regional assignments did not impact student perceptions of outcome accomplishment. Preceptors may play a pivotal role in providing students with opportunities to further polish their skills and increase confidence, specifically in the areas of patient advocacy and problem solving.

Facilitating Learner-Centered Transition to Residency: A Scoping Review of Programs Aimed at Intrinsic Competencies

Phenomenon: There is currently a move to provide residency programs with accurate competency-based assessments of their candidates, yet there is a gap in knowledge regarding the role and effectiveness of interventions in easing the transition to residency. The impact of key stakeholder engagement, learner-centeredness, intrinsic competencies, and assessment on the efficacy of this process has not been examined. The objective of this scoping review was to explore the nature of the existing scholarship on programs that aim to facilitate the transition from medical school to residency. Approach: We searched MEDLINE and EMBASE from inception to April 2020. Programs were included if they were aimed at medical students completing undergraduate medical training or first year residents and an evaluative component. Two authors independently screened all abstracts and full text articles in duplicate. Data were extracted and categorized by type of program, study design, learner-centeredness, key stakeholder engagement, the extent of information sharing about the learner to facilitate the transition to residency, and specific program elements including participants, and program outcomes. We also extracted data on intrinsic (non-Medical Expert) competencies, as defined by the CanMEDS competency framework. Findings: Of the 1,006 studies identified, 55 met the criteria for inclusion in this review. The majority of the articles that were eligible for inclusion were from the United States (n = 31, 57%). Most of the studies (n = 47, 85%) employed quantitative, or mixed method research designs. Positive outcomes that were commonly reported included increased self-confidence, competence in being prepared for residency, and satisfaction with the transition program. While a variety of learner-centered programs that focus on specific intrinsic competencies have been implemented, many (n = 29, 52%) did not report engaging learners as key stakeholders in program development. Insights: While programs that aim to ease the transition from medical school to residency can enhance both Medical Expert and other intrinsic competencies, there is much room for novel transition programs to define their goals more broadly and to incorporate multiple areas of professional development. The existing literature highlights various gaps in approaches to easing the transition from medical school to residency, particularly with respect to key stakeholder engagement, addressing intrinsic CanMEDS competencies, and focusing on individual learners' needs.

Outcomes of an Online Virtual Boot Camp to Prepare Fourth-Year Medical Students for a Successful Transition to Internship

Introduction Changes in medical education and health care delivery have limited the ability of fourth-year medical students to perform the role of an intern prior to graduating from medical school. To address this issue, many schools have instituted residency preparation courses (sometimes referred to as boot camps) particularly for students entering surgical fields. Courses for students entering nonprocedural fields are less common and most assess increases in self-reported confidence without providing objective evidence of a gain in knowledge or skills improvement. Materials and Methods We used a Plan, Do, Study, Act (PDSA) model to develop and pilot cycle 1 of a nonprocedural internship preparation elective in 2019. Feedback was used to refine the course and map sessions to core competencies outlined by the Accreditation Council of Graduate Medical Education (ACGME) for PDSA cycle 2. The curriculum was adapted for remote synchronous delivery due to the coronavirus pandemic in spring 2020 using a combination of didactic lectures containing embedded polls and case-based role play responses using a chat box. Students completed anonymous surveys assessing self-perceived levels of confidence, as well as an objective comprehensive assessment after course completion. Results A total of 89 students participated in the course. Pre-session confidence was lowest for transfusion medicine, handling pages from nursing while on call, and knowledge of the role of a chief resident. A statistically significant increase in median scores for self-reported knowledge or confidence was seen in all sessions. The percentage of students reporting that they were either confident or extremely confident also increased significantly after each session (p<0.001 for all). All sessions analyzed were rated as useful or extremely useful by more than half of the students, and 94% of the students scored 70% or higher on the comprehensive course assessment. Conclusions An online virtual synchronous boot camp increased students' confidence in handling common topics encountered during residency and demonstrated an appropriate gain in knowledge using a comprehensive assessment. We were able to adapt our curriculum to a remote model and will likely keep several sessions in an online format in the future.

Intern preparedness for the CanMEDS roles and the Dunning-Kruger effect: a survey

BACKGROUND

The purpose of this study was to determine whether the first cohort of graduates from a new undergraduate medical programme in Botswana were adequately prepared for internship.

METHODS

The authors surveyed 27 interns and 13 intern supervisors on site, who rated intern preparedness for 44 tasks using a previously validated instrument. Tasks were grouped according to the seven roles of the physician in the CanMEDS framework and Cronbach α values confirmed internal consistency. To determine the direction of differences between intern and supervisor ratings for tasks Likert scale ratings were treated as interval data and mean scores calculated. Rating frequencies for each role were compared using the χ² statistic. Reasons for differences between intern and supervisor ratings were explored by determining correlations between scores using the Spearman ρ statistic, and analysing qualitative data generated by the questionnaire.

RESULTS

Preparedness for all seven roles and the majority of tasks was found to be between 'Fairly well prepared' and 'Well prepared'. The ratings for four roles (Medical expert, Communicator, Collaborator, Professional) differed statistically, but not for the three others (Leader, Health advocate, Scholar). Interns rated their proficiency higher than their supervisors for the tasks in six roles; for the 'Professional' role intern ratings were mostly lower. Correlations between intern and supervisors scores were only significant for three roles (Medical expert, Communicator, Collaborator). Qualitative data provided further insights into the reasons for these associations.

CONCLUSIONS

Intern preparedness for tasks and roles varied but was generally satisfactory. Based on the analysis of the data seeming discrepancies in between interns and supervisor ratings were investigated and explanations are offered. For three roles the data indicate that their component tasks are understood in the same way by interns and supervisors, but not for the other roles. The Dunning-Kruger effect offers a plausible explanation for higher intern scores for tasks in six of the roles. For the 'Professional' role differences between interns' internal, individual understanding and supervisors' external, group understanding may explain lower intern scores. The fact that respondents may understand the tasks they rate differently has implications for all research of this nature.

Medical Students Learn Professionalism in Near-Peer Led, Discussion-Based Small Groups

Problem: Medical educators recognize that professionalism is difficult to teach to students in lecture-based or faculty-led settings. An underused but potentially valuable alternative is to enroll near-peers to teach professionalism. Intervention: We describe a novel near-peer curriculum on professionalism developed at Queen's University School of Medicine. Senior medical students considered role models by their classmates were nominated to facilitate small-group seminars with junior students on topics in professionalism. Each session was preceded by brief pre-readings or prompts and engaged students in semistructured, open-ended discussion. Three 2-hour sessions have occurred annually. Context: The near-peer sessions are a required component (6 hours; 20%) of the 1st-year professionalism course at Queen's University (30 hours), which otherwise includes faculty-led seminars, lectures, and online modules. Senior facilitators are selected through a peer nomination process during their 3rd year of medical school. This format was chosen to create a highly regarded position to which students could aspire by demonstrating positive professionalism. Outcome: We performed a qualitative descriptive evaluation of the near-peer curriculum. Fifty-six medical students participated in 11 focus group interviews, which were coded and analyzed for themes inductively and deductively. Quantitative reviews of student feedback forms and a third-party thematic analysis were performed to triangulate results. Medical students preferred the near-peer-led discussion-based curriculum to faculty-led seminars and didactic or online formats. Junior students could describe specific examples of how the curriculum had influenced their behavior in academic, clinical, and personal settings. They cited senior near-peer facilitators as the strongest aspect of the curriculum for their social and cognitive congruence. Senior students who had facilitated sessions regarded the peer teaching experience as formative to their own understanding of professionalism. Lessons Learned: Formal medical curricula on professionalism should emphasize near-peer-led small-group discussion as it fosters a nuanced understanding of professionalism for both early level students and senior students acting as teachers.

Bridging the gap: An evaluation of self-paced online transition modules for advanced pharmacy practice experience students

BACKGROUND AND PURPOSE

A three module online self-paced educational resource was developed for entry to practice students transitioning from the classroom to their inpatient practicums. The objective of this study was to determine the benefits of the transition modules on students' self-perceived competency as related to onsite performance and reduction in anxiety during their inpatient practicum.

EDUCATIONAL ACTIVITY AND SETTING

Evaluations of the three transition modules were conducted in two phases via electronic surveys distributed to final year advanced pharmacy practice students and focus group members including faculty, pharmacy practice educators, and pharmacy residents.

FINDINGS

Based on our findings, the modules addressed common learning needs. While 69.7% of student respondents from Phase II of the evaluation found the modules to have positively impacted their onsite performance, only 24.7% believed the modules reduced their anxiety.

DISCUSSION

The study indicates that students found the modules to be relevant to inpatient practice and of appropriate difficulty. Although most students perceived the modules to enhance performance on practicum, student anxiety levels appeared to remain unchanged.

SUMMARY

Based on feedback and results, it may be beneficial to expose students to transition modules earlier in the curriculum in tandem with other inpatient preparatory activities. The results from this study may be of interest or benefit other universities and healthcare educators pursuing work on transition activities.

Developing an Internship Preparedness Program for Final Year Medical Students

This article was migrated. The article was marked as recommended. Introduction: Medical students undertake extensive training yet often feel they lack the practical non-medical skills required for successful transition to internship. While research provides evidence for student perceptions and experiences regarding internship, there is little information regarding how students can be 'taught' work-readiness through learning non-medical skills. Methods: By reducing cognitive load when structured using a flipped classroom method, active learning resources may provide an effective approach to prepare medical students to be work-ready interns. Using a blended instructional method, the University of Queensland's Rural Clinical School (UQRCS) integrated face-to-face and online learning, to develop an Intern Preparedness program. Discussion: The Intern Preparedness program promotes student interaction in a range of active learning tasks to improve learning and engagement in a difficult and often neglected area of professional training. The program focused on providing knowledge and skills to increase competency in non-medical skills including time management on the ward, patient-focused prioritisation of tasks, and clinical conversations with the healthcare team. Conclusion: This program has become an integral part of the student learning experiences at the UQRCS as it continues to elevate student preparedness for internship. The program has become a fundamentally important aspect of improving cognitive skills such as critical thinking and reasoning, as well as soft skills, which are all essential for successful transitions to internship. A very high uptake and completion of program activities provided further incentive for program developers to continue its improvements over time.

Calibration of confidence and assessed clinical skills competence in undergraduate paediatric OSCE scenarios: a mixed methods study

BACKGROUND

The relationship between confidence and competence in clinical skills development is complex but important. This study aims to determine undergraduate paediatric student confidence in performing three common paediatric clinical skills framed as Objective Structured Clinical Examination (OSCE) scenarios and to compare this with subsequent assessed performance. The study also aims to explore possible barriers to successful paediatric skills completion.

METHODS

A mixed-methods study was conducted on medical students. Cross-sectional questionnaire data relating to confidence in performing a number of paediatric skills were compared with assessed paediatric skills competency. Focus groups were carried out to identify themes in paediatric skills completion to triangulate this data.

RESULTS

Eighty-five medical students participated in the study. Students had high levels of pre-test confidence in their ability to perform paediatrics skills. However agreement between pre-test confidence and subsequent task performance was poor and students had significantly greater belief in their skills ability than was subsequently demonstrated. Focus groups identified paediatric skills complexity, conflicting teaching and having limited supervised skills opportunities and as being possible contributory factors to this discrepancy.

CONCLUSIONS

Student paediatric skills confidence is not matched by performance. The reasons for this are diverse but mostly modifiable. A major factor is the lack of supervised skills experience with appropriate feedback to support students in learning to calibrate their confidence against their competence. A number of recommendations are made including the introduction of formative assessment opportunities.

Transitioning from medical school to residency: Evaluation of an innovative immersion rotation for PGY-1 paediatric residents

Transition from medical school to residency is stressful due to new responsibilities in patient care.

Objective

To evaluate a new immersion curriculum on the transition from medical school to paediatric residency and its implications for future use in paediatric education.

Methods

In July 2013, a month-rotation offering one-third of time for clinical rounds and two-thirds of time for formal courses was conducted for postgraduate year 1 residents beginning paediatric residency training. Surveys were administered to residents before and after this rotation about their self-confidence in several paediatrics topics and abilities.

Results

Eleven junior residents were enrolled (100% participation rate). Among this cohort, pre- and postintervention confidence surveys showed differences for neonatalogy (P<0.001), respiratory distress (P=0.01) and seizure management skills (P<0.001). Among abilities surveyed, significant differences were noted for medical emergencies (P<0.001) and drug prescriptions (P<0.002). The healthy childcare item was the only topic with decreased self-confidence levels. Overall, 45.5% of participants felt confident and ready to begin clinical rotations in the paediatric program following completion of the rotation.

Conclusion

First year paediatric residents who participated in this new curriculum felt their confidence was enhanced in several areas of paediatrics. These findings supported our program committee members in their decision to pursue this rotation since 2013, and may be generalizable to other programs and institutions.

Perception of Preparedness for Clinical Work Among New Residents: A Cross-sectional Study from Oman

OBJECTIVES

To evaluate new residents' perceptions of their own preparedness for clinical practice and examine the associated factors.

METHODS

This is a cross-sectional study conducted on August 20-23, 2016. New residents accepted for postgraduate training by Oman Medical Specialty Board were asked to complete the Preparation for Hospital Practice Questionnaire (PHPQ). Data was analyzed using the Statistical Package for the Social Sciences version 22.

RESULTS

A total of 160 residents were invited to participate in this study. Out of 160, 140 residents participated (87.5%), 70.7% were female and 59.3% were graduates from Sultan Qaboos University (SQU). Ninety-nine percent of the graduates were either 'well prepared' or 'fairly well prepared' for hospital practice. Male residents scored higher in the confidence scale, while residents who did a post-internship general practice placement scored higher in understanding science. Graduates from Oman Medical College felt more prepared compared to graduates from SQU.

CONCLUSIONS

Most of the new residents were well prepared to clinical work. Factors such as place of undergraduate study, training, and duration of internship significantly influenced the residents' perception of preparedness. Addressing these factors will enhance residents' preparedness for clinical work.

Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship

BACKGROUND

We interviewed graduates from the first two cohorts of a postgraduate medical program that had a senior year longitudinal integrated clerkship (LIC) in a practice setting in rural New South Wales, Australia to determine how well their training prepared them to be junior doctors (3-4 years after graduation), and what aspects of that training they thought were particularly useful.

METHODS

In-depth interviews.

RESULTS

Fourteen junior doctors were interviewed. Participants reported feeling well prepared in ability to develop close relationships with clinical supervisors, good clinical and procedural skills, ability to work autonomously and work in teams, knowledge of health systems, ability to ensure self-care, and professionalism. Consensus view was that a rural placement was an excellent way to learn medicine for a variety of reasons including relationships with clinicians, less competition for access to patients, and opportunities to extend their clinical skills and act up to intern level.

CONCLUSION

The advantages we found in the training these junior doctors received which prepared them well for internship were integral both to the longitudinal, unstructured placement, and to the fact that it was carried out in a rural area. The two aspects of these placements appear to act synergistically, reinforcing the learning experience.

Using Transitional Year Milestones to Assess Graduating Medical Students' Skills During a Capstone Course

BACKGROUND

Undergraduate medical education (UME) follows the lead of graduate medical education (GME) in moving to competency-based assessment. The means for and the timing of competency-based assessments in UME are unclear.

OBJECTIVE

We explored the feasibility of using the Accreditation Council for Graduate Medical Education Transitional Year (TY) Milestones to assess student performance during a mandatory, fourth-year capstone course.

METHODS

Our single institution, observational study involved 99 medical students who completed the course in the spring of 2014. Students' skills were assessed by self, peer, and faculty assessment for 6 existing course activities using the TY Milestones. Evaluation completion rates and mean scores were calculated.

RESULTS

Students' mean milestone levels ranged between 2.2 and 3.6 (on a 5-level scoring rubric). Level 3 is the performance expected at the completion of a TY. Students performed highest in breaking bad news and developing a quality improvement project, and lowest in developing a learning plan, working in interdisciplinary teams, and stabilizing acutely ill patients. Evaluation completion rates were low for some evaluations, and precluded use of the data for assessing student performance in the capstone course. Students were less likely to complete separate online evaluations. Faculty were less likely to complete evaluations when activities did not include dedicated time for evaluations.

CONCLUSIONS

Assessment of student competence on 9 TY Milestones during a capstone course was useful, but achieving acceptable evaluation completion rates was challenging. Modifications are necessary if milestone scores from a capstone are intended to be used as a handoff between UME and GME.

A proposed core curriculum for dental English education in Japan

BACKGROUND

Globalization of the professions has become a necessity among schools and universities across the world. It has affected the medical and dental professions in terms of curriculum design and student and patient needs. In Japan, where medicine and dentistry are taught mainly in the Japanese language, profession-based courses in English, known as Medical English and Dental English, have been integrated into the existing curriculum among its 83 medical and 29 dental schools. Unfortunately, there is neither a core curriculum nor a model syllabus for these courses.

METHODS

This report is based on a survey, two discussion forums, a workshop, and finally, the drafting of a proposed core curriculum for dental English approved by consensus of the participants from each university.

RESULTS

The core curriculum covers the theoretical aspects, including dental English terms and oral pathologies; and practical aspects, including blended learning and dentist-patient communication. It is divided into modules and is recommended to be offered for at least two semesters.

CONCLUSIONS

The core curriculum is expected to guide curriculum developers in schools where dental English courses are yet to be offered or are still in their early development. It may also serve as a model curriculum to medical and dental schools in countries in Asia, Europe, Africa, and Central and South America, where English is not the medium of instruction.

The relationship between medical student learning opportunities and preparedness for practice: a questionnaire study

BACKGROUND

Alongside providing a knowledge base and practical skills, undergraduate medical education must prepare graduates to immediately begin practice as qualified doctors. A significant challenge is to provide safe learning opportunities that will optimise students' preparedness to start work. This study examined UK graduates' preparedness for clinical practice, and their exposure to real-life and simulated immediate care scenarios during final year placements.

METHOD

A questionnaire measuring students' perceived preparedness, and their exposure to immediate care scenarios, was distributed to all new Foundation Year 1 doctors (F1s) attending an induction session in one region of the UK.

RESULTS

356 F1s responded to the questionnaire (91% response rate; 89% of cohort) and data from 344 graduates of UK medical schools were analysed. Respondents were generally prepared for practice, but many reported few 'hands-on' experiences of providing immediate care during final year placements (a median of 1-2 experiences).Those who had 1-2 experiences reported no greater preparedness for acute management than those reporting no experience. Several exposures are necessary for a significant increase in perceived preparedness. Real-life experience was a better predictor of preparedness than simulated practice.

CONCLUSIONS

Gaps still remain in medical students' acute care experience, with a direct relationship to their perceived preparedness. The format and facilitation of placements may need to be addressed in order to enhance the quality of experience during final year.