Influence of motivation, self-efficacy and situational factors on the teaching quality of clinical educators

[Success factors and obstacles in the implementation of competence-oriented teaching in surgery]

BACKGROUND AND OBJECTIVES

For successful competence-oriented teaching at the medical faculties it is important to identify the factors that influence its implementation in order to benefit from the strengths and balance out weaknesses. The present study examined the success factors and obstacles of the implementation of competence-oriented teaching in the surgical discipline from the point of view of students and lecturers.

METHODS

After implementation of competence-oriented teaching based on the teaching goals of the NKLM, in clinical examination courses (bedside teaching and block internship, BP) at two hospitals, a qualitative content analysis and quantification of the answers were performed using focus group interviews and questionnaires with students (S) and lecturers (D).

RESULTS

During the summer semester 2022 a total of 31 students and 14 lecturers were interviewed in focus groups and 143 questionnaires (123 S, 20 D) were analyzed. For the students the presence of concrete competences/teaching goals, guidelines for the lesson, transparent goals and ability to demand teaching goals as well as structured lessons and mentoring were the main success factors. Lecturers on the other hand reported the presence of concrete goals, assistance for the lesson preparation and the activity of the students as success factors. The results of the questionnaires showed that the majority (88% S, 75% D) were informed about the teaching goals and considered them to be followed (84%S, 95% D). Obstacles were the factors "time", "mentoring" and "information". Factors that were between negative and positive (indifferent factors) were "uncertainty about competence-orientation" and "uncertainty how to examine the teaching success".

DISCUSSION

Transparent structure and teaching goals as well as a mentoring system are the success factors for the implementation of competence-oriented lessons and should be used as strengths. Indifferent factors represent weaknesses and need to be addressed by training and instruction. Restricted time and personnel resources are the immanent problems that hamper the implementation and require fulminant structural changes.

Structure and quality of bedside teaching: A videographic analysis

Bedside teaching (BST) is a core element of medical education. In light of a reported decrease in BST, evidence on how to use BST time most efficiently should be developed. Given that little research into the tangible quality characteristics of good BST has been reported, we investigated the influence of various teacher and structural characteristics on the perceived quality of BST. We filmed and coded 36 BSTs involving 24 lecturers and 259 students. Structural characteristics of interest were: number of students and patients, overall duration, and the proportion of clinical examination. Lecturer questionnaires provided insight into teaching experience and intrinsic motivation, and student evaluations assessed the quality of BSTs in three dimensions. Correlations are reported using the Pearson r and a linear mixed model (LMM). The intrinsic motivation of lecturers was significantly positively correlated with perceived quality, but their experience was only weakly so correlated. In the LMM, a significant association was observed for the quality dimension of clinical teaching with the number of patients and the proportion of time spent on clinical examination. Based on our findings, we recommend including multiple patients in BSTs, and providing substantial opportunities for clinical examination. Regarding lecturers, motivation matters more than experience.

Influence of medical didactic training on the self-efficacy and motivation of clinical teachers

Objectives

Due to increasing workload and rising expectations for both undergraduate and speciality training in medicine, teaching in a clinical environment can be challenging. The "Train the Trainer" course, developed by CAL (Chirurgische Arbeitsgemeinschaft Lehre, Deutsche Gesellschaft für Chirurgie (DGCH)), aims to assist clinical teachers in their task. This study investigates the effect the course has on participants' self-efficacy and teaching motivation.

Methods

Prior to attending the course, participants anonymously completed a 50-question pre-course questionnaire using standardised questions to gather information on biographical data teaching experience, and validated tools measuring teaching motivation and self-efficacy (PRE). Directly after completing the course, participants evaluated it using a 25-question post-course questionnaire (POST1). At least 12 months after the course, participants received a follow-up questionnaire (POST2) by mail. This 44-question form aimed to gather biographical data, review the teaching methods participants had used since their training, and reassess their teaching motivation and self-efficacy.

Results

Between June 2016 and October 2019, 20 TTT courses were held across six German medical faculties. Data were gathered from 241 participants. After the course, 182 POST2 questionnaires were mailed, 61 of which were returned (equals a 39 % return rate). The findings revealed significant increases in teacher self-efficacy (p=0.0025), identified regulation (p=0.0000), and career motivation (p=0.0044). In contrast, there was a significant decrease in introjected regulation (p=0.0048). When comparing the participants to a reference sample selected from literature, significant differences emerged in intrinsic motivation (p=0.0000) and amotivation (p=0.0025).

Conclusions

Course participants already showed strong intrinsic motivation and self-efficacy before taking the course. After completing it, their confidence to meet specific teaching demands based on their abilities had increased. Notably, changes in motivational dimensions identified and introjected regulation point towards a shift in motivational sources, indicating a more self-regulated approach towards participants' teaching activities. Further research is needed to determine how much of this change was due to course participation.

Development of a blended teaching quality evaluation scale (BTQES) for undergraduate nursing based on the Context, Input, Process and Product (CIPP) evaluation model: A cross-sectional survey

OBJECTIVE

Developing a nursing undergraduate blended teaching quality evaluation tool based on the Context, Input, Process and Product model and evaluating its reliability and validity.

BACKGROUND

Blended teaching is a commonly used teaching method in medical education, but there are limited tools available to effectively measure the quality of blended teaching.

DESIGN

A Delphi study and cross-sectional study.

METHODS

Using the Context, Input, Process and Product model as the theoretical framework, a questionnaire was developed through literature review, expert consultation and pre-survey. From April to July 2023, 448 students from a certain university were selected as the research subjects and the questionnaire was examined for reliability and validity through a survey method.

RESULTS

The blended teaching quality evaluation scale with 35 items includes four dimensions Context, Input, Process and Product. The content validity and reliability of the blended teaching quality evaluation scale are both good, with a content validity index of 0.934 for the total scale and a content validity index of 0.750-1.00 for each item. The SEM shows that χ2/df = 6.89, RMSEA = 0.115, CFI = 0.882, NFI=0.865, RFI= 0.855, IFI = 0.882, TLI = 0.873. The Cronbach's α coefficient of the total scale is 0.991 and the Cronbach's α coefficient for each dimension is 0.944-0.984.

CONCLUSION

The scale is based on the characteristics of blended learning and quality evaluation covers all aspects of teaching. It can accurately evaluate the quality of teaching, evaluate the problems in the teaching process based on the teaching quality score and propose reasonable teaching improvement suggestions based on the weak links in the teaching process.

The effect of cadet resilience on self-efficacy and professional achievement: verification of the moderated mediating effect of vocational calling

Background

The primary objective of this study was to empirically examine the influence of cadets' resilience on their professional achievement within the unique context of a Military Academy. In doing so, the study sought to delineate the role of self-efficacy as a key mediator in the intricate relationship between the resilience of cadets and their professional achievements. The main focus of this study was to clarify the causal and effect relationships between the psychology and behavior mechanisms of the cadets. This was achieved through rigorous scrutiny of the moderated mediating effect of vocational calling within the multifaceted relationship involving cadets' resilience, self-efficacy, and professional achievement.

Methods

The study's participant pool consisted of 121 individuals, comprising cadets in their third and fourth years of study, all of whom aspired to attain the rank of officer within the Military Academy. To rigorously investigate the hypotheses presented, a series of causal relationships among the four core variables were evaluated using a robust regression analysis methodology. To facilitate this analysis, the PROCESS macro 3.5v, a Hayes-developed tool, was effectively used.

Results

The findings of this study revealed several critical insights. First, vocational calling emerged as a potent moderating factor in shaping the relationship between cadets' resilience and self-efficacy. Furthermore, it was demonstrated that vocational calling exerted a conditional influence on the impact of cadets' resilience on their professional achievement, with self-efficacy serving as a crucial mediating mechanism in this relationship. In particular, the study affirmed that self-efficacy functioned as a comprehensive mediator, elucidating the pathway through which the resilience of the cadets ultimately influenced their professional achievements.

Conclusion

The results of this research contribute significantly to enhancing our understanding of the intricate connection between the resilience levels exhibited by cadets and their corresponding professional achievements. Furthermore, these findings have valuable implications for the ongoing refinement of military education and training programs. They offer insights that could inform the development of more effective testing and selection protocols for military personnel, ultimately benefiting the armed forces in their pursuit of excellence.

Factors affecting the self-efficacy of medical teachers during a health crisis - a qualitative study on the example of the COVID-19 pandemic

BACKGROUND

The diversity of tasks entrusted to medical teachers with their simultaneous responsibility for the safety of patients and the effective education of future healthcare professionals requires maintaining a skillful balance between their teaching, scientific and clinical activities. Meanwhile, the COVID-19 pandemic disrupted the work of both healthcare facilities and medical universities, forcing already overworked medical teachers to establish a new balance. One's ability to perform effectively in new, ambiguous, or unpredictable situations was described by Albert Bandura as a self-efficacy concept. Consequently, this study aimed to identify factors affecting the self-efficacy of medical teachers and the influence of the COVID-19 pandemic on them.

METHODS

Twenty-five semi-structured interviews with medical teachers were conducted using a flexible thematic guide. They were transcribed and analyzed by two independent researchers (researcher triangulation) with phenomenology as the qualitative approach.

RESULTS

Identified themes demonstrate a process of the evolvement of clinical teachers' self-efficacy in response to the sudden outbreak of the COVID-19 pandemic, namely the decline of self-efficacy in the first phase of the crisis, followed by building task-specific self-efficacy and the development of general self-efficacy.

CONCLUSIONS

The study shows the significance of providing care and support for medical teachers during a health crisis. Crisis management decision-makers at educational and healthcare institutions should consider the different roles of medical teachers and the possibility of overburden associated with the cumulation of the excessive number of patient, didactic, and research duties. Moreover, faculty development initiatives and teamwork should become a vital part of the organizational culture of medical universities. A dedicated tool acknowledging the specificity and context of medical teachers' work seems necessary to quantitatively evaluate their sense of self-efficacy.

Psychometric properties of the persian version of the physician teaching self-efficacy questionnaire

INTRODUCTION

Theories and numerous empirical studies indicate teaching performance and students' learning progress are affected by teaching self-efficacy. Therefore, the present study examines the psychometric properties of the Persian version of the physician teaching self-efficacy questionnaire.

METHODS

The 16-item physician teaching self-efficacy questionnaire was translated from English to Persian and back-translated to English and then administered to 242 medical teachers from six medical universities. To assess construct validity, researchers made use of confirmatory factor analysis. To check the reliability and validity of the physician teaching self-efficacy questionnaire, we used internal consistency, discriminant, convergent, and criterion validity.

RESULTS

PLS-SEM results substantiated the original three factor structure of the questionnaire which is dyadic, triadic, and self-regulation. For all sub-scales, internal consistency- measured by Cronbach's alpha and composite reliability, convergent validity- measured by factor loading and AVE, and discriminant validity- measured by cross-loading, Fornell-Larcker, and HTMT metrics- confirmed the construct reliability and validity of the questionnaire. A positive correlation was, also, fund between teaching motivation and experience with the physician teaching self-efficacy questionnaire scales, proving the criterion validity of the questionnaire.

CONCLUSION

The Persian version of physician teaching self-efficacy questionnaire is a valid, highly reliable, and multidimensional tool to measure physicians' clinical teaching self-efficacy working in medical universities.

Bibliometric Analysis on the Influencing Factors of International Courses’ Effectiveness from the Perspective of Sustainable Development Education

Sustainable development education is a dynamic and developing process. In recent years, the rapid development of international courses has made great contributions to sustainable development education. The effectiveness of international courses is influenced by many factors. To promote the sustainable development of education and to improve the effectiveness of international courses, this paper studied the influencing factors on international courses by using literature analysis, system dynamics analysis, questionnaire survey, and correlation analysis methods. First, based on the literature analysis, 27 factors affecting course effectiveness were initially obtained. Second, using system dynamics to study the relationship between each factor, five additional factors were added, namely, learning motivation, social focus, lesson planning, class time, and class location. A total of 32 factors influencing course effectiveness were obtained and classified into three categories, namely, students, teachers, and external factors, and a relationship model of the 32 factors influencing course effectiveness was constructed. Finally, a questionnaire survey was conducted to quantify the 32 influencing factors, and a correlation analysis was performed on all undergraduates majoring in safety engineering enrolled in 2018 and 2019 in a university in 2019 and 2020. The results show that among the 32 influencing factors in the three categories of students, teachers, and external factors proposed, there were 7 strong correlations, 22 moderate correlations, and 3 weak correlations. All of the strong correlations belonged to the student dimension, thereby indicating that the effectiveness of international online courses is mainly influenced by student factors. In addition, these influencing factors can not only impact course effectiveness directly, but also indirectly through the interaction between factors. The relationship model of the influencing factors can provide a reference for improving the effectiveness of international programs and realizing the sustainable development research for international courses.

Did the Characteristics of Kosovar Teachers Influence the Results of Students in TIMSS 2019? Findings from the Performance of Kosovar Students in TIMSS 2019

This paper aimed to explore the impact of Kosovar teachers’ characteristics on the performance of fourth-grade students in TIMSS 2019. The paper addressed the characteristics of teachers, demographic, and academics, which are closely related to the overall performance of students. In this research, data from the TIMSS 2019 database were used, for which 4435 Kosovar students were tested, and 192 teachers were surveyed. The findings show that Kosovar students did not perform well in TIMSS 2019. They achieved 444 points in the field of mathematics and 413 points in science (average TIMSS 500 points) and were ranked 49th out of 56 countries participating in the test. Data from the teacher survey show that the characteristics of teachers, such as age, professional development, pre-service education, contemporary approach to teaching, etc., also played an important role in the low-scoring performance of Kosovar students in TIMSS 2019. Students who had a teacher with an average age of 30–60 years had a better performance on the test, achieving a difference of 20 points more, compared to students who had new or older teachers (under 30 years and over 60 years). The lack of professional development of teachers also had a major impact on student performance. On average, 25% of teachers in the last 2 years had attended training in certain areas, while on average 80% of them were willing to attend training programs that would improve the profile of their competencies.

To teach or not to teach? Assessing medical school faculty motivation to teach in the era of curriculum reform

BACKGROUND

Medical schools have undergone a period of continual curricular change in recent years, particularly with regard to pre-clinical education. While these changes have many benefits for students, the impact on faculty is less clear.

METHODS

In this study, faculty motivation to teach in the pre-clinical medical curriculum was examined using self-determination theory (SDT) as a framework. Basic science and clinical faculty were surveyed on factors impacting their motivation to teach using validated scales of motivation as well as open-ended questions which were coded using self-determination theory (SDT) as a guiding framework.

RESULTS

Faculty reported that teaching activities often meet their basic psychological needs of competence, autonomy, and relatedness. Professors were more likely than associate professors to report that teaching met their need for autonomy. Faculty were more motivated by intrinsic as compared to external factors, although basic science faculty were more likely than clinical faculty to be motivated by external factors. Motivating and de-motivating factors fell into the themes Resources, Recognition and Rewards, Student Factors, Self-Efficacy, Curriculum, Contribution, and Enjoyment. The majority of factors tied to the faculty's need for relatedness. Based on these findings, a conceptual model for understanding medical school faculty motivation to teach was developed.

CONCLUSIONS

Assessing faculty motivation to teach provided valuable insights into how faculty relate to their teaching roles and what factors influence them to continue in those roles. This information may be useful in guiding future faculty development and research efforts.

Teaching self-efficacy and its effects on quality of bedside teaching: Findings from a multi-center survey

INTRODUCTION

Evidence suggests that the performance of medical students is affected by the quality of teaching of clinical teachers, and the higher teachers' teaching quality leads to better students' clinical performance. Hence, the present research aimed to investigate the association between teaching self-efficacy and quality of bedside teaching among medical teachers.

METHODS

This is a cross-sectional study. To this end, 242 medical teachers and 830 medical students from 6 universities in different cities were selected using convenience sampling. The medical teachers filled out Physician Teaching Self-Efficacy Questionnaire (α=0.93), and medical students completed the quality of bedside teaching questionnaire (BST) (α=0.91). Confirmatory factor analysis (CFA), Pearson correlation coefficient, and multiple regression were used to analyze the collected data through SPSS 23 and Smart-PLS3 software.

RESULTS

The results of confirmatory factor analysis (CFA) demonstrated that all items and measurement models had adequate reliability and validity to enter the final analysis (α>0.7, CR>0.7 AND AVE>0.50). Furthermore, the results showed teaching self-efficacy (r=0.27, p<0.001) and its components including self-regulation (r=0.24, p<0.001), dyadic regulation (r=0.22, p<0.001), and triadic regulation (r=0.33, p<0.001) had a positive and significant relationship with quality of bedside teaching. Also, the results of multiple regression revealed that among the predictor variables, only the triadic regulation variable could predict the quality of bedside teaching of medical teachers (β=0.326, p<0.001).

CONCLUSION

According to the findings, as the medical teachers' teaching self-efficacy improves, they can provide high-quality teaching to students, which in turn will lead to better learning and, therefore better performance for medical students.

The Effect of Servant Leadership on Self-Efficacy and Innovative Behaviour: Verification of the Moderated Mediating Effect of Vocational Calling

This study aimed to verify the impact of servant leadership on innovative behaviour in non-governmental organisations (NGOs). It particularly investigated the role of a mediator for self-efficacy in the relationship between servant leadership and innovative behaviour. This study defined the organisational psychology-behaviour mechanism in non-profit organisations by verifying the moderated mediating effect of vocational calling in the relationship between servant leadership, self-efficacy, and innovative behaviour. The 174 pilot samples used in this study comprised community service participants in NGOs. The analysis verified the hypothesis set through causal correlations among four variables using regression analysis and the PROCESS macro developed by Hayes. Vocational calling played a moderating role in the relationship between servant leadership and self-efficacy, and vocational calling had a conditional effect on the impact of servant leadership on innovative behaviour through self-efficacy. Meanwhile, self-efficacy fully mediated servant leadership and innovative behaviour. Based on the verification of the mechanism of organisational psychology-action, this study sought ways to develop the organisation of NGOs and improve the working environment.

medPJplus - development and implementation of a concept for the acquisition and qualification of teaching practices for the final year in family medicine at the University Medical Center Göttingen

Aim: The Masterplan Medizinstudium 2020 (Masterplan for Medical Studies 2020) focuses on practice-oriented undergraduate training with increased involvement of rural teaching practices. The demand for teaching practices for the final year will increase at all medical faculties in Germany. The project medPJplus at the University Medical Center Göttingen (UMG) presents an approach for successfully acquiring general medical teaching practices in local rural areas. Project outline: The project medPJplus implemented eight measures in cooperation with medical students, interested general practitioners, and regional players in the surrounding districts to attract new teaching practices: we established public relations, accredited practices, organized the didactic training of participating general practitioners, created a digital platform for students that is linked to the nationwide PJ-Portal, and organized information events, workshops, and feedback reports to regional actors. Results: Within one year, a total of 40 new teaching practices with 57 new teachers in the local rural area joined the project in southern Lower Saxony. A three-stage didactic training concept for general practitioners was established at the UMG. A digital platform enhances the visibility of general practitioners and their activities for students. The teaching practices can now be found on the nationwide PJ-Portal. Fourteen students have currently completed their period of the final year in family medicine there. Conclusions: It is possible to acquire rural general medical teaching practices for the final year. This depends on four core elements: addressing and didactic training of interested general practitioners, networking of medical students with teaching physicians and regional actors, digitally presenting teaching practices, and developing solutions for mobility and living space during the final year.

Factors associated with teaching efficacy among nurse educators in hospital settings

AIMS AND OBJECTIVES

The objective of this study was to examine differences in personal characteristics, core practice competency and role stress according to levels of teaching efficacy among clinical nurse educators working in general hospitals.

BACKGROUND

In the clinical setting, successful adaptation to instruction among practicing clinical nurse educators is challenging.

DESIGN

Secondary analysis of data through a cross-sectional study design was adopted.

METHODS

Originally, 565 nurses were recruited from general hospitals; 364 were included in this study. Participants were nurses with more than 1 year of experience in various settings from 16 general hospitals wherein nursing students trained for clinical practicum in five cities in South Korea. Self-reported data were collected via the Teaching Efficacy, Core Practice Competency and Perceived Stress Scales assessing clinical education-related teaching efficacy, core practice competency and role stress. In the analyses, comparison between nurses with high and low teaching efficacy was conducted. We have followed through the EQUATOR (e.g. STROBE) research checklist for the preparation of this manuscript.

RESULTS

According to univariate analysis, levels of teaching efficacy were shown to be higher with age, longer clinical careers, in those undergoing a doctoral course or with a doctorate, previous experience in providing clinical education and enrolment in continuing education for clinical education. In the multivariate analysis, enrolment in continuing education for clinical education, assessment and intervention skills, critical thinking skills, teaching skills and role ambiguity were associated with level of teaching efficacy among nurse educators.

CONCLUSION

Based on the results of this study, we recommend that nursing administrators should foster the recognition of personal characteristics in potential clinical nurse educators or preceptors with high teaching efficacy.

RELEVANCE TO CLINICAL PRACTICE

Nurses should be supported by providing them with opportunities for professional development to enhance teaching efficacy.

An Online Educational Intervention to Influence Medical and Nurse Practitioner Students' Knowledge, Self-Efficacy, and Motivation for Antepartum Depression Screening and Education

OBJECTIVE

To evaluate nurse practitioner and medical students' knowledge, self-efficacy, and motivation for antepartum depression screening and education before and after an online educational intervention.

DESIGN

Quasi-experimental study design.

SETTING/LOCAL PROBLEM

The University of South Florida, College of Nursing and College of Medicine. Historically, nursing and medical school curricula have a focus on postpartum depression. Testing nurse practitioner and medical students regarding maternal depression throughout pregnancy may give insight into curriculum preparedness.

PARTICIPANTS

Medical and nurse practitioner students were recruited by convenience sampling. In total, 71 participants completed the study. There were 52 (73%) nurse practitioner students and 19 (27%) medical students.

INTERVENTION/MEASUREMENTS

Participants used a self-directed learning activity in the form of a slide presentation on the virtual platform REDCap. Knowledge was tested before and after the intervention using the "Speak Up When You're Down"-Postpartum Depression Awareness Campaign examination. Self-efficacy and motivation were measured before and after the intervention by using the Physician/Nurse Practitioner Student Teaching Self-Efficacy Questionnaire and the Physician/Nurse Practitioner Student Teaching Motivation Questionnaire.

RESULTS

Nurse practitioner and medical students exhibited a mean increase in scores for knowledge, self-efficacy, and motivation. Both groups performed similarly from before to after the intervention, and student profession did not moderate the increase from before to after the intervention.

CONCLUSION

An intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.

Student Perception of Case-based Teaching by Near-Peers and Faculty during the Internal Medicine Clerkship: A Noninferiority Study

INTRODUCTION

Third-year medical students traditionally receive their didactic or small group teaching sessions from clinical faculty during clerkship rotations. Near-peer teaching is increasingly recognized as an acceptable method for teaching, however most near-peer teaching takes place during the pre-clinical curriculum. We sought to determine if fourth year medical students were noninferior to faculty in facilitating small group discussions during clerkship rotations.

METHODS

Seventy-five third-year medical students participated in a small group session focused on rheumatologic diseases during their internal medicine clerkship rotation. Students were taught by fourth-year medical students who self-selected to participate as near-peer teachers at 1 clinical site (near-peers, N = 36) and by clinical faculty at another site (N = 39). At the end of the session, third-year medical students completed a survey evaluating teacher performance and effectiveness.

RESULTS

There was no significant difference between the 2 groups on each of the 17 survey items assessing teacher performance, the total teaching performance score, and the teaching effectiveness rating (all P-values >.05). A mean between-group difference of 2% in favor of the near-peers indicated noninferiority of the near-peer teachers compared with faculty teachers on the total teaching performance score. An absolute difference of 14% in favor of the near-peers indicated noninferiority of the near-peer teachers compared with faculty teachers on the teaching effectiveness score. Near-peer teachers reported several benefits, including improving their own medical knowledge and skills as a future educator.

DISCUSSION

Our data supports the noninferiority of the perceived performance and effectiveness of near-peer teachers compared to faculty teachers in the clerkship setting. Adding near-peer teachers to the clerkship setting is feasible and can be beneficial to all stakeholders.

Competence and training in interventional pulmonology

Interventional pulmonology (IP) is experiencing a rapid evolution of new technologies. There is a need to develop structured training programs, organized in high volume expert centers in order to improve trainee education, and including the development of validated metrics for their competency assessment. Concerning teaching methods, a gradual progression from theory to practice, using new teaching techniques, including live sessions and low and high-fidelity simulation, flipped classroom models and problem-based learning (PBL) exercises would provide a training setting more suitable for our current need to improve skills and update professionals. Training programs should be learner-centered and competence-oriented, as well as being based on a spiral-shaped approach in which the same subject is addressed many times, from new and different perspectives of knowledge, ability, behavior and attitude, until the trainee has demonstrated a high degree of skill and professionalism. Furthermore there is a need to standardize the training programs as guide for physicians wishing to undertake a gradual and voluntary improvement of their own competencies, and assist those planning and organizing training programs in IP. The article includes a general part on core curriculum contents, innovative training methods and simulation, and introduces the following articles on the skills that the Interventional Pulmonologist must master in order to perform the different procedures. This monography should be considered a starting point that will evolve over time and results in better training for practitioners and better care for our patients. The task of establishing a trainee's competence to practice independently as an Interventional Pulmonologist remains the responsibility of the IP fellowship program director and faculty, who validate logbooks and assess competence for each procedure. These standards need to be reviewed and approved by national and International Scientific Societies and Healthcare Institutions with the aim to improve, disseminate and incorporate them in healthcare programs.

Medical student experiences in prison health services and social cognitive career choice: a qualitative study

BACKGROUND

One of the purposes of undergraduate medical education is to assist students to consider their future career paths in medicine, alongside the needs of the societies in which they will serve. Amongst the most medically underserved groups of society are people in prison and those with a history of incarceration. In this study we examined the experiences of medical students undertaking General Practice placements in a prison health service. We used the theoretical framework of the Social Cognitive Career Theory (SCCT) to explore the potential of these placements to influence the career choices of medical students.

METHODS

Questionnaire and interview data were collected from final year students, comprising pre and post placement questionnaire free text responses and post placement semi-structured interviews. Data were analysed using inductive thematic analysis, with reference to concepts from the SCCT Interest Model to further develop the findings.

RESULTS

Clinical education delivered in a prison setting can provide learning that includes exposure to a wide variety of physical and mental health conditions and also has the potential to stimulate career interest in an under-served area. While students identified many challenges in the work of a prison doctor, increased confidence (SCCT- Self-Efficacy) occurred through performance success within challenging consultations and growth in a professional approach to prisoners and people with a history of incarceration. Positive expectations (SCCT- Outcome Expectations) of fulfilling personal values and social justice aims and of achieving public health outcomes, and a greater awareness of work as a prison doctor, including stereotype rejection, promoted student interest in working with people in contact with the criminal justice system.

CONCLUSION

Placements in prison health services can stimulate student interest in working with prisoners and ex-prisoners by either consolidating pre-existing interest or expanding interest into a field they had not previously considered. An important aspect of such learning is the opportunity to overcome negative preconceptions of consultations with prisoners.