Student preparedness characteristics important for clinical learning: perspectives of supervisors from medicine, pharmacy and nursing

A Comprehensive Review of Chloride Management in Critically Ill Patients

Chloride, often overshadowed in electrolyte management, emerges as a crucial player in the physiological intricacies of critically ill patients. This comprehensive review explores the multifaceted aspects of chloride, ranging from its significance in cellular homeostasis to the consequences of dysregulation in critically ill patients. The pathophysiology of hyperchloremia and hypochloremia is dissected, highlighting their intricate impact on acid-base balance, renal function, and cardiovascular stability. Clinical assessment strategies, including laboratory measurements and integration with other electrolytes, lay the foundation for targeted interventions. Consequences of dysregulated chloride levels underscore the need for meticulous management, leading to an exploration of emerging therapies and interventions. Fluid resuscitation protocols, the choice between crystalloids and colloids, the role of balanced solutions, and individualized patient approaches comprise the core strategies in chloride management. Practical considerations, such as monitoring and surveillance, overcoming implementation challenges, and embracing a multidisciplinary approach, are pivotal in translating theoretical knowledge into effective clinical practice. As we envision the future, potential impacts on critical care guidelines prompt reflections on integrating novel therapies, individualized approaches, and continuous monitoring practices. In conclusion, this review synthesizes current knowledge, addresses practical considerations, and envisions future directions in chloride management for critically ill patients. By embracing a holistic understanding, clinicians can navigate the complexities of chloride balance, optimize patient outcomes, and contribute to the evolving landscape of critical care medicine.

Clinical supervisors' and students' perspectives on preparedness for veterinary workplace clinical training: An international study

BACKGROUND

The alignment of student and workplace supervisors' perspectives on student preparedness for veterinary workplace clinical training (WCT) is unknown, yet misalignment could negatively impact workplace learning. The aim of this study was to quantify the relative importance of WCT preparedness characteristics according to students and supervisors and to identify differences.

METHODS

A survey was completed by 657 veterinary students and 244 clinical supervisors from 25 veterinary schools, from which rankings of the preparedness characteristics were derived. Significant rank differences were assessed using confidence intervals and permutation tests.

RESULTS

'Honesty, integrity and dependability' was the most important characteristic according to both groups. The three characteristics with the largest rank differences were: students' awareness of their own and others' mental wellbeing and the importance of self-care; being willing to try new practical skills with support (students ranked both of these higher); and having a clinical reasoning framework for common problems (supervisors ranked higher).

LIMITATIONS

Using pooled data from many schools means that the results are not necessarily representative of the perspectives at any one institution.

CONCLUSION

There are both similarities and differences in the perspectives of students and supervisors regarding which characteristics are more important for WCT. This provides insights that can be used by educators, curriculum developers and admissions tutors to improve student preparedness for workplace learning.

Medical students' perception and attitudes on operating theatre learning experience in Sri Lanka

Objective

The operating room is a unique learning experience that has visual, aural, kinesthetic learning stimuli and provides benefits to the medical students such as development of sound clinical knowledge and skills, and gaining personal insight into ones' career choice. However, this can be a challenging place due to the unfamiliar learning environment. We aimed to study the Sri Lankan Medical students' perception and attitudes on operating theatre learning experience.

Design and setting

A descriptive cross-sectional survey was carried out among medical students undergoing surgical clinical training on the perspectives of the teaching and learning experience in the operating theatre in Sri Lanka.

Participants

Our study group consisted of 390 medical students from four different medical faculties in Sri Lanka representing all levels of surgical clinical rotations.

Results

A majority of the students had actively participated in the operating theater. Despite this, the students' clarity of the learning outcomes and expectations in a theatre varied greatly. Majority of the students felt that the surgeons were willingly to teach but also noted that there was no standardization in teaching. This study clearly shows a significant correlation between positive emotions and surgical teams welcoming attitude towards the medical students. Long standing hours were considered a negative emotion by a majority of students. We also observed that theatre environment can be physically and mentally exhausting.

Conclusions

Thus, empathy, feeling welcome and giving breaks to refresh can go a long way in making the learning experience better. Regular feedback to trainers on students' perception of the theatre experience is important to value the students' opinion and improve the quality of the surgical theatre. We strongly recommend initiation of clear induction sessions with introduction of well-structured teaching learning activities in the operating theatre.

Evaluating allied health students' readiness for placement learning

BACKGROUND

Experiential learning opportunities, such as work integrated learning placements, are often challenging for health professional students. It is therefore imperative that students are adequately prepared before engaging in placement learning. Operationalising 'readiness for learning on placement' as a construct, is necessary for providing quality student feedback and assessment.

METHODS

An integrative mixed methods approach was adopted for this study, utilising a survey to canvass the perspectives of academics, students, and placement educators around the construct of readiness to inform potential assessment items. An assessment tool measuring student readiness for placement was then developed. Data from occupational therapy, physiotherapy and speech pathology programs were evaluated using Rasch analysis to explore the unidimensionality of this construct.

RESULTS

The online survey was completed by 64 participants, confirming the importance and measurability of foundational skills integral to readiness for placement learning. These foundational skills were then reflected in a pilot 20-item tool covering domains of professional and learner behaviour, communication, information gathering skills and reasoning. The Rasch analysis of 359 pre-registration student assessments confirmed unidimensionality, suggesting that the skills and attributes (operationalised as assessment items) that are considered part of 'readiness for placement' are components of this construct. Together, these findings provide support that the items on this tool are relevant and representative of the skills and behaviours that indicate readiness for placement learning. Two items regarding documentation and appropriate professional dress demonstrated some lower importance scores and interpretation variance warranting further investigation.

CONCLUSION

Through the exploration of the construct of readiness for placement learning, we have created and subsequently revised, an innovative assessment tool that measures novice students' pre-placement capabilities. Further research is now needed to explore the psychometric properties of the tool.

The difference of primary school teachers' online teaching satisfaction in subject and educational level

The growth of online education requires high-quality online teaching. Teachers' satisfaction with online teaching is of great significance for improving online teaching effectiveness. This study was to explore the primary school teachers' online teaching satisfaction during the spread of COVID-19 from Shanghai, who have experienced online teaching, and explore whether there were differences of teachers' online teaching satisfaction in subject and educational level. 939 teachers from Shanghai participated in the study. The non-parametric Mann-Whitney U test and Kruskal-Wallis test of variance were performed. Results showed that teachers' online teaching satisfaction was at a high level. Moreover, there was a significant difference in teachers' subject and educational level on online teaching satisfaction. In terms of subject differences of teachers, there were significant differences in resource suitability (RS) among teachers of different subjects. Therefore, it is recommended that each subject should develop the online teaching resources to support teachers' online teaching. In terms of the differences in teachers' educational levels, there were no significant differences between the satisfaction of college-level teachers on non-technical variables such as content selectivity (CS) and teachers with undergraduate and graduate degrees, and only on technical variables such as self-efficacy (SE), resource suitability (RS), ease of use (EU), and intention to use (IU). Given the national context in China, the difference in educational levels may be more reflected in the age of the teachers. For teachers with college educational level, due to their older age, rather than simply enhancing motivation and improving learning ability to increase online teaching satisfaction, emphasis should be placed on providing appropriate teaching service support to help improve online teaching effectiveness. The findings provide new empirical evidence, strategies and Chinese experience for promoting teachers' online teaching satisfaction.

Rating and ranking preparedness characteristics important for veterinary workplace clinical training: a novel application of pairwise comparisons and the Elo algorithm

Quantitatively eliciting perspectives about a large number of similar entities (such as a list of competences) is a challenge for researchers in health professions education (HPE). Traditional survey methods may include using Likert items. However, a Likert item approach that generates absolute ratings of the entities may suffer from the "ceiling effect," as ratings cluster at one end of the scale. This impacts on researchers' ability to detect differences in ratings between the entities themselves and between respondent groups. This paper describes the use of pairwise comparison (this or that?) questions and a novel application of the Elo algorithm to generate relative ratings and rankings of a large number of entities, on a unidimensional scale. A study assessing the relative importance of 91 student "preparedness characteristics" for veterinary workplace clinical training (WCT) is presented as an example of this method in action. The Elo algorithm uses pairwise comparison responses to generate an importance rating for each preparedness characteristic on a scale from zero to one. This is continuous data with measurement variability which, by definition, spans an entire spectrum and is not susceptible to the ceiling effect. The output should allow for the detection of differences in perspectives between groups of survey respondents (such as students and workplace supervisors) which Likert ratings may be insensitive to. Additional advantages of the pairwise comparisons are their low susceptibility to systematic bias and measurement error, they can be quicker and arguably more engaging to complete than Likert items, and they should carry a low cognitive load for respondents. Methods for evaluating the validity and reliability of this survey design are also described. This paper presents a method that holds great potential for a diverse range of applications in HPE research. In the pursuit quantifying perspectives on survey items which are measured on a relative basis and a unidimensional scale (e.g., importance, priority, probability), this method is likely to be a valuable option.

An application of the caritative caring approach – nursing students’ experiences of practising caring and uncaring encounters by simulation at a clinical training centre

Purpose

Nurses’ lack of competence to be caring affects patients’ health and patients describe a desire for more individual and compassionate care. Nursing education tends, however, to focus less on the caring approach in nursing practice and more on developing knowledge in psychomotor skills. The aim of this study was to describe nursing students’ experiences of simulating caring and uncaring encounters founded on the caritative perspective at a Clinical Training Centre (CTC).

Method

A qualitative, inductive approach using a qualitative latent content analysis. Written reflections of 49 students were analysed.

Findings

By intertwining reflection with acting and observation, the students experienced that they achieved an open mind and gained an understanding of how important it was to treat the patient based on a caring approach. To act, first uncaring and thereafter caring, gave them an awakening. The students were touched and an overwhelming feeling of suddenly understanding human uniqueness and vulnerability appeared.

Conclusions

To simulate caritative caring and uncaring encounters at the CTC enhanced students’ knowledge and understanding about caring and strengthened their prerequisites to acquire a caritative ontological basic view and attitude which in the long run may lead to an increased feeling of patient well-being in the encounter.

Nursing students' experiences of service-learning at community and hospital pharmacies in Belize: Pedagogical implications for nursing pharmacology

OBJECTIVES

Many students seem to find pharmacology learning very challenging due to the complexity and variety of drugs they have to study. The number of drugs the students have to learn, the duration of time to learn the medications, and the evolving nature of diseases demanded learning beyond the classroom walls. This study explored and described nursing students' experiences in community and hospital-based pharmacy practice sites during their service-learning and its implications for pharmacology pedagogical practices.

METHODS

Kolb's learning theory provided the framework to explore nursing students' 48-hour service-learning experiences at community/hospital-based pharmacies in Belize and its implications for pharmacology pedagogy. The study utilized two qualitative approaches, reflective journals and focus group interviews, to collect data from 46 second-year nursing students. NVivo software and coding schemes were employed to analyze the data from the interviews and reflective journals.

RESULTS

Students reported learning medications, integrating classroom pharmacological knowledge at pharmacy practice sites, acquiring and enhancing communication skills, interpreting prescriptions, dispensing medications, drug calculations, taking inventory, doing vital signs, and patient education. In addition, students reported experiencing inter-professional relationships as healthcare team members. Anxiety was a major challenge experienced by many students at the beginning of the service-learning experience.

CONCLUSIONS

This study highlights the importance of experiential learning of pharmacology amongst second year nursing students, offering the opportunity to inform and support pharmacotherapeutics educators in designing strategies for more effective teaching of medications to nursing students. It also supports the addition of pharmacy placements to the nursing curriculum' as it shows that nursing students can learn medications, skills, and teamwork from experiential pharmacy site posting. Combining classroom instruction with pharmacy experiential service learning might be an effective complement for teaching nursing pharmacology.

Differential Analysis of Teachers’ Technological Pedagogical Content Knowledge (TPACK) Abilities According to Teaching Stages and Educational Levels

The development of educational informatization imposes new requirements on the cultivation of teachers’ digital competence, which appeals to teachers who aim to optimize their teaching by integrating appropriate Information and Communication Technology (ICT). The requirement of digital competence corresponds to the meaning of Technological Pedagogical Content Knowledge (TPACK). Therefore, the development of teachers’ TPACK abilities can also positively influence the cultivation of their digital competence. The study was to examine the level of teachers’ TPACK abilities, and whether any difference in such abilities would be found according to the different teaching stages and teachers’ educational levels. An online questionnaire was distributed to the target teachers. Data of 1342 participants were analyzed. SPSS was used to conduct the descriptive statistics, and the non-parametric Kruskal–Wallis test with the post-hoc pairwise comparisons was used to determine teachers’ TPACK ability levels and explore the differences in teachers’ TPACK according to their different teaching stages and educational levels. The results indicated that teachers’ TPACK abilities were at a generally high level. Moreover, significant differences in teachers’ TPACK abilities were found in the teaching stages and educational levels. Teachers with different teaching stages have significant differences in Content Knowledge (CK), Pedagogical Knowledge (PK), Technological Pedagogical Knowledge (TPK), Technological Content Knowledge (TCK), and Technological Pedagogical Content Knowledge (TPACK). However, no difference was found between Technological Knowledge (TK) and Pedagogical Content Knowledge (PCK). In addition, the results suggested that the seven sub-dimensions of TPACK differed significantly according to teachers’ educational levels, where the higher the educational level, the better the teachers’ TPACK abilities. Therefore, teachers should effectively integrate technology and apply appropriate pedagogies according to the teaching content in different teaching stages. A planned and targeted series of ICT application training courses for teachers with lower educational levels would be helpful to improve their self-confidence in using technology to promote their teaching effectiveness.

Digital Learning in Speech-Language Pathology, Phoniatrics, and Otolaryngology: Interdisciplinary and Exploratory Analysis of Content, Organizing Structures, and Formats

BACKGROUND

The digital revolution is rapidly transforming health care and clinical teaching and learning. Relative to other medical fields, the interdisciplinary fields of speech-language pathology (SLP), phoniatrics, and otolaryngology have been slower to take up digital tools for therapeutic, teaching, and learning purposes-a process that was recently expedited by the COVID-19 pandemic. Although many current teaching and learning tools have restricted or institution-only access, there are many openly accessible tools that have gone largely unexplored. To find, use, and evaluate such resources, it is important to be familiar with the structures, concepts, and formats of existing digital tools.

OBJECTIVE

This descriptive study aims to investigate digital learning tools and resources in SLP, phoniatrics, and otolaryngology. Differences in content, learning goals, and digital formats between academic-level learners and clinical-professional learners are explored.

METHODS

A systematic search of generic and academic search engines (eg, Google and PubMed); the App Store; Google Play Store; and websites of established SLP, phoniatrics, and otolaryngology organizations was conducted. By using specific search terms and detailed inclusion and exclusion criteria, relevant digital resources were identified. These were organized and analyzed according to learner groups, content matter, learning goals and architectures, and digital formats.

RESULTS

Within- and between-learner group differences among 125 identified tools were investigated. In terms of content, the largest proportion of tools for academic-level learners pertained to anatomy and physiology (60/214, 28%), and that for clinical-professional learners pertained to diagnostic evaluation (47/185, 25.4%). Between groups, the largest differences were observed for anatomy and physiology (academic-level learners: 60/86, 70%; clinical-professional learners: 26/86, 30%) and professional issues (8/28, 29% vs 20/28, 71%). With regard to learning goals, most tools for academic-level learners targeted the performance of procedural skills (50/98, 51%), and those for clinical-professional learners targeted receptive information acquisition (44/62, 71%). Academic-level learners had more tools for supporting higher-level learning goals than clinical-professional learners, specifically tools for performing procedural skills (50/66, 76% vs 16/66, 24%) and strategic skills (8/10, 80% vs 2/10, 20%). Visual formats (eg, pictures or diagrams) were dominant across both learner groups. The greatest between-group differences were observed for interactive formats (45/66, 68% vs 21/66, 32%).

CONCLUSIONS

This investigation provides initial insights into openly accessible tools across SLP, phoniatrics, and otolaryngology and their organizing structures. Digital tools in these fields addressed diverse content, although the tools for academic-level learners were greater in number, targeted higher-level learning goals, and had more interactive formats than those for clinical-professional learners. The crucial next steps include investigating the actual use of such tools in practice and students' and professionals' attitudes to better improve upon such tools and incorporate them into current and future learning milieus.

Soft skill elements in structured clinical nursing assessment for undergraduate nursing students: A systematic review

This systematic review aimed to appraise and synthesize the available evidence that examines the soft skill elements in clinical nursing assessment for undergraduate nursing students. This systematic review also is in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies were identified based on the inclusion criteria with language filters but were limited to articles published from January 2000 to March 2019. Two reviewers independently conducted the quality assessment, data extraction, and analysis on all included studies. A total of 17 articles were included in this review. Studies showed that without developing adequate soft skill elements in the clinical skill assessment, students are graduating unprepared to be successful in the workplace. There is a need to consider and adopt soft skill elements in clinical skill assessment to improve the quality of nursing graduates and ultimately to create a positive impact on patient outcomes.

Nursing supervisors' perspectives on student preparedness before clinical placements- a focus group study

METHODS

The study was conducted in a county in Southeastern-Norway, with 317.000 inhabitants, and within one hospital and one university college catchment area. Focus group interviews were conducted in the periode August to December 2018. Data were analyzed using Hsieh and Shannon's conventional content analysis.

RESULTS

34 nursing supervisors participated, three intellectual disability nurses and 31 registered nurses, working in four different primary healthcare wards and four different hospital wards. Participants' age ranged from 23 to 58 years, one male only. Through the analysis we derived the category 'Shared responsibility for preparation' with subcategories a) Individual initiative, and b) University college facilitation.

CONCLUSIONS

Findings indicate that there is a gap between nursing supervisors' expectations and reality regarding students' preparedness for clinical placements. Moreover, nursing supervisors did not seem to focus on their own role in student preparedness.

Student perspectives of preparedness characteristics for clinical learning within a fully distributed veterinary teaching model

The transition into the clinical environment is challenging and associated with significant stress and anxiety. This study aimed to examine the perspectives of students on the characteristics important for preparedness for clinical learning and the influence of gender, age, and graduate status on those perspectives. This descriptive, questionnaire-based study of 62 characteristics categorised into six themes was conducted within the Surrey School of Veterinary Medicine completed by 139 students commencing their final clinical year. The Friedman test and post-hoc Wilcoxon signed rank sum test explored for differences in ranking across the themes. Ordinal logistic regression and Mann-Whitney U pairwise comparisons were utilised to investigate for effects of gender, age, and graduate status on theme ranking. There was a significant difference (P <0.05) between medians for themes of preparedness characteristics with comparisons revealing willingness and communication and interaction as the most highly rated characteristics. Knowledge and understanding were viewed as the least important characteristic. Regression and pairwise Mann-Whitney U comparisons confirmed no significant effects (P >0.05) of gender, age or graduate status on student rating of preparedness characteristics. Integrating learning opportunities of those preparedness characteristics in the pre-clinical curriculum may improve students' preparedness for the clinical environment.

Navigating diagnostic uncertainty in musculoskeletal practice: The perspectives and experiences of new graduate physiotherapists

BACKGROUND

Diagnostic uncertainty in musculoskeletal pain presents as a frequent and challenging dilemma encountered by health professionals. Current literature indicates that diagnostic uncertainty impacts the clinical decision making of experienced physiotherapists. Despite this, the experiences and navigational strategies of new graduate physiotherapists, pertaining to this dilemma, are widely unknown.

OBJECTIVES

The aim of this study was to explore how new graduate physiotherapists experience and navigate diagnostic uncertainty when managing individuals with musculoskeletal pain.

METHODS

A qualitative study using a thematic analytical research approach was undertaken. A randomized sample of new graduate physiotherapists, working in musculoskeletal settings (n = 17), participated in semi-structured telephone interviews. Interview data was subsequently subject to thematic analysis.

RESULTS

Four key themes emerged from the data: 1) diagnostic uncertainty is fraught with challenges; 2) diagnosis is not the end game; 3) intrinsic strategies and extrinsic actions and 4) the imperative role of clinical practice.

CONCLUSION

New graduate physiotherapists frequently experience diagnostic uncertainty within musculoskeletal practice and are commonly challenged by this dilemma. Despite this, new graduates utilize several strategies to mitigate challenges including focusing on patient-centered care, maintaining transparency and relying on senior colleagues. Most strategies are directly attributed to clinical experiences. This study further outlines implications for physiotherapy curricula and workplace support.

Recommendations of behavioural facilitators for success in a physiotherapy clinical practice module: Successful students' perspectives

Background

Students struggle to bridge the gap between theory and application thereof in clinical settings. Exploring the behaviours of students who have been shown to be successful in the clinical practice module of physiotherapy could provide an insight into what facilitated their success. Sharing this information with other students could assist with decreasing anxiety and improving student success.

Objectives

The objective of this study was to explore behaviours that facilitate student success in a physiotherapy clinical practice module from the perspective of high-achieving students.

Method

Data were collected at the University of the Western Cape's physiotherapy department in South Africa. Ten students with the highest marks in clinical practice from the 2016 and 2017 final-year cohorts were purposively selected and invited to participate in two different Nominal Group Technique (NGT) discussions. In total, 14 students consented to participate in the study. A demographic and socio-economic status questionnaire and an NGT discussion were used to collect data. Participants analysed the NGT discussion data themselves by ranking facilitators in order of priority.

Results

Doing pre-block preparation, self-reflection and having a good rapport with patients as well as personal motivation and coping strategies were identified as the most important behavioural facilitators for physiotherapy students' success in a clinical practice module.

Conclusion

Clinical practice is considered to be the most stressful module for undergraduate physiotherapy students. Considering this, recommendations from previously successful students could contribute towards the success of present and future students and in decreasing the stress associated with clinical practice.

Clinical implications

Recommendations from students on behavioural facilitators that enabled them to be successful in a physiotherapy clinical practice module can assist future students entering clinical practice to be successful in this stressful module. This information is also useful for clinical educators to assist students who struggle, and to recommend potential changes or improvements to the current physiotherapy clinical practice module.

Self-perceived preparedness of undergraduate dental students in dental public universities in Malaysia: A national study

AIMS

To evaluate the self-perceived preparedness of final-year dental undergraduate students in dental public universities in Malaysia.

METHODS

Final-year dental undergraduate students from six dental public universities in Malaysia were invited to participate in an online study using a validated Dental Undergraduates Preparedness Assessment Scale DU-PAS.

RESULTS

In total, about 245 students responded to the online questionnaire yielding a response rate of 83.05%. The age range of the respondents was 23-29 years with a mean age of 24.36 (SD 0.797). The total score obtained by the respondents was ranged from 48 to 100 with a mean score of 79.56 (SD 13.495). Weaknesses were reported in several clinical skills, cognitive and behavioural attributes.

CONCLUSIONS

The preparedness of undergraduate students at six dental institutions in Malaysia was comparable to students from developed countries. The dental undergraduate preparedness assessment scale is a useful tool, and dental institutions may be used for self-assessment as well as to obtain feedback from the supervisors.