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Koch R, Steffen MT, Joos S. Stakeholder Participation and Cross-Sectoral Cooperation in a Quality Circle on Community-Based Teaching: Results of a Qualitative Interview Study. J Multidiscip Healthc 2022; 15:2767-2780. [PMID: 36510506 PMCID: PMC9739960 DOI: 10.2147/jmdh.s382939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Community-based learning in family medicine practices is an increasingly important part of the medical curriculum internationally. It is widely regarded as one solution to healthcare system needs, such as training and retaining a workforce willing to work in primary care. However, the perspectives of community-based medical educators and representatives from university-based medical education are rarely integrated. To improve teaching quality and promote exchange between those two sectors of medical education, the Institute for General Practice and Interprofessional Care at Tübingen University started a quality circle in family medicine teaching involving stakeholders from both sectors in 2018. The study aims to describe how the participants of this specific QC describe the cross-sectoral cooperation and participation of stakeholders in the quality management of community and university medical education. Methods After an observed meeting of the quality circle, semi-structured interviews were conducted with n=12 participants of the quality circle. Interview transcripts were analyzed using grounded theory. Results According to the participants, the quality circle provides a dynamic continuity which allows participants to navigate known barriers to transsectoral collaboration in the quality management of community-based medical education. The quality circle is perceived as an instrument for quality improvement that offered continuity and direction. At the same time, it allows for enough freedom and flexibility for the involved stakeholders to creatively work together on quality management and be inspired by their experiences. Discussion The quality circle has the potential to facilitate collaboration between the two teaching settings, form a creative community, and give medical students an active role in educational quality management.
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Affiliation(s)
- Roland Koch
- Institute for General Practice and Interprofessional Care, Tübingen University Hospital, Tübingen, Germany,Correspondence: Roland Koch, Tel +49 1758065961, Email
| | - Marie-Theres Steffen
- Institute for General Practice and Interprofessional Care, Tübingen University Hospital, Tübingen, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, Tübingen University Hospital, Tübingen, Germany
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Effect of Residents-as-Teachers in Rural Community-Based Medical Education on the Learning of Medical Students and Residents: A Thematic Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312410. [PMID: 34886136 PMCID: PMC8656610 DOI: 10.3390/ijerph182312410] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022]
Abstract
Residents-as-teachers (RaT) is a theoretical framework emphasizing the significance of the similar learning background of teachers and learners. In Japan, community-based medical education (CBME) is a practical approach to teaching family medicine. This study aimed to investigate the impact and challenges of RaT on the learning of medical students and residents in CBME at a rural community hospital in Japan. Over the course of a year, the researchers conducted one-on-one interviews with three residents and ten medical students participating in family medicine training at the hospital. The interviews were recorded and transcribed verbatim. Grounded theory was used in the data analysis to clarify the findings. Three key themes emerged from the research: lack of educational experience with RaT, effectiveness of RaT, and challenges of RaT. Although participants were prejudiced against RaT, they felt its implementation could facilitate the establishment of beneficial relationships between learners and teachers. They were also able to participate in medical teams effectively. The findings suggest that the increased participation of senior doctors in RaT could strengthen its learning effects. RaT in rural CBME should be applied in various contexts, and its effectiveness should be further investigated both qualitatively and quantitatively.
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Ohta R, Ryu Y, Sano C. The Uncertainty of COVID-19 Inducing Social Fear and Pressure on the Continuity of Rural, Community-Based Medical Education: A Thematic Analysis. Healthcare (Basel) 2021; 9:223. [PMID: 33671392 PMCID: PMC7922333 DOI: 10.3390/healthcare9020223] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/09/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022] Open
Abstract
Rural community-based medical education (CBME) enriches undergraduate and postgraduate students' learning but has been impacted by the coronavirus disease 2019 (COVID-19) pandemic. We identified the challenges faced by stakeholders as well as the relevant solutions to provide recommendations for sustainable CBME in community hospitals during the COVID-19 pandemic. A total of 31 pages of field and reflection notes were collated through direct observation and used for analysis. Five physicians, eight nurses, one clerk, fourteen medical trainees, and three rural citizens were interviewed between 1 April and 30 September 2020. The interviews were recorded and their contents were transcribed verbatim and analyzed using thematic analysis. Three themes emerged: uncertainty surrounding COVID-19, an overwhelming sense of social fear and pressure within and outside communities, and motivation and determination to continue providing CBME. Rural CBME was impacted by not only the fear of infection but also social fear and pressure within and outside communities. Constant assessment of the risks associated with the pandemic and the implications for CMBE is essential to ensure the sustainability of CBME in rural settings, not only for medical educators and students but also stakeholders who administrate rural CBME.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, Unnan 699-1221, Japan;
| | - Yoshinori Ryu
- Community Care, Unnan City Hospital, Unnan 699-1221, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 693-8501, Japan;
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Ohta R, Ryu Y, Sano C. The Contribution of Citizens to Community-Based Medical Education in Japan: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1575. [PMID: 33562329 PMCID: PMC7915629 DOI: 10.3390/ijerph18041575] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
Community-based medical education (CBME) offers vital support to healthcare professionals in aging societies, which need medical trainees who understand comprehensive care. In teaching comprehensive care practices, CBME can involve citizens from the relevant community. This research synthesizes the impact of the involvement of communities on the learning of medical trainees in CBME. We conducted a systematic review, in which we searched ten databases from April 1990 to August 2020 for original articles in Japan regarding CBME involving citizens and descriptively analyzed them. The Kirkpatrick model was used to categorize the outcomes. Our search for studies following the protocol returned 1240 results; 21 articles were included in this systematic review. Medical trainees reported satisfaction with the content, teaching processes, and teachers' qualities. Medical trainees' attitudes toward community and rural medicine improved; they were motivated to become family physicians and work in communities and remote areas. This review clarified that citizen involvement in CBME had an effective impact on medical trainees, positively affecting perceptions of this type of education, as well as improving trainees' knowledge about and attitude toward community and rural medicine.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan;
| | - Yoshinori Ryu
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Shimane, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, Izumo 693-8501, Shimane, Japan;
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Campbell N, Farthing A, Witt S, Anderson J, Lenthall S, Moore L, Rissel C. Health Professional Student Placements and Workforce Location Outcomes: Protocol of an Observational Cohort Study. JMIR Res Protoc 2021; 10:e21832. [PMID: 33443482 PMCID: PMC7843200 DOI: 10.2196/21832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 11/08/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background The successful recruitment and retention of health professionals to rural and remote areas of Australia is a health policy priority. Nursing or allied health professional students’ learning placements in the Northern Territory (NT) of Australia, most of which is considered remote, may influence rural or remote work location decisions. Objective The aim of this study is to determine where allied health professionals and nurses who have had a student placement in the NT of Australia end up practicing. Methods This research is an observational cohort study, with data collection occurring at baseline and then repeated annually over 10 years (ie, 2017-2018 to 2029). The baseline data collection includes a demographic profile of allied health and nursing students and their evaluations of their NT placements using a nationally consistent questionnaire (ie, the Student Satisfaction Survey). The Work Location Survey, which will be administered annually, will track work location and the influences on work location decisions. Results This study will generate unique data on the remote and rural work locations of nursing and allied health professional students who had a placement in the NT of Australia. It will be able to determine what are the most important characteristics of those who take up remote and rural employment, even if outside of the NT, and to identify barriers to remote employment. Conclusions This study will add knowledge to the literature regarding rates of allied health and nursing professionals working in remote or rural settings following remote or rural learning placements. The results will be of interest to government and remote health workforce planners. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000797976; https://www.anzctr.org.au/ACTRN12620000797976.aspx International Registered Report Identifier (IRRID) PRR1-10.2196/21832
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Affiliation(s)
| | - Annie Farthing
- Flinders University, Northern Territory, Alice Springs, Australia
| | - Susan Witt
- Flinders University, Northern Territory, Adelaide, Australia
| | - Jessie Anderson
- Flinders University, Northern Territory, Adelaide, Australia
| | - Sue Lenthall
- Flinders University, Northern Territory, Katherine, Australia
| | - Leigh Moore
- Flinders University, Northern Territory, Darwin, Australia
| | - Chris Rissel
- Flinders University, Northern Territory, Darwin, Australia
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Eggleton K, Wearn A, Goodyear-Smith F. Determining rural learning outcomes for medical student placements using a consensus process with rural clinical teachers. EDUCATION FOR PRIMARY CARE 2019; 31:24-31. [PMID: 31884886 DOI: 10.1080/14739879.2019.1705921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Short, longer and programmatic rural attachments have developed in a number of medical programmes around the world. However, there is limited literature on the development of the underpinning learning outcomes to guide these attachments. Rural populations are commonly under-served and the specific needs and challenges of rural health care need to be emphasised, as well as encouraging future practice in these areas. Our aim was to produce common rural-specific learning outcomes, aligned with a rationalisation of existing guiding principles and objectives, for our medical student regional-rural programmes. This was achieved through a Delphi technique involving the relevant clinical teachers and supervisors. Forty-nine consenting participants collectively provided 72 learning outcomes which were synthesised down to 16. A consensus process was used to anonymously rate and then rank to reach consensus for the top four learning outcomes. The learning outcomes were placed within the theoretical framework of a 'pedagogy of place' based on rurality and triangulated with rural learning outcomes from an Australian study. The four final outcomes were resolved around two areas of 'place': geographical and developmental. The co-design approach enabled those involved in providing the rural exposure education to generate appropriate learning outcomes.
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Affiliation(s)
- Kyle Eggleton
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Andy Wearn
- Faculty of Medical & Health Science, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
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Beehler S, Boulger J, Friedrichsen SC, Onello EC. Teaching Community Health Needs Assessment to First Year Medical Students: Integrating with Longitudinal Clinical Experience in Rural Communities. J Community Health 2019; 44:784-789. [DOI: 10.1007/s10900-019-00651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wright HM, Maley MAL, Playford DE, Nicol P, Evans SF. Feedback learning opportunities from medical student logs of paediatric patients. BMC MEDICAL EDUCATION 2019; 19:107. [PMID: 30975156 PMCID: PMC6460648 DOI: 10.1186/s12909-019-1533-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/25/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Feedback can alter medical student logging practices, although most learners feel feedback is inadequate. A varied case mix in rural and urban contexts offers diverse clinical encounters. Logs are an indicator of these clinical experiences, and contain opportunities for feedback, which can greatly influence learning: we labelled these 'feedback learning opportunities' (FLOs). We asked: How often do FLOs occur? What are the case complexities of rural compared to urban paediatric logs? Do more complex cases result in more FLOs? METHODS In Western Australia, 25% of medical students are dispersed in a Rural Clinical School (RCSWA) up to 2175 miles (3500 km) from the city. Urban students logged 20 written cases; rural students logged a minimum of 25 paediatric cases electronically. These were reviewed to identify FLOs, using a coding convention. FLO categories provided a structure for feedback: medical, professionalism, insufficient, clinical reasoning, student wellbeing, quality and safety, and sociocultural. Each log was assigned an overall primary, secondary or tertiary case complexity. RESULTS There were 76 consenting students in each urban and rural group, providing 3034 logs for analysis after exclusions. FLOs occurred in more than half the logs, with significantly more rural (OR 1.35 95% CI 1.17, 1.56; p < 0.0001). Major FLOs occurred in over a third of logs, but with no significant difference between rural and urban (OR 1.10 95% CI 0.94, 1.28; p = 0.24). Medical FLOs were the most common, accounting for 64.0% of rural and 75.2% of urban FLOs (OR 1.71 95% CI 1.37, 2.12; p < 0.0001). Students logged cases with a variety of complexities. Most cases logged by urban students in a tertiary healthcare setting were of primary and secondary complexity. Major medical FLOs increased with increasing patient complexity, occurring in 32.1% of tertiary complexity cases logged by urban students (p < 0.001). CONCLUSIONS Case logs are a valuable resource for medical educators to enhance students' learning by providing meaningful feedback. FLOs occurred often, particularly in paediatric cases with multiple medical problems. This study strengthens recommendations for regular review and timely feedback on student logs. We recommend the FLOs categories as a framework for medical educators to identify FLOs.
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Affiliation(s)
- Helen M. Wright
- The Rural Clinical School of Western Australia, Faculty of Health and Medical Sciences, University of Western Australia, M706, 35 Stirling Highway, Crawley, WA 6009 Australia
- Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, M501, 35 Stirling Highway, Crawley, WA 6009 Australia
- Department of General Paediatrics, Perth Children’s Hospital, 15 Hospital Ave, Nedlands, WA 6009 Australia
| | - Moira A. L. Maley
- The Rural Clinical School of Western Australia, Faculty of Health and Medical Sciences, University of Western Australia, M706, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Denese E. Playford
- The Rural Clinical School of Western Australia, Faculty of Health and Medical Sciences, University of Western Australia, M706, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Pam Nicol
- Division of Paediatrics, Faculty of Health and Medical Sciences, University of Western Australia, M501, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Sharon F. Evans
- The Rural Clinical School of Western Australia, Faculty of Health and Medical Sciences, University of Western Australia, M706, 35 Stirling Highway, Crawley, WA 6009 Australia
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de Villiers M, van Schalkwyk S, Blitz J, Couper I, Moodley K, Talib Z, Young T. Decentralised training for medical students: a scoping review. BMC MEDICAL EDUCATION 2017; 17:196. [PMID: 29121923 PMCID: PMC5680751 DOI: 10.1186/s12909-017-1050-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/02/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Increasingly, medical students are trained at sites away from the tertiary academic health centre. A growing body of literature identifies the benefits of decentralised clinical training for students, the health services and the community. A scoping review was done to identify approaches to decentralised training, how these have been implemented and what the outcomes of these approaches have been in an effort to provide a knowledge base towards developing a model for decentralised training for undergraduate medical students in lower and middle-income countries (LMICs). METHODS Using a comprehensive search strategy, the following databases were searched, namely EBSCO Host, ERIC, HRH Global Resources, Index Medicus, MEDLINE and WHO Repository, generating 3383 references. The review team identified 288 key additional records from other sources. Using prespecified eligibility criteria, the publications were screened through several rounds. Variables for the data-charting process were developed, and the data were entered into a custom-made online Smartsheet database. The data were analysed qualitatively and quantitatively. RESULTS One hundred and five articles were included. Terminology most commonly used to describe decentralised training included 'rural', 'community based' and 'longitudinal rural'. The publications largely originated from Australia, the United States of America (USA), Canada and South Africa. Fifty-five percent described decentralised training rotations for periods of more than six months. Thematic analysis of the literature on practice in decentralised medical training identified four themes, each with a number of subthemes. These themes were student learning, the training environment, the role of the community, and leadership and governance. CONCLUSIONS Evident from our findings are the multiplicity and interconnectedness of factors that characterise approaches to decentralised training. The student experience is nested within a particular context that is framed by the leadership and governance that direct it, and the site and the community in which the training is happening. Each decentralised site is seen to have its own dynamic that may foreground certain elements, responding differently to enabling student learning and influencing the student experience. The insights that have been established through this review have relevance in informing the further expansion of decentralised clinical training, including in LMIC contexts.
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Affiliation(s)
- Marietjie de Villiers
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Julia Blitz
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Kalavani Moodley
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Zohray Talib
- Departments of Medicine and Health Policy, George Washington University, Washington DC, USA
| | - Taryn Young
- Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Archer E, Bitzer EM, van Heerden BB. Interrogating patient-centredness in undergraduate medical education using an integrated behaviour model. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1386869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- E Archer
- Centre for Health Professions Education, Stellenbosch University, Cape Town, South Africa
| | - EM Bitzer
- Centre for Higher and Adult Education, Stellenbosch University, Cape Town, South Africa
| | - BB van Heerden
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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De Villiers MR, Blitz J, Couper I, Kent A, Moodley K, Talib Z, Van Schalkwyk S, Young T. Decentralised training for medical students: Towards a South African consensus. Afr J Prim Health Care Fam Med 2017; 9:e1-e6. [PMID: 29041802 PMCID: PMC5645562 DOI: 10.4102/phcfm.v9i1.1449] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/20/2017] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Health professions training institutions are challenged to produce greater numbers of graduates who are more relevantly trained to provide quality healthcare. Decentralised training offers opportunities to address these quantity, quality and relevance factors. We wanted to draw together existing expertise in decentralised training for the benefit of all health professionals to develop a model for decentralised training for health professions students. METHOD An expert panel workshop was held in October 2015 initiating a process to develop a model for decentralised training in South Africa. Presentations on the status quo in decentralised training at all nine medical schools in South Africa were made and 33 delegates engaged in discussing potential models for decentralised training. RESULTS Five factors were found to be crucial for the success of decentralised training, namely the availability of information and communication technology, longitudinal continuous rotations, a focus on primary care, the alignment of medical schools' mission with decentralised training and responsiveness to student needs. CONCLUSION The workshop concluded that training institutions should continue to work together towards formulating decentralised training models and that the involvement of all health professions should be ensured. A tripartite approach between the universities, the Department of Health and the relevant local communities is important in decentralised training. Lastly, curricula should place more emphasis on how students learn rather than how they are taught.
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Affiliation(s)
- Marietjie R De Villiers
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University.
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Mausz J, Tavares W. Learning in professionally 'distant' contexts: opportunities and challenges. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:581-600. [PMID: 27295218 DOI: 10.1007/s10459-016-9693-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
The changing nature of healthcare education and delivery is such that clinicians will increasingly find themselves practicing in contexts that are physically and/or conceptually different from the settings in which they were trained, a practice that conflicts on some level with socio-cultural theories of learning that emphasize learning in context. Our objective was therefore to explore learning in 'professionally distant' contexts. Using paramedic education, where portions of training occur in hospital settings despite preparing students for out-of-hospital work, fifty-three informants (11 current students, 13 recent graduates, 16 paramedic program faculty and 13 program coordinators/directors) took part in five semi-structured focus groups. Participants reflected on the value and role of hospital placements in paramedic student development. All sessions were audio recorded, transcribed verbatim and analyzed using inductive thematic analysis. In this context six educational advantages and two challenges were identified when using professionally distant learning environments. Learning could still be associated with features such as (a) engagement through "authenticity", (b) technical skill development, (c) interpersonal skill development, (d) psychological resilience, (e) healthcare system knowledge and (f) scaffolding. Variability in learning and misalignment with learning goals were identified as potential threats. Learning environments that are professionally distant from eventual practice settings may prove meaningful by providing learners with foundational and preparatory learning experiences for competencies that may be transferrable. This suggests that where learning occurs may be less important than how the experience contributes to the learner's development and the meaning or value he/she derives from it.
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Affiliation(s)
- Justin Mausz
- School of Community and Health Studies, Centennial College, P.O. Box 731, Station A, Toronto, ON, M1K 5E9, Canada.
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Peel Regional Paramedic Services, Regional Municipality of Peel, Brampton, ON, Canada.
| | - Walter Tavares
- School of Community and Health Studies, Centennial College, P.O. Box 731, Station A, Toronto, ON, M1K 5E9, Canada
- Division of Emergency Medicine, Faculty of Medicine, McMaster University, Hamilton, ON, Canada
- York Region Emergency Medical Services, Sharon, ON, Canada
- Ornge Transport Medicine, Mississauga, ON, Canada
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Salminen H, Öhman E, Stenfors-Hayes T. Medical students' feedback regarding their clinical learning environment in primary healthcare: a qualitative study. BMC MEDICAL EDUCATION 2016; 16:313. [PMID: 27964713 PMCID: PMC5154156 DOI: 10.1186/s12909-016-0837-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/05/2016] [Indexed: 05/16/2023]
Abstract
BACKGROUND An increasing part of medical students' learning takes place in primary healthcare (PHC) but little is known about how the students perceive PHC as a clinical learning environment. This study aimed to explore medical students' perceptions of the clinical learning environment in PHC and how these vary with stage of education. METHODS Free-text course evaluation comments from students in nine different semesters during spring 2014 were analysed using qualitative content analysis. The students had placements in PHC from the first semester, progressing through the whole 5.5 year medical programme, and this was their main clinical training environment during the final 11th semester. RESULTS In total, 800 students (56%) agreed to participate in the study and 437 of these (54%) provided comments. Two overall themes were identified: the supervisor was the central factor that determined the meaningfulness of the placement at all stages of the education, and basic prerequisites for perceived clinical learning were to have an active role in an authentic clinical context and to be trusted to work independently with patients. The three main categories found under these themes were: i) the perceived relationship with the supervisor; ii) the perceived journey to become a doctor; and iii) the perceived structure and culture. CONCLUSION The supervisor's role was perceived as central at all stages of the education but the focus changed for other aspects, related to the students' professional development. The need for trust and independence in patient work increased towards the end of the education.
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Affiliation(s)
- Helena Salminen
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden
| | - Eva Öhman
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, 141 83 Huddinge, Sweden
| | - Terese Stenfors-Hayes
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Solna, Sweden
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Arscott-Mills T, Kebaabetswe P, Tawana G, Mbuka DO, Makgabana-Dintwa O, Sebina K, Kebaetse M, Mokgatlhe L, Nkomazana O. Rural exposure during medical education and student preference for future practice location - a case of Botswana. Afr J Prim Health Care Fam Med 2016; 8:e1-6. [PMID: 27380783 PMCID: PMC4926713 DOI: 10.4102/phcfm.v8i1.1039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 02/11/2016] [Accepted: 01/14/2016] [Indexed: 12/15/2022] Open
Abstract
Background Botswana’s medical school graduated its first class in 2014. Given the importance of attracting doctors to rural areas the school incorporated rural exposure throughout its curriculum. Aim This study explored the impact of rural training on students’ attitudes towards rural practice. Setting The University of Botswana family medicine rural training sites, Maun and Mahalapye. Methods The study used a mixed-methods design. After rural family medicine rotations, third- and fifth-year students were invited to complete a questionnaire and semi-structured interview. Data were analysed using descriptive statistics and thematic analysis. Results The thirty-six participants’ age averaged 23 years and 48.6% were male. Thirty-three desired urban practice in a public institution or university. Rural training did not influence preferred future practice location. Most desired specialty training outside Botswana but planned to practice in Botswana. Professional stagnation, isolation, poorly functioning health facilities, dysfunctional referral systems, and perceived lack of learning opportunities were barriers to rural practice. Lack of recreation and poor infrastructure were personal barriers. Many appreciated the diversity of practice and supportive staff seen in rural practice. Several considered monetary compensation as an enticement for rural practice. Only those with a rural background perceived proximity to family as an incentive to rural practice. Conclusion The majority of those interviewed plan to practice in urban Botswana, however, they did identify factors that, if addressed, may increase rural practice in the future. Establishing systems to facilitate professional development, strengthening specialists support, and deploying doctors near their home towns are strategies that may improve retention of doctors in rural areas.
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Affiliation(s)
- Tonya Arscott-Mills
- Botswana-UPenn Partnership, Botswana and Department of Paediatrics, Perelman School of Medicine, University of Pennsylvania, USA and Department of Paediatrics, University of Botswana, Faculty of Medicine.
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15
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Maley MA, Wright HM, Moore SJ, Auret KA. Pedagogy Rules: Open Mindset in Adopting Fit-for-Purpose Educational Tools in Teaching Dispersed Medical Students. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2015; 2:10.4137_JMECD.S22214. [PMID: 35187253 PMCID: PMC8855443 DOI: 10.4137/jmecd.s22214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/27/2015] [Accepted: 01/29/2015] [Indexed: 05/25/2023]
Abstract
Students in the Rural Clinical School of Western Australia (RCSWA) spend one year of clinical study learning in small groups while embedded in rural or remote communities. This aims to increase the locally trained rural medical workforce. Their learning environment, the clinical context of their learning, and their rural doctor-teachers all contrast with the more traditional learning setting in city hospitals. The RCSWA has succeeded in its outcomes for students and in rural medical workforce impact; it has grown from 4 pilot sites to 14 in 12 years. This reflective piece assimilates observations of the formation of the RCSWA pedagogy and of the strategic alignment of education technologies with learning environment and pedagogy over a seven-year period. Internal and external influences, driving change in the RCSWA, were considered from three observer perspectives in a naturalistic setting. Flexibility in both education technologies and organizational governance enabled education management to actively follow pedagogy. Peter Senge's learning organization (LO) theory was overlaid on the strategies for change response in the RCSWA; these aligned with those of known LOs as well with LO disciplines and the archetypal systems thinking. We contend that the successful RCSWA paradigm is that of an LO.
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Affiliation(s)
- Moira A.L. Maley
- Rural Clinical School of Western Australia (Albany), The University of Western Australia, Albany, Western Australia
| | - Helen M. Wright
- School of Paediatrics and Child Health (SPACH), The University of Western Australia, Crawley, Western Australia
| | - Sarah J. Moore
- Rural Clinical School of Western Australia (Busselton), The University of Western Australia, Busselton, Western Australia
| | - Kirsten A. Auret
- Rural Clinical School of Western Australia (Albany), The University of Western Australia, Albany, Western Australia
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Casey MG, David M, Eley D. Diversity and consistency: a case study of regionalised clinical placements for medical students. AUST HEALTH REV 2014; 39:95-100. [PMID: 25513982 DOI: 10.1071/ah14033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 09/16/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A major challenge for medical schools is the provision of clinical skills training for increasing student numbers. This case study describes the expansion of the clinical school network at The University of Queensland (UQ). The purpose of the study was to investigate consistency in medical education standards across a regional clinical teaching network, as measured by academic performance. METHODS A retrospective analysis of academic records for UQ medical students (n = 1514) completing clinical rotations (2009-2012) was performed using analysis of covariance (ANCOVA) for comparisons between clinical school cohorts and linear mixed-effects modelling (LEM) to assess predictors of academic performance. RESULTS In all, 13 036 individual clinical rotations were completed between 2009 and 2012. ANCOVA found no significant differences in rotation grades between the clinical schools except that Rural Clinical School (RCS) cohorts achieved marginally higher results than non-RCSs in the general practice rotation (5.22 vs 5.10-5.18; P = 0.03) and on the final clinical examination (objective structured clinical examination; 5.27 vs 5.01-5.09; P < 0.01). LEM indicated that the strongest predictor of academic performance on clinical rotations was academic performance in the preclinical years of medical school (= 0.38; 95% confidence interval 0.35-0.41; P < 0.001). CONCLUSIONS The decentralised UQ clinical schools deliver a consistent standard of clinical training for medical students in all core clinical rotations across a range ofurban, regional and rural clinical settings. Further research is required to monitor the costs versus benefits of regionalised clinical schools for students, local communities and regional healthcare services.
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Affiliation(s)
- Mavourneen G Casey
- Medical Education Unit, School of Medicine, Mayne Medical Building, The University of Queensland, Herston Road, Herston, Qld 4006, Australia
| | - Michael David
- School of Public Health, Public Health Building, The University of Queensland, Herston Road, Herston, Qld 4006, Australia. Email
| | - Diann Eley
- Medical Education Unit, School of Medicine, Mayne Medical Building, The University of Queensland, Herston Road, Herston, Qld 4006, Australia. Email
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Dopelt K, Davidovitch N, Yahav Z, Urkin J, Bachner YG. Reducing health disparities: the social role of medical schools. MEDICAL TEACHER 2014; 36:511-517. [PMID: 24796237 DOI: 10.3109/0142159x.2014.891006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Medical education based on the principles of social medicine can contribute toward reducing health disparities through the "creation" of doctors who are more involved in community programs. PURPOSE This study compared the social medicine orientation of graduates from various medical schools in Israel. METHODS The authors conducted an online cross-sectional survey in May 2011 among physicians who are graduates of Israeli medical schools. RESULTS The study included 1050 physicians practicing medicine in Israel: 36% who are graduates from the Hebrew University, 26% from Tel Aviv University, 22% from the Technion and 16% from Ben-Gurion University. A greater percentage of physicians who studied either at the Technion or Ben-Gurion are working or have worked in the periphery (∼50% vs. ∼30% at the Hebrew and Tel Aviv Universities). Among Ben-Gurion graduates, 47% are active in social medicine programs vs. 34-38% from other schools. Among physicians active in social medicine programs, 32% of Ben-Gurion alumni estimated that their medical education greatly influenced their social medicine involvement vs. 8-15% from other schools. Hebrew University alumni described their studies as more research-oriented. In contrast, Ben-Gurion graduates described their studies as more social medicine-oriented and they exhibited more positive attitudes about the role of physicians in reducing health disparities. DISCUSSION Social medicine-oriented medical education induces a socialization process reinforcing human values regarding doctor-patient relationships and produces positive attitudes among future doctors about social involvement. Findings emphasize the need to develop educational programs with this orientation and to strengthen medical schools in the periphery.
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Daly M, Perkins D, Kumar K, Roberts C, Moore M. What factors in rural and remote extended clinical placements may contribute to preparedness for practice from the perspective of students and clinicians? MEDICAL TEACHER 2013; 35:900-7. [PMID: 23930600 DOI: 10.3109/0142159x.2013.820274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Community-based rural education opportunities have expanded in Australia, attracting more medical students to placements in rural and remote settings. AIM To identify the factors in an integrated, community-engaged rural placement that may contribute to preparedness for practice (P4P) from the perspective of students and clinicians. METHOD Forty-two semi-structured interviews with medical students, supervisors and clinicians analysed thematically. RESULTS Opportunities for clinical learning, personal and professional development and cultural awareness were reported by students and clinicians as key factors that contribute to P4P. Potential barriers in rural and remote settings included geographical and academic isolation, perceived educational risk and differing degrees of program engagement. CONCLUSIONS A longitudinal clinical placement in a rural setting may enable development of enhanced competencies leading to P4P. A rural setting can provide a unique experience through hands-on learning, enhanced personal and professional development opportunities and observation of the cultural and contextual impact on health.
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Affiliation(s)
- Michele Daly
- Broken Hill University Department of Rural Health, University of Sydney , Australia
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19
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Crampton PES, McLachlan JC, Illing JC. A systematic literature review of undergraduate clinical placements in underserved areas. MEDICAL EDUCATION 2013; 47:969-78. [PMID: 24016167 DOI: 10.1111/medu.12215] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/04/2013] [Accepted: 02/25/2013] [Indexed: 05/16/2023]
Abstract
CONTEXT The delivery of undergraduate clinical education in underserved areas is increasing in various contexts across the world in response to local workforce needs. A collective understanding of the impact of these placements is lacking. Previous reviews have often taken a positivist approach by only looking at outcome measures. This review addresses the question: What are the strengths and weaknesses for medical students and supervisors of community placements in underserved areas? METHODS A systematic literature review was carried out by database searching, citation searching, pearl growing, reference list checking and use of own literature. The databases included MEDLINE, EMBASE, PsycINFO, Web of Science and ERIC. The search terms used were combinations and variations of four key concepts exploring general practitioner (GP) primary care, medical students, placements and location characteristics. The papers were analysed using a textual narrative synthesis. FINDINGS The initial search identified 4923 results. After the removal of duplicates and the screening of titles and abstracts, 185 met the inclusion criteria. These full articles were obtained and assessed for their relevance to the research question; 54 were then included in the final review. Four main categories were identified: student performance, student perceptions, career pathways and supervisor experiences. CONCLUSIONS This review reflects the emergent qualitative data as well as the quantitative data used to assess initiatives. Underserved area placements have produced many beneficial implications for students, supervisors and the community. There is a growing amount of evidence regarding rural, underserved areas, but little in relation to inner city, deprived areas, and none in the UK.
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Affiliation(s)
- Paul E S Crampton
- Centre for Medical Education Research, Durham University, Durham, UK
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Toomey P, Lovato CY, Hanlon N, Poole G, Bates J. Impact of a regional distributed medical education program on an underserved community: perceptions of community leaders. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2013; 88:811-818. [PMID: 23619079 DOI: 10.1097/acm.0b013e318290f9c7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE To describe community leaders' perceptions regarding the impact of a fully distributed undergraduate medical education program on a small, medically underserved host community. METHOD The authors conducted semistructured interviews in 2007 with 23 community leaders representing, collectively, the education, health, economic, media, and political sectors. They reinterviewed six participants from a pilot study (2005) and recruited new participants using purposeful and snowball sampling. The authors employed analytic induction to organize content thematically, using the sectors as a framework, and they used open coding to identify new themes. The authors reanalyzed transcripts to identify program outcomes (e.g., increased research capacity) and construct a list of quantifiable indicators (e.g., number of grants and publications). RESULTS Participants reported their perspectives on the current and anticipated impact of the program on education, health services, the economy, media, and politics. Perceptions of impact were overwhelmingly positive (e.g., increased physician recruitment), though some were negative (e.g., strains on health resources). The authors identified new outcomes and confirmed outcomes described in 2005. They identified 16 quantifiable indicators of impact, which they judged to be plausible and measureable. CONCLUSIONS Participants perceive that the regional undergraduate medical education program in their community has broad, local impacts. Findings suggest that early observed outcomes have been maintained and may be expanding. Results may be applicable to medical education programs with distributed or regional sites in similar rural, remote, and/or underserved regions. The areas of impact, outcomes, and quantifiable indicators identified will be of interest to future researchers and evaluators.
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Affiliation(s)
- Patricia Toomey
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Benbassat J, Baumal R. Expected benefits of streamlining undergraduate medical education by early commitment to specific medical specialties. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2012; 17:145-155. [PMID: 21698422 DOI: 10.1007/s10459-011-9311-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 06/14/2011] [Indexed: 05/31/2023]
Abstract
Undergraduate medical education is too long; it does not meet the needs for physicians' workforce; and its content is inconsistent with the job characteristics of some of its graduates. In this paper we attempt to respond to these problems by streamlining medical education along the following three reforms. First, high school graduates would be eligible for undergraduate medical education programs of 4 years duration. Second, medical school applicants would be required to commit themselves to a medical specialty and choose one of four undergraduate paths: (1) "Interventions/consultations" path that would prepare its graduates for residencies in secondary and tertiary specialties, such as cardiology and surgery, (2) "continuous patient care" path for primary care specialties, such as family medicine and psychiatry, (3) "diagnostic laboratory medicine and biomedical research" path that would prepare for either laboratory-based careers, such as pathology, biochemistry and bacteriology, or research in e.g., immunology and molecular genetics, and (4) "epidemiology and public health" path that would include population-based research, preventive medicine and health care administration. Third, the content of each of these paths would focus on relevant learning outcomes, and medical school graduates would be eligible for residency training only in specialties included in their path. Hopefully, an early commitment to a medical specialty will reduce the duration of medical education, improve the regulation of physicians' workforce and adapt the curricular content to the future job requirements from medical school graduates.
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Affiliation(s)
- Jochanan Benbassat
- Myers-JDC-Brookdale Institute, Smokler Center for Health Policy Research, PO Box 3886, 91037, Jerusalem, Israel.
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Cleland J, Johnston PW, Walker L, Needham G. Attracting healthcare professionals to remote and rural medicine: learning from doctors in training in the north of Scotland. MEDICAL TEACHER 2012; 34:e476-e482. [PMID: 22746965 DOI: 10.3109/0142159x.2012.668635] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Research exploring the experiences of trainee doctors in remote and rural locations is scarce. Our aim was to gain an understanding of the experiences and perceptions of Foundation Programme (FP) doctors training in placements in remote and rural areas of the north of Scotland. METHODS FP doctors training in remote and rural areas in Scotland took part in a qualitative study (focus groups and individual interviews) exploring their training experiences and career plans. To make sense of a potential multitude of factors, we selected social cognitive careers theory (SCCT) to underpin data collection and analysis. RESULTS A total of 20 trainees participated. Using data-driven analysis, three themes relevant to the SCCT emerged. These are the educational experience (e.g., opportunities to develop skills, greater responsibility), geographical isolation factors (e.g., the impact of staff shortages, poor accommodation, travel) and personal factors (e.g., social isolation, attitudes towards the experience). CONCLUSION Many factors impact on trainees' experience of learning and living in remote and rural medicine (R&R) environments. These experiences can be very positive for some individuals but factors external to the educational environment influence the perception of the overall experience. SCCT helps clarify the interaction between individual and contextual factors in career decision making.
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Affiliation(s)
- J Cleland
- Center for Academic Primary Care, University of Aberdeen, Aberdeen, UK.
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Waller KA. Using a Symbolic Interactionist Approach to Role and Identity to Illuminate Medical Student Avoidance of Primary Care. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2011; 31:99-111. [DOI: 10.2190/iq.31.1.g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A symbolic interactionist approach is presented and analyzed in reference to helping solve the problem of medical students not choosing primary care practice for a career. The concepts of “Role” and “Identity” are examined in the social interaction context of pre-med and med students and the larger environment in the United States. Recommendations for application of these findings in selection of students and their training are included.
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Snadden D. Using rural and remote settings in the undergraduate medical curriculum: Guide supplement 47.1 - viewpoint. MEDICAL TEACHER 2011; 33:765-767. [PMID: 21854155 DOI: 10.3109/0142159x.2011.566651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Rudland J, Tordoff R, Reid J, Farry P. The clinical skills experience of rural immersion medical students and traditional hospital placement students: a student perspective. MEDICAL TEACHER 2011; 33:e435-e439. [PMID: 21774640 DOI: 10.3109/0142159x.2011.586745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Recent decades have seen an international trend for the development of undergraduate medical programmes in rural locations. These have been considered educationally equivalent alternatives to traditional hospital-based programmes. A pilot Rural Medical Immersion Programme (RMIP) was launched at the University of Otago. AIMS To examine the clinical skills experience of RMIP students and to compare it to that of fifth-year students based in the traditional, often urban and hospital-based, rotations. METHODS An online questionnaire was completed by 23 medical students: six RMIP students and 17 hospital-based students. Students rated their level of experience in a variety of skills and their self-perceived competence for performing these skills after their fifth year. Total experience and confidence was compared using Mann-Whitney U test, as were subsets of skills. RESULTS There was no difference found in the total clinical skills experience and confidence between RMIP and traditional students. RMIP students reported greater experience of patient examination and patient education skills; traditional students reported greater experience and confidence in investigation and interpretative skills. CONCLUSION Clinical skills experience of the RMIP students is at least equivalent to that of their peers in the tertiary hospital setting. However, attention may be needed in the development of 'investigative and interpretative skills' for rural immersion students.
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Affiliation(s)
- Joy Rudland
- Faculty Education Unit, Faculty of Medicine, University of Otago, PO Box 913, Dunedin 9054, New Zealand.
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Kruger E, Tennant M. Short-stay rural and remote placements in dental education, an effective model for rural exposure: a review of eight-year experience in Western Australia. Aust J Rural Health 2010; 18:148-52. [PMID: 20690910 DOI: 10.1111/j.1440-1584.2010.01149.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The increase in demand for dental care over the next 10 years is expected to outstrip the supply of dental visits in Australia, resulting in an ongoing shortage of dental practitioners. As trends in medicine have shown, the greatest effect will be felt in rural and remote regions, where an undersupply of dentists already exists. It is clearly evident that it is important to provide strategies that will increase the recruitment and retention of practitioners in rural and remote areas. Previous research suggested an increased likelihood for health graduates to choose rural practice if they have a rural background, or were exposed to rural practice during their education. Short-stay (three to four weeks) placements for final-year dental students has been part of dental education in Western Australia for near on a decade. METHODS This paper reflects on the experiences gained from managing this placement program. CONCLUSIONS Short-stay placements are a quality learning initiative but need a high level of planning and a clear vision to be effective. IMPLICATIONS The key factors in ensuring sustainable, student centred learning is driven through a small core group of staff who have strong direct links with rural and remote communities, students and support providers. The integration of service, education and research goals have played a critical role in sustaining placements. The philosophy underpinning the rural placements needs to be clearly articulated and applied effectively in each step of their implementation and a highly focused customer-service driven implementation is required to make short-stay rural and remote placements effective.
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Affiliation(s)
- Estie Kruger
- Centre for Rural and Remote Oral Health, University of Western Australia, Perth, Western Australia, Australia.
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Maley MA, Lockyer-Stevens VL, Playford DE. Growing rural doctors as teachers: a rural community of medical education practice. MEDICAL TEACHER 2010; 32:983-989. [PMID: 20874009 DOI: 10.3109/0142159x.2010.509421] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This reflective work considered the journey of rural doctors from diverse backgrounds as teachers and academics during the establishment and rapid expansion of an Australian rural clinical school. The observed social and academic processes are analysed in the context of social learning theory. The extent to which the theoretical social processes match observations during a period of transformational change indicates how social learning processes contributed to the outcome. Ten areas of thematic teacher concerns were identified during teachers' professional development and the strategies used to address these declared. Despite the concurrent evolution of both the overall organisation (teacher environment) and teachers' task (curriculum approach), a community of rural educational practice (CREP) formed and thrived. It adopted a culture of sharing experiences which enabled ongoing knowledge brokering, engaged experts and transformed members. Critical reflection resulting from engagement in mutual activity and a supporting culture of enablement driven by senior leadership was central to success. A generic framework for building a successful CREP includes, leadership that 'enables' its members to flourish, a rural academic identity with a 'Community of Practice' governance, internal benchmarking by members to measure and refine practice, critical reflection 'in' and 'on' academic practice, vertical and horizontal mentoring.
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Snadden D. From medicine's margins--why all the interest in rural and remote education? MEDICAL TEACHER 2009; 31:967-968. [PMID: 19909035 DOI: 10.3109/01421590903307857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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