Students' hopes and fears about early patient contact: lessons to be learned about preparing and supporting students during the first year

Comparing the Effectiveness of Role-Play Simulation versus Real Patient Transferal Skills Training in Occupational Therapy Students in Saudi-Arabia- A Quasi-Experimental Study

Purpose

To compare the effectiveness of using role-play simulation as a possible alternative to real-patient training to teach transferal skills to occupational therapy students.

Patients and Methods

Seventy-one occupational therapy students (including those in their second, third and fourth years) participated in a quasi-experimental study. The students were randomly divided into two groups. One group received role-play simulation at the university. The other received training on real patients with mild to moderate stroke and spinal cord injury (one session/week for six weeks) in clinical (inpatient) settings in Jeddah to learn patient transferring skills. Student performance was taken as a measure of teaching method effectiveness, and was evaluated by using a validated OSCE-type assessment tool developed at the end of training. The tool showed good reliability (Cronbach's α was > 0.7) and inter-reliability (Kappa < 0.001).

Results

A total number of 71 students participated in the study. The majority of the students were female (66.2%, N=47) and 33.8% (N=24) were male. About 33.8% (N=24) of students were in the second year, 29.6% (N=21) were in the third year and 36.6% (N=26) were in the fourth year. There were 36 (49.3%) students in the simulation group The mean age of the students was 20.70 (SD=1.2). There was no significant difference in the students' performance in both groups with a P-value of 0.139.

Conclusion

Role-play simulation can effectively be used for students' training as there was no difference in the outcome of the students' performance in patient transferring skills in both groups. This finding can help in designing and implementing training through simulation, especially in situations where training on severely ill patients may be a safety risk.

Exploring predoctoral dental student use of YouTube as a learning tool for clinical endodontic procedures

PURPOSE/OBJECTIVES

The goal of the present study was to examine perceived barriers to achieving clinical competence in endodontics and explain how YouTube is used to supplement formal education in this discipline.

METHODS

Postgraduate endodontic students conducted focus groups with fourth-year dental students at NYU College of Dentistry. The discussion was facilitated by a semistructured interview guide. Open-ended questions about participants' perceived barriers to clinical competency in endodontics, experiences using YouTube to learn about clinical endodontics, and preferences for video format learning were asked. Demographic information was gathered. Thematic analysis of data was conducted and data collection was terminated once saturation was achieved.

RESULTS

Thirty fourth-year dental students were enrolled in the study. The majority, 96.7%, reported using YouTube as a learning tool for dental procedures and 83.3% to learn about endodontics, specifically. The following domains were explored during data analysis: barriers to clinical competency, YouTube uses/experiences, and content preferences. The following themes within barriers to clinical competency were identified: psychological, educational, and clinical. Within the YouTube domain, the following themes were examined: goals of use, timing and frequency of use, search strategies, benefit/ shortcomings of YouTube, and validity of content. Students primarily used YouTube to enhance confidence and understand procedural flow.

CONCLUSION

YouTube videos were primarily used to help students overcome perceived educational and psychological barriers that resulted in gaps in confidence and knowledge of performing endodontic procedures. Dental students placed high value on easily accessible video content of limited duration, where clinical procedures were performed on live patients.

Assessing the pipeline: Perceived barriers to applying to dental school among pipeline program alumni

PURPOSE/OBJECTIVES

The aim of this study was to increase the understanding of perceived barriers to applying to dental school experienced by underrepresented minority (URM), pipeline program alumni.

METHODS

A qualitative study of alumni of New York University College of Dentistry pipeline programs, aimed at increasing the number of URM and low-income students in the dental profession, was conducted in 2020. Focus groups were convened to examine perceived barriers to applying to dental school and identified through a combination inductive and deductive thematic analysis.

RESULTS

Twenty-three pipeline program alumni, ranging in age from 18 to 30 years old, participated in focus groups held between January and April 2020. All students identified as underrepresented minorities and 78% were first generation college students. Fifteen (65%) of the participants had not yet applied to dental school. Eight participants (35%) had applied to dental school, 3 (13%) were currently enrolled in dental school, and 5 (22%) were matriculating into dental school in Fall 2020. The following themes emerged as the most prominent challenges to applying to dental school: pre-health advisors (e.g., lack of knowledge about the pre-dental process and discouragement), and the cost of the application process (e.g., application fees, DAT and DAT preparation course costs, and interview costs).

CONCLUSION

Through pre-dental pipeline programs, participants have access to informational resources and mentorship; however, despite participation in these programs, perceived barriers are still prevalent. Identification of the alumni's perceived barriers offer targeted areas where increased intervention may be helpful to reduce challenges and strengthen the pipeline.

Simulated patient contributions to enhancing exercise physiology student clinical assessment skills

Background

The aim of this study was to evaluate exercise physiology students' perceptions of two simulation-based learning modules focused on communication and interpersonal skills during history taking.

Methods

A prospective, repeated-measures cohort study was conducted with 15 participants. The study evaluated two simulation-based learning modules in a 1-year Graduate Diploma of Exercise Science program. Surveys were administered at four time points: prior to each module and following each module. Students rated their confidence in communication and history taking, and perception of preparedness for practice, motivation for learning, and benefits of undertaking simulation-based learning. Quantitative data were analyzed descriptively and by using repeated measures tests. Qualitative data underwent thematic analyses.

Results

Students reported a significant improvement in their confidence in communication (P = 0.043) and in two parameters related to history taking (P = 0.034 and 0.035) following the completion of the two modules. There was 96% agreement that the simulation-based learning better prepared students for practice as an exercise physiologist. Significant changes occurred in all aspects of motivation for learning (P ranging from < 0.001 to 0.036) except for usefulness, where there was a ceiling effect (medians of 7 on a 7-point scale). Qualitative analysis demonstrated benefit to participants around themes of experiential learning, realism, opportunity to develop clinical skills, and debriefing. Students also made suggestions with respect to the activity structure of the simulation-based learning modules.

Conclusions

The results of this study indicated that simulation-based learning employing SPs increased the confidence and preparedness of exercise physiology students for conducting history taking, a requisite exercise physiology skill. Future studies should include behavioral measures of skill attainment and include follow-up evaluation to appraise the application of these skills into clinical practice.

Stretching the Comfort Zone: Using Early Clinical Contact to Influence Professional Identity Formation in Medical Students

PURPOSE

To explore first-year medical students' affective reactions to intimate encounters with severely sick patients in their homes, within a curricular innovation targeting the development of a patient-centered professional identity.

BACKGROUND

Early patient encounters create complex emotional challenges and constitute fertile ground for professional identity formation. The literature indicates that students often learn, largely through the hidden curriculum, to avoid and suppress emotion. This can culminate in mental health problems and loss of empathy.

METHOD

A qualitative descriptive analysis of 28 randomly selected, mandatory, reflective essays focused on a home visit to a previously unknown patient, in an unsupervised group of 4 students, within the context of a structured course called Patient Contact-PASKON.

RESULTS

Students described a wide range of affect-laden responses, positive and negative, elicited by the home visits. The observations were typically related to loss of control, struggles to behave "professionally," and the unmasking of stereotypes and prejudices.

CONCLUSIONS

Medical students' initial clinical encounters elicit emotional responses that have the potential to serve as triggers for the development of emotional maturity, relational skills, and patient-centered attitudes. Conversely, they can foreground uncertainty and lead to defensive distancing from patients' existential concerns. The findings point to a role for structured educational strategies and supervision to assist students in the emotion work necessary in the transition from a "lay" to a "medical" identity.

Learning health 'safety' within non-technical skills interprofessional simulation education: a qualitative study

BACKGROUND

Healthcare increasingly recognises and focusses on the phenomena of 'safe practice' and 'patient safety.' Success with non-technical skills (NTS) training in other industries has led to widespread transposition to healthcare education, with communication and teamwork skills central to NTS frameworks.

OBJECTIVE

This study set out to identify how the context of interprofessional simulation learning influences NTS acquisition and development of 'safety' amongst learners.

METHODS

Participants receiving a non-technical skills (NTS) safety focussed training package were invited to take part in a focus group interview which set out to explore communication, teamwork, and the phenomenon of safety in the context of the learning experiences they had within the training programme. The analysis was aligned with a constructivist paradigm and took an interactive methodological approach. The analysis proceeded through three stages, consisting of open, axial, and selective coding, with constant comparisons taking place throughout each phase. Each stage provided categories that could be used to explore the themes of the data. Additionally, to ensure thematic saturation, transcripts of observed simulated learning encounters were then analysed.

RESULTS

Six themes were established at the axial coding level, i.e., analytical skills, personal behaviours, communication, teamwork, context, and pedagogy. Underlying these themes, two principal concepts emerged, namely: intergroup contact anxiety - as both a result of and determinant of communication - and teamwork, both of which must be considered in relation to context. These concepts have subsequently been used to propose a framework for NTS learning.

CONCLUSIONS

This study highlights the role of intergroup contact anxiety and teamwork as factors in NTS behaviour and its dissipation through interprofessional simulation learning. Therefore, this should be a key consideration in NTS education. Future research is needed to consider the role of the affective non-technical attributes of intergroup contact anxiety and teamwork as focuses for education and determinants of safe behaviour.

ABBREVIATIONS

AUM: Anxiety/uncertainty management; NTS: Non-technical skills; TINSELS: Training in non-technical skills to enhance levels of medicines safety.

Cultural sensitivity or professional acculturation in early clinical experience?

AIM

This study aimed to explore the early clinical experience of medical students following the adaptation of an Early Patient Contact curriculum from a European culture in Ireland to an Arab culture in Bahrain.

METHODS

Medical students in Bahrain took part in an Early Patient Contact module modelled on a similar module from a partner medical school in Ireland. We used a qualitative approach employing thematic analysis of 54 student reflective logbooks. Particular attention was placed on reflections of cultural influences of experience in the course.

RESULTS

Medical students undergoing this module received reported documented benefits of early clinical experience. However, students in Bahrain were exposed to cultural norms of the local Arab society including gender values, visiting the homes of strangers, language barriers and generous hospitality that led to additional challenges and learning for the medical students in acculturating to norms of the medical profession.

CONCLUSION

Modules intended for curriculum adaptation between two cultures would be best served by a group of "core" learning outcomes with "secondary" outcomes culturally appropriate to each site. Within the context of the Arab culture, early clinical experience has the added benefit of allowing students to learn about both local and professional cultural norms, thereby facilitating integration of these two cultures.

Using focus groups in medical education research: AMEE Guide No. 91

Qualitative research methodology has become an established part of the medical education research field. A very popular data-collection technique used in qualitative research is the "focus group". Focus groups in this Guide are defined as "… group discussions organized to explore a specific set of issues … The group is focused in the sense that it involves some kind of collective activity … crucially, focus groups are distinguished from the broader category of group interview by the explicit use of the group interaction as research data" (Kitzinger 1994, p. 103). This Guide has been designed to provide people who are interested in using focus groups with the information and tools to organize, conduct, analyze and publish sound focus group research within a broader understanding of the background and theoretical grounding of the focus group method. The Guide is organized as follows: Firstly, to describe the evolution of the focus group in the social sciences research domain. Secondly, to describe the paradigmatic fit of focus groups within qualitative research approaches in the field of medical education. After defining, the nature of focus groups and when, and when not, to use them, the Guide takes on a more practical approach, taking the reader through the various steps that need to be taken in conducting effective focus group research. Finally, the Guide finishes with practical hints towards writing up a focus group study for publication.

Authentic early experience in Medical Education: a socio-cultural analysis identifying important variables in learning interactions within workplaces

This paper addresses the question 'what are the variables influencing social interactions and learning during Authentic Early Experience (AEE)?' AEE is a complex educational intervention for new medical students. Following critique of the existing literature, multiple qualitative methods were used to create a study framework conceptually orientated to a socio-cultural perspective. Study participants were recruited from three groups at one UK medical school: students, workplace supervisors, and medical school faculty. A series of intersecting spectra identified in the data describe dyadic variables that make explicit the parameters within which social interactions are conducted in this setting. Four of the spectra describe social processes related to being in workplaces and developing the ability to manage interactions during authentic early experiences. These are: (1) legitimacy expressed through invited participation or exclusion; (2) finding a role-a spectrum from student identity to doctor mindset; (3) personal perspectives and discomfort in transition from lay to medical; and, (4) taking responsibility for 'risk'-moving from aversion to management through graded progression of responsibility. Four further spectra describe educational consequences of social interactions. These spectra identify how the reality of learning is shaped through social interactions and are (1) generic-specific objectives, (2) parallel-integrated-learning, (3) context specific-transferable learning and (4) performing or simulating-reality. Attention to these variables is important if educators are to maximise constructive learning from AEE. Application of each of the spectra could assist workplace supervisors to maximise the positive learning potential of specific workplaces.

Barriers to undergraduate peer-physical examination of the lower limb in the health sciences and strategies to improve inclusion: a review

Peer-physical examination is a widely adopted and an integral component of the undergraduate curriculum for many health science programs. Unwillingness or perceived inability to participate in peer-physical examination classes may have a negative impact upon students' abilities to competently conduct physical examinations of patients in future as registered health professionals. A literature review on the perceptions and attitudes of peer-physical examination of the lower limb amongst medical and health science students was conducted to identify potential barriers to participation, and to review strategies to improve participation in classes designed to develop clinical examination skills. A pragmatic search strategy of the literature from PubMed and Google Scholar published prior to June 2012 yielded 23 relevant articles. All articles were concerned with the views of medical students' education and there were no articles explicitly addressing the role of peer-physical examination in health science disciplines. Several ethical issues were identified including feelings of coercion, embarrassment, and perceptions of a lack of consideration for cultural and religious beliefs. The available evidence suggests that barriers to participation may be overcome by implementing standard protocols concerned with obtaining informed written consent, adequate choice of peer-examiner, changing facilities and garment advice, and possible alternative learning methods.

Impact of increased authenticity in instructional format on preclerkship students' performance: a two-year, prospective, randomized study

PURPOSE

To address whether increasingly authentic instructional formats are more effective in improving preclerkship medical students' performance.

METHOD

From 2007 to 2009, the authors conducted a prospective, randomized, crossover study with second-year medical students in a clinical reasoning course at the Uniformed Services University of the Health Sciences. The authors randomly assigned students to one of three cohorts and used instructional formats of differing authenticity (paper, DVD, standardized patient) to teach three subject areas (abdominal pain, anemia, polyuria). Each cohort received one instructional format for each subject area. The authors collected outcome measures (objective structured clinical exam, video quiz, and essay exam scores) at the end of each academic year. They stratified the students into tertiles by first-year grade point average to investigate the impact of instructional formats on learners of different abilities.

RESULTS

Outcomes for students in the top tertile improved with increased authenticity of the instructional format compared with outcomes for students in the middle and bottom tertiles (0.188 versus -0.038 and -0.201, P=.001 and .027, respectively). However, outcomes for students in the bottom tertile decreased when students were given only the paper case, compared with the middle and top tertiles (-0.374 versus 0.043 and 0.023, respectively, P=.001), but subsequently improved with more authentic instructional formats.

CONCLUSIONS

The authors could not demonstrate that increased authenticity of the instructional format resulted in improved learner performance. However, they believe that there may be some benefit to tailoring preclerkship clinical education based on students' ability.

Emotional learning of undergraduate medical students in an early nursing attachment in a hospital or nursing home

BACKGROUND

Entering medicine for the first time is highly impressive for students, but we know little about the actual emotional learning processes taking place.

AIMS

We aimed to get more insight into expectations, experiences and emotions of students during their first clinical experiences in a hospital compared to a nursing home.

METHODS

We carried out a qualitative and a quantitative survey by administering questionnaires about expectations, impressive experiences and learning activities within two cohorts of first-year medical students before and after a 4-week nursing attachment.

RESULTS

Despite different expectations, students reported similar experiences and learning activities for the nursing home and the hospital. Most impressive events were related to patient care, being a trainee, or professional identities being challenged. Students in nursing homes most often referred to their own relationships with patients. Students expressed different emotions, and frequently experienced positive and negative emotions at the same time.

CONCLUSIONS

Rewarding experiences (not only difficult or stressful events) do matter for medical professional development. Students need to learn how to deal with and feel strengthened by the emotions evoked during clinical experiences, which should be supported by educators. The nursing home and the hospital seem to be equally suited as learning environments.

Students' views on the impact of peer physical examination and palpation as a pedagogic tool for teaching and learning living human anatomy

BACKGROUND

Modern medical education teaching and learning approaches now lay emphasis on students acquiring knowledge, skills and attitudes relevant to medical practice.

AIMS

To explore students' perceived impacts of using hands-on approaches involving peer/life model physical examination and palpation in teaching and learning living human anatomy on their practice of physical examination of real patients.

METHODS

This study used exploratory focus groups and a questionnaire survey of years 3-5 medical students.

RESULTS

The focus group discussions revealed new insights into the positive impacts of the hands-on approaches on students' clinical skills and professional attitudes when dealing with patients. Students' exposure to the hands-on approaches helped them to feel comfortable with therapeutically touching unclothed patients' bodies and physically examining them in the clinical environment. At least 60% of the questionnaire survey respondents agreed with the focus group participants on this view. Over 75% also agreed that the hands-on experiences helped them develop good professional attitudes in their encounter with patients.

CONCLUSIONS

This study highlights the perceived educational value of the hands-on approaches as a pedagogic tool with a positive impact on students' clinical skills and professional attitudes that helps in easing their transition into clinical practice.