Qualitative Analysis of Written Reflections during a Teaching Certificate Program

Understanding of 'generalist medical practice' in South African medical schools

BACKGROUND

In South Africa, medical students are expected to have acquired a generalist competence in medical practice on completion of their training. However, what the students and their preceptors understand by 'generalist medical practice' has not been established in South African medical schools.

AIM

This study aimed to explore what the students and their preceptors understood by 'generalist medical practice'.

SETTING

Four South African medical schools: Sefako Makgatho Health Sciences University, University of KwaZulu-Natal, Walter Sisulu University and the University of the Witwatersrand.

METHODS

The exploratory descriptive qualitative design was used. Sixteen focus group discussions (FGDs) and 27 one-on-one interviews were conducted among students and their preceptors, respectively. Participants were recruited through purposive sampling. The inductive and deductive data analysis methods were used. The MAXQDA 2020 (Analytics Pro) software was used to arrange data, yielding 2179 data segments.

RESULTS

Ten themes were identified: (1) basic knowledge of medicine, (2) first point of contact with all patients regardless of their presenting problems, (3) broad field of common conditions prevalent in the community, (4) dealing with the undifferentiated patient without a diagnosis, (5) stabilising emergencies before referral, (6) continuity, (7) coordinated and (8) holistic patient care, necessitating nurturance of doctor-patient relationship, (9) health promotion and disease prevention, and (10) operating mainly in primary health care settings.

CONCLUSION

The understanding of 'generalist medical practice' in accordance with internationally accepted principles augurs well in training undergraduate medical students on the subject. However, interdepartmental collaboration on the subject needs further exploration.Contribution: The study's findings can be used as a guide upon which the students' preceptors and their students can reflect during the training in generalist medical practice.

Reflective metacognition and objective structured clinical examination performance in introductory pharmacy practice experiences

BACKGROUND AND PURPOSE

Objective structured clinical examinations (OSCEs) allow for holistic evaluation of clinical competence, but integration of reflective practices on OSCE performance has not been well-studied.

EDUCATIONAL ACTIVITY AND SETTING

To develop metacognitive skills, second-year pharmacy students completed a self-reflection assignment on a mock medication therapy management OSCE in an introductory pharmacy practice experience course. Students who completed the course during the prior year (no self-reflection assignment) served as the control. The study assessed the correlation of students' reflections of their OCSE abilities to OSCE performance and evaluated if student demographics influenced the correlation.

FINDINGS

There were 107 students in the control group and 95 students in the intervention group. A higher proportion of students passed the overall OSCE in the control group (67.4%) compared to the intervention group (58.9%), but this was not statistically significant. Neither gender, age, nor Pharmacy College Admissions Test score had an effect on OSCE pass rates. Grade point average did have a significant effect on OSCE pass rates (P = .019). Overall, no statistically significant association was seen in summative OSCE performance between students who used structured, guided questions to reflect on their formative OSCE performance and those who did not (P > .05).

SUMMARY

Despite this study's results, faculty continue to embrace the concept of reflective practice. Further research is needed to assess the value and role of reflective practice in pharmacy education.

Development and introduction of a communication skills module for postgraduate students of ophthalmology

Purpose

Effective communication lies at the heart of a patient--doctor relationship. Communication skills (CS) teaching and assessment is not a part of the postgraduate (PG) curriculum. Lack of effective CS in current PG students' results in patient distrust and dissatisfaction, conflicts, and compromised healthcare. The regulatory authorities of medical education have recognized the need to inculcate soft skills among medical graduates, one of which is CS. The purpose of this study was to assess the need for teaching CS to ophthalmology PG students and develop and introduce a module for the same.

Methods

In this prospective, interventional study done at the ophthalmology department of a tertiary hospital, a validated 8 day CS workshop was conducted for 60 PG students through interactive lectures, observations, video sessions, and role plays. Feedbacks were obtained through narratives, validated Google survey, reflections and verbal method and analyzed.

Results

In the needs assessment done on 27 departmental faculties, 20 faculties found poor communication to be a major reason for patient complaints. All faculties agreed that CS should be taught to medical students. Statistically significant improvement in CS awareness was noted among students after the workshop. Lack of CS training, work burden, and language were identified as main barriers to effective communication. All the students were satisfied with the workshop and wanted it to be conducted regularly.

Conclusion

This study establishes that CS training is essential to improve patient satisfaction and patient-doctor relationships. Barriers to effective CS could be identified, for which possible solutions could be found.

Student Pharmacists' Use of Patient-Centered Communication Skills During an Introductory Pharmacy Practice Experience

Objective. To assess how Doctor of Pharmacy (PharmD) students use patient-centered communication (PCC) during a community pharmacy introductory pharmacy practice experience (IPPE). Methods. All first-year student pharmacists at the University of Arkansas for Medical Sciences completed a required course in patient-centered communication that included training in motivational interviewing. After subsequently completing their first IPPE, the students submitted written reflections on their use of PCC during the experience. The reflections were de-identified and template analysis was conducted. With this method, predetermined codes are established, and a constant comparison method is used to finalize overarching themes. The students' overall level of reflection was assessed and each reflection was coded. Discrepancies were resolved through in-depth discussion and negotiated consensus. Results. Of the 116 student reflections submitted, 951 codes were applied. Six overarching themes were identified: acknowledgement of motivational interviewing skills/components; philosophy of patient-centeredness; barriers to using PCC or motivational interviewing; benefits from use of PCC; demonstration of good general communication skills; and perceptions of patient encounters. Approximately 46% of students reflected at a level three or higher (ie, personal insight or intended behavior change). Conclusion. First-year student pharmacists successfully used PCC skills during their IPPE. These findings demonstrate the impact that a PCC course can have on students' overall patient-centeredness and highlights barriers that students struggle to overcome. Other pharmacy schools may benefit from implementing a similar PCC course. Activities that reiterate these skills and provide additional opportunities to practice PCC are necessary throughout the curriculum.

Conducting and presenting qualitative research in pharmacy education

SITUATION

The evolution of practices in healthcare and the content and delivery of pharmacy education have generated new challenges for practitioners and academicians. Fittingly, pharmacy education research in the academic setting has grown rapidly to provide innovative solutions to these challenges. One approach for addressing these challenges includes the collection and analysis of qualitative research (QR). Though a useful methodological tool, many pharmacy educators are not trained to appropriately conduct QR and present the findings of their work.

METHODOLOGICAL LITERATURE REVIEW

QR offers many advantages for pharmacy education researchers. However, prior to delving into QR projects it is important to understand the key distinctions of the approach, role of the researcher, and the significance of situating the study so that the research question, data collection techniques, and analysis procedures are aligned.

RECOMMENDATIONS

We provide recommendations for several key components for conducting QR, articulating the process, and presenting and contextualizing the findings.

IMPLICATIONS

This article serves as a primer on QR methods, offering relevant background information, ways to apply this approach in pharmacy education research, and recommendations for presenting qualitative findings. Employing rigorous qualitative approaches in pharmacy education and appropriately presenting the procedures and findings will increase the visibility of QR and provide an opportunity for scholars to become familiar with the approach.

Use of mixed-methods approach to assess the impact of a pre-professional health humanities honors course on developing interpersonal skills

INTRODUCTION

The purpose of this study was to use a mixed-methods approach to provide evidence for growth in empathy, respect for patient autonomy, ability to relate to others, and self-awareness as a result of participating in a health humanities course.

METHODS

The mixed-methods approach gathered quantitative data using a quasi-experimental design of a pre/post course survey and qualitative data from reflective writings and student papers. The reflective writings and student papers were evaluated using an adapted rubric to assess the quality of the reflections on measures of empathy, respect for patient autonomy, ability to relate to others, and self-awareness.

RESULTS

Twenty-five students were enrolled in the course. Matched pair data was available from 22 students (88% response rate) for the quantitative survey data. Qualitative data was available from all 25 participants. The pre- and post-course surveys revealed a statistically significant increase in empathy (p < 0.001) as a result of completing the health humanities course. The final written report contained the highest quality of reflections compared to all other reflective writing assignments. Evidence for understanding empathy was prominent in the final written report.

CONCLUSIONS

The evaluation of development of interpersonal skills through use of health humanities resources may be reproduced by using a mixed-methods assessment approach. The quantitative and qualitative data presented provide some evidence for enhancing awareness and understanding of empathy, particularly by utilizing health humanities resources in an undergraduate interdisciplinary seminar course.

Strategies for Improving Learner Metacognition in Health Professional Education

Metacognition is an essential skill in critical thinking and self-regulated, lifelong learning. It is important for learners to have skills in metacognition because they are used to monitor and regulate reasoning, comprehension, and problem-solving, which are fundamental components/outcomes of pharmacy curricula. Instructors can help learners develop metacognitive skills within the classroom and experiential setting by carefully designing learning activities within courses and the curriculum. These skills are developed through intentional questioning, modeling techniques, and reflection. This article discusses key background literature on metacognition and identifies specific methods and strategies to develop learners' metacognitive skills in both the classroom and experiential settings.

Emphasizing Bloom's Affective Domain to Reduce Pharmacy Students' Stigmatizing Attitudes

Objective. To create a learning environment using Bloom's affective domain as a framework that would reduce third-year pharmacy students' stigmatizing attitudes toward patients with mental illness. Design. Prior to the start of the module, students were asked to complete the 27-question Attribution Questionnaire Short Form (AQ-27). The teaching approach and in-class activities were designed to allow students' to experience the major categories within Bloom's affective domain. The module used patient cases, interactive-learning activities, and reflective discussions to augment pharmacological and therapeutic knowledge with a humanistic understanding of mental illness. Students were asked to retake the AQ-27 after completing the module. Assessment. Paired responses on the AQ-27 were reported for 74 of 104 students, which represents a response rate of 71.2%. Students' scores changed significantly on nine of the 27 questions. Students' attitudes pre- to post-module revealed a significant increase in the help construct, while there was a significant decrease in the dangerousness and fear constructs. Conclusion. Designing and implementing a course along the continuum of Bloom's affective domain resulted in appropriate changes in students' attitudes toward patients with mental illness.