Distance Electronic Learning Strategy in Medical Teaching During the COVID-19 Pandemic: Cross-Sectional Survey Study

BACKGROUND

Teaching hospitals have been regarded as the primary settings where doctors teach and practice high-quality medicine, as well as where medical students learn the profession and acquire their initial clinical skills. A percentage of instruction is now done over the internet or via electronic techniques. The present COVID-19 epidemic has pushed distance electronic learning (DEL) to the forefront of education at all levels, including medical institutions.

OBJECTIVE

This study aimed to observe how late-stage medical students felt about DEL, which was put in place during the recent COVID-19 shutdown in Jordan.

METHODS

We conducted a prospective, cross-sectional, web-based, questionnaire-based research study during the COVID-19 pandemic lockdown between March 15 and May 1, 2020. During this period, all medical schools in Jordan shifted to DEL.

RESULTS

A total of 380 students responded to a request to fill out the questionnaire, of which 256 completed the questionnaire. The data analysis showed that 43.6% (n=112) of respondents had no DEL experience, and 53.1% (n=136)of respondents perceived the DEL method as user-friendly. On the other hand, 64.1% (n=164) of students strongly believed that DEL cannot substitute traditional clinical teaching. There was a significant positive correlation between the perception of user-friendliness and the clarity of the images and texts used. Moreover, there was a strong positive correlation between the perception of sound audibility and confidence in applying knowledge gained through DEL to clinical practice.

CONCLUSIONS

DEL is a necessary and important tool in modern medical education, but it should be used as an auxiliary approach in the clinical setting since it cannot replace conventional personal instruction.

The importance of developing meaningfulness and manageability for resilience in rural doctors

INTRODUCTION

Retention of rural doctors is a problem in many countries. A previous study has identified resilience as a factor associated with longer retention. However, this needs a deeper study to understand what local and personal factors are at play. Studies suggest resilience can be developed during training. We propose that a better understanding of factors associated with resilience might assist in training students for rural practice and increase retention.

AIM

This study aimed to understand the differences in resilience development between the more and the less resilient rural doctors. A secondary purpose was to identify how to assist this developmental process through health professional education.

METHODS

This study employed a mixed-method design and was part of a more extensive study aiming to develop rural doctors' resilience in a low-resource setting. A prior survey assessed rural doctors' resilience levels. This study sampled high-level and low-level resilience participants to be interviewed. A total of 22 rural doctors participated in the individual semi-structured interviews. The interviews were analyzed qualitatively based on Richardson's Resilience Model and the six resilience dimensions looking for factors that explained high or low resilience.

RESULTS

Two important themes emerged during the qualitative analysis: 'meaningfulness' and 'manageability.' The different responses of high and low-resilient participants can be explained through cases.

CONCLUSIONS

The participants' perceived meaningfulness and manageability of the stressor determine the responses. We suggest that teachers may better construct students' resilience by focussing on assisting them in finding meaning and developing a sense of manageability.

Self-assessment scale for the community-based and emergency practice

BACKGROUND

For current medical education, community-based primary care for the elderly is an essential topic. This study aimed to establish a scale of community-based assessment for clinical and emergency practice (C-CEP).

METHODS

A self-assessment scale for C-CEP was developed according to four steps. Initially, we reviewed publications from the societies of the United States, British, and Japan regarding educational goals. In addition, we searched MEDLINE for educational goals regarding attitude, skills, and knowledge. Getting together, we established 23 items as the educational goals of the C-CEP. Second, we collected responses for these 23 items from 5th-grade medical students (n = 195). Third, we conducted an exploratory factor analysis (EFA) using their responses to determine the fundamental structure of the self-assessment scale. Finally, a confirmatory factor analysis (CFA) was performed to assess the fitness of the self-assessment scale developing the EFA, resulting in modification of the items.

RESULTS

In EFA and CFA results, C-CEP Scale consisted of four factors with 15 items: "Attitude and communication in emergency care," Basic clinical skills," "Knowledge of community healthcare," and "Knowledge of evidence-based medicine perseverance." The model fit indices were acceptable (Goodness of Fix Index = 0.928, Adjusted Goodness of Fit Index = 0.900, Comparative Fit Index = 0.979, and Root Mean Square Error of Approximation = 0.045). The values of McDonald's omega as an estimate of scale reliability were more than 0.7 in all four factors. As for test-retest reliability, the intraclass correlation coefficients were ≥ 0.58 for all factors. All four factors of the C-CEP Scale correlated positively with the Medical Professionalism Evaluation Scale subscales.

CONCLUSIONS

We developed a valid and reliable self-assessment scale to assess student competence.

Effective Veterinary Clinical Teaching in a Variety of Teaching Settings

This review explores different modalities for clinical teaching of veterinary learners globally. Effective clinical teaching aims to prepare graduates for a successful career in clinical practice. Unfortunately, there is scant literature concerning clinical teaching in veterinary medicine. Our intent for this review is to stimulate and/or facilitate discussion and/or research in this important area. We discuss the different forms that veterinary clinical teaching can take, depending on their setting, which can be university-based clinical activities, work-based in commercial clinical practices, or in a traditional academic setting with little to no real-time exposure to clients and patients. We suggest that each of these modalities has a place in clinical teaching of veterinary learners at any point in the curriculum but that a mix of these approaches will likely provide an improved experience for the learner. Further, we discuss strategies to improve clinical teaching in these different settings. Potential strategies related to the teaching skills of clinical instructors could include training in delivery of clinical teaching in a variety of learning settings, and instructors’ official recognition, including opportunities for career progression. Potential strategies to improve clinical teaching in different teaching settings would vary with the learning settings. For example, in traditional academic settings, case-based learning with incorporation of simulation models is one proposed strategy. The involvement of learners in ‘teach-others’ is a strategy for both traditional academic and clinical settings. Finally, clearly addressing Day One competencies is required in any clinical teaching setting.

Impact of clinical placement sites on general practice as a career preference for Australian medical students

OBJECTIVE

This study investigates whether General Practice placement experience or locations (urban/metropolitan vs non-metropolitan) promote student interest in pursuing general practice.

DESIGN

SurveyMonkey was used in the design of the survey.

SETTING

The study was conducted online.

PARTICIPANTS

A total of 520 and 705 clinical-year students were surveyed in 2009 and 2019, respectively. The study was conducted online, using SurveyMonkey, and the participants were mostly non-indigenous Australian medical students, between the ages of 18 and 30.

INTERVENTIONS

Students were recruited from the General Practice Students' Network membership database to complete the survey online. Chi-squared testing, Pearson's correlation and a multivariate logistic regression analysis were used to investigate the correlation between general practice placements and intention to become a general practice.

MAIN OUTCOME MEASURES

The association and causation between general practice placement location, student experience and students' intended career outcomes.

RESULTS

In 2009, majority of students rated their general practice experience 'mostly positive' while most metropolitan participants and majority of non-metropolitan placement participants in the 2019 survey responded with 'mostly positive' in 2019. Based on 2009 and 2019 data, general practice placement location had no association with the likelihood of pursuing general practice as a career, while student experience had a stronger positive correlation with the likelihood of pursuing general practice as a career.

CONCLUSION

Our study shows that students' overall experience with their general practice placements significantly encourages medical students to pursue the general practice pathway. As such, increasing both metropolitan and non-metropolitan placement experiences can potentially overcome general practice shortage.

The impact of clerkship model and clinical setting on medical student's participation in the clinical workplace: A comparison of rural LIC and rural block rotation experience

PURPOSE

To compare the participation of rural Longitudinal Integrated Clerkship (LIC) and rural Block Rotation (BR) students in surgical clinical activities.

METHODS

Third-year medical students from Deakin University's Rural Clinical Schools were invited to record their participation during clinical encounters with ten common surgical conditions, using a descriptive five-point progressive entrustment scale. Participation levels of LIC and BR students were compared for differences, according to clinical task and context.

RESULTS

LIC students recorded greater active participation across all clinical tasks.Highest levels of active participation occurred in General Practice, a setting only LIC students were exposed to at this course stage. BR students recorded the majority of their surgical encounters in the hospital inpatient setting, where their involvement was predominantly observational. Both groups recorded high levels of participation in the Emergency Department.

CONCLUSIONS

Active participation in clinical encounters with surgical patients was enhanced by participation in a LIC program and cannot be attributed to the rural context alone. Student participation is influenced by clinical context, presenting the opportunity to reconsider the design of clerkships to include models that facilitate active student participation. Further research is required to investigate the learner, supervisor and contextual factors influencing entrustment decisions within clerkships.

Medical Students Can Learn Surgery Effectively in a Rural Longitudinal Integrated Clerkship

BACKGROUND

At Deakin University School of Medicine, compulsory formal teaching in Surgery occurs in year 3. This may occur as part of a rural longitudinal integrated clerkship (LIC), or in a traditional teaching hospital block rotation (BR). The purpose of this study was to compare these groups' exposure to surgical common conditions and their academic outcomes.

METHODS

Part I: This was a survey of students' encounters with patients with common surgical conditions between 2016 and 2018. Self-reported data were collected describing the nature of the encounters and their clinical settings. Part II: All third year Surgery MCQ and OSCE results from 2011 to 2017 were analyzed. Students were deidentified and grouped according to whether they were in the LIC or BR programme.

RESULTS

Part I: Thirty-eight third year students (20 LIC, 18 BR) submitted data for a total of 188 clinical encounters. Both groups encountered all nominated common surgical conditions, but the settings in which this occurred were different. BR students saw most patients as hospital inpatients whereas LIC student encounters were distributed across multiple clinical sites. Part II: A total of 942 (121 [26%] LIC and 821 [74%] BR) students' assessment results were analyzed. The groups performed similarly in the MCQ (p = 0.21) and OSCE (p = 0.16) examinations.

CONCLUSIONS

Students who were taught surgery in a LIC program performed similarly to on their final exams to their peers in traditional clerkships, with self-reported student data indicating both groups encountered a similar range of conditions.

Ripple effect of a clinical teaching fellow programme in an Australian paediatric hospital

AIM

Bedside teaching performed by experienced clinicians is an expected component of medical student training. As clinicians often have high clinical demands and a lack of formal training in teaching methods, clinical teaching fellowships have been established. In clinical teaching fellowships, clinicians with an interest and expertise in medical education provide medical students with standardised teaching. Studies about the impact of clinical teaching fellowships have demonstrated benefits for both clinical teaching fellows (CTFs) and medical students. However, studies have not evaluated the impact of these fellowships on other clinicians or learning relationships within the institution. In this study, we aimed to address this gap by gathering data on the perspectives of CTFs, medical students and hospital consultants.

METHOD

A mixed-method design was used, utilising a combination of surveys for CTFs, medical students and hospital consultants and semi-structured telephone interviews for CTFs. Quantitative and qualitative data were obtained.

RESULTS

The combination of data from CTFs, medical students and consultants enabled a more comprehensive understanding of the impact of the CTF programme within the institution. Although benefits were identified for CTFs and medical students, the consultant group noted that they were less involved in teaching medical students and that the CTFs were not well integrated into the ward team.

CONCLUSION

This research highlights the importance of considering not only direct outcomes of teaching and learning but broader influences on more implicit teaching opportunities and relationships within hospital teams.

The Physiotherapy in Preschools Program: Describing a Student-Led Assessment Service for Children With Possible Motor Skill Difficulties

The aim of this study was to describe and undertake an initial evaluation of a student-led assessment service for children with possible motor-skill difficulties. A secondary analysis of cross-sectional descriptive clinical data collected from 2015 to 2016 was undertaken. Children (N = 102) were assessed in preschools by physiotherapy students (supervised by qualified physiotherapists). Key outcomes included the following: Children's Activities Scale, Movement Assessment Battery for Children-2, and demographic/service-usage/onward referral statistics. The results highlighted that for every five children referred/assessed, two were at risk of motor-skill difficulties (∼43%). About 66% of children were subsequently referred on or monitored (40% requiring multidisciplinary follow-up). Conversely 34% of children did not require further services. In conclusion, a student-led assessment service may be a sustainable and feasible option to assist children at risk of motor-skill difficulties, enabling onward referral. Additional evaluation is required to garner stakeholder feedback.

The role of vertically integrated learning in a rural longitudinal integrated clerkship

BACKGROUND

Deakin's Rural Community Clinical School (RCCS) is a Longitudinal Integrated Clerkship (LIC) program in Western Victoria. Students undertake a year-long placement in a rural General Practice, many of which also host General Practice Registrars. There is a lack of evidence addressing the role and impact of Vertically Integrated Learning (VI) in practices hosting both LIC medical students and General Practice Registrars. The objective of the study was to establish how VI is perceived in the LIC context and the impact that it has on both learners and practices, in order to consider how to potentiate the role it can play in facilitating learning.

METHODS

Semi-structured, in-depth, qualitative interviews were undertaken, with 15 participants located in RCCS General Practices. Emergent themes were identified by thematic analysis.

RESULTS

Five main interconnected themes were identified; (i) understanding and structure, (ii) planning and evaluation, (iii) benefits, (iv) facilitators, and (v) barriers.

CONCLUSION

VI in a rural LIC is not clearly understood, even by participants. VI structure and methodology varied considerably between practices. Benefits included satisfying and efficient sharing of knowledge between learners at different levels. VI was facilitated by the supportive and collegiate environment identified as being present in a rural LIC context. Resources for VI are needed to guide content and expectations across the continuum of medical training and evaluate its role. The financial impact of VI in a rural LIC warrants further exploration.

Students' experiences and perceptions of interprofessional education during rural placement: A mixed methods study

BACKGROUND

Interprofessional collaboration is key to addressing the complexity of contemporary health care, therefore it is imperative that students from different disciplines have access to interprofessional education to equip them with the requisite skills and attributes. While interprofessional education promotes a person-centred approach and mutual recognition of one another's contributions to health outcomes, interprofessional education in Australian universities is fragmented and presents challenges that can be addressed through clinical placements.

OBJECTIVES

This article reports student perceptions and readiness for interprofessional education in the rural clinical learning environment in one region of Australia.

DESIGN

A mixed methods approach.

SETTINGS

Rural clinical learning environments in one geographic area in Victoria, Australia.

PARTICIPANTS

60 undergraduate healthcare students from allied health, medicine, nursing and midwifery.

METHODS

A survey incorporating Readiness for Interprofessional Learning Scale, Interdisciplinary Education Perception Scale and focused interprofessional questions. Qualitative data were collected via survey comments, interviews and focus groups.

RESULTS

Students had numerous opportunities for interprofessional education, to observe role modelling in the workplace and considered that learning with other professions would help them become more effective members of the health care team. Students valued learning about collaborative practice, the roles of other professions and identified activities that enhanced interprofessional engagement.

CONCLUSIONS

This study provides important insights regarding students' perceptions and readiness for interprofessional education. These results demonstrate that there are numerous opportunities to embed interprofessional education within the rural clinical learning environment and offer new insights into students' experiences and preferences for potential activities. These findings may resonate with others implementing interprofessional education in the workplace and guide facilitators in planning activities for students. Factors influencing differences in attitudes towards interprofessional education and how students acquire an understanding of their professional or disciplinary role warrant further study.

Stakeholder views of rural community-based medical education: a narrative review of the international literature

CONTEXT

Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders.

OBJECTIVES

The aim of this review is to examine stakeholder experiences of RCBME programmes internationally.

METHODS

This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated.

RESULTS

Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation.

CONCLUSIONS

Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature.

The perspective of medical students regarding the roles and characteristics of a clinical role model

Background

As medical students spend most of their time with their clinical teachers and imitate their roles and characteristics during the school year, it is important to identify the roles and characteristics that they find essential in their role models. These traits play a part in their future professions as doctors.

Objective

The aim of this study was to determine the perspective of students, interns, and residents regarding the roles and characteristics of a clinical role model.

Methods

In an analytical cross-sectional study, a structured and self-developed questionnaire was completed by 185 medical students at educational hospitals of Kerman University of Medical Sciences during April and May 2015. Participants were selected using convenience sampling method. For data analysis, we used descriptive and inferential statistics. SPSS software version 16 was used as needed.

Results

In total, 90 medical students (48.7%), 65 interns (35.1%), and 30 residents (16.2%) participated in this study. Male respondents (n=75) comprised 40.5% and female respondents (n=110) 59.5% of the study sample. The three most important roles of a clinical teacher were organizer role (99.7), teacher role (101.7), and supporter role (109.5) for students, interns, and residents respectively. On the other hand, supporter role (85.4), communicator role (86.4) and organizer role (83.4) were ranked as the least important for students, interns, and residents respectively. There was no significant association among the three batches and the roles of a clinical teacher (p>0.05). Conversely, Females rated the roles of a clinical teacher significantly higher than males (p<0.05).

Conclusions

As teachers are frequently perceived by students as role models in medical schools, great attention should be given to their roles. Teachers must be aware that their roles have an impact on students’ professional development and performance.

Preparing the future workforce for healthcare in Australia

Medical education fails to prepare young doctors for the nature of the work they will encounter. Doctors face a rapidly changing medical landscape, which relies more and more upon interprofessional collaboration to optimise patient outcomes and upon non-clinical skills to provide care efficiently and cost effectively. The current response to change is a reactive and resource-intensive effort, where established doctors are directed towards new ways of working. A better response would be interprofessional clinical and non-clinical training, incorporating a philosophy and style that accommodate innovation, communication and change. This preparative training should be overseen by a single educational enterprise that links undergraduate and postgraduate instruction. Improved training might enable better design of the healthcare system from within.

Practice education: A snapshot from Australian university programmes

BACKGROUND/AIM

Practice education is an integral component of the learning process for occupational therapy students. The dramatic increase in Australian occupational therapy programmes and students enrolled over the last decade is placing exponential demands on universities and practice education providers to meet accreditation and registration requirements. This study aimed to explore practice education from the perspectives of Australian occupational therapy university programmes.

METHODS

A purpose-designed survey was emailed to the heads of all Australian occupational therapy programmes. The survey gathered qualitative and quantitative data on courses offered, number of students, practice education hours and models, practice education administration and funding, and challenges for stakeholders. All data were summarised and are presented descriptively.

RESULTS

Responses were received from 21 (95.5%) Australian university occupational therapy programmes, with a total enrolment of 5569 undergraduate and 659 graduate-entry masters students. Practice education hours were predominantly in the later years of study and used an apprenticeship model for supervision. There was a trend for observation, simulation and service-learning experiences to be placed in the early years of programmes. Participants reported that the increasing student numbers presented difficulties within the changing clinical contexts. There was a call to re-examine the 1000-hour requirement for practice education.

CONCLUSION

Practice education is a critical issue for Australian occupational therapy. Increasing student numbers place mounting financial and resource demands on education programmes and practice education providers. There is a need for a national, collaborative approach to develop guidelines and processes to ensure sustainability relating to practice education.

Clinical participation of medical students in three contemporary training models

OBJECTIVES

As community settings are being used increasingly in undergraduate medical programmes, this study aimed to explore and compare the clinical experiences of students in hospital-based and community-based training programmes. It measured students' clinical participation and compared the perspectives of Year 3 medical students in three different models of clinical education: a tertiary hospital block programme; a community hybrid programme, and a rural longitudinal integrated clerkship (LIC) programme.

METHODS

The study used a mixed methodology approach to examine the clinical experiences of students through the analysis of logbooks and semi-structured student interviews. This involved the quantitative analysis of 88 logbook weeks, data from which were triangulated through the analysis of 101 individual interviews using grounded theory.

RESULTS

A total of 35 students across the three different clinical training models participated in the study. The results demonstrate significant differences among the three models in students' clinical participation and suggest that community settings provide more opportunities to students for meaningful engagement in patient care activities.

CONCLUSIONS

Consistent wider and more direct access to patients for students, as found in the community-based model, provides a pathway for engaging students in the learning processes, and a step towards making them aware of their learning needs and knowledge. Interviews provide evidence that authentic clinical activities can be enhanced through structured systems of supervision and through the provision of authentic roles for students in clinical teams.

Outcomes of longitudinal integrated clinical placements for students, clinicians and society

CONTEXT

Longitudinal integrated clerkships (LICs) have been widely implemented in both rural and urban contexts, as is now evident in the wealth of studies published internationally. This narrative literature review aims to summarise current evidence regarding the outcomes of LICs for student, clinician and community stakeholders.

METHODS

Recent literature was examined for original research articles pertaining to outcomes of LICs.

RESULTS

Students in LICs achieve academic results equivalent to and in some cases better than those of their counterparts who receive clinical education in block rotations. Students in LICs are reported to have well-developed patient-centred communication skills, demonstrate understanding of the psychosocial contributions to medicine, and report more preparedness in higher-order clinical and cognitive skills in comparison with students in traditional block rotations (TBRs). Students in LICs take on increased responsibility with patients and describe having more confidence in dealing with ethical dilemmas. Continuity of supervision reportedly facilitates incremental knowledge acquisition, and supervisors provide incrementally progressive feedback. Despite early disorientation regarding the organising of their learning, students feel well supported by the continuity of student-preceptor relationships and value the contributions made by these. Students in LICs living and working in rural areas are positively influenced towards primary care and rural career choices.

DISCUSSION

A sound body of knowledge in the field of LIC research suggests it is time to move beyond descriptive or exploratory research that is designed to justify this new educational approach by comparing academic results. As the attributes of LIC alumni are better understood, it is important to conduct explanatory research to develop a more complete understanding of these findings and a foundation for new theoretical frameworks that underpin educational change.

CONCLUSIONS

Longitudinal integrated clerkships are now recognised as representing credible and effective pedagogical alternatives to TBRs in medical education.