A systematic literature review of undergraduate clinical placements in underserved areas.

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

Teaching webside manner: development and initial evaluation of a video consultation skills training module for undergraduate medical students

Background Video consultations are increasingly used to communicate with patients, particularly during the current COVID-19 pandemic. However, training in video consultation skills receives scant attention in the literature. We sought to introduce this important topic to our undergraduate medical school curriculum. Objective To increase final year medical students’ video consultation skills and knowledge. Methods We used Plan, Do, Study, Act (PDSA) quality improvement methodology with a pre-post study design to develop a teaching session for 5th year medical students, informed by a literature review and online clinician survey. The 2 hour session comprised an introduction and three practical stations: patient selection and ethics, technology and example videos, and simulation. Subjective pre- and post-session confidence was reported by students across seven domains using 5-point scales (1: not at all confident; 5: extremely confident). Students and facilitators completed post-session feedback forms. Results The 40 students and 3 facilitators who attended, over two separate teaching sessions, provided unanimously positive feedback. All students considered the session relevant. Subjective confidence ratings (n = 34) significantly increased from pre- to post-session (mean increase 1.78, p < 0.001). Conclusions The inaugural teaching session was well-received and subjective assessment measures showed improvement in taught skills. This pilot has informed a UK-wide multi-centre study with subjective and objective data collection

Echocardiography curriculum development for physician assistants using entrustable professional activities

BACKGROUND: With the projected increase of cardiovascular disease in the aging population, a higher demand for echocardiography use is predicted. However, there is a shortage in the supply of cardiologists, to the point that a 2009 American College of Cardiology survey report called it a "cardiology workforce crisis". The report also recommends a more aggressive use of PAs and NPs as one of the solutions to fill the shortage. Currently, echocardiography is not routinely included in the scope of practice for PAs in cardiology. While PAs attain strong basic science knowledge and clinical training experience in PA school, they typically do not receive additional formal postgraduate training. PAs have limited training opportunities to train in echocardiography and receive certification of recognition, but a formally standardized training program and certifying examination geared specifically for PAs are yet to be developed. This study seeks to develop a pilot curriculum in training echocardiography which can be standardized for utilization across various regions and medical subspecialties. The curriculum draws on the concept of Entrustable Professional Activities (EPA), which is being actively used in graduate medical education. HYPOTHESIS: After participating in the proposed pilot curriculum which involves online didactic learning and supervised hands-on clinical training, trained PAs will be able to reach proficiency in echocardiography operation and interpretation at level 4 supervision according to the EPA guidelines. METHODS: This study proposes a pilot curriculum with framework based on the EPA titled “performing and interpreting echocardiography” by PAs. The curriculum involves didactic and clinical training in echocardiography, with the goal to achieve mastery of level 4 supervision (minimal supervision). 2 subjects will be recruited from a teaching medical institution in the Greater Boston area with an IAC accredited echocardiography laboratory. After the 12-month training, participants will take ASCeXAM/ReASCE Online Practice Exam Simulation offered by the ASE. Upon 1) achievement of individualized EPAs as assessed by supervisor, and 2) simulation exam score of >80%, participants will earn a STAR in echocardiography. CONCLUSION: The study is the first step to establishing an effective training curriculum that will eventually be a basis for creating a certifying exam in echocardiography, designed specifically for PAs. As this study merely suggests a new curriculum, future studies should focus on identifying strengths and weaknesses of the curriculum after implementation and expansion to multiple sites, and gather data to use for continual improvement of the training curriculum

Primary care placements in the post-COVID era: A qualitative evaluation of a final year undergraduate clerkship.

INTRODUCTION: In March 2020, UK primary care changed dramatically due to the COVID-19 pandemic. It now has a much greater reliance on triaging, e-consultations, remote consultations, online meetings and less home visits. Re-evaluating the nature and value of learning medicine in primary care has therefore become a priority. METHOD: 70 final-year medical students placed in 38 GP practices (primary care centres) across the East of England undertook a 5-week clerkship during November 2020. A sample of 10 students and 11 supervising general practitioners from 16 different GP practices were interviewed following the placement. Qualitative analysis was conducted to determine their perceptions regarding the nature and value of learning medicine in primary care now compared with prior to the pandemic. RESULTS: A variety of models of implementing supervised student consultations were identified. Although contact with patients was felt to be less than pre-pandemic placements, triaging systems appeared to have increased the educational value of each individual student-patient contact. Remote consultations were essential to achieving adequate case-mix and they conferred specific educational benefits. However, depending on how they were supervised, they could have the potential to decrease students' level of responsibility for patient care. CONCLUSIONS: Undergraduate primary care placements in the post-COVID era can still possess the educationally valuable attributes documented in the pre-pandemic literature. However, this is dependent on specific factors regarding their delivery

Digital undergraduate medical education and patient and carer involvement: a rapid systematic review of current practice

BACKGROUND: Involving patients and carers in medical students' learning aims to centralise the perspective of healthcare users and supports our future medical workforce in the development of key skills. Medical schools are increasingly using digital technology for teaching and it is timely to understand how to maintain patient and carer involvement in this context. METHODS: Ovid MEDLINE, Ovid EMBASE and medRxiv were searched in October 2020 and reference lists of key articles were hand searched. Eligible studies reported authentic patient or carer involvement in undergraduate medical education where technology was also used. Study quality was assessed by the Mixed Methods Appraisal Tool (MMAT). Levels of patient or carer involvement were assessed using Towle et al.'s (2010) taxonomy, from Level 1 (lowest level) to Level 6 (highest level). RESULTS: Twenty studies were included in this systematic review. In 70% of studies, patients and carers featured in video or web-based case scenarios with no interaction between healthcare users and students. The remaining 30% of studies reported real-time interactions between students and patients via remote clinical encounters. Digital teaching sessions involving patients or carers were perceived to be valuable by students and educators, and increased student engagement, patient-centred attitudes, clinical knowledge, and communication skills. No studies reported the perspective of patients or carers. DISCUSSION: Digital technology has not yet driven higher levels of patient and carer involvement in medical training. "Live" interactions between students and patients are becoming more common but challenges need addressing to ensure positive experiences for all involved. Future teaching should enhance the role of patients and carers in medical education and support them to overcome any potential barriers to doing so remotely

Virtual WIL clinics in medicine: overcoming the COVID-19 challenge

In the current context of COVID-19 restrictions, the perceived infection risk in healthcare facilities has resulted in limited opportunities for clinical placements. This paper aims to demonstrate how virtual WIL clinics (virtual simulated general practice clinics), provide an authentic clinical experience and to ascertain whether these virtual clinics allow the practice of generic WIL competencies. The clinics provide students with WIL experience without the face-to-face contact of a physical clinic via telehealth. The practice of WIL through virtual WIL clinics at James Cook University, Australia, is assessed using the Work Skill Development (WSD) framework via GoSoapBox surveys. Students surveyed (N=66) expressed a high level of motivation to engage, reflect and learn through this medium. The survey also highlighted some possible areas of improvement in time management and communication. Virtual WIL clinics are a suitable substitution for WIL clinical activity and ideally suited to the COVID-19 context

The Scholarship Circle: an introduction to writing for publication for nursing faculty

Background: This case report describes a collaborative effort between a health sciences librarian and an instructional designer to create and implement a writing professional development experience called the Scholarship Circle. It was aimed at increasing scholarly productivity by junior and nontenure-track faculty in a college of nursing. Case Presentation: The Scholarship Circle activities were carried out in a synchronous and an asynchronous online environment over ten weeks and included weekly lectures from nurse-scholars, discussions and peer reviews, and writing support from the librarian. The Scholarship Circle designers surveyed participants before and after the course to explore faculty perceptions and conducted a bibliographic analysis to gauge increases in scholarly productivity. Conclusions: While both tenure-track and nontenure-track faculty perceived lack of time as a significant barrier to publication, only nontenure-track faculty perceived lack of writing experience and getting started as significant obstacles. In the two years following the Scholarship Circle, faculty with doctor of philosophy and doctor of education degrees produced the greatest number of scholarly publications, whereas faculty with other degrees demonstrated a modest increase in scholarship. Online writing support programs have the potential to positively impact scholarly productivity for junior and nontenure-track faculty, especially if they emphasize time management for writing, confidence-building strategies, and a flexible format that allows peer review and collaboration as well as participation by seasoned scholars and remote participants. Partnership between health sciences librarians and instructional designers is key to the successful design and implementation of writing support programs.Publisher allows immediate open acces

PSYCHIATRY THROUGH A SCREEN: ADAPTING TRAINING FOR A NEW REALITY?

The Covid-19 pandemic has had a profound impact on the way psychiatry is taught. Both the formal teaching components and the clinical placements pivoted to run in a virtual world. Students learnt psychiatry through a screen, either through online teaching sessions or remote clinical activity. Two medical students passionate to pursue a career in psychiatry (KB, FR) reflected with an undergraduate department faculty member (SB) upon their experiences of the adapted mental health block, how the delivery may have affected their motivations for psychiatry, as well as considering their learning on psychiatry training for a new, virtual reality