Maximising the acquisition of core communication skills at the start of medical training

Background Clinical communication teaching for medical undergraduates may involve real patient contact alongside simulated patient contact. However, there is still comparatively little known about the experience of learning with real patients and how that may impact on the simulated patient encounter. Aim To explore the impact of real patient contact on the experience of communication skills training and simulated patient contact for first year medical undergraduate students. Methods As part of the six-year MBBS undergraduate medical degree at Imperial College London, students are obliged to undertake communication skills training, which involves teaching with simulated and real patients. In 2017 (toward the end of formal teaching), a small sample of Year 1 medical students, who had taken part in extra-curricular teaching with real patients were recruited for the study to compare their performance with a control group in a simulated patient encounter. The performance of both groups was analysed alongside follow up focus group data from a sample of the study group. Results Quantitative analysis revealed there was no significant difference in communication skills during a scored simulated patient interview between students with real patient contact and those without. Focus group data, however, revealed valuable insights into the experience of learning with real patients. Students reported a marked increase in their confidence and ability to naturalise their communication skills as a result of real patient contact. Students also reported that skills gained through real patient contact may not always transfer easily to the simulated patient setting. Conclusion Real patient contact is an invaluable component of communication training for undergraduate medical students. For successful implementation there needs to be a clear curricular purpose at pedagogical, practical and organisational levels. Students’ experience of real patient contact can provide an informed foundation upon which to implement other modes of teaching. Keywords: Real patient contact, Communication skills training, Early years curriculu

Realizing Empathy and Expertise through Accounts Lived (REEAL)-An Integrated Learning Experience

Undergraduate nursing students have historically learned to focus on the clinical and technical components of patient care. There is an increasing body of literature about the importance of incorporating empathy into healthcare curricula, and various techniques, such as role modelling, have been utilized. The increasing complexity and demands on nurses, and other healthcare providers, in today\u27s healthcare system have led to a higher incidence of burnout and turnover. It is recognized that patients have felt the effects of this burnout in that they cite feeling a lack of connection and empathy from their clinical providers. We have sought to create a new learning experience that integrates traditional teaching methods with real patients’ lived experiences

Mission Impossible? Putting the Patient Back in Patient Care

The primary focus of this teaching case is the patient journey, as facilitated and influenced by an e-system or electronic health record (EHR) system. The goal of this case is to provide the learner with the knowledge and skills needed to effectively incorporate patient-centered e-health (PCEH) principles into existing and planned e-health systems such as EHRs. This case can be used to help students understand a hospital experience from the perspective of a patient and her family. It is loosely based on an experience one of the authors had with an actual patient. This case is intended for use with upper level undergraduate and graduate health informatics, information systems, and nursing students. Students assigned to this case should have a working knowledge of clinical terms and the general workings of a hospital. This teaching case is best suited to an advanced course in a health informatics curriculum. Possible applications of the case include, but are not limited to, describing the patient journey, modeling the process flow, diagramming the data flow, and applying the principles of patient-centered e-health

Describing Pediatric Hospital Discharge Planning Care Processes Using the Omaha System

Purpose Although discharge planning (DP) is recognized as a critical component of hospital care, national initiatives have focused on older adults, with limited focus on pediatric patients. We aimed to describe patient problems and targeted interventions as documented by social workers or DP nurses providing specialized DP services in a children\u27s hospital. Methods Text from 67 clinical notes for 28 patients was mapped to a standardized terminology (Omaha System). Data were deductively analyzed. Results A total of 517 phrases were mapped. Eleven of the 42 Omaha System problems were identified. The most frequent problem was health care supervision (297/517; 57.4%). Three Omaha System intervention categories were used (teaching, guidance, and counseling; case management; and surveillance). Intervention targets are varied by role. Conclusion The findings provide a rich description of the nature of DP for complex pediatric patients and increase our understanding of the work of DP staff and the influence of the DP practice model

Patient safety in health care professional educational curricula: examining the learning experience

This study has investigated the formal and informal ways pre-registration students from four healthcare professions learn about patient safety in order to become safe practitioners. The study aims to understand some of the issues which impact upon teaching, learning and practising patient safety in academic, organisational and practice „knowledge? contexts. In Stage 1 we used a convenience sample of 13 educational providers across England and Scotland linked with five universities running traditional and innovative courses for doctors, nurses, pharmacists and physiotherapists. We gathered examples of existing curriculum documents for detailed analysis, and interviewed course directors and similar informants. In Stage 2 we undertook 8 case studies to develop an in-depth investigation of learning and practice by students and newly qualified practitioners in universities and practice settings in relation to patient safety. Data were gathered to explore the planning and implementation of patient safety curricula; the safety culture of the places where learning and working take place; the student teacher interface; and the influence of role models and organisational culture on practice. Data from observation, focus groups and interviews were transcribed and coded independently by more than one of the research team. Analysis was iterative and ongoing throughout the study. NHS policy is being taken seriously by course leaders, and Patient Safety material is being incorporated into both formal and informal curricula. Patient safety in the curriculum is largely implicit rather than explicit. All students very much value the practice context for learning about patient safety. However, resource issues, peer pressure and client factors can influence safe practice. Variations exist in students? experience, in approach between university tutors, different placement locations – the experience each offers – and the quality of the supervision available. Relationships with the mentor or clinical educator are vital to student learning. The role model offered and the relationship established affects how confident students feel to challenge unsafe practice in others. Clinicians are conscious of the tension between their responsibilities as clinicians (keeping patients safe), and as educators (allowing students to learn under supervision). There are some apparent gaps in curricular content where relevant evidence already exists – these include the epidemiology of adverse events and error, root cause analysis and quality assessment. Reference to the organisational context is often absent from course content and exposure limited. For example, incident reporting is not being incorporated to any great extent in undergraduate curricula. Newly qualified staff were aware of the need to be seen to practice in an evidence based way, and, for some at least, the need to modify „the standard? way of doing things to do „what?s best for the patient?. A number of recommendations have been made, some generic and others specific to individual professions. Regulators? expectations of courses in relation to patient 9 safety education should be explicit and regularly reviewed. Educators in all disciplines need to be effective role models who are clear about how to help students to learn about patient safety. All courses should be able to highlight a vertical integrated thread of teaching and learning related to patient safety in their curricula. This should be clear to staff and students. Assessment for this element should also be identifiable as assessment remains important in driving learning. All students need to be enabled to constructively challenge unsafe or non-standard practice. Encounters with patients and learning about their experiences and concerns are helpful in consolidating learning. Further innovative approaches should be developed to make patient safety issues 'real' for students

Engaging students and faculty with diverse first-person experiences: Using an interpretive research group

This article is about a teaching strategy that operationalizes an aspect of the National League for Nurses’ position statement “Transforming Nursing Education” and the Institute of Medicine’s report “Crossing the Quality Chasm.” Engaging students with patients’ first-person experiences related to health and illness and their experiences with health care can help students learn about the multiplicity of views on experience, help them focus on the patient as an individual, and heed the call for more patient-centered care. This article describes how an interpretive research group can be used to develop these skills by teaching undergraduate nursing students, in a caring, open environment, what life is like from the patient’s perspective

Developing and translating a new model for teaching empowerment into routine chronic care management: An international patient-centred project

Background: Health professional education has been criticized for not integrating patient expertise into professional curricula to develop professional skills in patient empowerment. Objective: To develop and translate a new expert patientcentered model for teaching empowerment into professional education about routine chronic care management. Methods: Eight Finnish patients (known as expert patients), 31 students, and 11 lecturers from 4 European countries participated in a new pilot intensive educational module. Thirteen focus groups, artefacts, and an online student evaluation were analyzed using a thematic analysis and triangulated using a meta-matrix. Results: A patient-centered pedagogical model is presented, which describes 3 phases of empowerment: (1) preliminary work, (2) the elements of empowerment, and (3) the expected outcomes. These 3 phases were bound by 2 cross-cutting themes “time” and “enabling resources.” Conclusion: Patient expertise was embedded into the new module curriculum. Using an example of care planning, and Pentland and Feldman’s theory of routine organization, the results are translated into a patient-centered educational model for teaching empowerment to health profession students

Taking the learning beyond the individual:how reflection informs change in practice

OBJECTIVES: The purpose of this research was to explore the value of reflection and its application to practice through the implementation of educational modules within a new Diabetes Care and Education Master Degree Programme in Kuwait, and to realise how this teaching intervention informs changes in practice. METHODS: A small exploratory case study was conducted within the Dasman Diabetes Institute, Kuwait. A qualitative approach using focus group interviews was carried out with seventeen participants all of whom are studying on the Diabetes Care and Education Master Degree Programme in Kuwait. An inductive approach to thematic analysis, which focused on examining themes within data, was performed. RESULTS: The results indicate that participants value the opportunity to study through organised, structured and assessed reflection. The learning provides useful information and support to the participant by highlighting the role which reflection plays to enhance personal and professional development, the value of educational theory, continuing professional development, collaboration and enhancing patient education and practice. CONCLUSIONS: The significance of reflection is often seen in the literature as an important aspect of professional competence. This research has highlighted the value of reflection as a key component within a new educational programme

Strengthening Clinical Knowledge: Repeating High Fidelity Patient Simulation

The clinical environment provides important learning opportunities for health care professions, especially nursing students. The clinical environment offers students a social learning experience not available in the classroom. Providing safe and competent patient care is a critical component of nursing education; however, approaches to preparing nursing students for practice remains relatively unchanged for the past 50 years (Gonzalez & Kardong-Edgren, 2017). Technological advances, increased imperatives for patient safety, and emphasis on evidence informed interventions means that traditional teaching strategies for preparing nursing students for clinical practice need to evolve to improve care outcomes while ensuring patient safety. High fidelity patient simulation (HFPS) is a teaching strategy increasingly used by nurse educators to provide students with opportunities to practice nursing care without risking patient injury. As in clinical education, debriefing and feedback are key elements in the development of clinical competence and mastery learning in HPFS (Taras & Everett, 2017). Many nursing programs have integrated HFPS into their curricula as a replacement or compliment to clinical practice with little research on the philosophical and pedagogical underpinnings (Harder, 2010; Schiavenato, 2009). This study used qualitative methodologies to explore the value of repeating the HFPS scenario after debriefing as a pedagogical strategy for maximizing students’ learning. Two focus groups consisting of second and fourth year undergraduate nursing students’ shared their perceptions on repeated the HFPS scenario after debriefing as a pedagogical strategy for learning. Drawing on Vygotsky’s (1978) Sociocultural Theory, Kolb’s (1984) Experiential Learning Cycle, and the National League for Nursing/Jeffries Simulation Model (2012) the findings revealed six (6) themes: developing competence, teamwork, cueing, anxiety, making mistakes, and feedback. Participants reported repeating the scenario reduced their anxiety and stress, while allowing them to focus on using critical thinking skills more effectively when providing patient care

A randomised controlled trial of patient led training in medical education: protocol

<p>Abstract</p> <p>Background</p> <p>Estimates suggest that approximately 1 in 10 patients admitted to hospital experience an adverse event resulting in harm. Methods to improve patient safety have concentrated on developing safer systems of care and promoting changes in professional behaviour. There is a growing international interest in the development of interventions that promote the role of patients preventing error, but limited evidence of effectiveness of such interventions. The present study aims to undertake a randomised controlled trial of patient-led teaching of junior doctors about patient safety.</p> <p>Methods/Design</p> <p>A randomised cluster controlled trial will be conducted. The intervention will be incorporated into the mandatory training of junior doctors training programme on patient safety. The study will be conducted in the Yorkshire and Humber region in the North of England. Patients who have experienced a safety incident in the NHS will be recruited. Patients will be identified through National Patient Safety Champions and local Trust contacts. Patients will receive training and be supported to talk to small groups of trainees about their experiences. The primary aim of the patient-led teaching module is to increase the awareness of patient safety issues amongst doctors, allow reflection on their own attitudes towards safety and promote an optimal culture among the doctors to improve safety in practice. A mixture of qualitative and quantitative methods will be used to evaluate the impact of the intervention, using the Attitudes to Patient Safety Questionnaire (APSQ) as our primary quantitative outcome, as well as focus groups and semi-structured interviews.</p> <p>Discussion</p> <p>The research team face a number of challenges in developing the intervention, including integrating a new method of teaching into an existing curriculum, facilitating effective patient involvement and identifying suitable outcome measures.</p> <p>Trial Registration</p> <p>Current controlled Trials: <a href="http://www.controlled-trials.com/ISRCTN94241579">ISRCTN94241579</a></p