An examination of pain education of medical students in Australia and New Zealand

Background: Unrelieved pain is a significant public health challenge in Australia and New Zealand. Medical practitioners play an essential role in the management of acute, cancer and chronic non-cancer pain. Aim: This thesis aimed to examine the delivery of pain education at medical schools in Australia and New Zealand, and to determine how effectively it equips medical students with pain medicine competencies required for internship. Methods: An explanatory sequential mixed methods approach was used. Quantitative studies focused on gathering information regarding the pain-related content of medical curricula of all medical schools; and on testing pain medicine competencies of final-year medical students and interns across different universities and hospitals. Qualitative methods were used to appraise perceptions of healthcare practitioners and students working alongside interns regarding the extent to which the existing medical student education programme prepared interns to manage patients with pain. Results: Nineteen out of 23 medical schools completed the curriculum audit and innovative Medical School Pain Curriculum Questionnaire. Medical schools do not have well-documented or comprehensive pain curricula. Pain medicine education is not delivered and assessed using pedagogically sound approaches considering the complexity of the topic, and the prevalence and public health burden of pain. Important barriers and enablers influencing the delivery of successful pain medicine education were identified. The Medical Students Pain Attitudes and Knowledge Questionnaire, designed to assess pain medicine knowledge and attitudes, was completed by 351 students from 10 universities and 36 interns from two geographical areas. Twenty-one medical students participated in a pain-focused objective structured clinical examination. Gaps in students’ and interns’ pain medicine competencies were evident in basic concepts of pain processing, multidimensional aspects of pain, pain assessment and management, multiprofessional approach to pain management and pain medicine ethics. Fifteen healthcare practitioners and students participated in the qualitative interview study. The three major themes emerged: 1) gaps in the current medical curriculum regarding pain medicine education; 2) interns’ competencies not matching their pain medicine responsibilities; and 3) gaps in interns’ pain medicine competencies affecting the patient and wider community, the intern themselves and the hospital system. Conclusion: This research has highlighted the necessity for major changes to the current medical curriculum in Australia and New Zealand so that medical students are adequately prepared to address the pain management needs of the communities they will serve in the future. The Pain Medicine Curriculum Framework for improving pain medicine education for medical students is proposed to assist in the ongoing process of ensuring that medical graduates meet the professional and ethical challenges that arise in caring for those in pain

2nd International Nursing Conference: Transforming nursing future - Technology, innovation and collaboration

Conference Abstract

Education and training methods for healthcare professionals to lead conversations concerning deceased organ donation: An integrative review

Objectives: To determine which training methods positively influenced healthcare professionals’ communication skills and families’ deceased organ donation decision-making. Methods: An integrative review using systematic methods and narrative synthesis for data analysis. Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (OVID) and ProQuest Dissertations & Theses Global, were searched between August 1997 and March 2020, retrieving 1019 papers. Included papers (n = 14) were appraised using the Medical Education Research Study Quality Instrument. Results: Training programmes offered theory, experiential learning, feedback and debriefing including self-reflection, the opportunity to role-play and interact with simulated participants within realistic case scenarios. Programmes reported observed and self-rated improvements in communication learning and confidence. The methodological quality score averaged 13, (72% of maximum); few studies used an experimental design, examined behavioural change or families’ perspectives. Weak evidence suggested training could increase organ donation authorisation/consent rates. Conclusions: Multiple training strategies are effective in improving interprofessional healthcare professionals’ confidence and learning of specialised communication. Methodological limitations restricted the ability to present definitive recommendations and further research is warranted, inclusive of family decision-making experiences. Practice implications: Learning of specialised communication skills is enhanced by using multiple training strategies, including role-play and debriefing

The Effect of a Web-based Training on Suicide Knowledge, Attitudes, and Health Access Behaviors of Behavioral Health Nurses Regarding Suicide Prevention

Background: Nurses, critical to the health care delivery system, experience a variety of psychological stressors that predispose them to suicide risk. Recent studies have verified elevated suicide risks in nurses when compared to the general population. There is limited understanding regarding the effectiveness of various strategies to reduce risk factors and increase protective factors for suicide among nurses. Purpose: The purpose of this study was to evaluate if a web-based education module can improve the knowledge, attitudes, and ratings of willingness to access help related to suicide prevention in behavioral health nurses. Conceptual Framework: Ajzen’s theory of planned behavior was used to guide this project. The theory of planned behavior suggests that attitudes, subjective norms, and perceived behavioral control predicts the intention to engage in a behavior, influencing the actual performance of the behavior. Methodology: This study employed a quasi-experimental one-group pretest-posttest design. One hundred and one registered nurses from an academic medical center inpatient psychiatric unit, a state psychiatric hospital, and a personal care home were invited to participate. Baseline knowledge of suicide risk and prevention, attitudes towards seeking help, subjective norms towards seeking help, perceived behavioral control towards seeking help, and intent to seek help upon experiencing suicidal ideations were obtained prior to and after administering a 25-minute web-based training. Results: A total of 29 participants completed the pre-survey, web-based education module, and post-survey. There was a statistically significant increase in knowledge, attitude, subjective norms, and intention related to help-seeking behaviors for nurse suicide prevention. Perceived behavioral control median scores increased, but not at a statistically significant level. Discussion: A web-based educational intervention can be effective in increasing knowledge and intention to seek behavioral health services. Further exploration is needed to determine if other non-web-based strategies, focused on the reduction of nurse suicide, could offer benefits. Conclusion: Understanding the effectiveness of strategies to reduce nurse suicide can provide insights into building better nurse suicide prevention programs

Differences in Student Perceptions with Virtual Clinical Simulation

Background: Simulation has been a part of nursing education since its inception, with virtual clinical simulation gaining expanded use since the Coronavirus Pandemic. Once considered only a supplemental teaching method, this form of education has become an imperative means of program progression for nursing students when hospital clinical spaces are limited. Purpose: The purpose of the study is to evaluate potential differences in nursing student perceptions of anxiety and self-confidence with clinical decision making in virtual clinical simulation compared to traditional face-to-face clinicals. Design Methods: A descriptive, quantitative study using the NASC-CDM© tool completed by 5th (final) semester nursing students was analyzed using a series of paired t-tests. The 27-item post-test survey was completed after both virtual clinical simulation sessions and traditional face-to-face clinical sessions using a numerical scale for students to rate their perceptions of anxiety and self-confidence with clinical decision making. Conclusion: Fourteen items were identified as statistically significant for reported increased self-confidence with clinical decision making in traditional face-to-face clinicals compared to virtual clinical simulation. Two items were identified as statistically significant for increased anxiety with clinical decision making in virtual clinical simulation compared to traditional face-to-face clinicals. Implications for Nursing: This study may enlighten the schools of nursing, accrediting bodies, and state boards of nursing with the usefulness of virtual clinical simulation in future nursing curriculum

Workshop 08. Professional Delivery of Clinical Reasoning in Medicine

Objectives To consider the specific challenges for students in developing clinical reasoning skills in contemporary systems-based curricula. To consider case vignettes portraying specific student cognitive-processing difficulties in diagnostic reasoning and design a teaching approach to address these difficulties. To share best practice with colleagues. To watch and discuss one example of teaching and learning practice demonstrated in the authors’ DVD recording of an innovative teaching session .Workshop Summary A brief presentation will explore recent evidence in current literature regarding clinical teaching in this area. The delegates will work in small groups on real case vignettes bringing these specific student cognitive difficulties to life. This will enable delegates, in collaboration, to generate suitable teaching and learning approaches for consideration by the whole group. Watching the authors’ own demonstration DVD depicting an innovative teaching approach will stimulate further discussion and reflection on incorporating novel approaches in delegates` own teaching. There will be time for Questions/Answers and sharing best practice with other delegates

P33. Optimising student experience: an innovative and integrated tutor support and development programme

Background The curriculum of the five year MBBS course at HYMS is integrated and student–centred with regular clinical skills sessions throughout the first two years. The clinical skills tutors are practising clinicians who deliver their teaching role alongside everyday clinical practice. The essential features of our successful support system have evolved during our first eight years, creating a vibrant integrated and innovative Community of Practice. Our support system includes:• Peer observation • Regular online student-tutor feedback • Regular tutor training sessions • Regular Action Learning Sets • New tutor mentoring • Annual Performance Review 65 • Tutor commitment to completing a Postgraduate Certificate in Medical Education • Core staff in key roles facilitating inclusion of tutors in all aspects of the medical school. • Involvement in student assessment.Our tutors benefit and learn from each other’s experiences whilst developing professionally as educators embedded within medical school life. The Community of Practice ensures that tutors deliver consistently high quality student learning experience. The evaluation includes:• Students complete online, anonymous evaluation of tutors • We performed an evaluation of one session by observing all tutors • Informal evaluation that problems are now frequently managed by the tutor group rather than by faculty

P06. Clinical Reasoning in Medicine: Developing Students' metacognitive skills

This poster outlines the introduction of formal Clinical Reasoning Skills sessions - initially a Student Selected Component (SSC) - as compulsory sessions in the core second year curriculum. Observations of 4th and 5th Year students’ performances in live examinations and student feedback indicated that, despite having excellent core communication skills, students struggled with the skills needed for effective analytical thinking when faced with complex diagnostic challenges.A three week SSC was designed around current research introducing students to the concepts underpinning the process of clinical reasoning. This SSC is founded on experiential practice where students analyse their thought processes and hypothetico-deductive reasoning governing the choices and conclusions reached whilst interviewing patients. All sessions are conducted in small interactive groups with experienced simulated patients and academic clinician tutors. Student feedback was extremely positive; all students felt these sessions must become part of the core undergraduate curriculum. The iterative processes required for developing higher order thinking skills in students are described