Medical Education for the 21st Century

Medical education has undergone a substantial transformation from the traditional models of the basic classroom, laboratory, and bedside that existed up to the late 20th century. The focus of this text is to review the spectrum of topics that are essential to the training of 21st-century healthcare providers. Modern medical education goes beyond learning physiology, pathophysiology, anatomy, pharmacology, and how they apply to patient care. Contemporary medical education models incorporate multiple dimensions, including digital information management, social media platforms, effective teamwork, emotional and coping intelligence, simulation, as well as advanced tools for teaching both hard and soft skills. Furthermore, this book also evaluates the evolving paradigm of how teachers can teach and how students can learn – and how the system evaluates success

Exploring and improving the escalation of care process for deteriorating patients on surgical wards in UK hospitals

Despite impressive progress in technical skills, the rate of adverse events in surgery remains unfavourably high. The variation seen in surgical outcomes may be dependent on the quality of ward-based surgical care provided to post-operative patients with complications, specifically, the recognition, communication and response to patient deterioration. This process can be termed escalation of care and is an under-explored area of surgical research. This thesis demonstrates the impact of delays in the escalation of care process on patient outcome. The facilitators of, and barriers to, escalation of care are then identified and described in the context of the UK surgical department. In order to prioritise areas within the escalation of care process amenable to intervention, a systematic risk assessment was conducted revealing suboptimal communication technology and a lack of human factors education as key failures. To ensure that communication technology intervention was conducted based on evidence, several exploratory studies describe the current methods of communication in surgery and explore areas of innovation and intervention. Following this, a human factors intervention bundle was implemented within a busy surgical department, which successfully improved supervision, escalation of care and safety culture. This thesis describes, for the first time, escalation of care in surgery and outlines important strategies for intervention in this safety-critical process. To date, ward-based care has been one of the most under-researched areas in surgery, despite its clear importance. The tools to improve escalation of care in surgery have been described and initial attempts at implementation have demonstrated great promise. Future use of these strategies should benefit surgeons and other clinical staff of all grades and ultimately, the surgical patient.Open Acces

A Project To Improve Advanced Practice Provider Financial Metrics Through A Practice Management Program

A Project to Improve Advanced Practice Provider Financial Metrics Through a Practice Management Program This DNP project developed a practice management program for ambulatory Advanced Practice Providers (APPs) practicing in a large academic healthcare system with the goal to improve financial metrics. In 2020, Centers for Medicare and Medicaid Services (CMS) reported $25.74 billion in incorrect payments citing documentation errors and insufficiency as the common cause. The growth of the APP workforce necessitates APP practice management knowledge to avoid significant revenue loss since APPs collectively report lack of healthcare business knowledge. Twenty ambulatory APPs participated in a 12-week practice management program focused on visit code assignment, global procedural period, modifiers, charge capture, and revenue cycle management. A 10-minute podcast lecture for each concept was sent to participants’ mobile phones via text message every 2-weeks. Participants completed a pre- and post-program practice management knowledge assessment and a perceived self-efficacy survey. The participants received monthly productivity metrics. Average work relative value units (wRVUs) per session benchmarks for each participant were established and monitored during and for 2-months after the program. There was a highly significant improvement post -program in average total perceived self-efficacy of (t = 4.8695, p \u3c 0.0001) and average total knowledge acquisition of (t = 2.579, p = 0.014). Areas within these domains also demonstrated significant trends in improvement. Mean wRVUs per session during implementation was found to be statistically significant (t = 2.63, p = 0.017). at 0.60 above benchmark. In conclusion, a short, focused practice management program improved APP practice management confidence and knowledge and increased in APP estimated financial productivity

Digital learning for breaking bad news in clinical training and practice

Introduction Good communication and the ability to break bad news are essential skills for clinicians but are underemphasised in training programmes. In recent years, digital learning has come to the forefront in healthcare education. However, the evidence for its use in breaking bad new (BBN) training is limited. This thesis explores clinicians’ digital learning needs, highlights pre-existing curricular requirements for BBN training, and examines how this translates into clinical practice. Methods Digital learning needs and curricular requirements for BBN training were established through (i) a systematic review and narrative synthesis of the literature, (ii) a thematic analysis of semi-structured interviews exploring clinicians’ perceptions, and (iii) a content analysis of UK postgraduate medical and nursing curricula. From this, a novel digital learning framework for BBN training was presented and used to evaluate pre-existing digital learning resources (DLRs). The acceptability of one DLR and its impact on confidence in BBN was tested with clinicians in a pre-post mixed-methods pilot study. Results Three digital learning needs were identified from the narrative synthesis of a heterogenous group of 26 studies, including positioning the learner as an active participant in a safe digital environment. Five learning needs were extracted from interviews with doctors (n=16) and nurses (n=16), including accessibility and catering to learning preferences. Thirty-one pre-existing curriculum requirements were identified from the content analysis of curricula. The learning needs and curriculum requirements were collated to form a digital learning framework. In the pilot study, a mobile learning application (VitalTips) proved to enable skills acquisition and improve confidence in BBN, as it was user-friendly, emulated clinical practice, and highlighted challenges for learning in the workplace. Conclusions The research presented in this thesis showcases the requirements for and effectiveness of digital learning for BBN training. Though it may not replace learning through clinical practice, digital learning can be a powerful adjunct. As digital learning develops, there will be exciting future advancements in this field of education.Open Acces

Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study

Background: Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates’ registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns’ competencies. Methods: Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns’ responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. Results: Findings included agreement across informants on deficiencies in interns’ practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns’ competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. Conclusion: Perception of medical graduates’ unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practic

The factors influencing nurse graduates use of mobile technology in clinical settings in Perth Western Australia: A mixed method study

The ubiquitous use of mobile technology in today’s society extends to the learning and teaching environment. Most academics in universities encourage its use, aided by libraries offering online resources. Whilst the literature highlights benefits of using mobile technology in learning, particularly for nurses to keep up-to-date, there is limited evidence on such use in clinical settings by graduate nurses in Western Australia (WA). Additionally, there is a lack of information and clarification on the use of such technology in WA hospitals. The purpose of this study was to identify and explore factors influencing the use of mobile technology by newly graduated registered nurses in the clinical area. The location of the study was in Perth, Western Australia. The study sought to answer the following questions: What factors influence nurse graduates use of mobile technology in the clinical setting? To what extent and in what ways do nurse graduates currently use mobile technology in the clinical setting? and What are the perceptions of nurse coordinators, educators and managers of graduate programs regarding mobile technology use in the clinical setting. In order to answer these questions, an explanatory, sequential, mixed method design was used. Initially, a review was undertaken of existing policy and guidelines, regarding use of mobile technology, from both public and private hospitals. This phase of the study was followed by two major phases: (quantitative and qualitative). As a preparation to the quantitative phase, a survey was developed involving the modified use of the Technology Acceptance Model (TAM2). This model was used as the theoretical framework underpinning the study. The survey was administered online to registered nurse graduates using SurveyMonkey™. Both descriptive and inferential statistics were used to analyse the data. Findings from the data informed the next phase of the study. Data collection for the qualitative phase of the study, involved synchronous Skype™ online text-based focus group interviews with the graduates. Additionally, nurse coordinators, educators and managers of graduate programs from both public and private hospitals, were invited to complete an online open-ended survey. Thematic analysis was used to analyse the data from this phase of the study. The findings from both the quantitative and qualitative phases was synthesised to answer the research questions, forming a holistic picture to offer conclusions to the study. This study is significant, as there appears to be a gap between learning with mobile technology in Universities, and its use in the clinical setting. This problem may be associated with the lack of standardised policies in the use of mobile technology, or from senior nurses’ misperception of its benefits. The results of this study may lead to policies and guidelines being reviewed and implemented by local healthcare agencies, and could lead to review of current mobile technology integration into nursing undergraduate degrees