Promoting medical student engagement through co-development and peer-assisted learning: a new patient safety course as a case study

Introduction Peer-assisted learning programs have been focused on providing students with competencies to deliver lectures and facilitate workshops, whereas involvement of students as co-developers of educational programmes has been relatively under-described in the literature. Likewise, the use of students as facilitators in simulation-based training and debriefing is also scarce. In this paper, we describe how medical students were co-developers of a novel course on patient safety and how they were trained as student facilitators to conduct simulation-based training and debriefing, as well as workshops. Methods Medical students co-developed a course in patient safety consisting of three simulation-based scenarios and three workshops. The students were educated in relevant patient safety topics. They were trained to become student facilitators to conduct workshops, simulations and debriefings at a patient safety course for medical students. A questionnaire was developed to evaluate the course participants´ perception of the learning objectives and the student facilitators following the latest course in 2020. In addition, semi-structured interviews with the student facilitators were conducted to explore their perceptions of being part of the course. Results A total of 92% of the course participants completed the evaluation of the course. The majority of the course participants found that the student facilitators created a safe learning environment and had the necessary skills to teach. The learning objectives for the course were found to be useful. A total of 10 interviews with the student facilitators were conducted. We found that the student facilitators were motivated to teach in the course, as a way of improving their teamwork, leadership qualities and communication skills, as well as their resume. Some of the student facilitators mentioned that they were able to create a safe learning environment, whereas others mentioned a feeling of inadequacy for their teacher role. In addition to developing their teaching skills, they mentioned that they developed their medical expertise, alongside their communication-, collaboration-, leadership- and professional skills. Conclusion This study illustrates how medical students were involved in the co-development, delivery and implementation of a course in patient safety. The evaluation of the course shows that student facilitators succeeded in creating a safe learning environment. The interviews of the student facilitators reveal their various motivations for teaching, in addition to different perceptions of their experience as a student facilitator. Some expressed a positive feeling of being able to establish a safe learning environment, whilst others expressed a feeling of inadequacy when facilitating peers. In addition, the student facilitators indicated that they developed themselves both professionally and personally.publishedVersio

Medical students’ experiences, perceptions, and management of second victim: an interview study

The term second victim describes a healthcare professional who has been involved in an adverse event and feels wounded by the event. The effects of this experience differ. It can present as second victim syndrome, describing a wide range and degree of emotional and behavioural responses. Studies show that medical students can also experience second victim. The aim of this study was to elucidate medical students’ experiences, perceptions, and management of second victim and second victim syndrome and to describe possible learning needs around these issues. Thirteen medical students and two recent medical graduates participated in semi-structured focus group interviews. The interviews lasted 1.5–2 h and were audiotaped, transcribed, and analysed using Braun and Clarke’s six-step approach for thematic analysis. Four main themes were identified: contributing factors; current coping strategies; perception of own requirements and learning needs; wishes for the future healthcare system. Students’ behavioural and emotional response to dilemmas were affected by stakeholders and practices embedded in the healthcare system. Students described patient-injury and unexpected events as triggers for second victim, but also harmful interactions with individuals and feelings of self-blame. Students’ coping centred around their network, formal offers, and separation of personal- and work-life. Students sought a clear definition of second victim and a desire for role-models. Students' wished to learn how to handle feeling like a burden to others, managing waiting time after patient complaints, and learning how to help second victims recover. Students emphasized the importance of the healthcare organisation understanding students’ needs and providing them relevant support. Students experience second victim as described in the literature. Students’ emotional responses were caused by classical second victim triggers, but also other triggers in the educational environment: harmful interactions and self-blame. Although some triggers differ from the second victim definition, these different triggers should be considered equally serious and acknowledged. We must aim to prepare students for future adverse events and emotional responses. The health organisation and healthcare professionals must support students’ mental well-being and contribute to ideal conditions for students' professional development and management of second victim as future physicians.publishedVersio

Driving following defibrillator implantation: development and pilot results from a nationwide questionnaire

Abstract Background Implantable cardioverter defibrillator (ICD) implantation is associated with driving restrictions which may have profound effects on the patient’s life. However, there is limited patient-reported data on the information given about driving restrictions, the adherence to the restrictions, the incidence of arrhythmic symptoms while driving, and the driving restrictions’ effect on ICD patients’ daily life and quality of life factors. A specific questionnaire was designed to investigate these objectives, intended for use in a nationwide ICD cohort. Methods The conceptual framework based on literature review and expert opinion was refined in qualitative semi-structured focus group interviews with ten ICD patients. Content validity was pursued through pre-testing, including expert review and 28 cognitive interviews with patients at all ICD implanting centres in Denmark. Finally, the Danish Pacemaker and ICD registry was used to randomly select 50 ICD patients with a first-time implantation between January 1, 2013 and November 30, 2016 for pilot testing, followed by a test-retest on 25 respondents. Test-retest agreement was assessed using kappa statistics or intraclass correlation coefficients. Results The pilot test achieved a response rate of 78%, whereof the majority were web-based (69%). Only 49% stated they had been informed about any driving restrictions after ICD implantation, whereas the number was 75% after appropriate ICD shock. Among respondents, 95% had resumed private driving, ranging from 1 to 90 days after ICD implantation. In those informed of a significant (≥ 1 month) driving ban, 55% stated the driving restrictions had impeded with daily life, especially due to limitations in maintaining employment or getting to/from work and 25% admitted they had knowingly been driving during the restricted period. There were six episodes of dizziness or palpitations not necessitating stopping the vehicle. Test-retest demonstrated good agreement of questionnaire items, with 69% of Kappa coefficients above 0.60. Conclusions We have developed a comprehensive questionnaire on ICD patients’ perspective on driving. Pre-testing and pilot testing demonstrated good content validity, feasible data collection methods, and a robust response rate. Thus, we believe the final questionnaire, distributed to almost 4000 ICD patients, will capture essential evidence to help inform driving guidelines in this population