Clinical Reasoning by Veterinary Students in the First-Opinion Setting: Is It Encouraged? Is It Practiced?

A mixed-methods study was performed to investigate the perceived importance and efficacy of teaching clinical reasoning (CR) skills among students and faculty in a university first-opinion veterinary practice, as this has not previously been described. Qualitative analysis of interview data, discussing objectives and factors considered important for effective learning and the understanding of CR, was performed alongside quantitative analysis of the Preceptor Thinking-Promotion Scale (PTPS) and the Learner Thinking-Behavior Scale (LTBS) (assessing the level of CR encouraged by clinicians and displayed by students) in peri-consultation discussions. Themes that emerged from analysis of the interviews regarding objectives included the desire to develop data acquisition and the need to improve data manipulation and CR. Themes associated with effective learning were a positive student-centered learning environment and feedback. Type II CR was fairly well described, but recognition of the importance of type I CR was poor among clinicians and students and, in some instances, was deemed to be inappropriate. Although many clinicians and students expressed a desire to develop student CR, there was little evidence of this actually occurring in the interactions analyzed, with low PTPS and LTBS scores achieved. There was also poor understanding of whether effective teaching of CR had occurred, demonstrated by a lack of correlation between LTBS and the interaction score for development of student CR. Further training of clinicians and students of the value of type I CR in first-opinion practice is required, as well as clinician education in how best to support the development of CR in students

Faculty development program evaluation: a need to embrace complexity

Nicolas Fernandez,1 Marie-Claude Audétat21Centre for Pedagogy Applied to the Health Sciences, Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC H3C 3J7, Canada; 2Unité des Internistes Généralistes et Pédiatres (UIGP), Unité de développement et de recherche en éducation médicale (UDREM), Faculty of medicine, University of Geneva, Centre Médical Universitaire, Genève 4 1211, SwitzerlandAbstract: Faculty development is essential for renewing and assisting faculty to maintain teaching effectiveness and adapt to innovations in Health Professions educational institutions. The evaluation of faculty development programs appears to be a significant step in maintaining its relevance and efficiency. Yet, little has been published on the specific case of faculty development program evaluation in spite of the availability of general program evaluation models. These models do not measure or capture the information educators want to know about outcomes and impacts of faculty development. We posit that two reasons account for this. The first is the evolving nature of faculty development programs as they adapt to current reforms and innovations. The second involves the limitations imposed by program evaluation models that fail to take into account the multiple and unpredictable outcomes and impacts of faculty development. It is generally accepted that the outcomes and impacts are situated at various levels, ranging from the individual to the institutional and cultural levels. This calls for evaluation models that better capture the complexity of the impacts of faculty development, in particular the reciprocal relationships between program components and outcomes. We suggest conceptual avenues, based on Structuration Theory, that could lead to identifying the multilevel impacts of faculty development.Keywords: Structuration Theory, complexity theory, identity development, organizational norms, interpersonal relationships, program assessment &nbsp

A medical student in private practice for a 1-month clerkship: a qualitative exploration of the challenges for primary care clinical teachers

Virginie Muller-Juge, Anne Catherine Pereira Miozzari, Arabelle Rieder, Jennifer Hasselgård-Rowe, Johanna Sommer, Marie-Claude Audétat Unit of Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland Purpose: The predicted shortage of primary care physicians emphasizes the need to increase the family medicine workforce. Therefore, Swiss universities develop clerkships in primary care physicians’ private practices. The objective of this research was to explore the challenges, the stakes, and the difficulties of clinical teachers who supervised final year medical students in their primary care private practice during a 1-month pilot clerkship in Geneva.Methods: Data were collected via a focus group using a semistructured interview guide. Participants were asked about their role as a supervisor and their difficulties and positive experiences. The text of the focus group was transcribed and analyzed qualitatively, with a deductive and inductive approach.Results: The results show the nature of pressures felt by clinical teachers. First, participants experienced the difficulty of having dual roles: the more familiar one of clinician, and the new challenging one of teacher. Second, they felt compelled to fill the gap between the academic context and the private practice context. Clinical teachers were surprised by the extent of the adaptive load, cognitive load, and even the emotional load involved when supervising a trainee in their clinical practice. The context of this rotation demonstrated its utility and its relevance, because it allowed the students to improve their knowledge about the outpatient setting and to develop their professional autonomy and their maturity by taking on more clinical responsibilities.Conclusion: These findings show that future training programs will have to address the needs of clinical teachers as well as bridge the gap between students’ academic training and the skills needed for outpatient care. Professionalizing the role of clinical teachers should contribute to reaching these goals. Keywords: clinical teacher, clinical teachers’ training, clerkship in private clinical practice, supervision, primary car

Giant uranium deposits formed from exceptionally uranium-rich acidic brines

Giant uranium deposits were formed during the Mesoproterozoic era, 1.6-1.0 Gyr ago, in both Canada and Australia. The deposits are thought to have formed from large-scale circulation of brines at temperatures of 120-200 °C that percolated between sedimentary basins and underlying crystalline basement rocks. However, the precise conditions for transport of the uranium in these brines are poorly understood. Here we use mass spectrometry to analyse the uranium content of brines preserved in naturally occurring fluid inclusions in ore deposits from the Athabasca Basin, Canada. We measure concentrations of uranium in the range 1.0 × 10¯⁶-2.8 × 10¯³ moll¯¹. These concentrations are three orders of magnitude above any other common crustal fluids. Experimentally, we measure the solubility of uranium as a function of NaCl content and pH, in mixtures that are analogous to ore-forming brines at 155 °C. To account for the high uranium content observed in the Athabasca deposits, we find that the brines must have been acidic, with a pH between 2.5 and 4.5. Our results strongly suggest that the world's richest uranium deposits formed from highly concentrated uranium-bearing acidic brines. We conclude that these conditions are a necessary requirement for the formation of giant uranium deposits in relatively short periods of time of about 0.1-1 Myr, similar to other world-class deposits of lead-zinc and gold