\u27Compassion, the first emotion ditched when I\u27m busy\u27. The struggle to maintain our common humanity

Introduction: A considerable body of literature has been built around the socialisation of medical students and junior doctors into the culture of medicine, yet our appreciation of how their affective learning is shaped through practice, over time, continues to challenge our understanding and subsequent educational practice. This study addresses this gap by using compassion as a lens to unpack affective learning. Methods: This research asked interns undertaking their first year of medical practice “What have been the main influences (positive and/or negative) in how you have learned to express compassion for your patients when working in the clinical context? Their individual narratives, generated through reflective journals and unstructured interviews, when thematically analysed, told us how and why they struggled. Findings: The eight interns expressed their struggle to maintain their compassionate aspirations when confronted with the complexity and competing demands of their community of practice. Their emotional disquiet triggered their safety ethic resulting in their compassion, a prosocial moral emotion, being replaced by a more reductionist approach where patient care was reframed as patient management. Discussion: While neither inevitable nor static, the interns’ narratives tell a story where, after a year embedded in their community of practice, their increased self-efficacy, derived primarily from their perceived biomedical competence, enables them to revisit their original aspirations - to be both compassionate and competent - recognising that being a ‘good’ doctor does not have to eclipse being a kind and caring human being. Conclusions: The interns’ reflections uncovered a narrative of emotional vulnerability, where fearing failure and seeking perfection, contributed to a diminished self‑efficacy resulting in risk aversive behaviours protecting their doctor identity. In the recommendations the authors propose strategies for safe engaged connection, where self‑understanding replaces self‑criticism and self‑compassion is cultivated to guard against contempt and cynicism

A reflective practice model for paramedic students to self-direct their learning during ambulance clinical placements

Background No standardised model exists for paramedic students’ on-road clinical placements. The variation between paramedicine courses in Australia means students on placements have different levels of knowledge and clinical skills, and therefore different learning requirements. A new reflective practice model for on-road clinical placements was implemented into The University of Queensland’s Paramedicine program, requiring students to set their own learning objectives. This study investigated the ability of students to self-assess their learning using this approach. Summary of work Students were required to develop an individual learning plan for their clinical placement, based on their identified knowledge gaps, capabilities assessment, learning needs and course requirements. The final placement portfolio, after their placement, included a self-assessment of how well they met their learning objectives. The self-assessment data were used to explore the ability of students to develop appropriate and achievable learning objectives, through analysis of the discourse they used and range of learning objectives set. Summary of results This model provides paramedicine students with a more structured learning experience during on-road clinical placements, allowing them to address gaps in their knowledge; however students need to learn more about what makes a good learning objective, as many were broad with no measurable outcome. Conclusions and take-home message Students need support and guidance when setting their own learning plans. Requiring students to take control over their learning during on-road clinical placements can improve learning outcomes, however students need support and guidance when setting their own learning objectives