Re-visiting the educational environment of a metropolitan medical school in Sri Lanka with special emphasis on clinical learning

Introduction: Clinical competence is central to effective and efficient medical practice. Thus, clinicaltraining lies at the heart of undergraduate medical education. This study examined medicalundergraduates’ perceptions of their clinical learning environment as a means to identify service gapsand work towards remediation.Methods: The DREEM (Dundee Ready Educational Environment Measure) questionnaire was used tomeasure student perceptions on their clinical learning environment from 262 medical undergraduatesat different seniority levels of clinical training. Additionally, two open ended questions were asked.Results: Overall student perception reflected as overall DREEM score, was more positive on the clinicallearning environment. However, sub domain scores revealed “Students’ perception of learning”significantly increases and “Students’ perception of teachers” significantly reduces with advancing yearsof seniority. Analysis of individual items under each sub-domain revealed problem areas having scoresof 2 or less representing all subscales. The thematic analysis of qualitative comments resulted in severalthemes verifying and elaborating more on quantitative findings.Conclusions: Despite overall positive student perception scores on the existing clinical learningenvironment, detailed analysis revealed several problem areas representing all sub domains at avariable degree. Majority of the problems were related to the domain on “students’ perception ofteachers”. Several other issues related to clinical rotations and the undergraduate medical curriculumwas identified creating a vicious circle of ineffective student learning and poor clinical performance.Therefore, the DREEM questionnaire along with qualitative comments could be considered as a costeffective means of obtaining a broader understanding of any learning environment and could beadopted by an organization to add more depth into quantitative analysi

Intermediate fidelity simulation to educate emergency management skills

Medical students learn clinical skills related to the management of emergencies during their clerkships, mainly via peripheral participation and observation. Simulation-based training is identified as an adjunct to clinical practice enabling students to learn clinical skills in a safe environment. Nevertheless, simulation-based training is still underutilised in many countries in the developing world. The purpose of this study was to explore the value of simulation-based learning using an intermediate fidelity simulator to train medical undergraduates on the management of medical emergencies. A pilot group of 80 fourth year medical students attended four simulation-based clinical skills sessions. The students completed a self-administered evaluation, which included both open and close-ended questions postsimulation. Descriptive statistics were employed to analyse the responses to close-ended questions, and the responses to open-ended questions were analysed for recurring themes. All participating students responded to the evaluation. Students rated the simulation-based learning experience with high positivity. The self-competency of 74 (92.5%) students had increased following the sessions. The sessions have provided a “safe” learning environment to all students, and 70 (87.5%) felt it helped apply theory into practice. Thirty-three (41.2%) noted the simulation session as an important learning tool for practising clinical skills. Thirty-one (38.5%) wished to participate in more sessions, and 39 (48.7%) felt that simulation should be introduced to the curriculum from the first-year. Students have recognised intermediate fidelity simulators as a valuable learning tool to train on the management of clinical emergencies and should be integrated into undergraduate medical curricula

Learning clinical reasoning skills during the transition from a medical graduate to a junior doctor

INTRODUCTION: The literature confirms the challenges of learning clinical reasoning experienced by junior doctors during their transition into the workplace. This study was conducted to explore junior doctors experiences of clinical reasoning development and recognise the necessary adjustments required to improve the development of clinical reasoning skills.METHODS: A hermeneutic phenomenological study was conducted using multiple methods of data collection, including semi-structured and narrative interviews (n=18) and post-consultation discussions (n=48). All interviews and post-consultation discussions were analysed to generate themes and identify patterns and associations to explain the dataset.RESULTS: During the transition, junior doctors’ approach to clinical reasoning changed from a ‘disease-oriented’ to a ‘practice- oriented’ approach, giving rise to the ‘Practice-oriented clinical skills development framework’ helpful in developing clinical reasoning skills. The freedom to reason within a supportive work environment, the trainees’ emotional commitment to patient care, and their early integration into the healthcare team were identified as particularly supportive. The service-oriented nature of the internship, the interrupted supervisory relationships, and early exposure to acute care settings posed challenges for learning clinical reasoning. These findings highlighted the clinical teachers' role, possible teaching strategies, and the specific changes required at the system level to develop clinical reasoning skills among junior doctors.CONCLUSION: The ‘Practice-oriented clinical skills development framework’ is a valuable reference point for clinical teachers to facilitate the development of clinical reasoning skills among junior doctors. In addition, this research has provided insights into the responsibilities of clinical teachers, teaching strategies, and the system-related changes that may be necessary to facilitate this process

Learning clinical reasoning skills during the transition from a medical graduate to a junior doctor

INTRODUCTION: The literature confirms the challenges of learning clinical reasoning experienced by junior doctors during their transition into the workplace. This study was conducted to explore junior doctors experiences of clinical reasoning development and recognise the necessary adjustments required to improve the development of clinical reasoning skills.METHODS: A hermeneutic phenomenological study was conducted using multiple methods of data collection, including semi-structured and narrative interviews (n=18) and post-consultation discussions (n=48). All interviews and post-consultation discussions were analysed to generate themes and identify patterns and associations to explain the dataset.RESULTS: During the transition, junior doctors’ approach to clinical reasoning changed from a ‘disease-oriented’ to a ‘practice- oriented’ approach, giving rise to the ‘Practice-oriented clinical skills development framework’ helpful in developing clinical reasoning skills. The freedom to reason within a supportive work environment, the trainees’ emotional commitment to patient care, and their early integration into the healthcare team were identified as particularly supportive. The service-oriented nature of the internship, the interrupted supervisory relationships, and early exposure to acute care settings posed challenges for learning clinical reasoning. These findings highlighted the clinical teachers' role, possible teaching strategies, and the specific changes required at the system level to develop clinical reasoning skills among junior doctors.CONCLUSION: The ‘Practice-oriented clinical skills development framework’ is a valuable reference point for clinical teachers to facilitate the development of clinical reasoning skills among junior doctors. In addition, this research has provided insights into the responsibilities of clinical teachers, teaching strategies, and the system-related changes that may be necessary to facilitate this process

Implement the vertical greenery wall (facade) to multi-stored building in Sri Lankan context

The use of vertical greening has an important impact on the thermal performance of buildings and on the effect of the urban environment, in both summer and winter. Plants are functioning as a solar filter and help to prevent the absorption of heat radiation of building materials extensively. Applying green façades wall (GFW) is not a new concept, where most of the developed countries have been implemented the vertical greenery to their buildings while realising its sustainable benefits. However, vertical greening can provide a cooling potential on the building surface, which is to be very important during summer periods in warmer climates. In this study, an analysis of the effect on temperature (air and surface) of vertical greening systems on the building level is presented. An experimental approach was set up to measure the temperature on direct and indirect GFW, using infrared thermometer and psychrometer. And the energy saving effect of the thermal resistance was identified by using heat transfer calculation. A comparison between measurements on a bare façade wall (BFW) and a GFW were done in the summer season to understand the contribution of vegetation to the thermal behaviour of the building envelope. Since the research was focused on quantifying the vertical greening systems and in the possible effect on the thermal resistance, the main conclusions that could be drawn from the selected buildings are presented. The evaluation was done in different locations, namely, in front of bare facade wall (BFW) and greened facade wall (GFW), and identified small differences of air temperature between façade walls. Further, it was investigated that inside and outside surface temperature of walls and finally concluded that the vertical greening systems are effective natural sunscreens, due to a reduction of the surface temperatures behind the green layer compared to the BFW. It was found that the energy recovering value between the BFW and GFW. The final result of energy requirement was less to the GFW than the BFW

Factors affecting career preferences of medical students at the College of Medicine, Malawi

Background. The shortage of doctors in all specialties in Malawi is particularly severe in rural areas. Contributory factors are the low number of students graduating each year, migration of doctors, and the preference of new graduates for practising in urban areas. Attempts to increase the output from Malawi’s only medical school are insufficient to meet the country’s healthcare needs. Methods. We studied the factors influencing career choices of medical undergraduates of the College of Medicine in Blantyre, Malawi, who were surveyed by means of a self-administered questionnaire (N=205) and individual interviews (N=17). Results. Most respondents (89.4%) indicated that they intend to specialise abroad, predominantly to study in ‘better institutions’ and to get the ‘experience’ of a different country; 87.0% indicated that they intend to live in Malawi long term. Although, in general, the rural lifestyle was unattractive to medical students, respondents from rural areas and small towns, and whose parents were ‘non-professionals’, were more likely to intend working in rural areas and small towns, and to settle in Malawi, than students from urban and professional families. Conclusions. The College of Medicine should consider increasing its intake of students with lower socio-economic backgrounds and from rural areas/small towns to increase the number of doctors working in rural areas and settling in Malawi. However, the Ministry of Health may need a multipronged approach to reduce the mismatch between doctors’ career expectations and the country’s healthcare needs

Progress and divergence in palliative care education for medical students: A comparative survey of UK course structure, content, delivery, contact with patients and assessment of learning.

BACKGROUND: Effective undergraduate education is required to enable newly qualified doctors to safely care for patients with palliative care and end-of-life needs. The status of palliative care teaching for UK medical students is unknown. AIM: To investigate palliative care training at UK medical schools and compare with data collected in 2000. DESIGN: An anonymised, web-based multifactorial questionnaire. SETTINGS/PARTICIPANTS: Results were obtained from palliative care course organisers at all 30 medical schools in 2013 and compared with 23 medical schools (24 programmes) in 2000. RESULTS: All continue to deliver mandatory teaching on 'last days of life, death and bereavement'. Time devoted to palliative care teaching time varied (2000: 6-100 h, mean 20 h; 2013: 7-98 h, mean 36 h, median 25 h). Current palliative care teaching is more integrated. There was little change in core topics and teaching methods. New features include 'involvement in clinical areas', participation of patient and carers and attendance at multidisciplinary team meetings. Hospice visits are offered (22/24 (92%) vs 27/30 (90%)) although they do not always involve patient contact. There has been an increase in students' assessments (2000: 6/24, 25% vs 2013: 25/30, 83%) using a mixture of formative and summative methods. Some course organisers lack an overview of what is delivered locally. CONCLUSION: Undergraduate palliative care training continues to evolve with greater integration, increased teaching, new delivery methods and wider assessment. There is a trend towards increased patient contact and clinical involvement. A minority of medical schools offer limited teaching and patient contact which could impact on the delivery of safe palliative care by newly qualified doctors.This is the author accepted manuscript. The final version is available from Sage Publications via http://dx.doi.org/10.1177/026921631562712

The development of building assessment criteria framework for sustainable non-residential buildings in Saudi Arabia

To quantify the environmental impacts of building construction, many environmental assessment methods for measuring building performance have been proposed worldwide, such as BREEAM (UK), LEED (US) and Green Star (AU). However, much debate exists about the efficacy of these international assessment tools in measuring building performance outside their country of origin, due to global variations in climate, geography, economics and culture. To address this debate, this study proposes a framework for developing domestic sustainable non-residential building assessment criteria for Saudi Arabia. To create this framework, five major building assessment methods were compared with respect to their application methods, major characteristics and categories. Surveys were conducted with a range of Saudi sustainable construction experts to gain their expertise in reflecting the local context of Saudi Arabian construction. The analytical Hierarchy Process (AHP) method was applied to evaluate survey data. Nine criteria and 36 sub-criteria were defined in this study for inclusion as the most appropriate assessment criteria for sustainable non-residential construction in Saudi Arabia. These criteria include water efficiency and energy efficiency, indoor air quality, materials selection, effective management, land and waste, whole-life cost, quality of service and cultural aspects