Medical students in general practice: students' learning experiences and perspectives from supervisors and patients

During the last decades considerably more of medical students’ clinical training has shifted into general practice. The aim of this thesis was to study medical students’ learning experiences in general practice, work-based assessment, and the perspectives of GP supervisors and patients. Results Senior students’ learning in a portfolio pilot was mainly on patient-centred communication, clinical reasoning and professional development. Junior students appreciated contact with good role models. Long-term use of a work-based assessment tool for senior students significantly increased the proportion of specific goals and feedback to students, supervisors’ stringency of the assessment, and their satisfaction with the tool. The work-based assessment and the portfolio assessment had acceptable reliability, validity and educational impact. GPs were highly motivated teachers and took pride in their discipline. In their teaching of junior students, their main reward was improved quality of own work. Their predominant problem was lack of time for teaching, but relationship to patients and provision of feedback were other concerns. Teacher training was required. The vast majority of patients were satisfied with both senior and junior student encounters, even though caution was recommended when patients attend for sensitive matters. Patients perceived their teaching role mainly as facilitators of students’ development of professional skills

Storleksstrukturerad konkurrens vid hummertinor

De flesta arter med ett kommersiellt värde i våra hav hotas idag av ett överfiske. Ett sätt att säkerställa målarternas överlevnad är genom en hållbar fiskeriförvaltning och populationsövervakning. En strategi för att mildra effekterna av ett överfiske är införandet av marina skyddade områden, så kallade MPA från engelskans Marine Protected Area, vilket har visat sig ha en effekt på både storleken på individer och abundansen. Kåvra är ett marint skyddat område beläget på den svenska västkusten och hem till den europeiska hummern, Homarus gammarus. Den europeiska hummern är en kommersiellt viktig art i Sverige som normalt utsätts för ett högt fisketryck, men som är skyddad i Kåvra. Skyddet ger forskare möjligheten att studera en orörd hummerpopulation med en naturlig populationsdynamik. I denna studie har kameror satts på hummertinor vid ett övervakningsfiske i Kåvra, med syftet att genom visuell information och dataanalys, kartlägga hur konkurrensbeteenden hos europeisk hummer influerar fångsten i hummertinor. Genom visuell information och datoranalys implicerar denna studie en korrelation mellan hummerbeteende och fångsten i hummertinorna. Högre dominansnivåer observerades för stora och mellanstora hummerindivider tillsammans med en ökad fångstbarhet jämfört med mindre humrar

Student-centred GP ambassadors: Perceptions of experienced clinical tutors in general practice undergraduate training

Objective. To explore experienced general practitioner (GP) tutor perceptions of a skilled GP tutor of medical students. Design. Interview study based on focus groups. Setting. Twenty GPs experienced in tutoring medical students at primary health care centres in two Swedish regions were interviewed. Method. Four focus-group interviews were analysed using qualitative content analysis. Subjects. Twenty GP tutors, median age 50, specifically selected according to age, gender, and location participated in two focus groups in Gothenburg and Malmo, respectively. Main outcome measures. Meaning units in the texts were extracted, coded and condensed into categories and themes. Results. Three main themes emerged: "Professional as GP and ambassador to general practice", "Committed and student-centred educator", and "Coordinator of the learning environment". Conclusion. Experienced GP tutors describe their skills as a clinical tutor as complex and diversified. A strong professional identity within general practice is vital and GP tutors describe themselves as ambassadors to general practice, essential to the process of recruiting a new generation of general practitioners. Leaders of clinical education and health care planners must understand the complexity in a clinical tutor's assignment and provide adequate support, time, and resources in order to facilitate a sustainable tutorship and a good learning environment, which could also improve the necessary recruitment of future GPs

A survey of UK medical schools' arrangements for early patient contact

Background: Many U.K. medical schools have patient contact in the first two years of the undergraduate course. Aim: To compare the purposes and organization of early patient contact in UK medical schools and to relate these arrangements to the schools' curricular objectives. Methods: A telephone survey of lead educators in UK medicals schools. Categories of contact were plotted against phases of the course to discern patterns of organisation. Results: The quantity of contact varies considerably (four to 65 days). There is a pattern, with learning objectives around the social context of health and illness preceding skills based work and integrated clinical knowledge for practice coming later. Schools fall into three categories: close adherence to the preclinical/clinical split, with limited early contact acting as an introduction to social aspects of health; provision of substantial patient contact to maximize the integration of knowledge and skills; and transitional, with limited clinical goals. General practice provides between one third and one half of early patient contact. Conclusions: Arrangements meet the objectives set by each school and reflect differing educational philosophies. Change is toward more early contact. There appears to be no national guidance which supports a minimum quantity of patient contact or specific educational purpose in the early years of U.K. basic medical training

When only the real thing will do: junior medical students’ learning from real patients

Bell, K., Boshuizen, H. P. A., Scherpbier, A. J. J. A., & Dornan, T. L. (2009). When only the real thing will do: junior medical students' learning from real patients. Medical Education, 43(11), 1036-1043. doi:10.1111/j.1365-2923.2009.03508.xOBJECTIVES This study aimed to explore how medical students experience contacts with real patients and what they learn from them. METHODS We carried out a post hoc, single-group study in one teaching sector of a 5-year, problem-based, horizontally integrated, outcome-based and community-oriented undergraduate programme, in which students lacked clinical exposure in the pre-clerkship phase. Subjects comprised five cohorts of students on their first clerkships. Data consisted of purposively selected, voluntary, self-report statements regarding real patient learning (RPL). Constant comparative analysis was performed by two independent researchers. RESULTS Respondents valued patients as an instructional resource that made learning more real. They reported learning through visual pattern recognition as well as through dialogue and physical examination. They more often used social than professional language to describe RPL. They reported affective outcomes including enhanced confidence, motivation, satisfaction and a sense of professional identity. They also reported cognitive outcomes including perspective, context, a temporal dimension, and an appreciation of complexity. Real patient learning helped respondents link theory learned earlier with reality as represented by verbal, visual and auditory experiences. It made learning easier, more meaningful and more focused. It helped respondents acquire complex skills and knowledge. Above all, RPL helped learners to remember subject matter. Most negative responses concerned the difficulty of acquiring appropriate experience, but RPL made a minority of respondents feel uncomfortable and incompetent. CONCLUSIONS Real patient learning led to a rich variety of learning outcomes, of which at least some medical students showed high metacognitive awareness. Sensitivity from clinical mentors towards the positive and negative outcomes of RPL reported here could support reflective clinical learning

Team Objective Structured Bedside Assessment (TOSBA) as formative assessment in undergraduate Obstetrics and Gynaecology: a cohort study.

BACKGROUND: Team Objective Structured Bedside Assessment (TOSBA) is a learning approach in which a team of medical students undertake a set of structured clinical tasks with real patients in order to reach a diagnosis and formulate a management plan and receive immediate feedback on their performance from a facilitator. TOSBA was introduced as formative assessment to an 8-week undergraduate teaching programme in Obstetrics and Gynaecology (O\u26G) in 2013/14. Each student completed 5 TOSBA sessions during the rotation. The aim of the study was to evaluate TOSBA as a teaching method to provide formative assessment for medical students during their clinical rotation. The research questions were: Does TOSBA improve clinical, communication and/or reasoning skills? Does TOSBA provide quality feedback? METHODS: A prospective cohort study was conducted over a full academic year (2013/14). The study used 2 methods to evaluate TOSBA as a teaching method to provide formative assessment: (1) an online survey of TOSBA at the end of the rotation and (2) a comparison of the student performance in TOSBA with their performance in the final summative examination. RESULTS: During the 2013/14 academic year, 157 students completed the O\u26G programme and the final summative examination . Each student completed the required 5 TOSBA tasks. The response rate to the student survey was 68 % (n = 107/157). Students reported that TOSBA was a beneficial learning experience with a positive impact on clinical, communication and reasoning skills. Students rated the quality of feedback provided by TOSBA as high. Students identified the observation of the performance and feedback of other students within their TOSBA team as key features. High achieving students performed well in both TOSBA and summative assessments. The majority of students who performed poorly in TOSBA subsequently passed the summative assessments (n = 20/21, 95 %). Conversely, the majority of students who failed the summative assessments had satisfactory scores in TOSBA (n = 6/7, 86 %). CONCLUSIONS: TOSBA has a positive impact on the clinical, communication and reasoning skills of medical students through the provision of high-quality feedback. The use of structured pre-defined tasks, the observation of the performance and feedback of other students and the use of real patients are key elements of TOSBA. Avoiding student complacency and providing accurate feedback from TOSBA are on-going challenges

Active involvement of learning disabilities service users in the development and delivery of a teaching session to pre-registration nurses : students' perspectives

A teaching session about service users' experiences of accessing and receiving health and social care was designed and delivered by service users to first year BSc Nursing students. The aim was to enhance students' knowledge, skills and confidence in caring for people with a learning disability. An evaluation research study was undertaking at one university in London into the perceived effectiveness of the teaching session, including students' perceptions of the extent to which the service users' teaching session was useful, the impact of the session, its benefits and challenges and the sustainability of teaching sessions delivered by service users. Data were collected through an online questionnaire. Quantitative analysis was undertaken of Likert-style questions and qualitative analysis was undertaken using the Framework Method. The session impacted on students' knowledge and understanding of people with a learning disability. Students reported that they felt more comfortable and confident interacting with people with a learning disability. In addition, they reflected on their feelings about caring for people with a learning disability

"I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors

<p>Abstract</p> <p>Background</p> <p>Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors.</p> <p>Methods</p> <p>Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method.</p> <p>Results</p> <p>In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: <it>(a) Pleasure and stimulation</it>. Informants appreciated tutorship and meeting both students and fellow tutors, <it>(b) Disappointment and stagnation</it>. Occasionally, tutors were frustrated and expressed negative feelings, <it>(c) Demands and duty</it>. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, <it>(d) Impact of workplace relations</it>. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and <it>(e) Multitasking difficulties</it>. Combining several duties with those of a tutorship was often reported as difficult.</p> <p>Conclusions</p> <p>It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system.</p

Patient attitudes towards medical students at Damascus University teaching hospitals

Background: The cooperation of patients and their consent to involve medical students in their care is vital to clinical education, but large numbers of students and lack of experience as well as loss of privacy may evoke negative attitudes of patients, which may sometimes adversely affect the clinical teaching environment. This study aimed to explore the attitudes of patients towards medical students at Damascus University hospitals, and to explore the determinants of those attitudes thus discussing possible implications applicable to clinical teaching. Methods: This cross-sectional study was conducted at three teaching hospitals affiliated to the Faculty of Medicine at Damascus University. Four hundred patients were interviewed between March and April 2011 by a trained sociologist using a structured questionnaire. Results: Of the patients interviewed, 67.8 % approved the presence of medical students during the medical consultation and 58.2 % of them felt comfortable with the presence of students, especially among patients with better socio-economic characteristics. 81.5 % of the patients agreed to be examined by students in the presence of the supervisor, while 40.2 % gave agreement even in the absence of the supervisor. Privacy was the most important factor in the patients ’ reticence towards examination by the students, whilst the relative safety and comfort if a supervisor was available determined patients ’ agreement