Medical students' perceptions of their development of ‘soft skills' Part II : The development of ‘soft skills' through ‘guiding and growing'

BackgroundThis paper reports on medical students' views on the ways in which their ‘soft skills' were developed. It is the result of a study on soft skills among two groups of students before and after curriculum reform at the School of Medicine of the University of Pretoria. One of the aims of the reform was to provide more teaching and learning opportunities for the development of soft skills. Soft skills include professional interpersonal and social skills, communication skills, and professional and ethical attitudes.MethodsAs symbolic interactionism was used as the theoretical framework to guide the research, qualitative methods were used to collect the data. A purposive-theoretical sample of 42 final-year medical students from the traditional curriculum and 49 from the reformed curriculum was recruited. Data were collected by means of focus groups, individual in-depth interviews and autobiographical sketches. ResultsThe same categories of comments emerged from the data collected from the study participants from both the traditional and the reformed curriculum. The students ascribed their behaviour related to soft skills to personality and innate features. They had varying opinions on whether soft skills could be taught, but there was as a strong feeling that teaching should focus on principles and guidelines for dealing with difficult situations. They believed that, in the end, they should take responsibility for their own development of soft skills. Most participants felt they could at least grow through exposure to teaching activities and the observation of role models. They also indicated that they had developed their soft skills and constructed their own identity through their interaction with others. Their definition of situations was shaped by their interactions with doctors and educators, fellow students and other health professionals. Interaction with patients was considered the most important. For both groups of students their third year was a watershed, as it is the first year of more intensive patient contact and the beginning of serious learning from interaction with patients. The views on the development of soft skills differed very little between the traditional and reformed curriculum groups, except that students who had followed the reformed curriculum felt more prepared through the increased teaching and training efforts. Further consideration needs to be given to the intention of the changed curriculum compared to the actual effect. The way in which the participants in the study described their development of soft skills could be categorised as a complex interplay between ‘being' and ‘becoming'. Instead of using the word ‘acquisition' of soft skills, ‘development' seemed to be more appropriate. The metaphor of ‘guiding' and ‘growing' also captures the development of these skills better than the terms ‘teaching' and ‘learning'.ConclusionTeaching activities in the clinical years should be adapted with a view to facilitating the students' professional growth. New models for the development of medical educators should be created and institutional barriers should be investigated.For full text, click here: SA Fam Pract 2006;48(8):15-15

The conceptualisation of "soft skills" among medical students before and after curriculum reform

Objective: This paper reports on the conceptualisation of "soft skills" as part of a study carried out among two groups of undergraduate medical students before and after curriculum reform at the School of Medicine of the University of Pretoria. Congruent with a call from the World Psychiatric Association, the curriculum reform that was undertaken aimed, inter alia, to place more emphasis on soft skills, including professional interpersonal and social skills, communication skills, and professional and ethical attitudes. Methods: Qualitative methods were used to arrive at a descriptive comparison of the conceptualisation of soft skills by final-year medical students of the traditional curriculum with those of final-year students who had followed the reformed curriculum. A purposive-theoretical sampling method was followed; 42 students from the traditional curriculum and 49 from the reformed curriculum were sampled. Data were collected from seven focus groups, 16 individual interviews, and 23 essays (autobiographical sketches). Results: Both groups of students revealed conceptualisations of soft skills that were similar in kind. The themes they pinpointed were the doctor-patient relationship; relationships with other professionals; being a good listener; explaining things to patients; using good communication skills; establishing rapport with patients from different cultural backgrounds; having a professionally correct attitude; being really interested in patients' well being; having empathy; coping with patients, managing difficult situations, and being ethical and professional. However, the traditional curriculum students offered fewer examples and described fewer experiences that exemplified their soft skills. Students following the reformed curriculum gave rich accounts of their conceptualisation in terms of their own experiences and practical examples of how soft skills had been or could be used, particularly in difficult interpersonal situations. Moreover, they came up with helpful ways of dealing with difficult situations, which surpassed the suggestions offered by the students following the traditional curriculum. Conclusion: The educational and training efforts of the reformed curriculum are associated with an adeptness on the part of the students at applying soft skills to the demands of difficult clinical situations. Keywords: soft skills, interpersonal skills, doctor-patient relationship, professional socialisation South African Psychiatry Review Vol. 9(1) 2006: 33-3

Medical students on the value of role models for developing 'soft skills' - "That's the way you do it

Objective: The Soft Skills Project examined the professional development of medical students at the University of Pretoria, especially their doctor-patient interaction skills and professional socialisation. This paper reports on one of the findings of the project, namely the importance that medical students attach to role models in the development of soft skills. Methods: We used a qualitative method with symbolic interactionism and grounded theory as framework. Fourty two final-year students from the last cohort following the traditional curriculum at the University of Pretoria in 2001, and 49 final years from the first cohort following the reformed curriculum in 2002 were recruited. Data were collected by applying focus groups, in-depth, individual interviews, as well as autobiographical sketches. Data were captured by means of audio tape recordings, transcripts of the tapes, researchers' field notes, and written accounts by students, and were analysed by using a general inductive approach. Results: There were no striking differences between the comments of the two groups. Students considered registrars to be the most influential role models in the clinical teaching context, followed by specialist consultants. Their idea of a good role model was a clinically and academically competent doctor that cared about patients, had good interpersonal skills, and who could inspire students. Students needed and appreciated good role models to help them to develop their own soft skills. They expected guidance and behavioural examples from clinical teachers. Although there were competent role models, the students were exposed to poor role models. Poor role models mainly affect students negatively. Students tend to imitate and perpetuate unacceptable behaviour. Furthermore, poor role models have a negative emotional effect on students and are detrimental to their moral and learning environment. Sometimes, poor role models have a paradoxical positive effect in the sense that they inform students how not to behave. Conclusion: Medical schools and medical doctors working with medical students should be consciously aware of the importance of role models both when allocating clinical teachers to students, and while performing duties with students. It is especially necessary to realise that poor role modelling has important detrimental effects on students. Therefore, an attempt should be made to ensure that not only clinical examination skills, but also soft skills, are demonstrated at the bedside. Measures to ensure adequate exposure of students to positive role models could include: staff development; the identification of good role models to guide registrars; and a reallocation of tasks, where possible, to increase the exposure of students to the ‘natural' role models. Keywords: soft skills, role models, medical students, professionalism South African Psychiatry Review Vol. 9(1) 2006: 28-3

Learning health professionalism at Makerere University: an exploratory study amongst undergraduate students

<p>Abstract</p> <p>Background</p> <p>Anecdotal evidence shows that unprofessional conduct is becoming a common occurrence amongst health workers in Uganda. The development of appropriate professional values, attitudes and behaviors is a continuum that starts when a student joins a health professional training institution and as such health professionals in training need to be exposed to the essence of professionalism. We sought to explore undergraduate health professions students' perceptions and experiences of learning professionalism as a preliminary step in addressing the problem of unprofessional conduct amongst health workers in Uganda.</p> <p>Methods</p> <p>Eight focus group discussions were conducted with 49 first to fifth year health professions undergraduate students of the 2008/2009 academic year at Makerere University College of Health Sciences. The focus group discussions were recorded and transcribed, and were analyzed using content analysis with emergent coding.</p> <p>Results</p> <p>The difference in the way first and fifth year students of Makerere University College of Health Sciences conceptualized professionalism was suggestive of the decline in attitude that occurs during medical education. The formal curriculum was described as being inadequate while the hidden and informal curricula were found to play a critical role in learning professionalism. Students identified role models as being essential to the development of professionalism and emphasized the need for appropriate role modeling. In our setting, resource constraints present an important, additional challenge to learning universal standards of health professionalism. Furthermore, students described practices that reflect the cultural concept of communalism, which conflicts with the universally accepted standard of individual medical confidentiality. The students questioned the universal applicability of internationally accepted standards of professionalism.</p> <p>Conclusions</p> <p>The findings call for a review of the formal professionalism curriculum at Makerere University College of Health Sciences to make it more comprehensive and to meet the needs expressed by the students. Role models need capacity building in professionalism as health professionals and as educators. In our setting, resource constraints present an additional challenge to learning universal standards of health professionalism. There is need for further research and discourse on education in health professionalism in the Sub-Saharan context of resource constraints and cultural challenges.</p

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Medical students' perceptions of their development of ‘soft skills' Part I: A qualitative research methodology

Background Following the introduction of a new, integrated, problem-oriented undergraduate medical curriculum at the University of Pretoria (UP) in 1997, a research project was undertaken to study interpersonal skills, professional attitudes, teamwork, ethics and related topics – which have come to be known collectively as ‘soft skills'. This contribution is the first of two articles on the professional socialisation of medical students and their development of ‘soft skills'. It describes the particular qualitative methodology developed for, and applied to, the study of soft skills among medical students at UP.MethodsThis paper describes the aim of the study, reasons for adopting a qualitative research approach to achieve this aim, the theoretical orientation underpinning the qualitative approach that we considered most suitable, the design, the sampling, the data management and analysis, and the methods that we deployed to ensure the credibility of the findings.Research Design The aim of the study was to explore the subjective meanings that students attributed to soft skills, as they understood them. These subjective meanings involve the way students interact meaningfully with fellow students, lecturers and other individuals participating in the medical and clinical education programme, and the way they construct shared conceptualisations of soft skills and medical education in their lives and social world. A qualitative approach was considered most appropriate, as this study set out to uncover subjective and diverse meanings that do not necessarily amount to generalisable truths. The particular qualitative strategy or design used was that of an extended case study, or ‘casing', within the modernist theoretical orientation of symbolic interactionism. Elements of process evaluation were incorporated into the design to account for the process of curriculum reform within which this study was embedded.We recruited participants for this study from two cohorts of students. The first group, who completed their studies in 2001, had followed the traditional curriculum, while the second group, who completed their programme in 2002, had followed the reformed curriculum. The data collection tools were face-to-face individual interviews, focused group interviews and solicited autobiographical sketches. The utilisation of more than one method or data source enabled triangulation or cross-checking of findings. We followed an inductive reasoning approach, which means that we did not search for data to test any hypotheses that had been formulated prior to commencing the study, but focused instead on building constructs that were grounded in or reflected intimate familiarity with the students' world.ConclusionThe modernist qualitative research approach enabled us to uncover, describe and illuminate the subjective points of view on soft skills as expressed by final-year medical students before and after curriculum reform. More specifically, by carrying out an extended case study we were able to perform a process evaluation of the curriculum reform in terms of soft skills and the professional socialisation of the students. This paper outlines how qualitative research methods enabled us to capture and explore aspects of the inner life (social worlds) of these students. Whether they would be the same, similar or different in another setting are questions for further exploration or research – questions prompted by our study in a manner that illuminates the qualities that may be inherent in these subjective meanings.For full text, click here: SA Fam Pract 2006;48(8):14-14

Guest EditorialTraining undergraduate medical students in 'soft skills' - a qualitative research project at the University of Pretoria

No Abstract. South African Psychiatry Review Vol. 9(1) 2006: 12-1