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

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

What information and the extent of information research participants need in informed consent forms: a multi-country survey

Background: The use of lengthy, detailed, and complex informed consent forms (ICFs) is of paramount concern in biomedical research as it may not truly promote the rights and interests of research participants. The extent of information in ICFs has been the subject of debates for decades; however, no clear guidance is given. Thus, the objective of this study was to determine the perspectives of research participants about the type and extent of information they need when they are invited to participate in biomedical research. Methods: This multi-center, cross-sectional, descriptive survey was conducted at 54 study sites in seven Asia-Pacific countries. A modified Likert-scale questionnaire was used to determine the importance of each element in the ICF among research participants of a biomedical study, with an anchored rating scale from 1 (not important) to 5 (very important). Results: Of the 2484 questionnaires distributed, 2113 (85.1%) were returned. The majority of respondents considered most elements required in the ICF to be \u27moderately important\u27 to \u27very important\u27 for their decision making (mean score, ranging from 3.58 to 4.47). Major foreseeable risk, direct benefit, and common adverse effects of the intervention were considered to be of most concerned elements in the ICF (mean score = 4.47, 4.47, and 4.45, respectively). Conclusions: Research participants would like to be informed of the ICF elements required by ethical guidelines and regulations; however, the importance of each element varied, e.g., risk and benefit associated with research participants were considered to be more important than the general nature or technical details of research. Using a participant-oriented approach by providing more details of the participant-interested elements while avoiding unnecessarily lengthy details of other less important elements would enhance the quality of the ICF

Use of portfolios for assessment of global health residents: qualitative evaluation of design and implementation

Background: When the Global Health training program was created at the University of Calgary, residents were encouraged to seek learning experiences that met their career goals and individualized objectives. An assessment tool was sought that could be reliable, valid, yet flexible. A portfolio process was chosen, but research was necessary to determine whether it was robust.Methods: A qualitative study was conducted with academic experts in Canadian residency training, as well as directors and residents involved in Global Health study in order to assess the validity and benefit of such a tool. Through an online survey, interviews, and focus groups, views on the portfolio and intended content were collected and coded thematically.Results: Multiple themes emerged from the content analysis. Overall, all stakeholders (residents and faculty) were supportive of the use of portfolios for summative assessment, mentioning authentic and varying assessments, reflective and narrative components, and mentor interaction as positive attributes, but they did have many recommendations.Conclusion: This qualitative evaluation validated the use of portfolios for this cohort of students while yielding comments and suggestions that will further enhance the interactive and flexible nature of this seldom used assessment tool. These findings contribute to the understanding of how Global Health assessment can remain individualized yet rigorous