\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

Compassion: Wherefore Art Thou?

Compassion is a health professional value that has received a lot of attention recently. In this paper we consider the nature of compassion, its definition and its expression in practice. We further link compassion to patient-centred care. There is debate about whether compassion can be learned, and therefore assessed. There are similar discussions in relation to ‘professionalism’ and the effects of the hidden curriculum. We conclude that compassion is everyone’s business and that learners require early and sustained patient and client contact with time for reflection to enable the delivery of compassionate care

Exploring tutor perceptions and current practices in facilitating diagnostic reasoning in preclinical medical students: Implications for tutor professional development needs

Introduction: This study explores tutors’ experience of teaching diagnostic reasoning (DR) – a key component of clinical reasoning – to build understanding into the use of explicit strategies in facilitating development of DR skills in preclinical medical students. Methods: A qualitative, interpretive study was undertaken with 14 preclinical problem-based learning tutors who participated in semi-structured interviews. A thematic analysis was conducted to identify key factors that influence students’ learning of diagnostic reasoning. Results: Tutor dispositions towards facilitating learning of DR were variable in this study. Explicit strategies to teach DR were thought to exert positive influences on the development of DR skills, through improving student knowledge and reducing potential error. The advantages of using explicit strategies to teach DR outweighed the perceived difficulties identified in this context. Explicit strategies may need modification for preclinical students and the focus should be on building knowledge of classic presentations and developing metacognitive awareness. Conclusion: The use of explicit educational strategies will contribute to facilitating preclinical student learning of DR skills. Tutor professional development is a key component in the successful implementation of these strategies

A manually annotated Actinidia chinensis var. chinensis (kiwifruit) genome highlights the challenges associated with draft genomes and gene prediction in plants

Most published genome sequences are drafts, and most are dominated by computational gene prediction. Draft genomes typically incorporate considerable sequence data that are not assigned to chromosomes, and predicted genes without quality confidence measures. The current Actinidia chinensis (kiwifruit) 'Hongyang' draft genome has 164\ua0Mb of sequences unassigned to pseudo-chromosomes, and omissions have been identified in the gene models

Intern underperformance is detected more frequently in emergency medicine rotations

Objective: To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. Methods: A retrospective review of intern assessment forms from a 2 year period (2009-2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as 'requiring substantial assistance' and/or 'requires further development' on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. Results: During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5-3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (

The impact of simulation on undergraduate nursing students\u27 confidence and learning satisfaction over time and practice: A pretest, post-test study design

The study examined the effect on the confidence and learning satisfaction of final year nursing students when a clinical story is told over a weekly series of simulated ward experiences. A pretest, post-test study design was undertaken inside a cohort of 237 students enrolled in a 3-year Bachelor of Nursing program. Participants completed an online survey prior to and following participation in five weekly simulation workshops. The effect of serial simulation was evaluated with students self-reporting confidence and learning satisfaction adhering to a checklist for reporting of survey studies. A sample of 96 nursing students completed a pre- and post-test survey. Results revealed that nursing students’ overall learning satisfaction remained unchanged. In contrast, overall self-confidence among students had improved. Confidence in playing the role of registered nurse improved over time as students became familiar with what would be expected of them during a series of simulated experience

Mini-CEX as a workplace-based assessment tool for interns in an emergency department – does cost outweigh value?

Background: The mini-clinical evaluation exercise (mini-CEX) has been proposed as a method to address the deficiencies of intraining assessment for junior doctors