Pharmacology through play: using Lego® to revise core concepts for undergraduates

Background: Pharmacology, while critical knowledge for healthcare professionals, is often viewed by students as dry and difficult to understand. We sought to examine the student acceptability of a Lego®-based learning session, in an attempt to improve pharmacology learning. Methods: In line with constructivist theories, students were facilitated to build, in small groups, their own Lego® shape to represent an area of core pharmacology and to use this to explain the concept to other students (e.g. agonistreceptor interactions). The validated Course Experience Questionnaire (CEQ) was used to gauge students’ ideas on the session. Multiple choice questions were used before and after the session to evaluate knowledge. Results: Most students were positive regarding the session, finding it enjoyable, relevant for their learning and even recommending it be used to explore more complex areas of pharmacology. In addition, there was a significant increase in the MCQ scores following the session. Conclusions: This study used constructivist theory to develop a novel teaching intervention to create a more student-centred, active learning environment. This effective low-cost method could be applied to other teaching programmes to enhance student learning.</p

Undergraduate medical students' usage and perceptions of anatomical case-based learning: comparison of facilitated small group discussions and elearning resources

While case-based discussions can empower students to apply knowledge to contextual clinical situations, scheduling these activities is a challenge in crowded curricula. Case-based eLearning activities, derived from existing cases discussed within anatomy small group tutorials, were created incorporating principles such as interactivity, reinforcement, and feedback. Over half of the students accessed one or more of these online cases, with 18% accessing all eight online cases provided. Access increased as the semester progressed, particularly just before summative examinations, implying students used these primarily as revision aides. Students rated both formats highly, but favored the online format with regard to enjoyment (P = 0.048), learning (P = 0.101), and feedback (P = 0.086). However, more students discussed these cases in small group tutorials within the anatomy dissecting room than completed them online (122 vs. 67) and themes emerging from free text comments included a desire to have more time dedicated to these cases during small group tutorials, and an appreciation for the opportunity for discussion with staff and learning through doing. Additionally, native English speakers rated the anatomy room discussions significantly higher in all aspects than non-native English speakers, suggesting that non-native speakers may be hesitant or reluctant to fully participate in front of peers. While online case-based learning activities are a useful adjunct to anatomy teaching, particularly for revision, assumptions that "digital natives" have an innate preference for digital resources require critical evaluation, as students still place a high value on opportunities for discussion with staff during their studies. </p

Learning cardiac embryology-which resources do students use, and why?

With increasing class sizes, small group activities for learning embryology are present in few institutions. How then do students supplement their lectures in order to ask and answer questions, or delve into concepts in detail? Arguably, animations and videos are ideal for visualizing four-dimensional anatomy, but how do students find and filter these? First-year medical students were surveyed with respect to the cardiac embryology component of their course and asked their opinions regarding the clinical relevance of this content and the resources they used to enhance learning. Students indicated that they considered cardiac embryology to be of relevance to clinical practice and that videos are a useful resource in helping them to learn this material. However, when seeking videos or resources, it emerged that students tended to Google information in preference to accessing online resources (or textbooks) specifically recommended by their instructor, despite students' recognition that "accuracy of information" was paramount when choosing what resource to use. While all students seemed reluctant to contact a staff member with questions, those with less proficiency in English were less likely to approach faculty for assistance. While acknowledging students as adult learners, self-regulated learning skills do not develop automatically and the development of these skills should be viewed as a "shared responsibility" between students and staff. Likewise, students also need to be taught critical appraisal of learning resources, especially in the complex online environment, with design of their bespoke institutional virtual learning environment facilitating easy identification and access of recommended resources. </p

Enhancing clinical educator well-being.

Life as a clinical educator can be a double-edged sword. The privilege of working with patients and supporting the health professionals of the future, carries with it the responsibility to manage the, frequently conflicting, demands of both. Add to this the pressures of career development – interviews, professional exams – and the routine tribulations of adult life, and it’s clear to see that the personal resources of clinical educators can become easily depleted. These challenges are often further complicated by institutional and societal pressures e.g., overstretched health systems and a global trend for increased student numbers. It comes as no surprise then that we see a worrying prevalence of stress, burnout and mental health difficulties for those working in health care roles.[1,2] When we consider that educators likely role model coping skills as well as clinical skills for the next generation of health professionals, this leads to the question: how can those charged with facilitating both quality health care and education, nurture their own health and well-being? 2 Although it can be difficult to define, it has been proposed that stable well-being exists “when individuals have the psychological, social and physical resources they need to meet a particular psychological, social and/or physical challenge.”[3] In this article, we suggest several practical ways to improve staff well-being in clinical education settings, in this context of balancing supportive resources against challenges. We begin by exploring well-being from the perspective of the institution, and the role organisational leaders can play in effecting positive change. We will then highlight individual and team-level, evidence-based well-being strategies that can be used by practising clinical educators.</p

How can pharmacists develop patient-pharmacist communication skills? A realist synthesis

Objective: To understand how pharmacists develop patient-pharmacist communication skills.Methods: A realist synthesis approach was used to understand how educational interventions work to improve patient-pharmacist communication. Initial programme theories were developed through a scoping search and stakeholder focus groups (faculty, students, patients and public). A systematic search was then conducted for evidence to test initial theories. Included papers were assessed for relevance and rigour. Extracted data was synthesised to refine the initial programme theories and develop modified programme theories.Results: Forty-seven papers were included in the final synthesis. Role-play with simulated patients and peers, video recording and lectures were the most widely reported interventions. Repeated practice, feedback, reflection and confidence were among the mechanisms by which interventions work. Modified programme theories relating to interactions of role-play, experiential learning, video recording, self-assessment and workshops were developed.Conclusions: Outcomes of communication education interventions are influenced by the level of learner. Educational interventions that promote reflection are particularly useful.Practical implications: There are a wide range of theory-informed interventions, which should be used in a programmatic approach to communications education. A longitudinal programme of communication skills training, with intervention choice based on level of learning, is important.</div

Early longitudinal community pharmacy placements: Connection, integration and engagement

Background: Longitudinal placements are defined as involving "a regular, recurrent placement in the same setting with the same supervisor over a period of time". "Continuity" is the organising principle for promoting learning through continuity of care, curriculum and supervision. Longitudinal placements are widely used in medicine, but less is known about their use in pharmacy and whether the educational principles translate to community pharmacy practice.Objective: This study sought to explore if a longitudinal community pharmacy placement (LCPP) for Year 2 pharmacy students promoted learning through student patient-centeredness, curricular integration, and growing professional engagement.Methods: An explanatory mixed methods study design was used. Quantitative data for the study was collected prior to and after the LCPP using a questionnaire incorporating a validated measure of professional engagement and items relating to patient-centeredness and curriculum integration. Pre and post-responses were compared using the Wilcoxon-signed rank test. To further understand the quantitative findings, semi-structured interviews were conducted with students, supervisors and practice-educators and thematically analysed through a constructivist lens.Results: There was a 78% response rate (47/60 paired responses) to the questionnaire and 25 interviews were conducted. There was quantitative and qualitative evidence of patient connection during LCPPs, yet some students had limited opportunities to connect with people. Curriculum integration was enhanced by the longitudinal nature of the placement. There was a significant increase in the sum scores of the S-PIPE instrument indicating enhanced professional engagement. Qualitatively there was evidence that engagement was promoted through role modelling and supervision, but continuity was compromised with changing supervisors.Conclusions: An early LCPP promotes learning by providing opportunities for curriculum integration and professional engagement. It may be worth considering as a way to enhance integration through experiential learning in curriculum design. The placement needs to be of a sufficient length to enable repeated patient interaction and ideally provide continuity of supervision for maximum benefit.</div

A scoping review: virtual patients for communication skills in medical undergraduates

Background: Communication is an essential competence for medical students. Virtual patients (VP), computerized educational tools where users take the role of doctor, are increasingly used. Despite the wide range of VP utilization, evidence-based practical guidance on supporting development of communication skills for medical students remains unclear. We focused this scoping review on VP affordance for student learning especially important in the current environment of constrained patient access. Methods: This scoping review followed Arksey & O'Malley's methodology. We tested and used a search strategy involving six databases, resulting in 5,262 citations. Two reviewers independently screened titles, full texts (n= 158) and finally performed data extraction on fifty-five included articles. To support consideration of educational affordance the authors employed a pragmatic framework (derived from activity theory) to map included studies on VP structure, curricular alignment, mediation of VP activity, and socio-cultural context. Results: Findings suggest that not only the VP itself, but also its contextualization and associated curricular activities influence outcomes. The VP was trialled in the highest proportion of papers as a one-off intervention (19 studies), for an average duration of 44.9 minutes (range 10-120min), mainly in senior medical students (n=23), notably the largest group of studies did not have VP activities with explicit curricular integration (47%). There was relatively little repeated practice, low levels of feedback, self-reflection, and assessment. Students viewed VPs overall, citing authenticity and ease of use as important features. Resource implications are often omitted, and costings would facilitate a more complete understanding of implications of VP use. Conclusion: Students should be provided with maximal opportunity to draw out the VPs' full potential through repeated practice, without time-constraint and with curricular alignment. Feedback delivery enabling reflection and mastery is also key. The authors recommend educators to explicitly balance computerized authenticity with instructional design integrated within the curriculum.</p

Checking the checklists: hospitals are not airplanes

Whilst it is obvious that medicine is not aviation, and that they have many differences, they also share many commonalities. Including the fact that the practice of aviation, like medicine is both art and science. The political placement of aviation on a pedestal for medicine to admire and mimic is potentially injuring the specialty of human factors. The cookbook approach to checklists, the confusion of CRM (crew resource management) with the wider science of HFE (human factors ergonomics), along with shifting of responsibility to the individual for systems error is everything that human factors is not. Idealizing aviation may make medical professionals defensive, and rightly so, as they state that hospitals and people are not airplanes.</p

Patient involvement in assessing consultation quality: validation of patient enablement instrument (PEI) in Lithuanian general practice

Background: The Patient Enablement Instrument (PEI) was designed to encapsulate consultation outcome from the perspective that increasing their understanding and coping ability would underpin a positive consultation outcome for patients. The objective of the study was the validation of the PEI in Lithuanian general practice and comparison of Lithuanian patients' enablement with previous studies in Europe to see if factors associated with patient enablement in Lithuania were reflective of those in the previous studies. Methods: The Patient Enablement Instrument was translated into Lithuanian and included in the questionnaire along with the questions about a person's health, reasons for visiting the doctor and feeling about the consultation. Practices from 4 different municipalities that are situated in different geographical regions which have both town and rural areas were sampled randomly. Patients scheduled consecutively aged 18 years or more were the subjects of the study. The data analyses focused on internal reliability and concept validity. Results: The overall mean patient enablement score was 6.43. Enablement scores declined with increasing patient age, and female patients were more enabled. Patients with biomedical problems had the highest enablement results, while patients with complex problems had the lower results. Enablement was positively related to receiving a prescription and knowing a doctor, and negatively related to wish having consultation with another doctor. Conclusions: This study substantiates the rationality of using PEI in assessing primary care consultations in Lithuania. The correlations of enablement largely reflect the situation in Western and Central Europe: longer consultation and access to the same physician increases patient enablement.</p

Risky business: medical students' feedback-seeking behaviours: a mixed methods study

There are differing views on how learners' feedback-seeking behaviours (FSB) develop during training. With globalisation has come medical student migration and programme internationalisation. Western-derived educational practices may prove challenging for diverse learner populations. Exploring undergraduate activity using a model of FSB may give insight into how FSB evolves and the influence of situational factors, such as nationality and site of study. Our findings seek to inform medical school processes that support feedback literacy. Using a mixed methods approach, we collected questionnaire and interview data from final-year medical students in Ireland, Bahrain, and Malaysia. A validated questionnaire investigated relationships with FSB and goal orientation, leadership style preference, and perceived costs and benefits. Interviews with the same student population explored their FSB experiences in clinical practice, qualitatively, enriching this data. The data were integrated using the 'following the thread' technique. Three hundred and twenty-five of a total of 514 completed questionnaires and 57 interviews were analysed. Learning goal orientation (LGO), instrumental leadership and supportive leadership related positively to perceived feedback benefits (0.23, 0.2, and 0.31, respectively, p p first, do no harm) and overcoming barriers (beat the system) and goal-centred curation (shop around) to optimise benefits. Diverse medical students across three continents undertake FSB with careful navigation, as a valued but risky business, that is highly contextualised. Promoting a constructive FSB is complex. Overcoming outdated theory and practices on the wards remains a challenge to psychologically safe, learner-centred feedback. </p