Adherence to a national consensus statement on informed consent: medical students' experience of obtaining informed consent from patients for sensitive examinations.

AIM: To determine whether the guidance from the New Zealand medical programmes' national consensus statement on obtaining informed consent from patients for sensitive examinations are being met, and to explore medical students' experience of obtaining consent. METHOD: A self-reported, online, anonymous questionnaire was developed. Data were collected in the period just after graduation from final year medical students at The University of Auckland in 2019. RESULTS: The response rate was 35% (93/265). Most students reported that they were "not always compliant" with the national consensus statement for obtaining informed consent for almost all sensitive examinations. The main exception was for the female pelvic examination (not in labour) under anaesthesia, where most students reported being "always compliant". We identified factors related to students, supervisors, institution, and the learning context as reasons for lack of compliance. CONCLUSION: Adherence to the national consensus statement on obtaining informed consent for sensitive examinations is unsatisfactory. The medical programme needs to review the reasons for lapses in implementing the policy in practice, to ensure a safe learning environment for patients and our students.

Sleep well to perform well: the association between sleep quality and medical student performance in a high-stakes clinical assessment.

Study Objectives: To investigate medical students' sleep quality and duration prior to a major clinical assessment, and their association with clinical performance. Methods: Third year medical students were surveyed following the end of year Observed Structured Clinical Examination (OSCE) using a self-completed questionnaire. The questionnaire focussed on sleep in the month and night before the assessment. OSCE scores were linked to questionnaire data for analysis. Results: The response rate was 76.6% (216/282). Poor sleep quality (Pittsburgh Sleep Quality Index > 5) was reported by 56.9% (123/216) and 34.7% (75/216) of students the month and night before the OSCE, respectively. Sleep quality the night before the OSCE was significantly associated with OSCE score (p = .038), but not sleep quality in the preceding month. The night before the OSCE, students obtained an average of 6.8 h sleep (median 7, SD 1.5, range 2-12 h). Short sleep duration (≤6 h) was reported by 22.7% (49/216) and 38.4% (83/216) of students in the month and the night before the OSCE, respectively. Sleep duration the night before the OSCE was significantly associated with OSCE score (p = .026), but no significant association was found between OSCE score and sleep duration in the preceding month. Use of medication to help with sleep was reported by 18.1% (39/216) of students in the preceding month and by 10.6% (23/216) in the night before the OSCE. Conclusions: Medical students' sleep quality and duration the night before a clinical assessment were correlated with their performance in that assessment.

Australian and New Zealand Medical Students' Attitudes and Confidence Towards Providing Nutrition Care in Practice.

The prevalence of lifestyle-related chronic disease is increasing. Doctors in primary care are ideally placed to support patient nutrition care, but recent reviews show education is still lacking. This study aimed to identify medical students' attitudes towards the role of nutrition in health, nutrition knowledge, and perceptions of nutrition education, in postgraduate (Australia) and undergraduate (New Zealand) programs in order to identify gaps in nutrition knowledge and skills to better inform future education. Second-year graduate and third-year undergraduate students participated in semi-structured focus groups and interviews. A general inductive approach was used to investigate students' 1) attitudes toward the role of nutrition in health, 2) nutrition knowledge based on nutrition-specific competencies and 3) perceived adequacy of nutrition education received. Interviews (nine) and focus groups (seven) identified four common themes: 1) role of medical practitioners in nutrition care, 2) barriers to nutrition education, 3) nutrition knowledge, and 4) nutrition-related skills. Students perceive that doctors are well-placed to provide some level of nutrition care, but poor translation of nutrition knowledge to clinical contexts is a key limitation in nutrition education. In summary, nutrition education may be insufficient to support the nutrition-related competency development of the undergraduate and postgraduate student participants in this study. Focusing on the integration of these skills into the curriculum may be a priority.

Medical students' experience of performing female pelvic examinations: Opportunities and barriers.

BACKGROUND: Teaching and learning female pelvic examination within the undergraduate medical curriculum offers some potential challenges. One such is the extent to which students are provided practice opportunities with patients in the clinical setting. AIMS: To quantify how many pelvic examinations, on real patients, have been performed by medical students at the point of graduation, and to explore opportunities and barriers to performing these examinations. MATERIALS AND METHODS: A retrospective study using a self-completed, anonymous, electronic survey was developed as part of a multi-centre study. Data were collected in the immediate period after graduation from the medical programs at the University of Auckland and Flinders University in 2013. An ordinal set of range categories was used for recording numbers of examinations. RESULTS: The combined response rate for the survey was 42.9% (134/312). The median range category for the number of pelvic examinations performed in patients who were not in labour was 6-9 and in labour was 2-3. Thirty-three percent of medical students had never performed a pelvic examination in labour. Male medical students performed significantly fewer pelvic examinations compared with female students. Self-reported barriers to performing the pelvic exam include: gender of the student, 'gate-keeping' by other health professionals, lack of confidence and patient factors. CONCLUSIONS: The majority of medical students have performed several pelvic examinations on real patients at graduation. Male gender and access being limited by midwives were the main barriers to performing female pelvic examinations. Medical curricula need to address these issues in the learning environment.

Abnormal findings in peers during skills learning.

BACKGROUND: Peer physical examination (PPE), where students examine each other, is common in contemporary clinical skills learning. A range of benefits and risks have been explored in the literature. One persistent concern has been the identification and management of abnormal physical findings. Two previous studies have attempted to quantify the risk, one through the discussion of two exemplar cases and the other with a retrospective student survey. METHODS: Here, we report the first prospective study of the number and type of abnormalities encountered as part of early clinical skills learning in a medical programme. We have a formal written consent process for PPE, which includes the management of abnormal findings through the completion of an event form. Our data come from cohorts undertaking years 2 and 3 of the programme between 2003 and 2014. One persistent concern (of PPE) has been the identification and management of abnormal physical findings RESULTS: Nineteen event forms were completed over this period. The incidence rates per year ranged from 0.23 to 1.05 per cent. Abnormal findings included raised blood pressure, heart murmur, abnormal bedside test values, and eye and skin conditions. DISCUSSION: The low event rate, along with a feasible process for dealing with this issue, goes some way to reassuring those with concerns. We acknowledge that some abnormalities may have been missed, and that some data may have been lost as a result of incorrect process; however, even the highest annual rate is low in absolute terms. We recommend a formal process for managing abnormalities. Ideally this would be part of an overall PPE written policy, communicated to students, enacted by tutors and approved by the local ethics committee.

Evaluation of the effect of hand hygiene reminder signs on the use of antimicrobial hand gel in a clinical skills center.

Hand hygiene is a critical element of patient care, which needs to be learned and reinforced to become an autonomous behavior. Previous studies have explored aspects of hand hygiene behavior in the clinical workplace, but not in controlled learning environments with health professional students. Development of good hand hygiene behavior requires a multi-faceted approach, including education, reinforcement, feedback and audit. Our study aimed to identify the effect of unannounced hand hygiene reminder signs on the use of antimicrobial hand gel in a clinical skills center. Year 2 MBChB students received practical learning regarding hand hygiene in their clinical skills sessions. Baseline hand gel use was measured using before and after weighing of the bottles. An A5 sign was created to remind the students to hand cleanse and was used as an unannounced intervention. In semester 2 (2012), the student groups were randomly allocated as intervention (signs) or control (no signs). Hand gel use at all sessions was measured. Data were compared between groups and over time. In total, 237 students attended the skills sessions twice during the study. Hand gel use was not significantly different between the two study arms. Overall use was low, typically 1-2 hand gel pumps per student per session. In addition, hand gel use fell over time. A visual reminder to cleanse hands did not appear to have any effect on behavior. These findings may have implications for their value in a clinical setting. Low overall use of hand gel may be context-dependent. Students are in a simulated environment and examine 'healthy' peers or actors. There may have been inconsistent tutor role-modeling or problems with the educational approach to the skill. Analysis at the level of the group, and not the individual, may have also limited our study.

Exploration of the attitudes of nursing students to peer physical examination and physical examination of patients.

BACKGROUND: The use of peer physical examination (PPE) in early clinical skills has been studied amongst medical students. The majority of students are comfortable with using peer physical examination, when sensitive areas are excluded. Students' attitudes are related to their personal characteristics: gender, age, religious faith, and ethnicity. There is no data on nursing students' attitudes to peer physical examination. OBJECTIVES: Identify and explore: DESIGN: Dual cohort, cross-sectional, anonymous survey. SETTING: Three-year undergraduate nursing programme, skills centre and service clinical learning. METHODS: All first and third year nursing students were asked to complete a modified Examining Fellow Students questionnaire at the end of 2008. The questionnaire asked students to indicate which of 12 body areas they would not be willing to examine/have examined by a peer of the same/opposite gender. This study also asked students which of the 12 body areas they felt uncomfortable examining on patients. RESULTS: The response rate was 76% (128/168). The students were predominantly female (93% female; 7% male). Most students were comfortable with examining non-sensitive body regions of peers (78.2%-100% willing) and patients (92.3-100% willing). Male gender was significantly associated with willingness to examine and be examined by peers (p=0.001); Asian students were significantly less willing to engage in peer physical examination with opposite gender (p<0.007). Year 3 students were significantly more comfortable than Year 1 in examining patients of either gender (p<0.001). DISCUSSION AND CONCLUSIONS: In spite of the male gender findings, this predominantly female population expresses similar attitudes to the gender-balanced medical student studies - high acceptability for non-sensitive areas. The role of characteristics and attitudes to peer physical examination shows similarities and differences to other studies. Student characteristics were not related to patient examination attitudes.

Are doctors team players, and do they need to be?

Evidence suggests that teamwork failures contribute to poor outcomes in hospitals and that changes in healthcare delivery have at times worked against the development of effective healthcare teams. Doctors' engagement with the concept of healthcare teams, although variable, has generally been supportive and there have been several successful initiatives. However, lack of evidence on the critical components that improve the performance of healthcare teams impedes growth in our understanding and development of effective teams. In an endeavour to improve the function of healthcare teams through education and systems change, the psychology literature remains a useful framework for studying the critical components of team processes.

Evaluation of consent for peer physical examination: students reflect on their clinical skills learning experience.

INTRODUCTION: Early clinical skills teaching often requires students to learn through examining one another. This model should acknowledge ethical, practical and individual issues, disclosure and identification of abnormalities. Consent to peer physical examination (PPE) is usually expected rather than discussed and sought. OBJECTIVES: We sought to evaluate a formal written consent process for PPE and to explore students' views of this approach. METHOD: A survey tool was designed and distributed to all years 2 and 3 students in the Auckland University medical programme (2004). Results were analysed using univariate statistics and thematic analysis. RESULTS: The response rate was 57% (146/258). Most students had read the participant information sheet prior to signing, with 78% giving consent. They had not felt coerced and the in-course experience matched the 'promise'. Comments included: PPE gave insights into the 'patient's world', encouraged peer learning and raised some professional issues. More than 95% of students took the examination role at least once (less likely if female, P = 0.002). Some European, Maori and Pacific students never took the role; all Asian students did at least once. Students preferred PPE in groups consisting of 'friends'. The task influenced group composition by sex (P < 0.0001) but not ethnicity. DISCUSSION: Students accept and support a formal consent process. PPE participation rates are similar to predictions. The experience must match the promises made. Formal preparation alone might have produced similar student outcomes. Female students are more selective about tasks undertaken. The influence of ethnicity and the effect on future behaviour and attitudes needs further exploration.