Longitudinal evaluation of a pilot e-portfolio-based supervision programme for final year medical students: views of students, supervisors and new graduates.

BACKGROUND: Little is known about how best to implement portfolio-based learning in medical school. We evaluated the introduction of a formative e-portfolio-based supervision pilot for final year medical students by seeking views of students, supervisors and graduates on use and educational effects. METHODS: Students and supervisors were surveyed by questionnaire, with free text comments invited. Interviews were held with new graduates in their first Foundation Programme placement. RESULTS: Most students used the e-portfolio (54%) and met with their supervisor (62%) 'once or twice' only. Students had more negative views: 22% agreed that the pilot was beneficial, while most supervisors thought that e-portfolio (72%) and supervision (86%) were a 'good idea'. More students reported supervision meetings benefited learning (49%) and professional development (55%) than the e-portfolio did (16%; 28%). Only 47% of students felt 'prepared' for future educational processes, though graduates noted benefits for navigating and understanding e-portfolio building and supervision. Factors limiting engagement reflected 'burden', while supervision meetings and early experience of postgraduate processes offered educational value. CONCLUSION: Final year students have negative attitudes to a formative e-portfolio, though benefits for easing the educational transition are recognised by graduates. Measures to minimize time, repetition and redundancy of processes may encourage use. Engagement is influenced by the supervisor relationship and educational value may be best achieved by supporting supervisors to develop strategies to facilitate, and motivate self-directed learning processes in undergraduates.

A video analysis of clinical handovers between paramedics and emergency care staff.

AIMS: Studies examining communication during clinical handovers involving paramedics are rare. A recent National Institute of Health Research (NIHR) report has noted a significant gap in our knowledge and understanding of what happens during clinical handovers between ambulance services and emergency departments. This PhD study has used a video analysis to understand issues in communication and teamwork during these clinical handovers by examining cases of good practice. METHODS: A video analysis of 100 examples of handovers from different TV programmes, including 24 Hours in A&E and The Real A&E, was conducted. This methodology emphasised the capturing of real-world practice, without the limitation of semi-structured interviews which are reliant on recall of events. These examples highlighted how interprofessional teamworking and communication were conducted during these high pressured and complex situations. The videos were transcribed verbatim and idiosyncratically to show variances in the style of communication as well as the non-verbal actions used by the staff during the exchange of patient information. RESULTS: The emergent findings demonstrate a variety of interactional strategies that paramedics use when conducting handovers. These strategies often involved a paramedic team member drawing attention to themselves by stating they were ready to do the handover or loudly introducing the patient's name. This was typically followed by an account of the treatment the paramedic team provided and ended with questions from those receiving the handover. The questions asked by the receiving team would be about the treatment provided and during this exchange the paramedic team would justify the methods used in assisting the patient. When handovers were being taken for high-risk patients, for example 'haemorrhaging of a femoral artery', the structure of the handover changed. In such examples, the paramedic team were found to dictate how the receiving team handled continuation of treatment for the patient. CONCLUSION: The variations in handover examples that have been captured and analysed have been beneficial in understanding the interactions between paramedics and the emergency care team. Initial findings have shown how the structure of communication during handovers can be altered due to situational or contextual factors. These results have highlighted where potential improvements in communication can be made during handovers, which would subsequently increase patient safety and experience.