Bronchoscopy Teaching Without a Gold Standard: Attending Pulmonologists' Assessment of Learners, Supervisory Styles, and Variation in Practice.

BACKGROUND: Despite the growing role of simulation in procedural teaching, bronchoscopy training largely is experiential and occurs during patient care. The Accreditation Council for Graduate Medical Education sets a target of 100 bronchoscopies to be performed during pulmonary fellowship. Attending physicians must balance fellow autonomy with patient safety during these clinical teaching experiences. Few data on best practices for bronchoscopy teaching exist, and a better understanding of how bronchoscopy currently is supervised could allow for improvement in bronchoscopy teaching. RESEARCH QUESTION: How do attending bronchoscopists supervise bronchoscopy, and in particular, how do attendings balance fellow autonomy with patient safety? STUDY DESIGN AND METHODS: This was a focused ethnography conducted at a single center using audio recording of dialog between attendings and fellows during bronchoscopies, supplemented by observation of nonverbal teaching. Interviews with attending bronchoscopists and limited interviews of fellows also were recorded. Interviews were transcribed verbatim before analysis. We used constant comparative analysis to analyze data and qualitative research software to support data organization and thematic analysis. Education researchers from outside of pulmonary critical care joined the team to minimize bias. RESULTS: We observed seven attending bronchoscopists supervising eight bronchoscopies. We noted distinct teaching behaviors, classified into themes, which then were grouped into four supervisory styles of modelling, coaching, scaffolding, and fading. Observation and interviews illuminated that assessing fellow skill was one tool used to choose a style, and attendings moved between styles. Attendings accepted some, but not all, variation in both performing and supervising bronchoscopy. INTERPRETATION: Attending pulmonologists used a range of teaching microskills as they moved between different supervisory styles and selectively accepted variation in practice. These distinct approaches may create well-rounded bronchoscopists by the end of fellowship training and should be studied further.

[Knowledge and attitude of medical students in Germany towards palliative care : Does the final year of medical school make a difference?]. / Wissen und Selbsteinschätzung in Bezug auf palliativmedizinische Fragestellungen bei Medizinstudierenden : Macht das praktische Jahr einen Unterschied?

BACKGROUND: The practical year (PY) during the final year of medical education is intended to deepen and broaden knowledge, skills, and abilities that were acquired during previous years of their studies. Against this background, this study pursues the question of how the knowledge of future physicians and their confidence in terms of cancer pain therapy and other palliative care issues develops during the PY. MATERIALS AND METHODS: At the end of the PY, students from two university hospitals completed a 3-part online questionnaire (self-assessment of the confidence, questions about palliative care knowledge, and assessment of palliative care training during the PY). These results are compared with previously published data from the same collective that had been collected at the beginning of the PY. RESULTS: Overall, 92 of 318 students participated (28.9 %). Less than 10 % of students said that they were more confident regarding palliative care topics at the end of their medical studies. Improvements in the self-assessment could only be observed in the recognition of and screening for cancer pain (increase from 36 % to 65%). With regard to the palliative care knowledge, only the knowledge of how to treat symptoms other than pain improved significantly; however, knowledge in this regard prior to the PY was particularly low (an increase from 25 % to 35 %, p < 0.05). In the only multiple-choice question about ethics, the correct answer rose slightly from 51 % (before) to 55 % (after the PY). Of participating students, 21% (prior to the PY 27 %) stated that not providing fluids to dying patients is a form of euthanasia. In terms of palliative care training, between 36 and 83 % of participants stated having insufficient opportunities to gain knowledge and experience on various topics in the treatment of patients with advanced and incurable diseases during their PY. CONCLUSION: In the present study, considerable deficits in confidence and knowledge regarding palliative care issues were also observed at the end of PY. Integration of palliative care into the medical school curriculums should be given special attention in terms of a longitudinal training of the PY.

Being a preceptor-a Nordic qualitative study.

BACKGROUND: Positive preceptor experiences enhance learning and even affect the decisions of students to remain in nursing. In light of this, nurse managers have a responsibility, besides maintaining staff competence, to assess whether preceptors live up to their professional obligations. AIM: The aim of this Nordic qualitative study was to gain a deeper understanding of the perceived experiences of preceptorship used to support undergraduate student nurses during their clinical education. METHOD: Data was collected through narrative interviews with 31 preceptors in Finland and Sweden before being analysed using a hermeneutical approach. FINDINGS: Preceptorship is all about teaching in a supportive environment with ethical dimensions uniting theory and praxis. A caring relationship is essential and the basis for student learning and development. CONCLUSION: The preceptors emphasise a caring relationship as the foundation for student learning. Moreover, preceptorship is an ethical issue, a responsibility that should be recognised by all stakeholders. The findings suggest that preceptorship should be examined from a new perspective. The ethical dimension must be recognised and linked to the further education of preceptors. Nurse managers are in a key position to lead for change.

Audiology: student perception of preceptor and fellow student ethics.

BACKGROUND: Health care professionals are expected to uphold high ethical standards. Recently, ethical practices in health care have received increased scrutiny and study in an effort to ensure that clinicians meet such high ethical standards in serving their patients and clients. The American Academy of Audiology's Code of Ethics establishes professional standards that allow for the proper discharge of an audiologist's responsibilities while maintaining the integrity of the profession. Under this code, student academy members are included and required to abide by the code, the same as practicing members. The code is composed of a preamble and eight principles. METHOD: The present study provides an overview of students' perceptions across a broad spectrum of ethical topics governing our profession. Specifically, this study examined audiology students' perceptions of preceptor ethics relating to these eight principles using an online survey. RESULTS: Responses were collected from 143 of 600 audiology students contacted and indicated that they believed that their preceptors consistently followed each of the eight principles. Results also indicated that students believe fellow students also behave ethically and that it is the primary responsibility of academic faculty, not preceptors, to teach ethics. CONCLUSION: It can be concluded that preceptors are perceived by their students to be acting with high ethical standards. However, more research and discussion may be needed to determine who should teach these ethics to students.

Perspectives on good preceptorship: A matter of ethics.

BACKGROUND: Clinical education is an essential part of the Bachelor's program in Nursing and a keystone of professional nursing education. Through clinical experiences, the student nurses acquire nursing knowledge and essential skills for professional practice. The preceptor plays a vital role in the development of student nurses becoming professional nurses. AIM: The aim of this Nordic qualitative study was to explore the experiences of good preceptorship in relation to undergraduate student nurses in clinical education from the perspective of the preceptors themselves. METHOD: Data were collected by narrative interviews with 27 preceptors in Finland and Sweden and analyzed using a hermeneutical approach. FINDINGS: A caring relationship, based on caring ethics, is seen as the foundation for learning and development. Moreover, a mutual respect is a prerequisite for fellowship and a good atmosphere. As such, encounters are characterized by reciprocity and mutuality. The preceptors have a deep sense of responsibility toward the students and the profession. Furthermore, the preceptors have an inner responsibility to guide the students into working life and to share their knowledge by acting as role models. CONCLUSION: The findings suggest that preceptorship should be examined through new lenses. Moreover, preceptorship is an ethical issue that should be recognized by all stakeholders.

Ethical concerns in the student/preceptor relationship: a need for change.

Nursing schools are required to ensure that the clinical and academic milieu prepares nurses not only to recognize but also to act on various ethical issues. As a result of our years teaching nursing ethics to undergraduate nursing students we have come to believe there is a disconnect between classroom teaching and students' experiences in practice. How then can nurse educators help nursing students not only to see the ethical components of their work but also to take the necessary steps to solve ethical dilemmas and challenge unethical practice? One such strategy is the use of preceptorship. In this paper, we set out to learn about nursing students' ethical encounters in the clinical area, specifically those within the preceptor/student relationship. To this end we conducted an integrative review and are weaving in Gesler's (1992) concepts who argued that ethical issues play out in our physical and social environments. We identified nine articles that describe students' perceptions of ethical problems in their relationships with preceptors. However, it was rare for the authors of these articles to label these as 'ethical' issues. The integrative review revealed first, that students describe ethical issues in their narratives, and second, their most common response to these issues is silence. We continue to be concerned that nursing students' classroom learning of ethics is disconnected from their everyday nursing practice. Further research and education implications are discussed and explored in this paper.

Moral issues in mentoring sessions.

This article describes the results of research that investigated whether student nurses identified the moral aspects of everyday nursing care situations and, if so, how they dealt with them. We intended to elucidate the role of mentoring situations in moral development. Student written documents reflecting discussions during mentoring situations were analysed quantitatively and qualitatively. The students studied in one of the three nursing schools involved in the research. In only a small proportion of cases (<13%) did the students identify the ethical questions in those situations. The results indicate that the nursing students rarely identified moral issues, implying that there was little conscious moral reflection and deliberation in their mentoring situations dealing with their problematic experiences during their internship. Additional competences will be required for session leaders in order to allow mentoring situations to play a more prominent role in moral development.

Keeping the center of nursing alive: a framework for preceptor discernment and accountability.

This research served to explicate the profile of the nurse preceptor and illuminate the knowledge that nurse preceptors accrue while teaching students in the final clinical practicum. The analysis of the descriptive survey, sent to approximately 770 preceptors, along with the interpretive analysis of 16 focus groups and 5 interviews, revealed understandings of discovering, learning, and engaging as central to the relational elements of professional discernment and accountability. Preceptor discernment is essential to ensuring competent nursing practice for student nurses preparing for entry-level practice. Dissemination of the findings is suggested through the creation of an educational framework reflective of, relevant to, and used by nurse preceptors that may be used in both practice and academic settings.

An Australian perspective: the art of being with students.

This article focuses on two nursing and midwifery tutors' subjective experiences of working with students. It considers the feelings and friendships that are built during the learning process, and the impact the experience has on the tutor. The emotional stresses, ethical dilemmas, and personal reflections that a tutor encounters while facilitating students' learning are also explored. Parse's Human Becoming Theory is proposed as an example of a theoretical framework on which to base the facilitation of nursing and midwifery students' learning experience, and is contrasted with the traditional model of nursing and midwifery education.