The impact of clerkship model and clinical setting on medical student's participation in the clinical workplace: A comparison of rural LIC and rural block rotation experience.

PURPOSE: To compare the participation of rural Longitudinal Integrated Clerkship (LIC) and rural Block Rotation (BR) students in surgical clinical activities. METHODS: Third-year medical students from Deakin University's Rural Clinical Schools were invited to record their participation during clinical encounters with ten common surgical conditions, using a descriptive five-point progressive entrustment scale. Participation levels of LIC and BR students were compared for differences, according to clinical task and context. RESULTS: LIC students recorded greater active participation across all clinical tasks.Highest levels of active participation occurred in General Practice, a setting only LIC students were exposed to at this course stage. BR students recorded the majority of their surgical encounters in the hospital inpatient setting, where their involvement was predominantly observational. Both groups recorded high levels of participation in the Emergency Department. CONCLUSIONS: Active participation in clinical encounters with surgical patients was enhanced by participation in a LIC program and cannot be attributed to the rural context alone. Student participation is influenced by clinical context, presenting the opportunity to reconsider the design of clerkships to include models that facilitate active student participation. Further research is required to investigate the learner, supervisor and contextual factors influencing entrustment decisions within clerkships.

Medical Students Can Learn Surgery Effectively in a Rural Longitudinal Integrated Clerkship.

BACKGROUND: At Deakin University School of Medicine, compulsory formal teaching in Surgery occurs in year 3. This may occur as part of a rural longitudinal integrated clerkship (LIC), or in a traditional teaching hospital block rotation (BR). The purpose of this study was to compare these groups' exposure to surgical common conditions and their academic outcomes. METHODS: Part I: This was a survey of students' encounters with patients with common surgical conditions between 2016 and 2018. Self-reported data were collected describing the nature of the encounters and their clinical settings. Part II: All third year Surgery MCQ and OSCE results from 2011 to 2017 were analyzed. Students were deidentified and grouped according to whether they were in the LIC or BR programme. RESULTS: Part I: Thirty-eight third year students (20 LIC, 18 BR) submitted data for a total of 188 clinical encounters. Both groups encountered all nominated common surgical conditions, but the settings in which this occurred were different. BR students saw most patients as hospital inpatients whereas LIC student encounters were distributed across multiple clinical sites. Part II: A total of 942 (121 [26%] LIC and 821 [74%] BR) students' assessment results were analyzed. The groups performed similarly in the MCQ (p = 0.21) and OSCE (p = 0.16) examinations. CONCLUSIONS: Students who were taught surgery in a LIC program performed similarly to on their final exams to their peers in traditional clerkships, with self-reported student data indicating both groups encountered a similar range of conditions.

Palliative sedation.

The focus of palliative care is to relieve human suffering; however, about 90% of patients with advanced cancer will experience severe pain. Intolerable human suffering may be defined in the healthcare setting as symptoms that cannot be tolerated or endured for any length of time. If the patient is unable to communicate, the family or identified decision maker for the patient may decide when symptoms cannot be endured any longer. All dimensions (i.e., physical, psychological, social, emotional, and spiritual) of the symptom causing suffering must be evaluated.