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1.
Med Teach ; 45(8): 877-884, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36905609

RESUMO

PURPOSE: Progress tests (PTs) assess applied knowledge, promote knowledge integration, and facilitate retention. Clinical attachments catalyse learning through an appropriate learning context. The relationship between PT results and clinical attachment sequence and performance are under-explored. Aims: (1) Determine the effect of Year 4 general surgical attachment (GSA) completion and sequence on overall PT performance, and for surgically coded items; (2) Determine the association between PT results in the first 2 years and GSA assessment outcomes. MATERIALS AND METHODS: All students enrolled in the medical programme, who started Year 2 between January 2013 and January 2016, were included; with follow up until December 2018. A linear mixed model was applied to study the effect of undertaking a GSA on subsequent PT results. Logistic regressions were used to explore the effect of past PT performance on the likelihood of a student receiving a distinction grade in the GSA. RESULTS: 965 students were included, representing 2191 PT items (363 surgical items). Sequenced exposure to the GSA in Year 4 was associated with increased performance on surgically coded PT items, but not overall performance on the PT, with the difference decreasing over the year. PT performance in Years 2-3 was associated with an increased likelihood of being awarded a GSA distinction grade (OR 1.62, p < 0.001), with overall PT performance a better predictor than performance on surgically coded items. CONCLUSIONS: Exposure to a surgical attachment improves PT results in surgically coded PT items, although with a diminishing effect over time, implying clinical exposure may accelerate subject specific learning. Timing of the GSA did not influence end of year performance in the PT. There is some evidence that students who perform well on PTs in preclinical years are more likely to receive a distinction grade in a surgical attachment than those with lower PT scores.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Humanos , Avaliação Educacional/métodos , Aprendizagem , Estudantes , Currículo , Educação de Graduação em Medicina/métodos
2.
Educ Prim Care ; 34(4): 204-210, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37621057

RESUMO

BACKGROUND: Telehealth involves real-time communication (telephone or video-call) between patients and health providers. The COVID-19 pandemic propelled general practitioners to conduct most consultations remotely, seeing patients face-to-face only when required. Placement opportunities and experience for medical students were reduced. Initially online learning programmes replaced clinical attachments. Subsequently, clinical teachers supervised students to engage in remote consultations, either in clinics or from their homes. This study aimed to explore the experience of New Zealand general practitioners undertaking clinical teaching with medical students when telehealth consulting. METHODS: Semi-structured interviews with general practitioners who had taught medical students whilst consulting remotely. General inductive thematic analysis of transcribed interviews. RESULTS: Six female and four male participants aged 40 to over 65 years. Participants often focused on general practicalities of telehealth consultations and effects on the patient-doctor relationship, and needed direction to consider remote consultations with students, which added to the interactions. Four themes were identified: changes needed in teaching delivery format; direct comparison with face-to-face; challenges and advantages to remote teaching, each with subthemes. DISCUSSION: Clinicians needed to determine practical logistics and develop skills for both remote consulting and teaching. New format and structures of consultations needed planning. Differences from face-to-face teaching included scene-setting for the consultation and supervision factors. Telehealth teaching conferred new opportunities for learning but also challenges (e.g. consent, cues, uncertainty). Remote consultations are likely to remain a significant mode for doctor-patient interactions. Preliminary guidelines for teaching and learning using telehealth need to be developed and embedded into medical programmes and then evaluated.


Assuntos
Medicina Geral , Consulta Remota , Estudantes de Medicina , Humanos , Masculino , Feminino , Pandemias , Medicina Geral/educação , Medicina de Família e Comunidade
3.
Med Teach ; 44(9): 1015-1022, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35343860

RESUMO

INTRODUCTION: There is limited published research on medical students' perspectives of a significant interruption to their academic progression. This study sought to identify the factors that contribute to difficulties with academic progression and to understand how medical students successfully respond. METHODS: This interpretive phenomenological study reports on the findings from in-depth interviews of 38 final year medical students who had experienced a significant academic interruption. RESULTS: The two superordinate themes were: the factors contributing to the interruption and their experience of the interruption. Factors identified as contributing to the interruption were: workload, learning in medicine, motivation for medicine, isolation, adapting to local culture, health and external factors. Their experience of the interruption focused on stages of working through the process: 'what happened,' 'how it felt,' 'managing the failure,' 'accepting the failure' and 'making some changes.' DISCUSSION: Each factor affected how the participants reacted and responded to the interruption. Regardless of the origins of the interruption, most reacted and responded in a comparable process, albeit with varying timespans. These reactions and responses were in a state of fluctuation. In order to succeed many stated they shifted their motivation from external to internal, in direct response to the interruption, resulting in changed learning behaviours. CONCLUSIONS: The process of working through an interruption to academic progression for students may benefit from a model of interval debriefing, restorative academic and personal development support. Facilitation of this process could enable students to face an interruption constructively rather than as an insurmountable emotionally burdensome barrier. Medical schools could utilise these findings to implement further support strategies to reduce the number of significant academic disruptions.


Assuntos
Estudantes de Medicina , Humanos , Aprendizagem/fisiologia , Motivação , Estudantes de Medicina/psicologia
4.
Med Teach ; 44(10): 1081-1086, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-33969788

RESUMO

For every commencing cohort of medical students, a small but significant number will experience an interruption to their academic progression because of academic difficulties, health concerns or external influences outside of the students' control. During the process of researching the factors surrounding difficulties with academic progression, students told us many ways that they have learned from that experience, which then allowed most of them to graduate. This paper combines the shared experiences of students who have had an interruption, and those of the authors as medical educators.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Humanos , Aprendizagem
5.
Adv Health Sci Educ Theory Pract ; 25(3): 731-754, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31312926

RESUMO

Touch is an integral part of human life. Consequently, touching and being touched are also fundamental to healthcare practice. Despite a significant literature on touch, it is rarely conceptualized or discussed in terms of the student journey from layperson to practitioner. We chose to explore professional touch using the threshold concepts framework (TCF), which provides a theoretical model for exploring the way in which learners encounter, engage with and understand fundamental concepts in a discipline. This qualitative research synthesis (QRS) describes the use of the TCF to identify key issues involved in developing and using professional touch. Through a cross-professional analysis and synthesis of recent international literature, we aimed to identify key characteristics of the transitional journey for professional touch. Three orders of analysis were applied, employing a methodology described by Major and Savin-Baden (An introduction to qualitative research synthesis: managing the information explosion in social science research, Routledge, London, 2010). Following identification of threshold characteristics in the overall sample of articles, second order analysis revealed the nuances of professional touch associated with the characteristics. The final synthesis led to identification of five themes: touch as dialogue; being changed by touch; multiple boundaries of touch; multiple meanings of touch and influences on touch. Whilst providing support for some assertions within the literature, this QRS also offers new insights into the complexity of professional touch. Given the paucity of explicit learning and reflection around professional touch in training programmes of health professionals, the TCF reveals ways in which professional preparation might be improved to promote understanding of the role and impact of touch in practice.


Assuntos
Pessoal de Saúde , Profissionalismo , Tato/fisiologia , Humanos , Pesquisa Qualitativa
6.
Med Teach ; 42(4): 422-428, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31738610

RESUMO

Introduction: Experience in palliative medicine provides a beneficial learning opportunity for doctors-in-training. There is, however, a gap in understanding which aspects of learning are most useful, which are problematic and how learning can best be facilitated. This study addresses that gap using the 'threshold concepts' framework. Threshold concepts are critical points of learning, often unique to a discipline. The learning occurs within a transitional or 'liminal' space and has specific characteristics including being 'troublesome' and 'transformative.'Methods: A qualitative, exploratory study was carried using the threshold concept framework. Semi-structured focus group interviews were held with doctors-in-training who had undertaken a 6-month palliative medicine attachment. Data were analysed using a content analysis approach with deductive and inductive phases, in order to identify threshold concepts.Results: Five threshold concepts were identified. Two of these, 'emotional engagement' and 'communication management,' displayed all the typical characteristics of threshold concepts. This learning was highly valued by participants, had not occurred elsewhere in training and continued to influence practice.Conclusions: Specific threshold concepts were identified for doctors undertaking a palliative medicine placement. These highlights where specific supports are required for learning and can be used to inform curriculum design.


Assuntos
Medicina Paliativa , Competência Clínica , Currículo , Humanos , Aprendizagem , Pesquisa Qualitativa
7.
Educ Prim Care ; 31(1): 24-31, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31884886

RESUMO

Short, longer and programmatic rural attachments have developed in a number of medical programmes around the world. However, there is limited literature on the development of the underpinning learning outcomes to guide these attachments. Rural populations are commonly under-served and the specific needs and challenges of rural health care need to be emphasised, as well as encouraging future practice in these areas. Our aim was to produce common rural-specific learning outcomes, aligned with a rationalisation of existing guiding principles and objectives, for our medical student regional-rural programmes. This was achieved through a Delphi technique involving the relevant clinical teachers and supervisors. Forty-nine consenting participants collectively provided 72 learning outcomes which were synthesised down to 16. A consensus process was used to anonymously rate and then rank to reach consensus for the top four learning outcomes. The learning outcomes were placed within the theoretical framework of a 'pedagogy of place' based on rurality and triangulated with rural learning outcomes from an Australian study. The four final outcomes were resolved around two areas of 'place': geographical and developmental. The co-design approach enabled those involved in providing the rural exposure education to generate appropriate learning outcomes.


Assuntos
Educação de Graduação em Medicina/métodos , Saúde da População Rural/educação , Estudantes de Medicina , Técnica Delphi , Humanos , Aprendizagem , Nova Zelândia , Atenção Primária à Saúde/métodos
8.
BMC Med Educ ; 19(1): 69, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832630

RESUMO

BACKGROUND: Medical student wellbeing - a consensus statement from Australia and New Zealand outlines recommendations for optimising medical student wellbeing within medical schools in our region. Worldwide, medical schools have responsibilities to respond to concerns about student psychological, social and physical wellbeing, but guidance for medical schools is limited. To address this gap, this statement clarifies key concepts and issues related to wellbeing and provides recommendations for educational program design to promote both learning and student wellbeing. The recommendations focus on student selection; learning, teaching and assessment; learning environment; and staff development. Examples of educational initiatives from the evidence-base are provided, emphasising proactive and preventive approaches to student wellbeing. MAIN RECOMMENDATIONS: The consensus statement provides specific recommendations for medical schools to consider at all stages of program design and implementation. These are: Design curricula that promote peer support and progressive levels of challenge to students. Employ strategies to promote positive outcomes from stress and to help others in need. Design assessment tasks to foster wellbeing as well as learning. Provide mental health promotion and suicide prevention initiatives. Provide physical health promotion initiatives. Ensure safe and health-promoting cultures for learning in on-campus and clinical settings. Train staff on student wellbeing and how to manage wellbeing concerns. CONCLUSION: A broad integrated approach to improving student wellbeing within medical school programs is recommended. Medical schools should work cooperatively with student and trainee groups, and partner with clinical services and other training bodies to foster safe practices and cultures. Initiatives should aim to assist students to develop adaptive responses to stressful situations so that graduates are prepared for the realities of the workplace. Multi-institutional, longitudinal collaborative research in Australia and New Zealand is needed to close critical gaps in the evidence needed by medical schools in our region.


Assuntos
Consenso , Promoção da Saúde/métodos , Faculdades de Medicina , Estudantes de Medicina/psicologia , Austrália , Currículo , Humanos , Nova Zelândia , Avaliação de Programas e Projetos de Saúde , Critérios de Admissão Escolar
9.
J Appl Meas ; 19(4): 428-441, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30433884

RESUMO

The Revised Two-Factor Study Process Questionnaire (R-SPQ-2F) was developed in 1998 using the true score theory to measure students' deep approaches (DA) and surface approaches (SA) to learning. Using Rasch analyses, this study aimed to 1) validate the R-SPQ-2F's two-factor structure, and 2) explore whether the full scale (FS), after reverse scoring responses to SA items, could measure learning approach as a uni-dimensional construct. University students (N = 327) completed an online version of the R-SPQ-2F. The researchers validated the R-SPQ-2F by showing that items on the three rating scales (DA, SA, and FS) had acceptable fit; both DA and FS, but not SA, showed acceptable targeting function; and all three scales had acceptable reliabilities (0.74 - 0.79). The DA and SA scales, not the FS, satisfied the unidimensionality requirement, supporting the claim that student approaches to learning are represented by DA and SA as separate constructs.


Assuntos
Avaliação Educacional , Psicometria , Inquéritos e Questionários/normas , Adulto , Algoritmos , Avaliação Educacional/métodos , Avaliação Educacional/normas , Feminino , Humanos , Masculino , Modelos Estatísticos , Psicometria/métodos , Psicometria/normas , Estudantes/psicologia , Adulto Jovem
10.
Adv Health Sci Educ Theory Pract ; 22(3): 653-665, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27436352

RESUMO

Peer Physical Examination (PPE) is an educational tool used globally for learning early clinical skills and anatomy. In quantitative research, there are differences in students' preferences and actual participation in PPE by gender. This novel study qualitatively explores the effect that gender has on medical students' experiences of learning physical examination through PPE. We employ an interpretative approach to uncover the PPE experiences of students from a European, graduate-entry medical school. Volunteers participated in either individual or group interviews. The data were transcribed, de-identified and analysed using thematic analysis. There was evidence of gender inequity in PPE, with students describing significant imbalances in participation. Male students adopted roles that generated significant personal discomfort and led to fewer experiences as examiners. Assumptions were made by tutors and students about gender roles: male students' ready acceptance of exposure to be examined and female students' need to be protected from particular examinations. In contrast with the first assumption, male students did feel coerced or obliged to be examined. Students described their experiences of taking action to break down the gender barrier. Importantly, students reported that tutors played a role in perpetuating inequities. These findings, whilst relating to one university, have implications for all settings where PPE is used. Educators should be vigilant about gender issues and the effect that they may have on students' participation in PPE to ensure that students are not disadvantaged in their learning.


Assuntos
Educação de Graduação em Medicina/métodos , Grupo Associado , Exame Físico , Estudantes de Medicina/psicologia , Adulto , Competência Clínica , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pesquisa Qualitativa , Fatores Sexuais
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