Healthcare professionals' experiences with education in short term medical missions: an inductive thematic analysis.

BACKGROUND: Short-term medical mission (STMM) providers supplement healthcare delivery and education in low- and middle-income countries (LMIC). Despite numerous providers working in this space, the views of volunteers who contribute their time and skills to these programs are rarely sought. METHOD: A qualitative study of 24 volunteers for Pangea Global Health Education (Pangea) was undertaken using semi-structured interviews to better understand their perspectives on program design and delivery, personal and professional outcomes of their volunteer experiences and the resulting implications for STMM program design. An inductive thematic analysis of their responses was completed. Social constructionist theory was utilised to contextualise themes and implications for program design. RESULTS: Participants highlighted the importance of co-creation with local learners and staff, the necessity to understand clinical context and the importance of relating to culture in the advancement of patient care. They reported personal growth, including a better understanding of others, and identifying commonalities between people. Professionally, participants reported learning from their colleagues, including new medical content, as well as refining their teaching practices. They also reported learning from those they taught and respecting the resourcefulness of medical and nursing staff working in LMIC. CONCLUSION: STMM providers may benefit from co-creation with their learners in the development of health professional education programs. A deep understanding of local context and culture provides for a richer learning environment and enables sustainable long-term program delivery. Utilising a social constructionist framework enables a better understanding of cultural barriers, which inhibit group learning, including the tendency to maintain hierarchical divides; addressing these will allow for optimised patient care.

Blended (online and in-person) Women's Health Interprofessional Learning by Simulation (WHIPLS) for medical and midwifery students.

BACKGROUND: Blended teaching combines traditional in-person components (simulation-based training and clinical-based placement) with online resources. Due to the COVID-19 pandemic, we modified our Women's Health Interprofessional Learning through Simulation (WHIPLS) program - to develop core obstetric and gynaecological skills - into a blended teaching program. There is limited literature reporting the observations of blended teaching on learning. AIMS: To qualitatively evaluate the blended teaching program and explore how it contributes to learning. MATERIALS AND METHODS: This study was performed at Monash University in Melbourne, Australia. A total of 98 medical students and 39 midwifery students participated. Data were collected by written survey and analysed by authors using a thematic analysis framework. RESULTS: Students reported that in-person teaching remains a vital aspect of their curriculum, contributing an averaged 63.2% toward an individual's learning, compared with online. Five substantial themes demonstrate how students learnt and maximised education opportunities using a blended teaching program: 'low-pressure simulation environments', 'peer-assisted learning', 'haptic learning', 'scaffolded learning' and 'the impact of online discourse'. DISCUSSION: In-person teaching remains a cornerstone of obstetric and gynaecological clinical skills education, of which interprofessional simulation and clinical-based placement are key components. Teaching via online discourse alone, is not sufficient to completely replace and provide comparable learning outcomes, but certainly plays an important role to prime students' learning and to maximise in-person opportunities and resources. Our study reveals key pedagogies of a blended (online and in-person) learning program, providing further evidence to support its ongoing utility as a feasible and warranted approach to learning.

Impact of the COVID-19 pandemic on teaching and learning in health professional education: a mixed methods study protocol.

BACKGROUND: Due to the complex nature of healthcare professionals' roles and responsibilities, the education of this workforce is multifaceted and challenging. It relies on various sources of learning from teachers, peers, patients and may focus on Work Integrated Learning (WIL). The COVID-19 pandemic has impacted many of these learning opportunities especially those in large groups or involving in person interaction with peers and patients. Much of the curriculum has been adapted to an online format, the long-term consequence of which is yet to be recognized. The changed format is likely to impact learning pedagogy effecting both students and teachers. This requires a systematic approach to evaluation of online teaching and learning adaptation, in comparison to the previous format, where, in person education may have been the focus. METHODS: The proposed study is a broad based evaluation of health professional education in a major Australian University. The protocol describes a mixed methods convergent design to evaluate the impact of online education on students and teachers in health professional courses including Medicine, Nursing, Allied Health and Biomedical Science. A framework, developed at the university, using Contribution Analysis (CA), will guide the evaluation. Quantitative data relating to student performance, student evaluation of units, quantity of teaching activities and resource utilization will be collected and subjected to relevant statistical analysis. Data will be collected through surveys (500 students and 100 teachers), focus groups (10 groups of students) and interviews of students and teachers (50 students beyond graduation and 25 teachers, for long term follow up to 12 months). Application of CA will be used to answer the key research questions on the short term and long-term impact of online education on teaching and learning approaches. DISCUSSION: The protocol describes the study, which will be widely implemented over the various courses in Health Professional Education and Biomedical Science. It will evaluate how students and teachers engage with the online delivery of the curriculum, student performance, and resources used to implement these changes. It also aims to evaluate longitudinal outcome of student learning attributes and impact on graduate outcomes, which is poorly reported in educational literature.

Introduction of an interprofessional gynaecology surgical skills workshop for undergraduate medical and nursing students.

BACKGROUND: Medical and nursing students may feel under-prepared to perform basic surgical and gynaecology procedural skills. There also remains scope within undergraduate programs to integrate interprofessional education, and better prepare students for interprofessional collaboration to improve patient care. AIMS: A simulation-based gynaecology surgical skills workshop program was introduced for undergraduate medical and nursing students. The aim of this study was to explore students' perceptions of a simulation-based interprofessional gynaecological skills program, using students' pre- and post-workshop confidence in taught skills reported in a post-workshop questionnaire as an outcome measure. MATERIALS AND METHODS: One hundred and sixty undergraduate medical (n = 133) and nursing (n = 27) students attended the workshop program at a tertiary university in Melbourne, Australia. A survey was completed by all students immediately after the workshop, addressing students' perceptions of surgical education, the four skill-stations (gowning/gloving, suturing, intrauterine device insertion, and urethral catheterisation), and interprofessional education. A Wilcoxon signed-rank test was performed to compare students' pre- and post-workshop confidence scores. RESULTS: Most medical and nursing students (86%) agreed their course should provide more structured surgical education. There was a statistically significant increase in post-workshop self-reported confidence scores for medical and nursing students in all four taught skills. Confidence in interprofessional behaviours also improved in both cohorts, but the improvement in nursing students did not reach statistical significance. CONCLUSIONS: Simulation-based, interprofessional, gynaecological surgery skills workshops are practical and valuable additions to undergraduate medical and nursing curricula. Further research should explore long-term retention of procedural skills and changes in interprofessional attitudes in clinical practice.

Online interprofessional simulation for undergraduate health professional students during the COVID-19 pandemic.

This report describes the Obstetric and Neonatal Simulation (ONE-Sim) workshop run in a remote learning format for medical and midwifery students in an interprofessional setting during the COVID-19 pandemic. It explores the observation of students as participants in the online learning of using Personal Protective Equipment and simulation-based learning of perinatal emergency management. This was followed by their mutual interaction and reflections. This paper aims to understand the role of synchronous remote learning through simulation and its impact on interprofessional interactions. We describe the experience of medical and midwifery students with the ONE-Sim workshop, facilitated by medical (obstetric and neonatal) and midwifery educators. Formal thematic analysis will be performed as part of the ongoing study; however, initial direct observation demonstrated that students reacted positively to the online ONE-Sim workshop and engaged well with facilitators and peers. Students mutually interacted amongst themselves, shared their previous experiences, knowledge of roles as medical and midwifery practitioners and how they see themselves in those roles in a perinatal emergency setting. The initial observations demonstrate that interprofessional education delivered in an e-learning format can be useful and meaningful, and may be utilized across a number of specialties.

Medical student psychological distress and academic performance.

INTRODUCTION: The impact of medical student psychological distress on academic performance has not been systematically examined. This study provided an opportunity to closely examine the potential impacts of workplace and study related stress factors on student's psychological distress and their academic performance during their first clinical year. METHODS: This one-year prospective cohort study was performed at a tertiary hospital based medical school in Melbourne, Australia. Students completed a questionnaire at three time points during the year. The questionnaire included the validated Kessler psychological distress scale (K10) and the General Health Questionnaire-28 (GHQ-28), as well as items about sources of workplace stress. Academic outcome scores were aggregated and correlated with questionnaire results. RESULTS: One hundred and twenty six students participated; 126 (94.7%), 102 (76.7%), and 99 (74.4%) at time points one, two, and three, respectively. 33.1% reported psychological distress at time point one, increasing to 47.4% at time point three. There was no correlation between the K10 scores and academic performance. There was weak negative correlation between the GHQ-28 at time point three and academic performance. Keeping up to date with knowledge, need to do well and fear of negative feedback were the most common workplace stress factors. CONCLUSIONS: Poor correlation was noted between psychological distress and academic performance.

Embedding assessment in a simulation skills training program for medical and midwifery students: A pre- and post-intervention evaluation.

BACKGROUND: Simulation-based programs are increasingly being used to teach obstetrics and gynaecology examinations, but it is difficult to establish student learning acquired through them. Assessment may test student learning but its role in learning itself is rarely recognised. We undertook this study to assess medical and midwifery student learning through a simulation program using a pre-test and post-test design and also to evaluate use of assessment as a method of learning. METHODS: The interprofessional simulation education program consisted of a brief pre-reading document, a lecture, a video demonstration and a hands-on workshop. Over a 24-month period, 405 medical and 104 midwifery students participated in the study and were assessed before and after the program. Numerical data were analysed using paired t-test and one-way analysis of variance. Students' perceptions of the role of assessment in learning were qualitatively analysed. RESULTS: The post-test scores were significantly higher than the pre-test (P < 0.001) with improvements in scores in both medical and midwifery groups. Students described the benefit of assessment on learning in preparation of the assessment, reinforcement of learning occurring during assessment and reflection on performance cementing previous learning as a post-assessment effect. CONCLUSION: Both medical and midwifery students demonstrated a significant improvement in their test scores and for most students the examination process itself was a positive learning experience.

Interprofessional education and practice guide No. 9: Sustaining interprofessional simulation using change management principles.

Collaboration between teams is an essential component of patient safety in the complex ever-changing environment of healthcare. Collaborative practice requires training, which needs to start prior to registration for it to be established in the clinical workforce by graduation. Despite the perceived value and motivation of course coordinators, interprofessional training programs often struggle to sustain, due to various reasons related to logistics of timetabling, staff availability and/or absence of institutional support. We present a guide, outlining the lessons learned from implementing a sustainable change from our 6-year experience of the Women's Health Interprofessional Learning through Simulation (WHIPLS) program. The WHIPLS program was initially piloted to teach clinical skills in an interprofessional environment for pre-registration medical and midwifery students and has become a core component of the clinical curriculum. We describe the steps that were required to attain this outcome using the Kotter's 8-step plan for management change. The key lessons learned were identifying overlaps in course curriculum, planning for leadership and implementation, creating institutional "buy-in", aligning with national goals, focusing on the learner, translating into routine clinical practice, keeping the program simple, accepting innovation and considering a strategic evaluation.

Can we teach core clinical obstetrics and gynaecology skills using low fidelity simulation in an interprofessional setting?

Core clinical skills acquisition is an essential component of undergraduate medical and midwifery education. Although interprofessional education is an increasingly common format for learning efficient teamwork in clinical medicine, its value in undergraduate education is less clear. We present a collaborative effort from the medical and midwifery schools of Monash University, Melbourne, towards the development of an educational package centred around a core skills-based workshop using low fidelity simulation models in an interprofessional setting. Detailed feedback on the package was positive with respect to the relevance of the teaching content, whether the topic was well taught by task trainers and simulation models used, pitch of level of teaching and perception of confidence gained in performing the skill on a real patient after attending the workshop. Overall, interprofessional core skills training using low fidelity simulation models introduced at an undergraduate level in medicine and midwifery had a good acceptance.

Using the Endsley Model to Evaluate Simulation-Based Situation Awareness Training for Medical and Nursing Students in India: A Qualitative Analysis.

INTRODUCTION: Situation awareness (SA) training is a vital part of healthcare training, and opportunities to provide SA training to healthcare workers are limited in low- and middle-income countries. We aimed to analyze undergraduate medical and nursing students' perception of their understanding of SA through an interprofessional obstetric neonatal emergency simulation workshop (ONE-Sim) and subsequently evaluate their perceived changes in SA understanding using the Endsley model ( Hum Factors 1995;37(1):32-64). METHODS: Feedback on SA before and after the workshop was collected through questionnaire-based surveys. Thematic analysis was performed, with themes emerging from an inductive analysis followed by a deductive analysis using the Endsley model. RESULTS: The themes emerging from the inductive analysis included environmental awareness, evolving knowledge, skill development, and applicability to practice. These aligned with the 3 levels of SA in the Endsley model in the deductive analysis suggesting that participants transformed their perception, comprehension, and projection of SA after the workshop. CONCLUSION: Simulation-based education enhanced SA perception in obstetric and neonatal emergencies for medical and nursing students in a low- and middle-income country, and the Endsley model is a feasible framework to measure learner perceived changes in SA understanding through simulation-based education.

The utility of an interprofessional education framework and its impacts upon perceived readiness of graduates for collaborative practice. A multimethod evaluation using the context, input, process, product (CIPP) model.

BACKGROUND: Frameworks in higher education can support strategic curriculum change in complex systems. The impact of these frameworks in achieving their stated purpose is less known. An interprofessional education (IPE) framework and related multi-activity curriculum designed to develop health profession graduates with the requisite skills for collaborative care, was introduced in a large university, across eleven health professions. OBJECTIVE: To determine the utility of an interprofessional framework and impact upon perceived work readiness for collaborative practice. METHOD: A multimethod design using the context, input, process, product (CIPP) evaluation model was selected taking a social constructivist theoretical stance. Data collection included staffing allocation to IPE, curriculum audit, and reflections from representatives of all health professions courses offered at the institution. Data was analyzed using framework analysis. PARTICIPANTS: Interviews or focus groups were undertaken with academic Faculty (n = 13), recent graduates (n = 24) and clinical supervisors/employers of recent graduates (n = 17). RESULTS: The framework assisted the systematic implementation of interprofessional curriculum across the different health courses at the university. Collaborative work-ready learning outcomes were identified in graduates where targeted curriculum had been implemented across all four domains of the framework. Gaps identified in framework implementation were consistent with gaps identified in graduate knowledge and skills related to collaborative practice. The combination of formal university-based IPE and informal workplace learning as part of clinical placements contributed to achieving the desired learning outcomes. CONCLUSIONS: These findings offer insights into the use of shared frameworks to drive specific learning activities related to collaborative practice.

Using contribution analysis to evaluate health professions and health sciences programs.

Introduction/background: Course evaluation in health education is a common practice yet few comprehensive evaluations of health education exist that measure the impact and outcomes these programs have on developing health graduate capabilities. Aim/objectives: To explore how curricula contribute to health graduate capabilities and what factors contribute to the development of these capabilities. Methods: Using contribution analysis evaluation, a six-step iterative process, key stakeholders in the six selected courses were engaged in an iterative theory-driven evaluation. The researchers collectively developed a postulated theory-of-change. Then evidence from existing relevant documents were extracted using documentary analysis. Collated findings were presented to academic staff, industry representatives and graduates, where additional data was sought through focus group discussions - one for each discipline. The focus group data were used to validate the theory-of-change. Data analysis was conducted iteratively, refining the theory of change from one course to the next. Results: The complexity in teaching and learning, contributed by human, organizational and curriculum factors was highlighted. Advances in knowledge, skills, attitudes and graduate capabilities are non-linear and integrated into curriculum. Work integrated learning significantly contributes to knowledge consolidation and forming professional identities for health professional courses. Workplace culture and educators' passion impact on the quality of teaching and learning yet are rarely considered as evidence of impact. Discussion: Capturing the episodic and contextual learning moments is important to describe success and for reflection for improvement. Evidence of impact of elements of courses on future graduate capabilities was limited with the focus of evaluation data on satisfaction. Conclusion: Contribution analysis has been a useful evaluation method to explore the complexity of the factors in learning and teaching that influence graduate capabilities in health-related courses.

Start here- principles of effective undergraduate training.

Obstetric and gynaecology undergraduate training is an intense time for learners as they encounter various health conditions related to women's health and also learn about pregnancy care and birth. The experience is directed to familiarise students with basic clinical management of gynaecological conditions, also develop communication and related core examination and procedural skills. Similarly, midwifery training encompasses independent care of low-risk pregnant women and assist in care of high-risk pregnancy in partnership with obstetricians. Although its necessary to acquaint most learners with core clinical skills in obstetrics and gynaecology, learning opportunities on patients can be limited, due to the intrusive nature of women's health examination. Simulation Based Education (SBE) can facilitate learning hands-on clinical examination and procedural skills, using realistic part-task and high-fidelity simulators prior to approaching patients. This can apply to both medical and midwifery undergraduate training, further creating opportunities for professional interaction and shared learning space to facilitate interprofessional education. IPE has been shown to improve professional relationships in practicing clinicians. This learning pedagogy can be applied in the undergraduate setting as well, to decrease risk of conflict and appreciate roles of other interprofessional staff in future clinical practice. In this chapter we highlight some challenges faced by medical and midwifery undergraduates in their learning from a global perspective. We also describe some teaching and learning initiatives that can be applicable across various settings of obstetrics, gynaecology medical undergraduate and midwifery teaching with relevant case studies to facilitate new graduates preparedness for practice.

Perspectives of pregnant women during the COVID-19 pandemic: A qualitative study.

BACKGROUND: The current COVID-19 pandemic has been shown to have profound effects on pregnant women globally, particularly, on their psycho-social wellbeing. Despite this, there has been limited qualitative inquiry into the experiences of pregnant women during the pandemic. AIM: This original research aimed to study the perspectives of pregnant women in Australia in relation to the impact of the COVID-19 pandemic on their pregnancy experience. METHODS: A qualitative descriptive study design with semi-structured interviews was adopted. The study was performed in Melbourne, Australia. A total of fifteen interviews were conducted. Data was analysed thematically to develop major themes and subthemes. RESULTS: A total of four major themes were developed: support for a positive experience, impact on preparedness in pregnancy and beyond, facing uncertainty of a pandemic, and retaining resilience and optimism. CONCLUSIONS: The COVID-19 pandemic has affected the experience of pregnant women with potential to compromise their psycho-social wellbeing. The major themes identified in this study offer insight to organisations to develop woman-centred care during the pandemic and optimise the psycho-social wellbeing of pregnant women.

Student and Educator Perspectives of Adapting to Remote Health Professions Education: A Mixed-Methods Study.

During the COVID-19 pandemic, universities across the world transitioned rapidly to remote education. Engaging with a curriculum that has been transitioned from in-person to remote education mode is likely to impact how students and educators adapt to the changes and uncertainties caused by the pandemic. There is limited knowledge about individual differences in students' and educators' adaptability to remote education in response to the pandemic. This paper explored healthcare students' and educators' adaptability experiences to remote education. Drawing on pragmatism, a convergent mixed-methods design was adopted. Data were collected between May and August in 2020 using an online survey, followed by interviews with students and educators of five large health courses at an Australian research-intensive University. Data included 476 surveys and seven focus group interviews with 26 students, and 95 surveys and 17 individual interviews with educators. Results were interpreted through an integration of quantitative and qualitative elements from student and educator experiences. Findings indicated that students were less adaptable than educators. Whilst remote learning was less appealing than in-person learning, some students adapted well to the new learning environment. Limited social learning, transmissive pedagogy, and lack of technical and non-technical skills were identified as factors that impacted upon the experience of students and educators. Navigating the challenges associated with remote education provided students and educators with a unique opportunity to improve adaptability-an attribute critical for future uncertainties in healthcare practice.

Evaluation of online interprofessional simulation workshops for obstetric and neonatal emergencies.

Objectives: To explore student perceptions of learning and interprofessional aspects of obstetric and neonatal emergencies through online simulation-based workshops. Methods: This qualitative study was conducted at Monash University, Australia. Data were obtained from six separate online Obstetric Neonatal Emergency Simulation workshops held between May 2020 and August 2021. A total of 385 students attended and were invited to participate in the study by completing an online survey two-three weeks later. Of the attendees, 144 students completed the survey (95 medical, 45 midwifery), equating to a response rate of 37%. Survey responses were downloaded from online survey platform and separated into medical and midwifery responses. Thematic analysis of data was performed using a coding framework, resulting in development of themes and subthemes. Results: Main themes were adaptability, connectivism, preparedness for practice, experiential learning, learning through modelling and dynamics of online interaction. Students reported that online workshop was a useful alternative method to experience simulation-based learning, increase their readiness for clinical practice and foster positive interprofessional relationships. Consistent with existing literature evaluating similar in-person programs, midwifery students were most interested in interprofessional interaction (predominant theme: dynamics of online interaction), whilst medical students were more concerned with developing clinical skills (predominant themes: learning through modelling, experiential learning). Conclusions: Online learning may be a useful and convenient way of delivering interprofessional simulation-based education during the pandemic, in remote areas and as an adjunct to in-person teaching. Future studies should evaluate the impact of online learning with a mixed methods study and in comparison, to in-person programs.