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.

'More effort and more time.' Considerations in the establishment of interprofessional education programs in the workplace.

The argument for integrating interprofessional education (IPE) activities into the workplace has been made concurrently with the call for collaborative clinical practice. An exploratory case study investigation of existing activities in a large metropolitan health care network was undertaken to inform the development of future IPE initiatives. Purposive sampling invited clinicians involved in the design or delivery of workplace IPE activities to participate in a semi-structured interview to discuss their existing programs and the opportunities and challenges facing future work. Interviews were audiotaped, transcribed and thematically analysed. In total, 15 clinicians were interviewed representing medicine, nursing, occupational therapy, pharmacy, physiotherapy, psychology, social work and speech pathology. The IPE programs identified included one medical and midwifery student workshop, several dedicated new graduate or intern programs combining the professions and multiple continuing professional development programs. Three dominant themes were identified to inform the development of future work: clinician factors, organisational factors and IPE considerations. In addition to the cultural, physical and logistical challenges associated with education that integrates professions in the workplace, the time required for the design and delivery of integrated team training should be accounted for when establishing such programs. Considerations for sustainability include ongoing investment in education skills for clinicians, establishment of dedicated education roles and expansion of existing education activities.

Teaching teamwork: an evaluation of an interprofessional training ward placement for health care students.

The establishment of interprofessional teamwork training in the preprofessional health care curriculum is a major challenge for teaching faculties. Interprofessional clinical placements offer an opportunity for teamwork education, as students in various professions can work and learn together. In this sequential, mixed-method study, focus group and survey techniques were used to evaluate students' educational experiences after 2-week ward-based interprofessional clinical placements. Forty-five senior nursing, medicine, and other health care students cared for patients in hospital wards under professional supervision, with nursing-medicine student "teams" leading care. Thirty-six students attended nine exit focus groups. Five central themes that emerged about training were student autonomy and workload, understanding of other professional roles, communication and shared knowledge, interprofessional teamwork/collaboration, and the "inner circle", or being part of the unit team. The learning environment was described as positive. In a postplacement satisfaction survey (n=38), students likewise rated the educational experience highly. In practicing teamwork and collaboration, students were able to rehearse their future professional role. We suggest that interprofessional clinical placements be regarded as an essential learning experience for senior preprofessional students. More work is needed to fully understand the effect of this interactive program on students' clinical learning and preparation for practice.

A guide for interprofessional case presentations.

BACKGROUND: Opportunities for interprofessional learning (IPL) and the promotion of interprofessional (IP) communication at the undergraduate level are important goals of health science faculties. IPL activities with shared curriculum validity to promote full student engagement can be challenging to identify. Case presentations that focus on patient-centred learning are one type of activity that is likely to have clinical relevance to all undergraduate groups. Guiding students and facilitators on this approach using a structured framework is necessary to maximise the desired IPL outcomes. CONTEXT: The framework was informed by two settings. Firstly, by a large metropolitan health service that provided IP clinical placements (ICPs). Six 2-week placements in aged care rehabilitation were completed by medical, nursing and allied health students Secondly, by a an inner Melbourne private hospital where weekly IP case presentations were established. INNOVATION: The innovation was a framework developed by clinical teachers and academics across two health services to guide facilitators and students participating in an IP case presentation. IMPLICATIONS: This framework, highlighting both strategies for success and potential pitfalls, may provide a guide to teachers wishing to establish student IP case presentations within their health service or clinical placement context. The deployment and use of this framework may then provide a basis to evaluate IP case-based presentations for formative or summative student assessment.

Trying on the professional self: nursing students' perceptions of learning about roles, identity and teamwork in an interprofessional clinical placement.

AIM: This study aims to describe how senior nursing students viewed the clinical learning environment and matured their professional identity through interprofessional learning in a student-led hospital 'ward'. BACKGROUND: Undergraduate nursing and medical student teams participated in a trial of ward-based interprofessional clinical learning, managing patients over 2 weeks in a rehabilitation ward. METHODS: Qualitative and quantitative program evaluation was conducted using exit student focus groups and a satisfaction survey. RESULTS: Twenty-three nursing and medical students in three placement rounds provided positive feedback. Five main themes emerged describing their engagement in 'trying on' a professional role: 'experiencing independence and autonomy'; 'seeing clearly what nursing's all about'; 'altered images of other professions'; 'ways of communicating and collaborating' and 'becoming a functioning team'. CONCLUSIONS: Ward-based interprofessional clinical placements offer senior students authentic ideal clinical experiences. We consider this essential learning for future interprofessional collaboration which should be included in senior nursing students' education.

Prior experience of interprofessional learning enhances undergraduate nursing and healthcare students' professional identity and attitudes to teamwork.

BACKGROUND: How willing are today's medical, nursing and other healthcare students to undertake some of their studies as shared learning? There is a lack of evidence of students' views by discipline despite this being a priority task for higher education sectors. This study explored the views of nursing, midwifery, nursing-emergency health (paramedic), medical, physiotherapy and nutrition-dietetics students. METHODS: Senior undergraduate students from six disciplines at one university completed the Readiness for Interprofessional Learning Scale prior to participating in interprofessional clinical learning modules. RESULTS: For 741 students, the highest ranked response was agreement about a need for teamwork (mean 4.42 of 5 points). Nursing students held significantly more positive attitudes towards Teamwork/Collaboration, and were more positive about Professional Identity than medical students (p < .001). Midwifery and nursing-emergency-health students rejected uncertainty about Roles/Responsibilities compared with medical students (p < .001). One-third of all students who had prior experience of interprofessional learning held more positive attitudes in each of four attitude domains (p < .05). CONCLUSION: Overall, students' attitudes towards interprofessional learning were positive and all student groups were willing to engage in learning interprofessionally. Early introduction of IPL is recommended. Further studies should explore the trajectory of students' attitudes throughout the university degree.