Patients as teachers: Evaluating the experiences of volunteer inpatients during medical student clinical skills training.

PURPOSE: Early patient encounters in medical education are an important element of clinical skill development. This study explores the experiences of volunteer inpatients (VIPs) participating in clinical skills training with junior medical students (JMS) solely for educational purposes. METHODS: Following first-year medical students practicing history taking and clinical examinations with VIPs at Toronto General Hospital (TGH) and Toronto Western Hospital (TWH), patients completed a questionnaire and a short audio-recorded interview. This study used a mixed methodological approach. A 5-point Likert-scaled survey queried satisfaction regarding the recruitment process, student and faculty interactions and patient demographics (e.g. age and educational background). A 10-minute follow-up interview investigated patient perspectives. Survey responses were correlated to patient demographics and descriptive thematic analysis summarized trends in patient perspectives. RESULTS: Of 93 consenting VIPs, 66% were male and 58% participated at TGH. The mean overall experience was positive (4.76 and 4.93 at TGH and TWH, respectively). Three themes emerging through thematic analysis were Not "Just" a Medical Student, Patient as Teacher, and Promoting Best Practices. VIPs reported positive experiences when they were adequately informed of the VIP role during recruitment, and when students exhibited confidence, interest, and respect throughout the session. CONCLUSION: Study results provide clarity about VIP experiences with JMS and lay a foundation for improved patient satisfaction and best practices within clinical skills curricula in the health professions.

OBJECTIF: L'exposition clinique précoce en éducation médicale est un élément important du développement des habiletés cliniques. Cette étude explore les expériences de patients hospitalisés bénévoles (PHB) qui participent à la formation sur les habiletés cliniques des étudiants de 1re année en médecine (ÉJM) à des fins purement éducatives. MÉTHODES: Après que les étudiants de première année aient effectué des anamnèses et des examens cliniques auprès de PHB à la Toronto General Hospital (TGH) et à la Toronto Western Hospital (TWH), les patients ont répondu à un questionnaire et ont fait une courte entrevue audio qui a été enregistrée. Cette étude a utilisé une approche méthodologique mixte. Un sondage basé sur l'échelle de Likert à 5 points a évalué le degré de satisfaction en ce qui a trait au processus de recrutement, aux interactions entre les étudiants et le corps professoral et aux caractéristiques démographiques des patients (p. ex. âge et niveau d'instruction). Une entrevue de suivi de dix minutes a permis d'examiner le point de vue des patients. Les réponses du sondage ont été mises en corrélation avec les caractéristiques démographiques des patients et une analyse thématique descriptive a résumé les tendances liées aux perspectives des patients. RÉSULTATS: Sur les 93 PHB consentants, 66 % étaient des hommes et 58 % d'entre eux ont participé à la TGH. En moyenne, l'expérience générale s'est avérée positive (4,76 et 4,93 à la TGH et à la TWH, respectivement). Les trois thèmes qui ont émergé de l'analyse thématique sont: pas « seulement ¼ un étudiant en médecine; le patient comme enseignant et, la promotion des pratiques exemplaires. Les PHB ont rapporté avoir eu des expériences positives lorsqu'ils étaient bien informés de leur rôle durant le recrutement et lorsque les étudiants faisaient preuve de confiance, d'intérêt et de respect tout au long de la session. CONCLUSION: Les résultats de l'étude apportent des clarifications en ce qui a trait aux expériences des PHB avec les étudiants en première année de médecine, et ils jettent les bases qui permettront d'améliorer la satisfaction des patients et les meilleures pratiques du programme de formation en habiletés cliniques dans les professions de la santé.

The role of "improv" in health professional learning: A scoping review.

Background: The use of improvizational theater ("improv") in health professional education ("medical improv") is an emerging field. However, optimal curricular design features and learning outcomes have not yet been systematically described. Objective: To synthesize evidence on learning outcomes and curricular design elements of improvizational theater training in health professions education. Methods: A literature search with keywords "Improv" and "Improvisational Theatre" was undertaken in January 2016 in Ovid MEDLINE, CINHAL, EMBASE, SCOPUS, Web of Science, and ERIC, with an accompanying gray literature search. Four authors coded and achieved consensus on themes relating to curricular design elements and learning outcomes, which were mapped onto the CanMEDS framework. Results: Seven articles met inclusion criteria. Key curricular design features included (i) facilitators with dual clinical and theater expertise; (ii) creating a low-stakes environment; and (iii) engaging in debrief to highlight clinical relevance. Improv curricula were found to impact most CanMEDS roles, including: Medical Expert (comfort with uncertainty); Leader (team management); Scholar (feedback, self-reflection); Communicator (empathy, active listening, non-verbal communication); Collaborator (culture of trust); and Professional (resiliency and confidence). Mechanisms by which improv may promote acquisition of these professional competencies, and the utility of improv in areas such as interprofessional team development, leadership, and wellness and resiliency are discussed.

Celebrating 10 Years of Undergraduate Medical Education: A Student-Centered Evaluation of the Princess Margaret Cancer Centre--Determinants of Community Health Year 2 Program.

Between 2000 and 2011, over 170 second-year medical students participated in a Determinants of Community Health (DOCH 2) project at Princess Margaret Hospital (PMH). Students undertook community-based research projects at the hospital or with PMH community partners involving activities such as producing a literature review, writing a research proposal, obtaining ethics approval, carrying out data collection and analysis, presenting their data to classmates and supervisors, and production of a final report. An electronic survey consisting of both quantitative and qualitative questions was developed to evaluate the PMH-DOCH 2 program and was distributed to 144 past students with known email addresses. Fifty-eight students responded, a response rate of 40.3%. Data analysis indicates that an increase in oncology knowledge, awareness of the impact of determinants of health on patients, and knowledge of research procedures increased participants' satisfaction and ability to conduct research following DOCH 2. Furthermore, the PMH-DOCH 2 program enhanced the development of CanMEDS competencies through career exploration and patient interaction as well as through shadowing physicians and other allied health professionals. In addition, some students felt their PMH-DOCH 2 projects played a beneficial role during their residency matching process. The PMH-DOCH 2 research program appeared to provide a positive experience for most participants and opportunities for medical students' professional growth and development outside the confines of traditional lecture-based courses.

Exploring internet needs and use among adolescents with haemophilia: a website development project.

Youth frequently access health information online, yet little is known about internet use among adolescents with haemophilia (AWH). A youth-centred, age-appropriate online programme is being developed to address the heightened educational needs of AWH as they transit from paediatric to adult care. To describe internet needs and use among AWH treated at the Hospital for Sick Children and determine the features that would make the website useable and desirable for this population. Semi-structured interviews addressed participants' internet use and thoughts about a website for AWH. The interviews were audio-recorded and transcribed verbatim. Three independent reviewers coded the data to determine descriptive categories and grouped them into themes. Eleven of 12 subjects approached consented to interviews. Data saturation was achieved. Most participants had used the internet to find haemophilia information, although none could recall specific websites they had visited for information. Some felt more comfortable using the internet than asking health care providers. Others liked the 24/7 availability of the internet if questions arose. Overall, they felt a website for AWH would help them to learn about haemophilia and explain it to others. Online social networking with an older peer mentor with haemophilia, as well as with others of their age was cited as a potentially valuable source of support. AWH are interested in a haemophilia website and have identified a variety of features which they believe may help to support them during transition to adult care and beyond. Website development is ongoing.

Informational stories: a complementary strategy for patients and caregivers with brain metastases.

OBJECTIVE: We compared the efficacy of a story-based writing style with that of a fact-based writing style for educational material on brain metastases. METHODS: Identical informational content on four topics-radiation therapy, side effects, steroid tapering, and palliative care-was constructed into equivalent story-based and fact-based materials. The content and reader preference for style were evaluated using a questionnaire of 20 + 1 items. Cancer patients and caregivers were invited to evaluate the materials. RESULTS: A total of 47 participants completed the questionnaire. The recorded preferences for facts, stories, or both were 42%, 7%, and 51% respectively (p = 0.0004). The fact-based materials were rated superior in providing factual information (for example, discussion of treatment, side effects) and selected general characteristics (clarity of information, for instance). A rating trend suggested that story-based materials were superior in describing "how it feels to have brain metastases" (21/40 fact-based vs. 26/43 story-based) and "how brain metastases affected a spouse" (17/41 fact-based vs. 21/47 story-based), and in being "sensitive to the frustrations of a patient with brain metastases" (25/40 fact-based vs. 30/44 story-based). CONCLUSIONS: Half the participants preferred to read both fact-based and story-based materials. A combined story-based and fact-based educational resource may be more effective in conveying sensitive information and should be further investigated.

Design characteristics that affect speed of information access and clarity of presentation in an electronic neuroanatomy atlas.

Functional Neuroanatomy, an interactive electronic neuroanatomical atlas, was designed for first year medical students. Medical students have much to learn in a limited time; therefore a major goal in the atlas design was that it facilitate rapid, accurate information retrieval. To assess this feature, we designed a testing scenario in which students who had never taken a neuroanatomy course were asked to complete two equivalent tests, one using the electronic atlas and one using a comparable hard copy atlas, in a limited period of time. The tests were too long to be completed in the time allotted, so test scores were measures of how quickly correct information could be retrieved from each source. Statistical analysis of the data showed that the tests were of equal difficulty and that accurate information retrieval was significantly faster using the electronic atlas when compared with the hard copy atlas (P < 0.0001). Post-test focus groups (n = 4) allowed us to infer that the following design features contributed to rapid information access: the number of structures in the database was limited to those that are relevant to a practicing physician; all of the program modules were presented in both text and image form on the index screen, which doubled as a site map; pages were layered electronically such that information was hidden until requested, structures available on each page were listed alphabetically and could be accessed by clicking on their name; and an illustrated glossary was provided and equipped with a search engine.

More than just a pamphlet: development of an innovative computer-based education program for cancer patients.

Patients with cancer continue to lack practical information regarding their illness and report low levels of awareness and use of patient services. The challenge to educators is to find cost-effective and timely ways to deliver a complex mix of interesting and high-quality information and expertise to this large and diverse audience, while still tailoring the content to individual needs and situations. In the present article, we describe the Princess Margaret Hospital (PMH) computer-based patient education program. The program is aimed toward empowering those dealing with cancer and provides comprehensive medical information and support via an interactive Intranet web site containing information about cancer (the Oncology Interactive Education Series), library resources, Internet links, information about PMH services, and a hospital calendar of events. Preliminary evaluation results have provided valuable direction for on-going program development and suggest that the program is easy to use, informative, and enjoyable for patients, families, volunteers, and health professionals.

Tyrosine hydroxylase-like immunoreactivity in the brain of fifth instar Rhodnius prolixus Stål (Hemiptera: Reduviidae).

The distribution of tyrosine hydroxylase-like immunoreactivity was mapped in whole-mount preparations of the brain of fifth instar Rhodnius prolixus Stål. Immunoreactivity was limited to neuronal cell bodies and processes, which were distributed over both ventral and dorsal surfaces of the CNS. The brain, excluding the optic lobes, contained about 160 tyrosine hydroxylase-like immunoreactive cells. Each optic lobe contained two groups of small round cell bodies, which were too numerous to count. The wide distribution of immunoreactivity suggests that tyrosine hydroxylase is present in neurons with diverse central functions. Tyrosine hydroxylase is the rate-limiting enzyme in catecholamine synthesis in vertebrates. A comparison of a map of the distribution of catecholamine-induced fluorescence obtained using the glyoxylic-acid technique (Flanagan; J. Insect Physiol. 30(9):697-704, 1984) with that generated for tyrosine hydroxylase reveals considerable overlap between the two systems, suggesting that tyrosine hydroxylase is used in the catecholamine pathway in this insect. The mapping of these reactive neurons is an important step for identification of unique tyrosine hydroxylase-containing neurons, and is our initial step in the analysis of identified catecholamine-containing neurons in R. prolixus.