The only chance for a 'bird's-eye view': General practice registrar experiences of direct observation.

BACKGROUND AND OBJECTIVES: Direct observation is a teaching and assessment method in general practice training, providing important and timely feedback to registrars on their clinical and consultation skills. Registrar perspectives on direct observation are essential for understanding its utility for learning. The aim of this study was to explore registrar experiences of direct observation to identify key considerations for using direct observation in general practice training. METHOD: In-depth semi-structured interviews were conducted with seven general practice registrars in Victoria, across different stages of training. Data were analysed thematically RESULTS: The main themes identified related to registrar engagement, supervisor engagement, practice engagement and training organisation engagement. DISCUSSION: Using the principles of adult learning and work-based learning, this study offers an understanding of the individual and workplace-based factors that affect registrar experience of direct observation and suggests some strategies for achieving best outcomes for registrar learning.

Ensuring best practice in genomics education and evaluation: reporting item standards for education and its evaluation in genomics (RISE2 Genomics).

PURPOSE: Widespread, quality genomics education for health professionals is required to create a competent genomic workforce. A lack of standards for reporting genomics education and evaluation limits the evidence base for replication and comparison. We therefore undertook a consensus process to develop a recommended minimum set of information to support consistent reporting of design, development, delivery, and evaluation of genomics education interventions. METHODS: Draft standards were derived from literature (25 items from 21 publications). Thirty-six international experts were purposively recruited for three rounds of a modified Delphi process to reach consensus on relevance, clarity, comprehensiveness, utility, and design. RESULTS: The final standards include 18 items relating to development and delivery of genomics education interventions, 12 relating to evaluation, and 1 on stakeholder engagement. CONCLUSION: These Reporting Item Standards for Education and its Evaluation in Genomics (RISE2 Genomics) are intended to be widely applicable across settings and health professions. Their use by those involved in reporting genomics education interventions and evaluation, as well as adoption by journals and policy makers as the expected standard, will support greater transparency, consistency, and comprehensiveness of reporting. Consequently, the genomics education evidence base will be more robust, enabling high-quality education and evaluation across diverse settings.

Twelve things we have learned from medical students during the Pandemic.

This article was migrated. The article was marked as recommended. While the COVID-19 pandemic has disrupted every aspect of modern life, including medical education, the response has been remarkable. Ingenuity and innovation have flourished in the face of adversity. An international community of practice has blossomed in response to the challenges posed by COVID-19. Communication and sharing of information have been a hallmark of this community. In Australasia, the Medical Education Collaborative Committee hosted a series of meetings and webinars which enabled educators from all Australian and New Zealand medical schools to share experiences, solutions and resources. This group is auspiced by the Medical Deans Australia and New Zealand, which is the peak body representing professional entry-level medical education, training and research. One of these webinars focused on the student experience, featuring a panel of Australasian medical students drawn from a range of medical schools. The discussion during this session was wide reaching, including topics such as communication, co-designing curriculum changes, the importance of compassion, innovative practice, and meaningful student participation in placements. The ideas drawn from the panel discussion augmented by rich audience participation form the basis of the twelve tips presented in this paper. While derived from the experience in Australia and New Zealand, the authors believe these lessons are likely to be relevant in other jurisdictions.

Trainees' perspectives of assessment messages: a narrative systematic review.

OBJECTIVES: This study was designed as a narrative systematic literature review of medical specialist trainees' perspectives of the assessment messages they receive in the context of clinical performance assessments. The aim of the study was to determine if trainees value the information they receive through the formats designed to promote their development and, if not, the reasons for this. METHODS: The authors searched the ERIC, EMBASE, Ovid MEDLINE and PsycINFO databases for articles published up to 16 June 2018 that present original data on trainees' perspectives of the assessment messages they receive in the context of work-based assessments (WBAs) and in-training assessments (ITAs) used within their training programmes. All authors screened 938 abstracts and 139 full-text articles were assessed after this. Descriptions of quantitative data and thematic analysis of qualitative data were used to present the opinions of trainees. RESULTS: Thirty-three articles met the inclusion criteria. Twenty-six articles (79%) described trainees' perspectives in the context of WBA and the remaining articles referred to ITA formats. Wide-ranging opinions were reported. The analysis categorised these into three themes: trainees value developmental assessment messages; trainees become disengaged when assessment messages are not developmental, and trainees' views depend on the environment, the assessor and themselves. Some trainees reported that the assessment messages were valuable and provided input on their performance to guide their development, but many disagreed. In particular, the trainee's own level of engagement with the assessments influenced his or her perspectives on the messages received. CONCLUSIONS: Trainees do not universally perceive that clinical performance assessments provide them with the valuable developmental input on their performance they were designed to do. Factors related to the environment, the assessor and themselves influence their perspectives.

Keeping mum in clinical supervision: private thoughts and public judgements.

CONTEXT: The seemingly obvious claim that people prefer to keep mum about undesirable messages - termed 'the MUM effect' - was initially reported in the psychology literature in the 1970s. More recently, it has been discussed in contexts including performance appraisals and the reporting of unsuccessful projects in workplace settings, but only sparsely in educational ones. We wished to review the published literature on the MUM effect in order to understand the implications for clinical assessment. METHODS: We performed a narrative literature review on the MUM effect and clustered findings together into three themes: those that describe what MUM behaviours look like, those that explore potential reasons for the MUM effect and those that consider factors that can influence MUM behaviours. RESULTS: This paper summarises the extensive literature on the MUM effect, including its manifestations and modifiers and discusses how the effect may be used to consider issues faced by many clinical supervisors faced with delivering 'negative' assessment messages to trainees. DISCUSSION: We suggest, that as a pervasive phenomenon, the MUM effect can both help to explain the difficulties that some assessors face when delivering undesirable messages (including feedback or ratings) and offer new insights in how to deal with such issues.

Novice students navigating the clinical environment in an early medical clerkship.

CONTEXT: The black box that is student learning in clinical environments is an ongoing research project. Our previous research showed that despite the time that students are given to learn with, about and from patients, some lack confidence for those encounters and see few patients. The study reported here investigated individual and environmental factors affecting medical students' self-directed learning time in hospital. METHODS: We studied second year students in the four-year postgraduate Melbourne Medical School programme as they undertook the first of their four 9-week hospital placements in medical wards. Each week approximately 10 hours of structured teaching is offered; the remaining time is spent in self-directed learning. Over six weeks, we observed 31 medical students and interviewed 17 of them. The interviews were subjected to content analysis procedures and the observation notes added contextual information to what was said in interviews. We considered the findings through the Experience-based Learning framework. RESULTS: We found four main themes in the data: finding and contacting patients challenges all students and overwhelms some; the educational design of the placement is a flawed navigational device providing inadequate clarity and security; the physical and social terrain of a large tertiary hospital is replete with obstacles making it easy for some students to stumble and retreat; finally, any positive connection with peers, staff and patients is empowering. CONCLUSIONS: This study throws light on to the uncertain path of the novice clinical learner illuminating both the intractable aspects of hospital environments and opportunities for pedagogical and affective supports that can compensate. The processes and conditions for self-directed learning time need attention in order to provide for a safe, efficient or successful clerkship experience for all students. Particular effort is needed to sensitively identify those individuals who struggle and suffer on the journey, and provide appropriate support.