Mentorship in health professions education - an AMEE guide for mentors and mentees: AMEE Guide No. 167.

This AMEE guide discusses theoretical principles and practical strategies for health professions educators to promote impactful mentoring relationships. Traditional definitions are challenged, distinctions are made between roles such as mentor, advisor, coach and sponsor. As educational environments change and options for professional development expand, we argue that the traditional dyadic format of mentoring alone will not help mentees to maximise their professional growth. Newer formats of mentoring are discussed in detail and their advantages and disadvantages compared. We use a variety of theoretical concepts to anchor the practice of mentorship: self-focussed and other-focussed motives; psychological safety; personal interpretive framework; Daloz model for balancing support and challenge; zone of proximal development; communities of practice; and development along multiple layers of competence. Recommended strategies for effective mentoring are based on extensive review of literature, as well as combined professional mentoring experiences of the authors. We use key principles from the theories described and phases of mentoring relationships as foundations for the suggested best practices of mentorship. Finally, we emphasise the role of mentees in their own professional development and provide tips for them on seeking mentors, expanding their mentoring network and taking the lead in setting the agenda during mentoring meetings and formulating action plans for their own advancement.

Development of affective learning in dietetics graduates: A qualitative longitudinal study.

BACKGROUND: The development of affective learning during healthcare student education is essential for professional practice. Current studies are limited to short-term studies with medicine and nursing students. Longitudinal studies are emerging; however, the research within allied health students remains scant. The present study investigates the value of simulation-based learning activities in relation to affective learning among dietetic students. METHODS: A double hermeneutic, interpretative phenomenological approach (IPA) approach was employed, followed by an analysis of the trajectory of participants' affective learning across three-interview time points via the application of Krathwohl's affective learning levels. RESULTS: The simulation developed affective learning in four of the six participants, specifically in relation to their view of themselves as practitioners and their understanding of their future responsibilities to patient care. Three key themes were identified in the participants: (1) feeling of workforce readiness, (2) valuing lifelong learning and (3) attitudes towards interprofessional teamwork. CONCLUSIONS: This IPA methodology described dietetic students' affective learning development as they transitioned to practice as graduate health professionals. Simulation-based learning is one activity that enhances students' learning in the affective domain and educators should consider its value within their programs.

Facilitating interprofessional affective learning in health professional students through digital client documentation: a comparison of simulation modes.

Digital Interprofessional Learning Client Documentation (D-IPL Client Docs) is an initiative designed to develop student interprofessional communication skills through electronic record writing and a virtual simulation (VS) or live virtual simulation (LVS) case conference. The aims of the study were to (a) identify whether D-IPL Client Docs supports student learning in the affective domain and (b) compare the learning outcomes for students participating in the VS versus the LVS case conference. Data were drawn from 83 Bachelor of Social Work students who had participated with other health professional students in the D-IPL Client Docs activities. The reflective journals submitted by this cohort of social work students were analyzed qualitatively and quantitatively using the Griffith University Affective Learning Scale. Qualitative analyses revealed that the activities enabled students in both groups to learn about themselves, their roles, and the roles of others, and the benefits of interprofessional collaboration in optimizing client outcomes. Quantitatively, the VS mode appeared to be more effective in supporting students to develop higher order affective learning; however, the effect size was small. Future studies should involve a larger sample size and include students from various professions to ascertain the transferability of findings.

Beyond communication training: The MaRIS model for developing medical students' human capabilities and personal resilience.

Purpose: Human capabilities in medicine, including communication skills, are increasingly important within the complex, challenging and dynamic landscape of healthcare. Supporting medical students to manage unavoidable role-related stressors adaptively may help mitigate the anguish that is too commonly reported among the profession. We developed a model, "MaRIS", underpinned by contemplative pedagogy, to support medical students to enhance their human capabilities, across all three domains of Bloom's taxonomy, and their personal resilience. It is the first to integrate Mindfulness, affective Reflection, Impactive experiences and a Supportive environment into medical curriculum design. Here, we describe the theoretical basis underpinning MaRIS and present a preliminary study to evaluate its impact on students' subjectively-rated capabilities.Materials and Methods: A questionnaire capturing self-ratings of competence, empathy and resilience, as well as impressions of their experiences, was administered to foundation year medical students before (T0), during (T1) and after delivery (T2).Results: Fifty-five students completed the survey at all time points. Mean scores for all domains increased significantly from T0 to T1 and from T0 to T2. Free-text comments suggest learning impact across the cognitive, psychomotor and affective domains.Conclusions: MaRIS appears to facilitate medical students' establishment of the foundations for building the human capabilities and personal resilience required for professional practice.

Twelve tips for organising speed mentoring events for healthcare professionals at small or large-scale venues.

Mentors play a critical role in the development of professionals, influencing their job satisfaction, career aspirations and evolving professional identity. A variety of mentoring models exist, each with distinct benefits and challenges. Speed mentoring, based on the concept of speed dating, provides mentees with opportunities to meet multiple mentors over a short time and pose focussed career development questions. At large-scale events such as the annual AMEE (Association for Medical Education in Europe) meeting, speed mentoring sessions can successfully connect aspiring, novice and mid-career educators with international educational leaders to facilitate transfer of valuable insights for professional growth. For some mentors and mentees, this might spur ongoing communications or even longitudinal relationships. In this paper, we aim to provide strategies for planning and implementing speed mentoring events, combining insights gained from the literature and our experience of organising speed mentoring at the 2019 AMEE meeting in Vienna. These tips will be useful to a variety of professionals planning to organise speed mentoring initiatives.

Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV.

Despite the life-preserving benefits of antiretroviral therapy (ART), some people living with HIV (PLHIV) delay, decline or diverge from recommended treatment while paradoxically being willing to use potentially dangerous substances, such as recreational drugs (RD) and complementary medicines (CM). During 2016 and 2017, interviews were conducted with 40 PLHIV, in Australia to understand drivers underpinning treatment decisions. While many believed ART to be effective, they expressed concerns about long-term effects, frustration over perceived lack of autonomy in treatment decisions and financial, emotional and physical burdens of HIV care. In contrast, they ascribed a sense of self-control over the use of RD and CM, along with multiple professed benefits. The perceived burden of ART emerged as a motivator for deviating from recommended treatment, while positive views towards RD and CM appear to justify use. This study may serve as guidance for the development of future strategies to address barriers to treatment uptake and adherence and subsequently health outcomes for PLHIV in Australia and elsewhere.

Medical student wellbeing - a consensus statement from Australia and New Zealand.

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.

Open book exams: A potential solution to the "full curriculum"?

In this Personal View article, as curriculum designers, we consider whether there is a place for open book exams in Medical School curricula. Specifically, at a time when medical teachers complain about the difficulties of delivering a full curriculum, we propose that open book assessment approaches may help to free up the curriculum as learners become less reliant on memorizing facts. Moreover deeper learning of higher level outcomes can be achieved and more authentic assessment approaches undertaken. We also look at the recent literature and consider reasons, both for and against open book exams, at theoretical and practical levels. Though there are potential challenges with delivering an open book exam, we conclude that the benefits appear to outweigh these difficulties. As part of a balanced assessment strategy it may be necessary and timely to adopt open book exams.

Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review.

In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.

Patient-reported impact of after-hours house-call services on the utilization of emergency department services in Australia.

Objectives: This paper explores, from the patients' perspective, the likely impact of the Australian after-hours house-call (AHHC) medical services on emergency department (ED) presentations. This has become imperative given the significant cost difference between patient presentations to either the AHHC or ED and their practical implications for health care funding. Design, setting and participants: A cross-sectional, self-reported survey of all 10 838 patients in Australia known to have patronized AHHC services over the last week of January 2016. Main outcome measure: The study used a validated, self-completion questionnaire, dispatched through a mixture of online and postal methods. Results: A total of 1228 questionnaires were returned, of which 1211 included all relevant sections of the survey (11.2% response rate). Four hundred and eighty-six patients (40.1%) indicated that they would have gone to the ED on the same day or night of their illness had the AHHC not been available, with the elderly (≥65) and children (<16) accounting for nearly two-thirds of these (64.6%). Following their AHHC consultations, 103 (8.5%) patients eventually attended the ED, meaning that the service prevented 383 patients from attending the ED, a decrease of 78.8%. Stratification based on location showed that this impact was seen across all states and territories in Australia where AHHC services exist, ranging from a reduction of 73.9% in Western Australia to 85.0% in Tasmania. Similarly, the impact cuts across all patient demographics, including age ranges, gender and social divides. Conclusions: Based on our respondents' reports, AHHC services appear to be associated with a reduction in ED visits in Australia, with the impact cutting across all regions and patient demographics.

Levels and predictors of patient satisfaction with doctor home-visit services in Australia.

BACKGROUND: The Australian after-hours house-call (AHHC) services has grown rapidly in the past few years. Even though recent studies have looked at aspects of the service as it concerns the medical personnel involved, no national study has explored patient satisfaction with the service. OBJECTIVE: This study aims to assess patient satisfaction with Australian AHHC services and its predictors, with the hope of improving quality and patient outcomes. The findings might also have international relevance, given the developing nature of the AHHC in most countries. METHODS: A cross-sectional survey of all 10838 patients known to have patronized the AHHC service in Australia over a 1-week period. The main outcome measure was the Patient Satisfaction Questionnaire 18 (PSQ-18). RESULTS: A total of 1228 questionnaires were returned. General Satisfaction (GS) level was found to be 85.2% (mean 4.16/5). Other Scales of Satisfaction, in decreasing order, were 'Financial Aspects, FA' (87.4%; 4.36/5), 'Communication, CM' (87.3%; 4.18), 'Technical Quality, TA' (82.1%; 4.09), 'Time Spent with Doctor, TSD' (77.7%; 3.91), 'Interpersonal Manner, IM' (75.7%; 3.87) and 'Accessibility and Convenience, A&C' (72.9%; 3.82). The major predictor of increased satisfaction was the time it took the doctor to arrive, with increased satisfaction on GS (T < 4 hours; P < 0.01), IM (T < 30 minutes; P = 0.03), FA (T < 2 hours; P = 0.01), TSD (T < 2 hours; P < 0.01) and A&C (T < 4 hours; P < 0.01). Other positive predictors of aspects of satisfaction included 'being a student', 'age of patient ≤ 16' and 'being Australian born', while 'being on a pension' was negatively associated with Communication (P = 0.03). No associations were found with gender, marital status, employment status, family income or having children in the household. CONCLUSIONS: This study concludes that satisfaction in Australian AHHC is high on all scales but recommends that the service providers should aim to attend to patients within 4 hours of their initial calls.

Development of a phenomenologically derived method to assess affective learning in student journals following impactive educational experiences.

BACKGROUND: Assessment of affective learning (AL) is difficult but important, particularly for health professional students, where it is intimately linked to the development of professional values. This study originally aimed to determine whether an emotionally impactive, extended, multimethod, interprofessional simulation experience enhanced the AL of senior medical students, compared to conventional seminars and workshops alone. This necessitated the development of a method to assess for the presence and quality of AL. METHODS: We developed a "double hermeneutic" method, derived from Smith's Interpretative Phenomenological Analysis, to identify examples of AL, according to Krathwohl's hierarchy ("receiving," "responding," "valuing," "organization," "characterization"), in the journals of students from each arm of a randomized educational trial. Three assessors rated the highest level of AL seen in each journal and then we compared ratings from the two study arms. RESULTS: A total of 135 journals were available for assessment (81 Intervention, 54 Control). The method proved to be effective in identifying and characterizing examples of uniprofessional and interprofessional AL. The median level identified in Intervention journals ("valuing") was significantly higher than Control journals ("responding," p < 0.0001). CONCLUSIONS: The method described provides a means to assess affective learning among health professional students. An extended, immersive simulation experience appears to enhance affective learning.

International consensus statement on the assessment of interprofessional learning outcomes.

Regulatory frameworks around the world mandate that health and social care professional education programs graduate practitioners who have the competence and capability to practice effectively in interprofessional collaborative teams. Academic institutions are responding by offering interprofessional education (IPE); however, there is as yet no consensus regarding optimal strategies for the assessment of interprofessional learning (IPL). The Program Committee for the 17th Ottawa Conference in Perth, Australia in March, 2016, invited IPE champions to debate and discuss the current status of the assessment of IPL. A draft statement from this workshop was further discussed at the global All Together Better Health VIII conference in Oxford, UK in September, 2016. The outcomes of these deliberations and a final round of electronic consultation informed the work of a core group of international IPE leaders to develop this document. The consensus statement we present here is the result of the synthesized views of experts and global colleagues. It outlines the challenges and difficulties but endorses a set of desired learning outcome categories and methods of assessment that can be adapted to individual contexts and resources. The points of consensus focus on pre-qualification (pre-licensure) health professional students but may be transferable into post-qualification arenas.

A randomised controlled trial of extended immersion in multi-method continuing simulation to prepare senior medical students for practice as junior doctors.

BACKGROUND: Many commencing junior doctors worldwide feel ill-prepared to deal with their new responsibilities, particularly prescribing. Simulation has been widely utilised in medical education, but the use of extended multi-method simulation to emulate the junior doctor experience has rarely been reported. METHODS: A randomised controlled trial compared students who underwent two, week-long, extended simulations, several months apart (Intervention), with students who attended related workshops and seminars alone (Control), for a range of outcome measures. RESULTS: Eighty-four third year students in a graduate-entry medical program were randomised, and 82 completed the study. At the end of the first week, Intervention students scored a mean of 75% on a prescribing test, compared with 70% for Control students (P = 0.02) and Intervention teams initiated cardiac compressions a mean of 29.1 seconds into a resuscitation test scenario, compared with 70.1 seconds for Control teams (P < 0.01). At the beginning of the second week, an average of nine months later, a significant difference was maintained in relation to the prescribing test only (78% vs 70%, P < 0.01).At the end of the second week, significant Intervention vs Control differences were seen on knowledge and reasoning tests, a further prescribing test (71% vs 63% [P < 0.01]) and a paediatric resuscitation scenario test (252 seconds to initiation of fluid resuscitation vs 339 seconds [P = 0.05]). CONCLUSIONS: The study demonstrated long-term retention of improved prescribing skills, and an immediate effect on knowledge acquisition, reasoning and resuscitation skills, from contextualising learning activities through extended multi-method simulation.

Gamification in pharmacy education: a systematic quantitative literature review.

OBJECTIVES: Gamification involves applying game attributes to non-game contexts and its educational use is increasing. It is essential to review the outcomes and the efficacy of gamification to identify evidence to support its use in pharmacy education. THIS ARTICLE: systematically and quantitatively reviews and evaluates the alignment of learning outcomes and the quality of peer-reviewed literature reporting gamification in pharmacy education. KEY FINDINGS: A literature search was undertaken in February 2022 using CINAHL Complete, MEDLINE, Science Direct, Scopus and ERIC databases, via keywords (game* OR gaming OR gamif*) AND pharmac* AND education. Google Scholar was searched using 'gamification of pharmacy education' and 'serious games in pharmacy education'. Data extracted included type of gamified intervention, mode of delivery, game fidelity, intended learning outcomes and outcomes reported. Quality assessments aligned with key aspects of the SQUIRE-EDU Reporting Guidelines. Of 759 abstracts and 95 full-text papers assessed, 66 articles met the inclusion criteria. They described gamification from 12 countries in the education of 8272 pharmacy and health professional students. Gamified interventions ranged from board games to immersive simulations, with escape rooms most frequently reported. Reporting quality was inconsistent, with observed misalignment between intended learning outcomes and outcomes reported, an apparent overreliance on student perceptions as primary data and a lack of reference to reporting guidelines. SUMMARY: Gamification is included in the curricula of many pharmacy degrees, across multiple subject areas. This review identified evidence gaps and reinforces the need for improved quality of gamification research, critical alignment of learning outcomes with evaluation, and use of reporting guidelines.

Virtualized Gamified Pharmacy Simulation during COVID-19.

Extended and immersive gamified pharmacy simulation has been demonstrated to provide transformative learning in pharmacy education, preparing graduates for real-world practice. An international consortium of universities has implemented local adaptations of the Pharmacy Game into their curricula. From early 2020, pharmacy academics modified the delivery of gamified simulation in response to the COVID-19 pandemic, while still aiming to deliver the important learning outcomes of enhanced communication, collaboration, confidence and competence. Australian universities went into full lockdown from March 2020, and the critical gamified simulation at Griffith University was delivered entirely virtually in 2020. An array of synchronous and asynchronous approaches and software platforms was employed, including Microsoft Teams, Forms and Stream plus the online interview platform Big Interview. These allowed for the simulation activities, including dispensing, counselling and clinical cases, to be conducted by students online. In 2021, Griffith University conducted hybrid delivery of its Pharmacy Game, balancing student participation both in person and online. Microsoft Power Apps was added to the hosting platform to enhance the simulation interface, and Power Virtual Agent artificial intelligence chatbots, with natural language processing, were used to enable asynchronous clinical interaction. The combination of learning technologies provided the means to deliver successful gamified simulation in the virtual and hybrid environments while still achieving outstanding learning outcomes from the capstone activity. This paper details the technologies used to virtualize the Australian Pharmacy Game and the analytics available to educators to assess student participation, engagement and performance.