really good stuff
Clinical teaching with minimal and indirect supervision Ernesto A Figueir o-Filho, Eliana Amaral, DanetteMcKinley, Juanita Bezuidenhout & Ara Tekian What problems were addressed? In medical education, the adequate supervision of medical students is known to result in improved patient outcomes.1 However, this presents a challenge in clinical clerkships, in which faculty supervisors need to balance their time and resources. As such, the ability to provide indirect supervision to students – particularly in a setting in which the faculty member is not directly managing the student–patient encounter – is an important skill. Although minimal supervision of students presents a feasible solution to challenges in faculty supervision, it is unclear how such practices are perceived by patients and how they affect the learning experiences of students. To investigate this issue, this study examined patient and medical student perceptions of clinical teaching in a setting with minimal faculty supervision. What was tried? We performed a cross-sectional study with a sequential sample of obstetrics patients at an antenatal out-patient clinic. Questionnaires focusing on perceptions of students’ performance during the consultation were administered pre- and post-student consultation. In addition, patients were asked to write three words representing what they felt before and after the consultation. Students’ selfperceptions of their performance while consulting with patients were obtained through a questionnaire administered at the end of the process. An openended question requested students to write five words representing what they felt after consulting with patients with minimal clinical supervision. What lessons were learned? Of the 95 pregnant women studied, 95% knew that the student would perform routine antenatal care and would receive feedback from the supervisor following the consultation. They acknowledged that it was important for students to perform prenatal care as part of their training (85%). Before the consultation, 22% were not sure if they felt comfortable being examined by a medical student and 20% were unsure whether they could trust a student. After the consultation, 97% of patients felt comfortable about the examination and 99% felt they trusted the students. Of the pre-consultation descriptor words, ‘anxiety’ was the most frequently used word. ‘Calm’ and ‘satisfaction’ were the most frequently used post-consultation descriptors. Of the 77 students, 56% were in Year 5 of medical school and 44% were in Year 6. Students agreed
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that the ambulatory format with minimal faculty supervision encouraged their participation and engagement (82%). They felt that case discussions with faculty staff were useful (90%) and contributed to their learning (88%). The words ‘trust’, ‘secure’, ‘responsibility’ and ‘autonomy’ were the most representative of those used by students to express their feelings about meeting patients by themselves, supported by the outside supervision of the preceptor. Students expressed interest in knowing the opinions of the pregnant women about their performance in providing supportive medical care (92%) and confirmed that they would feel comfortable about being assessed by patients (84%). We observed positive patient feedback, and the perceptions of finalyear students regarding this out-patient clinical teaching method with minimal faculty supervision reinforced the potential to expand their autonomy. These findings may support additional assessments that incorporate patient perspectives into the overall clinical evaluation of students, which may improve the validity of the clinical assessment system. REFERENCE 1 Kilminster SM, Jolly BC. Effective supervision in clinical practice settings: a literature review. Med Educ 2000;34 (10):827–40. Correspondence: Ernesto A. Figueir o-Filho, Faculty of Medicine, Federal University of Mato Grosso do Sul, Rua Nagib Ourives 175, Caranda Bosque I, Campo Grande, Mato Grosso do Sul 79032-424, Brazil. Tel: 00 55 67 3345-7355; E-mail: [email protected] doi: 10.1111/medu.12440
Integrated pharmacy and medical student practical prescribing teaching Kathleen J Birley, John Moreiras, Caroline R Fertleman & Ian Bates What problems were addressed? Although doctors and pharmacists are expected to work closely together once qualified, there are currently few ways in which members of the two disciplines are able to integrate and understand one another’s roles. We wanted to provide prescribing teaching that would address the interprofessional aspects of learning to a joint group of undergraduate pharmacy and medical students. By working through practical problems in small mixed groups, we envisaged that, in addition to the benefits
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
really good stuff of collaborative learning, students would gain a better understanding of their future roles, which would aid interdisciplinary working relationships. What was tried? Selected medical students on a paediatric attachment and final-year pharmacy students were placed in mixed groups of approximately 30 students per group. Over the academic year, we conducted six 3-hour workshops on theoretical and practical aspects of prescribing. Students were split into smaller mixed groups and together worked through realistic prescribing scenarios. A workbook of scenarios and an accompanying slide show were prepared. These resources were developed by the present authors to allow the course to be taught by a variety of instructors, thereby improving its sustainability. The session was run in a teaching room in the medical school by a doctor and a pharmacist. At the end of each session, students were asked to complete a feedback form. We ran two mixed focus groups to allow students to comment on the usefulness of the teaching and resources. What lessons were learned? Both groups of students had little prior teaching on practical prescribing. All of the medical students (n = 43) and 86.6% of the pharmacy students (71/82) found the session relevant. Both sets wanted more prescribing teaching in their courses. The majority of those who did not consider the session relevant found it to be overly geared towards medical students. One of the challenges involved adjusting the curriculum to meet the needs of both student sets. Another difficulty involved the coordination of the teaching staff, students and administrators of two different courses. Numerous logistical difficulties arose. The drive of the authors helped to overcome this to some degree, but the issue creates problems in integrating the course into the curriculum on a long-term basis. Pharmacy students (91.7%) and medical students (94.6%) found it useful to learn in an interdisciplinary group, which represented a new experience for both sets of students. Students had little prior knowledge of one another’s roles. Some students revealed prejudices about the other group; some pharmacy students said they perceived doctors as ‘being intimidating’, and some medical students considered pharmacists to be overly oriented on ‘fault-finding’. The students felt the relaxed nature of the session helped to dispel stereotypes and considered it would improve future working relationships. Overall, the students felt the mixed sessions gave them a unique opportunity to work with other disciplines and understand the roles of different health
professionals. We were surprised by the extent to which student perceptions were altered by the session. Although there are logistical difficulties, this is a worthwhile endeavour and should be continued and integrated as a formal part of the joint undergraduate curriculum in this area and others. Correspondence: Kathleen J Birley, Flat 57, Vogans Mill Wharf, 17 Mill Street, London SE1 2BZ, UK. Tel: 07747873040; E-mail: [email protected] doi: 10.1111/medu.12447
Transgender history taking through simulation activity Richard E Greene, Ann R Garment, Allison Avery & Chelsea Fullerton What problem was addressed? Eliciting a thorough sexual history can be an intimidating experience for medical students, especially when it comes to transgender patients. Furthermore, most students do not encounter transgender patients until they are alone in an examination room or in the emergency department. In these high-pressure settings, students often become flustered and have difficulty applying classroom knowledge. Because of this, it is essential to build a realistic encounter in the preclinical years to prepare students to interact with transgender patients in a culturally competent manner. A clinical librarian conducted a comprehensive literature search; at the time of this writing, no such programme had been described. What was tried? As part of a larger simulation (SIM) activity about taking a sexual history, we piloted a case with standardised patients (SPs) who portrayed transgender patients coming in for general check-ups. The 18 students participating in the SIM were enrolled in their first course at medical school. Our intent was to give students a low-risk opportunity to take a sexual history from a transgender patient by removing obstacles such as patient distress or uncontrolled medical conditions. Students were asked to take a thorough sexual history in 10 minutes. In the case instructions, students were informed that the patient was transgender (some were male-to-female, others female-to-male) and had already agreed to talk with the student. We intentionally sought actors who identified as transgender and coached them prior to the SIM on the history of the patient in the case, the structure of a sexual history, and how to react to students who were struggling. Additionally, we instructed the
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
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Clinical teaching with minimal and indirect supervision Ernesto A Figueir o-Filho, Eliana Amaral, DanetteMcKinley, Juanita Bezuidenhout & Ara Tekian What problems were addressed? In medical education, the adequate supervision of medical students is known to result in improved patient outcomes.1 However, this presents a challenge in clinical clerkships, in which faculty supervisors need to balance their time and resources. As such, the ability to provide indirect supervision to students – particularly in a setting in which the faculty member is not directly managing the student–patient encounter – is an important skill. Although minimal supervision of students presents a feasible solution to challenges in faculty supervision, it is unclear how such practices are perceived by patients and how they affect the learning experiences of students. To investigate this issue, this study examined patient and medical student perceptions of clinical teaching in a setting with minimal faculty supervision. What was tried? We performed a cross-sectional study with a sequential sample of obstetrics patients at an antenatal out-patient clinic. Questionnaires focusing on perceptions of students’ performance during the consultation were administered pre- and post-student consultation. In addition, patients were asked to write three words representing what they felt before and after the consultation. Students’ selfperceptions of their performance while consulting with patients were obtained through a questionnaire administered at the end of the process. An openended question requested students to write five words representing what they felt after consulting with patients with minimal clinical supervision. What lessons were learned? Of the 95 pregnant women studied, 95% knew that the student would perform routine antenatal care and would receive feedback from the supervisor following the consultation. They acknowledged that it was important for students to perform prenatal care as part of their training (85%). Before the consultation, 22% were not sure if they felt comfortable being examined by a medical student and 20% were unsure whether they could trust a student. After the consultation, 97% of patients felt comfortable about the examination and 99% felt they trusted the students. Of the pre-consultation descriptor words, ‘anxiety’ was the most frequently used word. ‘Calm’ and ‘satisfaction’ were the most frequently used post-consultation descriptors. Of the 77 students, 56% were in Year 5 of medical school and 44% were in Year 6. Students agreed
530
that the ambulatory format with minimal faculty supervision encouraged their participation and engagement (82%). They felt that case discussions with faculty staff were useful (90%) and contributed to their learning (88%). The words ‘trust’, ‘secure’, ‘responsibility’ and ‘autonomy’ were the most representative of those used by students to express their feelings about meeting patients by themselves, supported by the outside supervision of the preceptor. Students expressed interest in knowing the opinions of the pregnant women about their performance in providing supportive medical care (92%) and confirmed that they would feel comfortable about being assessed by patients (84%). We observed positive patient feedback, and the perceptions of finalyear students regarding this out-patient clinical teaching method with minimal faculty supervision reinforced the potential to expand their autonomy. These findings may support additional assessments that incorporate patient perspectives into the overall clinical evaluation of students, which may improve the validity of the clinical assessment system. REFERENCE 1 Kilminster SM, Jolly BC. Effective supervision in clinical practice settings: a literature review. Med Educ 2000;34 (10):827–40. Correspondence: Ernesto A. Figueir o-Filho, Faculty of Medicine, Federal University of Mato Grosso do Sul, Rua Nagib Ourives 175, Caranda Bosque I, Campo Grande, Mato Grosso do Sul 79032-424, Brazil. Tel: 00 55 67 3345-7355; E-mail: [email protected] doi: 10.1111/medu.12440
Integrated pharmacy and medical student practical prescribing teaching Kathleen J Birley, John Moreiras, Caroline R Fertleman & Ian Bates What problems were addressed? Although doctors and pharmacists are expected to work closely together once qualified, there are currently few ways in which members of the two disciplines are able to integrate and understand one another’s roles. We wanted to provide prescribing teaching that would address the interprofessional aspects of learning to a joint group of undergraduate pharmacy and medical students. By working through practical problems in small mixed groups, we envisaged that, in addition to the benefits
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
really good stuff of collaborative learning, students would gain a better understanding of their future roles, which would aid interdisciplinary working relationships. What was tried? Selected medical students on a paediatric attachment and final-year pharmacy students were placed in mixed groups of approximately 30 students per group. Over the academic year, we conducted six 3-hour workshops on theoretical and practical aspects of prescribing. Students were split into smaller mixed groups and together worked through realistic prescribing scenarios. A workbook of scenarios and an accompanying slide show were prepared. These resources were developed by the present authors to allow the course to be taught by a variety of instructors, thereby improving its sustainability. The session was run in a teaching room in the medical school by a doctor and a pharmacist. At the end of each session, students were asked to complete a feedback form. We ran two mixed focus groups to allow students to comment on the usefulness of the teaching and resources. What lessons were learned? Both groups of students had little prior teaching on practical prescribing. All of the medical students (n = 43) and 86.6% of the pharmacy students (71/82) found the session relevant. Both sets wanted more prescribing teaching in their courses. The majority of those who did not consider the session relevant found it to be overly geared towards medical students. One of the challenges involved adjusting the curriculum to meet the needs of both student sets. Another difficulty involved the coordination of the teaching staff, students and administrators of two different courses. Numerous logistical difficulties arose. The drive of the authors helped to overcome this to some degree, but the issue creates problems in integrating the course into the curriculum on a long-term basis. Pharmacy students (91.7%) and medical students (94.6%) found it useful to learn in an interdisciplinary group, which represented a new experience for both sets of students. Students had little prior knowledge of one another’s roles. Some students revealed prejudices about the other group; some pharmacy students said they perceived doctors as ‘being intimidating’, and some medical students considered pharmacists to be overly oriented on ‘fault-finding’. The students felt the relaxed nature of the session helped to dispel stereotypes and considered it would improve future working relationships. Overall, the students felt the mixed sessions gave them a unique opportunity to work with other disciplines and understand the roles of different health
professionals. We were surprised by the extent to which student perceptions were altered by the session. Although there are logistical difficulties, this is a worthwhile endeavour and should be continued and integrated as a formal part of the joint undergraduate curriculum in this area and others. Correspondence: Kathleen J Birley, Flat 57, Vogans Mill Wharf, 17 Mill Street, London SE1 2BZ, UK. Tel: 07747873040; E-mail: [email protected] doi: 10.1111/medu.12447
Transgender history taking through simulation activity Richard E Greene, Ann R Garment, Allison Avery & Chelsea Fullerton What problem was addressed? Eliciting a thorough sexual history can be an intimidating experience for medical students, especially when it comes to transgender patients. Furthermore, most students do not encounter transgender patients until they are alone in an examination room or in the emergency department. In these high-pressure settings, students often become flustered and have difficulty applying classroom knowledge. Because of this, it is essential to build a realistic encounter in the preclinical years to prepare students to interact with transgender patients in a culturally competent manner. A clinical librarian conducted a comprehensive literature search; at the time of this writing, no such programme had been described. What was tried? As part of a larger simulation (SIM) activity about taking a sexual history, we piloted a case with standardised patients (SPs) who portrayed transgender patients coming in for general check-ups. The 18 students participating in the SIM were enrolled in their first course at medical school. Our intent was to give students a low-risk opportunity to take a sexual history from a transgender patient by removing obstacles such as patient distress or uncontrolled medical conditions. Students were asked to take a thorough sexual history in 10 minutes. In the case instructions, students were informed that the patient was transgender (some were male-to-female, others female-to-male) and had already agreed to talk with the student. We intentionally sought actors who identified as transgender and coached them prior to the SIM on the history of the patient in the case, the structure of a sexual history, and how to react to students who were struggling. Additionally, we instructed the
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
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