Simulation
Medical students’ perceptions of role models on clinical placements Louise Greenstock and Peter Brooks, Australian Health Workforce Institute, The University of Melbourne, Australia Elizabeth Malloy, HealthPEER, Monash University, Melbourne, Australia Patrick Fiddes, Peninsula Health, Melbourne, Australia Catriona Fraser, Medical Education Unit, The University of Melbourne, Australia
Clinical placements are often [medical students] first interaction with other health professionals
SUMMARY Background: Clinical placements have been reported as being challenging, demanding and rewarding for health professional students. For medical students, clinical placements are often their first interaction with other health professionals, who are often graduates. This study was designed to explore medical students’ experiences of a clinical placement, in which their
perceptions about role models from the same or other disciplines emerged. Methods: A total of three focus groups (n = 15) were conducted with medical students following the completion of their clinical placement rotation in palliative and rehabilitative settings. Findings: Role models and influential figures were key themes to emerge from the focus group data, reflecting an
underlying tension between the practitioners that the students wanted to learn from and the practitioners who were actually willing, and available, to teach and model certain clinical skills. Discussion: The extent to which doctors, nurses and allied health professionals were seen as role models became a central focus in exploring how the professional identity of students is influenced on clinical placement.
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Clinical placements provide opportunities for students to practise their clinical skills
INTRODUCTION
C
linical placements provide opportunities for students to practise their clinical skills whilst being appropriately guided and supervised.1 The extent to which students are fully able to embrace this experience depends on multiple factors, including the structure of the clinical placement, students’ social disposition and attitudes, their understanding of the placement’s learning objectives, and the attitudes and responsiveness of the health professionals around them.2,3 The receptivity and responsiveness of practising health professionals towards students may indicate their underlying understanding of the character-forming influence of being a professional role model.4 This reflects Hammick’s refinement of the important component of collaborative learning for achieving the goals of interprofessional education, recommending a reset of interprofessional education processes to ‘about, from and with’, where the ‘with’ becomes the prime component.5 This article reports the findings of a study exploring medical students’ responses to experiential learning opportunities whilst interacting with doctors, nurses and allied health professionals on clinical placement. The research question was: ‘How and why does the placement of medical students during their first clinical year into a clinical learning environment working with nurses and allied health professionals affect medical students’ knowledge of the roles, responsibilities and functions of, and alter behaviour toward, such staff?’
METHODS During their first clinical year, medical students were rotated in groups of three or four, working
either in pairs or singly, during 3–week clinical placements at a subacute hospital palliative and rehabilitative care facility. The academic coordinator informed the students that the aim for them was to undertake selfdirected experiential learning about, from and with health professionals other than the ward doctors. The learning process was predicated on the pedagogic theme of self-directed, adult education used at the university, and structured teaching was not provided. The researchers did not observe this briefing, nor were they involved in the clinical placement. Focus groups were conducted away from the clinical setting, separate from the students’ placement activities.
Participants were recruited from the cohort of 36 students undertaking this rotation during the academic year of 2011 (n = 15). There were no additional volunteers. Students were invited by e–mail to participate in one of three focus groups held in March, May and August 2011, and were informed that their attendance was not compulsory. A focus group approach was selected to enable discussion within the groups. It is possible that the sample size may have been different if students had been invited to individual interviews. Students who did volunteer were given a full briefing and reminded of their full ethical rights, and were advised that the research was given full ethical approval by
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108 105
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The extent to which doctors and other health professionals were seen as role models became a central focus
the Human Research Ethics Committee at the University of Melbourne (HREC 1034874.1 /05.10.10). The focus groups were facilitated by two researchers who adopted a semi-structured approach, and loosely followed a focus group topic guide. The topic guide is shown in Box 1. The raw data were transcribed and anonymised; a thematic analysis commenced with coding by highlighting passages of data and labelling them with a node.6 Coding was undertaken by three researchers independently (L.G., E.M. and C.F.), facilitated by QSR NVivo2 data management software. The list of nodes was consolidated by grouping nodes of similar meaning, which became the emerging themes that were then further refined.
FINDINGS AND DISCUSSION In this short report, the themes arising from the qualitative data
Table 1. Themes arising from the analysis Theme 1
Theme 2
Theme 3
Placement properties
Ways of learning
Professional socialisation
• • Observational • The setting • learning • Structure and timing • Students’ evaluation • Self-initiated learning • No formal assessment of the clinical • of learning placement
analysis are briefly introduced in Table 1. On any clinical placement the medical student is surrounded by qualified health professionals of the same and different professions. Professional role models are seen as both knowledge facilitators and powerful contributors to identity formation among student health professionals.7 The extent to which doctors and other health professionals were seen as role models became a central focus as themes emerged from the pilot study data.
Box 1. Loosely followed focus group topic guide, indicative of the questions posed to focus group participants 1. Could you please provide a brief summary of the placement – what was the clinical focus? Have you completed any other placements? 2. Would anyone in the group like to comment on the possible benefits and outcomes of their learning at [the placement facility]? 3. Could you please describe the interactions you had with nurses or allied health professionals? 4. Could members of the group please explain whether they feel their perceptions of the roles and responsibilities of the health professionals have altered? 5. Could members of the group comment on what they think is the best time to learn with, from, and about nurses and allied health professionals? 6. Could members of the group comment on whether shared/interprofessional learning (if you feel you experienced any) assisted the development of communication skills and/or patient care? 7. Would anyone in the group like to comment on whether they feel that shared learning helps medical student learning, or not? 8. Could members of the group please comment on whether they feel that the period of learning at [the placement facility] has had any influence on the development of the way you might practice as a doctor? 9. Do you feel that you modelled your supervisors at all?
Role models Development of professional identity Working together for the patient
Some of the medical students reported that they sought opportunities to observe other health professionals; however most of the medical students reported that they were there to learn from doctors.
Every time you see a doctor do something good or do something bad, you think oh I want to do that, or I don’t want to do that. Focus Group 2 You never actually go see what the physio is doing, but you learn from other doctors. Focus Group 3 Pitkala highlighted that in many cases credibility among teachers was paramount for students, and that ‘non-doctors’ have been rejected as potential role models.2 What was more evident in this study was, as Reeves et al. argued, ‘medical students were expecting the ward to provide them with a profession-specific experience of working as a junior doctor’.8
The students tend to want to just attach themselves to the doctors and the consultants and learn from them, rather than trying to ask a social worker whether they could follow them. Focus Group 3
106 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108
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We are studying medicine and I personally tend to try to emulate what the doctor’s doing. Focus Group 1 This was not true of all students, however, and there were positive accounts of the impact of other health professionals in facilitating learning. Nurses and allied health professionals were portrayed by some students as ‘active teachers’ in the placement, just as much if not more than doctors, despite the fact that most of their universitybased lecturers were doctors. Reeves et al. argued that, in reality, students could not always depend on profession-specific facilitators for support, a finding mirrored in this study.8 In some cases, students reported that the nurses and allied health professionals were more willing, or had more opportunity, to adopt the role of the teacher in certain scenarios. The extent to which the medical student learned from the health professionals around them appeared to depend, then, on the disposition and availability of both the student and the health professionals in the setting. Some students’ accounts indicated that their expectations of teaching in the setting were not always in alignment with what and who was available. In particular, they highlighted that the ‘busyness’ of doctors acted as an impediment to productive learning encounters.
Because the doctors were quite busy or stressed or something, I spent a lot of my time talking to the nurses. Focus Group 3 Quite a few times the physio used to explain to me what was going on. Focus Group 2 Many of the students expressed that they focused on the need to meet profession-specific
curricular milestones and pass examinations in order to satisfy course requirements. This ‘strategic approach’ has been cited in other studies, which have also demonstrated a fear of failing among medical students and the effects of academic pressures on the behaviour of students.9
We’re just trying to acquire all that medical knowledge. Focus Group 1 We [also] have so much other stuff that’s more important at this moment – like studying for exams. Focus Group 3 This pressure to meet examination requirements influenced their responses to learning opportunities involving nurses and allied health professionals.
If your priorities aren’t matching, of course you’re going to pick your own and that’s when tensions arise. Focus Group 2 Baernstein et al. argued that it is the responsibility of medical schools to ensure that students are exposed to appropriate role models who demonstrate the ‘ideals of professionalism’, and work with students over longer periods of time.10 This approach was referred to as the ‘informal professionalism curriculum’, but it was not clear in Baernstein’s study whether these role models should be exclusively of the same discipline as the students.10 There appeared to be a tension emerging between the influential figures that students wanted to learn from and who was available and willing to teach them in the setting. The skills that students acquire may depend on the behaviours demonstrated by the health professionals whose behaviour they model.4
Medical students may desire direction from the busy doctor, but actually have more interaction with the seemingly available and accessible nurses and allied health professionals. This may be because some doctors are not as willing or able to protect designated time for reflection and discussion with students,4 and indicates that insufficient importance has been placed on role-modelling when students are present. Expectations for students to initiate learning opportunities with non-medical staff may be seen as unrealistic and unfair; however, the clinical learning philosophy of their university is one of self-directed learning, and is consistent with the study objective.
The ‘busyness’ of doctors acted as an impediment to productive learning encounters
Limitations The limitations of this study stem from the small sample size, the variable level of staff understanding of the clinical placement objectives and the students’ focus on assessment rather than experiential learning.
CONCLUSION The findings from this pilot study reinforce the idea that a number of important factors intersect to provide students with meaningful, challenging and purposeful clinical experiences. Students reported that non-medical staff were often more available, willing and able to participate in learning opportunities than medical staff. However, the focus of students was still on medical staff teachers, reflecting their preoccupation with a narrow professionalisation goal and summative assessment to get them there. The results call for a further examination of how medical students are socialised in both the preclinical environment and their clinical workplace to achieve the learning that is essential to promote teamwork. How medical students make decisions about what to prioritise in their learning, and how they access the capability of others to contribute
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108 107
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Rich and underutilised sources of clinical workplace learning opportunities exist
to their practice development, requires further study. This research confirms that rich and underutilised sources of clinical workplace learning opportunities exist, and are readily available from non-medical health professionals. The challenge remains in how to convince students that it is worth investing in these activities. REFERENCES 1. Barnett T, Cross M, Shahwan-Akl L, Jacob E. The evaluation of a successful collaborative education model to expand student clinical placements. Nurse Educ Pract 2010;10:17–21. 2. Pitkala K, Mantyranta T. Professional socialisation revised: medical students’ own conceptions
related to adoption of the future physician’s role—a qualitative study. Med Teach 2003;25:155–160. 3. Drolet B, Rodgers S. A Comprehensive Medical Student Wellness Program—Design and Implementation at Vanderbilt School of Medicine. Acad Med 2010;85:103–110. 4. Cruess S, Cruess R, Steinert Y. Role modelling – making the most of a powerful teaching strategy. BMJ 2008;336:718–721. 5. Hammick M, Olckers L, CampionSmith C. AMEE guide no. 38: Learning in interprofessional teams. Med Teach 2009;31:1–12. 6. Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook (2nd edn). Thousand Oaks, CA: Sage, 1994.
7. Weaver R, Peters K, Koch J, Wilson I. ‘Part of the team’: professional identity and social exclusivity in medical students. Med Educ 2011;45:1220–1229. 8. Reeves S, Freeth D, McCrorie P, Perry D. ‘It teaches you what to expect in future’: interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students. Med Educ 2002;36:337–344. 9. Moffat KJ, McConnachie A, Ross S, Morrison JM. First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004;38:482–491. 10. Baernstein A, Amies Oelschlager A, Chang T, Wenrich M. Learning Professionalism: Perspectives of Preclinical Medical Students. Acad Med 2009;84:574–581.
Corresponding author’s contact details: Dr Louise Greenstock, Level 3, 766 Elizabeth Street, Parkville, Victoria 3010, Australia. E-mail: lgreens@ unimelb.edu.au
Funding: This research was funded by a grant from the Collier Charitable Fund. Conflict of interest: None. Ethical approval: This research was given full ethical clearance by the Human Research Ethics Committee at the University of Melbourne Research Office. doi: 10.1111/tct.12063
108 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108
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Medical students’ perceptions of role models on clinical placements Louise Greenstock and Peter Brooks, Australian Health Workforce Institute, The University of Melbourne, Australia Elizabeth Malloy, HealthPEER, Monash University, Melbourne, Australia Patrick Fiddes, Peninsula Health, Melbourne, Australia Catriona Fraser, Medical Education Unit, The University of Melbourne, Australia
Clinical placements are often [medical students] first interaction with other health professionals
SUMMARY Background: Clinical placements have been reported as being challenging, demanding and rewarding for health professional students. For medical students, clinical placements are often their first interaction with other health professionals, who are often graduates. This study was designed to explore medical students’ experiences of a clinical placement, in which their
perceptions about role models from the same or other disciplines emerged. Methods: A total of three focus groups (n = 15) were conducted with medical students following the completion of their clinical placement rotation in palliative and rehabilitative settings. Findings: Role models and influential figures were key themes to emerge from the focus group data, reflecting an
underlying tension between the practitioners that the students wanted to learn from and the practitioners who were actually willing, and available, to teach and model certain clinical skills. Discussion: The extent to which doctors, nurses and allied health professionals were seen as role models became a central focus in exploring how the professional identity of students is influenced on clinical placement.
104 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108
tct_12063.indd 104
3/6/2014 2:43:45 PM
Clinical placements provide opportunities for students to practise their clinical skills
INTRODUCTION
C
linical placements provide opportunities for students to practise their clinical skills whilst being appropriately guided and supervised.1 The extent to which students are fully able to embrace this experience depends on multiple factors, including the structure of the clinical placement, students’ social disposition and attitudes, their understanding of the placement’s learning objectives, and the attitudes and responsiveness of the health professionals around them.2,3 The receptivity and responsiveness of practising health professionals towards students may indicate their underlying understanding of the character-forming influence of being a professional role model.4 This reflects Hammick’s refinement of the important component of collaborative learning for achieving the goals of interprofessional education, recommending a reset of interprofessional education processes to ‘about, from and with’, where the ‘with’ becomes the prime component.5 This article reports the findings of a study exploring medical students’ responses to experiential learning opportunities whilst interacting with doctors, nurses and allied health professionals on clinical placement. The research question was: ‘How and why does the placement of medical students during their first clinical year into a clinical learning environment working with nurses and allied health professionals affect medical students’ knowledge of the roles, responsibilities and functions of, and alter behaviour toward, such staff?’
METHODS During their first clinical year, medical students were rotated in groups of three or four, working
either in pairs or singly, during 3–week clinical placements at a subacute hospital palliative and rehabilitative care facility. The academic coordinator informed the students that the aim for them was to undertake selfdirected experiential learning about, from and with health professionals other than the ward doctors. The learning process was predicated on the pedagogic theme of self-directed, adult education used at the university, and structured teaching was not provided. The researchers did not observe this briefing, nor were they involved in the clinical placement. Focus groups were conducted away from the clinical setting, separate from the students’ placement activities.
Participants were recruited from the cohort of 36 students undertaking this rotation during the academic year of 2011 (n = 15). There were no additional volunteers. Students were invited by e–mail to participate in one of three focus groups held in March, May and August 2011, and were informed that their attendance was not compulsory. A focus group approach was selected to enable discussion within the groups. It is possible that the sample size may have been different if students had been invited to individual interviews. Students who did volunteer were given a full briefing and reminded of their full ethical rights, and were advised that the research was given full ethical approval by
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108 105
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3/6/2014 2:43:49 PM
The extent to which doctors and other health professionals were seen as role models became a central focus
the Human Research Ethics Committee at the University of Melbourne (HREC 1034874.1 /05.10.10). The focus groups were facilitated by two researchers who adopted a semi-structured approach, and loosely followed a focus group topic guide. The topic guide is shown in Box 1. The raw data were transcribed and anonymised; a thematic analysis commenced with coding by highlighting passages of data and labelling them with a node.6 Coding was undertaken by three researchers independently (L.G., E.M. and C.F.), facilitated by QSR NVivo2 data management software. The list of nodes was consolidated by grouping nodes of similar meaning, which became the emerging themes that were then further refined.
FINDINGS AND DISCUSSION In this short report, the themes arising from the qualitative data
Table 1. Themes arising from the analysis Theme 1
Theme 2
Theme 3
Placement properties
Ways of learning
Professional socialisation
• • Observational • The setting • learning • Structure and timing • Students’ evaluation • Self-initiated learning • No formal assessment of the clinical • of learning placement
analysis are briefly introduced in Table 1. On any clinical placement the medical student is surrounded by qualified health professionals of the same and different professions. Professional role models are seen as both knowledge facilitators and powerful contributors to identity formation among student health professionals.7 The extent to which doctors and other health professionals were seen as role models became a central focus as themes emerged from the pilot study data.
Box 1. Loosely followed focus group topic guide, indicative of the questions posed to focus group participants 1. Could you please provide a brief summary of the placement – what was the clinical focus? Have you completed any other placements? 2. Would anyone in the group like to comment on the possible benefits and outcomes of their learning at [the placement facility]? 3. Could you please describe the interactions you had with nurses or allied health professionals? 4. Could members of the group please explain whether they feel their perceptions of the roles and responsibilities of the health professionals have altered? 5. Could members of the group comment on what they think is the best time to learn with, from, and about nurses and allied health professionals? 6. Could members of the group comment on whether shared/interprofessional learning (if you feel you experienced any) assisted the development of communication skills and/or patient care? 7. Would anyone in the group like to comment on whether they feel that shared learning helps medical student learning, or not? 8. Could members of the group please comment on whether they feel that the period of learning at [the placement facility] has had any influence on the development of the way you might practice as a doctor? 9. Do you feel that you modelled your supervisors at all?
Role models Development of professional identity Working together for the patient
Some of the medical students reported that they sought opportunities to observe other health professionals; however most of the medical students reported that they were there to learn from doctors.
Every time you see a doctor do something good or do something bad, you think oh I want to do that, or I don’t want to do that. Focus Group 2 You never actually go see what the physio is doing, but you learn from other doctors. Focus Group 3 Pitkala highlighted that in many cases credibility among teachers was paramount for students, and that ‘non-doctors’ have been rejected as potential role models.2 What was more evident in this study was, as Reeves et al. argued, ‘medical students were expecting the ward to provide them with a profession-specific experience of working as a junior doctor’.8
The students tend to want to just attach themselves to the doctors and the consultants and learn from them, rather than trying to ask a social worker whether they could follow them. Focus Group 3
106 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108
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We are studying medicine and I personally tend to try to emulate what the doctor’s doing. Focus Group 1 This was not true of all students, however, and there were positive accounts of the impact of other health professionals in facilitating learning. Nurses and allied health professionals were portrayed by some students as ‘active teachers’ in the placement, just as much if not more than doctors, despite the fact that most of their universitybased lecturers were doctors. Reeves et al. argued that, in reality, students could not always depend on profession-specific facilitators for support, a finding mirrored in this study.8 In some cases, students reported that the nurses and allied health professionals were more willing, or had more opportunity, to adopt the role of the teacher in certain scenarios. The extent to which the medical student learned from the health professionals around them appeared to depend, then, on the disposition and availability of both the student and the health professionals in the setting. Some students’ accounts indicated that their expectations of teaching in the setting were not always in alignment with what and who was available. In particular, they highlighted that the ‘busyness’ of doctors acted as an impediment to productive learning encounters.
Because the doctors were quite busy or stressed or something, I spent a lot of my time talking to the nurses. Focus Group 3 Quite a few times the physio used to explain to me what was going on. Focus Group 2 Many of the students expressed that they focused on the need to meet profession-specific
curricular milestones and pass examinations in order to satisfy course requirements. This ‘strategic approach’ has been cited in other studies, which have also demonstrated a fear of failing among medical students and the effects of academic pressures on the behaviour of students.9
We’re just trying to acquire all that medical knowledge. Focus Group 1 We [also] have so much other stuff that’s more important at this moment – like studying for exams. Focus Group 3 This pressure to meet examination requirements influenced their responses to learning opportunities involving nurses and allied health professionals.
If your priorities aren’t matching, of course you’re going to pick your own and that’s when tensions arise. Focus Group 2 Baernstein et al. argued that it is the responsibility of medical schools to ensure that students are exposed to appropriate role models who demonstrate the ‘ideals of professionalism’, and work with students over longer periods of time.10 This approach was referred to as the ‘informal professionalism curriculum’, but it was not clear in Baernstein’s study whether these role models should be exclusively of the same discipline as the students.10 There appeared to be a tension emerging between the influential figures that students wanted to learn from and who was available and willing to teach them in the setting. The skills that students acquire may depend on the behaviours demonstrated by the health professionals whose behaviour they model.4
Medical students may desire direction from the busy doctor, but actually have more interaction with the seemingly available and accessible nurses and allied health professionals. This may be because some doctors are not as willing or able to protect designated time for reflection and discussion with students,4 and indicates that insufficient importance has been placed on role-modelling when students are present. Expectations for students to initiate learning opportunities with non-medical staff may be seen as unrealistic and unfair; however, the clinical learning philosophy of their university is one of self-directed learning, and is consistent with the study objective.
The ‘busyness’ of doctors acted as an impediment to productive learning encounters
Limitations The limitations of this study stem from the small sample size, the variable level of staff understanding of the clinical placement objectives and the students’ focus on assessment rather than experiential learning.
CONCLUSION The findings from this pilot study reinforce the idea that a number of important factors intersect to provide students with meaningful, challenging and purposeful clinical experiences. Students reported that non-medical staff were often more available, willing and able to participate in learning opportunities than medical staff. However, the focus of students was still on medical staff teachers, reflecting their preoccupation with a narrow professionalisation goal and summative assessment to get them there. The results call for a further examination of how medical students are socialised in both the preclinical environment and their clinical workplace to achieve the learning that is essential to promote teamwork. How medical students make decisions about what to prioritise in their learning, and how they access the capability of others to contribute
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108 107
tct_12063.indd 107
3/6/2014 2:43:54 PM
Rich and underutilised sources of clinical workplace learning opportunities exist
to their practice development, requires further study. This research confirms that rich and underutilised sources of clinical workplace learning opportunities exist, and are readily available from non-medical health professionals. The challenge remains in how to convince students that it is worth investing in these activities. REFERENCES 1. Barnett T, Cross M, Shahwan-Akl L, Jacob E. The evaluation of a successful collaborative education model to expand student clinical placements. Nurse Educ Pract 2010;10:17–21. 2. Pitkala K, Mantyranta T. Professional socialisation revised: medical students’ own conceptions
related to adoption of the future physician’s role—a qualitative study. Med Teach 2003;25:155–160. 3. Drolet B, Rodgers S. A Comprehensive Medical Student Wellness Program—Design and Implementation at Vanderbilt School of Medicine. Acad Med 2010;85:103–110. 4. Cruess S, Cruess R, Steinert Y. Role modelling – making the most of a powerful teaching strategy. BMJ 2008;336:718–721. 5. Hammick M, Olckers L, CampionSmith C. AMEE guide no. 38: Learning in interprofessional teams. Med Teach 2009;31:1–12. 6. Miles MB, Huberman AM. Qualitative data analysis: an expanded sourcebook (2nd edn). Thousand Oaks, CA: Sage, 1994.
7. Weaver R, Peters K, Koch J, Wilson I. ‘Part of the team’: professional identity and social exclusivity in medical students. Med Educ 2011;45:1220–1229. 8. Reeves S, Freeth D, McCrorie P, Perry D. ‘It teaches you what to expect in future’: interprofessional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students. Med Educ 2002;36:337–344. 9. Moffat KJ, McConnachie A, Ross S, Morrison JM. First year medical student stress and coping in a problem-based learning medical curriculum. Med Educ 2004;38:482–491. 10. Baernstein A, Amies Oelschlager A, Chang T, Wenrich M. Learning Professionalism: Perspectives of Preclinical Medical Students. Acad Med 2009;84:574–581.
Corresponding author’s contact details: Dr Louise Greenstock, Level 3, 766 Elizabeth Street, Parkville, Victoria 3010, Australia. E-mail: lgreens@ unimelb.edu.au
Funding: This research was funded by a grant from the Collier Charitable Fund. Conflict of interest: None. Ethical approval: This research was given full ethical clearance by the Human Research Ethics Committee at the University of Melbourne Research Office. doi: 10.1111/tct.12063
108 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 104–108
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