really good stuff A paediatric registrar and a nurse educator were involved in the course design and implementation. Educational outcomes and expected standards were agreed by both faculty members in line with each undergraduate curriculum. Reusable lesson plans and scenarios were developed to enable future implementation. What lessons were learned? All students attended a focus group following the pilot programme. The programme was well received, with students finding it ‘helpful’ [MS1] and ‘worthwhile’ [NS1]. The simulation session was perceived to be of great educational benefit, both for the group undertaking the simulation and for the group observing. The formative nature of the sessions and provision of feedback helped to alleviate the potentially stressful nature of the simulation. One student commented: ‘. . .the more mistakes you do, the more you can be aware of what to do.’ The interprofessional nature of the programme was welcomed and strong desires for further realistic interprofessional experiences were expressed. Students described previously being aware of ‘tension between the two professions’ [MS2], and feelings of ‘a hierarchy’ [NS3]. They also felt that the two groups work in ‘different system[s]’ [MS2], resulting in communication difficulties. It was suggested that interprofessional education throughout undergraduate training might eliminate these problems, and help professionals ‘all know what each other are doing’ [MS2]. Overall, the pilot programme was felt to be a success by all involved, and has shown that not only is it feasible to provide undergraduate IPSE in a DGH, but that it is greatly appreciated by students. REFERENCE 1 Gough S, Hellaby M, Jones N, MacKinnon R. A review of undergraduate interprofessional simulation-based education (IPSE). Collegian 2012;19:153–70. Correspondence: Ahmed Osman, Department of Paediatrics, University Hospitals of Leicester, Leicester LE1 5WW, UK. Tel: 00 44 7930 571972; E-mail: [email protected] doi: 10.1111/medu.12452
Practice interviews for final-year medical students Anna T Ryan,1 Hamish P Ewing & Richard C O’Brien What problem was addressed? Australian medical students are interviewed as part of the internship
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(postgraduate year 1) recruitment process. For many, this high-stakes occasion is their first interview experience. The challenge was to provide practice interviews for students which allowed for the provision of individual feedback whilst being timeefficient within an already busy curriculum. What was tried? Final-year students at two clinical school sites were given an e-mail outline of likely interview structure, some general information about common clinical questions and a list of recommended resources for interview preparation. All students were then invited to participate in practice interviews prior to the beginning of the formal interview period. Fourteen medical staff volunteered to participate as interviewers and 80 of the entire cohort of 101 students requested to participate. Students were allocated into groups of four and booked into 1hour blocks with each interviewer. Each student spent 15 minutes as the interviewee (for both interview and brief feedback) and the other three students acted as observers until their turns. Students were encouraged to bring their curriculum vitae and a cover letter to help direct the interview. They were asked five questions in total, which included three general questions, one question about the curriculum vitae and one clinical question. Students were also invited to bring their smartphone or tablet device to record the interview. Interviewers were directed to look for a safe, organised and structured approach in students’ answers and for evidence of their understanding of the junior doctor’s role in the treating team. At the conclusion of the interview, they were requested to ask students to give an impression of their own performance, and then to provide brief verbal and written feedback (within a template) with a focus on specific plans to assist in preparation for students’ forthcoming interviews. What lessons were learned? A SurveyMonkey link was sent to all of the students who participated, 62 (78%) of whom completed the anonymous questionnaire. Using a 5-point Likert scale, 98% of students agreed or strongly agreed that the practice interview session was helpful as preparation for internship interviews, and 92% agreed or strongly agreed that they felt more confident about the real interviews after this practice session. There was initial concern that students would not appreciate the format of the session (given that most internship interviews are not conducted in a group), but this was allayed by the finding that 85% of students agreed or strongly agreed that the format of the session was appropriate. A number of students made comments on the helpfulness of
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
really good stuff becoming used to others being in the room, the value of watching other students being interviewed, and the usefulness of having their practice interview recorded. This format of practice interview is very time-efficient: 80 students were interviewed and provided with feedback in a total of 20 interview hours. The involvement of 14 staff member interviewers and a few hours of administrative staff time for scheduling and room bookings spread the load amongst all involved, making this a practical and acceptable way of providing interview practice to large numbers of students. Correspondence: Anna T Ryan, Austin Hospital Clinical School, The University of Melbourne, PO Box 5555, Heidelberg, Victoria 3084, Australia. Tel: 00 61 3 9496 4737; E-mail: [email protected] doi: 10.1111/medu.12449
An operationalised approach to biopsychosocial formulation David A Ross, Gerrit I van Schalkwyk & Robert Rohrbaugh What problem was addressed? A core skill in all disciplines of medicine is the ability to understand complex patient presentations. Although the classroom setting may allow for in-depth exploration of foundational knowledge, this experience may be distinct from the development of ‘clinical judgement’ skills that are typically learned in situ. Such clinical learning often has a practical or utilitarian quality, emphasising higher-level pattern recognition, and may be divorced from a deeper understanding of the underlying processes. In psychiatry, one such core clinical skill is the ability to construct a comprehensive formulation that incorporates data from biological, psychological and social domains. Trainees are frequently in awe of experts’ ability to craft well-articulated formulations, seemingly out of thin air. Although inspiring, such performances may also be frustrating as trainees do not know how their mentors achieve this task. This all too common gap reflects the stages of learning described by Dreyfus and Dreyfus,1 whereby a master may perform at a high level without conscious awareness of how he or she is doing so, but a novice requires explicit focus on relevant rules that the expert may or may not be able to provide. We sought to deconstruct this expert skill into a clear operationalised approach that would meet the
needs of the novice learner at his or her stage of learning. We believe that explicit emphasis on the underlying process will help trainees learn faster and more accurately and, ultimately, have a deeper understanding of the material. What was tried? We developed a new method for teaching biopsychosocial formulation that is based on an explicit notation system, applied to a written case report. As trainees read the case, we ask them to identify and label primary data in the text and then arrange the data into a simple, jargon-free, organisational framework. For example, as a first step in the psychological formulation, we ask the trainee to place an asterisk above any identifiable stressors, to place brackets around strong thoughts and feelings, and to circle any adaptive or maladaptive coping mechanisms. Importantly, for each case the trainee formulates, he or she is now able to directly compare this work with an answer key that reflects the primary process by which an expert would approach the same material. After introducing the basic approach using sample materials, we meet weekly to analyse cases the trainees are actively treating. As they progress, we gradually introduce them to more advanced conceptual frameworks that can be easily superimposed on our model. What lessons were learned? The course has been positively received by trainees, who report that this experience translates well into the clinical setting: previously, when asked to demonstrate formulation skills, residents would describe feeling ‘lost’; using our new method they now feel more comfortable and confident. Critically, by creating an objective assessment measure, this approach provides trainees with a richer formative feedback experience while enabling us to directly measure progress towards our curricular learning objectives. We believe that this type of approach could be of benefit in other medical disciplines that struggle with the issue of how to optimise the teaching of complex clinical topics to novice trainees. REFERENCE 1 Dreyfus S, Dreyfus H. A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition. Berkeley, CA: California University Berkeley Operations Research Center 1980. www.dtic.mil/cgi-bin/ GetTRDoc?AD=ADA084551. [Accessed 16 February 2014.] Correspondence: Gerrit I van Schalkwyk, Department of Psychiatry, Yale University, 300 George Street, 9th Floor, New Haven, Connecticut 06511, USA. Tel: 00 1 203 393 5891 E-mail: [email protected] doi: 10.1111/medu.12448
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
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Practice interviews for final-year medical students Anna T Ryan,1 Hamish P Ewing & Richard C O’Brien What problem was addressed? Australian medical students are interviewed as part of the internship
528
(postgraduate year 1) recruitment process. For many, this high-stakes occasion is their first interview experience. The challenge was to provide practice interviews for students which allowed for the provision of individual feedback whilst being timeefficient within an already busy curriculum. What was tried? Final-year students at two clinical school sites were given an e-mail outline of likely interview structure, some general information about common clinical questions and a list of recommended resources for interview preparation. All students were then invited to participate in practice interviews prior to the beginning of the formal interview period. Fourteen medical staff volunteered to participate as interviewers and 80 of the entire cohort of 101 students requested to participate. Students were allocated into groups of four and booked into 1hour blocks with each interviewer. Each student spent 15 minutes as the interviewee (for both interview and brief feedback) and the other three students acted as observers until their turns. Students were encouraged to bring their curriculum vitae and a cover letter to help direct the interview. They were asked five questions in total, which included three general questions, one question about the curriculum vitae and one clinical question. Students were also invited to bring their smartphone or tablet device to record the interview. Interviewers were directed to look for a safe, organised and structured approach in students’ answers and for evidence of their understanding of the junior doctor’s role in the treating team. At the conclusion of the interview, they were requested to ask students to give an impression of their own performance, and then to provide brief verbal and written feedback (within a template) with a focus on specific plans to assist in preparation for students’ forthcoming interviews. What lessons were learned? A SurveyMonkey link was sent to all of the students who participated, 62 (78%) of whom completed the anonymous questionnaire. Using a 5-point Likert scale, 98% of students agreed or strongly agreed that the practice interview session was helpful as preparation for internship interviews, and 92% agreed or strongly agreed that they felt more confident about the real interviews after this practice session. There was initial concern that students would not appreciate the format of the session (given that most internship interviews are not conducted in a group), but this was allayed by the finding that 85% of students agreed or strongly agreed that the format of the session was appropriate. A number of students made comments on the helpfulness of
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
really good stuff becoming used to others being in the room, the value of watching other students being interviewed, and the usefulness of having their practice interview recorded. This format of practice interview is very time-efficient: 80 students were interviewed and provided with feedback in a total of 20 interview hours. The involvement of 14 staff member interviewers and a few hours of administrative staff time for scheduling and room bookings spread the load amongst all involved, making this a practical and acceptable way of providing interview practice to large numbers of students. Correspondence: Anna T Ryan, Austin Hospital Clinical School, The University of Melbourne, PO Box 5555, Heidelberg, Victoria 3084, Australia. Tel: 00 61 3 9496 4737; E-mail: [email protected] doi: 10.1111/medu.12449
An operationalised approach to biopsychosocial formulation David A Ross, Gerrit I van Schalkwyk & Robert Rohrbaugh What problem was addressed? A core skill in all disciplines of medicine is the ability to understand complex patient presentations. Although the classroom setting may allow for in-depth exploration of foundational knowledge, this experience may be distinct from the development of ‘clinical judgement’ skills that are typically learned in situ. Such clinical learning often has a practical or utilitarian quality, emphasising higher-level pattern recognition, and may be divorced from a deeper understanding of the underlying processes. In psychiatry, one such core clinical skill is the ability to construct a comprehensive formulation that incorporates data from biological, psychological and social domains. Trainees are frequently in awe of experts’ ability to craft well-articulated formulations, seemingly out of thin air. Although inspiring, such performances may also be frustrating as trainees do not know how their mentors achieve this task. This all too common gap reflects the stages of learning described by Dreyfus and Dreyfus,1 whereby a master may perform at a high level without conscious awareness of how he or she is doing so, but a novice requires explicit focus on relevant rules that the expert may or may not be able to provide. We sought to deconstruct this expert skill into a clear operationalised approach that would meet the
needs of the novice learner at his or her stage of learning. We believe that explicit emphasis on the underlying process will help trainees learn faster and more accurately and, ultimately, have a deeper understanding of the material. What was tried? We developed a new method for teaching biopsychosocial formulation that is based on an explicit notation system, applied to a written case report. As trainees read the case, we ask them to identify and label primary data in the text and then arrange the data into a simple, jargon-free, organisational framework. For example, as a first step in the psychological formulation, we ask the trainee to place an asterisk above any identifiable stressors, to place brackets around strong thoughts and feelings, and to circle any adaptive or maladaptive coping mechanisms. Importantly, for each case the trainee formulates, he or she is now able to directly compare this work with an answer key that reflects the primary process by which an expert would approach the same material. After introducing the basic approach using sample materials, we meet weekly to analyse cases the trainees are actively treating. As they progress, we gradually introduce them to more advanced conceptual frameworks that can be easily superimposed on our model. What lessons were learned? The course has been positively received by trainees, who report that this experience translates well into the clinical setting: previously, when asked to demonstrate formulation skills, residents would describe feeling ‘lost’; using our new method they now feel more comfortable and confident. Critically, by creating an objective assessment measure, this approach provides trainees with a richer formative feedback experience while enabling us to directly measure progress towards our curricular learning objectives. We believe that this type of approach could be of benefit in other medical disciplines that struggle with the issue of how to optimise the teaching of complex clinical topics to novice trainees. REFERENCE 1 Dreyfus S, Dreyfus H. A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition. Berkeley, CA: California University Berkeley Operations Research Center 1980. www.dtic.mil/cgi-bin/ GetTRDoc?AD=ADA084551. [Accessed 16 February 2014.] Correspondence: Gerrit I van Schalkwyk, Department of Psychiatry, Yale University, 300 George Street, 9th Floor, New Haven, Connecticut 06511, USA. Tel: 00 1 203 393 5891 E-mail: [email protected] doi: 10.1111/medu.12448
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
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