Simulation
Theatre etiquette course: students’ experiences James Nutt and Roshana Mehdian, Academic Foundation Rotation, Heart of England NHS Foundation Trust, Birmingham, UK Catherine Kellett, Golden Jubilee National Hospital, Glasgow, UK
SUMMARY Background: Prior to 2008 medical students at the University of Dundee had no formal teaching in scrubbing, gloving and gowning for theatre. The students had reported high levels of stress, and a lack of knowledge and confidence, when asked to scrub, glove and gown for theatre. We present a cohort study of the effect on students’ experiences in theatre following the implementation of a new theatre etiquette course to the undergraduate curriculum. Design: We implemented a new theatre etiquette course for
medical students, in which they learned scrubbing, gowning and gloving for theatre. We then identified two cohorts of students: the year group who attended the new course and the year above who did not. At the end of year 4, both cohorts completed a questionnaire about their confidence and experiences in theatre. The results from the year below were compared with the year above, who had no such formal teaching. Results: Questionnaire responses from over 70 per cent of each cohort demonstrated that students attending the new
formal course felt significantly more confident in theatre etiquette skills and had an improved experience in the operating theatre, compared with the previous year group. Conclusion: The implementation of a theatre etiquette course improved students’ preparation and experience in theatre. It also outlines the need for consistent teaching at an undergraduate level. This formal teaching method is recommended for any curriculum in which students attend theatre.
Students reported lack of knowledge when asked to scrub, glove and gown for theatre
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135 131
tct_12083.indd 131
3/6/2014 3:00:08 PM
Medical students unprepared for visiting the operating theatre were a potential source of infection
INTRODUCTION
T
he formal teaching of theatre etiquette skills for undergraduates was implemented in 2008 at the University of Dundee Medical School. This addition to the core curriculum takes place at the end of year 3, before clinical attachments commence. Prior to 2008 such teaching did not form part of the curriculum. It was suggested by a local infection control team that medical students who were unprepared for visiting the operating theatre were a potential source of infection. The paper by Kellett et al. outlines the background and structure of the new theatre etiquette course.1 The course foundations were laid by the Department of Infection Control and research into medical students’ experiences in the operating room. Lyon reported that medical students could find the operating theatre a ‘confronting, unpredictable and disorientating place for a student to learn within’.2
Lyon also analysed medical students’ perceptions and experiences in the operating theatre. Medical students reported breaching infection control measures, lack of awareness of theatre protocol and wearing theatre attire incorrectly. The questionnaire also showed that more than 70 per cent of medical students agreed with the statement ‘It’s easy to be made to look like a fool in theatre’.3 In 2007 Fernando recommended that the pre-teaching of theatre skills and etiquette is likely to improve the student learning experience. Such pre-teaching would also reduce the amount of support and instruction provided by the theatre staff, who usually have no allocated time for such
tasks.4,5 This is particularly relevant in the setting of the National Health Service (NHS) in the UK. Anxiety is believed to be a significant factor affecting students’ experience of the operating room. Yerkers-Dobson Law has explained that Clark confirmed that some anxiety can assist in learning, but that a high level of anxiety is detrimental to effective learning.6,7 Du Boulay has described how students found learning practical procedures on patients very stressful.8 He also described how this could both inhibit them from undertaking the task, and reduces the educational value of it. Our theatre etiquette course was designed to address the issues raised by infection control and authors such as Lyon and Fernando. The objectives of this study are to measure the effect of this course on the students’ experience in theatre and relate any findings to the existing evidence previously described. In 2008 the first cohort of students took part in the theatre etiquette course. This gave a unique opportunity to compare their experiences in theatre with the previous year’s students, who had no such formal teaching.
total of 151 students took part in the course during the end of their third year of study. These year–3 students were designated the trial group. The control group was designated as the 156 students who had just completed their fourth year and first surgical placements. This group had received no formal theatre etiquette training. Data capture A questionnaire was designed to cover the relevant aspects of students’ experiences in theatre following either formal or informal theatre etiquette teaching. The same questionnaire was used for both cohorts. The questionnaire consisted of three parts, covering the following areas.
Evidence about these student experiences was deemed valuable in appraising the effectiveness of the new theatre etiquette course, potentially securing it as part of the curriculum for years to come.
2. Perceived confidence and competence.
METHODS
3. Personal experience in the operating theatre.
Study design and setting Questionnaire-based cohort study. Conducted at Dundee University Medical School, this study took place between 2008 and 2009. Target population The theatre etiquette course was designed and implemented as described by Kellett et al.1 A
1. Student demographics and previous teaching in theatre etiquette.
Student anxiety was also targeted in the personal experience section of the form. Part two of the questionnaire was constructed from rank-order questions. All questions had forced rank answers, with the options of strongly agree, agree,
132 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135
tct_12083.indd 132
3/6/2014 3:00:12 PM
Data analysis Percentage responses were calculated for answers to forced rank questions to enable direct comparisons to be made between the two cohorts. Data were explored for outliers and none were found. Quantitative questionnaire data were analysed and compared using the non-parametric Mann–Whitney Wilcoxon test, with significance set at the level of p = 0.05. To capture qualitative data, the questionnaire also left room for free text, to allow students to comment on their teaching and theatre experiences.
RESULTS Response rates of 81.3 per cent for the trial group and 74.8 per cent for the control group were achieved.
5 = Strongly agree
5
AƩended theatre course No formal theatre course 4
3
2
1= Disagree
neither agree nor disagree, disagree and strongly disagree. These answers were ranked from 5 to 1, respectively, to enable quantitative statistical analysis.
Two comparable cohorts of students were identified and targeted who had been taught by different methods
1
0 The theatre teaching I received increased my basic knowledge
The teaching I received was well organised and professionally conducted
I would have liked Students felt My first visit to further instrucƟon in theatre following my prepared in all three techniques theatre eƟqueƩe teaching method was a daunƟng and anxious experience
Figure 1. Mean response rates to forced rank questions
the cohorts for all questions asked in relation to general theatre etiquette knowledge. When asked about knowing the correct technique in scrubbing, gowning and gloving, students who had been on the formal Theatre Etiquette Course were significantly more likely to rank their answers higher. Table 2 shows positive and negative themes derived from free text answers attained from both cohorts.
Quantitative results Figure 1 shows graphical representation of the mean responses of each cohort to the rank questions asked.
DISCUSSION
Qualitative results Table 1 shows significant differences were found between
This article has studied the effect of implementing the theatre etiquette course on students’ experiences in the operating
theatre. Two comparable cohorts of students were identified and targeted who had been taught by different methods (formal and informal theatre etiquette teaching). In total, 238 students were questioned with a greater than 70 per cent response rate for each cohort. The majority of students who took part in the theatre etiquette course reported that they strongly agreed or agreed with the statement that their teaching was well organised and professionally conducted. These results were significantly different from the students who had no formal teaching
Table 1. The results of the non-parametric Mann–Whitney Wilcoxon test for each of the questions asked Question asked
Students confidence in scrubbing, gloving and gowning
Asymptotic 0.000* significance (two-tailed)
Students desire for further training in all areas
Did students feel anxious prior to first theatre exposure?
Did students feel in control of their situation during first theatre exposure?
Students would have liked further instruction
Students felt their teaching was well organised
The students felt that their teaching increased basic knowledge
0.000*
0.004*
0.010*
0.000*
0.000*
0.000*
*Statistically significant difference (p = 0.05). © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135 133
tct_12083.indd 133
3/6/2014 3:00:13 PM
The students who attended the theatre etiquette course had an overall more positive experience
(Table 1). The students who had no formal teaching had a more mixed opinion of their teaching experience, with a more even spread of data between the ‘agree’ and ‘disagree’ answers. This is likely to be a reflection on the previously described unpredictability of teaching experienced by students receiving non-standardised theatre etiquette lessons.1,4,5 Significant differences were found between the two cohorts for all questions asked in relation to knowledge on general theatre etiquette. When asked about knowing the correct technique for scrubbing, gowning and gloving, students who had been on the formal theatre etiquette course were significantly more likely to strongly agree or agree with the statement (Table 1). For questions related to all three individual skills (scrubbing, gloving and gowning), the percentage of students ranking their answers at the highest level (strongly agree) was higher in the cohort who did not attend formal teaching. It is possible that a minority of these students were fortunate to have been taught by a keen and interested member of staff, or more worryingly, that they were unaware of the correct technique but felt falsely reassured of their knowledge. Questions related to the students’ experiences in theatre revealed similar patterns. Significant differences were found between both cohorts of students when asked if their first visit to theatre following teaching was a daunting and anxious experience, and if they felt in control of their situation at all times (Table 1). High levels of student anxiety in the operating theatre is not conducive to learning, and will lead to the loss of a valuable learning opportunity. It is acknowledged by the authors that anxiety in theatre may be multifactorial; however, we hypothesised that students who attend a formal theatre etiquette course are less likely to find their
Table 2. Themes highlighted by students in the free-text box No formal theatre course
Formal theatre course
Positive responses • Individual teaching was useful • Junior surgeons could be very keen and interested in teaching Negative responses • The teaching received was stressful and time pressured • Theatre experience was not as useful through a lack of practise • Different methods were taught by each supervisor • Students felt they were a hindrance to the theatre staff • Students did not feel fully prepared
Positive responses • A great addition to the course • I felt prepared for what to expect in theatre • Helpful and informative tutors • Good teaching materials • Good quality videos Negative responses • First surgical block was some time after teaching • Crowded equipment in teaching lab • Further practice sessions would help • The teaching received was different to what some surgeons practised
first visit to theatre a daunting and anxious experience.
courses are currently being implemented.
Quantitative results were analysed for recurring themes. These themes are shown in Table 2. The students who had not received formal teaching appear to highlight the same themes that were identified prior to the introduction of the theatre etiquette course: non-standardised and opportunistic teaching, and high levels of stress and feeling anxious about visiting theatre. A minority of these students were lucky enough to receive good teaching, which could be expected within a large teaching hospital. The students who attended the theatre etiquette course had an overall more positive experience during the teaching and from subsequent theatre visits. This cohort also described potential issues with the time between the course and their first surgery block: as a result of medical school timetabling, this was as long as 4 months in some cases. Further opportunities to practise theatre etiquette should reduce this problem, and refresher
CONCLUSION This study has shown that the theatre etiquette course, in comparison with previous teaching methods, increases student confidence and perceived knowledge in theatre etiquette. It prepares students and reduces anxiety in subsequent theatre visits. Students’ perception is that they need further supervision and training following the theatre etiquette course, although this is yet to be proven. These factors guide students towards safe practice and maintaining a productive learning environment within the operating theatre. It is recommended that a future randomised controlled trial be conducted, or a comparison be conducted with other UK medical schools implementing such a course. This may be useful in further validating the results of this study. We recommend that a formal theatre etiquette course is a valuable and validated addition to a medical school curriculum.
134 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135
tct_12083.indd 134
3/6/2014 3:00:13 PM
REFERENCES 1.
Kellett C, Stirling K, McLeod R, Dent J, Boscainos P. Development of an undergraduate medical student theatre etiquette course. IJOCS 2009;3:issue 2.
2.
Lyon PMA. Making the most of learning in the operating theatre: student strategies and curricular initiatives. Med Educ 2003;37:680–688.
3.
Lyon PM. A model of teaching and learning in the operating theatre. Med Educ 2004;38:1278–1287.
4.
5.
6.
Fernando N, McAdam T, Cleland J, Yule S, McKenzie H, Youngson G. How can we prepare medical students for theatre-based learning? Med Educ 2007;41:968–974. Fernando N, McAdam T, Youngson G, McKenzie H, Cleland J, Yule S. Undergraduate medical students’ perceptions and expectations of theatre-based learning: how can we improve the student learning experience? Surgeon 2007;5:271–274. Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit-formation. Journal
of Comparative Neurology and Psychology 1908;18:459–482. 7.
Clark R. Cognitive methods to support attention. In: Building Expertise: Cognitive Methods to Avoid Working Memory Overload. Clark R, ed. Washington DC: International Society for Performance Improvement; 1999; 57–70.
8.
du Boulay C, Medway C. The clinical skills resource: a review of current practice. Med Educ 1999;33:185–191.
These factors guide students towards safe practice
Corresponding author’s contact details: Miss Catherine F Kellett, Consultant Orthopaedic Surgeon, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK. E-mail: [email protected]
Funding: No funding was received for this study therefore all researchers were independent from any form of funding. Conflict of interest: None. Ethical approval: Ethical approval was obtained from the University of Dundee’s Research Ethics Committee. doi: 10.1111/tct.12083
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135 135
tct_12083.indd 135
3/6/2014 3:00:13 PM
Theatre etiquette course: students’ experiences James Nutt and Roshana Mehdian, Academic Foundation Rotation, Heart of England NHS Foundation Trust, Birmingham, UK Catherine Kellett, Golden Jubilee National Hospital, Glasgow, UK
SUMMARY Background: Prior to 2008 medical students at the University of Dundee had no formal teaching in scrubbing, gloving and gowning for theatre. The students had reported high levels of stress, and a lack of knowledge and confidence, when asked to scrub, glove and gown for theatre. We present a cohort study of the effect on students’ experiences in theatre following the implementation of a new theatre etiquette course to the undergraduate curriculum. Design: We implemented a new theatre etiquette course for
medical students, in which they learned scrubbing, gowning and gloving for theatre. We then identified two cohorts of students: the year group who attended the new course and the year above who did not. At the end of year 4, both cohorts completed a questionnaire about their confidence and experiences in theatre. The results from the year below were compared with the year above, who had no such formal teaching. Results: Questionnaire responses from over 70 per cent of each cohort demonstrated that students attending the new
formal course felt significantly more confident in theatre etiquette skills and had an improved experience in the operating theatre, compared with the previous year group. Conclusion: The implementation of a theatre etiquette course improved students’ preparation and experience in theatre. It also outlines the need for consistent teaching at an undergraduate level. This formal teaching method is recommended for any curriculum in which students attend theatre.
Students reported lack of knowledge when asked to scrub, glove and gown for theatre
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135 131
tct_12083.indd 131
3/6/2014 3:00:08 PM
Medical students unprepared for visiting the operating theatre were a potential source of infection
INTRODUCTION
T
he formal teaching of theatre etiquette skills for undergraduates was implemented in 2008 at the University of Dundee Medical School. This addition to the core curriculum takes place at the end of year 3, before clinical attachments commence. Prior to 2008 such teaching did not form part of the curriculum. It was suggested by a local infection control team that medical students who were unprepared for visiting the operating theatre were a potential source of infection. The paper by Kellett et al. outlines the background and structure of the new theatre etiquette course.1 The course foundations were laid by the Department of Infection Control and research into medical students’ experiences in the operating room. Lyon reported that medical students could find the operating theatre a ‘confronting, unpredictable and disorientating place for a student to learn within’.2
Lyon also analysed medical students’ perceptions and experiences in the operating theatre. Medical students reported breaching infection control measures, lack of awareness of theatre protocol and wearing theatre attire incorrectly. The questionnaire also showed that more than 70 per cent of medical students agreed with the statement ‘It’s easy to be made to look like a fool in theatre’.3 In 2007 Fernando recommended that the pre-teaching of theatre skills and etiquette is likely to improve the student learning experience. Such pre-teaching would also reduce the amount of support and instruction provided by the theatre staff, who usually have no allocated time for such
tasks.4,5 This is particularly relevant in the setting of the National Health Service (NHS) in the UK. Anxiety is believed to be a significant factor affecting students’ experience of the operating room. Yerkers-Dobson Law has explained that Clark confirmed that some anxiety can assist in learning, but that a high level of anxiety is detrimental to effective learning.6,7 Du Boulay has described how students found learning practical procedures on patients very stressful.8 He also described how this could both inhibit them from undertaking the task, and reduces the educational value of it. Our theatre etiquette course was designed to address the issues raised by infection control and authors such as Lyon and Fernando. The objectives of this study are to measure the effect of this course on the students’ experience in theatre and relate any findings to the existing evidence previously described. In 2008 the first cohort of students took part in the theatre etiquette course. This gave a unique opportunity to compare their experiences in theatre with the previous year’s students, who had no such formal teaching.
total of 151 students took part in the course during the end of their third year of study. These year–3 students were designated the trial group. The control group was designated as the 156 students who had just completed their fourth year and first surgical placements. This group had received no formal theatre etiquette training. Data capture A questionnaire was designed to cover the relevant aspects of students’ experiences in theatre following either formal or informal theatre etiquette teaching. The same questionnaire was used for both cohorts. The questionnaire consisted of three parts, covering the following areas.
Evidence about these student experiences was deemed valuable in appraising the effectiveness of the new theatre etiquette course, potentially securing it as part of the curriculum for years to come.
2. Perceived confidence and competence.
METHODS
3. Personal experience in the operating theatre.
Study design and setting Questionnaire-based cohort study. Conducted at Dundee University Medical School, this study took place between 2008 and 2009. Target population The theatre etiquette course was designed and implemented as described by Kellett et al.1 A
1. Student demographics and previous teaching in theatre etiquette.
Student anxiety was also targeted in the personal experience section of the form. Part two of the questionnaire was constructed from rank-order questions. All questions had forced rank answers, with the options of strongly agree, agree,
132 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135
tct_12083.indd 132
3/6/2014 3:00:12 PM
Data analysis Percentage responses were calculated for answers to forced rank questions to enable direct comparisons to be made between the two cohorts. Data were explored for outliers and none were found. Quantitative questionnaire data were analysed and compared using the non-parametric Mann–Whitney Wilcoxon test, with significance set at the level of p = 0.05. To capture qualitative data, the questionnaire also left room for free text, to allow students to comment on their teaching and theatre experiences.
RESULTS Response rates of 81.3 per cent for the trial group and 74.8 per cent for the control group were achieved.
5 = Strongly agree
5
AƩended theatre course No formal theatre course 4
3
2
1= Disagree
neither agree nor disagree, disagree and strongly disagree. These answers were ranked from 5 to 1, respectively, to enable quantitative statistical analysis.
Two comparable cohorts of students were identified and targeted who had been taught by different methods
1
0 The theatre teaching I received increased my basic knowledge
The teaching I received was well organised and professionally conducted
I would have liked Students felt My first visit to further instrucƟon in theatre following my prepared in all three techniques theatre eƟqueƩe teaching method was a daunƟng and anxious experience
Figure 1. Mean response rates to forced rank questions
the cohorts for all questions asked in relation to general theatre etiquette knowledge. When asked about knowing the correct technique in scrubbing, gowning and gloving, students who had been on the formal Theatre Etiquette Course were significantly more likely to rank their answers higher. Table 2 shows positive and negative themes derived from free text answers attained from both cohorts.
Quantitative results Figure 1 shows graphical representation of the mean responses of each cohort to the rank questions asked.
DISCUSSION
Qualitative results Table 1 shows significant differences were found between
This article has studied the effect of implementing the theatre etiquette course on students’ experiences in the operating
theatre. Two comparable cohorts of students were identified and targeted who had been taught by different methods (formal and informal theatre etiquette teaching). In total, 238 students were questioned with a greater than 70 per cent response rate for each cohort. The majority of students who took part in the theatre etiquette course reported that they strongly agreed or agreed with the statement that their teaching was well organised and professionally conducted. These results were significantly different from the students who had no formal teaching
Table 1. The results of the non-parametric Mann–Whitney Wilcoxon test for each of the questions asked Question asked
Students confidence in scrubbing, gloving and gowning
Asymptotic 0.000* significance (two-tailed)
Students desire for further training in all areas
Did students feel anxious prior to first theatre exposure?
Did students feel in control of their situation during first theatre exposure?
Students would have liked further instruction
Students felt their teaching was well organised
The students felt that their teaching increased basic knowledge
0.000*
0.004*
0.010*
0.000*
0.000*
0.000*
*Statistically significant difference (p = 0.05). © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135 133
tct_12083.indd 133
3/6/2014 3:00:13 PM
The students who attended the theatre etiquette course had an overall more positive experience
(Table 1). The students who had no formal teaching had a more mixed opinion of their teaching experience, with a more even spread of data between the ‘agree’ and ‘disagree’ answers. This is likely to be a reflection on the previously described unpredictability of teaching experienced by students receiving non-standardised theatre etiquette lessons.1,4,5 Significant differences were found between the two cohorts for all questions asked in relation to knowledge on general theatre etiquette. When asked about knowing the correct technique for scrubbing, gowning and gloving, students who had been on the formal theatre etiquette course were significantly more likely to strongly agree or agree with the statement (Table 1). For questions related to all three individual skills (scrubbing, gloving and gowning), the percentage of students ranking their answers at the highest level (strongly agree) was higher in the cohort who did not attend formal teaching. It is possible that a minority of these students were fortunate to have been taught by a keen and interested member of staff, or more worryingly, that they were unaware of the correct technique but felt falsely reassured of their knowledge. Questions related to the students’ experiences in theatre revealed similar patterns. Significant differences were found between both cohorts of students when asked if their first visit to theatre following teaching was a daunting and anxious experience, and if they felt in control of their situation at all times (Table 1). High levels of student anxiety in the operating theatre is not conducive to learning, and will lead to the loss of a valuable learning opportunity. It is acknowledged by the authors that anxiety in theatre may be multifactorial; however, we hypothesised that students who attend a formal theatre etiquette course are less likely to find their
Table 2. Themes highlighted by students in the free-text box No formal theatre course
Formal theatre course
Positive responses • Individual teaching was useful • Junior surgeons could be very keen and interested in teaching Negative responses • The teaching received was stressful and time pressured • Theatre experience was not as useful through a lack of practise • Different methods were taught by each supervisor • Students felt they were a hindrance to the theatre staff • Students did not feel fully prepared
Positive responses • A great addition to the course • I felt prepared for what to expect in theatre • Helpful and informative tutors • Good teaching materials • Good quality videos Negative responses • First surgical block was some time after teaching • Crowded equipment in teaching lab • Further practice sessions would help • The teaching received was different to what some surgeons practised
first visit to theatre a daunting and anxious experience.
courses are currently being implemented.
Quantitative results were analysed for recurring themes. These themes are shown in Table 2. The students who had not received formal teaching appear to highlight the same themes that were identified prior to the introduction of the theatre etiquette course: non-standardised and opportunistic teaching, and high levels of stress and feeling anxious about visiting theatre. A minority of these students were lucky enough to receive good teaching, which could be expected within a large teaching hospital. The students who attended the theatre etiquette course had an overall more positive experience during the teaching and from subsequent theatre visits. This cohort also described potential issues with the time between the course and their first surgery block: as a result of medical school timetabling, this was as long as 4 months in some cases. Further opportunities to practise theatre etiquette should reduce this problem, and refresher
CONCLUSION This study has shown that the theatre etiquette course, in comparison with previous teaching methods, increases student confidence and perceived knowledge in theatre etiquette. It prepares students and reduces anxiety in subsequent theatre visits. Students’ perception is that they need further supervision and training following the theatre etiquette course, although this is yet to be proven. These factors guide students towards safe practice and maintaining a productive learning environment within the operating theatre. It is recommended that a future randomised controlled trial be conducted, or a comparison be conducted with other UK medical schools implementing such a course. This may be useful in further validating the results of this study. We recommend that a formal theatre etiquette course is a valuable and validated addition to a medical school curriculum.
134 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135
tct_12083.indd 134
3/6/2014 3:00:13 PM
REFERENCES 1.
Kellett C, Stirling K, McLeod R, Dent J, Boscainos P. Development of an undergraduate medical student theatre etiquette course. IJOCS 2009;3:issue 2.
2.
Lyon PMA. Making the most of learning in the operating theatre: student strategies and curricular initiatives. Med Educ 2003;37:680–688.
3.
Lyon PM. A model of teaching and learning in the operating theatre. Med Educ 2004;38:1278–1287.
4.
5.
6.
Fernando N, McAdam T, Cleland J, Yule S, McKenzie H, Youngson G. How can we prepare medical students for theatre-based learning? Med Educ 2007;41:968–974. Fernando N, McAdam T, Youngson G, McKenzie H, Cleland J, Yule S. Undergraduate medical students’ perceptions and expectations of theatre-based learning: how can we improve the student learning experience? Surgeon 2007;5:271–274. Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit-formation. Journal
of Comparative Neurology and Psychology 1908;18:459–482. 7.
Clark R. Cognitive methods to support attention. In: Building Expertise: Cognitive Methods to Avoid Working Memory Overload. Clark R, ed. Washington DC: International Society for Performance Improvement; 1999; 57–70.
8.
du Boulay C, Medway C. The clinical skills resource: a review of current practice. Med Educ 1999;33:185–191.
These factors guide students towards safe practice
Corresponding author’s contact details: Miss Catherine F Kellett, Consultant Orthopaedic Surgeon, Golden Jubilee National Hospital, Glasgow, G81 4DY, UK. E-mail: [email protected]
Funding: No funding was received for this study therefore all researchers were independent from any form of funding. Conflict of interest: None. Ethical approval: Ethical approval was obtained from the University of Dundee’s Research Ethics Committee. doi: 10.1111/tct.12083
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 131–135 135
tct_12083.indd 135
3/6/2014 3:00:13 PM
