SOLAR: student oriented learning about radiography

The success or otherwise of a radiographic examination is like other health-related interventions, crucially dependent upon the knowledge base of the radiographer and the quality of his/her clinical acumen. Traditional curricular approaches are limited in their ability to assist students to make vital connections between science and clinical decision making. This paper describes a computer-based case-oriented program called SOLAR (student oriented learning about radiography) that has been designed to achieve the necessary level of integration. The key feature of SOLAR is the requirement for students to construct a clinical action plan in response to a scenario provided. Upon submitting this plan, the student can then compare his/her plan to that prepared by an expert. The browsing configuration of SOLAR makes it highly attractive for other health professions as well. Student feedback indicates a high degree of approval for this approach.     

Peer assisted learning in patient-centred interviewing: the impact on student tutors

Effective methods for teaching patient-centred interviewing skills are resource intensive. Providing students the opportunity to work in small groups with simulated patients is highly valued and has demonstrable long-term benefits. Expanding cohorts of medical students and diminishing faculty resources led to the implementation of a peer assisted learning (PAL) project in patient-centred interviewing skills. The paper reports the evaluation of a PAL project on student tutors. The methodology included direct and indirect measures of student tutors' skills in facilitation and patient-centred interviewing. The self-report evaluations strongly suggest that participating in a PAL project has substantial benefits for student tutors that included both interviewing and facilitation skills. Objective measures revealed no change in patient-centred interviewing skills after participating in the project. The study concludes that formalizing PAL may tap a valuable resource within the medical school and provide benefits for student tutors. Careful consideration needs to be given to ways in which student tutors are supported before, during and after the project.     

Factors that influence medical student learning in the operating room

Introduction: The operating room (OR) is a dynamic, high-pressure clinical setting that offers a unique workplace-based learning environment for students. We undertook a narrative synthesis of the literature to identify factors that influence medical student learning in the OR, and we recommend educational strategies that maximize “theater-based learning”.

Methods: Key words were searched across three databases PubMed, EMBASE and ERIC (Education Resource Information Center). Eligible studies included original articles published after 1997 presenting empirical research on factors that influence medical students learning in the OR. Methodological quality was measured using the Newcastle-Ottawa Score for education.

Results: We identified 764 studies on the topic of student learning in the OR, of which 16 studies fulfilled inclusion criteria. The quality assessments demonstrated a mean value of 2.1 out of a maximum of 6.

Conclusions: We identified five key domains that influence student learning in the OR: emotional factors, socio-environmental factors, organizational factors, factors related to educational relevance and factors related to the educator. Educational strategies to enhance theater-based learning include: an induction and physical orientation, clear learning objectives, educator feedback, and simulation.     

Design for learning: deconstructing virtual patient activities

Digital technologies are used in almost every aspect of contemporary health professional education (HPE) but our understanding of their true potential as instructional tools rather than administrative tools has not significantly advanced in the last decade. One notable exception to this has been the rise of the 'virtual patient' as an educational intervention in HPE. This article attempts to deconstruct the virtual patient concept by developing a model of virtual patients as artifacts with intrinsic encoded properties and emergent constructed properties that build on the core concept of 'activity'.     

Clinical coaching: Evolving the apprenticeship model for modern housestaff

Feedback is one of the core components of teaching in the clinical setting. Traditionally, this activity has emphasized observations made by senior physicians and delivered to medical trainees. However, the optimal approach to feedback remains uncertain, and the literature abounds with trainee-perceived inadequacies in feedback content, quality, and impact. Moreover, given the multiplicity of demands on trainees and their physician mentors, we propose that medical trainees themselves—specifically, medical residents—are poised to serve as unique adjunct effectors of feedback. We propose a model of “clinical coaching” for residents as teachers, with emphasis on the active roles of both the feedback “giver” and “recipient”. We define “clinical coaching” as “a helping longitudinal relationship between coach and apprentice that provides continuing feedback on and assistance with improving performance.” Here, “coach” is the more experienced trainee (e.g. supervising resident), and “apprentice” is the less experienced trainee (e.g. intern or medical student). By working to better recognize and prepare residents for this vital role, we propose to encourage efforts to optimize the structure, execution, and impact of feedback in the contemporary climate of medical education.     

Perceptions of student peer tutors in a problem-based learning programme

The use of student peer tutors is an attractive and affordable alternative in a problem-based programme. Previous literature has focused on comparing the academic performance of faculty-tutored and student-tutored groups. This study used qualitative methods to examine a peer-tutoring model from the perspective of the student tutor. Students in the final semester of a two-year accelerated physiotherapy programme kept a reflective journal outlining their experiences in facilitating a group of peers from the same class. Content analysis of 56 journals indicated that the students struggled with basic facilitation skills and had difficulty separating the role of student from that of tutor. Students also developed strategies to allow them to succeed, were able to evaluate their performance in a positive light and appeared to value their tutoring experience.     

A 3-year experience implementing blended TBL: active instructional methods can shift student attitudes to learning

Medical educators have been encouraged to adopt active instructional strategies that require learners to engage in and direct their own learning. These innovations may be seen as disruptive and face early challenges due to student resistance. We report 3 years of experience implementing a blend of team-based learning (TBL) and online learning modules in an undergraduate medical course. Three sequential cohorts of first year medical students were surveyed exploring how they valued different instructional methods during a period of evolving curricular design. In addition to a demonstrated increase in acceptance of new teaching methods, there was a shift in student perceptions of the relative merits of didactic, online and TBL teaching. Medical students' appreciations of different instructional methods are influenced by the maturity of instructional design. Educational change is best viewed through a longer term lens, acknowledging the necessity for teachers to develop experience in implementing new methods in the context of their institution.     

A review of interprofessional training wards: Enhancing student learning and patient outcomes

Background: In an interprofessional training ward (ITW), students from different health professions collaboratively perform patient care with the goal of improving patient care. In the past two decades, ITWs have been established world-wide and studies have investigated their benefits. We aimed to compare ITWs with respect to their logistics, interprofessional learning outcomes and patient outcomes.

Methods: We explored PubMed, CINAHL, Web of Science and EMBASE (1990–June 2017) and included articles focusing on interprofessional, in-patient training wards with student teams of medical and other health professions students. Two independent reviewers screened studies for eligibility and extracted data.

Results: Thirty-seven articles from twelve different institutions with ITWs were included. ITWs world-wide are organized similarly with groups of 2–12 students (i.e. medical, nursing, physiotherapy, occupational therapy, and pharmacy) being involved in patient care, usually for a period of two weeks. However, the type of clinical ward and the way supervisors are trained differ.

Conclusions: ITWs show promising results in short-term student learning outcomes and patient satisfaction rates. Future ITW studies should measure students’ long-term interprofessional competencies using standardized tools. Furthermore, a research focus on the impact of ITWs on patient satisfaction and relevant patient care outcomes is important.     

Evaluation of the role of incentive structure on student participation and performance in active learning strategies: A comparison of case-based and team-based learning

Background: Student participation is important for the success of active learning strategies, but participation is often linked to the level of preparation. At our institution, we use two types of active learning activities, a modified case-based learning exercise called active learning groups (ALG) and team-based learning (TBL). These strategies have different assessment and incentive structures for participation. Non-cognitive skills are assessed in ALG using a subjective five-point Likert scale. In TBL, assessment of individual student preparation is based on a multiple choice quiz conducted at the beginning of each session.

Methods: We studied first-year medical student participation and performance in ALG and TBL as well as performance on course final examinations.

Results: Student performance in TBL, but not in ALG, was strongly correlated with final examination scores. Additionally, in students who performed in the upper 33rd percentile on the final examination, there was a positive correlation between final examination performance and participation in TBL and ALG. This correlation was not seen in students who performed in the lower 33rd percentile on the final examinations.

Conclusions: Our results suggest that assessments of medical knowledge during active learning exercises could supplement non-cognitive assessments and could be good predictors of performance on summative examinations.     

The impact of a student learning journal: a two-stage evaluation using the Nominal Group Technique

Reflection offers a strategy that can help learners connect what they learn with their everyday practice. It can also assist them in taking control of their learning and in developing insight into the way that they learn. This study used the Nominal Group Technique to evaluate a reflective learning journal on a one-year course for GPs and pharmaceutical advisers. Changes were introduced in answer to the students' responses in the first year, and the evaluation at the end of the second year showed a significant reduction in students' levels of confusion and anxiety related to keeping the diary. They also said that keeping the diary benefited their learning styles but they reported that keeping a learning diary was time-consuming.     

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

Background: Assessment of affective learning (AL) is difficult but important, particularly for health professional students, where it is intimately linked to the development of professional values. This study originally aimed to determine whether an emotionally impactive, extended, multimethod, interprofessional simulation experience enhanced the AL of senior medical students, compared to conventional seminars and workshops alone. This necessitated the development of a method to assess for the presence and quality of AL.

Methods: We developed a “double hermeneutic” method, derived from Smith’s Interpretative Phenomenological Analysis, to identify examples of AL, according to Krathwohl’s hierarchy (“receiving,” “responding,” “valuing,” “organization,” “characterization”), in the journals of students from each arm of a randomized educational trial. Three assessors rated the highest level of AL seen in each journal and then we compared ratings from the two study arms.

Results: A total of 135 journals were available for assessment (81 Intervention, 54 Control). The method proved to be effective in identifying and characterizing examples of uniprofessional and interprofessional AL. The median level identified in Intervention journals (“valuing”) was significantly higher than Control journals (“responding,” p?Conclusions: The method described provides a means to assess affective learning among health professional students. An extended, immersive simulation experience appears to enhance affective learning.     

Using information contained in the curriculum management information tool (CurrMIT) to capture opportunities for student learning and development

The purpose of this paper is to examine how West Virginia University Medical School used the AAMC Curriculum Management Information Tool (CurrMIT) to map the undergraduate medical school curriculum. Information gleaned from this analysis identified what students are expected to learn, how they learn and how they are assessed. Information about the curriculum was entered into CurrMIT, creating a comprehensive picture of the curricular landscape. Learning outcomes were parceled out according to a competence-based framework. In addition, learning methods and assessment measures were identified. A total of 639 learning outcomes were identified across several competences. A total of 13 learning methods and 13 assessment measures were also identified in the undergraduate curriculum. The results suggest that students are expected to acquire varied knowledge, skills and attitudes. Further, students are presented with diverse learning methods and assessment measures. The curriculum map ascertains whether the program's components, such as learning outcomes, learning approaches and assessment methods, are designed and linked to further students' learning. This analysis will lead to curricular improvements. The implications of this work can help faculty, students and other academic stakeholders shift tacit expectations of learning and development to a curricular reality and, in turn, help prepare future physicians for the changing field of medicine.     

Triage in the ICU

Some patients in intensive care units are too sick to derive much benefit from being there, while others are too well to require the technology and skills offered. When ICU resources are scarce, they may ethically be withdrawn from either sort of patient in favor of one more likely to benefit from the care.