Perceptions of inclusive learning in academic and clinical environments: a survey of pre-registration healthcare students

Healthcare students' evaluation of the clinical learning environment and supervision – a cross-sectional study

To explore how adult, child and mental health nursing and midwifery students, selected using multiple mini interviews, describe their 'values journey' following exposure to the clinical practice environment. Values based recruitment (VBR) incorporates assessment of healthcare students' personal values using approaches like multiple mini interviews. Students' experience of adjustment to their values during their programme is conceptualized as a 'values journey'. The impact of VBR in alleviating erosion of personal values remains unclear. A cross-professional longitudinal cohort study was commenced at one university in England in 2016 with data collection points at the end of years one, two and three. Non-probability consecutive sampling resulted in 42 healthcare students (8 adult, 8 child and 9 mental health nursing and 17 midwifery students) taking part. Six semi-structured focus groups were conducted at the end of participants' Year One (DC1). Data analysis incorporated inductive and deductive approaches in a hybrid synthesis. Participants described a 'values journey' where their values, particularly communication, courage and wanting to make a difference, were both challenged and retained. Participants personal journeys also acknowledged the: 'courage it takes to use values'; 'reality of values in practice' and 'need for self-reflection on values'. A 'values journey' may begin early in a healthcare student's education programme. This is important to recognize so that appropriate interventions designed to support students in higher education and clinical practice can be implemented. The values incorporated in VBR should be continually evaluated for fitness for purpose.

Leadership in the management of education: a handbook for educational supervisors: Commonwealth Secretariat, London.

To understand health care students' perception of implicit bias and examine their insights to create a bias-free training environment. Clinical phase students from one university's 4 health care programs participated in this study. Students were surveyed regarding their knowledge of implicit bias and perception of their experiences in the clinical learning environment. The response rate was 50.9%, N = 161. In total, 52.6% reported having prior training on implicit bias, and 55% self-reported that they had personally observed preceptors who exhibited an implicit bias toward patients based on race, ethnicity, or other qualities. There was no statistically significant relationship between those with prior training on implicit bias and being able to identify implicit bias exhibited by preceptors. Participants also expressed their unwillingness to report an incident unless it is confidential due to fear of retribution. This study found that health care students from one university's 4 health care programs perceived implicit bias in their clinical learning environment, which they believe could be improved by taking intentional steps. Some suggestions provided were "Safe space to report and openly discuss bias," "Education/training on implicit bias," "Time for self-reflection," and "Hiring process that evaluates/trains against implicit bias." The implication of our study is to create a bias-free training environment that will help interrupt the propagation of biases contributing to health disparity. Further research should examine a national population and identify interventional methods and outcomes in multiple health care disciplines.

BackgroundThe COVID-19 pandemic has served as a catalyst for recognizing the challenging environments in which healthcare workers operate, underscoring the urgent need to enhance their wellness to better support themselves and others. The implementation of a culture of wellness within the context of healthcare education, with a particular emphasis on individual-level strategies, allows for the realization of its intrinsic value and significance as a foundation for broader organizational strategies. This approach facilitates the establishment of a sustainable culture of wellness that benefits both current and subsequent generations of healthcare professionals.MethodsWe implemented our wellness program using a pragmatic pre-post study design for different settings. Our wellness intervention program was tested in three ways by creating combinations of different intensities (high, moderate, or low), delivery methods (face-to-face vs. virtual), different motivations (incentive, mandatory, or volunteer participation), and different timings (during medical programs or before entering into healthcare programs) among medical and nursing students. The effects of the wellness program were measured on quality of life, emotional intelligence, and efficacy scores among healthcare students. Statistical methods included repeated measures analysis of variance and paired t-tests.ResultsA total of 224 students (13 in high, 145 in moderate, and 66 in low-dose interventions) participated in our study program. Most scores were significantly improved except for a few factors in the high-dose face-to-face Well-Teach intervention cohort. Among quality of life components, the average psychological scores were markedly increased after high (13.2 vs. 14.7, p = .018), moderate (13.9 vs. 14.8, p < .001), and low (12.8 vs. 13.4, p < .001) intensity intervention cohorts. The moderate and low intensity of wellness intervention cohorts had the highest impact on the total emotional intelligence scores (mean difference = 3.021, 95%CI:0.553–5.488, p = .008) and (mean difference = 5.197, 95%CI:3.057–7.337, p = < 0.001), respectively. The low-dose healthcare intervention program yielded improvements in all components of all scores to a greater extent than moderate-dose or high-dose with face-to-face intervention programs.ConclusionsThis study demonstrates that our multifaceted Well-Teach model can be used to improve the quality of life, emotional intelligence, and self-efficacy of healthcare students. Low- or moderate-intensity intervention programs integrated into the curriculum may be more practical in health sciences education to sustain and promote lifelong wellness practices as solid steps toward attaining a “culture of wellness”. Our model should be considered to be beneficial, sustainable, cost-effective, comprehensive, and effective for current and future generations of healthcare providers.

BackgroundIt has been suggested that the university environment, to improve students’ health status and educational outcomes, should be based on a health promoting approach. More knowledge is needed about health promoting resources and lifestyle factors that may be of value for students in higher education and their future work-life balance. The aim of this study was to explore health-promoting resources, general health and wellbeing, and health promoting lifestyle factors among fourth and final semester students in higher education in healthcare and social work.MethodsThis longitudinal study is based on self-reported data collected through a web-based questionnaire that included questions about general health, wellbeing, and healthy lifestyle factors and made use of instruments: the Sense of Coherence (SOC) scale, the Salutogenic Health Indicator Scale (SHIS), and five questions from the General Nordic Questionnaire (QPS Nordic). The questionnaire was distributed among students enrolled in seven different healthcare and social work programmes at six universities in Sweden. Data was collected when students were in their fourth (2019/2020) and final (2020/2021) semesters analysed with multiple linear and logistic regressions.ResultsThe survey included responses from students during the fourth (n = 498) and the final (n = 343) semester of higher education programmes in health and social work. Total SOC scores decreased between the fourth semester and the final semester. The prevalence of the health promoting lifestyle factor of physical exercise decreased between the fourth and final semesters. Students in their final semester reported valuing group work more highly than did students in their fourth semester. Despite this, students in both the fourth and the final semester reported high SOC, low levels of good general health and perceived wellbeing, and sleeping problems.ConclusionsStudents’ report of good general health were associated with wellbeing, high-intensity physical training, and no sleeping problems A high SOC level was associated with good general health, perceived wellbeing, and no sleeping problems. A higher SHIS level was also associated with wellbeing and no sleeping problems. Therefore, we suggest further research focusing on how to prepare students in healthcare and social work during higher education for a future work-life in balance targeting effects on sleep quality.

Background: Stereotyping is one factor theorized to facilitate or inhibit effective interprofessional healthcare education and collaboration. The primary purpose of this paper is to systematically review the literature to determine what stereotypes are present among healthcare students about other healthcare students and practitioners. The secondary purpose of this paper is to identify the instruments most commonly used to measure stereotypes held by healthcare practitioners and students. Methods and Findings: A search of nine electronic databases identified studies that examined stereotypes among healthcare students. Studies were included if they met three search criteria: utilized quantitative methods; collected data on the stereotypes of healthcare students, including medical students, toward other healthcare students or healthcare practitioners; and included participants who were enrolled in a professional healthcare program. Thirteen studies were identified for this review. The results demonstrate that students of various healthcare professions hold stereotypes characterized by both positive and negative adjectives of students and practitioners in their own and other healthcare professions. Conclusions: The presence of stereotypes among students may have an influence on patterns of communication and collaboration during future practice in the healthcare environment. Key Words: Stereotypes, Interprofessional, Healthcare Students, Healthcare Education

Should I stay or should I go? A study exploring why healthcare students consider leaving their programme

Introduction:Communication skills are integral amongst healthcare students and professionals. With growing numbers of students and need for undergraduate and post- graduate training, it is often difficult to further enhance communication skills training through usual methods such as clinical placements or standardised patients [1]. With a digital shift in healthcare, especially catalysed within healthcare education during the Coronavirus-19 pandemic [2], there could be potential use for the application of Virtual Standardised Patients (VSPs) to enhance such training, providing an emotionally intelligent, and conversational interface [3]. This systematic review aims to evaluate the efficacy of using Virtual Standardised Patients for communication skills training within healthcare professionals and students compared to other educational activity.Methods:This systematic review combined searches from 5 bibliographic databases (MEDLINE OVID, EMBASE OVID, ERIC EBSCO, AMED EBSCO, and CINAHL EBSCO) and search of reference lists to scope RCTs that met the study’s pre-determined eligibility criteria. Upon retrieval of studies, data collection and critical analysis of risk of bias and methodological quality took place. A narrative synthesis was then conducted exploring findings based on the Kirkpatrick’s Four-Level Training Evaluation Model.Results:Upon search retrieval: MEDLINE OVID= 1248, EMBASE OVID=2410, ERIC EBSCO= 27, AMED EBSCO= 16, and CINAHL EBSCO= 127, six studies successfully met the eligibility criteria and were included in the result synthesis, with a total of 816 participants. Studies showed an overall greater effect in favour of VSPs in comparison to other educational activity, as well as maintenance of this difference, however, showed inconsistency in findings for user experience.Discussion:Although not to replace current training, VSP, as an interactive, conversational tool, can provide scope to enhance communication skill training. However, further research is necessary to assess effects of more long-term training and clinical outcomes.Ethics statement:Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

ABSTRACTData from international investigations indicate that gender‐based violence is a phenomenon that also occurs in the university environment. Despite the fact that clinical learning environments have been widely studied, little attention has been paid to sexual violence in the clinical placement setting of Health Sciences students. Consequently, the aim of this study was to describe situations and/or behaviours of harassment, such as assault and/or sexual abuse experienced by the students of one university in Barcelona, Spain, during their clinical placements. A cross‐sectional study was conducted using an ad‐hoc online questionnaire. A convenience sample was used including bachelor's degree students as subjects during their clinical placements in the second half of 2022. A total of 156 responses were collected from the students of four degrees (Nursing, Physiotherapy, Nutrition and Dietetics and Pharmacy). Of the total results collected, 74.5% (117) corresponded to women and the remaining 25.5% (40) to men. 71.3% of students reported that they had experienced one (or more) of the 25 types of conduct described in the questionnaire at some time. The behaviours of social interaction with sexual content and sexual harassment in the placement setting showed that such behaviours were mostly experienced by women on the Nursing degree. In relation to the perpetrators of such behaviours, the respondents manifested that the greatest aggressor was a patient and that most of the aggression took place in hospitalisation units, rehabilitation centres and nursing homes. It is essential that academic institutions, in collaboration with health institutions, carry out joint actions, awareness‐raising, identification and interventions, with students, professionals and teams from a culture of non‐violence and the eradication of sexual harassment in academic placements.

Culturally and linguistically diverse healthcare students’ experiences of learning in a clinical environment: A systematic review of qualitative studies

This article reports on the formation of an innovative new unit, termed the Clinical Placement Support Unit (CPSU), within a Faculty of Health in a Midlands university. The CPSU is concerned with managing the clinical experiences of the Faculty's health care students and promoting a healthy dialogue between the staff in the Faculty and their clinical colleagues. Several approaches by which a relatively small group of people (the Faculty staff) keep informed a relatively large group of people (the clinical staff within the local NHS Trusts) are detailed. One of the approaches is an assessors newsletter and a second is a website for use by both health care students and the clinical assessors of those students. The main part of the website is an ambitious attempt to help better prepare students prior to their clinical placements and this section of the website is called the Placement Directory. The Placement Directory currently holds details on hundreds of placements where the health care students may be placed. Each web page gives details about a specific clinical placement and has a number of hyperlinks to relevant internet resources.

To identify challenging interpersonal interactions experienced by nursing and pharmacy students during clinical placement, and strategies used to manage those situations. Healthcare students and staff experience elevated stress when exposed to dynamic clinical environments, complex care and challenging professional relationships. Emotionally intelligent behaviours are associated with appropriate recognition and management of emotions evoked by stressful experiences and development of effective relationships. Nursing and pharmacy students' use of emotionally intelligent behaviours to manage challenging interpersonal situations is not well known. A qualitative design, using semi-structured interviews to explore experiences of challenging interpersonal situations during clinical placement (Phase two of a larger mixed-methods study). Final-year Australian university nursing and pharmacy students (n=20) were purposefully recruited using a range of Emotional Intelligence scores (derived in Phase one), measured using the GENOS Emotional intelligence Inventory (concise version). Challenging interpersonal situations involving student-staff and intrastaff conflict, discourteous behaviour and criticism occurred during clinical placement. Students used personal and relational strategies, incorporating emotionally intelligent behaviours, to manage these encounters. Strategies included reflecting and reframing, being calm, controlling discomfort and expressing emotions appropriately. Emotionally intelligent behaviours are effective to manage stressful interpersonal interactions. Methods for strengthening these behaviours should be integrated into education of nursing and pharmacy students and qualified professionals. Education within the clinical/workplace environment can incorporate key interpersonal skills of collaboration, social interaction and reflection, while also attending to sociocultural contexts of the healthcare setting. Students and staff are frequently exposed to stressful clinical environments and challenging interpersonal encounters within healthcare settings. Use of emotionally intelligent behaviours to recognise and effectively manage these encounters may contribute to greater stress tolerance and enhanced professional relationships. Nursing and pharmacy students, and their qualified counterparts, need to be educated to strengthen their emotional intelligence skills.

Public stigma in health and non-healthcare students: Attributions, emotions and willingness to help with adolescent self-harm

Introduction/Background The Ohio State University is located in the heart of the state and is one of the largest land grant universities in the nation. Over the last several years, multiple collaborative simulated experiences have been developed to enrich the education of healthcare professional students on campus. Three influences stand out as having leveraged their development. First, the Institute of Medicine has recommended that principles of interprofessional (IP) team training be integrated into the education of all healthcare students.1 The Interprofessional Education Collaboration, in response, has laid out competencies for interprofessional healthcare training including teamwork and collaboration.3 Finally, Ohio State is home to seven health science colleges in close proximity allowing multiple opportunities for collaboration. Interprofessional simulation helps to promote teamwork and collaboration among healthcare professional students as well as practicing professionals. Healthcare professionals that train alongside one another in carefully developed patient care scenarios can learn to communicate more effectively with those outside of their profession, increase their knowledge of the others scope of practice and gain confidence in advocating and making decisions for their patients. Ultimately, this training method may improve future patient outcomes. Though the benefits of IP simulation are vast, few have been successful in implementing this type of training. Developing an interprofessional simulation program can be very challenging for multiple reasons. The logistics of getting multiple healthcare students together that are on differing schedules can be an insurmountable task. By in by necessary planning team members can be lacking due to previous experiences and attitudes about simulation in general as well as the value of team training. Choosing and matching the levels of participants and creating patient scenarios that meet the needs of the entire team rather than one profession can be a grueling activity. Many feel defeated before getting started. Methods In May of 2012, a core group of IP faculty and staff at The Ohio State University began the development of a simulated experience which would eventually incorporate eight different health professional students. Students from Nursing (both BSN and MSN levels), Medicine, Pharmacy, Social Work, Physical Therapy, Respiratory Therapy, Occupational Therapy and Medical Dietetics would participate together in a two patient acute care scenario. Six months were spent planning the simulation objectives, patient cases and all of the necessary logistics which culminated in a series of simulations that occurred in November 2012. Components of the experience included team rounding and collaborative patient treatment planning for two complex patients on a progressive care unit. The objectives of the experience were to create a climate of mutual respect and understanding, understand the roles and responsibilities of the other professions participating in the simulation, develop interprofessional communication skills and develop a multidisciplinary team plan of care to improve patient outcomes across the lifespan. The experience was considered successful and encouraging by all involved. Students repeatedly exclaimed that all healthcare students should have the opportunity to go through the experience and that it was their most valuable simulation of all. The series was repeated in April 2013 and a total of 400 health science students participated the first year. Results: Conclusion This presentation will showcase a successful interprofessional simulation program detailing the process and outcomes. Participants will improve their knowledge and skills in creating and maintaining interprofessional simulations in their healthcare education programs. They will also be equipped to overcome challenges and potential pitfalls related to the implementation of inter-professional simulation.