Basic Clinical Skills Research Articles

Integrating psychiatry into basic clinical skills: A three-year nationwide quantitative assessment of postgraduate training programs.

The aim of this study was to develop quantitative outcome indicators for psychiatric training programs integrated into the General Medicine In-Training Examination (GM-ITE) and to investigate which characteristics correlate with high scores in psychiatry. A nationwide cross-sectional study was conducted over 3 fiscal years (2021-2023). An anonymous online questionnaire was distributed to postgraduate year 1 and 2 residents who completed the GM-ITE. The primary outcome was GM-ITE score, with a particular focus on psychiatry. Multiple-choice questions for the psychiatry field were created by board-certified psychiatrists with various subspecialties, then reviewed and piloted. Multiple regression analysis examined correlations between GM-ITE score and various resident and facility characteristics. A total of 18,226 residents participated over the 3 years, of whom 5%-6% aspired to specialize in psychiatry. Quantitative scores were effective in the psychiatry field across all 3 years. Psychiatry aspirants had lower scores in internal medicine, emergency, and total scores but higher scores in psychiatry. Residents from university hospitals had lower psychiatry scores, while the number of psychiatry beds and supervising psychiatrists did not correlate with higher psychiatry scores. These findings indicate the need for psychiatric training programs distinct from general internal medicine and emergency training. Based on these quantitative psychiatry scores, this study highlights the necessity of improving physical assessment skills during residency for psychiatry aspirants, who score higher in psychiatry. Future research should identify effective training programs and facility practices that lead to higher psychiatry scores among residents, and thereby better integrate psychiatry into basic clinical skills.

Enhancing medical training in conflict zones and remote areas through innovation: introducing the Canadian Virtual Medical University Initiative

The WHO projects a global shortage of 4.3 million physicians by 2030, with the largest deficits in developing and conflict-affected regions. Our aim is to train competent physicians rapidly and affordably through remote education programs. We developed an online medical training curriculum with four levels, focusing on different aspects of human body systems using a competency-based, student-centered approach. This study evaluates the first three levels; level four (internship) is outside this scope. The 105 medical students from eight Afghan universities were randomly assigned to nine groups. The curriculum includes Entrustable Professional Activities (EPA) for the cardiovascular system: level 1 covers basic medical sciences, level 2 pathology and basic clinical skills, and level 3 full clinical competencies. EPAs were delivered asynchronously online via Lecturio, CyberPatient, and Zoom. The 30-day intervention included 4h of weekly online classes for formative assessment, collaborative learning, and evaluation, supervised by medical faculty members. Virtual pre- and post-intervention evaluations used multiple-choice questions and objective structured clinical examination (OSCE). We also conducted a satisfaction survey and open interview forum. Data triangulation from observations, surveys, and interviews validated curriculum effectiveness. The benchmarking method assessed cost-effectiveness. Pre- and post-intervention analysis showed a significant increase in clinical competencies and knowledge acquisition (P<0.0001). The CyberPatient intervention improved clinical competency quality (P<0.0001) and shortened decision-making time (P<0.001). Cost analysis revealed that a virtual medical university would be 95% more cost-effective than traditional medical education. Integrating virtual technology with modern curriculum concepts in pre-internship years can effectively address healthcare training gaps and enhance education quality for healthcare workers at a low cost. Provided by CanHealth International. A UBC spin-off not-for-profit organization.

Effects of Simulated Patient Practice on attitudes towards communication skills training of medical students: An intervention study

Communication is a basic clinical skill that can be learned, taught, and evaluated. This study aimed to assess the attitudes of medical faculty sophomore students toward the communication skills training module consists theory courses and simulated patient interviews. This study was planned in a before-and-after intervention study and was carried out with 257 second-year medical students. The Communication Skills Attitude Scale (CSAS) was used for data collection. The scale was administered to the participants before the training (1), after the training (2), and after the simulated patient interviews (3). Positive attitude scores (PAS 1,2,3), and negative attitude scores (NAS 1,2,3) were evaluated. The mean age of the students was 20.13±2.13 years, and 133 (51.8%) were female. PAS 1 and PAS 3 scores were 55.38±6.58 and 58.05±7.39, respectively, while NAS 1 and 3 scores were 30.25±4.49 and 28.88±4.96, respectively. PAS 3 was considerably higher than PAS 1 and 2 scores (p=.03), at the same time NAS 3 was significantly lower than NAS 1 and 2 scores (p=.00). There was no difference between the positive and negative attitudes of females and males before the training (p&gt;.05). However, after the training, female's positive scores significantly increased compared to men (p=.03), and their negative scores decreased (p=.01).

Patients' Expectations of Doctors' Clinical Competencies in the Digital Health Care Era: Qualitative Semistructured Interview Study Among Patients.

Digital technologies have impacted health care delivery globally, and are increasingly being deployed in clinical practice. However, there is limited research on patients' expectations of doctors' clinical competencies when using digital health care technologies (DHTs) in medical care. Understanding these expectations can reveal competency gaps, enhance patient confidence, and contribute to digital innovation initiatives. This study explores patients' perceptions of doctors' use of DHTs in clinical care. Using Singapore as a case study, it examines patients' expectations regarding doctors' communication, diagnosis, and treatment skills when using telemedicine, health apps, wearable devices, electronic health records, and artificial intelligence. Findings were drawn from individual semistructured interviews with patients from outpatient clinics. Participants were recruited using purposive sampling. Data were analyzed qualitatively using thematic analysis. Twenty-five participants from different backgrounds and with various chronic conditions participated in the study. They expected doctors to be adept in handling medical data from apps and wearable devices. For telemedicine, participants expected a level of assessment of their medical conditions akin to in-person consultations. In addition, they valued doctors recognizing when a physical examination was necessary. Interestingly, eye contact was appreciated but deemed nonessential by participants across all age bands when electronic health records were used, as they valued the doctor's efficiency more than eye contact. Nonetheless, participants emphasized the need for empathy throughout the clinical encounter regardless of DHT use. Furthermore, younger participants had a greater expectation for DHT use among doctors compared to older ones, who preferred DHTs as a complement rather than a replacement for clinical skills. The former expected doctors to be knowledgeable about the algorithms, principles, and purposes of DHTs such as artificial intelligence technologies to better assist them in diagnosis and treatment. By identifying patients' expectations of doctors amid increasing health care digitalization, this study highlights that while basic clinical skills remain crucial in the digital age, the role of clinicians needs to evolve with the introduction of DHTs. It has also provided insights into how DHTs can be integrated effectively into clinical settings, aligning with patients' expectations and preferences. Overall, the findings offer a framework for high-income countries to harness DHTs in enhancing health care delivery in the digital era.

Optimizing resident training in obstetrics and gynecology: a new perspective on the refined Peyton four-step teaching method

ObjectiveIn the surgery-focused field of obstetrics and gynecology (OB-GYN), the development of residents’ skills is paramount. This study aims to evaluate the impact of an enhanced Peyton Four-Step Teaching Model on the foundational skill training of first-year OB-GYN residents.MethodsUtilizing a cohort study design, we assessed 116 first-year residents from the OB-GYN residency program at Shengjing Hospital of China Medical University from June 2021 to June 2023. The 57 residents beginning their training in 2022 were part of the Refined Peyton (RP) group, introduced to the RP method; the 59 residents from 2021 served as the Traditional Teaching-mode (TTM) group, receiving conventional simulation-based instruction. Teaching effectiveness was assessed by comparing theoretical knowledge and skill performance assessments, National Medical Licensing Examination (NMLE) pass rates, direct observation of procedural skills (DOPS) one year post-training, and survey feedback.ResultsThe theoretical knowledge scores for both groups were comparable at 78.78 ± 4.08 and 78.70 ± 3.83, with no significant difference (P = 0.76). However, the experimental group demonstrated superior performance in skill operation assessments, first-time NMLE pass rates, and DOPS evaluations one year after training [(77.05 ± 5.39) vs. (84.60 ± 5.65), 100.0% (57/57) vs. 86.4% (51/59), and (75.22 ± 3.56) vs. (82.54 ± 3.43)], as well as higher teaching satisfaction scores [(4.63 ± 0.46) vs. (3.92 ± 0.62)], with all differences being statistically significant (P < 0.05).ConclusionThe refined Peyton Four-Step Teaching Model significantly improves the immediate acquisition and long-term retention of clinical basic skills among OB-GYN residents, enhancing both teaching efficacy and resident satisfaction.

Self-Assessment Kompetensi Praktik Klinis Awal Mahasiswa Keperawatan di Rumah Sakit

Self-assessment is one way of self-assessment, which is needed to achieve the initial basic clinical practice skills for female nursing students in hospitals. Early basic clinical practice in hospitals is a learning tool for nursing students to apply nursing theory and, integrate theoretical knowledge and practical skills, which have received guidance from academic supervisors (lecturers) and clinical supervisors (hospitals). This study aims to conduct a self-assessment of the ability of female nursing students at the initial basic level of clinical practice in hospitals is the main goal of nursing education. The method used is quantitative research using descriptive-analytic research design, to answer the identification of the research problem of self-assessment of how skillful the implementation of basic clinical practice of early female nursing students in hospitals. The results showed five categories of skills: Very skilled, 12 female students (33.33%), skilled, 12 female students (33.33%), quite skilled 7 female students (18.42%), less skilled, 3 female students (7.89%), and unskilled, 2 female students (5.26%). The conclusion shows that the average percentage of Self-Assessment in performing basic initial clinical practice skills at the hospital is in the category of highly skilled, skilled, and moderately skilled. However, there are still nursing students in the less skilled and unskilled categories in relatively smaller numbers compared to those in the highly skilled, skilled,, and moderately skilled categories.

Perceived opportunities of clinical reasoning learning in postgraduate psychiatry training: Trainees' and faculty's perspectives.

Learning clinical reasoning is less effective in isolation of clinical environments because contextual factors are a significant component in the clinical reasoning process. This study investigated the differences in opinions between novice and expert clinicians on learning clinical reasoning in the workplace. The author used a cross-sectional online survey design to investigate the perceived learning of six clinical reasoning skills in 13 learning opportunities. Questionnaires were emailed to 41 postgraduate psychiatry trainee doctors and 37 faculty members. Data were analyzed descriptively. The Chi-square test was used to compare the responses of the two groups. Statistical significance was set at P < 0.05. The combined response rate was 73.07%. The two groups perceived the learning of advanced clinical reasoning skills to be lower than that of basic skills. There were significant differences in the perceived learning of basic clinical reasoning skills in self-study/exam preparations (P = 0.032), general hospital grand rounds (P = 0.049), and clinical rounds (P = 0.024 for consultant-led rounds and P = 0.038 for senior peer-led rounds). There were also significant differences in the perceived learning of advanced clinical reasoning skills among peer-led tutorials (P = 0.04), journal clubs (P = 0.006), morning reports (P = 0.002), and on-call duties (P = 0.031). The trainees showed a significant preference for structured learning environments rather than clinical environments, especially for advanced clinical reasoning skills. Trainees likely struggled with cognitive overload in clinical environments. Local postgraduate psychiatry programs will likely benefit from implementing multiple educational interventions that facilitate teaching and learning clinical reasoning in complex clinical environments.

Effectiveness of Problem-Based Learning and Case-Based Learning Teaching Methodology in Vascular Surgery Internship

Objective: To investigate the practical effect of problem-based learning (PBL) combined with case-based learning (CBL) teaching method used in the teaching of vascular surgery internship. Methods: 60 clinical medical graduates who interned in vascular surgery in our hospital from June 2022 to June 2023 were divided into the control group and the observation group of 30 each by applying the random number division method. The control group adopted the traditional lecture mode, and the observation group adopted the comprehensive teaching mode of PBL + CBL teaching method. The indicators of students’ job competence and teaching satisfaction scores in the two groups were compared. Results: The scores of students’ job competence in basic theoretical knowledge of vascular surgery, basic operation, clinical analysis, medical records writing, etc. in the observation group were higher than those in the control group, and the scores of satisfaction with teaching method were higher than those in the control group, with statistically significant differences (P &lt; 0.01). Conclusion: PBL + CBL teaching method used in vascular surgery internship teaching is effective and can significantly improve the students’ basic theoretical knowledge and clinical practice skills, with a high satisfaction rating, thus it is worthwhile to promote the application in the field of clinical teaching.

Current status and continuing medical education need for general practitioners in Tibet, China: a cross-sectional study

BackgroundThe Tibetan area is one of China’s minority regions with a shortage of general practice personnel, which requires further training and staffing. This research helps to understand the current condition and demand for general practitioner (GP) training in Tibetan areas and to provide a reference for promoting GP education and training.MethodsWe conducted a cross-sectional survey using stratified sampling targeting 854 GPs in seven cities within the Tibetan Autonomous Region, utilizing an online questionnaire. Achieving a high response rate of 95.1%, 812 GPs provided invaluable insights. Our meticulously developed self-designed questionnaire, available in both Chinese and Tibetan versions, aimed to capture a wide array of data encompassing basic demographics, clinical skills, and specific training needs of GPs in the Tibetan areas. Prior to deployment, the questionnaire underwent rigorous development and refinement processes, including expert consultation and pilot testing, to ensure its content validity and reliability. In our analysis, we employed descriptive statistics to present the characteristics and current training needs of GPs in the Tibetan areas. Additionally, chi-square tests were utilized to examine discrepancies in training needs across various demographic groups, such as age, job positions, and educational backgrounds of the participating GPs.ResultsThe study was completed by 812 (812/854, 95.1%) GPs, of whom 62.4% (507/812) were female. The top three training needs were hypertension (81.4%, 661/812), pregnancy management (80.7%, 655/812), and treatment of related patient conditions and events (80.5%, 654/812). Further research shows that the training required by GPs of different ages in “puncturing, catheterization, and indwelling gastric tube use” (64.6% vs. 54.8%, p = 9.5 × 10− 6) varies statistically. GPs in various positions have different training needs in “community-based chronic disease prevention and management” (76.6% vs. 63.9%, p = 0.009). The training needs of GPs with different educational backgrounds in “debridement, suturing, and fracture fixation” (65.6% vs. 73.2%, p = 0.027) were also statistically significant.ConclusionsThis study suggests the need for targeted continuing medical education activities and for updating training topics and content. Course developers must consider the needs of GPs, as well as the age, job positions, and educational backgrounds of GPs practicing in the Tibetan Plateau region.Trial registrationNot applicable.

MOBILIZATION OF MIDWIFERY CARE FOR POSTPARTUM WOMEN AT PMB MONICA ROSWIYANTI, S.Tr.Keb

Involution is when the uterus returns to its pre-pregnancy state weighing about 60 grams. This process begins immediately after delivery of the placenta due to contractions of the smooth muscles of the uterus. Involution is caused by continuous contraction and retraction of uterine muscle fibers. The way to reduce morbidity in the postpartum period is to carry out early mobilization to accelerate uterine involution. Early mobilization or activity as soon as possible after resting for several hours and getting out of the mother's bed. This report's purpose is to teach patients early mobilization independently according to the steps and theory trained in Basic Clinical Practice Skills. The method used in this report is a case study. This report shows that after being taught to do early mobilization, postpartum mothers can tilt, sit, and walk around. Early mobilization steps have been carried out according to the procedure. The author suggests improving the Midwifery Clinic Basic Skills that are owned to improve the care that, by standards carried out skillfully, can overcome real problems in practice and apply according to the theory obtained in lectures.

A Web-Based Educational Module Using Clinical Neuroscience to Deliver the Diagnosis of Functional Neurological Disorder.

Neuroscience-based patient education has become an evidence-based strategy for enhancing chronic pain treatment. Advances in understanding the neuroscience of functional neurological disorder (FND) may allow similar approaches to be developed and disseminated to clinicians, given the public health need for greater provider awareness and expertise around the condition. Accordingly, the authors developed an online video module for clinicians that delivers neuroscience-based psychoeducation for FND and assessed whether the intervention would be associated with changes in clinicians' perception of FND patients and knowledge about the condition. The online intervention consisted of a 20-minute video module, including an 8-minute scripted role-play that modeled neuroscience-informed diagnosis delivery. Pre- and postintervention questionnaires were embedded into the online module and included a self-assessment of FND-related perceptions and knowledge and a multiple-choice assessment of retention of the neuroscience-based content. Wilcoxon signed-rank tests and McNemar's tests were used for statistical analyses. Of the 103 individuals who submitted surveys, 40 participants provided a complete data set from before and after the intervention. Following the intervention, self-assessment items showed respondents had significantly greater comfort with diagnosis delivery and treatment options and decreased negative perception of FND patients. The percentage of correct responses on a multiple-choice assessment regarding the functional neuroanatomy of FND was significantly increased. In summary, the online neuroscience-based educational intervention was effective for increasing clinician knowledge about FND and comfort with diagnosis delivery and treatment options. Implementing web-based formats may be a viable and cost-effective approach to disseminating knowledge and basic clinical skills in the care of patients with FND.

Evaluating clinical communication skills of medical students, assistants, and professors

BackgroundThe skill of communicating with the patient is one of the basic clinical skills and part of the necessary competencies for medical doctors. The present study aimed to evaluate the knowledge, attitude, and performance (KAP) of medical students, assistants, and professors of Shahrekord University of Medical Sciences regarding clinical communication skills with patients.MethodThis cross-sectional study was conducted at the hospitals of Shahrekord University of Medical Sciences in Iran. The study included a total of 289 participants, consisting of 51 professors, 72 assistants, 90 external staff, and 76 interns who work at these hospitals. The participants were selected through a convenience sampling method. The data-gathering tools used included a questionnaire to collect demographic characteristics, a researcher-made questionnaire to assess knowledge, a communication skills attitude questionnaire, and a communication skills survey questionnaire. The data were analyzed using descriptive statistics such as mean, standard deviation, and frequency, as well as statistical tests that included one-way ANOVA and Pearson’s correlation test. The significance level for the study was considered to be 0.05.ResultsThe mean scores of knowledge of professors were higher compared to other groups (P = 0.002). All participating groups had a positive attitude toward learning communication skills. There were statistically significant differences between the mean scores of the communication performance of the study groups (P < 0.001). There was a positive relationship between positive attitude and communication performance, and a significant negative relationship was observed between negative attitude and communication performance.ConclusionThe results indicate the relatively favorable attitude and performance of the groups and their low knowledge. It is suggested that the doctor-patient communication skills courses be included as one of the necessary courses in the medical education curriculum.

Developing veterinary basic clinical skill items based on Korean Veterinary Entrustable Professional Activity.

Developing clinical skills is an essential element of veterinary education to ensure the competency of veterinary graduates. Although the Korean Veterinary Education Graduation Competencies were established in 2016, reflecting domestic needs and international trends in competency-based veterinary education, they have yet to be implemented in Korean veterinary education. This study aimed to establish the basic veterinary clinical skills required to ensure graduates of Korean veterinary universities have the day-one competency to independently perform their professional duties. The Education Committee of the Korean Association of Veterinary Medical Colleges, composed of veterinary school professors and an experienced veterinarian in the clinic, reviewed domestic and international veterinary education-related materials to define basic clinical skills. The Korean Veterinarian Entrustable Professional Activities (KVEPA) was introduced, followed by the subsequent development of 54 essential clinical skills based on the KVEPA. The veterinary basic clinical skills established through this study can be used as a specific guide for clinical education in Korean veterinary school, and is expected to play an important role in meeting the needs of the educational sector of the veterinary education accreditation standards.

OLDER ADULT VOLUNTEERS AS MENTORS IN GERIATRIC EDUCATION

Abstract Health professions education that involves older adults has been shown to be effective in improving students’ clinical skills and attitudes towards older adults. With the goal of introducing healthcare students to geriatric care through first-hand experiences, the “Seniors Assisting in Geriatrics Education (SAGE)” Program involves older adult volunteers age 65+ in virtual person-centered health promotion visits with teams of three to four students. Through an application process, mentors are selected and receive orientation materials before visits with their assigned team. Students represent eight disciplines: dietetics, medicine, nursing, pharmacy, physical therapy, physician assistant studies, social work, and speech language pathology. Students practice basic clinical skills and screening techniques while working as a team and receiving feedback and input from their mentor. In 2022, we surveyed older adult volunteers to evaluate their mentor experience using open-ended and Likert style questions on a scale from strongly agree to strongly disagree. Survey responses (n=99) show that most mentors agreed students collaborated well (94%), health promotion topics for each visit were beneficial (83% to 85%), and they were satisfied with their SAGE experience (96%). Mentors identified opportunities for improvement related to student and mentor preparation, in-person versus online visits, and establishing rapport between mentors and teams. Results were used to enhance mentor training and engagement and to create community partnerships for recruitment and mentor diversity. By prioritizing recruitment of and training for volunteers, older adults can actively and effectively participate in meaningful educational experiences with health professions students.

Combined Teaching Method in Teaching Basic Clinical Skills to Midwifery Students: A Quasi-experimental Study

Background: The utilization of effective educational methods is crucial for enhancing the clinical skills of health sciences students. Objectives: This study aimed to assess the impact of a blended teaching approach involving videos and demonstrations in clinical skills training on midwifery students’ performance and satisfaction. Methods: This quasi-experimental study was carried out with 41 midwifery students from Hamadan University of Medical Sciences, Hamadan, Iran, using a census sampling method within 2018 to 2019. The experimental group received training through a combination of video presentations and demonstrations; nevertheless, the control group received training solely through demonstrations. The data were collected using a demographic questionnaire, a satisfaction scale, and the objective structured clinical examination (OSCE). Data analysis was performed using the Mann-Whitney U test and chi-square test with SPSS software (version 16). Results: The experimental group exhibited significantly higher mean scores in vital signs assessment, intravenous therapy, injection techniques, urinary catheterization, application and removal of sterile gloves, and prepping and draping for normal delivery (P &lt; 0.001). There were no significant differences in the mean scores for hand washing (P = 0.380) and oxygen therapy (P = 0.604) between the two groups. The combined group achieved notably better scores in the OSCE, with scores of 18.25 (1.58) compared to 16.60 (1.60) in the control group (P = 0.002). Additionally, the combined group expressed higher satisfaction with the training method, scoring 86.10 (9.50) compared to 75.52 (16.07) in the control group (P = 0.027). Moreover, the combined group reported significantly higher levels of satisfaction regarding the facilitation of educational content transfer and overall satisfaction with the training course (P &lt; 0.05). Conclusions: Employing instructional videos and demonstrations as a combined teaching method for basic clinical skills training results in improved student performance and satisfaction.

Self-perceived preparedness of new dental graduates from a Middle Eastern university.

Preparedness for independent clinical practice is a core goal of undergraduate dental education. The aim of this study was to evaluate the self-reported preparedness for the dental practice among new dental graduates from a University in the Middle East. Following ethics approval, a purposive sampling techniques were used to invite newly qualified dental graduates at a Middle Eastern University. A validated research instrument, namely the Dental Undergraduate Preparedness Assessment Scale (DU-PAS), was used to evaluate the self-perceived preparedness of the participants. Data collection was undertaken online using Google Forms and data were analysed to compute the descriptive statistics, reliability and demographic differences among the participants. A total of 82 participants provided their response yielding a response rate of 68%. The participants included 49 males and 33 females. The overall reliability of DU-PAS was excellent. (α = 0.93). The participants included less than 40% of participants were able independently to prescribe medications, assess orthodontics needs and perform endodontic treatment on multirooted teeth. In addition, more than 65% indicated low confidence in evaluating new dental materials and products, interpreting new research findings and behavioural management of children. The present findings identified strengths and weaknesses of new dental graduates from a Middle Eastern university. The participants were confident in basic clinical skills but lower confidence was reported for complex dental procedures. The findings highlight the learning needs of new dental graduates and can serve to inform the undergraduate curriculum to enhance the preparedness of future cohorts of dental graduates.

Case report of rare tissue injury and left arm dislocation after incorrect blood pressure measurement during clinical practice

In midwifery education based on theoretical and practical foundations, students encounter midwifery profession education which based on for the first time in the Basic Clinical Skills in Midwifery Course. The aim of the Basic Clinical Skills in Midwifery Course is to help students understand the basic philosophy of midwifery and the role of the midwife in the health system, and to provide the student with knowledge, skills and attitudes about the basic concepts, principles and methods in midwifery care. In the Basic Clinical Skills in Midwifery Course, students are offered learning methods that will enable them to develop behaviors in the cognitive, affective and psychomotor domains. In this context, the course is carried out in skill development laboratories and clinical environments, after the lecturer in the classroom explains the basic concepts, the health system and midwifery, the protection and development of health, the fulfillment of physiological care needs, and the demonstration of the skills related to the psychomotor domain. Clinical practices are an indispensable element of midwifery education. The Midwifery Basic Clinical Skills Course has a very important place in clinical skills training, as students experience the hospital environment for the first time in their education life and experience midwifery practices for the first time on real patients. The aim here is to discuss a case that can be experienced after the correct application of vital sign measurement techniques and erroneous measurement.

Training needs for staff providing remote services in general practice: a mixed-methods study.

Contemporary general practice includes many kinds of remote encounter. The rise in telephone, video and online modalities for triage and clinical care requires clinicians and support staff to be trained, both individually and as teams, but evidence-based competencies have not previously been produced for general practice. To identify training needs, core competencies, and learning methods for staff providing remote encounters. Mixed-methods study in UK general practice. Data were collated from longitudinal ethnographic case studies of 12 general practices; a multi-stakeholder workshop; interviews with policymakers, training providers, and trainees; published research; and grey literature (such as training materials and surveys). Data were coded thematically and analysed using theories of individual and team learning. Learning to provide remote services occurred in the context of high workload, understaffing, and complex workflows. Low confidence and perceived unmet training needs were common. Training priorities for novice clinicians included basic technological skills, triage, ethics (for privacy and consent), and communication and clinical skills. Established clinicians' training priorities include advanced communication skills (for example, maintaining rapport and attentiveness), working within the limits of technologies, making complex judgements, coordinating multi-professional care in a distributed environment, and training others. Much existing training is didactic and technology focused. While basic knowledge was often gained using such methods, the ability and confidence to make complex judgements were usually acquired through experience, informal discussions, and on-the-job methods such as shadowing. Whole-team training was valued but rarely available. A draft set of competencies is offered based on the findings. The knowledge needed to deliver high-quality remote encounters to diverse patient groups is complex, collective, and organisationally embedded. The vital role of non-didactic training, for example, joint clinical sessions, case-based discussions, and in-person, whole-team, on-the-job training, needs to be recognised.

Student engagement and learning outcomes: an empirical study applying a four-dimensional framework

ABSTRACT Introduction This study applies Reeve’s four-dimensional student engagement framework to a medical education context to elucidate the relationship between behavioral, emotional, cognitive, and agentic engagement and learning outcomes. Meanwhile, we categorize learning outcomes in knowledge and skills, and added taxonomies to the cognitive education objectives for the knowledge part, including memorization, comprehension, and application. Methods We used the China Medical Student Survey to investigate student engagement, and combined it with the Clinical Medicine Proficiency Test for Medical Schools results as a standardized measurement of learning outcomes. We performed multivariate regression analyses to delve into the effectiveness of different types of student engagement. Moreover, we evaluated the moderating roles of gender and the National College Entrance Examination (NCEE) within the relationships between student engagement and learning outcomes. Results We observed that emotional engagement is most effective in promoting learning outcomes in basic medical knowledge and basic clinical skills. Emotional engagement and cognitive engagement could effectively contribute to learning outcomes in all three aspects of basic medical knowledge. In contrast, behavioral and agentic engagement showed negative effects on learning outcomes. Besides, we found that the results of the NCEE played a positive moderating role. Conclusion This study provides robust evidence for the effectiveness of emotional engagement and cognitive engagement in promoting learning outcomes. Whereas behavioral and agentic engagement may not be good predictors of learning outcomes in macro-level general competence tests. We suggest a combined effort by students and institutions to promote student engagement and bridge the distance between general competency tests and daily learning activities.

Flexner has fallen: Transitions in medical education system across time, a gradual return to pre-Flexnerian state (de-Flexnerization).

The modern medical education system has gradually evolved starting from 1910 incorporating the suggestions by Abraham Flexner, his public disclosure of the poor conditions at many medical schools provided a means to galvanize all the constituencies needed for reform to occur. He could say what other reformers could not, due to their links to the medical education community. But now we are again going back to a pre-Flexnerian state due to multiple reasons such as gradually diminishing importance of basic science subjects for the students, the decline in the number and quality of investigator initiated research among clinical researchers, lesser emphasis to bedside training by means of detailed clinical examination and making appropriate observation of signs to reach to a diagnosis rather than over reliance on the laboratory tests and radiological modalities for the diagnosis, poor exposure to basic clinical skills starting from college throughout residency and the trend of disrespect and absenteeism from both theoretical and clinical/practical classes. The attitude of students is just to complete their required attendance so that they are not barred from appearing in examinations. This de-Flexnerization trend and regression to pre-Flexnerian era standards, ideologies, structures, processes, and attitudes, are bound to beget pre-Flexnerian outcomes, for you get what you designed for.