Clinical Education Research Articles

Rolling Through the Complications With the Clinical Judgment Model.

Nurse educators have been challenged to creatively implement the clinical judgment model (CJM) across the curriculum. Opportunities exist to utilize rich patient data in clinical debriefing. Rolling Through the Complications with the CJM, a scripted clinical debriefing tool, was created to help students think beyond the clinical day and apply clinical judgment to potential complications. In a pilot study, five medical-surgical clinical instructors implemented the clinical debriefing tool. Survey responses from 29 students following the clinical debriefing expressed the activity was a positive experience encouraging focused analysis beyond typical post-conference discussions. Comments focused on critical thinking, collaborative learning, application to future practice, and holistic care. Clinical post-conferences offer excellent opportunities to implement scripted debriefing encompassing the CJM. [J Nurs Educ. 2024;63(X):XXX-XXX.].

Implementing the organizational readiness for change survey during a novel midwifery preceptor program in Sierra Leone: stakeholder results

BackgroundSierra Leone has one of the world’s highest maternal and infant mortality rates and suffers from a shortage of well-trained health professionals, including midwives. Prior to engaging in systematic interventions, it is critical to measure organizational readiness to gauge members’ psychological and behavioral preparedness to implement change. We aimed to measure the organizational readiness for implementing change and compare results among midwives and administrative leaders at two schools of midwifery in Sierra Leone prior to the rollout of a midwifery preceptor program.MethodsThe Organizational Readiness for Implementing Change (ORIC) survey is a validated 12-item questionnaire designed to assess two domains of organizational readiness for change: change commitment (motivation) and change efficacy (capacity). All survey items begin with the same prompt and a five-item Likert scale response, with seven questions about change commitment and five about change efficacy. Data collection occurred in two schools of midwifery in Sierra Leone during two day-long meetings with stakeholders. Statistical analysis was conducted using descriptive statistics and Wilcoxon rank-sum test to compare independent samples: School 1 versus School 2 (site), midwife versus other roles (role).ResultsParticipants included 42 respondents (mean age 41 years, 95% female). Surveys were distributed evenly between the two sites. Occupations included midwifery faculty (n = 8), administrators (n = 5), clinicians (n = 25), and clinical educators (n = 4). Domain 1 (change commitment) had a mean score of 4.72 (SD 0.47) while Domain 2 (change efficacy) had a mean score of 4.53 (SD 0.54) out of a total potential score of five. There were no statistically significant differences between site responses for Domain 1 (p = 0.5479) and Domain 2 (p = 0.1026) nor role responses for Domain 1 (p = 0.0627) and Domain 2 (p = 0.2520).ConclusionStakeholders had very high overall readiness for change across all ORIC questions for both change commitment and change efficacy. Mean scores for change commitment were slightly higher which is not surprising given the low-resourced settings stakeholders work in while training students. High mean scores across sites and roles is encouraging as this novel preceptor program is currently being rolled out.

Analysis of the Feedback on Teacher Training in an Affiliated Hospital in Shaanxi Province

Objective: This article aims to deeply analyze the feedback on teacher training in an affiliated hospital, so as to clarify the current needs and situation of teacher training and provide a scientific basis for further optimizing the teacher training system. Methods: The current situation and needs of teacher training in the affiliated hospital were collected by designing and distributing Tomato Form questionnaires on the DingTalk platform. The questionnaire adopted a percent-point system, all of which were indeterminate multiple-choice questions. Results: The average age of the clinical teachers participating in the survey was 40.44 ± 7.85 years old, with an average teaching length of 4–10 years. The results showed that 60.20% of teachers think that the amount of teacher training in an affiliated hospital is sufficient; 91.10% of teachers think that the factors affecting training conflict with working hours; 97.96% of teachers believe that the training time has an impact on the training effect; 81.63% of teachers prefer online training; 51.53% of teachers tend to arrange training time on working days; 33.16% of teachers tend to train once a month; 17.78% of teachers prefer to receive training on clinical theoretical courses and practical teaching norms and skills content. Conclusion: Based on the above survey results, we propose to build a comprehensive management mechanism for teacher training, including improving the access, training, and assessment mechanism for clinical teachers, and adjusting and optimizing the training program according to actual needs. At the same time, an effective communication platform should be built to promote the deep integration of teaching and practice and enhance social recognition, so as to comprehensively improve the teaching quality and medical service of the hospital.

Prenatal Screening of Chromosomal Anomalies Using Genome-Wide or Target Cell-Free DNA: Preferences and Satisfaction of Pregnant Women.

Background/Objectives: Cell-free DNA (cfDNA) is a non-invasive prenatal test used to screen for common trisomies (target cfDNA) that can be expanded to assess all autosomal chromosomes (genome-wide cfDNA). As cfDNA testing gains popularity, it is crucial to examine the factors influencing the decision-making process of pregnant individuals when choosing between these two approaches. Methods: In this prospective cohort study, 190 individuals undergoing cfDNA testing for aneuploidy screening, according to the current screening protocol, were allowed to make their own choice between target and genome-wide cfDNA testing. They were asked to complete a first survey at 11-13 weeks, designed to explore their characteristics, preferences, and satisfaction with the prenatal genetic counseling session, as well as a Decisional Conflict Scale. A postnatal survey was administered three months after delivery, including the Decisional Regret Scale and two open questions. Results: 84% of participants opted for genome-wide cfDNA. However, 17% found the decision challenging, and 14% felt that the results might increase anxiety. No significant differences in participant characteristics were found when comparing decisions between genome-wide and target cfDNA. However, significant differences were observed regarding ethnicity (p = <0.001), educational level (p = 0.029), previous cfDNA experience (p = 0.004), and having sufficient information when comparing termination options (p = 0.002). After delivery, only 4% would have changed their decision. Conclusions: Individuals, regardless of their characteristics, prefer genome-wide cfDNA; however, the complexity of the results necessitates enhanced genetic education for prenatal care clinicians.

Entrustable professional activities for bedside clinical teachers

BackgroundBedside teaching is an important modality for training medical students and postgraduate trainees in clinical settings. Despite its significance, the effective practice of Bedside teaching has been declining over the past few decades. The literature highlighted the need for structured training, assessment, and certification or in other words entrustment of bedside teachers. The current study aims to develop and validate the Entrustable Professional Activities (EPAs) for bedside clinical teachers.MethodsA multi-method study with clinical teachers, medical educationists, and postgraduate medical students was conducted from July 2021-22. First, a nominal group using the jigsaw puzzle technique was conducted with 16 participants to identify EPAs. Then these EPAs were mapped and validated by the skills/competencies identified in the literature. Next, the EPAs were evaluated using the EQual rubric by 3 medical educationists. This was followed by two-rounds of modified Delphi to develop consensus among 90 participants in round-one and 69 in round-two. For qualitative data, a thematic analysis was conducted. For quantitative data, means and standard deviations were calculated.ResultsThe study identified five EPAs for bedside clinical teachers: developing bedside teaching program, planning bedside teaching session, conducting bedside teaching, conducting bedside assessments and evaluating bedside teaching.ConclusionsThis study comprehensively developed and validated a full description of EPAs for bedside clinical teachers. The EPAs identified in the study can serve as a guiding framework for bedside clinical teachers’ training, assessment, and entrustment.

STEM Cooperating Teachers’ Professional Growth: The Positive Impacts of a Year-Long Clinical Residency Collaboration

Teacher residency programs integrate coursework with clinical practice in a year-long residency in which pre-service teachers work under the guidance of a cooperating teacher who has demonstrated excellence in teaching and mentoring. The purpose of this study was to examine the reasons for serving as a cooperating teacher and investigate how clinical residency pre-service teachers promote growth in the professional practice of cooperating teachers as teachers and teacher leaders. In this longitudinal qualitative study, we gathered data through semi-structured interviews and responses to survey questions over a five-year period. Ten STEM cooperating teachers (six female and four male) with 7 to 18 years of full-time teaching experience in biology, chemistry, or mathematics participated. A thematic analysis was used to analyze the interview transcripts and survey responses. The primary motivation for serving as a cooperating teacher was the desire to share experiences and support new teachers. Cooperating teachers described the following benefits: increased self-reflection and continuing reflective practice; meaningful collaboration with pre-service teachers; learned new teaching strategies to enrich their own teaching practice; improved communication skills; and the impetus to become teacher leaders. These findings support that clinical residency teaching programs are beneficial for STEM cooperating teachers and promote their professional growth.

Evaluation of the pandemic biosafety protocol in a dental teaching clinic from the patient's perspective

Evaluation of the pandemic biosafety protocol in a dental teaching clinic from the patient's perspective

Midwifery educators' knowledge of antenatal exercises in selected Nigerian midwifery schools.

Exercise during pregnancy is beneficial to both the pregnant woman and the foetus. Midwifery educators play a crucial role in ensuring that midwifery students receive the knowledge and training needed to demonstrate antenatal exercises. To ensure that their students understand and deliver adequate antenatal care, midwifery educators should be highly knowledgeable in pregnancy-related exercises. The study was conducted to determine the knowledge of midwifery educators about antenatal exercise. A descriptive cross-sectional study was conducted of the knowledge about antenatal exercises by midwifery educators. A purposive total population of 54 midwifery educators from three midwifery schools in Cross River State, Nigeria, was included in the study. Questionnaires were used for data collection, and Statistical Package for Social Sciences (SPSS) version 27 was used for data analysis. Ethical issues and rigour were maintained. The study revealed that antenatal exercises are included in the midwifery curriculum and exercise demonstration were mainly done by midwifery educators and clinical instructors. The majority (n= 34, 66.7%) of the respondents were knowledgeable about World Health Organization (WHO) guidelines for exercise during pregnancy and had an average knowledge of the ideal antenatal exercises. Midwifery educators have average knowledge of the ideal antenatal exercises, which prompts the development of an exercise programme to guide midwifery training and practice. Midwifery educators should collaborate with exercise specialists to teach and demonstrate antenatal exercises.Contribution:The study highlighted the need for midwifery educators to obtain more information on antenatal exercises to adequately prepare midwifery students for evidence-based exercise care for pregnant women.

Perspectives of educators and students on the efficacy of online teaching and learning strategies employed during COVID-19 in a health sciences institution.

Healthcare education encountered unprecedented challenges during the COVID-19 pandemic, but the necessary responses have also provided learning opportunities for the future. We aimed to evaluate the impact of COVID-19 on teaching and learning strategies and the perceptions of clinical educators and health sciences students on novel methods to improve online student engagement in Ireland's largest medical school. Two separate online surveys designed to gain insights into the perceived efficacy of online teaching strategies were distributed to clinical educators and health sciences students (medical and pharmacy) over 7months via email. A total of 86.4% of educators responded that rapport was more difficult to build online, and 90.5% reported less engagement from students online. The most popular methods that improved student engagement included using polls, a chat box function for questions, small group discussions and having student cameras turned on. Amongst educators surveyed, 81.8% felt a training course focused on teaching strategies at the start of every academic year would be beneficial. From the students' perspective, no difference was noted between the medicine and the pharmacy students. Seventy-five percent reported using quizzes/polls, and 63% reported using game-based platforms as techniques to improve online learning. Sixty-two percent of students described it as a positive outcome of learning during the pandemic. Any pandemic poses unique challenges to the delivery of healthcare education. These surveys report educators' and students' views on online teaching and learning strategies, highlighting novel mechanisms to improve student engagement and ultimately impact on graduate outcomes.

The EAO Junior Committee—History, present and future activities

AbstractObjectiveTo describe the evolution and aims of the European Association for Osseointegration (EAO) Junior Committee (JC).Materials and MethodsFormer members of the EAO JC and members of the board were interviewed, and current projects and initiatives were summarized.ResultsThe EAO JC was launched in 2007 as the first young committee in Europe. Despite initial skepticism, it became a famous initiative, and the concept was copied by other dental and medical associations and societies. Since 2010, the committee organizes summer camps allowing young talents to discuss, network and interact beyond traditional boundaries.ConclusionsThe EAO JC is giving fresh energy to the entire society and provides education and network opportunities for young clinicians and scientists.

Leased clinical faculty model: Bridging gaps in nursing education

In response to the critical Registered Nursing (RN) shortage, John Carroll University, a not-for-profit, private, faith-based university in the Midwest, has developed an academic-practice partnership to bolster its new Bachelor of Science in Nursing (BSN) program. This initiative addresses the challenge of limited clinical faculty. Central to this strategy is a “leased employee agreement” with healthcare partners, which allows the university to employ practicing RNs as part-time clinical instructors. Formulated in collaboration with healthcare Chief Nurse Executives (CNEs), this model enables the seamless integration of hospital-employed RNs into the academic framework as clinical faculty. This model streamlines the onboarding process and enriches student learning experiences by leveraging the practical expertise of active nurses. Initial feedback following its launch in August 2023 has been positive, with students and clinical faculty reporting high levels of satisfaction and quality educational experiences. This approach presents a viable strategy to mitigate faculty shortages in nursing education and underscores the importance of inventive academic-practice partnerships in adapting to the dynamic demands of healthcare training.

Taking the next step: How student reflective essays about difficult clinical encounters demonstrate professional identity formation.

Difficult clinical encounters pose emotional and behavioural challenges for medical students. Unless resolved, they threaten students' professional competence and well-being. Learning how to humanistically interact with patients perceived as "difficult" is an important component of the developmental process that underlies professional identity formation (PIF). This study used thematic analysis to examine reflective essay data from the same set of students (N = 69), first in their third year and then in their fourth year of training at a US public medical school. Analysis focused on how student perceptions of patients', preceptors', and their own behaviour, attitudes, and emotions in difficult patient care situations evolved over time, and how such evolution contributed to their professional growth. Students identified clinical predicaments influenced by their own emotions and behaviour, as well as those of patients and preceptors. In response to patients perceived as angry, rude, and uncooperative, students described themselves and their preceptors primarily as engaging in routine medical behaviours, followed by expressions of empathy. These encounters resulted in residual emotions as well as lessons learned. Fourth-year students reported more empathy, patient-centeredness, and patient ownership than third-year students. While student-physicians grew in professionalism and compassion, they also noted unresolved distressing emotions post-encounter. From third to fourth year, medical students undergo a process of professional growth that can be documented at a granular level through their perceptions of themselves, their patients, and their preceptors. Despite positive professional growth, students' lingering negative affect merits attention and support from clinical teachers.

Evaluating the Experiences of Novice Veterinary Clinical Practice Educators: A Qualitative Reflection on a UK Training Program

Within the evolving landscape of veterinary education in the United Kingdom, an increasing shift toward a distributed model of instruction necessitates that clinicians who assume the role of novice educators, receive training as clinical educators. The University of Surrey has pioneered a training program aimed at promoting understanding and application of educational theory in veterinary educator identity development. This study investigated the reflections of novice educators upon conclusion of their training to delineate the program's efficacy and identify areas of educator training necessitating further research and enhancement. A convenience sample of 53 reflective narratives was subjected to inductive thematic analysis. Three principal themes emerged. The first encapsulated an enhanced cognizance of student learning needs, underscored by foundational learning theories. Notably, the introduction of “feedforward” and the incorporation of student reflection within the feedback mechanism were identified as innovative concepts. The second theme revolved around the personal growth experienced because of participation in the training program, with 47% of reflections articulating profound introspection. The final theme explored the perceptions of the rewards and challenges associated with balancing the educational program with routine professional responsibilities, highlighting an increase in self-confidence and the obstacles encountered in allocating time for training.

Long-term quality of life and influencing factors in elderly patients after vertebroplasty based on the EQ-5D-3L Chinese utility scoring system: a retrospective study

BackgroundThe quality of life of elderly patients after vertebroplasty is influenced by various factors. Although the EuroQol 5-Dimension 3-Level (EQ-5D-3L) scale has been widely used to assess quality of life, the factors affecting the long-term postoperative quality of life of elderly vertebroplasty patients in China have not been thoroughly studied.MethodsThis retrospective study included 519 patients aged 65 years and older who underwent elective vertebroplasty. We collected baseline data from these patients and conducted telephone follow-ups 12 months postoperation to evaluate their EQ-5D-3L health utility scores and EuroQol Visual Analogue Scale (EQ-VAS) scores. Univariate and multivariate linear regression models were used to analyse the factors affecting quality of life.ResultsOf the 519 patients, the majority were female (78.0%), aged 65 to 95 years, with an average age of 75.2 years. Twelve months postoperation, pain/discomfort was the most commonly reported issue for 68.4% of patients. The median EQ-5D-3L health utility score was 0.783, with a range between 0.450 and 0.887; the median EQ-VAS score was 75, ranging from 60 to 85. Multivariate linear regression analysis indicated that older age, hormone use, higher American Society of Anesthesiologists (ASA) grades, nondrinking habits, and low albumin levels were found to be independent risk factors affecting long-term quality of life in elderly patients after vertebroplasty. Additionally, a history of tumours, the number of vertebral compression fractures, and bone mineral density were also crucial influencing factors.ConclusionsBased on the use of the EQ-5D-3L Chinese utility scoring system, we evaluated the quality of life of patients aged 65 and above 12 months after vertebroplasty. This study identified several factors related to postoperative quality of life in elderly vertebroplasty patients, providing crucial evidence for further clinical decisions and patient education.

The role of sulbactam-durlobactam in treating carbapenem-resistant Acinetobacter infections.

Infections caused by multidrug-resistant Acinetobacter baumannii present a significant global health challenge. Available treatment options are limited and frequently constrained by unfavourable safety and pharmacokinetic profiles. Sulbactam-durlobactam is a novel β-lactamase inhibitors combination specifically developed to target A. baumannii, including carbapenem-resistant strains. The purpose of this review is to assess the current evidence supporting the role of sulbactam-durlobactam in the management of A. baumannii infections. We summarize the available evidence regarding the pharmacokinetic and pharmacodynamic profiles of sulbactam-durlobactam from key in-vitro and in-vivo studies. Additionally, efficacy results from the Phase III randomized controlled trial and real-world data on sulbactam-durlobactam's use against severe A. baumannii infections are also discussed. Sulbactam-durlobactam is a promising addition to the treatment options for carbapenem-resistant A. baumannii infections. Ongoing research and vigilance are essential to monitor the development of in-vivo resistance, assess effectiveness across diverse patient populations, and explore potential synergistic combinations with other antimicrobials. Careful stewardship and comprehensive clinician education will be crucial to optimizing the clinical use of sulbactam-durlobactam.

A Study on the Impact of Psychological Counseling for Minor Medical Students in Clinical Teaching and Learning

A Study on the Impact of Psychological Counseling for Minor Medical Students in Clinical Teaching and Learning

Fostering young talents for surgery : Laparoscopy in preclinical education-Too early or exactly right?

Due to the declining interest among medical students in pursuing asurgical career, the impact of demographic changes and the technical challenges, there is an increasing need to attract medical students to the surgical profession. Against this backdrop, ateaching project was developed to familiarize medical students with minimally invasive surgical techniques early in the preclinical education, thereby increasing the interest in surgery. Within the framework of the regular anatomical dissection course the following modules on laparoscopic surgery were integrated: (1)clinical lecture on the technique and application of laparoscopy, (2)exploratory live laparoscopy on abody donor and (3)practical exercises on laparoscopic trainers. The impact of this teaching project on the interest in asurgical career and on the clinical anatomical understanding was evaluated among 295 participating medical students. The evaluation revealed apronounced gender-independent interest in learning surgical skills early in the preclinical study phase. The teaching project led to asignificantly increased interest in pursuing asurgical career. Moreover, the incorporation of laparoscopic teaching modules into the preclinical anatomy course enhanced the learning motivation and understanding of clinically relevant topographic anatomy. The integration of practical surgical content into preclinical anatomical education can increase the attractiveness of surgical disciplines and simultaneously optimize teaching of anatomy. Longitudinal studies are required to examine the sustainability of these clinical teaching modules in career decisions of medical students.

A time study of ACPE certified educators

This is a descriptive, quantitative, cross-sectional study of how ACPE Certified Educators (CEs) allocated their time among varied responsibilities in calendar year 2021. Using a structured interview assisted survey instrument, 25 CEs at academic medical centers/university teaching hospitals were surveyed via Zoom/Phone. Results found a median commitment of 58% of time on clinical pastoral education (CPE) activities (38% to teaching and 20% to administration). CEs (7) who also serve as Spiritual Care Department directors/managers spent 45% on CPE and 30% on department activities. Sixteen of the CEs strongly or somewhat agreed that CE involvement in direct patient/family/staff care was important, yet median CE involvement in such care was 5%. Future studies should examine CE time commitment levels in a broader sample of ACPE accredited institutions.

Clinician-Reported Management Recommendations in Response to Universal Germline Genetic Testing in Patients With Prostate Cancer.

Identification of pathogenic germline variants in patients with prostate cancer can help inform treatment selection, screening for secondary malignancies, and cascade testing. Limited real-world data are available on clinician recommendations following germline genetic testing in patients with prostate cancer. Patient data and clinician recommendations were collected from unselected patients with prostate cancer who underwent germline testing through the PROCLAIM trial. Differences among groups of patients were determined by 2-tailed Fisher's exact test with significance set at P < .05. Logistic regression was performed to assess the influence of test results in clinical decision-making while controlling for time of diagnosis (newly vs previously diagnosed). Among 982 patients, 100 (10%) were positive (>1 pathogenic germline variant), 482 (49%) had uncertain results (>1 variant of uncertain significance), and 400 (41%) were negative. Patients with positive results were significantly more likely than those with negative or uncertain results to receive recommendations for treatment changes (18% vs 1.4%, P < .001), follow-up changes (64% vs 11%, P < .001), and cascade testing (71% vs 5.4%, P < .001). Logistic regression demonstrated that positive and uncertain results were significantly associated with both changes to treatment and follow-up (P < .001) when controlling for new or previous diagnosis. Germline genetic testing results informed clinical recommendations for patients with prostate cancer, especially in patients with positive results. Higher than anticipated rates of clinical management changes in patients with uncertain results highlight the need for increased genetic education of clinicians treating patients with prostate cancer.

Chairside learning on undergraduate clinics: general dental and human disease themes

Introduction Chairside teaching is an important part of dental undergraduate clinical education. Bedside teaching is well-reported in relation to undergraduate medicine but few publications relate to undergraduate dentistry.Aims and objectives To investigate the experience and benefits from chairside teaching/learning in the clinical years of a five-year dental programme in a UK university. We asked about general dental topic learning as well as human disease (HD) learning.Materials and methods An online survey gathered dental students' opinions on their recognition, knowledge and experience of chairside teaching/learning. We asked about clinics and clinicians and where they gained most from chairside teaching/learning. We encouraged free-text responses.Results Altogether, 127 students took part (62% response). Response rates approximated 60% for all three years. In total, 93% felt that chairside teaching/learning helped to a moderate/great extent for general dental topics and 73% felt that chairside teaching/learning helped to a moderate/great extent for HD topics. Free-text comments revealed students valued chairside teaching/learning and from which grade/level of staff they learned most.Discussion and conclusion Chairside teaching/learning is largely unreported and unrecognised in undergraduate education. Although not formally timetabled, enthusiastic staff with enough time to engage in chairside teaching can have a positive impact on student learning.