Clinical Education Research Articles

Who you are and who you want to be: a pilot study of dental hygiene students' professional identity formation

BackgroundDental hygienists play a crucial role in providing successful community-based healthcare for patients. They should perform expected roles to address various tasks, in response to changing social contexts and needs. The value created by the role of a dental hygienist closely relates to job satisfaction, which is formed through daily clinical experiences, and in the process of professional identity formation, learners must internalise a value system. This study examined how dental hygiene students developed their professional identities during their undergraduate education.MethodsThis study adopted a case study approach based on an interpretivist paradigm. Ten dental hygiene students in their final year were selected, and semi-structured interviews were conducted regarding changes in their views on dental hygienists and their identities as health professionals. The data were analysed using a thematic analysis approach to identify the components of their professional identities and the factors influencing identity formation.ResultsStudents pre-professional identities were transformed into inter-professional collaborators with a more patient-centric and generalist perspective. The following three aspects of professional identity were identified: their own roles in promoting oral and general health, broadening the perspectives on professional competencies of dental hygienists, and the context of inter-professional collaborative practice. Additionally, this study identified some key factors influencing their identity formation, namely role models, clinical experiences, health care system, and social relationships with others. Among these factors, role models and clinical experiences were the most influential.ConclusionsThis study suggests that recognition of professional roles during preclinical education, and collaborative opportunities in clinical education are necessary to promote professional identity formation. Such learning opportunities enable students to reflect on the kind of dental hygienist they want to become. Moreover, for the students to continuously pursue their profession with a sense of fulfilment, educators need to gain a deeper understanding of the challenges the students would encounter as they transition from their undergraduate degrees to employment. This understanding is essential for developing and supporting communities where dental hygienists connect, help, and learn from each other.

Qualitative perspectives of Medicaid-insured patients on ambulatory care at an academic medical center: challenges and opportunities

BackgroundAmbulatory access to academic medical centers (AMCs) for patients insured with Medi-Cal (i.e., Medicaid in California) is understudied, particularly among the 85% of beneficiaries enrolled in managed care plans. As more AMCs develop partnerships with these plans, data on patient experiences of access to care and quality are needed to guide patient-centered improvements in care delivery.MethodsThe authors conducted semi-structured, qualitative interviews with Medi-Cal-insured patients with initial visits at a large, urban AMC during 2022. Participant recruitment was informed by a database of ambulatory Medi-Cal encounters. The interview guide covered Medi-Cal enrollment, scheduling, and visit experience. Interviews were transcribed and inductively coded, then organized into themes across four domains: access, affordability, patient-provider interactions, and continuity.ResultsTwenty participant interviews were completed (55% female, 85% English speaking, 80% self-identified minority or “other” race, and 30% Hispanic or Latino) with primary and/or specialty care visits. Within the access domain, participants reported delays with Medi-Cal enrollment and access to specialist care or testing, though appointment scheduling was reported to be easy. Affordability concerns included out-of-pocket medical and parking costs, and missed income when patients or families skipped work to facilitate care coordination. Participants considered clear, bilateral communication with providers fundamental to positive patient-provider interactions. Some participants perceived discrimination by providers based on their insurance status. Participants valued continuity, but experienced frustration arising from frequent and unexpected health plan changes that disrupted care with their established AMC providers.ConclusionsThe missions of AMCs typically focus on clinical care, education, research, and equity. However, reports from Medi-Cal insured patients receiving care at AMCs highlight their stress and confusion related to inconsistent provider access, uncompensated costs, variability in perceptions of quality, and fragmented care. Recommendations based upon patient-reported concerns suggest opportunities for AMC health system-level improvements that are compatible with AMC missions.

Assessment of ChatGPT's Compliance with ESC-Acute Coronary Syndrome Management Guidelines at 30-Day Intervals.

Background: Despite ongoing advancements in healthcare, acute coronary syndromes (ACS) remain a leading cause of morbidity and mortality. The 2023 European Society of Cardiology (ESC) guidelines have introduced significant improvements in ACS management. Concurrently, artificial intelligence (AI), particularly models like ChatGPT, is showing promise in supporting clinical decision-making and education. Methods: This study evaluates the performance of ChatGPT-v4 in adhering to ESC guidelines for ACS management over a 30-day interval. Based on ESC guidelines, a dataset of 100 questions was used to assess ChatGPT's accuracy and consistency. The questions were divided into binary (true/false) and multiple-choice formats. The AI's responses were initially evaluated and then re-evaluated after 30 days, using accuracy and consistency as primary metrics. Results: ChatGPT's accuracy in answering ACS-related binary and multiple-choice questions was evaluated at baseline and after 30 days. For binary questions, accuracy was 84% initially and 86% after 30 days, with no significant change (p = 0.564). Cohen's Kappa was 0.94, indicating excellent agreement. Multiple-choice question accuracy was 80% initially, improving to 84% after 30 days, also without significant change (p = 0.527). Cohen's Kappa was 0.93, reflecting similarly high consistency. These results suggest stable AI performance with minor fluctuations. Conclusions: Despite variations in performance on binary and multiple-choice questions, ChatGPT shows significant promise as a clinical support tool in ACS management. However, it is crucial to consider limitations such as fluctuations and hallucinations, which could lead to severe issues in clinical applications.

Molecular detection of Ehrlichia spp., Anaplasma spp., and Bartonella spp. in dogs treated at a veterinary teaching clinic in Peru

In recent years, vector-borne diseases have become widespread throughout the world and affect the health of humans and domestic animals. These diseases spread to areas where their primary vectors, fleas and ticks, thrive, particularly in tropical and subtropical climate regions, providing ideal conditions for their proliferation. The growing closeness between people and their pets increases the likelihood of bites from these ectoparasites, which represents a latent zoonotic risk. Therefore, the objective of the study was to determine the presence of Anaplasma spp., Ehrlichia spp., and Bartonella spp. in dogs treated at the Small Animal Clinic of the Faculty of Veterinary Medicine of the Universidad Nacional Mayor de San Marcos, located in Lima, Peru. Blood samples from 214 dogs were molecularly analyzed for hemopathogen detection. The results revealed prevalences of 2.6 % (6/214) for Anaplasma platys, 5.14 % (11/214) for Ehrlichia canis, and 0.46 % (1/214) for Bartonella rochalimae. No statistically significant relationship was found between the animal infection and the age, sex, breed, presence of fleas (Ctenocephalides felis) and ticks (Rhipicephalus sanguineus), and locality. This study reported molecularly for the first time the presence of A. platys, E. canis, and B. rochalimae in dogs from Lima city, and demonstrates the occurrence of zoonotic pathogens in pets treated at the veterinary clinic.

Evaluation of Clinical Education Based on Cognitive Apprenticeship Model Using Maastricht Clinical Education Questionnaire

Introduction: One of the main aspects of medical students is clinical education. The cognitive apprenticeship model is one of the principles of clinical education and contains six dimensions, including modeling, coaching, scaffolding, articulation, reflection, and exploration. This research aimed to evaluate the clinical education at Kerman University of Medical Sciences based on the cognitive apprenticeship model in 2021. Method: In this descriptive-analytical cross-sectional research, the Maastricht Clinical Education Questionnaire was separated among 150 students, and with a response rate of 74%, 112 of them completed this. Results: In the evaluation of the clinical education at Kerman University of Medical Sciences, the score of the articulation domain was higher than others, and the lowest score was given to the reflection domain. Clinical education in the internal medicine department was the most consistent with the cognitive apprenticeship model. Conclusion: Identifying the strengths and weaknesses of clinical education is the first step toward improving the quality of medical education. In the subsequent steps, the practitioners and planners of the faculty member empowerment programs should design, implement, and evaluate educational empowerment programs for clinical faculty members to improve their academic skills in the clinical education environment.

Investigating Students' Clinical Experiences of Learning the Nursing Process Using an Integrated Teaching-Learning Method at Shahid Qazi Tabatabaei Hospital: A Qualitative Content Analysis

Introduction: Integrated teaching-learning methods have demonstrated potential in enhancing students' cognitive skills and, subsequently, the quality of patient care. This qualitative study aimed to explore the learning experiences of nursing students engaged in an integrated teaching-learning method during their clinical education in oncology nursing. Method: : Semi-structured interviews were conducted with 19 nursing students who had completed a clinical training program in oncology nursing using an integrated teaching-learning method. Conventional qualitative content analysis was employed to analyze the data, identifying sub-categories and categories related to students' experiences. Results: The analysis revealed four main categories: (1) sustained cognitive learning, (2) non-cognitive learning, (3) application of learned concepts in real-world situations, and (4) students' suggestions for improving the learning of the nursing process. Conclusion: The findings suggest that an integrated teaching-learning method, implemented as a creative and student-centered approach at the bedside, effectively enhances both cognitive and non-cognitive skills, facilitating the practical application of learned concepts. To fully leverage the benefits of this method, its implementation should be expanded across clinical education units, starting in lower semesters. Simultaneously, optimizing real-world clinical education environments will further accelerate positive educational outcomes, enhancing students' cognitive and non-cognitive skills and creating a foundation for applying learned concepts in clinical practice.

Role of Nurse Instructor in Integrating Theory-Practice Gap: A Cross-Sectional Study in Teaching Hospitals of Peshawar

Background: Bridging the gap between theory and practice in nursing education is essential for ensuring competent clinical practice. However, this gap remains a challenge in nursing programs worldwide.Objective: This study aimed to evaluate the perceptions of BSN students regarding the role of clinical instructors in integrating theory and practice in teaching hospitals in Peshawar, Pakistan.Methods: A descriptive cross-sectional study was conducted in three institutions in Peshawar. A total of 203 BSN students from semesters 4, 5, 6, and 7 were randomly selected. Data were collected using a structured questionnaire adapted from validated tools. Statistical analysis was performed using SPSS version 25, with an ANOVA test to compare mean scores across semesters, and a post-hoc Tukey test to identify significant differences.Results: The mean score for the role of clinical instructors varied significantly across semesters (F = 4.646, p = 0.004). Semester 4 had the highest mean score (75.73), while semester 5 had the lowest (67.00). Group 1 (25.1%) believed the role was not fulfilled, while Group 4 (23.6%) believed it was completely fulfilled.Conclusion: Clinical instructors play a critical role in addressing the theory-practice gap. Tailored teaching strategies are recommended to meet students' evolving needs.

Crying wolf, alarm safety and management in paediatrics: A scoping review.

To provide a contemporaneous evidentiary overview of neonatal and paediatric studies investigating alarm-related patient safety and alarm system management. Furthermore, to describe how clinical alarm burden is captured and reported, to identify clinical devices that contribute to alarm burden, to explore alarm-related and patient safety measures and terminologies and to review alarm management initiatives. Scoping review. A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus and EBSCOhost was conducted from 2013 to 2023 using predetermined search terms, index terms, medical subject headings and truncation. Observational and qualitative studies with neonatal and paediatric populations reporting monitoring and alarm practices; and interventional studies reporting the success of alarm safety interventions were included. The quality of the included studies was assessed using the mixed methods appraisal tool. The search yielded 37 studies of acceptable quality. The majority explored alarm burden associated with physiological monitoring (n = 35; 95%). Alarm definitions were reported in 46% (n = 17) of studies, and commonly included what constituted actionable and non-actionable alarms. While 32% (n = 12) of studies considered alarms in relation to clinical outcomes surrounding patient safety, clinician response to alarms was only reported in 19% (n = 7) of studies. Alarm and monitoring interventions were assessed in 51% (n = 19) of included studies, with categorization into six domains: changing alarm parameters, clinician education, communication and planning, technology, alarm ordering and standardization or guidelines. This review has demonstrated the enormity of alarms in clinical settings, heterogeneity of alarm definitions and outlined interventions associated with alarm burden and patient safety. Strategies to ensure appropriate alarm limits are set and clinicians are empowered through education to recognize and respond appropriately to alarms can maximize patient safety. This review adheres to the preferred reporting items for systematic reviews and meta-analysis protocols extension for scoping reviews. No patient or public contribution.

The Effectiveness of Simulation-based Learning in Clinical Education

The Effectiveness of Simulation-based Learning in Clinical Education

The Relationship Between Clinical Education Status and Academic Motivation of Clinical-Stage Medical Students at Gonabad University of Medical Sciences

Introduction: Motivation in education and learning are significant challenges in clinical education. This study aimed to determine the relationship between clinical education status and academic motivation among clinical-stage medical students Gonabad University of Medical Sciences. Method: This cross-sectional study was conducted with 198 medical interns and residents at Gonabad University of Medical Sciences during the academic year 2021-2022 using a census method. Data collection tools included the Clinical Education Status Questionnaire and the Harter Academic Motivation Questionnaire. Descriptive statistics (mean and standard deviation) were used to describe the participants' status, and data were analyzed using independent t-tests, Pearson, and Spearman correlation tests. Results: The mean score for clinical education status among interns was 51.93 ± 16.56, while for residents, it was 12.93 ± 08.12. The mean score for academic motivation among interns was 102.07 ± 11.30, and for residents, it was 100.07 ± 11.54. Overall, the clinical education status averaged 93.31, indicating a relatively moderate level and Academic motivation averaged 101.05 ± 11.44, indicating a high level, with a significant correlation observed between clinical education status and academic motivation (r = 0.454). Conclusion: Given the weakness in the clinical education status, as well as the direct relationship between clinical education status and academic motivation, it is recommended that university officials, particularly in the educational and clinical departments, focus on special attention and planning to improve the clinical education status at the university.

Student perspectives on designing and implementing an interprofessional education module in chronic disease management at primary care level in Vietnam

PurposeThis study explored students' perspectives on designing and implementing the new clinical interprofessional education (IPE) module for chronic disease management at the primary care level in the Vietnamese context.Design/methodology/approachStudents from seven different university-level healthcare programmes participated in a cross-sectional survey Course Experience Questionnaire-based study. Additionally, two open-ended questions were presented to gather qualitative data, mapping student perspectives. Statistical analyses and thematic analyses were performed.FindingsThe results show that students agree with quality statements about IPE design features, such as good teaching, clear goals and standards, appropriate workload, appropriate assessment and a blended learning approach. Answers to the open-ended comments pointed out the strengths of the IPE module in providing opportunities for interprofessional learning, improving interprofessional collaboration competencies, real-life interprofessional collaboration practice and continuous feedback from tutors. Students also reported weaknesses in the IPE module, including a lack of feedback on the care plan and logistics of the IPE module.Originality/valueStudents positively recognise key design features of the IPE module, combining classroom activities with standardised patient simulations, clinical practice and home visits. Chronic disease management at the primary care level is a suitable context for training students to work interprofessionally. The strengths and weaknesses identified by students could help in the redesign and future implementation of the IPE module in the Vietnamese context. They could inspire practices in Southeast Asian medical education and beyond.

Надання безоплатної правової допомоги населенню у процесі здійснювання навчальної діяльності: аспекти міжнародного та українського історичного досвіду

The article highlights the issues of international and Ukrainian historical experience of providing legal aid in general, and frees legal aid in the course of educational activities in particular. The author traces the peculiarities of this process from its origins to the present day. The author argues that the provision of free legal aid in the context of educational activities is a multifaceted process which, both in the world and in Ukraine, has been taking place for centuries in various forms and under the influence of various factors. It is emphasized that its undoubted prerequisite was the legalization of the legal profession and the establishment of an extensive system of legal education. The author emphasizes that these facts were the result of the growing importance of law in the process of regulation of social relations. The author analyzes the main stages and features of the European historical experience of legal aid in the period of Antiquity, theMiddle Ages and theModern era. The author also considers some historical experience of providing free legal aid in the context of educational activities which took place in Ukraine. The author proves that Ancient Rome was a pioneer in creating an extensive system of legal education and developing various forms of legal aid. The author establishes that the real establishment of the system of free legal aid, in particular, in the course of educational activities, took place only in the 1920s, and at first it was localized and limited mainly to the United States. It is argued that its implementation became possible as a result of a long scientific discussion in previous years, during which a new approach to legal training with a priority on practice was developed, and a form of such training – “legal clinic” – was found. The author shows that legal clinical education is considered to be one of the most effective today. The nature and peculiarities of the spread of legal clinical education, as well as the development of the relevant legal framework in Ukraine are traced.

Nursing Students' Perception of the Clinical Learning Environment: A Longitudinal, Cohort Study.

The clinical learning environment (CLE) plays a vital role in students' learning in clinical settings. However, to our knowledge, no longitudinal cohort studies have been published on how CLE influences nursing students' learning during clinical placements. This study investigated a cohort of nursing students' perceptions of CLE during their first and third-year clinical placements. The clinical learning environment inventory (CLEI) questionnaire was used in this study. In 2021, a convenience sample of 450 first-year nursing students was invited to complete the CLEI questionnaire. In 2023, the same cohort of students in their third year of study were invited to complete the questionnaire. Personalization, satisfaction, and task orientation had higher mean scores than the other CLEI subscales. The lowest mean scores were found for the teaching innovation and individualization subscales. Multiple regression and bivariate correlation analyses revealed task orientation as the strongest predictor of student satisfaction with the CLE. Nursing students in Singapore have a moderately positive satisfaction with their CLE. Clinical instructors should design innovative lesson plans to improve the student experience and learning in the CLE.

Implementing Telemedicine into Clinical Training Through Pre-recorded Video Consultations

Although the contribution of real patient encounters to medical education is well known, challenges such as a lack of suitable cases, patients not consenting to student involvement, physical space limitations that prevent every student from participating, the inability to replicate the same patient encounter, and reduced patient admissions to healthcare facilities during extraordinary periods are common obstacles that need to be addressed in clinical education. To overcome these challenges, video consultation (VC) recordings, which were made with the consent of patients having a telemedicine consultation, were collected as an archive of medical interview recordings covering a wide spectrum of pulmonary diseases. These recordings were watched by students in a classroom setting during clinical clerkships, with case discussions interspersed. This article, which also discusses the results of clinical clerkship evaluations, indicates that the use of pre-recorded VC sessions can be an effective tool for teaching good clinical practices through the ideal method of medical interviews, diagnostic approaches, evaluation of test results, communication skills with patients and their relatives, and addressing the socio-psychological aspects and social impacts of diseases. As an innovative attempt, sharing this process at an early stage of development may inspire enthusiasm for implementing this approach and open the field for further development.

Clinical Laboratory Science and Physician Assistant Students Interprofessional Education Event; Learning From Each Other

Clinical Laboratory Science and Physician Assistant Students Interprofessional Education Event; Learning From Each Other

Online Utilization of the Nominal Group Technique to Gather Consensus Opinion Across Geographically Disparate Locations

Introduction: The nominal group technique (NGT) is a structured focus group that gathers opinion and generates consensus from groups on topics of interest. Previous studies using online NGTs (ONGTs) in health have been conducted in regions of high population density and internet connectivity. This activity aimed to determine the feasibility and utility of ONGTs in gathering opinion and reaching consensus on curriculum topics for a continuing research education program for health professionals dispersed across various locations in Southern Queensland. Methods: Fifteen clinical education academics from a range of health professions participated in 1-hour ONGT sessions from 2 University Department of Rural Health sites or their home offices. The traditional NGT was adapted for online use, using two free online platforms (Zoom for videoconferencing and Wooclap for voting and response collation). Results: The chosen platforms were effective in presenting ONGTs, allowing active and effective contributions to research topic ideas from all participants, including those with low internet connectivity. Silent generation enabled sharing, open discussion, and clarification of generated ideas. Wooclap was effective in reviewing and voting on generated responses and providing real-time feedback on voting outcomes. Outcomes were consistent with group consensus and useful in prioritizing research training topics. Discussion: The modified ONGT is effective in gathering opinion and gaining consensus from a geographically dispersed health workforce with varied levels of internet connectivity and experience with online platforms. It represents a cost-effective and time-effective alternative to face-to-face NGTs that is less likely to be affected by workforce disruptions.

Stepping Back: How Should Pass/Fail Scoring Influence Step 1 Timing?

Although most students complete Step 1 before clerkships, some institutions delay the exam until after clerkships. The change to pass/fail grading adds additional complexity that should be considered when deciding about exam timing. Both early and late administration may affect learning outcomes, learner behavior, student well-being, and residency match success. Step 1 completion before clerkships promotes learning outcomes (e.g., integration and mastery of foundational material), may encourage students to focus on the curriculum, and may better prepare students for clinical science exams (CSEs). However, delaying the exam ensures that students maintain foundational knowledge and may encourage clinical educators to demonstrate basic science illustrations. An early Step 1 may affect learner behavior by allowing clerkship students to focus on clinical learning. The associated National Board of Medical Examiners performance report may also be used for Step 2 and CSE preparation. However, delaying Step 1 allows greater scheduling flexibility based on developmental milestones. Administration of Step 1 before clerkships removes a significant stressor from the clinical year and decompresses the residency application period. However, a delayed Step 1 reduces the pressure on students to engage in numerous extracurricular and research activities to distinguish themselves due to the pass/fail change. An early Step 1 exam may also lead to improved CSE performance, which is often linked to clerkship honors criteria, an increasingly valuable distinction for residency match success after the change to pass/fail. In contrast, delaying Step 1 is associated with higher first-time pass rates, which may be especially important for students at risk for failure. Medical educators and students should collaboratively approach the question of Step 1 timing, considering these factors within the context of the medical school program, curricular constraints and priorities, and students' individual needs and goals.

Why Do You Want to Be a Teacher? A Natural Language Processing Approach

Heightened concerns about the health of the teaching profession highlight the importance of studying the early teacher pipeline. This exploratory, descriptive article examines preservice teachers’ expressed motivation for pursuing a teaching career. Using data from a large teacher education program in Texas, we use a natural language processing algorithm to categorize into topical groups roughly 2,800 essay responses to the prompt, “Explain why you decided to become a teacher.” We identify 10 topics that largely reflect altruistic and intrinsic (although not extrinsic) reasons for teaching. The frequency of topics varied substantially by preservice teacher gender, race/ethnicity, and certification area. Intrinsic enjoyment of teaching and experiences with adversity predicted higher clinical teaching performance and lower attrition as a full-time teacher.

Shifting the Paradigm for Establishing and Maintaining Milk Production in the Setting of Mother/Infant Separation.

Establishing lactation when mother and infant are separated, such as when the neonate is admitted to the neonatal intensive care unit (NICU), is challenging. The most common clinical advice is to express milk eight or more times per day, every 3 hours, around the clock. Sometimes, the first time that parents hear this is after the birth of their baby. This can be overwhelming and sometimes unachievable. A five-step paradigm shift is proposed that refocuses lactation care on providing evidence-based assistance and ongoing clinical education, and assessment beginning prenatally and extending past maternal discharge, to improve outcomes through curated support. Simple guidelines can begin with expressing milk at least five times a day by Day 5 of life (5 × 5), and expressing milk at least once between 0100 and 0500 (overnight pumping). With these measures, neonatal care in the NICU setting can provide personalized and achievable guidance on pumping schedules.

Attitude of Students and Professors Toward Quality of Residency Medical Education at the Selected University of Medical Sciences in Tehran in 2023

Background: Clinical education is one of the most essential components of medical student education, as it significantly impacts students' professional futures and the training of healthcare experts. Objectives: This study aimed to assess the quality of clinical teaching from the perspective of residents and professors at selected medical schools in Tehran city. Methods: A descriptive cross-sectional study was conducted using the census technique on 81 residents and 48 faculty members from internal medicine, surgery, radiology, anesthesia, and physical medicine in 2023. The data collection instrument was a reliable and valid questionnaire. After gathering the data, SPSS software computed the score for each item and reported it as a percentage. Results: The research findings showed that residents reported morning reports are always held in 94% of the internal medicine group and 60% of the surgical group. Additionally, 80% of the residents and 100% of the professors in the surgery department stated that the group held regular mortality and morbidity meetings. Thirty-three percent of radiology and physical medicine residents mentioned that the hospital amenities are of good quality. The residents of the physical medicine department reported that theory classes are always held 83% of the time. Conclusions: According to the present findings, the quality of education in internal medicine and surgical courses is optimal from the perspective of both professors and students. Periodic studies on the sustainability and improvement of current educational conditions are recommended.