Clinical Observerships Research Articles

Community engagement in global health education supports equity and advances local priorities: an eight year Ecuador-Canada partnership

Global health education initiatives inconsistently balance trainee growth and benefits to host communities. This report describes a global health elective for medical trainees that focuses on community engagement and participatory research to provide mutually beneficial outcomes for the communities and trainees. An eight-year university-community partnership, the Chilcapamba to Montreal Global Health Elective is a two-month shared decision-making research and clinical observership experience in rural Ecuador for medical trainees at McGill University, Canada. Research topics are set by matching community-identified priorities with skillsets and interests of trainees, taking into consideration local potential impact. Community outcomes included development of a Community Health Worker program, new collaborations with local organizations, community identification of health priorities, and generation of health improvement recommendations. Collaborative academic outputs included multiple bursary awards, conference presentations and published manuscripts. This medical global health elective engages communities using participatory research to prioritise socially responsible and locally beneficial outcomes.

What makes a good surgical experience for the naïve learner?

This article was migrated. The article was marked as recommended. Early clinical observerships play a key role in pre-clerkship education and career selection. Using a cross sectional survey design, we attempted to assess the makeup of the student's observership throughout their time in the operating room (OR). Perceived educational value (EV), utility in career exploration (CE), and level of personal enjoyment (PE) were assessed after every encounter and utilized as primary outcomes. Twenty-eight (28) 1st year medical students participating in an intensive 2-week surgical exploration program completed eight 34 question electronic surveys characterizing each of their 8 surgical observerships (224 events). One hundred forty six (65.2%) surveys were completed, each representing a day of observerships, with a total of 207 surgeries observed. Following multivariate linear regression analysis, increased surgical team engagement with the student and a positive tone of interaction were each significantly associated with improved EV (p1 = 0.013, p2 <0.001), CE (p1=0.006, p2=0.012), and PE (p1 <0.001, p2 <0.001). Surgical subspecialty, type of case and ability to scrub in were not associated with improved experiences. Increased engagement and positive interaction with the surgical team are significantly associated with various measures of improved surgical experience, and each are highly modifiable factors in a learner's OR experience. This research emphasizes the diverse educational responsibility of academic surgeons.

The POSNA-COUR International Scholar Program. Results of the First 7 Years.

The Pediatric Orthopedic Society of North America (POSNA)-Children's Orthopedics in Underserved Regions (COUR) International Scholar Program was initiated in 2007 to provide educational opportunities for emerging leaders who treat children with orthopaedic conditions in resource-challenged environments worldwide. Financial support is available each year for 4 to 6 orthopaedic surgeons to attend either the POSNA Annual Meeting or the International Pediatric Orthopedic Symposium. The scholars are also encouraged to visit selected centers for observerships during their trip. Since 2007 there have been 41 international scholars who have participated in the program. We wished to assess the impact of the program and to obtain feedback to improve the experience for future participants. A 23-question web-based survey was created and sent to 38 past scholars from 22 countries who have participated in the program by July 2013. The responses were gathered online and the data were analyzed for the 24 (62%) respondents from 18 countries who completed the survey. Of the respondents, 16/24 (66%) reported that their current practice is comprised of at least 75% pediatrics. Twelve of 24 (52%) were fellowship trained in pediatric orthopaedics, typically outside of North America. All scholars found the meeting they attended to be very useful and have subsequently made changes to their clinical practice. Nineteen of 24 (82%) did a premeeting or postmeeting observership. Twenty-two of 24 (92%) participants have remained in contact with POSNA members they met at the meeting, with 86% of respondents stating that they have subsequently consulted POSNA members on management of patients. Sixty-two percent of the scholars had a POSNA member visit them following the scholarship and 29% have since returned to visit POSNA members for further clinical observerships. Twenty-one of 24 (91%) have had the opportunity to share the knowledge they gained with others in their region through lectures, surgical demonstrations, and/or clinical training. A common response from the scholars was that the scholarship program was a truly transformative life experience that provided them with an opportunity to receive the highest quality of professional education. The main challenges that these scholars report are lack of available fellowship/subspecialty training in their region, patients' inability to pay, and excessive physician workload. All of the respondents expressed interest in arranging a POSNA cosponsored regional meeting. Since 2007, the POSNA-COUR international scholar program has been a fruitful resource for orthopaedists practicing in resource-challenged environments worldwide. It has provided unique training for the scholars and has further enabled them to teach others in their region. The program has thus far succeeded in fostering lasting relationships that have led to continued educational exchanges. Level IV-case series.

Development of a Workshop for Malignant Hematology Nursing Education.

As part of a comprehensive orientation for nurses caring for patients with hematologic malignancies, nurses are expected to attend general corporate orientation immediately followed by hospital site-specific nursing orientation. The orientation is comprised of lectures, e-learning, and clinical observership, as well as clinical practice under supervision of a preceptor. Nurses also are expected to attend foundational courses. The goal of these courses is to consolidate practical and theoretical knowledge in a specific oncology nursing specialty. A workshop was developed that offers a unique vision by interweaving theory, practice, and patient voice. .

Training a Nonclinician to Become a Leader in Transdisciplinary Clinical Research: Clinical Observerships

As institutions and funders expand their efforts toward multidisciplinary, interdisciplinary, and even transdisciplinary research, there is a substantial need for scientists who can lead such efforts. The traditional image of a leader of transdisciplinary clinical research is a quantitatively savvy clinician conducting research at some point along the continuum from the “bench to the bedside.” However, this is not the only alternative. Nonclinician scientists can also provide effective leadership in multidisciplinary clinical research teams. To foster the development of such nonclinicianleaders, we suggest the completion of a comprehensive clinical observership as an appropriate and valuable training activity. The clinical setting can foster unique insight, providing invaluable training for leadership in translational research. Observing both providers and patients immerses nonclinician scientists in the health care experience, providing them with direct exposure to clinicians, patients, and patients’ families, and thereby motivating patient-centered research.

Shared care for chronic eye diseases: perspectives of ophthalmologists, optometrists and patients

To report the perspectives of optometrists, ophthalmologists and patients on a model of shared care for patients with chronic eye diseases. Qualitative study of a model of shared care between optometrists and ophthalmologists for patients with stable age-related macular degeneration, diabetic retinopathy and glaucoma, trialled by the Royal Victorian Eye and Ear Hospital in Melbourne during 2007–2009. Semi-structured interviews were conducted with optometrists, ophthalmologists and patients at completion of the project to obtain their perspectives on this model. Seventeen optometrists submitted expressions of interest to participate, and 12 completed web-based training modules and clinical observerships and adhered to specified examination and reporting protocols. All five participating ophthalmologists and 11 of the optometrists were interviewed. Ninety-eight patients participated and 37 were interviewed. Optometrists not only met ophthalmologists’ expectations but exceeded them, appropriately detecting and referring patients with additional, previously undetected conditions. Patients reported savings in travel time and were satisfied with the quality of care they received. Optometrists, ophthalmologists and patients indicated a general acceptance of shared care arrangements, although there were some issues relating to interprofessional trust. Shared care between local optometrists and hospital-based ophthalmologists can help to reduce patient waiting time for review and offers an opportunity for these two groups of eye care professionals to collaborate in providing localised care for the benefit of patients. However, trust and relationship building need to be further developed.

Development, implementation, and evaluation of a student-initiated undergraduate medical education elective in HIV care

Background: The literature indicates that medical students require more comprehensive HIV training.Aim: Medical students at the University of Toronto developed and implemented the preclerkship HIV elective (PHE) with the aim to increase trainee HIV knowledge, address important issues in HIV care, and prepare students to serve affected populations.Methods: Developed in partnership with the Ontario HIV Treatment Network and in consultation with local AIDS service organizations and the University of Toronto Faculty of Medicine, the PHE was inaugurated in November 2008 as an elective supplement to medical curriculum content. Eighteen second-year medical students participated in the PHE, consisting of lectures, small group sessions, clinical observerships, community placements, reading assignments, and an HIV counseling and testing workshop. Participants completed a self-assessment of HIV knowledge prior to starting and after PHE completion.Results: Self-assessment scores of HIV knowledge among PHE participants significantly increased from 78.1% (pre-PHE) to 90.2% (post-PHE) (p = 0.0016). Common themes from feedback on participant satisfaction included enthusiasm for small group sessions, clinical observerships, community agency placements, and the diversity of topics covered.Conclusions: Student-run initiatives can supplement medical curriculum content and program feedback may be used to advocate for curriculum changes. Factors influencing success include student leadership and interest, community partnerships, and faculty mentorship.

Clinical observership: A desirable adjunct to preclinical training

Clinical observership: A desirable adjunct to preclinical training

Clinical observership: A desirable adjunct to preclinical training.

In the existing system of medical education in India, students are exposed to the hospital environment only after they start their clinical years of training. Hence, during the preclinical phase of their training most students are unaware of the relevance of basic sciences to clinical medicine. The preclinical student needs to be made aware of the relevance of basic sciences in clinical practice as early as possible during their training period.In an attempt to achieve the above-mentioned goals, the first year medical students in a private medical school in India were exposed to a 'clinical observership' programme. This observership, spread over a period of eight weeks took the students by rotation through eight clinical disciplines wherein they observed the activities in these clinics and interacted with the consultants, laboratory personnel and patients. The programme was designed to introduce them to hospital scenarios and to impress upon them the fact that the basic sciences form the foundation for their clinical training. It was highly appreciated by the students, who found it very useful, interesting and motivating in its contents and delivery. A project of this nature requires careful planning, and calls for co-operation of the teachers in basic sciences, clinical consultants and administrators to make a success of such an effort. In the light of this experience and taking into account the promising educational value of such a programme, it is suggested that similar innovations may be incorporated into the academic schedule to make the preclinical training interesting, motivating and meaningful to a student who is at the threshold of being moulded into a physician.

Easing International Medical Graduates' Entry Into US Training

Despite recent increases in the number of US medical graduates, international medical graduates (IMGs) constitute an important part of the US health care system and will continue to be needed to meet the nation's demands for medical services.1,2 Due to differences in culture, education, and local health care systems, IMG applicants and residents and the institutions preparing them for their professional careers experience financial, social, and political challenges, as well as personal, emotional, and financial hardships. We present the perspective of IMGs and provide practical suggestions for making the selection process and transition into US residency smoother and more efficient. This will better prepare this group for their training and service to their patients and, ultimately, the US health care system.Many IMGs who score high on the US Medical Licensing Examination (USMLE) ultimately do not train in the United States due to visa issues. These individuals often have spent considerable time and financial resources to take the examination prior to applying for a visa. A potential solution to this problem could be to require IMGs to obtain a visa or “pre-visa certificate” prior to taking the USMLE. In addition, making visa policies more lenient would help significantly.The 2003 implementation of the privacy provisions of the Health Information Portability and Accountability Act of 1996 (PL104-191) has made it more difficult for IMGs to obtain clinical observerships or externships to gain knowledge and experience of the US health care system. This is frustrating for applicants as most residency programs now require US clinical experience for applicants. Research is needed to explore the practical benefits of clinical observerships, particularly correlation with residents' future performance.Some programs, as the interview season progresses and they have a more complete picture of their applicant pool, send rejection notices to applicants requiring visas, indicating they will not sponsor visas. Programs should clearly state their visa policies and adhere to them so that IMGs can avoid experiencing lost time, energy, and funds and added mental stress.Although there is a debate about the value of US medical graduates' dean's letters,3 the dean's letter for many foreign medical schools uses a standard form rather than a personalized statement about the individual applicant. More weight should be given by program directors to the actual examination scores in medical school transcripts, which offer more information about graduates' academic performance.The National Residency Matching Program (NRMP) allows IMGs to opt out of the match. Many programs ask IMGs to use this option to secure the best candidates. This forces IMGs to choose between a residency spot and the opportunity to apply to a better and more desirable program. There is information that some programs offer IMGs an out of the match position and then withdraw the offer, leaving the candidate in limbo. There often are no repercussions to these actions, as IMGs are insecure and uncertain of their rights in the NRMP and their new country. More awareness among IMGs about their rights and more strict NRMP rules may provide a solution.Work-related stress in the first weeks of residency is immense, but IMGs also feel added stress, related to communication, social interaction, and acculturation. Once accepted into a US residency, IMGs should be provided with opportunities to improve their language, communication, and interpersonal skills and their ability to provide culturally competent care. Faculty who work with IMGs need added development to better prepare them for assisting this group to adjust to the US culture and health system.In summary, multiple opportunities exist to improve the hiring, match, and selection process for IMGs, as well as to enhance their training and acculturation of US practice after acceptance into a residency program. Transparency and adherence to a set of common guidelines will enhance IMGs' sense of fairness and satisfaction with the process of transitioning to a US residency. Research is needed to demonstrate the value of preparatory programs for IMGs to ensure they correlate with future performance and to enhance the content of these programs.The authors acknowledge Dr Janet A Jokela's support in reviewing and editing the initial version of the draft.

Nonstandard Programs: The University of Pittsburgh Medical Centerʼs Next Frontier in Graduate Medical Education

The University of Pittsburgh Medical Center has seen continuous growth in the number and types of graduate training programs not accredited by the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties, or the American Osteopathic Association. For the purposes of ensuring best educational products and of controlling unrecognized competition with our accredited programs, a sequential process of centralized oversight of these nonstandard programs was undertaken. The first step involved programs whose fellows were hired and tracked like accredited fellows (i.e., not instructors). The basic process began with consensus among leadership, writing of policy with consultation as necessary, establishment of a registry of programs and graduates, and a committee to allow sharing of best practices and dissemination of policy. The second step applied the same process to instructor-level programs. Whereas the previous group of programs was made subject to ACGME regulations, more latitude in duty hours and progressive responsibility were allowed for instructor programs. The final step, in progress, is extending a similar but modified approach to short-duration clinical experiences and observerships. The outcomes of these efforts have been the creation of a centralized organizational structure, policies to guide this structure, an accurate registry of a surprising number of training programs, and a rolling record of all graduates from these programs. Included in the process is a mechanism that ensures that core program directors and department chairs specifically review the impact of new programs on core programs before allowing their creation.

Clinical observerships: ENT, head and neck surgery at Toronto University Health Network, Canada

Rotating to different institutions is considered an important method of enhancing the breadth of surgical training. Trainees typically arrange formal 6–12 month 'out of programme' attachments in sought-after units. Mr Persaud shares his experience of the shorter stints he has spent in such units as a clinical observer and outlines the reasons why this alternative would also be rewarding for surgeons in training.