Clinical Practice Skills Research Articles

Strengthening critical thinking through debriefing - experiential learning theory: A case study.

There is a dire need to strengthen students' critical thinking in clinical training since it is an essential skill in clinical practice to optimize patient care. Debriefing is a formal or informal post-activity discussion that aims to improve learning outcomes, including critical thinking in clinical practice. There is a lack of research that focuses on students' experiences of debriefing to promote critical thinking in the South African context using experiential learning theory as a theoretical lens. This study aimed to explore South African students' lived experiences of debriefing to improve critical thinking. The author employed a qualitative single-case study design within an interpretivist paradigm. A purposive sampling technique was adopted. Six participants were recruited for this study. The author invited the participants to participate in semi-structured interviews. Data were analyzed through the six-step data analysis framework proposed by Creswell. To ensure the trustworthiness, the author employed multiple techniques to improve the credibility, conformability, dependability, and transferability of this study. These techniques included a well-planned research design and methods, thick descriptions of data, and an audit trail that was audited by a second coder. The findings revealed that participants shared positive experiences toward debriefing and furthermore debriefing through optimized student engagement and improved learning outcomes. This study also revealed that students experienced less stress in group debriefings. However, this study also identified some challenges in conducting debriefing. The challenges were primarily related to incompetent facilitators, inappropriate duration of debriefing sessions, and limited space in the clinic. Moreover, small group debriefing is recommended. Debriefing is an effective pedagogical approach to optimize critical thinking in clinical practice. It is recommended that debriefing should be implemented as a norm in clinical training at higher education institutions. Further studies are recommended to be conducted at national and international levels.

Nursing Skills Boot Camp

The use of a nursing Boot Camp to provide didactic instruction and hands-on practice of common clinical skills is one component of a comprehensive transition-to-practice program required to empower the nursing workforce.

Efficacy of an Antimicrobial Reality Simulator (AMRSim) as an Educational Tool for Teaching Antimicrobial Stewardship to Veterinary Medicine Undergraduates.

Simulation-based medical education has changed the teaching of clinical practice skills, with scenario-based simulations being particularly effective in supporting learning in veterinary medicine. In this study, we explore the efficacy of simulation education to teach infection prevention and control (IPC) as part of Antimicrobial Stewardship (AMS) teaching for early years clinical veterinary medicine undergraduates. The intervention was designed as a 30-minute workshop with a simulation and script delivered online for 130 students as a part of hybrid teaching within the undergraduate curriculum. Learning outcome measures were compared between an intervention group and waitlist-control group using one-way between-groups analysis of covariance tests. Significant differences between groups were found for outcomes measures related to short-term knowledge gain and confidence in IPC and AMS in small animal clinical practice. However, lateral knowledge transfer to large animal species clinical practice showed no significant differences. Student feedback indicated that the intervention was an enjoyable and engaging way to learn AMS. The intervention provided short-term knowledge gain in IPC protocols and enhanced procedural skills via active learning and motivation to learn in large groups of students. Future improvements would be to include large animal clinical scenario discussions and evaluate longer-term knowledge gain.

Validation of the scale of reflective practice in clinical settings among nursing students in Morocco

Background and SettingThe Clinical Practice Reflection Questionnaire (CPRQ) for Nursing Students is a reliable assessment tool used to evaluate students’ reflective practice in clinical settings. However, its validation in the French and Moroccan context and its utilization in nursing education require further investigation. ObjectiveThis study aims to verify the validity of the French version of the CPRQ, specifically translated and adapted for nursing students. ParticipantsThe study included two purposive samples of nursing students from the Higher Institute of Nursing Professions and Health Techniques (HINPHT) in Fez, along with its affiliated campuses in Meknes and Taza. The first sample consisted of 400 nursing students from various academic backgrounds in their second or third year of study. The second sample comprised 800 nursing students. Design and MethodsAn exploratory factor analysis (EFA) was performed on the sample of 400 participants to identify the underlying factor structure. The EFA revealed six factors, which were further validated using confirmatory factor analysis (CFA) on the larger sample of 800 participants. ResultsThe principal factor analysis showed that the CPRQ consists of six factors, explaining 80.78% of the total variance. These factors are essential dimensions of the CPRQ, capturing a significant amount of variability in the scores. The reliability analysis indicated a Cronbach's alpha coefficient of 0.720, indicating good internal consistency. The model's fit indices in the CFA demonstrated high levels of agreement, confirming the strong performance and favorable fit of the measurement model. The CFA also confirmed the original structure proposed by Bijani et al. in 2021, encompassing factors such as professional competence, internal sources of motivation, stimulating clinical context, dynamic organizational atmosphere, reflection-based self-management, and dynamic professional growth. ConclusionsThe findings of this study provide empirical evidence supporting the validity and reliability of the French version of the CPRQ scale as an effective tool for evaluating nursing students’ reflection skills in clinical practice. The validated scale can be confidently employed by nursing educators to assess students’ reflective abilities in a rigorous and consistent manner.

Beyond multiple choice: Clinical simulation as a rigorous and inclusive method for assessing genetic counseling competencies.

Educational use of clinical simulation is a way for students to immerse themselves within a realistic yet safe and structured environment as they practice clinical skills. It is widely used in healthcare training and evaluation, and there are best practices for design, implementation, debriefing, and assessment. An increasing number of genetic counseling graduate programs use simulation in various ways, ranging from role-plays to working with professional simulated/standardized patient (SP) actors. At this time, there is very little consistency across programs, research on the approaches, and standards by which simulation is incorporated into training. Simulation is an understudied but promising approach for genetic counselor (GC) education and assessment. After graduation, GCs demonstrate their competence as entry-level providers through American Board of Genetic Counseling (ABGC) multiple-choice examination (MCE), along with their participatory clinical encounters from graduate training. Data from genetic counseling and other professions highlight the limitations and biases of MCEs, suggesting they not only fail to accurately capture competency, but also that they disadvantage underrepresented individuals from entering the field. In addition, MCEs are limited as a tool for assessing nuanced counseling and communication skills, as compared to more quantitative scientific knowledge. We propose that innovative, evidence-based approaches such as simulation have the potential to not only enhance learning, but also to allow GCs to better demonstrate competency during training and in relation to the board examination. Collaborative approaches, research, and funding are needed to further explore the viability of routinely incorporating simulation into GC training and assessment.

Information technologies used in medical education

Purpose: The objective of this article is to conduct a literature review to understand and analyze the use of information technologies in medical education. Design/methodology/approach: In this documentary article, the method employed focused on the review of various databases (Scopus, Redalyc, Scielo, and Web of Science). Findings: As a result, it was found that telemedicine, in particular, has facilitated online consultations and real-time feedback, enhancing the quality of healthcare and promoting continuous professional development. Virtual medical simulations have provided a safe and controlled environment for students and professionals to practice clinical skills, refine techniques, and build confidence before facing real-life situations. Additionally, access to online educational resources, such as digital libraries and medical journals, has expanded access to medical knowledge and enabled students and professionals to stay updated in an ever-evolving field.

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.

1945 Hospital at Home - developing a novel simulation induction programme through quality improvement

Abstract Introduction The UK is expanding provision of acute medical care in people’s own homes through Hospital at Home (H@H) and virtual wards. Our H@H service is training junior doctors to meet the growing clinical need in this environment. We describe the use of simulation training to improve the H@H induction process. Methods From their experiences in H@H, junior doctors identified specific training needs to build relevant competencies. From this feedback, PDSA cycle one involved junior doctors designing a dedicated simulation training (H@H-SIM). Stations addressed clinical, practical and advanced communication skills required in H@H using high- and low-fidelity simulation. PDSA cycle two used post-course evaluation to refine H@H-SIM through introduction of FP10 prescribing stations, point-of-care testing (POCT) and greater emphasis on practical skills. Revisions were evaluated via participant questionnaire before and after the H@H-SIM. Results Cycle two of H@H-SIM involved twenty doctors. The clinical scenarios, prescribing and practical skills stations, including POCT and IV administration, were perceived as the most useful parts of training. Overall self-rated confidence in knowledge and skills to work in H@H improved from a mean of 6.9 to 7.7/10. Before H@H-SIM, 60% were ‘not confident’ with recognising end of life (EOL), IV administration or decision-making around remaining at home; 10% with advance care planning (ACP). After H@H-SIM, 10% felt ‘not confident’ with recognising EOL or ACP and 5% with IV administration. Concerns persisted with using equipment, prescribing and availability of senior support. An additional station on recording ECGs was suggested. Conclusions Working in a H@H context and seeing patients in their homes can be daunting for junior doctors. H@H-SIM embedded into induction is one way to prepare doctors for this role, improve their confidence and has potential for wider replication.

Progress Testing in UK Medical Education: Evaluating Its Impact and Potential.

This comprehensive review critically examines the UK medical curriculum, with a particular focus on progress testing as an innovative assessment strategy. The curriculum, evolving from foundational sciences to practical applications, is encapsulated in the integrated curriculum model (ICM). This model adeptly combines theoretical knowledge with clinical practice, fostering cognitive, affective, and psychomotor skills among medical students. Central to this review is an exploration of progress testing. This method, grounded in constructivist learning theories, emphasises continuous assessment and professional development. Progress testing's regular, comprehensive examinations are instrumental in guiding students through the progressive stages of competence, as outlined in Miller's pyramid, from foundational knowledge to clinical proficiency. The review also addresses the broader impacts of progress testing on teaching approaches, student feedback, academic and pastoral support, and quality assurance. By aligning with the dynamic requirements of 21st-century medical training, progress testing not only nurtures well-rounded professionals but also ensures compliance with regulatory bodies like the General Medical Council. Its emphasis on continuous evaluation aligns with the practical realities of a medical career, driving curricular innovation and aligning with regulatory standards. The implementation of progress testing marks a significant advancement in medical education. Its continuous, holistic nature benefits both students and educators, nurturing a more engaged learning attitude and meeting evolving medical needs. The adoption of this assessment strategy is seen as pivotal in shaping competent medical professionals, ready to face the challenges of modern medical practice.

The influence of intensive clinical skills ‘bootcamps’ on nursing students' perceptions of ability to provide acute care: A mixed methods study

ObjectivesTo examine the influence of an intensive clinical skill bootcamp on students' perceptions to provide care in acute situations. SettingEvidence indicates that the recognition and response to patient change can be a challenge in nursing practice and especially so for undergraduate students (Goldsworthy et al., 2022). Additionally, the impact of the pandemic interrupted the preparation of undergraduate nursing students across the world. It is suggested that intensive clinical skills practice can enhance clinical skills, confidence and time management (Hinton and Chirgwin, 2010). However, little is known about the value of these intensive programs on the perceived ability of nursing students to provide care in acute situations. MethodsAn embedded mixed methods design was employed with a quasi-experimental repeated pre-post design using the Perception to Care in Acute Situations scale (Sterner et al., 2020) and qualitative focus groups. The intervention comprised 4 h of technical skills simulation and 2 h of immersive simulation. Data were analysed using descriptive and inferential statistics and inductive thematic analysis. ResultsFrom 130 final year nursing student who participated in the bootcamp, 73 responses to the survey were obtained. Fifty-four responses from students before the simulation activities and 19 responses after. Significant changes in student perceptions of their abilities to provide care in acute situations were noted. Three focus groups were conducted with four themes recognised in the qualitative data including interrupted preparation; factors that influence learning; role modelling; and making connections. ConclusionThe pandemic interrupted student preparation for clinical placement. Intensive clinical skills bootcamps develop student perceived confidence by providing feedback and opportunities for reflection to make connections. Opportunities for student reflection on their current competence supports developing realistic insights into perceived capabilities.

Assessing the validity of VR as a training tool for medical students

The advances in Virtual Reality technologies, increased availability and reducing hardware costs have diminished many of the early challenges in the adoption of VR. However, a commonly identified gap in immersive Virtual Reality-Head Mounded Display (VR-HMD) training for medical education is the confidence in the long-term validity of the applications, in particular, the acceleration of the learning curve efficacy of learning outcomes over time and actual skills translation into real environments. Research shows a wide range of ad hoc applications, with superficial evaluations often conducted by technology vendors, based on assumed environments and tasks, envisaged (as opposed to actual) users and effectiveness of learning outcomes underpinned with little or no research focusing on a requirements-driven validation approach. This presents decision-making challenges for those seeking to adopt, implement and embed such systems in teaching practice. The current paper aims to (i) determine whether medical VR training improves the skill acquisition of training candidates, (ii) determine the factors affecting the acquisition of skills and (iii) validate the VR-based training using requirement-driven approach. In this paper, we used within- and between-subject design approaches to assess the validity of VR-based surgical training platform developed by Vantari VR against requirements which have been identified to have impact on learning processes and outcomes in VR-based training. First, study and control groups were compared based on their level of skill acquisitions. Then, by tailoring a requirements framework, the system was validated against the appropriate requirements. In total, 74 out of 109 requirements were investigated and evaluated against survey, observer and stakeholder workshop data. The training scenario covered the topic of Arterial Blood Gas (ABG) collection for second-year university medical students. In total 44 students volunteered to participate in this study, having been randomly assigned to either the study or control group. Students exposed to VR training (the study group) outperformed the control group in practical clinical skills training tasks and also adhered to better safety and hygiene practices. The study group also had a greater procedural completion rate over the control group. Students showed increased self-efficacy and knowledge scores immediately post-VR training. Prior ABG training did not impact on VR training outcomes. Low levels of simulation sickness, physical strain and stress, coupled with high levels of enjoyability, engagement, presence and fidelity were identified as factors affecting the overall training experience. In terms of learning, high scores were recorded for active learning, cognitive benefit and reflective thinking. Lastly, by validating the system against 74 system requirements, the study found a user acceptance level of 75%. This enabled the identification of weaknesses of the current system and possible future directions.

Simulated cardiopulmonary bypass: a high fidelity model for developing and accessing clinical perfusion skills

BackgroundTraditionally, novice perfusionists learn and practice clinical skills, during live surgical procedures. The profession’s accrediting body is directing schools to implement simulated cardiopulmonary bypass (CPB) into the curriculum. Unfortunately, no CPB simulation models have been validated. Here we describe the design and application of a CPB simulation model.MethodsA CPB patient simulator was integrated into a representative operative theater and interfaced with a simple manikin, a heart-lung machine (HLM), clinical perfusion circuitry, and equipment. Participants completed a simulation scenario designed to represent a typical CPB procedure before completing an exit survey to assess the fidelity and validity of the experience. Questions were scored using a 5-point Likert scale.ResultsParticipants (n = 81) contributed 953 opinions on 40 questions. The participants reported that the model of simulated CPB (1) realistically presented both the physiologic and technical parameters seen during CPB (n = 347, mean 4.37, SD 0.86), (2) accurately represented the psychological constructs and cognitive mechanisms of the clinical CPB (n = 139, mean 4.24, SD 1.08), (3) requires real clinical skills and reproduces realistic surgical case progression (n = 167, mean 4.38, SD 0.86), and (4) would be effective for teaching, practicing, and assessing the fundamental skills of CPB (n = 300, mean 4.54, SD 0.9). Participants agreed that their performance in the simulation scenario accurately predicted their performance in a real clinical setting (n = 43, mean 4.07, SD 1.03)ConclusionThis novel simulation model of CPB reproduces the salient aspects of clinical CPB and may be useful for teaching, practicing, and assessing fundamental skills.

Testing the interrater reliability of integrated interpretations using a problem-solving model.

[Purpose] A method for evaluating integrated interpretation skills, which is an important educational goal in clinical practice, is yet to be established. This study examined the interrater reliability of a problem-solving model that was developed as a novel assessment method. [Participants and Methods] Three students created problem-solving models using fictitious case data. Ten clinical practice supervisors with at least 3 years of experience were asked to score the models, and the intraclass correlation coefficient (2, 1) was calculated. [Results] The intraclass correlation coefficient was 0.88, which indicates a good result. [Conclusion] Good interrater reliability was obtained using the problem-solving model, which suggests that this model may be used to assess integrated interpretation skills in clinical practice.

Assessment of Anaesthesia Teams' Non-Technical Skills in Clinical Practice before and after Simulation-Based Team Training: A Quasiexperimental Study.

In situ simulation-based team training of non-technical skills is considered an important initiative for preventing adverse events caused by poor teamwork among healthcare personnel. This study aimed to assess the non-technical skills of anaesthesia personnel before and after in situ simulation-based team training in a clinical setting. The study was conducted from October 2020 to June 2021 using a quasiexperimental before and after design based on video-recorded observations and ratings of anaesthesia teams' non-technical skills during anaesthesia induction in the operating room before and shortly after in situ simulation-based team training. Anaesthesia personnel were divided into 20 teams and video recorded during anaesthesia induction. The Anaesthetists' Non-technical Skills (ANTS) system was used to score the teams' non-technical skills. A paired-sample t-test was used to assess the impact of the intervention on the anaesthesia teams' scores on the various ANTS categories. Interrater agreement between the two ANTS raters was assessed using weighted kappa. At the category level, the overall scores had a statistically significant increase in performance after simulation-based team training (3.48 vs. 3.71; p < 0.001). Furthermore, scores of five of the 15 elements were significantly different. Interrater agreement revealed moderate agreement between the two raters (weighted kappa = 0.51, p value <0.001). The anaesthesia teams' increased non-technical skills after simulation-based team training may indicate the transfer of knowledge from training to clinical practice. The moderate agreement between the raters could be attributed to the subjective nature of the evaluation procedure. The ANTS was originally used as an individual assessment tool; however, this study has demonstrated its potential as a team assessment tool.

Effectiveness of plasmapheresis educational and training program on nurses’ competency

Background The growing prevalence of plasmapheresis within global healthcare generates distinct challenges. Mastering the intricate technical aspects and specialized knowledge associated with this procedure necessitates an elevated level of competency among nurses. Therefore, educational and training programs serve as the cornerstone strategy to mitigate potential complications and foster robust professional awareness in this domain. Aim To determine the effectiveness of a plasmapheresis educational and training program on nurses’ competency. Design A quasi-experimental study design was used. Setting The study was carried out at the plasmapheresis unit in the renal and urology hospital’s dialysis department and at the blood bank unit of El-Minia University Hospital. Sample A purposive sampling of 40 nurses who met the inclusion criteria. Tools A structured interview questionnaire, self-administered knowledge questionnaire, and competency-based practice for nurses were the three methods used in the data collection process. Results The study’s findings demonstrated a statistically significant enhancement in the mean scores for knowledge and competency-based practice related to the plasmapheresis technique, following the implementation of an educational and training program. This is evidenced by a highly significant P value of 0.000. Conclusion Baseline data showed unsatisfactory levels of both theoretical knowledge and competency-based practice in the majority of participating nurses. Subsequent implementation of an educational and training program yielded significant improvements, as evidenced by the nurses’ demonstrably high levels of knowledge and competency-based practice on completion. These findings strongly support the efficacy of targeted educational interventions in enhancing nurses’ knowledge and clinical practice skills. Recommendations To ensure a consistently high level of nurse proficiency within healthcare agencies, regular implementation of competency training programs is recommended. Furthermore, ongoing advancements in nursing education should strive to seamlessly integrate quality and safety education throughout the curriculum, with a particular focus on practical applications within nursing practice settings.

Learning effectiveness of clinical anatomy and practical spine surgery skills using a new VR-based training platform

IntroductionAs medical education becomes more complex, the demand for advanced teaching and training methods has grown. Technological advancements have opened up new possibilities, particularly in the realm of virtual reality (VR) simulations for training. Research QuestionOur prospective, randomized pilot study aims to assess whether a novel VR-based 3D training platform can effectively teach the knowledge and skills needed for complex spinal surgery, specifically pedicle screw placement. Material and MethodsWe enrolled 25 participants who received either a traditional lecture (control group, n=11) or a VR lecture with identical content featuring 3D/VR anatomical models (VR group, n=14). The VR group also underwent VR simulation for pedicle screw placement. We evaluated their learning through a quiz, a practical skills test, and selfassessment questionnaires. ResultsIn the theory multiple-choice test, the contral group scored an average of 69% (range 53-87%, SD 0.10), while the VR group scored 66% (range 47-87%, SD 0.11) (p=0.692, independent sample t-test).For the practical DOPS test (pedicle screw placement), the average score was 2.4 points (n=25; range 1-4). The VR group on average scored 2.9 points compared to the control (2 points) (p=0.134). Discussion and Conclusion Our study indicates that teaching with a new 3D VR training tool yields results comparable to traditional methods in terms of knowledge retention. This research supports the platform's effectiveness as an educational resource. Importantly, trainees can apply VR-acquired knowledge to real surgical procedures, which are well-received.

Student Nurses' Perceptions of the Role of High-Fidelity Simulation in Developing Decision-Making Skills for Clinical Practice: A Qualitative Research Study.

The integration of high-fidelity simulation (HFS) in nursing education has increased, but its effect on students' clinical decision-making skills and their ability to transfer these skills to clinical practice remains unclear. This qualitative study aimed to explore nursing students' perceptions of simulation's role in developing decision-making skills for clinical practice. Twenty-three self-selected final-year nursing students participated in an HFS exercise in 2016. They engaged in "think-aloud" activities during the simulation, reviewed videos of their performance, and attended a structured debriefing session. Four to six weeks later, face-to-face semistructured interviews were conducted to gather their views on the application of learning from simulation into practice. Thematic analysis was used to analyze the interview data. Four themes emerged from the analysis: "enhancing clinical decision-making skills," "recognition of the types of clinical decision-making," "recognition of cognitive biases," and "transferability and integrating theory into practice." Simulation improved student self-awareness, decision-making skills, and recognition of cognitive biases applied in practice. Overall, students found that the simulation improved their ability to apply theoretical knowledge gained through simulation to practice. The students' perception of the authenticity of activities in relation to real-world scenarios played a crucial role in enhancing the transferability and application of acquired knowledge from simulation to clinical practice. The findings provide valuable insights into how simulation optimizes learning and decision-making skills, ultimately promoting effective care in clinical settings.

Clinical educators of the medical colleges of South Asia need to be trained for educating clinical reasoning skills to medical students

Clinical reasoning is the process of reasoning to decide for managing the patient using data and applying medical knowledge and experience. Clinical reasoning skills are essential skills for the novice learner of medical education to learn the process of clinical diagnosis, thereby providing safe and effectual health care. These skills learning help clinicians arrive at a diagnosis and prevent making diagnostic errors which are reported to occur in five to 15% of cases. Poor clinical reasoning leads to a diagnostic error which may jeopardize the patient’s safety. The clinical reasoning skills are not generally explicitly imparted to the learners especially during their undergraduate learning period even though these may be documented in the curriculum of medical undergraduate study. The key elements in the clinical reasoning process are the patients’ story, data acquisition, problem representation, hypothesis generation, search and selection of illness script, differential diagnosis, and a leading diagnosis. Clinical reasoning is a complex process, difficult to teach learners and assess their skills, consumes clinical medical educators’ time, and requires resources for teaching and learning. There must be educational strategies both at the undergraduate and postgraduate levels to promote diagnostic reasoning skills; for this, clinical medical educators must be acquainted/trained in how to convey the reasoning approaches to beginners. The clinical medical educator has to a play dual role; provide quality care to the patients, teach clinical reasoning skills to the learners, and assess their skills to make them independent decision-makers and problem solvers in clinical settings. Clinical reasoning skills are among the core competencies to be learned by medical learners to become competent clinicians. The clinical competence of the clinician cannot be superseded by the advancement of technology and evidence-based medicine. All these three need to be integrated to minimize the errors in diagnosis. Clinical educators must unequivocally nurture and enhance the capacity of learners to include and integrate both analytical and non-analytical clinical reasoning strategies into their approach to arrive at diagnosis. The clinical medical educator must identify the learners’ approach to clinical reasoning and enable them to follow the right approaches towards clinical reasoning. Clinical reasoning skills are better learned/imparted during clinical encounters and deliberate practice enriches learning of these skills. Enhancement of clinical reasoning skills learning can be achieved through deliberate practice. The clinical medical educator may organize and supervise the simulation-based deliberate practice sessions for the learners to boost their clinical reasoning skills. For the deliberate practice of clinical reasoning skills, The New England Journal of Medicine (NEJM) has developed an application NEJM Healer, a screen-based interactive patient encounter (Virtual Bedside Encounter) through which learners are involved in each element of clinical reasoning process. Virtual Reality (VR) is also gaining popularity in educating the medical students and has been demonstrated to be beneficial in enhancing students’ comprehension and memory as well as in the development of transferable skills like surgical methods. The medical schools in South Asian countries need to reiterate the development/enhancement of clinical reasoning skills of both medical undergraduate and postgraduate learners. To achieve this objective, medical colleges must regularly organize training for clinical medical educators to facilitate students’ learning in reasoning skills, and for assessing their skills, and provide feedback to the learners. The institutes should also invest in infrastructure to pursue the use of modern technologies like VR, skills labs, etc. to attain this objective.

Electives in Medical Curriculum- An Insight of Medical Students

Background: Electives include courses that are interest based, where the students are free to choose the course content. NMC has introduced electives in medical curriculum and it has been implemented for the first time in various medical colleges. Aims and Objectives: The objective of this study is to assess the perception of MBBS students regarding Electives program. Methodology: This cross-sectional study was conducted among the first batch of MBBS students that completed the electives program after taking their consent and approval from ethical committee. Electives Experience scale (EES) and Electives Rating Scale (ERS) were developed, tested, and used for this study. Median, inter quartile range, Cronbach’s alpha and Mann Whitney tests were used for analysis. Results: Most of the students learnt theory, practical, AETCOM (ethics &amp; communication), clinical skills and research in both blocks of posting but research was more focussed in block 1 and practical knowledge and clinical skills in block 2. For the Likert scales (EES-1, EES-2, ERS-1, ERS-2 &amp; ERS), Cronbach’s alpha was found to be quite robust for all the scales. Median and inter quartile range were calculated for EES and ERS scores. Mann Whitney test showed significant gender difference for EES-2. If the student had got elective of his/her choice in block 1, the mean ranks of EES &amp; ERS were significantly higher but if the student had got the elective of his/her choice in block 2, significantly higher scores were seen in overall ERS, ERS-2 and EES-2 only. Conclusion: Electives is a welcome addition to the medical curriculum. However, proactive approach from the student is a must to utilize this opportunity to the fullest.

Music in medical education: A critical interpretive synthesis.

While many have championed the value of music in medical education, research specific to how and why music has been offered in medical education is sparse and there have been few attempts to synthesise the literature. A Critical Interpretive Synthesis (CIS) of 56 texts including published articles, correspondence, abstracts and one thesis published between 1977 and 2022 was undertaken to explore the evidence basis for offering music in medical education. A total of 52 music-focused programmes/activities were described, encompassing both curricular and extra-curricular, receptive and participatory music activities and a wide range of musical genres. Inductive analysis of data extracted from texts revealed a variety of rationales for the use of music in medical education, which could be grouped within seven interrelated themes: well-being; supportive learning environment; affective engagement; teaching and learning; developing skills for clinical practice; humanism in medicine; and creative expression (identity). The results of this synthesis demonstrate that there remains a gap between what is claimed about the affordances of music and what has been explicitly addressed in medical education research. Despite a paucity of research in this area, the available data support that the affordances of music are 'multiple' and may not be well represented by linear models. Evidence that engagement with music is beneficial for medical students is strongest in relation to the affordances of music for well-being, facilitating a supportive learning environment, affective engagement, memorisation and creative expression (identity). That engagement with music might enhance humanism, including developing skills for clinical practice, requires further investigation. Accounting for student agency and the 'multiple' affordances of music will ensure that future teaching and research are best positioned to benefit medical students' well-being and personal and professional development.