Clinical Role Models Research Articles

Professional identity: Students’ learning from the attributes and behaviours of midwives on clinical placement

BackgroundMidwifery practice experience is an important component of education to develop an understanding of professional identity in midwifery students. The responsibility of supporting student development in the clinical setting is predominantly undertaken by clinical midwives. There is minimal literature relating to the professional identity development of midwifery students. AimTo explore midwifery student experiences of the positive attributes of clinical midwives who supported the professional identity development of midwifery students in the clinical practice setting. MethodsAn Appreciative Inquiry approach guided this study. The setting was a university in Sydney, Australia. Participants comprised thirteen students from a postgraduate midwifery course. Data were collected via individual interviews and analysed thematically. Students had two to six months of placement in the clinical setting. FindingsData analysis identified three themes, Putting the woman at the centre of care; Supporting a woman-centred environment and Focusing on student success. DiscussionFindings from this study revealed that extended time spent with a midwife enabled the student to observe and reflect on the nuances of midwifery practice that are not overtly shared with students. Students were able to observe a midwife’s tacit way of being. This paper reveals the positive attributes and behaviours of midwives whose practice the students want to emulate. ConclusionsMidwifery students’ exposure to positive clinical midwife role models on clinical placement enables them to develop a greater understanding of professional identity.

Self‐appropriation in nurse engagement: Facilitating the development of expert nurses using Benner and Lonergan

AbstractExpert nurses, as described by the work of Patricia Benner, are at the peak of clinical nursing practice and vitally important in ensuring the best possible patient care and clinical outcomes. The development of Benner's theory and its relationship with the Dreyfus model of skill acquisition provides context for understanding the progression necessary for expert development. Contemporary healthcare challenges present implications to the development of advancing levels of nursing practice. Engagement has been identified as critical to achieving expert practice. I propose the incorporation of the philosophical framework of self‐appropriation from Benard Lonergan as a strategy to develop internal engagement in nurses to facilitate expert practice. I outline the synergy between Benner's theory and the work of Lonergan, which provide overlap and opportunity to overcome barriers to developing expert nursing practice. In the challenging climate of healthcare, there is an obligation to promote engagement and facilitate expert nurse development, necessary for patient outcomes as well as clinical role models, preceptors, and leaders to guide future nurses.

Examining the Role of Gender and Ethnic Concordance in Medical Student Specialty Selection.

Representation of female and minority physicians varies across specialties and may influence career selection by medical students. To investigate the effect of demographic concordance between medical students and clinical role models on specialty selection, we conducted a survey of graduating medical students to assess the perceived importance and influence of third-year clerkship experiences with demographically concordant preceptors on their choice of specialty for post-graduate training. An 11-question survey was shared nationally through AAMC Organizational Student Representatives to medical students in the Class of 2023. Information gathered included demographics; specialty of choice; extent of exposure to preceptors of the same gender, race, or ethnicity during clinical clerkships; and perceived importance and influence of those interactions (Likert 1-5, Low-High) on specialty selection. A total of 84 students responded. Female students ascribed more importance to gender concordance with preceptors on the third-year clerkship most associated with their specialty of choice than males [3.4 (SD 1.2) vs. 1.3 (SD 0.8) respectively, p < 0.0001] and greater influence to gender concordance on final specialty selection [2.37 (SD 1.1) vs. 1.31 (SD 0.8) respectively, p < 0.0001]. Non-Caucasians ascribed more importance to race/ethnicity concordance than Caucasians [2.8 (SD 1.4) vs. 1.2 (SD 0.5) respectively, p < 0.0001] and greater influence to race/ethnicity concordance on final specialty selection [2.0 (SD 1.3) vs. 1.1 (SD 0.4) respectively, p < 0.0001]. Caucasian females ascribed the greatest importance to gender concordance (p < 0.001), non-Caucasian females ascribed the greatest influence of gender concordance (p < 0.001), and non-Caucasian females ascribed both the greatest importance (p < 0.001) and influence (p < 0.001) to race/ethnicity concordance. We found that gender and race/ethnicity concordance between students and clinical preceptors during third year clerkships is perceived as especially important and influential in specialty selection by minority and female medical students. These findings highlight the importance of diversity in gender and race/ethnicity representation by preceptors on clinical clerkships. The online version contains supplementary material available at 10.1007/s40670-024-02044-6.

Perceptions on Medical Professionalism Among Future Healthcare Professionals: A Mixed Method Study.

Background Accreditation councils across the world constantly examine policies and practices in professionalism in their medical curriculum. The National Medical Commission (NMC) in India has recognized the pressing need to reform and include professionalism in its undergraduate curriculum. Objectives The objective of this study was to explore the perspectives of medical and nursing students on professional behavior, suitable teaching-learning methods, and assessment strategies for curriculum integration. Methodology The study utilized a concurrent triangulation mixed method design, collecting both qualitative and quantitative data simultaneously to gain a comprehensive understanding of medical and nursing students' perceptions of professionalism. It included 83 final-year undergraduate medical students and 42 final-year undergraduate nursing students. The approval of the Institutional Review Board of Meenakshi Medical College Hospital & Research Institute was obtained. A semi-structured questionnaire consisting of demographic characteristicsand opinions regarding academic professional behavior, teaching-learning, and evaluation of professionalism was used. Perceptions regarding the meaning of professionalism, behavior of professionalism to be emphasized in teaching, and pressing challenges of professionalism were explored. Students were also asked to rank the best behavior associated with professionalism. Frequency and percentages were used for descriptive statistics. Means and standard deviations were calculated for continuous variables. An unpaired t-test was used to determine a statistically significant difference between the means in the two groups. The quantitative data was analyzed with R programming and content analysis was performed for the qualitative data using ATLAS.ti qualitative data analysis software. Results Unexplained/unauthorized absence from academic activities (2.39 ± 1.553), not following the timeline (2.41 ± 1.560), making fun of patients and peers (2.16 ± 1.619), cheating in the exams (2.37 ± 1.651), and inebriation (2.39 ± 1.666) were unacceptable behaviors by undergraduate medical students compared with nursing students. Clinical experience (1.54 ± 0.857) and role models (1.74 ± 0.935) were the highly acceptable methods of teaching professionalism and interprofessional interactions (1.58 ± 0.650) and awards (1.98 ± 1.100) were the most common suggestions to improve the course curriculum by both groups. Community/field activity (1.78 ± 0.860) and clinical examination (1.89 ±1.123) were the most preferred methods of evaluation of professionalism. According to the students, dedication, honesty, respect, and self-improvement were identified as the best behaviors associated with professionalism. Conclusions The study revealed that students had a wide range of perspectives about professionalism. Different unprofessional acts were acceptable to students. The causes of these perspectives need to be explored and resolved to promote professionalism. Students identified the need for strong positive role models and frequent clinical experiences, along with improved interprofessional interactions and awards to improve teaching and learning professionalism. Community/field activity was the preferred assessment method proposed by the students. Medical institutions must promote these components in curriculum, faculty development, and clinical settings to foster the development of professionalism among students.

Registered nurses' perceptions and experience of working in aged care: A qualitative approach.

To understand and report on the perceptions and experiences of registered nurses in the aged care sector. An exploratory qualitative study. Semi-structured telephone interviews were utilised as the primary data collection method. Fifteen registered nurses were interviewed. All interviews were recorded, transcribed verbatim and analysed using conventional content analysis. Participants were quoted verbatim to ensure authenticity. The results indicated a demand for increased administrative and staffing support in the aged care workplace. Poor morale and unethical practices contributed to negative perceptions and attitudes among nurses towards aged care. Managing and communicating with older people was reported as challenging, which impacts nursing staff recruitment and retention. Future work is needed to ensure that outstanding clinical role models and leadership support nursing staff recruitment and retention. Incorporating aged care content into the nursing curriculum and providing professional development opportunities to aged care professionals would be the foundation towards solutions, as the study primarily explored nurses' perspectives.

85 I DO, I CARE: implementing delirium screening for older people to improve care, awareness and recognition in the emergency department

Abstract Background Delirium is prevalent (7%–20%) in older patients in emergency departments (ED). The diagnosis is often missed (57%–83%). This Quality Improvement (QI) project aimed to improve delirium screening by 30% in the ED, in keeping with the HSE’s ‘Early Identification and Management of Delirium in ED (2021) and to identify barriers to sustain screening. Methods The Institute for Health Improvement Quality Improvement essentials toolkit was used. Patients ≥75 years with Manchester triage category of 2–5 were included. Plan Do Study Act cycles included auditing 110 patient charts in a weekly rapid cycle audit was performed. Actions included 1) formation of an organisational oversight group 2) triage nurses and healthcare assistants placed ‘Screen me with 4AT’ stickers on charts 3) ED Doctors screened with 4-AT 4) 4AT tool was incorporated into all adult proforma 5) 5 face to face information sessions with ED nurses 6) 8 individualised information sessions with ED nurses 7) EM registrar education of junior doctors 8) 4-AT lanyard reminder card 9) twice-weekly WhatsApp group sharing of results 10) Informal feedback invited from doctors who did not complete the 4AT. Data was entered onto Excel and analysis done using descriptive statistics. Results The mean (SD) age was 84 (5.6) years, the mean (SD) Manchester triage was 2.6 (0.6) and 56% were female. At baseline 1/20 (5%) charts contained a completed 4-AT. On average the 4-AT completion improved to 38% (42/110) (range 10% to 60%). Delirium was diagnosed in 38% (16/42). Barriers identified pre and post implementation included knowledge deficits, no out-of-hours referral pathway, low priority above competing demands, and fluctuations in ED staffing. Conclusion The QIP achieved the target but sustainability due to doctor’s rotations is questionable. Senior clinical leadership and role modelling, nursing team buy-in, education, and referral pathways are required to build on current progress.

‘A role model is like a mosaic’: reimagining URiM students’ role models in medical school

BackgroundRole modelling is a widely acknowledged element of medical education and it is associated with a range of beneficial outcomes for medical students, such as contributing to professional identity development and a sense of belonging. However, for students who are racially and ethnically underrepresented in medicine (URiM), identification with clinical role models may not be self-evident, as they have no shared ethnic background as a basis for social comparison. This study aims to learn more about the role models of URiM students during medical school and about the added value of representative role models.MethodsIn this qualitative study we used a concept-guided approach to explore URiM alumni’s experiences with role models during medical school. We conducted semi-structured interviews with ten URiM alumni about their perception of role models, who their own role models were during medical school and why they considered these figures as role models. Sensitizing concepts guided the topic list, interview questions and finally served as deductive codes in the first round of coding.ResultsThe participants needed time to think about what a role model is and who their own role models are. Having role models was not self-evident as they had never thought about it before, and participants appeared hesitant and uncomfortable discussing representative role models. Eventually, all participants identified not one, but multiple people as their role model. These role models served different functions: role models from outside medical school, such as parents, motivated them to work hard. Clinical role models were fewer and functioned primarily as examples of professional behaviour. The participants experienced a lack of representation rather than a lack of role models.ConclusionsThis study presents us with three ways to reimagine role models in medical education. First, as culturally embedded: having a role model is not as self-evident as it appears in existing role model literature, which is largely based on research conducted in the U.S. Second, as cognitive constructs: the participants engaged in selective imitation, where they did not have one archetypical clinical role model, but rather approach role models as a mosaic of elements from different people. Third, role models carry not only a behavioural but also a symbolical value, the latter of which is particularly important for URiM students because it relies heavier on social comparison.

Effectiveness of clinical mentorship program for students of long-term aged care: A mixed-methods study

BackgroundInternationally, the population is rapidly aging with a strong demand for aged care services. In Taiwan, both recruiting and retaining staff to aged care poses difficulties. Good clinical role models can positively impact students' confidence and professional development and influence their willingness to enter the long-term aged care workforce. ObjectivesTo clarify clinical mentors' roles and competencies and assess the effectiveness of a mentorship program for improving students' professional commitment and self-efficacy in long-term aged care. DesignA mixed-methods study with a quasi-experimental research design and qualitative interviews. SettingsPurposive sampling was used to recruit long-term aged care professional clinical mentors with preceptor qualifications and nursing and aged care students enrolled in a two-year technical program in a Taiwanese university's gerontology care department. ParticipantsFourteen mentors and 48 students participated. The student control group received regular education; the experimental group received mentorship guidance. MethodsThis study included three phases. Phase one involved qualitative interviews to identify clinical mentors' roles and competencies. Phase two involved expert panel meetings to establish the clinical mentorship program's content and implementation. Phase three involved the program's evaluation. Quantitative questionnaires were administered before the program and subsequently at 6, 12, and 18 months to assess mentors' effectiveness and students' professional commitment and self-efficacy in long-term aged care. Qualitative focus groups solicited participants' feelings and suggestions for the program. ResultsClinical mentors' roles and competencies centered on two themes: professional role model and establishing good rapport. Quantitative analysis showed that mentoring effectiveness initially recorded a decline, followed by a subsequent increase. Both groups' professional self-efficacy and commitment followed an increasing trend. While the experimental group's professional commitment score was significantly higher than the control groups, their professional self-efficacy scores did not differ significantly. ConclusionsThe clinical mentorship program improved students' long-term aged care professional commitment and self-efficacy.

In the Setting of Heightened Economic and Workforce Issues, What Are Third-Year (PGY-4) Ophthalmology Residents' Perspectives of Pediatric Ophthalmology?

To investigate the factors influencing residents' choice to pursue a pediatric ophthalmology fellowship. A nine-question survey was distributed to third-year (PGY-4) ophthalmology residents of United States-based Accreditation Council for Graduate Medical Education residency training programs in ophthalmology. One hundred two of 502 residents completed the survey. Fifty percent of all respondents had no debt and 14.7% had more than $300,000 in debt. Forty-four (43.1%) rated the quality of pediatric ophthalmology teaching in their residency program as "excellent," 37 (36.3%) did not enjoy performing clinical ophthalmologic examinations on children, 83 (81.4%) had a clinical role model in pediatric ophthalmology, 29 (28.4%) believed pediatric ophthalmology is a prestigious subspecialty, 47 (46.1%) reported that economic factors influenced their post-residency decisions, 60 (58.8%) believed a hybrid fellowship combining adult cataract surgery and pediatric ophthalmology would be a popular fellowship, and 58 (56.9%) had a first-year (PGY-2) residency rotation of at least 1 month in pediatric ophthalmology. Enjoying the ophthalmologic examination of children most strongly predicted whether a resident would pursue a pediatric ophthalmology fellowship (Phi = 0.482). The desire to work with children overwhelmingly superseded other factors influencing a resident's decision to pursue a pediatric ophthalmology fellowship. Improving economic issues may be one of several factors that increase the attractiveness of the pediatric ophthalmology subspecialty. There is a dilemma in encouraging more residents to pursue pediatric ophthalmology in the setting of fewer technological advances consistent with lower perceived prestige. [J Pediatr Ophthalmol Strabismus. 2023;60(2):95-100.].

Mediating effects of ageism and knowledge on the relationship between contact with older adults and attitudes toward older adults' sexuality among nursing students

BackgroundHealthcare professionals often ignore sexuality in aging and avoid discussing related topics, especially in China. Nursing students, as future professionals, can address the sexuality of older adults encountered in clinical practice by establishing positive attitudes toward aging sexuality. Previous studies have demonstrated that contact has positive impacts on nursing students' attitudes toward aging sexuality. However, little is known about the mechanism underlying this relationship between contact and attitudes. ObjectivesTo explore the mediating effects of ageism and knowledge on the relationship between contact and nursing students' attitudes toward aging sexuality. DesignThis was a cross-sectional study. SettingsThe study was conducted at a nursing school in Hefei city, China. Participants and methods614 nursing students completed online-administered questionnaires measuring the level of contact with older adults, ageism, knowledge, and attitudes toward aging sexuality. Data were analyzed using SPSS and AMOS. ResultsThe mean scores for knowledge and attitudes toward aging sexuality were 85.70 (SD = 16.39) and 104.91 (SD = 14.88), respectively. Overall, our findings confirmed that these hypotheses were accepted. Ageism (β = −0.079, P = 0.007) and knowledge (β = −0.070, P < 0.001) mediated the relationship between contact and attitude. ConclusionGiven the mediating role of ageism and knowledge in the relationship between contact and attitude, reducing ageism and enhancing knowledge are vital to changing students' attitudes, including integrating ageism and aging sexuality knowledge learning into the nursing curriculum and creating opportunities for contact with older adults. The frequency and quality of contact between nursing students and older adults can be improved by rationalizing the internship duration, tasks, and assessment objectives of placements on geriatric wards and by the role of clinical faculty role models in cultivating positive attitudes toward aging sexuality.

Outstanding qualities of a successful role model in medical education: Students and professors' points of view.

IntroductionRole models play a crucial role in determining the professional development of medical trainees. The purpose of this study was to gain in-depth understanding of the outstanding qualities of successful role models.Material and methodsIn this qualitative-descriptive study, data were collected through conducting interviews, and the inductive content analysis was performed. The study was done at the school of medicine of Tehran University of Medical Sciences in Iran. Twenty-five medical students, medical graduates, and faculty members participated in 25 interviews from April to December 2019. The participants were recruited via purposive sampling.Resultsfive categories and 13 subcategories were extracted from the data. The results of this study illustrated five crucial qualities of a good clinical role model including an excellent character, effective coach and mentor, inspiring medical leader, expert clinical teacher, and a professional physician. Our results also highlighted the lasting effects of positive role modeling of clinical teachers on medical trainees' professional careers. Another category in the present study was connected to future consequences of being a role model in a clinical setting.ConclusionThe result of this study illustrated crucial qualities of a good medical role model. This result can assist the leaders to engage with medical educators to better understand the process of role modeling and design the best plan for development of role modeling in medical education.

Now showing: The presentation. Using video recording to enhance Balint leadership training.

Review of video recorded sessions is a powerful teaching tool in medical education, helping students appreciate both spoken and unspoken communications not fully appreciated in the moment. For many years, the American Balint Society has used video review in its Leadership Training Intensive courses, however technical challenges around setting up and operating the equipment have led some faculty to question whether the benefits are worth the effort and anxiety. We describe here an approach to video review in Intensives with a focus on the case presentation. Close attention to the case presentation can uncover important clues about a presenter's feelings and conflicts in a case, clues that may easily be missed on first pass. The Balint group leader listens for clues and cues to the patient's state of mind, and how the clinician is being distracted or deflected from their authentic role. Focusing the video review at an Intensive on the case presentation highlights for novice leaders the importance of maintaining keen focus on this initial section of the Balint group process for information on "what this case is about." Finally, we predict that Balint group leaders who emerge from an Intensive with this new appreciation for close listening to the presentation will not only be more effective Balint group leaders but will also be in a better position to serve as clinical role models, teaching by example to their Balint group members the importance of attending closely to the patient's communications in the patient - clinician encounter.

Evaluation of post-simulation sonographer students' professional behaviour in the workplace

IntroductionIn Australia, sonographer's professional identity is traditionally ‘caught’ from clinical role models. A four-year undergraduate-postgraduate course introduced professional identity education, with simulated practice, to prepare novice sonographer students prior to clinical practice. Preclinical students learnt sonographer professional behaviour, and humanistic attributes, during simulation designed with volunteer peers as standardised patients, educator role-models, immediate feedback, self-reflection, and longitudinal multi-observer assessment. This paper reports on the transfer of learnt professional behaviour and humanistic attributes to clinical practice. MethodsProfessional behaviour evaluations completed by 94 clinical assessors described 174 students' professional behaviour and attributes one month into their initial clinical practice (2015-6). Student performance of each behaviour, and behavioural category, was quantitatively analysed by modelling binomial proportions with logistic regression. ResultsStudents demonstrated substantial learning transfer to clinical practice, achieving an overall mean score of ‘consistent’ sonographer professional behaviour and humanistic attributes (mean score of equal to or >3/4), one month into clinical practice. Professional behaviours varied in transferability, with ‘response to patient's questions' showing least efficacy (P < 0.05). Increased deliberate practice with educator role-models improved transfer efficacy significantly (P < 0.001). ConclusionPreclinical application of theory to simulated practice, using standardised patients, educator role-models, immediate feedback, and multi-observer assessment, facilitated substantial transfer of sonographer professional behaviour and attributes to clinical practice. The efficacy of transfer varied but improved with increased deliberate practice and feedback. Implications for practiceThe incorporation of preclinical professional behaviour education with simulated practice into the core curriculum of sonographer courses is recommended for the formation of sonographer professional identity, improved clinical outcomes and increased patient safety during the early stages of ultrasound education.

Generating Recommendations for Medical Curricula to Reduce Stigma Towards Psychiatry From Medical Students

AimsIn 2021, we completed a project entitled: ‘Stigma Towards Psychiatry: Correlating Personal Experience with Existing Literature’ – ‘International Congress Award Winning’. We aim to use the themes generated from this to inform recommendations to medical educators to reduce stigma in their curricula towards psychiatry.MethodsUsing previously identified themes, we generated a set of recommendations aimed at the pre-admission, pre-clinical and clinical phases of learning. Pre-admission themes include: misconceptions of the role of the psychiatrist and disinterested medical applicants. Pre-clinical themes include: dissociation of psychiatry from medicine and clinical role modelling. Our final category, clinical, includes: cross-speciality support for psychiatry, pathophysiology in de-stigmatisation of psychiatric disease, discrimination of the aspiring psychiatrist, psychiatric exposure in training not seeing conversion of students to psychiatrists and the role of unofficial mentors in continuing enthusiasm for the speciality. Division in this way gave us multiple opportunities to look for areas of potential intervention in influencing medical student's views on psychiatry. Further influencing our recommendations was the feedback from a group of consultant psychiatrists this project was presented to.ResultsAddressing the themes driving stigma from the previous project saw us producing a list of recommendations targeted at each phase of medical school. (1) Pre-admission stage: selecting candidates who are more psychologically minded by recognition of A level psychology as a core subject; encouraging people with experience in mental health settings to apply for medical training (Srivastava et al, 2018); highlighting psychiatry as a medical career in the prospectus. (2) Pre-clinical stage: making students aware of their unconscious stigma towards psychiatry; clearer links made to psychiatry in early medical school to relevant biochemistry, anatomy, physiology and pharmacology (Mahli et al, 2003); tutor / doctor led psychiatry based extracurricular groups; highlighting mental health aspects of functional neurological disorders and disorders within rheumatology such as fibromyalgia. (3) Clinical stage: making clinicians aware of their unconscious stigma towards psychiatry; encouraging cross-speciality support for psychiatry; improving contact with psychiatrists on mental health placements (Archdall et al, 2013).ConclusionStigma towards psychiatry extends from medical school and into clinical practice. It feels important that medical school curricula should be altered in order to change students’ experience of psychiatry within medical school. The recommendations target each stage the themes were identified within. Our local medical school has agreed to let us present this at their curriculum meeting which may pave the way for further refinement and implementation of our suggestions.

Moral Elevation, Physician Role Models, and Selected Markers of Professional Identity Formation and Well-Being: A Secondary Analysis from Two National Surveys.

Moral elevation is the underlying emotion that arises when witnessing admirable acts, and it is theorized to be the psychological mechanism driving the impact that positive clinical role models have on medical students' professional identity formation (eg, growth in professional virtues, higher sense of meaning, and well-being). This proof-of-concept study explores the development of the Moral Elevation Scale in Medicine by testing the association of moral elevation with various markers of professional identity formation. A secondary data analysis of two nationally representative samples of 960 medical students and 2000 physicians was performed. Respondents completed validated measures of moral elevation as well as markers of professional identity formation, including patient-centered virtues (empathic compassion, interpersonal generosity, mindfulness) and measures of well-being (life meaning, life satisfaction, spirituality, burnout). The study obtained adjusted response rates of 56.2% (1047/1863, physician survey) and 48.7% (448/919, student survey). The national estimates for mean moral elevation in medical students and physicians are 4.34/5.00 and 4.22/5.00, respectively. In medical students and physicians, high moral elevation was associated with higher empathic compassion (student odds ratio [OR] 1.30, 95% confidence interval [CI] 1.02-1.67; physician OR 1.22, 95% CI 1.23-1.65) and, similarly, generosity. In addition, higher moral elevation in the physician cohort was associated with greater life meaning (OR 2.03, 95% CI 1.25-3.32) and similarly spirituality. In medical students and practicing physicians, self-reported experiences of high moral elevation with physician role models were associated with higher self-reported measures of patient-centered virtues, spirituality, and life meaning. Our Moral Elevation Scale in Medicine demonstrates preliminary promise as a measure to assess environmental precursors needed for virtue development in professional identity formation, but further reliability and validity testing of this measure is needed.

An investigation into nursing students' application of infection prevention and control precautions

BackgroundUndergraduate education of Health Care Workers is pivotal to ensuring that frontline clinicians have appropriate knowledge and skills in Infection Prevention and Control (IPC). ObjectivesThe aim of this study was to describe undergraduate nursing students' self-reported compliance with Standard Precautions and to explore the psychosocial factors that influence adherence in clinical practice. DesignA cross-sectional survey design was used. SettingThe study was conducted in the School of Nursing and Midwifery at an Australian University. ParticipantsAll undergraduate nursing students were invited to participate in an online survey; 321 participated, mean age 25.7 years (SD = 8.4). The majority, 196 (61%), had no healthcare work experience, 54 (17%) were patient-care assistants, 40 (13%) enrolled nurses, and 31 (9%) were nurses registered overseas. MethodsTwo validated instruments were used: the Compliance with Standard Precautions Scale (CSPS) and the Factors Influencing Adherence to Standard Precautions Scale– Student version (FIASPS-SV). Linear regression was used to measure the impact of psychosocial factors on self-reported compliance. ResultsOverall self-reported compliance with prevention of cross-infection was 83%, use of Personal Protective Equipment (81%), correct disposal of sharps (83%) and general waste (75%), and equipment decontamination (69%). The predominant factors endorsed on the FIASPS-SV were ‘Leadership’ (M = 15.21 SD = 5.28) and ‘Contextual cues’ (M = 19.09 SD = 6.37). Multivariate linear regression demonstrated that after adjusting for age, gender and years of nursing study, the Leadership factor predicted participants' self-reported compliance on the ‘prevention of cross-infection’ (p < .001), ‘use of PPE’ (p < .001), ‘waste disposal’ (p = .021), and ‘decontamination of equipment’ (p < .001) sub-domains of the CSPS. ConclusionsThese findings highlight that strong clinical leadership and role modelling are essential to ensure all healthcare students prioritise rigorous adherence with infection prevention and control guidelines.

Truly, there is no such thing as a bad teacher.

I can vividly recall one day during my first months of working as a new doctor in an Emergency Department (ED) when I admitted a stable patient presenting urticaria without informing the attending dermatologist. A day afterwards, the dermatologist came to the ED and yelled at me in front of the staff and patients because I did not inform her about the admission. She even literally pointed her finger to me. I felt nothing but anger, deep pain and shame. Following that humiliating event, I promised myself that I would never raise my voice toward my colleagues, even the younger ones, in public. If someday I broke that promise, I would be genuinely disappointed with myself. My negative memories of the experience have not gone away despite the millions of acts of goodness I have experienced since then.

A longitudinal, narrative study of professional socialisation among health students.

Interprofessional collaboration (IPC) among health professionals is well-recognised to enhance care delivery and patient outcomes. Emerging evidence suggests that the early socialisation of students in health professional programmes to teamwork may have a positive impact on their future as collaborative practitioners. With a purpose of contributing to growing evidence on the processes of professional identity construction, and to explore how early expectations and perceptions of IPC develop during professional socialisation and pre-licensure education, our study examined the early professional socialisation experiences among five groups of health professional students. A qualitative, narrative approach was used to examine early professional socialisation among five programmes of health professional students (dentistry, medicine, nursing, pharmacy, physiotherapy) at an Atlantic Canadian University. In March and October 2016, students participated in interviews after first term (n=44) and first year of study (n=39). Interviews focused on participants' professional identify formation, as well as their perceptions and experiences of IPC. The authors analysed interview transcripts using narrative analysis. Findings identify that despite the espoused importance of IPC within health professional training, students have a limited understanding of their professional roles and are largely focused on developing a uniprofessional, vs. interprofessional identity. Clinical experiences, role models and exposure to teamwork are critical to contextualise collaborative practice and enhance the development of an interprofessional identity. Findings can be used to guide the development of curricula that promote interprofessional identity development and IPC during early professional socialisation.

An evaluation of civilian and military dental foundation training.

Background and aim There is little available material relating to the quality of continuing professional development for dental professionals and no studies to investigate whether dental foundation training (DFT) is meeting its aims and objectives. This study aimed to evaluate the components of DFT within the military and Oxford deaneries from the perspective of the educational supervisors (ESs) and foundation trainees (FTs).Method Questionnaires were sent to all 124 FTs and ESs involved in DFT in the Oxfordshire and military deaneries between 2012 to 2015. Following thematic analysis of the free text from the questionnaires, an interview guide was produced which mapped the main themes for a series of semi-structured interviews.Results Sixty-six questionnaires were returned (53% response rate) from 18 military and 3 Oxford ESs (21), and 30 military and 15 Oxford FTs (45). Eighteen interviews were carried out (6 ES/12 FT). The questionnaires highlighted the educational benefit of workplace-based assessments, joint clinical sessions and the importance of an ES as a positive role model, while the interviews highlighted the facilitative benefit of effective supervision, timely feedback, practice-wide teamwork, appropriate assessments and formal/informal peer review.Conclusions This study demonstrates the benefit of creating an optimal learning environment for DFT within the context of professional and ethical organisational support and appropriate clinical resources. ESs have a critical part to play as professional and clinical role models, and in ensuring an accountable and formal educational delivery, targeted learning goals, flexible delivery and timely feedback.

Keck School of Medicine of the University of Southern California.

Keck School of Medicine of the University of Southern California.