Clinical Sessions Research Articles

More than three times as many Indigenous Australian clients at risk from drinking could be supported if clinicians used AUDIT-C instead of unstructured assessments

BackgroundAboriginal and Torres Strait Islander (‘Indigenous’) Australians experience a greater burden of disease from alcohol consumption than non-Indigenous peoples. Brief interventions can help people reduce their consumption, but people drinking at risky levels must first be detected. Valid screening tools (e.g., AUDIT-C) can help clinicians identify at-risk individuals, but clinicians also make unstructured assessments. We aimed to determine how frequently clinicians make unstructured risk assessments and use AUDIT-C with Indigenous Australian clients. We also aimed to determine the accuracy of unstructured drinking risk assessments relative to AUDIT-C screening. Finally, we aimed to explore whether client demographics influence unstructured drinking risk assessments.MethodsWe performed cross-sectional analysis of a large clinical dataset provided by 22 Aboriginal Community Controlled Health Services in Australia. We examined instances where clients were screened with unstructured assessments and with AUDIT-C within the same two-monthly period. This aggregated data included 9884 observations. We compared the accuracy of unstructured risk assessments against AUDIT-C using multi-level sensitivity and specificity analysis. We used multi-level logistic regression to identify demographic factors that predict risk status in unstructured assessments while controlling for AUDIT-C score.ResultsThe primary variables were AUDIT-C score and unstructured drinking risk assessment; demographic covariates were client age and gender, and service remoteness. Clinicians made unstructured drinking risk assessments more frequently than they used AUDIT-C (17.11% and 10.85% of clinical sessions respectively). Where both measures were recorded within the same two-month period, AUDIT-C classified more clients as at risk from alcohol consumption than unstructured assessments. When using unstructured assessments, clinicians only identified approximately one third of clients drinking at risky levels based on their AUDIT-C score (sensitivity = 33.59% [95% CI 22.03, 47.52], specificity = 99.35% [95% CI 98.74, 99.67]). Controlling for AUDIT-C results and demographics (gender and service remoteness), clinicians using unstructured drinking risk assessments were more likely to classify older clients as being at risk from alcohol consumption than younger clients.ConclusionsEvidence-based screening tools like AUDIT-C can help clinicians ensure that Indigenous Australian clients (and their families and communities) who are at risk from alcohol consumption are better detected and supported.

The Effectiveness of Simulation in Education 4.0: Application in a Transesophageal Echocardiography Training Program in Malaysia.

IntroductionA Malaysian Higher Education Provider has applied technology as part of its pedagogical approach, in alignment with Education 4. 0. The use of simulation, which aligns with the principles of Education 4.0, employs digital technologies and supports learning by bridging the classroom and the clinical areas. We reported the effectiveness of learning in our program that utilizes multimodal pedagogy, including interactive lectures, pre-recorded video lectures, simulation, and hands-on supervised clinical sessions, using the program's cumulative assessment data.MethodologyThis program evaluation was based on Kirkpatrick's framework. End-points for learning (Kirkpatrick level 2) were analyzed based on improved overall post-test theoretical and clinical assessment performance. Quantitative data analysis of theoretical pre-test, theoretical post-test, clinical assessment, and post-test scores was performed to compare cohorts.ResultsThe performance of 19 trainees, over six cohorts from 2012 to 2019, were analyzed. All our trainees had equal opportunities to learn using the multimodal pedagogy, including a simulator. The analysis of pre- and post-theoretical test scores showed a significant improvement in the mean scores (pre-test 48.7% (± SD 9), post-test 64.1% (± SD11.5); p ≤ 0.001). Overall, 19 out of 21 trainees completed the clinical assessment and case presentation satisfactorilyConclusionThe Kirkpatrick framework served as a useful framework to perform the evaluation of the TEE program. The significant improvement in post-test scores, when compared with pre-test scores, suggested that the program is effective with regard to learning. As part of a multimodal pedagogy, simulation has proven to be an added value to our training program, and this was reflected by the improvement in the clinical assessment scores when compared to the pre-test scores. This result aligned with the concept of technology-enhanced learning in Education 4.0, where simulation in TEE training is applicable in the Malaysian context.

Evaluating the implementation and use of patient-reported outcome measures in a mental health hospital in Denmark: a qualitative study.

Reporting of barriers and successes associated with the implementation and use of patient-reported outcomes (PROs) is limited as a means to ensure enhanced patient involvement, shared decision-making and improved treatment and care. We set out to evaluate the implementation and use of the PRO-Psychiatry initiative on patient-reported outcome measures in Danish mental health care. We aimed to described four specific areas: the quality of the clinical consultations before and after the implementation of PRO-Psychiatry as perceived by the patients (objective A), the motivation for participating in PRO-Psychiatry as perceived by patients and clinicians (objective B), the implementation process as perceived by patients, clinicians and managers (objective C) and suggestions for improvement (objective D). The PRO-Psychiatry initiative was evaluated through a participatory approach, including patients, clinicians and managers. A repeated cross-sectional interview-based survey explored the quality of the clinical consultation before and after the implementation of PRO-Psychiatry. A three-step semi-structured group interview, inspired by the modified mini-Delphi method, was used to establish consensus on the evaluation of the implementation and use of the initiative. The evaluation pointed at PRO-Psychiatry as a meaningful initiative, which motivated patients and supported clinicians. The patients emphasised the importance of PROs, but they also found that PROs were not used enough. Clinically relevant improvements were detected after the implementation of the initiative; more patients felt heard and experienced that clinicians took a greater interest in their problems. The clinicians valued the easily accessible real-time graphical display of the PRO responses in the electronic health record (EHR). Clinicians and managers agreed that clinical PRO practices, patient compliance and use of PROs in treatment and care should be supported during implementation. The evaluation was overall positive. Patients and clinicians were willing to participate, found the online reporting easy and valued the direct access to PRO responses in the EHR. An essential feature was the integration of well-defined and functional PRO practices into the existing clinical workflow. Using PROs in the clinical sessions in a way that was palpable to the patient was found to be a significant improvement need. At the individual level, PRO-Psychiatry can use patient outcome information to support dialogue, encourage shared decision-making and promote self-management during recovery. At the aggregated patient level, the PROs can be used for monitoring the patient-perceived quality of care and for research.

Clinical- and cost-effectiveness of a technology-supported and solution-focused intervention (DIALOG+) in treatment of patients with chronic depression\u2014study protocol for a multi-site, cluster randomised controlled trial [TACK

BackgroundMany with an acute depressive disorder go on to develop chronic depression, despite ongoing care. There are few specifically designed interventions to treat chronic depression. DIALOG+, a technology-assisted intervention based on the principles of solution-focused therapy, may be beneficial. It has been shown to be effective as a treatment for patients with psychotic disorders, especially in regards to increasing quality of life. DIALOG+ was designed to be flexibly applied and not diagnosis-specific, aiming to structure communication and generate a personally-tailored care plan. This cluster randomised controlled trial (RCT) is part of a programme of research to adapt and test DIALOG+ for patients with chronic depression.MethodsPatients will be eligible for the trial, if they have exhibited symptoms of depression or non-psychotic low mood for at least 2 years, have regular contact with a clinician and have a low subjective quality of life and moderate depressive symptoms. Clinicians, who routinely see eligible patients, will be recruited from a number of sites across NHS England. Clusters will have between 1 and 6 patients per clinician and will be randomised in a 1:1 ratio to either the intervention (DIALOG+) or active control group (treatment as usual + DIALOG scale). Clinicians in the intervention group are trained and asked to deliver the intervention regularly for 12 months. Active control participants receive treatment as usual and are asked to rate their satisfaction with areas of life and treatment on the DIALOG scale at the end of the clinical session. Approximately 112 clinician clusters will be recruited to reach a total patient sample size of 376. Clinical and social outcomes including costs are assessed at baseline and 3, 6 and 12 months post randomisation. The primary outcome will be subjective quality of life at 12 months.DiscussionThis definitive multi-site, cluster RCT aims to evaluate the clinical- and cost-effectiveness of DIALOG+ for people with chronic depression. If shown to be effective for this patient population it could be used to improve outcomes of mental health care on a larger scale, ensuring that patients with complex and co-morbid diagnoses can benefit.Trial registrationISRCTN11301686. Registered on 13 Jun 2019.

Top tips for teaching during a pandemic: reflections on teaching ophthalmology

As clinical teaching fellows, we have had the privilege to teach medical students between August 2020 to August 2021. In a usual year, this would involve exclusively face-to-face teaching for both lectures and clinical examination sessions. However, following the announcement of the second lockdown in October 2020 we had to adapt our programme. To reduce the number of students on site, one day a week became a ‘virtual learning day’, involving both small and large group tutorials. Following being tasked with the responsibility of teaching ophthalmology to the fourth-year medical students, an important question loomed: how can we ensure that teaching via a virtual learning platform is both engaging and beneficial? This was further compounded by the fact that ophthalmology is a sub-speciality in which most medical students have limited teaching in the UK . Following our experiences, we have outlined the key strategies which enabled us to teach effectively during the pandemic.

Sharing of Teleconsultation Experience with Spinal Cord Injury Patients

Background and aim: Teleconsultation (TC) is a new medical service provided remotely via communication technology. In Klinik Pakar Spinal (KPS), Hospital Rehabilitasi Cheras (HRC), TC is offered to follow up patients who are supposed to come for physical clinic consultation since January 2021 because of the COVID-19 pandemic and movement control order (MCO). Those interested will be scheduled for either virtual clinic (VC) sessions via Google Meet or telephone consultation. Methods: TC was planned since 2020 with two workshops conducted in HRC to decide on the policy and workflow for the TC service. In January 2021, the first VC was done in KPS, and patients were selected among stable, follow-up cases. The patient must have a valid email address and own a device with a suitable VC platform. The setting up of the VC in KPS is done in a room equipped with a webcam, speakers, and a stable intranet. Patients will be scheduled for their VC sessions via Google Meet the day before, and an invitation will be sent via email, while telephone consultations will be arranged accordingly and conducted on the scheduled day and time. After teleconsultation, the clinical input will be documented in the patient’s case note. In KPS, 18.24% of spinal cord injury patients were agreeable for TC. Results: The benefits of TC include patients not having to travel and being followed up safely at their homes. It also reduces the crowding of patients in the clinic. Therefore, reduce the risk of transmission of COVID-19. TC is also useful for those patients who have the anxiety to attend appointments physically due to the pandemic. However, TC’s limitations include lack of human touch and inability to perform the physical examination on patients, communication difficulties, and IT failure. Conclusion: Teleconsultation is a beneficial service that needs further exploring and promoting access to rehabilitation care for many people throughout the COVID-19 pandemic.

Clinical communication in orthodontics: Any questions?

To measure patient-perceived standards of clinician communication and identify elements of deficient performance. Good communication can improve the quality of care, patient satisfaction and compliance with treatment. Cross-sectional questionnaire service evaluation. Two university dental hospital orthodontic departments. Any patients aged 10 years and over attending the orthodontic department for treatment or consultation were eligible for inclusion. Patients who required third-party translation services were excluded. Clinicians provided the modified 15-item Communication Assessment Tool (CAT) to up to five patients in a clinical session. A front sheet for clinician characteristics was used and anonymised with a unique identifier. Univariable logistic GEE models examined associations among responses and clinician characteristics. There were 55 clinicians with 204 patient responses. The overall percentage of '5=excellent' ratings was 88% (SD 0.16). The lowest scoring item was 'encouraged me to ask questions' (55.8%). Based on clinician characteristics, there were lower odds of an excellent response for certain CAT items. There were higher odds of an excellent response if English was not the clinician's first language (1.05; 95% confidence interval = 1.00-1.09; P=0.03). There is a high standard of patient-clinician communication in the hospital orthodontic setting. Key areas of communication that require attention include encouraging patients to ask questions, talking in terms they can understand, recognising their main concerns and involving them in the decision-making process. The results of this study can be used to inform communication skills training and be replicated in similar dental settings (primary and secondary care) as part of quality improvement.

Novel Approach to Improving Confidence in Providing Sexual and Reproductive Healthcare to Adolescents for Pediatric Residents: A Pilot Study

Background: A recent study showed that about only 1/5 of recent graduates feel well trained to care for adolescent patients. There is an insufficient amount of data assessing the confidence of pediatric residents in providing sexual and reproductive healthcare (SRH) services to adolescents. We aimed to assess pediatric residents’ confidence in providing SRH education and services to adolescent patients before and after participating in clinic sessions in a Pediatric Adolescent Gynecology (PAG) Clinic.

Rhetorical moves and genre development analysis of hard science field abstracts

Non-native English scholars are expected to publish international journals with abstracts written in English. There are a lot of factors that caused the rejection of journal article publication; one of them is disorganized writing styles. Compared to the native English speakers, the issues regarding disorganized writing styles appeared more in the non-native English speakers’ research article since they have different writing styles, cultures, and mother tongues. Abstract Coaching Clinic Workshop was held for Indonesian University of Education (UPI) scholars so that it is hoped that there would be an increase in the quality of composing research article abstracts and an increase in the number of international publications from scholars. The purpose of this research is to uncover rhetorical moves and genre of the abstracts, its genre development, as well as the linguistics features used in the abstracts. Thirty abstracts made by fifteen UPI scholars who were also the participants of the Abstract Coaching Clinic Workshop were collected as the data for the analysis. Hyland’s (2000) theory was used to analyze each move and step of the abstracts. The results show the occurrence frequency of each move and step, along with the linguistic features used by the academicians; and the development of their abstract writing from before and after the coaching clinic session. The findings serve as a potential reference for those researchers that are concerned in discourse analysis, cross-cultural abstracts, and research publication needs.

THE INVESTIGATION OF THE PATIENTS WHO APPLY WITH THE CAUSE OF CHRONIC LOW BACK PAIN TO THE CHIROPRACTIC CLINIC

In this cross-sectional study, it was planned to examine the relationship between age, gender, daily life activity habits, clinical examination findings and treatment sessions number of the patients with chronic low back pain who applied for chiropractic treatment. After examination of the patient files, who were treated at Private Clinic between January 2010 and December 2017, 408 patients’ data were accepted into study. Patients; demographic characteristics, physical examination findings and imaging results were examined. Age, gender, sedentary time (sitting), activity level, stress level, pain duration, spinal dysfunction segments and treatment number were included. Patients’ mean age was 43.1 ± 12.6 years, 205 were male (50.2%) and 203 (49.8%) were female. When the total number of received treatment sessions were examined, the average for all patients was 3.5±2.9. The number of treatments were significantly higher in the groups with pain duration of 6-10 years and 11 years and above, compared to the group with 0-5 years of pain (p = 0.009). There was a significant difference between the patients' pain duration and number of treatment sessions. However, there was no significant difference in age, gender, daily life activity habits, clinical examination findings and number of treatment sessions in our study.

Implementation of a New Clinical Testing Tool to Assess Patients During Ictal and Postictal Periods.

BACKGROUND: A seizure is a sudden, uncontrolled electrical disturbance of the cortical neurons in the brain, which can cause changes in behavior, movements, feelings, and consciousness. Clinical signs and symptoms before, during, and after a seizure can help to determine the seizure onset. The use of standardized clinical testing tools has been reported as being valuable, although also challenging, by some institutions. This study investigated the effectiveness of implementing a new clinical testing tool designed with an emphasis on simplicity for use during and after seizures. METHODS: A pre-and-post evaluation study was conducted from January 2020 to November 2020 in the epilepsy monitoring unit/neurology unit at a hospital in Sydney, Australia. The primary outcome of interest was the incidence of clinical testing during seizures. The secondary outcome of interest was nurse knowledge about clinical testing during a seizure. This knowledge was measured via testing before and after clinical education sessions. The third outcome of interest was nurse confidence regarding the use of the clinical testing tool. The confidence level was measured via posteducation session follow-up surveying. RESULTS: Forty-seven nursing staff (10 neurophysiology nurse technologists and 37 neurology unit nurses) participated in the education program. Forty-four seizures were evaluated. Clinical testing during ictal and postictal periods was performed by nursing staff 82% of the time during 2020, compared with 67% during the 2018 to 2019 preeducation comparison period. This difference was not statistically significant, but it was clinically relevant (P = .07). In addition, the time from seizure alarm to clinical testing improved significantly from a median of 30.5 seconds in 2018 to 2019 to 14 seconds in 2020 (P < .001). CONCLUSION: The tool is easy and convenient for nursing staff to perform clinical examinations accurately during ictal and postictal periods.

Collaborative-Dialogic Practices in a Single-Session Therapy Format: A Clinical Example in an EAP

This article describes a way in which collaborative-dialogic practices in a single-session therapy format can be used as a therapeutic framework to design an employee assistance program (EAP) within an organization. The theoretical section will discuss some of the principles of single-session therapy (SST) and collaborative-dialogic practices (CDP) that inform the development of this therapeutic practice. The description of an EAP in a construction company in Mexico City will illustrate the service delivery. A clinical session and a theoretical discussion will serve as an example of this practice.

267 Improving the Surgical Teaching Opportunities: A QI Project to Deliver a Course at a Local Hospital Level During COVID-19 Pandemic

Abstract Aim During the COVID-19 pandemic, the training opportunities were markedly disrupted particularly, the surgical teaching which usually requires face to face teaching to help the acquisition of procedural skills. We implemented a QI project in a district hospital to improve the training opportunities for medical students &amp; foundation doctors. The project was a face-to-face free course for teaching generic procedural and clinical skills in surgery. Method The course was a mixture of two well-known surgical courses in the UK, Basic Surgical Skills and the CCrISP courses. It included clinical and procedural skills sessions on models which simulated the basic wound closure techniques and types of knots, as well as skin lesion excision training. The course was delivered to medical students, foundation year one &amp; two doctors and core surgical trainees. The improvement achieved by the course was measured by a questionnaire assessing the level of confidence between the candidates before and after each session. The questionnaire’s answers were categorised into (not confident, neutral, confident &amp; very confident). The course was delivered on two occasions. Results The qualitative analysis of the results on two different occasions showed a considerable improvement in the level of confidence between the candidates. They were able to demonstrate engagement throughout the course especially with the procedural skills sessions. Conclusions Formulating a course at a local hospital level was an efficient alternative for maximising the training opportunities reduced during the pandemic. It was an impressive opportunity for newly graduated doctors and medical students having any surgical placement.

A Central Nervous System Focused Treatment Program for People with Frozen Shoulder: A Feasibility Study.

Background: Frozen shoulder (FS) is a highly disabling pathology of poorly understood etiology, which is characterized by the presence of intense pain and progressive loss of range of motion (ROM). The aim of this study is to evaluate the feasibility and clinical impact of a CNS-focused treatment program for people with FS. Methods: 10 subjects with primary FS received a 10-week CNS-focused intervention including sensory discrimination training and graded motor imagery techniques delivered as clinic sessions (60 min) and home therapy (30 min five times per week). Measurements were taken at baseline, after a 2-week “washout” period, after treatment, and at three months follow-up. The Shoulder Pain and Disability Index (SPADI) was the primary outcome. Secondary measures were feasibility-related outcomes, self-reported shoulder pain, active and passive range of motion, two-point discrimination threshold (TPDT), left/right judgement task (LRJT), fear-avoidance (Tampa Scale for Kinesiophobia), pain catastrophization (Pain Catastrophizing Scale), and pain sensitization (Central Sensitization Inventory). A Student’s t-test was used to assess the “washout” period. A repeated measure analysis of variance (ANOVA) was used to evaluate within-subjects’ differences for all outcome measures in the different assessment periods and a pairwise analysis was used to compare between the different assessment points. Statistical significance was set at p < 0.05. Results: 70% of participants completed the treatment. No significant changes were found after “washout” period except for TPDT (p = 0.02) and SPADI (p = 0.025). Improvements in self-reported shoulder pain (p = 0.028) and active shoulder flexion (p = 0.016) were shown after treatment (p = 0.028) and follow-up (p = 0.001) and in SPADI at follow-up (p = 0.008). No significant changes were observed in TPDT, LRJT, fear-avoidance, pain catastrophization, and pain sensitization. Conclusions: a CNS-focused treatment program might be a suitable approach to improve pain and disability in FS, but further research is needed to draw firm conclusions.

Dental student oral surgery training-Comparing the impact of COVID-19 and cohort sizes.

The response to the COVID-19 pandemic potentially reduced the clinical experience and academic education of dental trainees through reduced supervised clinical sessions. Graduating dental students, future employers and regulators may be concerned over the level of clinical experience of graduates trained within the COVID-19 pandemic. The purpose of this study was to try and document the evidence for, and significance of, this impact. From dental student data in the 2017, 2018, 2019 and 2020 cohorts attending the University of Sydney, Australia, the number of dental extractions and adjunct oral surgery procedures, as well as final end-of-year examination results, was recorded. Results were compared to determine whether differences in experience and final academic achievement existed between these cohorts. The smallest student cohort, 2017, demonstrated greater clinical experience than the 2018, 2019 and 2020 cohorts. The 2020 COVID-19-affected cohort demonstrated no statistically significant reduction in clinical experience in all measured clinical procedures when compared to the 2018 and 2019 cohorts. The decrease in city teaching hospital clinical experience was compensated by an increase in rural placements. The 2020 cohort achieved the lowest academic results, and this was statistically significant. The oral surgery clinical experience of the 2020 dental cohort at the University of Sydney was comparable to prior cohorts. Rural clinics were able to compensate for COVID-19 interruptions to clinical training. The number of students in a cohort, if all other variables remain constant, appeared to affect clinical exposure to a greater extent than COVID-19.

Necesidades formativas y de investigación en hipotiroidismo de los médicos de atención primaria de la Comunidad de Madrid

ObjectiveTo document the opinion of primary care physicians on hypothyroidism and explore their educational and research needs. MethodsA web-based survey was released through Healthcare Management offices in Madrid to be answered anonymously by the doctors at the health centers. ResultsFive hundred and forty-six out of 3897 (14%) physicians completed the survey. More than 90% of respondents agreed that hypothyroidism is a common and easily managed health problem and that its poor control increases healthcare costs. This percentage was higher in older doctors and those with longer professional experience. 88.1% of respondents showed interest in educational activities (86.6% in receiving and 20.9% in providing education). The preference for clinical sessions in the health center (71.5%) exceeded that of sessions in the hospital (20.2%), while the preference for online courses (67.8%) exceeded that of face-to-face courses (50.9%). 53.5% of interviewees expressed interest in research on hypothyroidism. Women and professionals with a higher number of hypothyroid patients under their care were more likely to be interested in educational and research activities. ConclusionPrimary care physicians in the Community of Madrid are aware of the health problem posed by thyroid hormone deficiency and are clearly in favor of participating in educational and research activities in this area of knowledge.

Senior triaging of ENT emergency clinic referrals alleviates pressures on the outpatient department.

The ear, nose and throat (ENT) emergency clinic is managed by foundation year (FY) doctors from taking referrals to discharging patients, under the supervision of a registrar. FYs learn essential skills and knowledge on how to manage common ENT problems. The clinic is often overloaded because of a high patient demand, and this limits the opportunities for teaching. We hypothesised that the clinic bookings would be better managed if referrals from general practitioners (GPs) were triaged by registrars. Telephone referrals from GPs for the ENT emergency clinic were directed to the on-call ENT registrar, between 8am and 1pm from Monday to Friday, and to the FY outside of this period. Consecutive referrals to the emergency clinic were analysed in a baseline audit and a post-intervention cycle. A total of 646 and 611 patients were given clinic appointments in the first and second cycles, respectively. Clinic session overbookings decreased from 85% to 46.3%. Appointments for referrals that were deemed inappropriate had reduced from 22% to 12.1%. Involvement of a registrar in taking referrals for the ENT emergency clinic was associated with a reduction in clinic overbookings. It is feasible and productive to involve a senior decision maker in the operational management of the emergency clinic, while preserving the delivery of this service by FYs for its training value.

Senior triaging of ENT emergency clinic referrals alleviates pressures on the outpatient department.

The ear, nose and throat (ENT) emergency clinic is managed by foundation year (FY) doctors from taking referrals to discharging patients, under the supervision of a registrar. FYs learn essential skills and knowledge on how to manage common ENT problems. The clinic is often overloaded because of a high patient demand, and this limits the opportunities for teaching. We hypothesised that the clinic bookings would be better managed if referrals from general practitioners (GPs) were triaged by registrars. Telephone referrals from GPs for the ENT emergency clinic were directed to the on-call ENT registrar, between 8am and 1pm from Monday to Friday, and to the FY outside of this period. Consecutive referrals to the emergency clinic were analysed in a baseline audit and a post-intervention cycle. A total of 646 and 611 patients were given clinic appointments in the first and second cycles, respectively. Clinic session overbookings decreased from 85% to 46.3%. Appointments for referrals that were deemed inappropriate had reduced from 22% to 12.1%. Involvement of a registrar in taking referrals for the ENT emergency clinic was associated with a reduction in clinic overbookings. It is feasible and productive to involve a senior decision maker in the operational management of the emergency clinic, while preserving the delivery of this service by FYs for its training value.

Understanding the building blocks of the paediatric dentistry curriculum for undergraduate students in an Australian University

PurposeTo investigate the attitude of final-year dental students towards their paediatric dentistry training and their confidence in treating child patients.MethodsA 55-item questionnaire was distributed online and physically to the final-year BDSc (Hons) students at The University of Queensland (Australia). The questionnaire consisted of four parts including theoretical knowledge, clinical observational experience, preclinical training and clinical training in paediatric dentistry. Self-reported confidence was recorded using five-point Likert scale questions ranging from ‘not confident at all’ to ‘completely confident’, which were allocated the numbers 1–5, respectively. Jamovi and GraphPad Prism were used for data analysis and creation of graphs.ResultsA total of 47 students completed the questionnaire giving a response rate of 77%. Approximately two-thirds of participants had previous experience working with children and 70% had observed a practitioner providing paediatric dental treatment. The students reported the lowest level of clinical confidence for pulp therapy (M = 2.32; SD = 1.08). The clinical confidence in dental trauma management was also reported to be low (M = 2.50; SD = 1.15). The clinical administration of local anaesthetic (LA) had the highest level of confidence (M = 3.95; SD = 1.03). The students reported that they were highly confident in the theoretical knowledge of behaviour guidance techniques (M = 3.64; SD = 0.97) and preclinical training involving examination, treatment planning and preventative procedures (M = 4.33, SD = 0.67).ConclusionThis study showed that students reported low levels of confidence in pulp therapies and trauma management in children as compared to other aspects of paediatric dentistry. Students indicated the need for more preclinical and clinical training sessions, as well as more opportunities to perform a wider variety of treatments on paediatric patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40368-021-00688-1.

Student-run free clinic project: lessons in compassion, community, and courage

For 25 years, UC San Diego Student-Run Free Clinic Project has provided free high-quality care to underserved communities, while inspiring the next generation of health professionals. Free thorough ongoing care is provided in community settings to people who have nowhere to turn and do not qualify for access to care. The clinic philosophy has four tenets: empowerment - creating environments where patients take charge of their lives and achieve wellbeing, a humanistic approach - embodying Rogerian principles of empathy, respect, and self-awareness, a transdisciplinary model, one where the patient and community are the teacher. This philosophy permeates the life of the clinic. These values are taught, modeled, expected, and observed in curricular components throughout the four years of medical school. 250 medical, 75 pharmacy, and 100 predental students are involved each year as well as students in law, social work, and acupuncture. Students learn to be healers, artists, teachers as they become health professionals. At each clinic session student leaders gather the team in a large circle, and lead a sharing of recent stories and experiences reflecting the core tenets. All work is directly supervised by licensed clinicians, many of whom were once free clinic students. During the era of COVID, care became virtual. Promotors helped patients learn to use Zoom to receive care. Visit attendance increased to 100%. Our Spanish language empowerment group met online. The clinic already provided healthy food bags to patients at medical visits. Students and volunteers organized to deliver food and medication to people’s homes.