Clinical Students Research Articles

Role of Clinical Legal Education in Social Justice in Nigeria

Very few faculties of law in Nigerian universities that offer law programme have established law clinics that offer live-client services to the public as part of their legal education training. Across the border, clinical legal education is gaining more popularity by the day as a tool to imbibe the necessary skills in students to become sound legal practitioners. This article assesses the impact of law clinics on the skills of law students to enable them handle effectively the demands of the legal profession. The article analyses the correlation between law clinics that provide services to live clients and the skills acquired vis-à-vis the performance of student clinicians. The article recommends the need to integrate live-client law clinics into the mainstream legal education system in Nigeria.

Team Hearing

Team Hearing

Advances in medical education and practice: role of massive open online courses.

Massive open online courses (MOOCs) are increasingly available in the area of health and medicine. These MOOCs are offered through various commercial and noncommercial online platforms. When offered through reputable institutions, they can provide valuable access to reliable information without the constraints of time, geographical location, or level of education. Most current courses appear introductory in nature. In its drive for quality health care, the National Academy of Medicine has prioritized a focus on known chronic care conditions. Many of these conditions are shared internationally. Among its initiatives, the academy encourages consumer and professional groups, patients, clinicians, health care organizations, and universities to work together to identify evidence-based care processes consistent with best practices, organize major prevention programs to target key associated health risk behaviors, and develop systems to measure and evaluate improvements in the provision of patient- and family-centered health care. Carefully designed and collaboratively developed MOOCs would appear a valuable resource to contribute to these initiatives. Such MOOCs can, 1) increase the health literacy of the public with regard to the prevention and treatment of known chronic care conditions, 2) provide ready access to continuing professional, and interprofessional, education, and 3) explore innovative teaching models for student learning focused on patient- and family-centered care. MOOCs would also appear helpful to facilitate effective communication among international communities of patients and clinicians, including student clinicians, with shared interests. Further, the accumulation of MOOC data through large-scale measurement and analysis, obtained nationally and internationally, has the potential to assist in greater understanding of the risk for diseases and their prevention, with this translating into medical education, and authentic, patient- and family-centered methods for student learning. This paper explores these issues.

Nutrition Counseling by Medical Students at a Student-Run Free Clinic Using Goal-Setting and the MyPlate Method

Background: Lifestyle counseling in the primary care setting has been shown to have significant health outcome benefits for patients with chronic diseases like diabetes, obesity, and cardiovascular disease. General physicians often do not provide adequate lifestyle and nutrition counseling due to time constraints or lack of knowledge and training. In order to increase access to nutrition counseling in a low-resource setting and to increase physician comfort in counseling patients, we designed an intervention in which medical students conducted nutrition counseling using goal-setting and teaching MyPlate.Methods: This study was conducted at the East Harlem Health Outreach Partnership, a student-run, physician-supervised free clinic that serves uninsured adults. Student clinicians used a standardized script to provide nutrition counseling to patients, and patients’ pre- and post-intervention knowledge of MyPlate and nutrition goals were recorded. Results: Fifty-seven patients and 36 students participated in the intervention with a significant increase in patients’ knowledge of MyPlate and health goals. Conclusions: We posit that this simple intervention can be implemented in primary care clinics, especially those in which medical students rotate.

Experiential Learning to Advance Student Readiness for Level II Fieldwork

Occupational therapy (OT) students question their readiness for Level II fieldwork prior to their first placement. Many request more hands-on experiences with clients during their coursework, in preparation for the practice setting. As part of a two year Master of Occupational Therapy program, a fourth semester course was designed to address readiness for fieldwork and engage students in the OT process with actual volunteer clients. This course utilized the primary components of a clinical setting: client interaction, evaluation, intervention and outcomes review, clinical decision making, documentation, and communication, to promote student proficiencies as clinicians in preparation for fieldwork experiences. Weekly student reflections, survey data, and exit interviews identified that the experience was a highly valuable process that aided participants in their readiness to practice as student clinicians. This paper will describe the experiential learning course design, the learning methods used and the outcomes as identified by student perceptions of the impact on their learning and readiness for fieldwork.

The Effect of Real-Time Feedback Using a Smartwatch on the Clinical Behavior of Novice Student Clinicians

The use of computer monitors to provide technology-based written feedback during clinical sessions, referred to as “bug-in-the-eye” (BITi) feedback, recently emerged in the literature with preliminary evidence to support its effectiveness (Carmel, Villatte, Rosenthal, Chalker & Comtois, 2015; Weck et al., 2016). This investigation employed a single-subject, sequential A-B design with two participants to observe the effects of implementing BITi feedback using a smartwatch on the clinical behavior of student clinicians (SCs). Baseline and treatment data on the stimulus-response-consequence (S-R-C) contingency completion rates of SCs were collected using 10 minute segments of recorded therapy sessions. All participants were students enrolled in a clinical practicum experience in a communication disorders and sciences (CDS) program. A celeration line, descriptive statistics, and stability band were used to analyze the data by slope, trend, and variability. Results demonstrated a significant correlative relationship between BITi feedback with a smartwatch and an increase in positive clinical behaviors. Based on qualitative interviews and exit rating scales, SCs reported BITi feedback was noninvasive and minimally distracting. Preliminary evidence suggests BITi feedback with a smartwatch may be an effective tool for providing real-time clinical feedback.

Graduate Student Perceptions Regarding Common Speech-Language Pathology Supervisory Practices

The American Speech-Language-Hearing Association (ASHA) describes the supervisory process as a collaborative effort between both the student clinician and the certified supervisor. In order to support this process, it is important that both the supervisor and supervisee's preferences be considered regarding how these efforts will proceed. The purpose of this study was to investigate the opinions of graduate speech-language pathology clinicians regarding the supervision provided by on-campus clinical educators. Eighty-four graduate students completed an online survey. Results indicated that students generally preferred supervisory practices that simultaneously promote clinical independence while offering knowledge and support in a structured and timely manner.

The Impact of Cumulative Vocal Demands on Vocal Performance of Student Clinicians in Speech-Language Pathology

Effects of cumulative vocal demands on voice performance of student clinicians majoring in speech-language pathology were observed at three distinct points over the period of an academic semester. Acoustic and aerodynamic voice parameters were monitored in controlled and natural settings; participants also provided subjective information related to their voice usage. Comparisons of voice parameters in student clinicians repeatedly measured throughout an extended period of time did not lead to statistically significant differences. Self-reported data revealed a satisfactory level of knowledge and awareness regarding voice concerns in this population. These outcomes suggested consistent voice stability in this group, over the cycle of an academic semester.

University Practicum for Transgender Voice Modification: A Motor Learning Perspective

The student clinician who wishes to develop the clinical skill to work in the area of transgender voice modification requires a strong theoretical framework and a supportive relationship with the supervisor. Given the stresses that the trans individual and the novice clinician must cope with during the client's transition, a perspective that explains the cognitive demands and variation in motor behavior is of paramount importance. Motor learning theory emphasizes not only the necessity for repetition and practice during the acquisition of a new motor skill, but rationalizes the temporary instability as one modifies, stabilizes, and consolidates the sought-after vocal identity.

Memory and Cognitive Prevention Training for Typically Aging Seniors in a University Clinic Setting: A Feasibility Study

Purpose: While diagnosis and treatment are the major focus for SLPs, professional roles are expanding to include preventative related services with the elderly. Evidence exists as to the effects of preventative cognitive training (CT), yet few studies have examined viable models for SLP implementation. The purpose of this feasibility study was to compare group and individual CT programs delivered in a university based speech and hearing clinic. Method: Forty-eight adults, between the ages of 68-92 years-old were assigned to individual or group based conditions in which they received sixteen hours of CT, implemented by an SLP and graduate student clinicians. Cognitive, memory, language, visuospatial and other skills were trained. Formal and informal, pre-post and 12-week follow-up measures were administered. Function and Satisfaction surveys were administered to determine participant perceptions of functional outcomes. Results: Participants in both CT conditions demonstrated pre-post training gains, although individually trained seniors made more significant improvements than group trained seniors on specific formal measures. The amount of pre to post gain on all assessment measures was similar between groups. Improvements in test scores were maintained at 12-week follow-up testing intervals by both groups. Survey results indicated high satisfaction with CT, although differences were found in perceptual outcomes between groups. Conclusions: Whereas individual participants yielded more significant effects, the Group condition also represents an effective and efficient model for prevention related services with elderly populations, as demonstrated by pre-post training effects and participant satisfaction responses. Clinical training applications for CT implementation in a university training setting are discussed.

OCD Taboo Thoughts and Stigmatizing Attitudes in Clinicians.

Individuals who suffer from obsessive-compulsive disorder have persistent intrusive thoughts that cause severe distress that impairs daily functioning. These individuals often conceal their intrusive thoughts and delay help-seeking for fear of being stigmatized. Stigma can be problematic when it is present among mental health professionals because they may distance themselves from their clients and have a negative outlook on treatment outcome. To date there has not been any research that focuses on stigma that clinician's may hold towards obsessive-compulsive disorder or specific obsessions; however, there is evidence that mental health professionals may have prejudices towards individuals who suffer from other mental illnesses. The current study aimed to explore clinician and student clinician attitudes about obsessional content from varying symptom dimensions. Results indicated participants were more likely to socially reject or be concerned by individuals with obsessions related to contamination, harming, and sexual obsessions than those with scrupulous obsessions, and that they would be less likely to reveal sexual obsessions to others if they were experiencing them than the other three types of obsessions.

The Clinical Fellow Licensure Conundrum

The Clinical Fellow Licensure Conundrum

Interpreter training for medical students: pilot implementation and assessment in a student-run clinic.

BackgroundTrained medical interpreters are instrumental to patient satisfaction and quality of care. They are especially important in student-run clinics, where many patients have limited English proficiency. Because student-run clinics have ties to their medical schools, they have access to bilingual students who may volunteer to interpret, but are not necessarily formally trained.MethodsTo study the feasibility and efficacy of leveraging medical student volunteers to improve interpretation services, we performed a pilot study at the student-run clinic at the Icahn School of Medicine at Mount Sinai. In each fall semester in 2012–2015, we implemented a 6-h course providing didactic and interactive training on medical Spanish interpreting techniques and language skills to bilingual students. We then assessed the impact of the course on interpreter abilities.ResultsParticipants’ comfort levels, understanding of their roles, and understanding of terminology significantly increased after the course (p < 0.05), and these gains remained several months later (p < 0.05) and were repeated in an independent cohort. Patients and student clinicians also rated participants highly (averages above 4.5 out of 5) on these measures in real clinical encounters.ConclusionsThese findings suggest that a formal interpreter training course tailored for medical students in the setting of a student-run clinic is feasible and effective. This program for training qualified student interpreters can serve as a model for other settings where medical students serve as interpreters.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0760-8) contains supplementary material, which is available to authorized users.

Nasal carriage frequency of Staphylococcus aureus according to education years of medical students

Objective: Nasal carriage of Staphylococcus aureus (NCSa) is one of the most important risk factors for nosocomial infection. Although there are numerous studies concerning NCSa frequency among medical staff, studies dealing specifically with medical students are less common. We aimed to investigate NCSa frequency among medical students and to compare the rates of clinical students (CS), comprising interns and stagers, with those of preclinical students (PS). Materials and Methods: This study was performed at Sakarya University Medical School. All students were invited to participate into the study. Nasal swab samples were taken anterior nares from 146 medical students (PS=82, CS=64). The samples were inoculated into the Chapman agar medium, and incubated at 370 C for 48 hours. Antibiotic sensitivity tests were performed on these colonies. The obtained data were analyzed statistically. Chi-square test was used for qualitative variables and t test was used as quantitative data. P <0.05 was considered significant. Results: A total of 146 students were agreed to participate in the study (53 subjects were male and 93 were female). While NCSa frequency within the PS group was 2/82 (2.4%), that within the CS group was 7/64 (10.9%) (p=0.042). Methicillin resistance was not detected in any subject. Conclusion: As a result, the frequency of NCSa in the CS group (10.9%) was found to be about 4 times higher than that in the PS group (2.4%). We recommend that clinical students should be expected to observe infection-control precautions. J Microbiol Infect Dis 2016; 6(3): 103-106

Addressing clinician burnout: How can we build resilience in tomorrow's health professionals?

Purpose: The clinical impact of burnout is known to threaten patient care, 1 El-bar N. Levy A. Wald H.S. et al. Compassion fatigue, burnout and compassion satisfaction among family physicians in the Negev area-a cross-sectional study. Israel J Health Policy Res. 2013; 2: 31 Crossref Scopus (53) Google Scholar but the personal impact is much more difficult to measure. In Victoria, Australia, employment as a paramedic/ambulance clinician has been found to correlate to a four-fold higher suicide rate than the average population. 2 Hennessey J. Working together to improve paramedic mental health. State Government of Victoria, Melbourne, Australia2015 Google Scholar Both educational and health service organisations have a responsibility to equip and encourage student clinicians and staff to address this issue. We set out to determine the extent and effects of burnout in pre-hospital clinical medicine, and to identify what strategies exist to manage this problem.

Youth social skills groups: A training platform for promoting graduate clinician interprofessional competence

Despite growing recognition of the benefits of interprofessional (IP) education and practice, many graduate programs in allied health fields still do not target such skills directly in their training programs, nor assess students' IP competence. We describe a social skills group program that involves collaboration between graduate students and faculty in clinical psychology and speech-language pathology to deliver patient-centered care designed to improve children's social communication. Groups consist of 6–8 children who meet weekly for a 50-min session for 8–10 weeks; graduate student clinicians co-lead the groups following an evidence-based curriculum and meet weekly with faculty for group supervision. Qualitative feedback from graduate student clinicians indicates that the social skills program fosters their IP competence in the four key areas identified by the Interprofessional Education Collaboration Expert Panel (2011) – values and ethics, roles and responsibilities, communication, and teams and teamwork – while addressing a significant clinical need.

A Pedagogical Note: Use of Telepractice to Link Student Clinicians to Diverse Populations.

Telepractice is the application of telecommunications technology to the delivery of telehealth services via the online connection of clinicians, clients, and patients for assessment, intervention, or consultation. This article describes a pilot project in which speech-language pathology students in a university training program gained experience in working with culturally diverse preschool students using telepractice technology. The preschool students benefited by making gains in communication skills, while the university students acquired competency in the use of telepractice and in working with children whose cultural and linguistic backgrounds were outside of their experience. To assess the training experience, a Likert-scale survey administered to student clinicians revealed a high degree of satisfaction and improved familiarity with the use of telepractice, and an increased comfort level working with multi-cultural populations.

Guiding Student Clinicians as They Develop AAC Goals and Monitor Progress During School-Based Externship

Student clinicians find goal writing and progress monitoring to be difficult tasks to learn, especially when children on the caseload have complex communication needs (CCNs). School-based externship supervisors play an important role in developing students' understanding and competence in these skills. This article provides supervisors with strategies for instructing student clinicians to write goals and evaluate the effectiveness of services for children who use augmentative and alternative communication (AAC). Additionally, the authors adapt the Continuum of Supervision Model (Anderson, 1988) for supervisors who train students to write goals and monitor progress for children who use AAC.

Guiding Student Clinicians as They Develop AAC Goals and Monitor Progress During School-Based Externship

Student clinicians find goal writing and progress monitoring to be difficult tasks to learn, especially when children on the caseload have complex communication needs (CCNs). School-based externship supervisors play an important role in developing students' understanding and competence in these skills. This article provides supervisors with strategies for instructing student clinicians to write goals and evaluate the effectiveness of services for children who use augmentative and alternative communication (AAC). Additionally, the authors adapt the Continuum of Supervision Model (Anderson, 1988) for supervisors who train students to write goals and monitor progress for children who use AAC.

A Review of the Expectations of Speech-Language Pathology Externship Student Clinicians and Their Supervisors

Students bring skills gleaned from academic learning and any previous university clinic internship experiences to externship clinical placements. Speech-language pathologists (SLPs) in their personal work settings share their caseload, supervise, and guide these novice professionals as they advance their clinical skills in preparation for independent practice. Supervisors and student clinicians with varying skills, goals, and previous supervision experiences have expectations for these final placements that can impact the effectiveness of the supervisory relationship and experience. Educational theories indicate that a strong supervisory relationship is built on practices of modeling, active listening, and facilitative learning as students mature toward independent evidence-based practices and decisions, with supervisors that offer constructive feedback and encouragement. Supervisors should work to create an atmosphere that fosters trust and openness to promote the most effective supervisory relationship with their supervisees. An important component of an effective working relationship is to be aware of expectations and a willingness to adapt to varying and/or changing expectations. Increasing understanding of expectations will create an opportunity to exchange information and build a strong, effective supervisory relationship. An awareness of students' expectations and perceptions allows supervisors to target the students' needs and personalize guidance to facilitate maximum growth in clinical skills.