Clinical Teaching Environment Research Articles

ChatGPT as a Tool for Medical Education and Clinical Decision-Making on the Wards: Case Study.

Large language models (LLMs) are computational artificial intelligence systems with advanced natural language processing capabilities that have recently been popularized among health care students and educators due to their ability to provide real-time access to a vast amount of medical knowledge. The adoption of LLM technology into medical education and training has varied, and little empirical evidence exists to support its use in clinical teaching environments. The aim of the study is to identify and qualitatively evaluate potential use cases and limitations of LLM technology for real-time ward-based educational contexts. A brief, single-site exploratory evaluation of the publicly available ChatGPT-3.5 (OpenAI) was conducted by implementing the tool into the daily attending rounds of a general internal medicine inpatient service at a large urban academic medical center. ChatGPT was integrated into rounds via both structured and organic use, using the web-based "chatbot" style interface to interact with the LLM through conversational free-text and discrete queries. A qualitative approach using phenomenological inquiry was used to identify key insights related to the use of ChatGPT through analysis of ChatGPT conversation logs and associated shorthand notes from the clinical sessions. Identified use cases for ChatGPT integration included addressing medical knowledge gaps through discrete medical knowledge inquiries, building differential diagnoses and engaging dual-process thinking, challenging medical axioms, using cognitive aids to support acute care decision-making, and improving complex care management by facilitating conversations with subspecialties. Potential additional uses included engaging in difficult conversations with patients, exploring ethical challenges and general medical ethics teaching, personal continuing medical education resources, developing ward-based teaching tools, supporting and automating clinical documentation, and supporting productivity and task management. LLM biases, misinformation, ethics, and health equity were identified as areas of concern and potential limitations to clinical and training use. A code of conduct on ethical and appropriate use was also developed to guide team usage on the wards. Overall, ChatGPT offers a novel tool to enhance ward-based learning through rapid information querying, second-order content exploration, and engaged team discussion regarding generated responses. More research is needed to fully understand contexts for educational use, particularly regarding the risks and limitations of the tool in clinical settings and its impacts on trainee development.

Twelve tips on creating and using custom GPTs to enhance health professions education

The custom GPT is the latest powerful feature added to ChatGPT. Non-programmers can create and share their own GPTs (“chat bots”), allowing Health Professions Educators to apply the capabilities of ChatGPT to create administrative assistants, online tutors, virtual patients, and more, to support their clinical and non-clinical teaching environments. To achieve this correctly, however, requires some skills, and this 12-Tips paper provides those: we explain how to construct data sources, build relevant GPTs, and apply some basic security.

The effects of clinical learning environment and career adaptability on resilience: A mediating analysis based on a survey of nursing interns.

The resilience education of intern nursing students has significant implications for the development and improvement of the nursing workforce. The clinical internship period is a critical time for enhancing resilience. To evaluate the resilience level of Chinese nursing interns and explore the effects of factors affecting resilience early in their careers, focusing on the mediating roles of career adaptability between clinical learning environment and resilience. The cross-sectional study design was adopted. From March 2022 to May 2023, 512 nursing interns in tertiary care hospitals were surveyed online with the Connor-Davidson Resilience Scale, the Clinical Learning Environment Scale for Nurse and the Career Adapt-Abilities Scale. Structural equation modelling was used to clarify the relationships among these factors. Indirect effects were tested using bootstrapped confidence intervals. The nursing interns showed a moderately high level of resilience [M (SD) = 70.15 (19.90)]. Gender, scholastic attainment, scholarship, career adaptability and clinical learning environment were influencing factors of nursing interns' resilience. Male interns with good academic performance showed higher levels of resilience. Career adaptability and clinical learning environment positively and directly affected their resilience level (β = 0.62, 0.18, respectively, p < .01). Career adaptability was also positively affected by the clinical learning environment (β = 0.36, p < .01), and mediated the effect of clinical learning environment on resilience (β = 0.22, p < .01). Clinical learning environment can positively affect the resilience level of nursing interns. Career adaptability can affect resilience directly and also play a mediating role between clinical learning environment and resilience. Thus, promotion of career adaptability and clinical teaching environment should be the potential strategies for nursing interns to improve their resilience, especially for female nursing interns with low academic performance.

Perception of Nursing Students About Effective Clinical Teaching Environments: A Multi-Country Study.

The transition of nursing education from traditional methods to more advanced approaches is crucial for adequately preparing students to deliver competent care in tertiary care centers. Moreover, clinical faculty in nursing plays a key role in guiding nursing students through their clinical training in various healthcare settings. This study aims to describe the perceptions of undergraduate nursing students regarding the effectiveness of the learning environment and clinical teaching in clinical areas across various countries. The study, conducted using a descriptive, cross-sectional research design, gathered data from 215 nursing students using the Clinical Learning Environment Inventory and Clinical Teaching Effectiveness Instrument. Data analysis included frequencies, percentages, mean, standard deviation, t-tests, analysis of variance, and correlation assessments to comprehend the impact of clinical teaching and learning environments. Nursing students' perceptions of the clinical learning environment produced mean scores between 2.03 and 3.38 on a scale from 1 to 4, resulting in an overall mean score of 2.72 across 42 items. This indicates a general satisfaction with their clinical learning experiences. Regarding effective clinical teaching, the mean student responses varied from 3.02 to 3.40 out of a possible 5 points, with a total mean of 3.22. The study revealed notable correlations in the context of effective clinical teaching, particularly with demographic variables and the clinical learning environment. Specifically, a significant correlation with age (r = .177, p = .009) and the clinical learning environment (r = .572, p < .001) was identified. The study concludes that students expressed overall satisfaction with their clinical learning experiences. They recognized the importance of participating in clinical training, fulfilling clinical responsibilities for assigned patients, exerting extra effort for learning, receiving support from preceptors in clinical settings, and being attentive to communications from staff. The collaboration between clinical preceptors and academic nursing lecturers is crucial in providing a positive learning environment for students to complete clinical tasks effectively.

Efficacy of an impression disinfectant solution after repeated use: An in vitro study

Statement of problemThere are very few studies using Benzalkonium Chloride (BAC) as an active disinfection agent for immersion techniques and there are no studies investigating the efficacy of repeated use of a disinfectant solution. PurposeThis study evaluated an impression disinfectant by testing bacterial contamination of disinfectant batches used in a clinical setting after repeated use. Materials and methodsLiquid samples were collected from impression disinfectant solutions used to disinfect dental impressions taken at a university dental clinic. The experimental samples (500 ml from 1 L of solution) were collected from teaching and professional clinics and the in-house commercial processing laboratory and stored at room temperature each day of clinic operation over five weeks. To determine to what extent the disinfectant efficacy of the active product decreased over time, the following tests were carried out: a. Inoculation b. Gram staining technique c. Matrix Assisted Laser Desorption/Ionization Mass spectrometry (MALDI- MS). Microbial growth was monitored and photographed. A culture revival was made from colonies grown on sheep blood agar, to isolate pure colonies incubated for 24 h at 37 °C. Each morphologically distinct type of colony was gram stained and MALDI spectrometry analysis was performed using the VITEK MS (BioMerieux Inc.) ResultsEvidence of growth of bacteria was detected in teaching clinics’ samples, and no growth from the professional clinic or the commercial laboratory. ConclusionsThe study demonstrated that the impression disinfectant solution tested is effective against common oral bacteria, despite some rare species such as Bacillus circulans, Bacillus horneckiae, Bacillus altitudinis/pumilus and Bacillus cereus showing evidence of survival in solutions used for disinfection of impressions. However, in a high use teaching clinic environment its efficacy deteriorated. Though a second level disinfection protocol in the commercial laboratory-maintained impression disinfection.

Use of Effective Feedback in Veterinary Clinical Teaching

Feedback is essential for the development of veterinary medical learners. This review explores the theory and practical use of feedback in the modern clinical teaching environment. Our purpose is to assist veterinary teaching institutions engage in effective feedback exchange between instructors and learners. Based on literature evidence, quality feedback requires training for both learners and instructors. Effectively executed feedback should be a powerful learning and teaching tool in the development of competencies of the learner. Following the theoretical discussion, we propose a method for delivering scheduled feedback sessions to veterinary medical learners. This differs from ‘on-the-go’ feedback during each clinical encounter, which we have discussed in a previous article related to the use of the five microskills in clinical teaching.

Pharmacy preceptor training: addressing the challenges of clinical supervision in community practice.

Pharmacist preceptors are fundamental to experiential placements and their training is considered essential to provide a quality and consistent student placement experience. To optimise the impact of training, the views of key stakeholders are required to inform the design of a training program. This commentary aims to synthesise the perceptions of the stakeholders, including community pharmacy preceptors, academic staff and students on preceptor training requirements. Their opinions were sought to gain an understanding of preceptor roles and associated skills and attributes, training and support requirements, and barriers and enablers to training. Responses indicated a preference for a flexible online training program, with content including an overview of the university curriculum and expectations, teaching strategies, how to provide feedback and student management. A role was identified for the university to acknowledge the work of preceptors and ensure that they are included in their plans for future experiential placement activities and curriculum development. Several barriers were identified, which challenged precepting, providing the opportunity for this commentary to focus on preceptor training that will address these key challenges, in the context of a clinical teaching environment.

Conceptualizing the next patient interaction: A clinical skillset using an emulation model in critical thinking.

The next patient interaction is logical, essential, and largely done intuitively. To design and test a succinct learning guide for student guidance and student-faculty interaction in conceptualizing the next patient interaction. In 2021 and 2022, faculty scored questions from 1-5: Recognize deviation from the ideal? Articulate how and how much the situation deviated? Gage consequences of the situation? Assess own capabilities? To what extent does the student have a clear grasp of the procedural outcome? Faculty were also given open-ended questions. Forty-eight reports were completed, 25 D3 and 23 D4. Three hundred thirty-five faculty entries were made in the questions calling for a 1-5 response out of a possible 336 responses. Statistically significant differences were noted. Students were better able to recognize the situation as different from ideal than to articulate how and how much the situation deviated. Students were better able to grasp how and how much this situation differs from the ideal than to assess own capabilities. D4 students were better able to recognize deviation from the ideal and to articulate how and how much the situation deviated than were D3 students. For open-ended questions, more students were scored as "Prepared" than were scored as "Unsure" and "Missed" combined. The exercise is seen as a succinct and constructive (nonjudgmental) path to guide the student's conceptualization of the next patient encounter before the encounter begins. Next steps will be incremental for wider use in a clinical teaching environment.

An Assessment of Naturopathic Treatments, Health Concerns, and Common Comorbid Conditions in Fibromyalgia Patients: A Retrospective Medical Record Review

Background: Fibromyalgia (FM) is characterized by chronic pain, with allodynia and hyperalgesia being the most common signs. Many patients with FM explore, express interest, and use complementary and alternative medicine to help manage symptoms and improve quality of life. However, little is known about the clinical recommendations provided by naturopathic doctors (NDs). Objective: To describe trends in assessment and treatment of patients with FM by NDs. Methods: Retrospectively, medical records of 200 patients with the FM ICD-10 code were reviewed from the Robert Schad Naturopathic Clinic. Of these records, 70 met inclusion criteria and were further analyzed. Comorbid conditions, health concerns, physical and psychological examinations, and treatment were recorded. Patients were excluded if informed consent for research was not signed. The project was approved by the Research Ethics Board of the Canadian College of Naturopathic Medicine. Results: Seventy patients met criteria and were included in the current analysis. Most patients identified as female (96%). Vitamin D (57%), magnesium (54%), omega-3 fish oil (53%), acupuncture by an acupuncturist (53%) or an ND (40%), B12 orally or by injection (40%), and probiotics (40%) were highly utilized treatments. A past/current medical history of digestive complaints (64%) and depression/mental illness (63%) were common comorbidities, alongside a history of arthritic conditions (53%) and anxiety (43%). A family history of arthritic conditions (47%) was also prevalent. The Widespread Pain Index and Symptom Severity tool (43%) was used to assess pain and other symptoms. No adverse effects of treatment were readily identifiable. Conclusion: Findings from this study reveal elements of both consistency and variability in the treatment recommendations from NDs in a teaching clinic environment. Future research that assesses or compares treatment recommendations for FM in other settings may be informative to better understand health services, the nature of individualized care, and patient experiences.

Reflective Practice in Anesthesia Clinical Teaching

BackgroundReflective practice is an essential aspect of knowledge generation for professional practice. By reflecting on action, professionals learn to improve their practices. Through processes of reflection, practitioners participate in a dialogue between theory and practice. Even though reflective practice is an important approach for learning from experience, its place remains unclear in anesthesia clinical education as well as anesthesia practice in a broad sense.AimThe aim of this paper was to examine the affordances of reflective practice in anesthesia clinical education.MethodsTwo cases, illustrating critical incidents in the anesthesia clinical teaching environment, were examined to consider how incorporating reflective practice into clinical education can advance knowledge generation in the field.FindingsThe two cases studies show how reflective practice can contribute to experiential learning, particularly through reflection on critical incidents.ConclusionReflective practice can help bridge the gap between theoretical knowledge and practice in anesthesia education and practice.Rwanda J Med Health Sci 2021;4(3):406-411

How does a move towards a coaching approach impact the delivery of written feedback in undergraduate clinical education?

Feedback uptake relies on interactions between learners and educators Winstone (Educ Psychol 52: 17–37, 2017). Feedback that coaches using a feedforward approach, is considered to be more personal and emotionally literate Bussey (Bull R Coll Surg Engl 99: 180–182, 2017), Hattie (Rev Educ Res 77: 81–112, 2007). Many modes of feedback are employed in clinical teaching environments, however, written feedback is particularly important, as a component of feedback discourse, as significant time may elapse before a similar clinical situation is encountered. In practice, time constraints often result in brief or descriptive written feedback rather than longer coaching feedback. This study aimed to explore whether a change in ethos and staff development would encourage clinical dental tutors to utilise a coaching approach in their written feedback. Across two time-points, written feedback was categorised into either descriptive, evaluative or coaching approaches. Cross-sections of data from 2017 to 2019 were examined to determine whether changes in practice were noted and whether there were any alterations in the affective nature of the language used. Feedback moved significantly towards coaching and away from a descriptive approach. A shift towards the use of more positive language was seen overall, although this was solely driven by a change in the evaluative feedback category. Descriptive feedback generally used neutral language with coaching feedback using marginally more positive language. Both categories employed significantly lower levels of affective language than evaluative feedback. These data indicate a move towards feedback approaches and language that may support increased uptake and utilisation of feedback.

Encouraging a Little Help from Our Friends: Resident Physician Burnout & Peer Communication Curriculum.

INTRODUCTIONResident physician burnout and depression rates are increasing faster than in the non-physician workforce. To foster a supportive community where such concerns may be addressed, residents can be educated in identification and first-line support of burnout in fellow residents. The literature has not described peer roleplaying applied toward aiding fellow residents with burnout.METHODThis pilot study evaluated an educational component aimed at fostering a strong emotional and informational social support system. The curriculum used peer roleplaying to develop self-awareness and social support, improve communication skills, and teach about existing mental health resources, thereby encouraging intervention. Residents listed behavioral manifestations of burnout and dysphoria that we developed into real-life scenarios. During experiential workshops, residents roleplayed “distressed” and “helper” residents and practiced communicating empathy. To tackle mental health stigma, all were required to practice expressing distress and seeking help. Residents completed a pre-roleplaying questionnaire, curriculum satisfaction questionnaire, and reflection essay.RESULTSAll 42 Internal Medicine and Transitional Year residents (69% male, 93% international medical graduates) participated. Resident-reported comfort, competence, confidence, and knowledge increased, as did positive appraisals of the clinical teaching environment representing a safe atmosphere. Six themes were cited in >25% of essays: knowledge of communication techniques, knowledge of approach tactics or strategies, knowledge of hospital resources, commitment to helping colleagues, importance of burnout, and belief this training produced a better understanding of oneself.CONCLUSIONAs first-witnesses of resident physician distress, peers occupy an underutilized, yet crucial preventive and supportive role in burnout and mental health intervention, especially during times of shared crises such as the coronavirus pandemic. Creating roleplays from personal experiences facilitated meaningful discussion of burnout and dysphoric emotions. Roleplaying offered a low-cost, effective method to destigmatize and encourage discussion of burnout, educate on signs and symptoms, and learn available resources to offer an afflicted colleague in osteopathic and allopathic residency programs.

Total Joint Arthroplasty During the COVID-19 Pandemic: A Scoping Review with Implications for Future Practice.

BackgroundRecent studies have examined the impact of the COVID-19 pandemic on the practice of total joint arthroplasty. A scoping review of the literature with compiled recommendations is a useful tool for arthroplasty surgeons as they resume their orthopedic practices during the pandemic.MethodsIn June 2020, PubMed, Embase (Ovid), Cochrane Library (Wiley), Scopus, LitCovid, CINAHL, medRxiv, and bioRxiv were queried for articles using controlled vocabulary and keywords pertaining to COVID-19 and total joint arthroplasty. Studies were characterized by their region of origin, design, and Center of Evidence Based Medicine level of evidence. The identified relevant studies were grouped into 6 categories: changes to future clinical workflow, education, impact on patients, impact on surgeons, technology, and surgical volume.ResultsThe COVID-19 pandemic has had a significant impact on arthroplasty practice, including the disruption of the clinical teaching environment, personal and financial consequences for patients and physicians, and the drastic reduction in surgical volume. New pathways for clinical workflow have emerged, along with novel technologies with applications for both patients and trainees.ConclusionsThe COVID-19 pandemic emphasizes the recent trend in arthroplasty toward risk stratification and outpatient surgery, which may result in improved clinical outcomes and significant cost-savings. Furthermore, virtual technologies are a promising area of future focus that may ultimately improve upon previous existing inefficiencies in the education and clinical environments.

Clinical Teaching: Sixty Tips for Successful Implementation

A good preparation of clinical teaching which is followed by systematic implementation will result in better training outcomes. In this short descriptive paper, we provide 60 tips to everyone who conducts clinical supervision or teaching to medical students in the ward. These tips highlight the roles and characteristics of (1) clinical tutors, (2) students, (3) clinical teaching environment and (4) patients. They serve as a mini guide.

Strategies of Female Teaching Attending Physicians to Navigate Gender-Based Challenges: An Exploratory Qualitative Study.

Women in medicine experience discrimination, hostility, and unconscious bias frequently and with deleterious effects. While these gender-based challenges are well described, strategies to navigate and respond to them are less understood. To explore the lived experiences of female teaching attending physicians emphasizing strategies they use to mitigate gender-based challenges in clinical environments. Multisite exploratory, qualitative study. Inpatient general medicine teaching rounds in six geographically diverse US academic hospitals between April and August 2018. With use of a modified snowball sampling approach, female attendings and their learners were identified; six female attendings and their current (n = 24) and former (n = 17) learners agreed to participate. Perceptions of gender-based challenges in clinical teaching environments and strategies with which to respond to these challenges were evaluated through semistructured in-depth interviews, focus group discussions, and direct observations of rounds. Observations were documented using handwritten field notes. Interviews and focus groups were audio recorded and transcribed. All transcripts and field note data were analyzed using a content analysis approach. Attending experience levels ranged from 8 to 20 years (mean, 15.3 years). Attendings were diverse in terms of race/ethnicity. Strategic approaches to gender-based challenges clustered around three themes: female attendings (1) actively position themselves as physician team leaders, (2) consciously work to manage gender-based stereotypes and perceptions, and (3) intentionally identify and embrace their unique qualities. Female attendings manage their roles as women in medicine through specific strategies to both navigate complex gender dynamics and role model approaches for learners.

Virtual Reality: a Tool for Preservice Science Teachers to Put Theory into Practice

The purpose of the present study was to investigate, compare, and characterize interactive VR-based preservice science teacher clinical teaching environments with those of real-life teaching environments. Fifty-four college-aged students were assigned randomly to either real-life conditions or VR conditions. The main effect of the VR condition versus real-life was not statistically significant in terms of the retrospective engagement survey, psychological measures, and composite neuroimaging. This finding suggests that use of VR, in terms of the realism of the environment for the preservice science teachers allowed them to learn from modeled real-life situations for transfer of skills from VR to classroom use.

SECONDARY NURSING SCHOOL STUDENTS PERCEPTION REGARDING CLINICAL LEARNING ENVIRONMENT AND CLINICAL SUPERVISION IN PORT SAID CITY

Background:The clinical learning environment refers to the learning placement that provides opportunities to integrate theory into practice, build clinical decision-making abilities, and develop a professional identity.Aim: to assess the perception of secondary nursing school students regarding their clinical learning environment and clinical supervision in Port Said City.Subjects and Method: A descriptive correlational research designwas used for the current study in three secondary nursing schools at Port- Said city. The study subjects will include 360 femalestudents.Two tools were used for data collection; Clinical learning environment inventory actual and expected form(CLEI), and clinical supervision questionnaire(CSQ).Results:The current study revealed that the majority of nursing students reported that there was low level of actual clinical learning environment (66.47%), andthe majority of nurse students had a high level of expected clinical learning environment (76.4%), also more than half of nurse students had a moderate level of clinical supervision (56.9%).Conclusion:It was evidenced that there was a significant difference between actual and expected clinical environments. Also the results suggested significant relationship between clinical learning environment and clinical supervision. Recommendations:The main recommendations are suggested, considering students’ expectations of clinical teaching environment and decreasingthe gap between the actual and expectedclinical environments is necessary. In addition,continuous studies on clinical teaching environment evaluation and their results, and to assess clinical instructors’ and clinical staff opinions about the clinical teaching environment are recommended.

Involving patients in the development of interpersonal skills of optometry students

BackgroundProviding patients an opportunity to give feedback to optometry students on their communication and interpersonal skills allows for a unique learning opportunity. The aim of the current project was to determine if the Doctors’ Interpersonal Skills Questionnaire (DISQ) was suitable for use with optometry students in a large teaching clinic and if it provided useful feedback to the students for learning purposes.MethodsThe DISQ is a 12‐item questionnaire that utilises a five‐point Likert scale; a higher score indicates better performance. The DISQ was modified for an optometry context and developed into an online questionnaire. Patients were invited to complete the survey following their consultation with a final year student. Patients provided feedback on the interpersonal skills of the student optometrist who conducted the consultation under supervision. Students were provided with both individual and collated feedback obtained for the entire student group; strategies for improving communication were discussed. This activity did not form part of the grades of the students.ResultsPatients were very satisfied with the interpersonal skills of final year optometry students. Highest scores were given for questions relating to the warmth of greeting, respect shown and time given. Lowest scores were for questions relating to explanations, reassurance and confidence. There was a significant improvement in the communication and interpersonal skills of students following the provision of patient feedback and strategies for improving these skills, and an additional period of clinical experience.ConclusionPatients can provide feedback on the interpersonal skills of optometry students using the DISQ. This feedback results in further skill development for students and makes patients feel valued within the teaching clinic environment. This activity assisted in ensuring that graduating optometrists have the interpersonal skills required to communicate clearly and effectively with patients, a requirement for practising with a patient‐centred focus.

Assessment of correlates of hand hygiene compliance among final year medical students: a cross-sectional study in the Netherlands

ObjectivesTo identify the factors that influence the hand hygiene compliance of final year medical students, using a theoretical behavioural framework.DesignCross-sectional survey assessing self-reported compliance and its behavioural correlates.SettingInternships of medical...

A Tutorial for Implementing Strategic Questioning in the Clinical Teaching Environment

Purpose The implementation of strategic questioning within the clinical teaching context has recently gained appeal among clinical educators as a method for stimulating critical thinking and other higher order thinking skills. This article will (a) address evidence for the use of strategic questioning approaches in the clinical teaching environment, (b) examine some of the complexities associated with effectively selecting and implementing questioning types, and (c) discuss the potential significance that supervisory training and self-assessment may have on effective application of strategic questioning. Conclusion Strategic questioning can be a highly valuable teaching methodology within the clinical teaching context. Current available external evidence, albeit limited, provides some insight into the complexities involved with effectively implementing strategic questioning methods. Further research is needed to explore the efficacy and feasibility of specific strategic questioning approaches within the scope of communication sciences and disorders.