Clinical Training Experiences Research Articles

Anesthesiology Residents' Experiences and Perspectives of Residency Training.

Anesthesiology residents' experiences and perspectives about their programs may be helpful in improving training. The goals of this repeated cross-sectional survey study are to determine: (1) the most important factors residents consider in choosing an anesthesiology residency, (2) the aspects of the clinical base year that best prepare residents for anesthesia clinical training, and what could be improved, (3) whether residents are satisfied with their anesthesiology residency and what their primary struggles are, and (4) whether residents believe their residency prepares them for proficiency in the 6 Accreditation Council for Graduate Medical Education (ACGME) Core Competencies and for independent practice. Anesthesiologists beginning their US residency training from 2013 to 2016 were invited to participate in anonymous, confidential, and voluntary self-administered online surveys. Resident cohort was defined by clinical anesthesia year 1, such that 9 survey administrations were included in this study-3 surveys for the 2013 and 2014 cohorts (clinical anesthesia years 1-3), 2 surveys for the 2015 cohort (clinical anesthesia years 1-2), and 1 survey for the 2016 cohort (clinical anesthesia year 1). The overall response rate was 36% (4707 responses to 12,929 invitations). On a 5-point Likert scale with 1 as "very unimportant" and 5 as "very important," quality of clinical experience (4.7-4.8 among the cohorts) and departmental commitment to education (4.3-4.5) were rated as the most important factors in anesthesiologists' choice of residency. Approximately 70% of first- and second-year residents agreed that their clinical base year prepared them well for anesthesiology residency, particularly clinical training experiences in critical care rotations, anesthesiology rotations, and surgery rotations/perioperative procedure management. Overall, residents were satisfied with their choice of anesthesiology specialty (4.4-4.5 on a 5-point scale among cohort-training levels) and their residency programs (4.0-4.1). The residency training experiences mostly met their expectations (3.8-4.0). Senior residents who reported any struggles highlighted academic more than interpersonal or technical difficulties. Senior residents generally agreed that the residency adequately prepared them for independent practice (4.1-4.4). Of the 6 ACGME Core Competencies, residents had the highest confidence in professionalism (4.7-4.9) and interpersonal and communication skills (4.6-4.8). Areas in residency that could be improved include the provision of an appropriate balance between education and service and allowance for sufficient time off to search and interview for a postresidency position. Anesthesiology residents in the United States indicated they most value quality of clinical training experiences and are generally satisfied with their choice of specialty and residency program.

Medical Device-related Counseling Practice and Barriers among Sudanese Pharmacists: A Questionnaire-Based Study.

Objective:The aim of the present study was to assess medical devices-related counseling practice and barriers among pharmacists.Methods:This was a cross-sectional study conducted using a convenient sample of Sudanese pharmacists. An online-version survey was used to collect data.Findings:One hundred and thirty pharmacists responded to the online survey. Most pharmacists in this sample were master or Ph.D. degree holders (62.3% and 12.3%, respectively), having a clinical training experience (70%) and substantial proportion are board-certified (30%). Medical devices reported to be commonly inquired by patients were blood glucose monitors, nebulizers, blood pressure monitors, dry powder inhalers, and insulin pens. Devices most frequently requiring counselling were blood glucose monitors, blood pressure monitors, syringes, thermometers, nebulizers, dry powder inhalers, insulin, and weighing scales. The most frequently supplied devices reported were syringes, blood glucose monitors, insulin pens, blood pressure monitors, thermometers, nebulizers, and dry powder inhalers. Devices least frequently requiring counselling were implanted devices, respirometers, and stethoscopes. The least frequently supplied devices were respirometers, implanted devices, and heart rate monitors.Conclusion:Medical devices reported to be commonly inquired by patients were most frequently requiring counseling, and most frequently supplied. Findings reflect the availability of devices in the market and pharmacists' response to the needs of their patients. Pharmacists should maintain adequate knowledge about the proper use of medical devices because this is a common patient inquiry.

CTS teams: a new model for translational team training and team science intervention.

Clinical/translational science (CTS) is team-based, requiring effective collaboration and communication across many disciplines involving a variety of stakeholders. We implemented a pre-doctoral team-based training model with didactic and experiential curricular interventions to support the development of CTS research skills in a cross-disciplinary team environment. We assessed the potential impact of this new training model as a team science intervention that can catalyze new cross-disciplinary collaborations across the institution. Between 2016 and 2020, 32 pre-doctoral students and 26 co-mentors participated in the assessment of the CTS Team program over a two-year period of TL1 training grant support. Data collection and analyses followed a program logic model and used a variety of metrics for clinical and translational scientist career success. CTS training in the context of CTS Teams supported improved self-efficacy for clinical research skills and resulted in a significant increase in the frequency of participation in cross-disciplinary collaborative activities by both trainees and mentors. Most CTS Team co-mentor pairs had not previously collaborated. Two-thirds of the co-mentors plan to continue collaborating, and most (85%) currently use or plan to use collaboration tools, for example, written collaboration plans, authorship agreements. The CTS Team training model provides a unique clinical and translational science team training experience that embeds authentic cross-disciplinary research collaboration into PhD research projects. It establishes trainee cohorts that are diverse in terms of scientific disciplines and translational research phases, and creates a new cross-disciplinary community of practice across faculty members and research groups in multiple colleges.

Practice Patterns and Training Needs Among Physicians Certifying Patients for Medical Marijuana in Florida.

Background:Little is known about the clinical training or practice experiences among physicians who certify patients for medical marijuana. The objective of this study was to determine information sources, factors influencing recommendations, clinical practices in patient assessment, communications, and recommendations, and priority areas for additional training among physicians who certify patients for medical marijuana.Methods:A cross-sectional state-wide anonymous survey of registered medical marijuana physicians in Florida between June and October 2020 was administered. Numerical responses were quantified using counts and percentages. The frequencies for “often” and “always” responses were aggregated when appropriate.Results:Among 116 respondents, the mean (standard deviation) age was 57 (12) years old, and 70% were male. The most frequently used information sources were research articles (n = 102, 95%), followed by online sources (n = 99, 93%), and discussions with other providers and dispensary staff (n = 84, 90%). Safety concerns were most influential in patient recommendations (n = 39, 39%), followed by specific conditions (n = 30, 30%) and patient preferences (n = 26, 30%). Ninety-three physicians (92%) reported they “often” or “always” perform a patient physical exam. Eighty-four (77%) physicians provided specific administration route recommendations. Half (n = 56) “often” or “always” provided specific recommendations for Δ-9-tetrahydrocannabinol: cannabidiol ratios, while 69 (62%) “often” or “always” provided specific dose recommendations. Online learning/training modules were the most preferred future training mode, with 88 (84%) physicians “likely” or “very likely” to participate. The top 3 desired topics for future training were marijuana-drug interactions (n = 84, 72%), management of specific medical conditions or symptoms (n = 83, 72%), and strategies to reduce opioids or other drugs use (n = 78, 67%).Conclusions:This survey of over 100 medical marijuana physicians indicates that their clinical practices rely on a blend of research and anecdotal information sources. While physicians report clinical factors as influential during patient recommendation, patient assessment practices and treatment regimen recommendations vary substantially and rely on experimental approaches. More research is needed to inform evidence-based practice and training, especially considering details on drug interactions, risk-benefit of treatment for specific clinical conditions, and strategies to reduce opioid use.

The Ergonomic Challenges Students Face during Operative Dentistry Treatment

Introduction: Students must possess good theoretical knowledge in order to perform correct clinical treatments with good prognosis and in safe conditions but merging theoretical knowledge and clinical practice in dental education is a challenge for both the training staff and the students. Up until now, no studies have been published in our country regarding the challenges faced by dental students in their clinical works performance for restorative dentistry and endodontic treatments. Aim: The aim of this study was to assess the factors that may influence the performance of restorative and endodontic treatment procedures performed by 5th year dental students and their own perception on clinical work. Materials and Methods: This was a cross-sectional study carried out in February 2020. A self-made questionnaire with 13 questions was distributed via e-mail link to 5th year dental students at the University of Medicine and Pharmacy Iuliu Hat‚ieganu Cluj Napoca, Romania, Department of Conservative Dentistry, all 5th year dental student who had previously undergone two years of clinical training. One hundred eleven students were selected after applying the inclusion criteria that were, having two years of clinical training experience and having passed their theoretical ergonomics, restorative dentistry and endodontics examinations. Descriptive Statistics were used for data analysis. Results: The majority of the students 83% (n=92) encountered difficulties applying the rules of ergonomics related to posture. The most common causes that prevented students from applying the rules of ergonomics during the clinical work were challenges related to working in indirect vision (n=90), lack of help by an assistant during treatment (n=52), working time allocated being too short (n=50), lack of sufficient space around the unit (n=43). Regarding the theoretical level required for restorative cases diagnosis, treatment plan and treatment itself, 64% (n=71) of students claimed to have had the necessary theoretical knowledge in most cases they met and only 25% (n=28) could confidently treat all cases. Establishing the diagnosis and treatment plan for endodontic cases was difficult stage for 3.6% (n=4) of students, of average difficulty in the case of 81.1% (n=90) of students, while 15.3% (n=17) did not consider them difficult at all. Conclusion: The results indicated that students had high levels of confidence in their theoretical knowledge when establishing the diagnosis and the treatment plan, but they encountered multiple challenges both with working ergonomically and with mastering the practical skills needed in different stages of the treatment.

Factors Affecting Clinical Nursing Competency: A Cross Sectional Study.

The purpose of this study was to elucidate the factors which affect the achievement of clinical nursing competency. A survey was conducted on 717 nurses using an anonymous self-administered questionnaire. Their clinical nursing competency was assessed using the Clinical Nursing Competence Self-Assessment Scale (CNCSS). This study examined the factors affecting clinical nursing competency using regression analyses. A simple regression analysis was performed with the CNCSS as the objective variable. A multiple regression analysis was performed using the items for which the relationship was clarified as explanatory variables. The factors affecting the "basic nursing competency" were age, ease of taking time off, workplace with a clear vision, and good interpersonal relationships. The factors affecting the "competency in providing assistance commensurate with the patient's health status" were total years of experience, workplace with a clear vision, ease of taking time off, and use of acquired certifications. The factors affecting the "coordinating care environment and teamwork" were total years of experience, workplace with a clear vision, use of acquired certifications, and ease of taking time off. The factors affecting the "ability for professional growth in nursing practice" were use of acquired certifications, workplace with a clear vision, total years of experience, and ease of taking time off. For improvement of clinical nursing competency, the factors elucidated to be necessary were accumulation of experience as a nurse, a clear vision of goals, and a work environment with good interpersonal relationships and ease of getting days off. The way nurses make their nursing practice experience meaningful contributed toward their growth as nurses. It is important to train nurses through basic education and continued education with awareness of achievement and improvement of clinical nursing competency. Basic education should promote the ability to make clinical training experience meaningful and continuing education should enable nurses to continue to grow independently through reflection.

A Narrative Study of Equity in Clinical Assessment Through the Antideficit Lens.

Efforts to address inequities in medical education are centered on a dialogue of deficits that highlight negative underrepresented in medicine (UIM) learner experiences and lower performance outcomes. An alternative narrative explores perspectives on achievement and equity in assessment. This study sought to understand UIM learner perceptions of successes and equitable assessment practices. Using narrative research, investigators selected a purposeful sample of self-identified UIM fourth-year medical students and senior-level residents and conducted semistructured interviews. Questions elicited personal stories of achievement during clinical training, clinical assessment practices that captured achievement, and equity in clinical assessment. Using re-storying and thematic analysis, investigators coded transcripts and synthesized data into themes and representative stories. Twenty UIM learners (6 medical students and 14 residents) were interviewed. Learners often thought about equity during clinical training and provided personal definitions of equity in assessment. Learners shared stories that reflected their achievements in patient care, favorable assessment outcomes, and growth throughout clinical training. Sound assessments that captured achievements included frequent observations with real-time feedback on predefined expectations by supportive, longitudinal clinical supervisors. Finally, equitable assessment systems were characterized as sound assessment systems that also avoided comparison to peers, used narrative assessment, assessed patient care and growth, trained supervisors to avoid bias, and acknowledged learner identity. UIM learners characterized equitable and sound assessment systems that captured achievements during clinical training. These findings guide future efforts to create an inclusive, fair, and equitable clinical assessment experience.

Psychometric Evaluation of the Korean Version of the Student Evidence-Based Practice Questionnaire (S-EBPQ)

PurposeEvidence-based practice (EBP) is a key competency that undergraduate nursing students need to learn, as EBP competence is essential for the effective implementation of EBP. However, few studies have comprehensively assessed the aspects of EBP competence using a reliable and valid measure specific to Korean nursing students. This study aimed to translate the Student Evidence-Based Practice Questionnaire (S-EBPQ) into Korean and evaluate its psychometric properties. MethodsThe original S-EBPQ was translated into Korean. After a pilot test, a convenience sample of 249 college students with more than four weeks of clinical training experience was selected from three universities in September 2017. Reliability and construct validity were evaluated using exploratory and confirmatory factor analyses. Concurrent validity was evaluated by correlating the measure with informatics competency. ResultsThe exploratory factor analysis revealed four factors that explained 66.3 of the variance. The confirmatory factor analysis yielded a 4-factor structure (χ2/df = 1.52, p < .001, standardized root-mean-square residual = .07, root-mean-square error of approximation = .07, goodness of fit index = .84, comparative fit index = .91). The Cronbach’s α was .81 for the total scale. The scale’s correlation with informatics competency was r = .55. ConclusionsThe Korean S-EBPQ is a reliable and valid tool that has utility for assessing EBP competence in Korean nursing students and for making comparisons of the EBP competence of nursing students from other countries.

Queen's University Faculty of Health Sciences.

Queen's University Faculty of Health Sciences.

Trends in operative time and outcomes in minimally invasive hysterectomy from 2008 to 2018

There is a national shift toward laparoscopic hysterectomy as the predominant form of minimally invasive hysterectomy. Previous research suggests that vaginal hysterectomy is associated with lower operative time and improved outcomes; however, this has not been validated in a modern cohort of women. This analysis aims to evaluate whether total vaginal hysterectomy remains associated with lower operative times and fewer postoperative complications than total laparoscopic hysterectomy or laparoscopic-assisted vaginal hysterectomy, given recent shifts in clinical practice patterns and training experience. A secondary analysis of the National Surgical Quality Improvement Program database was performed. Three primary outcomes were defined for the analysis: operative time, rate of major complications, and rate of minor complications. Secondary outcomes included changes in route of surgery over time. Descriptive analyses were performed for all outcomes of interest. Operative time, rate of major complications, and rate of minor complications were compared for each of the 3 forms of minimally invasive hysterectomy: total laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total vaginal hysterectomy. Bivariate analyses were performed using analysis of variance, Kruskal-Wallis, Pearson chi-square, or Fisher exact tests where appropriate. Multivariable ordinary least squares and logistic regression were used to assess for overall differences in outcomes and trends over time, controlling for sociodemographic factors and medical comorbidities. Sensitivity analyses were performed using a propensity score-matched cohort created to balance groups across time. A total of 161,626 women met criteria for inclusion. Rates of total vaginal hysterectomy dropped from 51% to 13% between 2008 and 2018, whereas rates of total laparoscopic hysterectomy increased from 12% to 68% (P<.001). In multivariable analyses, total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy were associated with lower odds of major complications (adjusted odds ratio [95% confidence interval]: 0.813 [0.750-0.881] and 0.873 [0.797-0.957], respectively) and minor complications (adjusted odds ratio [95% confidence interval]: 0.723 [0.676-0.772] and 0.896 [0.832-0.964], respectively) than total vaginal hysterectomy. Temporal trends show an increase in total vaginal hysterectomy operative time and decreases in total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy operative times over the 11-year analysis period (P<.001), although total vaginal hysterectomy continues to have the shortest median operative time overall. No temporal trends were observed in rates of complications. This analysis highlights recent shifts in rates of minimally invasive hysterectomy. Alongside this change in practice pattern, this study also brings to light a resultant shift in the complication rates associated with each surgical approach, as laparoscopic hysterectomy has lower rates of complications than vaginal hysterectomy despite longer operative times.

Performativity, identity formation and professionalism: Ethnographic research to explore student experiences of clinical simulation training.

Developing professional identity is a vital part of health professionals' education. In Auckland four tertiary institutions have partnered to run an interprofessional simulation training course called Urgent and Immediate Patient Care Week (UIPCW) which is compulsory for Year Five medical, Year Four pharmacy, Year Three paramedicine and Year Three nursing students. We sought to understand student experiences of UIPCW and how those experiences informed student ideas about professional identity and their emergent practice as health professionals within multidisciplinary teams. In 2018, we commenced ethnographic research involving participant observation, field notes, interviews, photography and observational ethnographic film. A total of 115 students participated in this research. The emergent findings concern the potentially transformative learning opportunity presented within high fidelity multi-disciplinary simulations for students to develop their professional identity in relation to peers from other professions. Our work also exposes the heightened anxiety and stress which can be experienced by students in such interdisciplinary simulations. Student experience suggests this is due to a range of factors including students having to perform in front of peers and staff in such simulation scenarios when their own professional identity and capabilities are still in emergent stages. Staff-led simulation debriefs form a critical success factor for transformative learning to be able to occur in any such simulations so that students can reflect on, and move beyond, the emotion and uncertainty of such experiences to develop future-focused concepts of professional identity and strategies to support effective interprofessional teamwork.

Clinical Learning, Didactic Education, and Research Experiences of Radiation Oncology Resident Physicians in Canada.

Changes in the field of radiation oncology (RO) impacts residency training. Assessing trainee experiences is essential to inform curriculum development. We aim to explore gaps and strengths in current Canadian RO training, as we move towards competency-based medical education (CBME). An online survey was distributed to residents at all Canadian RO training programs. Surveys consisted of 66 open-ended, Likert-scale, matrix-style, and multiple-choice questions, and assessed clinical exposure, didactic teaching, professional relationships, and research experiences. Statistics were calculated from anonymized, aggregate responses. Out of 128 eligible residents, 53 responded (41% response rate). Of these, 57% were male, and 77% were Canadian medical graduates. Senior residents (PGY-4 to PGY-5) perceived insufficient exposure to lymphoma and ocular malignancies, brachytherapy for breast and esophagus malignancies, and stereotactic radiotherapy of the pancreas, prostate, and adrenal gland. Half (51%) had training on image-guided radiotherapy (IGRT) challenges, and 43% had a formal staff mentor. Most residents presented at least one research project at conferences (77%) and authored ≥ 1 publications (66%) during residency. Canadian RO residents are satisfied with their clinical training and educational experience in high-volume tumor sites and high-volume brachytherapy procedures. Areas identified for potential improvement are (1) low-volume tumor sites; (2) low-volume brachytherapy procedures; (3) low-volume stereotactic radiotherapy sites; (4) IGRT challenges; and (5) mentorship opportunities. These findings will inform future CBME curriculum revisions.

Learners' Perception of the Applicability of Pre-clinical Subjects to Clinical Training and Experience in Obafemi Awolowo University, Ile-Ife.

This article was migrated. The article was marked as recommended. Introduction: This study investigated how Final Year Students and Newly qualified Doctors of Obafemi Awolowo University (OAU) Medical School perceive the applicability of the three pre-clinical subjects (Anatomy, Biochemistry and Physiology) to clinical studies and medical practice with the aim of ascertaining whether or not the students are able to establish a real connect between knowledge acquired in the pre-clinical years and their experience during clinical exposure. Methods: A cross sectional study involving 106 final year medical students and 81 interns was conducted using convenience sampling method. Data was collected using a structured self-administered questionnaire consisting of demographic characteristics and 10 items regarding perception of the relevance of basic medical courses to clinical training experience. Responses were rated using a 5 point Likert scale, which ranged from "strongly disagree" to "strongly agree". Data analysis was carried out using descriptive and inferential statistics and values expressed as mean of scores. Results: Overall mean scores for anatomy, biochemistry and physiology were 26.4 ± 0.32, 25.7 ± 0.29 and 28.1 ± 0.31 respectively. Thus, physiology was rated as having the highest applicability with the highest score in 4 out of 10 items. Biochemistry had the lowest score for the item "I remember most of the content of the course even now". Newly qualified Doctors were found to have a more positive perception of anatomy and biochemistry than final year medical students. All Subjects were scored high (average of 3-0/4.0) on items having to do with introduction of curriculum integration and clinical studies to teaching. Conclusion: Findings from the study suggest that the responses of the subjects were based more on their ability to understand and recall content, rather than how relevant the subjects are to their clinical experience. The study concludes that there is an urgent need to embrace integration of the curriculum and introduce more learner-centered teaching methods.

Addressing the Impact of COVID-19 on the Residency Application Process Through a Virtual Subinternship.

Senior medical students are facing an unparalleled experiential gap left by COVID-19 restrictions. Due to a shared commitment to safety, equity, and well-being, away rotations are actively being discouraged or even prohibited. As a result, students transitioning to residency encounter reduced clinical training experiences and decreased access to advising, mentorship, and research opportunities. In addition, limited exposure to residency life across subspecialties and institutions poses unique challenges during the current residency application cycle. The otolaryngology-head and neck surgery community has met these unprecedented challenges by producing diverse electronic resources for specialty-specific clinical education, as well as discussing ways to increase access to advising. In this commentary, we review these initiatives and propose an institutional virtual event as a platform for meeting goals previously achieved by visiting subinternships.

Assessing the growth in clinical skills using a progress clinical skills examination.

BackgroundThis study evaluates the generalizability of an eight-station progress clinical skills examination and assesses the growth in performance for six clinical skills domains among first- and second-year medical students over four time points during the academic year.MethodsWe conducted a generalizability study for longitudinal and cross-sectional comparisons and assessed growth in six clinical skill domains via repeated measures ANOVA over the first and second year of medical school.ResultsThe generalizability of the examination domain scores was low but consistent with previous studies of data gathering and communication skills. Variations in case difficulty across administrations of the examination made it difficult to assess longitudinal growth. It was possible to compare students at different training levels and the interaction of training level and growth. Second-year students outperformed first-year students, but first-year students’ clinical skills performance grew faster than second-year students narrowing the gap in clinical skills over the students’ first year of medical school.ConclusionsCase specificity limits the ability to assess longitudinal growth in clinical skills through progress testing. Providing students with early clinical skills training and authentic clinical experiences appears to result in the rapid growth of clinical skills during the first year of medical school.

Japanese International Medical Graduates and the United States clinical training experience: Challenges abroad and methods to overcome them.

IntroductionDue to the large language and cultural distances between Japan and the US compared to many countries, Japanese International Medical Graduates (IMGs) may have a different US training experience, including more stress, than many IMGs. We examined the US clinical training experience for Japanese IMGs, including the challenges encountered, how those challenges are overcome, and the benefits of US training.MethodsWe performed individual semistructured interviews with 35 purposively sampled Japanese IMGs who had completed US clinical training. Exploratory thematic analysis was conducted using iterative data collection and constant comparison.ResultsAll participants reported high personal growth and that US clinical training was worth the sacrifices. Commonly fatigue was lower than during Japanese residency. Participants explained medical practice and local culture associated challenges that aligned with literature on US graduates and other IMGs. By contrast, nearly all participants reported that English communication was very challenging, and described specific language related struggles and methods to help overcome them. Communication struggles were contextualized within an American training culture that values verbal assertiveness. Self‐esteem varied among participants and, for some participants, improved with confidence in communication. Several participants reported depression and other mental illness. The training environment varied among residency programs.ConclusionsJapanese IMGs who completed US training report that it was worth it, but describe significant language and culture related struggles and effects on mental health. Further research should address which Japanese IMGs are most likely to struggle, how this will transpire, and how to optimize the US clinical training experience.

The Effect of Verbal ad Non-verbal Violence Experienced at Clinical Training Institutions on Major Satisfaction of Dental Hygiene Students

verbal and nonverbal violence during their clinical training, and the effects of these experiences on their training site satisfaction and major satisfaction.Method/Statistical Analysis: The present study involved 80 students of the Departments of Dental Hygiene of the B, S, and D Colleges in Chungnam who had experience of on-site clinical training. The subjects were asked to answer a questionnaire that included questions about their demographic characteristics, their experience of verbal and nonverbal violence. Independent samples t-test was used to analyze differences in clinical training satisfaction and major satisfaction between experience of verbal and non-verbal violence at clinical training sites.Findings: Regarding the effect of experiences of verbal and nonverbal violence on the clinical training satisfaction, the clinical training satisfaction score was 2.95 out of 5 among the students who had experienced verbal violence, while it was 3.88 among those who had not experienced verbal violence. In addition, the clinical training satisfaction score was 2.85 out of 5 among the students who had experienced nonverbal violence, while it was 3.68 among those who had not experienced nonverbal violence. Regarding the effect of the experience of verbal and nonverbal violence on the major satisfaction, the major satisfaction score was 3.58 out of 5 among the students who had experienced verbal violence, while it was 4.05 among those who had not experienced verbal violence. In addition, the major satisfaction score was 3.33 out of 5 among the students who had experienced nonverbal violence, while it was 4.04 points among those who had not experienced nonverbal violence, indicating that the major satisfaction was higher in the students who had not experienced nonverbal violence, although the difference between the two groups was not significant.Improvements/Applications: The results showed that a significantly high ratio of dental hygiene students had experienced violence, but that they had failed to react positively. Therefore, various efforts and countermeasures must be implemented to reduce the violence that may occur during clinical training.

Ensuring the Availability of Clinical Clerkships at U.S. Hospitals: A Tale of 2 States.

U.S. medical schools are facing growing competition for limited clinical training resources, notably slots for the core clerkships that students most often complete in the third year of their undergraduate medical education. In particular, medical schools in the Caribbean (often referred to as offshore medical schools) are buying clerkship slots at U.S. hospitals for their students, most of whom will be U.S. citizen international medical graduates. For hospitals, especially those that are financially stressed, these payments are an attractive source of revenue. Yet, this practice has put pressure on U.S. medical schools to provide similar remuneration for clerkship slots for their students or to find new clinical training sites.In this Perspective, the authors outline the scope of the challenge facing U.S. medical schools and the U.S. medical education system. They outline legislative strategies implemented in 2 states (New York and Texas) to address this issue and propose the passage of similar legislation in other states to ensure that students at U.S. medical schools can access the clerkships they need to obtain the requisite clinical experience before entering residency. Such legislation would preserve the availability of clerkships for U.S. medical students and the educational quality of these clinical training experiences and, therefore, preserve the quantity and quality of the future physician workforce in the United States.

Continuity from adult-nursing practice to clinical training: Reviewing students’ clinical training experience

Objective: In this study, we analyzed a sample of nursing students, focusing on their self-directed learning experiences as they completed a program comprising specialized exercises and examinations and clinical training. Through this, we aimed to identify means of improving nurses’ self-directed learning skills during nursing education.Methods: Sixty-six third-year university students underwent a six-week adult-nursing training involving participatory-type simulated-patient (SP) exercises and objective structured clinical examinations (OSCEs), during which they maintained portfolios in which they noted their experiences and thoughts as they engaged in this education. We analyzed, through qualitative induction, the written data in these portfolios. We followed this by cross-sectionally integrating, using a chronological perspective, experiences reported by the same sample in previous research, consequently clarifying the structure of the students’ self-directed learning.Results: The students’ self-directed learning experiences during the adult-nursing training were divided into six classifications. Comparison of self-directed learning in participatory-type SP exercises, OSCE, and training, respectively, showed that few students applied their experience of the SP and OCSE exercises in training. However, during training they showed a strong ability to independently perform reviews of challenges that arose in actual practice and to engage in collaboration. They also showed increased desire to perform nursing.Conclusions: As the exercises and practice were not conducted consecutively, external experiences may have affected the continuity of the education, and hindered the students’ ability to maintain a sense of continuous development. Thus, encouraging students to regularly review their education may enhance their self-directed learning skills.

Current status of gerodontology curriculum in India and other parts of the world: A narrative review.

The current rise in the world's geriatric population has placed additional demands on dental professionals, as the management of geriatric patients requires distinct competencies. To review and perform a content analysis of the gerodontology undergraduate curriculum worldwide. A search was carried out in PubMed, Web of Science, ERIC and EMBASE databases for the period-July 2008 till May 2019, using MeSH terms. A search for websites of Indian universities was also done, and undergraduate curricula were screened. The study included articles related to the undergraduate curriculum, which contained training in geriatric dentistry. Articles in foreign languages and those related to dental hygienists were excluded. A total of 218 articles were obtained, of which 19 met the inclusion criteria. A total of 301 colleges taught gerodontology. Amongst them, 50 colleges had a gerodontology department. Clinical training and outreach experience were provided in 175 and 73 colleges, respectively. There are no reports on the status of gerodontology in Asian countries (excluding Japan). In India, gerodontology is not taught as a separate subject. However, few gerodontology-related topics are covered in clinical subjects. There seems to be a wide variation in the content of gerodontology curriculum taught worldwide. Other than the European and American regions, gerodontology is yet to develop in other parts of the world. In India, a robust training programme is required to address the lack of dental care providers for the geriatric population using guidelines established by ECG and ADEA.