Early Clinical Contact Research Articles

Is it worth it? A comparison study of medical students’ aspirations for gaining the Health Care Certificate following employment as Healthcare Assistants

Background Medical students seek early patient contact but their curriculum starts with scientific knowledge. We integrated the Healthcare Assistant (HCA) course into semester one for early patient-facing clinical contact. This study compares students’ aspirations for this learning with the realities of employed work as HCAs. Methods This sequential mixed-methods study used pre-post-scored questionnaire data, followed by post-course focus groups, and interviews a year later. The quantitative data were analysed using SPSS and the qualitative data using thematic analysis. Results The learning was highly valued with early perceptions challenged. The learning both accelerated and advanced their medical skills. Their naivety of nurses’ work within team-based practice quickly eroded; they symbiotically linked their clinical and non-clinical learning; they acclimatised to the hospital environment while future gazing in preparation for clinical learning. Early anxieties for starting employment were overcome, building resilience. Conclusions HCA training offers a practical patient-facing set of competencies on which to build medical capability. Student text-book scientific knowledge was validated through their experiences with recognition of the importance of empathetic patient-centred care. They quickly learnt and absorbed ward function; experienced good and poor teamworking; highly valued the nursing role; and experienced the every-day stresses of being a front-line practitioner.

Tensions and Possibilities: A qualitative study of the views of nurse faculty training medical students to be Health Care Assistants

In the majority of pre-registration training programmes early theory is supported by later clinical learning. Unlike nursing, midwifery and the allied health professions, medical training often offers relatively little early clinical patient contact, though this does vary by medical school. To overcome this, recently, some medical schools offer patient-facing nurse training for the Care Certificate (CC) in the first year, but as yet little is known about how this is being received by nurses. We report on the experiences and perceptions of nurse-led faculty who led a pilot for first year medical students to gain the CC in the academic year 2019-20, in one UK medical school. The qualitative study involved one-to-one in-depth semi-structured interviews with the course educators. Data were analysed using reflexive thematic analysis. Seven faculty participated, sharing their delight at students’ willingness to embrace the CC. Five main themes arose: i) perceptions of doctors and nurses in the healthcare system; ii) affinity with the medical students; iii) benefits of the CC for medical students working as Health Care Assistants; iv) anxiety about teaching the medical students; and, v) uncertainty about whether this training should be compulsory. We discovered that, nurses yearn for greater appreciation for their work by the medical workforce. These teachers felt this could be realised through this change within first year medical training. Many benefits were perceived as an outcome of this training for medical students, all members of the clinical team and most importantly for patients.

Association Between Early Contact With Mental Health Services After an Offense and Reoffending in Individuals Diagnosed With Psychosis

Psychosis is a known risk factor for offending behavior, but little is known about the association between clinical contact with mental health services after an offense and reoffending. To examine the association between early contact with mental health services and reoffending after an index offense in individuals with psychosis. In this cohort study, individuals diagnosed with psychosis before their index offense from July 1, 2001, to December 31, 2012, and who received a noncustodial sentence were identified by linking health and offending databases in New South Wales, Australia. The incidence of and risk factors for reoffending and time to reoffending within 2 years from the index offense were examined using Cox proportional hazards regression and Kaplan-Meier survival estimates. Specifically, the association between contact with mental health services within 30 days after an offense and reoffending was examined. Data were analyzed from July 1, 2019, to March 5, 2020. Hospital admission, emergency department presentation, and contact with community mental health services associated with psychosis. Reoffending within 2 years of the index offense was compared in individuals with and without clinical contact with mental health services within 30 days after an offense, with adjustment for potential confounders. Of the 7030 offenders with psychosis (4933 male [70.2%]; median age at the index offense, 34 [interquartile range, 26-42] years), 2605 (37.1%) had clinical contact with mental health services within 30 days after the index offense. The risk of reoffending was significantly lower in those with vs without clinical contact (adjusted hazard ratio [AHR], 0.83; 95% CI, 0.76-0.91). The risk of reoffending was 30% less in male offenders with 5 or more clinical contacts compared with male offenders with no clinical contact (AHR, 0.71; 95% CI, 0.59-0.84). Reoffending in both male and female offenders was associated with younger age (eg, AHR for male offenders aged <18 years, 3.31 [95% CI, 2.39-4.59]; AHR for female offenders aged <18 years, 2.60 [95% CI, 1.69-3.99]) and offending history (eg, AHR for male offenders with ≥4 prior offenses, 2.28 [95% CI, 1.98-2.64]; AHR for female offenders with ≥4 prior offenses, 2.22 [95% CI, 1.67-2.96]). In this cohort, early and frequent clinical contact with mental health services after an offense in individuals with psychosis was associated with reduced risk of reoffending in this group. More support may be needed for early treatment of those with serious mental illness who are at risk of reoffending.

Empathy variation of undergraduate medical students after early clinical contact: a cross-sectional study in China

ObjectivesEmpathy education is very important for medical students. There is little research on the influence of early clinical practice on the development of empathy and other aspects of professionalism in...

Can an authentic EPortfolio succeed in First Year Medicine?

This article was migrated. The article was not marked as recommended. Introduction Despite evidence supporting ePortfolio use to promote reflective practice, most published studies focus on its use in senior years. This study explored how well the introduction of the Undergraduate Medical ePortfolio (UMeP) in Year 1 of an early clinical contact curriculum met its aims of supporting reflective practice and introducing portfolio learning. Effective mentoring, organisational support, authenticity and adequate time are key to success. Methods A constructivist study heard the voices of students n=14 (2 focus groups) and tutors n=6 (semi-structured interviews) who had used the UMeP in its first introductory year. Thus, triangulation was employed to gain a deeper appreciation. Results Analysis uncovered four major themes- Reflective Practice , Support/Training , ePortfolio functions,and Feedback/Assessment. The study revealed support for the introduction of portfolio learning in Year 1 Medicine, for its role in promoting reflective practice and for maintaining formative assessment. Discussion EPortfolio introduction in Year 1 provided a valuable early introduction to reflection and life-long-learning habits. Regular small group tutor support and feedback were positive factors. The study revealed a need for tutor training on reflection feedback. Introduced at a stage without the weight of clinical commitments, this ePortfolio's limited demands allowed students time to learn and become accustomed to its requirements. Scaffold boxes in ePortfolio forms facilitated reflective writing. Use of an authentic portfolio linked to a professional version was a key engagement factor. Through sharing submissions students learned from each other about reflective writing and confidentiality. Better curriculum integration is needed to develop its potential.

Stretching the Comfort Zone: Using Early Clinical Contact to Influence Professional Identity Formation in Medical Students.

Purpose:To explore first-year medical students’ affective reactions to intimate encounters with severely sick patients in their homes, within a curricular innovation targeting the development of a patient-centered professional identity.Background:Early patient encounters create complex emotional challenges and constitute fertile ground for professional identity formation. The literature indicates that students often learn, largely through the hidden curriculum, to avoid and suppress emotion. This can culminate in mental health problems and loss of empathy.Method:A qualitative descriptive analysis of 28 randomly selected, mandatory, reflective essays focused on a home visit to a previously unknown patient, in an unsupervised group of 4 students, within the context of a structured course called Patient Contact—PASKON.Results:Students described a wide range of affect-laden responses, positive and negative, elicited by the home visits. The observations were typically related to loss of control, struggles to behave “professionally,” and the unmasking of stereotypes and prejudices.Conclusions:Medical students’ initial clinical encounters elicit emotional responses that have the potential to serve as triggers for the development of emotional maturity, relational skills, and patient-centered attitudes. Conversely, they can foreground uncertainty and lead to defensive distancing from patients’ existential concerns. The findings point to a role for structured educational strategies and supervision to assist students in the emotion work necessary in the transition from a “lay” to a “medical” identity.

Teaching practice and thinking of the course of introduction to clinical medicine

In Chongqing Medical University, Introduction to Clinical Medicine was first launched in 2002. In this article, based on the summary of 2014 to 2015, we summarized respectively from teaching material construction, evaluation system with combination of formative assessment and summative assessment, network support platform, teaching quality monitoring system, and student questionnaire survey and evaluation. Through the study of the course, 99.5%(836/840)of the students think their team conscious-ness and cooperation ability were improved, 94.2%(791/840)of the students consider this course can improve their innovative ability of self-learning, 87.0%(731/840)of the students think it is beneficial to the improvement of their self expression ability and more than 78.0% of the students think they have achieved the goal of early clinical contact, expanding knowledge, and enhancing the basic professional quality. Key words: Iintroduction to clinical medicine; Teaching practice; Examination and evaluation system; Student assessment

Application of surgery experience teaching in early clinical contact education

To discover medical teaching method which is more funny and effective in early clinical contact education, Eye optical hospital affiliated to Wenzhou Medical University set up oph-thalmic microsurgery experience teaching course for junior medical students and set a variety of eye surgery simulation experience content, such as conjunctival suture surgery, corneal suture surgery, cataract surgery, eye surgery simulation and so on, which can effectively arouse students' professional interest in learning and promote students' thinking and exploration to their profession. Key words: Experience teaching; Early clinical contact; Ophthalmology; Medical education; Teaching methods

Characteristics and enlightenment of teaching and clinical model of medical imaging in Italy

Italian medical imaging education includes two parts: training for radiologists and for radiologic technologists. To be a radiologist, the six-year medical students after graduation must complete specialty training in radiology and pass the examination. Radiologic technologists are selected from the three-year bachelor graduates of medical imaging technology. There are basic medical science courses, cultural practice and clinical practice in medical college every year. Continuing medical imaging education includes lectures, case discussions and other forms. Radiologists are required to master all kinds of imaging techniques, working as clinical rotation in every section of medical imaging depart-ment. Patients need to make an appointment before having the medical imaging examination. Through the analysis of the characteristics of Italian medical imaging teaching and clinical patterns, the author puts forward the suggestion of putting emphasis on medical imaging curriculum reform, the full imple-mentation of the early clinical contact, and at the same time improving the professional medical image training mode to improve the radiologists' clinical ability. Key words: Medical imaging; Medical imaging technology; Clinical medicine

Characteristics and enlightenment of medical curriculum design in England

The medical curriculum which is designed reasonable, plays a decisive role in the training specifications and quality of medical talents. The medical education in England is always in the world first column, and its medical curriculum is distinctive. The courses are mostly offered by theform of integration. They pay more attention to the setup of selective courses, humanities and social sciences courses, and they also put emphasis on the early clinical contact and early scientific research training. In addition, they are also outstanding in practice and internship. There is much beneficial enlightenment for our country＇s course reform from the British medical curriculum design, namely to establish integration courses which is interdisciplinary, to strengthen the humanistic quality＇s cultiva- tion, to advocate early clinical contact and early scientific research, and to strengthen cooperation and coordination between medical colleges and social organizations in all aspects. Key words: England; Medical colleges and universities; Curriculum

Learning through work: Clinical shadowing of junior doctors by first year medical students

Background: Early clinical contact (ECC) is a key feature of undergraduate programmes, yet they make significant demands on senior clinicians delivering it and usually focus on patient contact.Aims: To explore the potential of an ECC activity oriented to work as a junior doctor and the clinical environment, and the use of very junior doctors as facilitators of this learning.Methods: For two academic years, all first year medical students at UCL Medical School shadowed a Foundation Year (FY) doctor for a four-hour shift to experience and understand the work of junior doctors. Feedback from students and FY doctors was gathered and analysed.Results: The students found the FY doctors to be good near-peer tutors and enjoyed exploring the clinical environment, but felt that the unstructured learning environment was difficult. The FY doctors felt that learning in and about the clinical environment was an important learning outcome for the students, although they found supervising junior medical students in a shadowing context difficult.Conclusions: FY doctors are an effective and under-utilised resource in introducing novices to the role of a medical professional in the clinical environment; however students and FY doctors need support to maximise the learning potential of early shadowing activities.

Student perceptions of the progress test in two settings and the implications for test deployment

The Progress Test (PT) was developed to assess student learning within integrated curricula. Whilst it is effective in promoting and rewarding deep approaches to learning in some settings, we hypothesised that implementation of the curriculum (design and assessment) may impact on students' preparation for the PT and their learning. Aim To compare students' perceptions of and preparations for the PT at two medical schools. Focus groups were used to generate items for a questionnaire. This was piloted, refined, and then delivered at both schools. Exploratory factor analysis identified the main factors underpinning response patterns. ANOVA was used to compare differences in response by school, year group and gender. Response rates were 640 (57%) and 414 (47%) at Schools A and B, respectively. Three major factors were identified: the PT's ability to (1) assess academic learning (2) support clinical learning; (3) the PT's impact on exam preparation. Significant differences were found between settings. In the school with early clinical contact, more frequent PTs and no end of unit tests, students were more likely to appreciate the PT as a support for learning, perceive it as fair and valid, and use a deeper approach to learning-but they also spent longer preparing for the test. Different approaches to the delivery of the PT can impact significantly on student study patterns. The learning environment has an important impact on student perceptions of assessment and approach to learning. Careful decisions about PT deployment must be taken to ensure its optimal impact.

Practice and understanding eight-year program clinical teaching of internal medicine during early clinical contact stage

“Early clinical contact” is one of the teaching means of pre-clinical education.Internal medicine department of Tongji hospital attached to Huazhong university of science and technology has done many exploration and has gained many experiences in the stage of “Early clinical contact” of 8-year medical program.They put forward some ideas,including intensifying legal,ethics and morality sense; intensifying communication ability and clinical thinking ability cultivation; intensifying cultivation of scientific research and clinical scientific thinking consciousness ; intensifying learning of clinical medical English.They also summarize a set of effective teaching methods with characteristics. Key words: Eight-year program; Early clinical contact; Internal medicine; Clinical medical teaching

New York University School of Medicine

New York University School of Medicine

What influences student experience of Graduate Entry Medicine? Qualitative findings from Swansea School of Medicine

Background: The Graduate Entry Programme (GEP) in Medicine delivered by Swansea University (currently in collaboration with Cardiff University) accepts students from a diverse range of academic backgrounds with no restriction in relation to the field of first degree. There is a growing body of literature, predominantly quantitative in nature, regarding the influence of academic background on student achievement but little published information on students’ views.Aim: To examine students’ views regarding the extent to which previous higher education and wider life experience influence their student experience on the GEP course.Method: Recruitment from three student cohorts and group interview data followed by descriptive thematic analysis of anonymized data.Results: Data themes were: (1) previous study experience and its impact on present student experience; (2) the impact of life experience; (3) the impact of the present study on life experience; (4) skills, status and difference; (5) characteristics and expectations of the course; (6) finances and (7) next steps. Previous study experience had little impact on present student experience. However, previous life experience, with time between first degree and GEP, clearly enhances the learning experience. Added maturity and early clinical contact enables students to manage the challenges of the course and the NHS environment despite financial strain and heavy coursework.Conclusions: Analysing students’ views is informative and provides richer insight into experience and expectations than that accessible from quantitative data alone.

Teaching professionalism in the early years of a medical curriculum: a qualitative study

Despite the growing literature on professionalism in undergraduate medical curricula, few studies have examined its delivery. This study investigated tutors' and students' perspectives of the delivery of professionalism in the early years of Glasgow's learner-centred, problem-based learning (PBL), integrated medical curriculum. A qualitative approach was adopted involving semistructured interviews, on a 1 in 6 sample of tutors involved in teaching in the early curricular years, and 3 student focus groups. The findings were subjected to between-method triangulation. Involvement in teaching raised students' and tutors' awareness of their professionalism. Learning activities promoting critical reflection were most effective. The integration of professionalism across the domains of Vocational Studies (VS) was important for learning; however, it was not well integrated with the PBL core. Integration was promoted by having the same tutor present throughout all VS sessions. Early patient contact experiences were found to be particularly important. The hidden curriculum provided both opportunities for, and threats to, learning. The small-group format provided a suitable environment for the examination of pre-existing perspectives. The portfolio was an effective learning tool, although its assessment should be formalised. Reflection is integral to professional development. Early clinical contact is an important part of the process of socialisation, as it allows students to enter the community of practice that is the medical profession. Role models can contribute powerfully to students' learning and identity formation. As students move towards fuller participation, the clinical milieu should be controlled to maximise the influence of role models, and opportunities for guided reflection should be sustained.

The development of reasoning skills and expertise in primary care

WHAT IS ALREADY KNOWN IN THIS AREA• The acquisition of clinical reasoning skills from novice to advanced student has been described and compared with experienced clinicians Research from the field of cognitive psychology suggests that development of such skills depends upon organizing packages of information into coherent structures which are quickly accessible from memory. These are called 'instance scripts?. Various strategies are employed in reasoning, starting with step-by-step analysis by novices, moving towards categorisation processes in-advanced practitioners (e.g. pattern recognition).WHAT THIS WORK ADDS• This work suggests a reference framework for reasoning skills and expertise development from novice to experienced practitioner within primary care. It extends ideas from existing Studies using medical students into postgraduate professional development, encompassing various transitions from newly qualified doctor to training registrar, and from new principal towards the experienced practitioner.• Within these transitory stages, reasoning strategies are highlighted, including potential problem areas and appropriate educational implications. The role of follow up mechanisms for GP registrars is suggested to enable validation of illness vectors in the natural history of disease and recovery. Extension of training schemes to provide for expertise development in primary care is proposed as the logical context where such skills can be improved.SUGGESTIONS FOR FUTURE RESEARCH• Current research in medical education in the UK appears to be heavily concentrated upon skills and competency assessment. These are more easily measured than cognitive skills. However, the impact of early clinical contact in UK medical schools upon cognitive skills could be compared with other countries where clinical contact is still delayed. Early patient contact may shift acquisition of some cognitive skills back in the proposed framework.• In addition to this, the impact of the foundation programme upon doctors subsequently entering primary care will provide the biggest stimulus for research, assuming that cognitive attributes, such as decision-making skills, are assessed alongside practical competencies.

Sometimes we do get it right! Early clinical contact is a rewarding experience.

Like many other medical education bodies, the Health Professions Council of South Africa has advocated changes in the education and training of medical practitioners. The suggested reform includes early clinical exposure in a range of settings. Early in the design of Curriculum 2001, a problem-based learning programme, health care visits in Year 1 were considered essential. Since the student population was diverse in many aspects, including age, it was necessary to evaluate whether students were prepared for the early exposure. Data on the impact of the health care visits were collected directly through a survey administered towards the end of the academic year and indirectly from student comments regarding their most rewarding experiences during the year. Responses to survey items indicated that students were generally prepared for their health care visits and gave them insights into the activities of a medical practitioner. Sixty-nine per cent of students indicated that aspects of their health care visits, particularly the labour ward and an ambulance duty where many had hands-on experience, were their most rewarding experiences. The decision of curriculum organisers to introduce students to patients in Year 1 of the new PBL curriculum was well received. Despite their young age, many students believed that they were psychologically prepared for this exposure. For many, it was the highlight of their academic year, often reinforcing their original desire to study medicine and allowing them to experience the real world of medicine.

The earlier, the better: the effect of early community contact on the attitudes of medical students to older people.

Early clinical contact for medical students is an important curricular innovation. We wished to determine if early contact with older people in the second year of a more vertically integrated medical undergraduate programme influenced attitudes to older people and if any effect was synergistic with the effect of an existing fourth year course. Second and fourth-year medical students. We used a modified version of the Rosencranz-McNevin semantic differential on ageing to assess attitudes of medical students before and after a one-week early community contact week. Some second-year students were followed into fourth year and the effect on their attitudes of a health care of the elderly course was measured. We compared these data with attitude scores from an earlier cohort of students who had undertaken the fourth-year but not the second-year component. Contact with older people during second-year had a significantly favourable effect on attitudes to older people, especially for students who saw older people in the community rather than in rest homes. The attitudes towards older people of students who had undertaken a fourth-year clinical health care of the elderly attachment were significantly better on two of three subscales than those of fourth-year students who had not seen older people during their second year. Contact with older people early in a medical student's training, and within a more vertically integrated programme, has a positive effect on attitudes to older people. This effect may be synergistic with contact later in training.

School visits: Medical students as teachers

Developing links with local communities is becoming a priority for medical schools, especially as they encourage students to enter primary care. In this early clinical contact program, second-year students make presentations in local schools. Our experience documents that community education projects can be successfully incorporated into the preclinical curriculum. However, outreach programs of this type need to focus on educational rather than promotional goals. Early in the program, a lack of educational materials and readily available promotional items distorted the image of the program and led to questions about its value. Providing high-quality teaching materials addressed these concerns and led to a significant increase in teacher ratings of the program.