First Year Of Clinical Training Research Articles

Multivariate analysis of the factors affecting medical students' decision to join the cardiovascular surgery department.

The purpose of this study was to statistically analyze the factors that influence cardiovascular surgery recruitment. Fifth- and sixth-year medical students and first-year residents who participated in cardiovascular surgery-related events at our university over a 10-year period from April 2013 to August 2022 were included. The primary endpoint was admission to the department of cardiovascular surgery. Gender, participation in sixth-year elective clinical training, participation in national academic conferences, participation in cardiovascular surgery summer school, and the cost of participation in these events (airfares and lodging) were included as analytic factors. Fifty-three participants attended cardiovascular surgery events during the study period. The sample included 48 males (84%) and 9 females (16%), and 3 fifth-year medical students (5%), 45 sixth-year students (79%), and 9 students in their first year of clinical training (16%). Eighteen (32%) of the participants eventually joined the department. Gender, participation in national academic conferences, cardiovascular surgery summer school, and cost of participation were not significantly related to the decision to join the department, but participation in elective clinical training was significantly positively related to the decision to join the department for sixth-year students (p < 0.01). We statistically analyzed the factors involved in the recruitment of students and initial clinical residents to the department of cardiovascular surgery. The results showed that participation in elective clinical training was significantly positively associated with the decision to join the department, suggesting that efforts to encourage participation in elective clinical training are important.

Assessing Diagnostic Reasoning Using a Standardized Case-Based Discussion.

Background:Development of diagnostic reasoning (DR) is fundamental to medical students’ training, but assessing DR is challenging. Several written assessments focus on DR but lack the ability to dynamically assess DR. Oral assessment formats have strengths but have largely lost favour due to concerns about low reliability and lack of standardization. Medical schools and specialist medical colleges value many forms of oral assessment (eg, long case, Objective Structured Clinical Examination [OSCE], viva voce) but are increasingly searching for ways in which to standardize these formats. We sought to develop and trial a Standardized Case-Based Discussion (SCBD), a highly standardized and interactive oral assessment of DR.Methods:Two initial cohorts of medical students (n = 319 and n = 342) participated in the SCBD as part of their assessments. All students watch a video trigger (based on an authentic clinical case) and discuss their DR with an examiner for 15 minutes. Examiners probe students’ DR and assess how students respond to new standardized clinical information. An online examiner training module clearly articulates expected student performance standards. We used student achievement and student and examiner perceptions to gauge the performance of this new assessment form over 2 implementation years.Results:The SCBD was feasible to implement for a large student cohort and was acceptable to students and examiners. Most students and all examiners agreed that the SCBD discussion provided useful information on students’ DR. The assessment had acceptable internal consistency, and the associations with other assessment formats were small and positive, suggesting that the SCBD measures a related, yet novel construct.Conclusions:Rigorous, standardized oral assessments have a place in a programme of assessment in initial medical training because they provide opportunities to explore DR that are limited in other formats. We plan to incorporate an SCBD into our clinical assessments for the first year of clinical training, where teaching and assessing basic DR is emphasized. We will also explore further examiners’ understanding of and approach to assessing DR.

An Assessment of Basic Patient Safety Skills in Residents Entering the First Year of Clinical Training.

During safety rounds, we observed few residents demonstrating hand hygiene and patient identification as they began their postgraduate clinical training. We assessed baseline performance of these 2 basic safety skills in residents entering the first year of postgraduate clinical training (PGY1). PGY1 residents beginning training on July 1, 2013, and July 1, 2014, at our institution were examined using a simulated scenario testing for hand hygiene and patient identification. Nurse volunteers posed as patients and evaluated each resident using a standardized scoring tool. Residents were observed for the following behaviors when interacting: (1) hand hygiene before or upon entry into the patient's room (HHE); (2) resident introducing himself or herself (INTRO); (3) resident identifying patient (IDNB); (4) resident comparing patient's stated name and date of birth to patient's ID band (IDC); (5) resident explaining procedure to patient (EXP); and (6) resident performing hand hygiene upon exiting patient's room (HHL). A total of 114 residents were examined. Compliance results were as follows: HHE at 66% (75); INTRO at 96% (110); IDNB at 52% (59); IDC at 42% (48); EXP at 90% (103); and HHL at 58% (66). Developing and hardwiring basic patient safety skills is essential for creating an institutional culture of safety. We used a simulated patient scenario to provide a baseline assessment of 2 important safety skills.The results obtained demonstrate poor compliance with hand hygiene and patient identification. Our results suggest that there is a need for additional training and perhaps new methods of training and reinforcement in medical school and beyond, to hardwire these basic patient safety skills.

An evaluation of a programme of problem-based learning within a clinical psychology doctorate

Problem-Based learning (PBL) is a widely used teaching method in UK Clinical Psychology training. This study considers the experience of using PBL as part of the University of Bath’s Doctorate in Clinical Psychology. Questionnaire and focus group analyses suggest PBL was predominantly experienced as useful by trainees when completed during the first year of clinical training, especially in terms of skill development around leadership and team working; which was maintained at two-year follow-up when the same cohort of trainees completed an adapted version of the questionnaire during their third year of training. Trainees suggested some difficulties with PBL (e.g. anxieties concerning the lack of a teacher) and suggested improvements (e.g. to timetabling and the case vignette), which have helped sculpt new PBL teaching for subsequent trainees. This study has its limitations, and future research is recommended to further evaluate the use of PBL within clinical psychology training courses nationally.

Developing Dyadic Evaluation for Supervision: An Exploratory Factor Analysis

This study addresses the need for empirically validated tools to support the training, supervision, and the discovery of best practices in Marital and Family Therapy (MFT). This project represents a first step in developing the Dyadic Supervision Evaluation (DSE), an assessment tool that is grounded in developmental and systemic theory and is psychometrically strong. An Exploratory Factor Analysis (EFA) approach was applied to data from 88 trainee-supervisor dyads across four time periods during the first year of clinical training, resulting in 20 factors, including 9 factors for trainees and 11 factors for supervisors with internal reliabilities ranging from α’s = .82–.98. Discussion addresses the utility of the DSE in documenting the developmental and dyadic progression of supervision during the first year of MFT training.

Towards an understanding of medical student resilience in longitudinal integrated clerkships.

BackgroundResilience is required to succeed academically, overcome challenges during clinical training and cope positively with stress in future professional life. With medical students at high risk of mental illness, socially accountable medical schools are seeking to foster student resilience. This exploratory study proposes a conceptual framework for student resilience in longitudinal integrated clerkships (LICs).MethodsThis qualitative study sought to understand student resilience during the first year of clinical training in a rural LIC where there were consistent anecdotal reports of high student resilience. In-depth interviews were conducted with a purposive sample of 19 medical students, professional staff and clinician teachers. An interpretive approach was used to analyse the data with emerging concepts compared to define evolving theoretical constructs, and develop a conceptual framework.ResultsLIC students experienced adversity during the first clinical year of the medical course due to challenges encountered in the learning environment. This distress was moderated by: a secure, supportive learning environment; their profound learning journey; and utilisation of organisational structures to stay on course.ConclusionThis triad of inter-related themes forms a conceptual model that challenges simplistic notions that medical courses should focus solely on providing tangible and emotional supports for students. How LIC programs may contribute to student wellbeing is discussed through the lenses of agentic, reflective and transformative learning.

Investigation of the utility of the acceptance and commitment therapy (ACT) framework for fostering self-care in clinical psychology trainees.

Clinical psychology trainees (CPTs) are susceptible to elevated stress. Despite recognition of the need for training in self-care strategies for CPTs, research in this area is limited, with little progress in the evaluation of effective models for guiding self-care training. This study explored the utility of the acceptance and commitment therapy (ACT) framework for identifying processes and strategies to enhance self-care in CPTs. A total of 116 CPTs completed questionnaires in the first year of clinical training. The ACT processes constituted the predictors: values, defusion (measured as thought suppression), mindfulness, and acceptance. The adjustment criterion variables included: stress, distress, life satisfaction, and clinical training satisfaction. The ACT processes explained significant amounts of variance in all of the adjustment outcomes, and thought suppression, values, and acceptance each emerged as significant predictors of 1 or more of the outcomes. With the exception of mindfulness, the ACT processes were related to better adjustment as predicted. The adverse effects of thought suppression were pervasive, whereas the beneficial effects of acceptance and values varied across adjustment outcomes. Acceptance had unexpected suppressor effects on mindfulness in regression analyses on distress and stress. Findings support the utility of the ACT framework for explaining and enhancing adjustment and self-care in CPTs.

Effects of geriatric clinical skills training on the attitudes of medical students.

BackgroundPhysicians’ attitudes, knowledge and skills are powerful determinants of quality of care for older patients. Previous studies found that using educational interventions to improve attitude is a difficult task. No previous study sought to determine if a skills-oriented educational intervention improved student attitudes towards elderly patients.MethodsThis study evaluated the effect of a geriatric clinical skills training (CST) on attitudes of University of Bern medical students in their first year of clinical training. The geriatric CST consisted of four 2.5-hour teaching sessions that covered central domains of geriatric assessment (e.g., cognition, mobility), and a textbook used by students to self-prepare. Students’ attitudes were the primary outcome, and were assessed with the 14-item University of California at Los Angeles Geriatrics Attitudes Scale (UCLA-GAS) in a quasi-randomized fashion, either before or after geriatric CST.ResultsA total of 154 medical students participated. Students evaluated before the CST had a median UCLA-GAS overall scale of 49 (interquartile range 44–53). After the CST, the scores increased slightly, to 51 (interquartile range 47–54; median difference 2, 95% confidence interval 0–4, P = 0.062). Of the four validated UCLA-GAS subscales, only the resource distribution subscale was significantly higher in students evaluated after the geriatric CST (median difference 1, 95% confidence interval 0–2, P = 0.005).ConclusionsTeaching that targets specific skills may improve the attitudes of medical students towards elderly patients, though the improvement was slight. The addition of attitude-building elements may improve the effectiveness of future skills-oriented educational interventions.

Reliability and Predictive Validity of a Comprehensive Preclinical OSCE in Dental Education

This study examined the reliability and predictive validity of a comprehensive, multidisciplinary objective structured clinical examination (OSCE) used to assess the transition from preclinical to clinical education in a dental school. The examination is administered prior to clinical training at the Columbia University College of Dental Medicine to assess student preparedness for patient care activity. The study population consisted of seventy-five students in the Class of 2010 and seventy students in the Class of 2011. The total reliability of the exam was assessed by Cronbach's coefficient alpha. Using polynomial regression, the predictive validity of the examination was evaluated by correlating student scores on the OSCE with clinical performance as measured by successfully completed clinical procedures during the first year of clinical training. Findings indicate a highly reliable exam (α=0.86 and α=0.80) with a moderately high correlation predicting future clinical performance (r=0.614, p<0.0001; r=0.540, p<0.0001) for the Classes of 2010 and 2011, respectively. The findings suggest that an OSCE can serve as a reliable and predictive assessment during the transition from preclinical to clinical education in the predoctoral dental curriculum.

Communities of clinical practice and normalising technologies of self: learning to fit in on the surgical ward

This paper reports observational research of Fourth Year medical students in their first year of clinical training doing their surgical attachment. Previously, the authors have argued that medical curricula constitute normalising technologies of self that aim to create a certain kind of doctor. Here, they argue that a key mechanism through which these normalising technologies are exercised in the workplace is Etienne Wenger's communities of practice. In the clinical environment the authors identify communities of clinical practice (CoCP) as groups of health professionals that come together with the specific and common purpose of patient care. Fourth Year medical students join these transient communities as participants who are both peripheral and legitimate. Communities of clinical practice are potent vehicles for student learning. They learn and internalise the normative professional values and behaviours that they witness and experience within the disciplinary block of the medical school and teaching hospital; specifically, the authors suggest, it is through their participation in communities of clinical practice that medical students learn how to ‘be one of us’.

Considerações sobre o ensino médico no Brasil: consequências afetivo-emocionais nos estudantes

Faz-se uma revisão não exaustiva da evolução do ensino médico no Brasil desde sua origem, passando pelas inúmeras reformas praticadas, que buscam melhorar a formação técnica dos estudantes. Chama-se a atenção para o fato de nessas reformas nunca terem sido referidas questões como o bem-estar e a saúde mental dos alunos. O curso de Medicina sempre foi considerado estressante, mas a preocupação com esse aspecto é recente na história. Alguns estudos tentam identificar a fase do curso mais estressante, e a maioria indica a primeira série do ciclo clínico. Outros tentam apontar os fatores mais responsáveis pelo estresse, buscando-os nas características dos alunos e do curso. São apontados os diagnósticos mais frequentes citados na literatura e sugestões para minimizar esse processo no âmbito das escolas médicas.

Influences on medical students' decisions to study at a rural clinical school

To identify factors that influenced medical students at Monash University to undertake their first year of clinical training (third year of the medical course) at a rural clinical school (RCS). Third-year Monash University medical students undertaking clinical placements at a RCS were surveyed in 2005. A semistructured questionnaire was used to ask students to rate the influence of a list of factors on their decision to undertake their year-long placement at a RCS. Under half (48%) of students studying at an RCS reported that they were of rural background. All surveyed items were identified as having had a positive influence. Greater clinical experience, learning opportunities and patient access were identified as having the greatest positive influence followed closely by free accommodation and other financial and supportive incentives. Future rural career intention was eight times more likely to be a positive influence in rural compared with urban background students. The most important positive influence on Monash third-year medical students' decision to study at an RCS is the perception of high-quality clinical experiences and education. This perception arises from rural exposure during pre-clinical years.

A Cross-sectional Measurement of Medical Student Empathy

Empathy is important in the physician-patient relationship. Prior studies have suggested that physician empathy may decline with clinical training. To measure and examine student empathy across medical school years. A cross-sectional study of students at Boston University School of Medicine in 2006. Incoming students plus each class near the end of the academic year were surveyed. The Jefferson Scale of Physician Empathy-Student Version (JSPE-S), a validated 20-item self-administered questionnaire with a total score ranging from 20 to 140. JSPE-S scores were controlled for potential confounders such as gender, age, anticipated financial debt upon graduation, and future career interest. 658 students participated in the study (81.4% of the school population). The first-year medical student class had the highest empathy scores (118.5), whereas the fourth-year class had the lowest empathy scores (106.6). Measured empathy differed between second- and third-year classes (118.2 vs 112.7, P < .001), corresponding to the first year of clinical training. Empathy appears to increase from the incoming to the first-year class (115.5 vs 118.5, P = .02). Students preferring people-oriented specialties had higher empathy scores than students preferring technology-oriented specialties (114.6 vs 111.4, P = .002). Female students were more likely than male students to choose people-oriented specialties (51.5 vs 26.9%, P < .001). Females had higher JSPE-S scores than males (116.5 vs 112.1, P < .001). Age and debt did not affect empathy scores. Empathy scores of students in the preclinical years were higher than in the clinical years. Efforts are needed to determine whether differences in empathy scores among the classes are cohort effects or represent changes occurring in the course of medical education. Future research is needed to confirm whether clinical training impacts empathy negatively, and, if so, whether interventions can be designed to mitigate this impact.

Enhancing the Clinical Reasoning Skills of Music Therapy Students through Problem Based Learning

Development of music therapy student clinical reasoning skills is important to ensure ethical and effective therapeutic practice. This action research project sought to evaluate a problem based learning activity with students in their first year of clinical training with an emphasis on developing clinical reasoning skills. Qualitative and quantitative data were sourced from entry and exit surveys, student assessment tasks, and lecturer feedback. Trustworthiness and reflections on the intervention and results were enhanced through discussion with other academics. Results indicate that students were better able to justify clinical decisions, source appropriate literature to support and check decisions, and felt more confident and competent in making clinical decisions. Further research into what constitutes effective lecturer feedback is needed in future studies.

Changes in self-perceived abilities among male and female medical students after the first year of clinical training

Background: It is known that male and female medical students have different experiences in their clinical training.Aims: To assess whether male and female medical students change in their self-rated work habits and interpersonal habits during the first year of clinical training.Method: Longitudinal study of self- and peer-assessment among 224 medical students in 3 consecutive classes at a private US medical school. Students rated themselves on global work habits (WH) and interpersonal attributes (IA). Students also rated and were rated by 6–12 peers on the same scale.Results: In the second year of medical school, there were no differences between men and women in quartiles of self-assessed WH or IA. At the end of the third year, however, women were more likely to be in the lower quartiles of self-assessed WH (X2 = 6.77; p = 0.03), as well as the highest quartiles of self-assessed IA (X2 = 11.36; p = 0.003). In both years, women rated their own WH skills significantly lower than they rated their peers, while men rated themselves similarly to peers. There were no sex differences in self-assessed IA.Conclusions: Although second-year male and female medical students appear similar to one another in terms of self-assessed WH and IA, by the end of the third year women rate themselves relatively lower in WH, while men rate themselves relatively lower in IA.

Extended Work Duration and the Risk of Self-reported Percutaneous Injuries in Interns

In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries. To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States. National prospective cohort study of 2737 of the estimated 18,447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed. Comparisons of rates of percutaneous injuries during day work (6:30 am to 5:30 pm) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 pm to 7:30 am) vs the daytime (7:30 am to 3:30 pm). From a total of 17,003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11). Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training.

"That never would have occurred to me": a qualitative study of medical students' views of a cultural competence curriculum

BackgroundThe evidence is mixed regarding the efficacy of cultural competence curricula in developing learners' knowledge, attitudes and skills. More research is needed to better understand both the strengths and shortcomings of existing curricula from the perspective of learners in order to improve training.MethodsWe conducted three focus groups with medical students in their first year of clinical training to assess their perceptions of the cultural competence curriculum at a public university school of medicine.ResultsStudents evaluated the informal curriculum as a more important source of learning about cultural competence than the formal curriculum. In terms of bias in both self and others, the cultural competence curriculum increased awareness, but was less effective in teaching specific interventional skills. Students also noted that the cultural competence curriculum did not always sufficiently help them find a balance between group-specific knowledge and respect for individual differences. Despite some concerns as to whether political correctness characterized the cultural competence curriculum, it was also seen as a way to rehumanize the medical education experience.ConclusionFuture research needs to pay attention to issues such as perceived relevance, stereotyping, and political correctness in developing cross-cultural training programs.

Incidence of Postoperative Pain After Intracanal Procedures Based on an Antimicrobial Strategy

The purpose of this prospective study was to evaluate the incidence of postoperative pain after intracanal procedures based on an antimicrobial strategy. Data were examined from 627 teeth that had necrotic pulps or required retreatment. Information was obtained for each patient treated with regard to presence of preoperative pain. Occurrence of periradicular bone destruction detected by radiographs was also recorded. The operators consisted of undergraduate students, who were in their first year of clinical training. Root canals were instrumented and then medicated with a calcium hydroxide/camphorated paramonochlorophenol paste. No systemic medication was prescribed. Approximately 1 week after the initial appointment, patients were asked about the occurrence of postoperative pain and the level of discomfort was rated as no pain, mild pain, moderate pain, or severe pain. Data were statistically analyzed using the Chi-square test. Mild pain occurred in 10% of the cases, moderate in 3.3%, and severe (flare-up) in 1.9%. Postoperative pain was significantly associated with the treatment of previously symptomatic teeth without periradicular lesions (p < 0.01). No other correlations were detected between the occurrence of postoperative discomfort and other clinical conditions. There was also no difference regarding the incidence of postoperative pain between treatment and retreatment (p > 0.01). The intracanal procedures used in this study to control root canal infections showed a small incidence of postoperative pain, particularly flare-ups, even performed by inexperienced undergraduate dental students.

Teaching and assessing clinical skills: a competency-based programme in China.

The objective of this study was to develop a competency-based clinical skills teaching and assessment programme in China utilizing modern teaching techniques. Medical teachers from three schools agreed on items for inclusion in the complete physical examination of an asymptomatic adult, an outline for an adult and paediatric history, and important interviewing skills. Lesson plans, performance checklists, and written and videotape training materials were developed. Standardized patients were trained at one school to assist with the teaching at that school and with the assessment at all three schools. A national, a provincial, and a local medical school in China were used. Before beginning the new curriculum for students in their first year of clinical training, baseline data were collected on skills of students at various levels of training in the previous curriculum at all three schools. Although in the previous curriculum there was some improvement in clinical skills among advanced compared to more junior students, performance was lower than expected by staff. One year after implementation of the new curriculum, students were evaluated. These students significantly outperformed their counterparts as well as the more senior level students tested the previous year. This project has established a competency-based teaching and assessment programme in China that allows for rapid improvement in the clinical skills of students. Within a short time, a sophisticated group of medical educators has been formed, who now function as consultants to other educators in their own country. Many aspects of this programme are being adapted throughout China and are applicable to medical schools throughout the world.