History-taking Skills Research Articles

1117. An HIV Primary Care Rotation Improved HIV and STI Knowledge, Enhanced Sexual History-Taking Skills, and Increased Interest in a Career in Infectious Diseases among Medical Students and Residents

BackgroundClinical rotations in HIV primary care provide a unique opportunity to teach trainees about the management of HIV and other sexually transmitted infections (STI), and enhance trainees’ skills in obtaining a culturally-competent sexual history. Positive educational experiences in this setting may also influence trainees’ decisions to pursue a career in HIV Medicine and Infectious Diseases (ID). However, little is known about the impact of an HIV clinic rotation on trainees’ fund of knowledge regarding HIV and STI management, confidence in obtaining a sexual history, or interest in HIV and ID as a career choice.MethodsThird year medical students and Internal Medicine residents rotate for two to four weeks in UCSD’s HIV primary care clinic. Over a six month period (September, 2019 - February, 2020) trainees were given a pre and post rotation survey to evaluate their fund of knowledge in managing patients with HIV and other STIs, their confidence in taking a sexual history, and their interest in pursuing a career in HIV and ID.ResultsTwenty-one of the 31 trainees completed both the pre- and post-rotation survey. Residents and medical students comprised 57% (12) and 43% (9) of the cohort, respectively. Fund of knowledge regarding antiretroviral management, HIV transmission, and STI diagnosis and treatment improved following the rotation (Figure. 1). Trainees’ confidence in their ability to manage patients with HIV and obtain a sexual history also improved (Figure. 2). Importantly, there was a substantial increase in the proportion of trainees interested in pursuing a career in HIV and ID after the rotation compared to beforehand (Figure. 2).Fund of Knowledge Pre and Post Rotation Self-Perceived Competency and Interest in HIV Clinical Care ConclusionClinical rotations in HIV primary care provide valuable learning experiences for trainees by improving their fund of knowledge about HIV and STIs, and their self-efficacy in obtaining a sexual history. These clinical experiences may also be important in recruiting trainees to pursue a career in HIV and ID. Given the importance of these clinical skills and the need to increase the number of trainees entering the field, additional support for educational experiences in HIV primary care clinics is warranted.Disclosures All Authors: No reported disclosures

Pharmacy Students’ Perceptions and Performance on the Use of an Online Virtual Experience Tool for Practicing Objective Structured Clinical Examinations

Objective. To examine pharmacy students' performance on and perceptions regarding the use of an interactive online tool for practicing to take objective structured clinical examinations (OSCEs).Methods. The Monash OSCE Virtual Experience (MOVE), an online module consisting of 20 pharmacy case scenarios with virtual patients, was piloted with final-year pharmacy students at Monash University campuses in Australia and Malaysia. A mixed methods approach that included reviewing user attempts and comparing grades, collecting student-administered questionnaires, and holding focus groups was used to examine students' perception and performance.Results. More than 99% of all students attempted at least one online case scenario in preparation for their final in-person OSCE, and 81% attempted all 20 scenarios two or more times. Ninety percent of students at the Malaysia campus and 70% of students at the Australia campus reported that MOVE was a helpful study tool for their OSCE preparation. However, a raw comparison of user attempts and OSCE grades did not find a direct correlation between online module attempts and assessment grades. Self-administered questionnaire and focus group results indicated that MOVE prepared students for targeted and time-restricted history-taking and problem-solving skills. Overall, students perceived MOVE to be a useful learning tool and a less overwhelming learning experience than were face-to-face sessions. Nevertheless, students still preferred face-to-face OSCE practice with simulated patients over online practice with virtual patients.Conclusion. The Monash OSCE Virtual Experience was perceived by our students as a flexible and useful online learning aid in preparing for their final-year OSCE However, there was no direct correlation between online practice attempts and students' exam grades.

Determining the utility of peer-assisted learning to enhance clinical skills at the bedside in a Postgraduate Homoeopathic Institute

Objectives: Despite considerable clinical material in hospitals, students often cannot hone their bedside skills; these skills need continuous practice and input from teachers and medical officers (MOs). Making such inputs frequently available to students in busy wards and casualties is very demanding. We, therefore, conducted this study to explore the utility of peer-assisted learning (PAL) as an alternative to enhance students’ clinical skills at the bedside in a Postgraduate Homoeopathic Institute. This study was conducted at a 100-bedded Homoeopathic PG institute hospital with a 24-h emergency ward where various clinical conditions and emergency cases are treated. The objectives of the study were to study the role of PAL in enhancing clinical skills in terms of receiving the patient, history taking, clinical examination, and developing collaborative and constructive practices at the bedside and exploring the role of PAL in developing a conducive atmosphere of learning and to enhance sensitivity to peers. Materials and Methods: An orientation session and checklist were created after input from MOs and through a pilot study of 25 Part one senior. The students were educated regarding the concept and were asked to take up one case every week to observe and discuss each other’s clinical skills for 12 weeks with the help of a checklist. A retrospective pre-questionnaire was used to analyze the enhancement of clinical bedside skills. The MO analyzed these using the same questionnaire and collectively analyzed student performance at the end of 12 weeks. Results: Student responses were evaluated statistically using the Wilcoxon matched pairs signed-rank test (P ≤ 0.05). The results revealed a significant change in history-taking attitude, history-taking skills and knowledge, examination skills, investigation correlations, interpersonal relationships, and learning atmosphere. Conclusion: The process of PAL enables student physicians to improve their clinical knowledge, skills, and attitude along with interpersonal relations. This process also enables collaborative and constructive learning and improves students’ sensitivities, allowing them to learn from each other.

Virtual care rotation for internal medicine residents during the COVID-19 pandemic.

All learning objectives were met. This rotation was particularly effective at allowing residents to hone history-taking, communication, counselling, and rapport-building skills due the nature of providing care virtually. In the absence of the ability to examine patients or use body language to support interactions, residents learned to ascertain patients’ emotions and build common-ground without the benefit of face-to-face interaction. The rotation provided increased exposure to the wide scope of ambulatory internal medicine, sparking at least one resident’s interest in ambulatory care. The rotation initially focused on COVID-19 care to allow residents to feel part of the solution to the pandemic. During the PAR reflection process, we identified that residents felt that CPAC care was algorithmic and less educational than GIM clinics. To improve the educational experience of the AVCR, we now provide opportunities in virtual subspecialty medicine clinics. For technical reasons, video visits only became a possibility partway through the rotation; and we will be incorporating more for the next iteration. Barriers to implementing virtual care, privacy, legal issues, and payment models were suggested as topics of formal discussion during the rotation; we will be incorporating these topics into a weekly journal club. Administratively, finding supervisors for residents was challenging. Faculty cited having to learn the novel technology and keep abreast with the ever-evolving COVID-19 knowledge required to supervise as deterrents. Clarifying supervisory expectations for attending physicians can be helpful; nonetheless, getting buy-in from sufficient potential supervisors was only achieved through significant persistence. Notably, the flow of resident supervision in clinical interactions was not different. Patients accepted waiting on hold for case review. Moreover, speakerphone and video telecommunication made engaging in conversations between the attending physician, residents, and patients seamless. AVCR was a success. The demand for virtual care is increasing, as is the need to educate physicians in these newer models of care.2 Incorporating novel models of care into residency should be done irrespective of a pandemic in order to build residents’ skills for the future and to integrate such ‘novel’ models of care into everyday medicine.

William F. Hoyt and the Neuro-Ophthalmology of Superior Oblique Myokymia and Ocular Neuromyotonia

The contributions of William F. Hoyt, MD, to the field of neuro-ophthalmology are immense. His precision in history-taking and examination skills provided the foundation to fully understand a clinical disorder-determining its underlying pathophysiology, prognosis, and management. We describe two unusual eye movement disorders, superior oblique myokymia and ocular neuromyotonia, and how Dr. Hoyt's contributions shaped our understanding of these clinical entities.

Addressing the Rapidly Increasing Need for Telemedicine Education for Future Physicians.

As the COVID-19 pandemic affected the ability to conduct in-person sessions to teach clinical skills, our medical school developed a curriculum to introduce first-year medical students to telemedicine visits, while also reinforcing their history-taking and clinical reasoning skills. All first-year medical students at Florida Atlantic University went through three sessions on telemedicine that began with a lecture, followed by a standardized patient interaction, then a small group meeting with clinical faculty. We assessed the sessions using survey questions on a 5-point Likert scale and additional narrative feedback. We also assessed students on a telemedicine objective structured clinical examination (OSCE) at the end of the semester and compared results to the previous year's same case done in person. Students overall found the sessions helpful for refining their history-taking skills and that the knowledge gained would be helpful in their future practices. They felt the online platform was a useful way to interact with patients, but had frustrations with technical difficulties. They also expressed a greater appreciation for the ability to perform an in-person physical examination. Students performed similarly on the OSCE station in person compared to virtual visits (mean score 93% vs 93.75%). Introducing telemedicine during a first-year medical school clinical skills course provides students with opportunities to refine their clinical skills while introducing a skill that will be commonplace in the postpandemic environment. This curriculum could be adopted not only during a time of necessary distance learning, but also continued as in-person education resumes.

The University of Texas Health Science Center at San Antonio, Joe R. and Teresa Lozano Long School of Medicine.

The University of Texas Health Science Center at San Antonio, Joe R. and Teresa Lozano Long School of Medicine.

Perspectives of medical students on local medical education during COVID-19.

Perspectives of medical students on local medical education during COVID-19.

Comparison of Assessment by a Virtual Patient and by Clinician-Educators of Medical Students' History-Taking Skills: Exploratory Descriptive Study

BackgroundA virtual patient (VP) can be a useful tool to foster the development of medical history–taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students’ skills, documenting and assessing skills acquired through a VP is a challenge.ObjectiveWe propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs).MethodsWe built upon 4 domains of medical history taking to be assessed (breadth, depth, logical sequence, and interviewing technique), adapting these to be implemented into a specific VP environment. A total of 10 CEs watched the screen recordings of 3 students to assess their performance first globally and then for each of the 4 domains.ResultsThe scores provided by the VPs were slightly higher but comparable with those given by the CEs for global performance and for depth, logical sequence, and interviewing technique. For breadth, the VP scores were higher for 2 of the 3 students compared with the CE scores.ConclusionsFindings suggest that the VP assessment gives results akin to those that would be generated by CEs. Developing a model for what constitutes good history-taking performance in specific contexts may provide insights into how CEs generally think about assessment.

CyberPatient<sup>TM</sup>—An Innovative Approach to Medical Education

Background: Variety of tools has been used to teach history-taking skills to novice learners. Standardized Patient (SP) is the gold standard for medical education. We hypothesized that the use of online simulation platforms CyberPatientTM (CP) is as effective as SP. Methods: In this prospective randomized controlled trial study, the educational effectiveness of CP was compared to SP in improving history taking skills. Twenty-two incoming students at University of British Columbia (UBC) were randomly divided in to two (SP and CP) groups. SP Group (n = 11) practiced their history taking skills with the standardized patients and CP Group (n = 11)—with CyberPatients. The content for both groups included 3 cases of GI pathology and the study time was 60 minutes. Assessment method included Objective Structured Clinical Examination (OSCE) before and after interventions. Data were analysed in a two-way between/within ANOVA and Wald test was used to deal with the violation of the ANOVA assumptions. Economic benefits were assessed as Cost-effectiveness (calculated as Cost/Effect Ratio) and Cost-Value Proposition (Cost-Vale Relationship). Results: Results of this study indicated that both groups had significant (SP group p = 0.006 and CP group p = 0.0001) improvement in the knowledge domain of history taking. The history taking knowledge variable in both groups manifested a significant main effect of time indicating that students did better after interventions, F (1, 15.1) = 10.5, p = 0.011. The groups performed at a similar level after intervention. Moreover, results show that the use of the CP is more cost-effective and has a better cost/value proposition for medical education. Conclusion: We conclude that CyberPatientTM is as effective as using standardized patients in delivery of practical knowledge for novice medical students, however, CyberPatientTM is more economically rewarding.

Effect of Paper- and Computer-based Simulated Instructions on Clinical Reasoning Skills of Undergraduate Medical Students: A Randomized Control Trial.

Background and objectivesSkilled clinical reasoning is a critical tool for physicians. Educators agree that this skill should be formally taught and assessed. Objectives related to the mastery of clinical reasoning skills appear in the documentation of most medical schools and licensing bodies. We conducted this study to assess the differences in clinical reasoning skills in medical students following paper- and computer-based simulated instructions.Materials and methods A total of 52 sixth semester medical students of the Dow University of Health Sciences were included in this study. A tutorial was delivered to all students on clinical reasoning and its importance in clinical practice. Students were divided randomly into two groups: group A received paper-based instructions while group B received computer-based instructions (as Flash-based scenarios developed with Articulate Storyline software [https://articulate.com/p/storyline-3]) focused on clinical reasoning skills in history-taking of acute and chronic upper abdominal pain. After one week, both groups were tested at two objective structured clinical examination (OSCE) stations to assess acute and chronic pain history-taking skills in relation to clinical reasoning.ResultsThere were 27 students in group A and 25 students in group B. The mean OSCE score for group A (paper-based) was 28.6 ± 9.4 and that for group B (computer-based) was 38.5 ± 6.0. Group B’s mean score was statistically significantly greater (p < 0.001) than group A’s mean score for clinical reasoning skills. ConclusionA computer simulation program can enhance clinical reasoning skills. This technology could be used to acquaint students with real-life experiences and identify potential areas for more training before facing real patients.

AN EXTINCT CURE FOR AN ANCIENT DISEASE: RECOGNIZING PLOMBAGE

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Despite advances in the treatment of pulmonary tuberculosis (TB) in the last century tuberculosis remains one of the top ten causes of death worldwide [1]. Antibiotic therapy has supplanted surgical treatment and it is unusual to recognize patients with previous surgical treatments. We review the case of a patient with a history of TB who presented with a lung mass. Our goal is to reinforce awareness of an outdated TB treatment and to emphasize the importance of thorough history-taking in reaching the correct diagnosis. CASE PRESENTATION: A 71-year-old lady was referred to our service for evaluation of a left upper lobe mass. She reported no respiratory symptoms, but confirmed an abnormal sensation and a stabbing pain from her fingers radiating up her arm and across her chest. Given her suspicious arm pain a shoulder and spine x-ray were ordered which showed a large calcified mass in the left lung apex and volume loss in the left lung. She revealed that she grew up in an orphanage in Columbia . When specifically questioned, she recalls being diagnosed with TB and treated with surgery as a teenager in 1961 eight years before immigrating to the United States. Physical exam was significant for a left posterior thoracotomy scar and equal bronchovesicular breath sounds. All other components of the physical exam were within normal limits. A subsequent CT scan showed a non-enhancing 12 cm heavily ossified septated left upper thorax mass possibly arising from an upper left ribs. The mass contains chondroid matrix and peripherally high-density septations throughout with a low-density center. Brachial plexus involvement cannot be excluded. The mass was consistent with plombage treatment for TB and biopsy was not recommended. DISCUSSION: During the 1930s-1950s the standard of care for TB involved surgical collapse of the lung; a treatment called, “plombage”. A shift toward antibiotic treatment was made with the development of streptomycin in 1946, which was found to have curative effects [2]. Inert plombage materials included mineral oil, air, paraffin wax, and polymethyl-methacrylate (Lucite) balls [3]. Upon insertion into the chest cavity, the affected lobe would collapse, decreasing ventilation to the region and starving the aerobic bacteria of oxygen. As antibiotics to TB were developed plombage treatment fell out of favor in most parts of the world. Late complications of plombage can include hemorrhage, infection, chest wall deformities, fistulization to bronchi, great vessels in the thoracic cavity, and esophagus or brachial plexopathy. CONCLUSIONS: Obtaining the patient’s complete history particularly of tuberculosis treated in her native country in 1961 became central to the diagnosis of retained calcified Plombage material.It is important for physicians to move beyond the most likely diagnosis and rely on thorough history-taking skills to arrive at the correct diagnosis. Reference #1: 1. Mathers et al (2009). “Global and Regional Causes of Death” British Medical Journal Reference #2: 2. D'Arcy Hart P (August 1999). "A change in scientific approach: from alternation to randomised allocation in clinical trials in the 1940s". British Medical Journal. Reference #3: 3. Historical TB treatment – Plombage; QJM: An International Journal of Medicine, 2017 DISCLOSURES: No relevant relationships by Kristin Fless, source=Web Response no disclosure on file for Nirav Mistry; No relevant relationships by Mihir Odak, source=Web Response No relevant relationships by Vagram Ovnanian, source=Web Response No relevant relationships by Killol Patel, source=Web Response No relevant relationships by Fariborz Rezai, source=Web Response No relevant relationships by Paul Yodice, source=Web Response

Interns as medical educators: student and intern experiences from the intern-delivered teaching program at University Hospital Limerick.

The acquisition and assimilation of knowledge through history-taking and clinical skills practice are core aspects of training for medical students. Interns, who have recently graduated and have entered into clinical practice, are uniquely positioned to assume a pivotal role in student education. The goal of this study was to evaluate feedback from both students as well as intern tutors on the intern-delivered teaching program at University Hospital Limerick (UHL) from 2015 to 2016. Eighty-five interns participated in the program at UHL in 2015 and 2016, aiming to deliver four 1-h tutorials to 285 Year 3 or Year 4 students from UL Graduate Entry Medical (GEMS) Program. A flexible schedule focused on practical skills and knowledge translation was created with oversight from Lead Interns and Professor of Medicine, with administrative support. Feedback was assessed using anonymous survey questionnaires. The survey response rate was 74% in 2015 and 75% in 2016. Student feedback on the performance of intern tutors was positive. More than 50% of students deemed tutorials on history-taking and clinical examination as the most valuable. Over 76% of students indicated a desire to participate as tutors after graduation. Logistical issues in agreeing mutually suitable timeslots were identified as the major barrier for delivery of teaching. From the intern perspective, over 85% reported benefits in areas of professional development and knowledge consolidation. Participation in intern-delivered teaching leads to clinical and educational benefits for both students and interns. However, several logistical barriers were identified and require refinement.

Using virtual standardized patients to accurately assess information gathering skills in medical students

Introduction: Practicing a medical history using standardized patients is an essential component of medical school curricula. Recent advances in technology now allow for newer approaches for practicing and assessing communication skills. We describe herein a virtual standardized patient (VSP) system that allows students to practice their history taking skills and receive immediate feedback.Methods: Our VSPs consist of artificially intelligent, emotionally responsive 3D characters which communicate with students using natural language. The system categorizes the input questions according to specific domains and summarizes the encounter. Automated assessment by the computer was compared to manual assessment by trained raters to assess accuracy of the grading system.Results: Twenty dialogs chosen randomly from 102 total encounters were analyzed by three human and one computer rater. Overall scores calculated by the computer were not different than those provided by the human raters, and overall accuracy of the computer system was 87%, compared with 90% for human raters. Inter-rater reliability was high across 19 of 21 categories.Conclusions: We have developed a virtual standardized patient system that can understand, respond, categorize, and assess student performance in gathering information during a typical medical history, thus enabling students to practice their history-taking skills and receive immediate feedback.

Reflective and feedback performances on Thai medical students\u2019 patient history-taking skills

BackgroundReflective practice (RP) plays a crucial role in encouraging learners to think critically and consciously about their performances. Providing constructive feedback can further enhance RP. But non-Western learners might face different learning barriers compared to learners in the West, where RP originated.MethodsIn this retrospective study, we assessed RP and feedback performances on Thai medical students’ patient history-taking skills. We applied RP and peer feedback, along with feedback from the instructors, during the history-taking sessions of the ten-week introduction course for fourth-year medical students. Twelve history-taking sessions were used for the analysis. Two instructors assessed students’ reflective performance and categorised them into one of the six stages of Gibbs’ reflective cycle; their feedback performances were analysed using Pendleton’s model. We investigated the correlations between students’ overall grade point average (GPAX) and patient history-taking scores on the Objective Structured Clinical Examination (OSCE). Students’ opinions of the RP teaching method were also collected.ResultsAll (n = 48) students participated in our study. The students’ mean age was 21.2 ± 0.5 years. The majority of the students were female (64.6%). The data indicated that 33 and 4% of the participants were categorised into the evaluation stage and action plan stage of Gibbs’ reflective cycle, respectively. In addition, 22 and 15% of the participants were able to state what their peers did well and suggest how peers could improve their skills, respectively. All students passed the minimum passing level of four history-taking OSCE stations. Participants agreed that RP was a useful tool (mean 9.0, SD 0.1), which enhanced their thought processes (mean 8.4, SD 0.2) and future performances (mean 8.2, SD 0.2). However, there was no correlation between the students’ highest Gibbs’ reflection levels and their history-taking OSCE scores.ConclusionsRP, together with feedback, proved to be a useful technique to help fourth-year Thai medical students improve their reflection skills, enhance their medical knowledge, and improve patient history-taking skills. Further study with longer monitoring is required to further explore negative and positive influential factors affecting students’ achievement of better reflection performances.

An Observational Study of a Simulation-Based Cross-Discipline Learning Activity Between Theater Arts and Physical Therapy Students.

Professional actors are often used to portray simulated patients during healthcare professional training. This study aimed to create an activity where physical therapy (PT) and theater arts (TA) students could address discrete learning outcomes in a common setting with mutual benefit. Mixed methods observational study of 246 university students (201 PT, 45 TA) undertaking a scenario involving the provision of a clinical history. All students completed a 5-question qualitative survey relating to the activity, and each group scored themselves and each other using an observer rubric rating performance from 1 (do not agree) to 10 (agree). For PT students, the range of means (SDs) across the five questions were significantly different (P < 0.001) with 6.2 (1.6) to 6.8 (1.4) for self-assessment and 8.2 (1.4) to 8.7 (1.1) for TA assessment of PT. For TA students, across all repetitions and all questions, the mean (SD) was 7.6 (1.5) for self-assessment and 7.9 (1.2) for PT assessment of TA, representing a significant difference (P < 0.001). After initial enactment, there was a significant improvement in TA self-assessment of performance (P = 0.002), but thereafter, there was no significant difference over time (P = 0.114).Qualitative data analysis revealed the following three themes common to both groups: worthiness, authenticity/realism, and anxiety/confidence. The PT students also identified history-taking skills and the importance of patient/PT relationships. The TA students identified learning around character portrayal, improvisation, and concentration. This study describes a simulation-based learning activity undertaken within existing infrastructure with complementary learning objectives for both TA and PT students that was realistic and engaging.

Australian doctors' perspectives on spiritual history-taking skills

Introduction: This original research examined the experience of Australian doctors using spiritual history-taking skills in holistic medical consultations and evaluated the support of Australian doctors for education on spiritual history-taking skills. Methods: General practice registrars and post-registrar graduate doctors, sourced primarily from the Hawkesbury Nepean region within NSW, Australia, completed an online survey. Excel data analysis tools were applied to analyse the quantitative results obtained. Line-by-line coding and manual analysis were applied to the free-text answers. Results: The survey was completed by 147 doctors practising medicine in Australia, a response rate of 24%. Registrars or residents-in-training accounted for 46%; 53% were post-registrar general practitioners. Most doctors (91%) recognised that spiritual care had some role in holistic medical care. Spirituality was included in medical consultations at least occasionally by 47% of doctors. However, only 21% felt confident with including spiritual history. Key barriers were insufficient time, lack of knowledge and lack of skills. Key facilitators included understanding other world views, knowledge of religions, awareness of own beliefs and basic communication skills. Spiritual history-taking skill education for all doctors was supported by 75%. Conclusions: The majority of Australian doctors who participated in this survey acknowledged the importance of spiritual history within holistic medical care, and many are incorporating this into their regular practice. Yet most doctors recognised a lack of knowledge and skills and desired further training, especially in spiritual history-taking skills. Inclusion of this in Australian medical education was strongly supported.

Common feline problem behaviours: Unacceptable indoor elimination

One of the reasons why cats enjoy such a high level of popularity as domestic pets is the fact that they are clean. When there is a breakdown in this fastidious behaviour and elimination occurs outside of the litter box or tray, the strain on the cat-owner bond and on human relationships within the household can be considerable. Indoor elimination behaviour is one of the most common reasons for cat owners to seek professional advice and there is a wide range of articles, book chapters and research papers that reference it. In many cases the topic of urination and defecation in unacceptable indoor locations is considered in combination with the deposition of urine or faeces as a marker, but this review focuses purely on problematic elimination. An accompanying article in this special issue discusses urine spraying. Indoor elimination problems necessitate a clinical approach combining knowledge from the fields of physical and emotional health and an understanding of normal feline behaviour. They also require comprehensive history-taking skills as well as effective communication skills and a degree of empathy for owners who are often finding their pet's behaviour very distressing. Early diagnosis of physical health disorders that are associated with indoor elimination is extremely important in terms of safeguarding feline welfare. As we become more aware of the interplay between physical and emotional health, the significance of identifying suboptimal social and physical environments in terms of optimising the welfare of domestic cats is also being recognised. The potential for indoor elimination problems to cause considerable human distress highlights the importance of the concepts of One Health and One Welfare.

Student Experiences in Practice-Based Small Animal Clerkships.

Practice-based clerkships provide a way for students to experience the types of cases, clients, and procedures that they can expect to see in a general practice setting.These clerkships are typically quite different from those offered in teaching hospitals. Forty-seven (65.28%) of the 72 invited veterinary medicine students from three cohorts participated in pre- and post-test surveys designed to compare their expectations to their actual experiences. Students reported significant positive changes in terms of adequate supervision, approachability of practitioner, and comfort level when asking questions, as well as seeing different cases than they see at the teaching hospital. Students reported significant negative changes in terms of their ability to interact with clients as much as they expected with respect to the practice of communication skills, history-taking skills, preventative therapy discussions with clients, and treatment.These findings were supported by written survey comments regarding the most and least helpful portions of the clerkship.We suggest further research to study student experiences over time and to survey practitioners before and following placement with veterinary students; the aim would be to obtain more information about the expectations and success of practice-based clerkships.

Prompting medical students to self–assess their learning needs during the ageing and health module: a mixed methods study

ABSTRACTUnderstanding our learning needs is fundamental for safe, effective and knowledge-based medical practice and facilitates life-long learning. A mixed methods study investigated fourth-year medical students’ self-perceived understanding of their learning needs using 1] a visual scale, before and after a four-week module in Ageing and Health (A&H) and 2] through focus group discussions. During 2013–14 academic year, all students (252) were invited to use a Visual Analogue Scale (VAS) tool to self-assess their learning needs that were linked to Ageing and Health curriculum learning outcomes. Assenting students (197 at pre-self-assessment, 201 at post-assessment) returned anonymous Visual Analogue Scales, self-assessing history-taking skills, examination skills, knowledge of medication use, co-morbidity, nutritional and swallowing assessment responses, before and after the A&H module. Three student focus groups explored whether completion of the VAS self-assessment had prompted improved self-awareness of their learning needs. The VAS responses increased for each curriculum domain with significant differences between the pre-and post responses – for the student-year-group. Nutritional and swallowing knowledge showed the greatest improvement from a self-assessed low baseline at entry. Focus-group students generally viewed the VAS tool positively, and as an aid for prompting consideration of current and future clinical practice. Some students recognised that ‘a need to be ready-for-work’ focused engaged learning; others demonstrated self-regulated learning through self-motivation and an action plan. The Visual Analogue Scale quantitative responses showed increased student-self-perceived learning for each curriculum domain at fourth-year completion of the A&H module, suggesting that prompting self-assessment had increased students’ knowledge and skills. Focus group students saw the VAS tool as useful for prompting awareness of their current and future learning needs. Additional educational strategies should be explored to enable all students to self-reflect and engage effectively on their learning needs, to gain the skills for the maintenance of professional medical competence.Abbreviations: A&H: Ageing and Health Module; e-portfolio: an electronic version of an evidence portfolio, which allows medical students and graduates to reflect and document learning and competencies; F1: year1 of post-graduate medical clinical training; GMC: General Medical Council-the regulation organisation for maintaining standards for doctors in UK; Logbook: usually a written document which can be used to record procedures and attendance at clinics or case-based discussions and can be used to set learning outcomes and to structure teaching in clinical settings for medical students and doctors; PDP: personal development plan is used to plan future learning and skills needs for work and education with an plan for action/s outcome; SPSS: Statistical Package for the Social Sciences; VAS: Visual Analogue Scale is a visual method of describing an experience.