Learning In Clinical Education Research Articles

Pearls of Wisdom from Teaching Rounds: Reconceptualizing “See One, Do One” as Social Learning

Abstract Background Experiential education is paramount to clinical instruction in medicine. During teaching rounds, faculty can assess medical knowledge and clinical reasoning while modeling evidence-based patient care and effective communication. This study aimed to describe observed traits common across faculty who contribute to favorable learning environments. Design Students completed an Internal Medicine (IM) Student Chief elective at a midwestern United States Academic Tertiary Care Center in which M4s aided Clerkship leadership in near-peer teaching and communicating with students. Chiefs participated in rounds for experiential learning in clinical teaching. For this qualitative, descriptive study, M4s were asked to provide at least three “pearls of wisdom,” on observations about teaching and learning in reflective essays during two consecutive academic years. Twenty-nine M4s participated in the elective and submitted 238 pearls. The research team undertook document review and qualitatively analyzed content of Chiefs’ reflective essays. Detailed codes were organized into primary and secondary themes by each author, and then re-evaluated until they reached consensus. Through thematic analysis, we identified faculty traits students found conducive to learning. Results Three primary themes emerged: Attributes, Autonomy, and Achieving Engagement. Conclusion Experiential educational encounters are transformative to developing new physicians. Chiefs highlighted positive aspects of teaching rounds described previously including providing clear expectations, promoting goal setting, engagement, and instilling confidence. They also valued humor, recognizing cognitive overload, displaying humility, listening skills, and mentorship. While one attending cannot replicate all described effective techniques simultaneously, faculty development that promotes refining these approaches may improve the clinical learning environment for all learners.

The Effectiveness of Simulation-based Learning in Clinical Education

The Effectiveness of Simulation-based Learning in Clinical Education

Enhancing the Graduate Medical Education Clinical Learning Environment Through Community of Practice Forums.

An optimal clinical learning environment (CLE) is associated with improved learning and patient care outcomes. Significant concerns exist about the state of the CLE in graduate medical education (GME). Research suggests GME programming falls short in interpersonal aspects of training that promote trainee engagement and psychological safety. Furthermore, published educational interventions in the CLE lack adequate theoretical backing to inform a rational approach to interventions in the CLE that could address these important problems.The authors apply the 2002 work of Etienne Wenger on communities of practice (COP) to address these GME CLE concerns. To distinguish this COP intervention from earlier theoretical work on COPs, the authors refer to this management concept as "COP forums." COP forums favorably influence the GME CLE through effects that complement experiential learning in patient care. COP forums support trainee psychological safety, mentorship from near peers, and opportunities to innovate-effects that can serve as a counterbalance to the time pressures, hierarchy, and compliance culture often experienced in the clinical environment. Deliverables of COP forums, including practice innovation and trainee self-efficacy, can favorably impact organization-wide performance and engagement.This article describes the historical position of COP forums in the evolution of COP theory and outlines the basic structure and function of COP forums. It contrasts COP forums to other COP-related concepts to explain their relevance to the GME CLE. Examples of innovative GME COP forums illustrate the structure and function of these interventions. Finally, the authors call for more research on the impact of COP forums on the GME CLE. To avoid confusion, such scholarship must account for the ongoing evolution of the larger COP framework and target specific dimensions of the theory most pertinent to the medical education research question at hand.

Simulation Based Teaching and Learning in Clinical Education

Medical education is undergoing significant changes each day in different corners of the world. Calls from different stakeholders for a change in the instructional methods have resulted in innovative medical curriculum. The new curriculum stresses the importance of proficiency in several clinical skills by medical students rather than mere acquisition of knowledge. Teaching and training using simulation technique is very powerful. It provides valuable opportunities to learn and practice the key competencies in medical education, such as communication, problem-solving, teamwork, and leadership as well as management skills such as physical examination, diagnostic and surgical procedures. Pedagogical innovations like simulation-based teaching needs to be brought to the forefront in clinical education in our country. Simulation programs may function well from a technical point of view, but they are often difficult to fit into a curriculum, especially in low-resource settings, where money and technical-know-how are the main limitations. Medical educators have been pushed inevitably to rely on such technology-based learning looking at the future of medical education. However, they should not only embrace it but also develop and evaluate its sustainability and application in preclinical and clinical settings. If well-designed, learning how to operate a simulation program generally requires little effort for them and their students. A short introduction by the teacher is often sufficient to enable the student to work with the program. Bang. J Neurosurgery 2023; 13(1): 24-28

Teaming in Graduate Medical Education: Ward Rounds and Beyond.

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.

Nurse anesthetist students' experiences of peer learning in clinical education - A qualitative study.

As part of an interprofessional operating team, nurse anesthetists need to be skilled in collaboration, problem solving, attentiveness, independent decision-making and knowledge of anesthesiology nursing. Factors that are vital for nurse anesthetist students' future profession. The educational model peer learning, characterized by collaboration and learning through social interaction between individuals, may support nurse anesthetist students' development in such skills. The aim of the study was to explore nurse anesthetist students' perceptions of their experiences of peer learning as an educational model during their clinical education in a Swedish context. The approach was a qualitative descriptive design. Seven nurse anesthetist students from four different universities were interviewed individually using a semi-structured interview guide. The data were analyzed with content analysis. Three generic categories revealed a description of the phenomenon: Increased independence, Holistic view and Expansive learning process. A main category brought together the content of the generic categories and shows the overall finding of the study: Peer learning promotes nurse anesthetist students' personal and professional development. Peer learning as an educational model during nurse anesthetist students' clinical education might facilitate preparation for their coming profession.

Peer assessment approach to promote clinical communication skills in a blended learning course of early clinical exposure

Background: Blended learning offers opportunities for the complexity of learning in clinical education. Student peer assessment is widely used as a form of formative assessment in early clinical exposure programs, especially clinical communication skills training. This study aimed to describe clinical communication skills competencies of second-year students and to identify the relationships between peer and faculty assessment of communication skills in a blended learning program format. Methods: A total of 474 second-year general medical students and dental students participated in the study. Peer and lecturer assessment forms with a 5-point Likert scale according to the Calgary-Cambridge guide format were used to evaluate students’ performance of basic communication skills, relationship building, and history taking. Pearson’s correlation coefficients and paired t-test were applied. A p-value < 0.05 was considered statistically significant. Results: Most of students were rated at distinction level (score at 7-8.4) in communication skills. Mean of the overall score by peer and faculty assessment were 7.46 ± 1.03 and 7.17 ± 0.68, respectively. Peers rarely provided negative ratings on subcategories of communication skills. Skills of understanding the patient’s perspectives and gathering information were the most reported skills needed to improve among students. Significant positive correlations were found between peer and faculty evaluations for building relationship, establishing initial rapport, and gathering information domains (p < 0.01). Students tended to grade their colleagues higher for building relationship (3.88 ± 0.62) and establishing initial rapport domains (3.72 ± 0.61) than other domains, meanwhile, teachers tended to grade building relationship (3.80 ± 0.55) and gathering information domains (3.64 ± 0.38) higher than other domains. Conclusion: The findings suggest that student peer evaluation can be valuable for clinical education. As part of a formative assessment, it can be also used for faculty to evaluate students’ clinical communication skills performance in innovative medical education programs. Key words: peer assessment, clinical communication skills, practice of medicine, early clinical practice, blended learning.

Integrating a Mobile-Learning Platform for Enhancing Clinical Teaching: The Learners’ Perspective

The role of mobile technology has become an integral part of daily activity among today’s society, including medical schools and hospitals. This study aimed to establish a mobile-learning platform for providing high-quality clinical teaching in undergraduate medical education. It was a mixed-methods design of quantitative survey and qualitative focus-group discussions to analyse the learners' view for acceptance of technology-integrated learning in clinical teaching at Universiti Sultan Zainal Abidin. Forty-two undergraduate medical students from years 3 and 5 participated in this study. The vast majority found that a mobile-learning platform was a helpful medium for the integration of leaning resources and collaboration with other health-care professionals in a clinical setting (p<0.001). They generally agreed that there is an improvement in clinical competence, confidence in clinical reasoning and focusing on the discussion by providing constructive feedback (p<0.001). The qualitative focused group discussion’s findings indicated that most of the participants expressed their satisfaction with improving their intellectual skills and their anticipation of achieving strategic learning via integrated bedside teaching with mobile-group discussions. Overall, the participants accepted that a mobile-learning platform integrated bedside teaching is a constructive, productive approach for enhancing and facilitating their learning in a clinical setting. This study offered a unique insight into learners’ perceptions of benefits and the limitation of technology-enhanced learning in undergraduate medical training. The essential attributes of mobile technology are crucial for technology integration in high-quality clinical teaching.

Experiential Learning in Clinical Education Guided by the Kolb’s Experiential Learning Theory

In clinical education, experiential learning can be an important component of the instructional process. We know that in medical college hospitals, learning that takes place at patient’s bed side or in wards is totally different from learning that takes place in the classroom. Each patient encounter is a new learning experience where new information is internalized and applied in the context of previous knowledge and experience. This emphasizes the importance of experiential learning where medical students should have the opportunity to effectively and efficiently internalize, process, and apply new information. However, a major global challenge for the clinical education is the workload placed on the clinical teachers, who struggle to divide time between clinical, teaching, administrative, and other duties. Experiential learning helps to form an integrated approach to clinical teaching that simplifies the relationship between a physician’s clinical and educational duties and erase the distinction between teaching and patient care duties; the students are also benefited. Kolb proposed experiential learning theory, a four-stage cyclical model of knowledge development that combined individuals’ conscious recognition and transformation of experience, which was first published in 1984.Experiential learning can be applied throughout the medical educational environment by institutional development programmes, including longitudinal outcome assessment, curriculum development, student development, and faculty development. The use of experiential learning, where students are purposefully engaged in direct experience with an emphasis on reflection, increases the ability of students to develop clinical skills and competences during their clinical phase of medical education. This review paper aims to discuss how experiential learning can be integrated in clinical education.International Journal of Human and Health Sciences Vol. 06 No. 02 April’22 Page: 155-160

Application of evidence-based scene simulation combined with problem-based learning in clinical teaching of critical care for nursing students

Application of evidence-based scene simulation combined with problem-based learning in clinical teaching of critical care for nursing students

Can students develop clinical competency in treatment planning remotely through flipped collaborative case discussion?

Effectiveness of flipped learning in clinical education is unknown. This study evaluates the effectiveness of remote case-based learning for teaching clinical treatment planning compared with traditional in-person clinical experience. Four cases containing medical and dental charts were discussed through flipped learning with faculty panel during the COVID-19lockdown. Prior to each session, students worked individually or in groups to complete assignments with leading questions. After the final assignment, students completed a survey to rate the learning experience from each case, compare the remote experience with the previous in-person clinical experience and provide suggestions to improve remote clinical instruction in the future. Students' performance measured by the number of case assessments and competencies completed post-lockdown was compared with pre-lockdown and the previous year using odd ratio (OR), Chi-squared test (χ2) and significant level p<.05. A total of 106students completed the course, and 99students completed all survey questions. Students reported positive learning experiences (overall mean=7.84, SD=1.11). Post-lockdown, statistically significant increase in the proportions of total passed attempts (χ2 p=.002, OR=2.23), competencies (χ2 p=.028, OR=2.05) and case assessments (χ2 p=.004, OR=2.73) was observed between the current class and the previous pre-COVID-19class (108students). Post-lockdown, students also passed significantly more attempts (χ2 p<.0001), competencies (χ2 p<.0001) and case assessments (χ2 p=.008) compared with pre-lockdown. Although a flipped classroom does not replace in-person clinical experience, teaching clinical treatment planning remotely improved students' readiness and clinical performance through collaborative learning, practice and case exposure.

Perception of Fourth Year Medical Students on Task-Based Learning in Clinical Teaching

Background Clinical teaching is always challenging. Different teaching strategies are used for effective teaching and learning in a clinical environment. Task-based learning (TBL) is the teaching strategy where tasks are used for the learning of students. We conducted this study to explore student’s perceptions about Task-based learning.&#x0D; Method This descriptive study was carried out for the academic year 2019-2020 in Shalamar medical college Lahore.TBL taught 4th-year MBBS students during a clinical rotation in Gynae/Obs, and at the end of rotation, they were asked to fill a questionnaire regarding their perceptions about TBL.&#x0D; Results 87 students participated in the study. All the students agreed that TBL is an effective teaching approach, and they have a positive response towards TBL in clinical setting.85%students said TBL improve communication skills, 89.6% Said TBL provide the opportunity of direct encounter with patients, 71.2% find it helpful and informative and 40.2%said that it promotes the active involvement of students.&#x0D; Conclusion: Students found TBL as an effective teaching approach in a clinical setting and find it more advantageous because it involves them more in teaching and learning and help them to improve their communication skills, and provide them opportunities to deal with patients.

Preliminary Evidence Supporting a Novel 10-Item Clinical Learning Environment Quick Survey (CLEQS).

The clinical learning environment (CLE) is a priority focus in medical education. The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review's (CLER) recent addition of teaming and health care systems obligates educators to monitor these areas. Tools to evaluate the CLE would ideally be: (1) appropriate for all health care team members on a specific unit/project; (2) informed by contemporary learning environment frameworks; and (3) feasible/quick to complete. No existing CLE evaluation tool meets these criteria. This report describes the creation and preliminary validity evidence for a Clinical Learning Environment Quick Survey (CLEQS). Survey items were identified from the literature and other data sources, sorted into 1 of 4 learning environment domains (personal, social, organizational, material) and reviewed by multiple stakeholders and experts. Leaders from 6 interprofessional graduate medical education quality improvement/patient safety teams distributed this voluntary survey to their clinical team members (November 2019-mid-January 2021) using electronic or paper formats. Validity evidence for this instrument was based on the content, response process, internal structure, reliability, relations to other variables, and consequences. Two hundred one CLEQS responses were obtained, taking 1.5 minutes on average to complete with good reliability (Cronbach's α ≥ 0.83). The Cronbach alpha for each CE domain with the overall item ranged from 0.50 for personal to 0.79 for social. There were strong associations with other measures and clarity about improvement targets. CLEQS meets the 3 criteria for evaluating CLEs. Reliability data supports its internal consistency, and initial validity evidence is promising.

A Multimodal Quality Improvement Curriculum for Pediatric GME Program Directors.

The 2016 Accreditation Council for Graduate Medical Education Clinical Learning Environment Review report identified knowledge gaps for quality in the clinical environment. It suggested quality improvement (QI) training is necessary to develop skills to improve health care quality. However, at the authors' institution, there is limited department-level QI mentorship and engagement, thus limiting QI experiences for residents and fellows. The authors developed pediatric graduate medical education program director (PD) proficiency in QI through a fellowship-focused QI project. PDs underwent an 18-month QI curriculum consisting of focused online QI education, a half-day workshop, additional QI didactic sessions, project presentations, and individual QI coaching. QI knowledge in 9 domains and participants' confidence were assessed. Participants' self-perceived confidence and skills increased by at least 20% in most domains. Overall, PDs felt prepared to help with their fellows' future QI projects. Fellowship-focused QI projects and individual coaching were key to course engagement.

Congruence between nursing students\u2019 and patients\u2019 views of student\u2013patient relationships

The growing emphasis on learning with and from patients has shifted the focus from education and healthcare professionals to the student–patient relationship. The relationship between student and patient, with a supportive preceptor as a resource, can influence the progression and development of an authentic person-centred approach to care among students. The purpose of this study was to analyse the congruence between nursing students’ and patients’ views of their relationship during students’ clinical placement. The study compared data from cross-sectional matched cohort pairs of nursing students (n = 187) and patients (n = 187) in Finland. The data were collected between March 2015 and May 2016 using corresponding questionnaires and procedures in both cases. Both students’ and patients’ views were moderately or weakly congruent in terms of facilitative relationship, characterised as a mutually enriching relationship for both students and patients through dialogue. Patients, however, tended to see the relationship significantly more often as mechanistic, focusing on students learning practical skills, compared to students who saw the relationship more often as facilitative. Patients’ age and the reasons for care were the only background variables that predicted the congruence between students’ and patients’ views of their relationships. These findings suggest ways in which student–patient relationships can be made more meaningful in supporting learning in clinical education.

Steps towards validation of the Dental Education Clinical Learning Instrument (DECLEI) in American dental schools (DECLEI-USA).

Few tools assess the dental school clinical learning environment from students' perspectives. Considering previous efforts to validate the Dental Education Clinical Learning Instrument (DECLEI) in the United States, the goal of this study was to look for the fewest number of items that accounted for the most amount of variability in responses and/or had the highest correlation to the total DECLEI score using a larger, multi-center sample. The DECLEI was distributed to 286 students in two dental schools (University of Iowa and University of Texas at Houston) during the 2017-2018 academic year. Two alternative methods were applied. In the first approach, all 24-items were regressed on the total composite score using a forward conditional method. In the second approach, the item-total correlation for the full scale was calculated and then items with relatively poor coefficients were eliminated. A cutoff of 0.30 or less was used. The first approach, Total R2 by Regression Model, produced a 9-item scale accounting for 90% of the variance in total score and a Cronbach's α coefficient of 0.79. The second approach, Item-Total Correlation, produced a larger scale (20 items), as well as a higher Cronbach's α coefficient of 0.89. The instrument also presented appropriate sensitivity to measure differences between race groups and school of origin. DECLEI may have the potential to be used as an instrument to measure clinical learning environments for U.S. dental students using either a smaller, concise scale (Mini DECLEI-USA) or a larger (DECLEI-USA), more thorough scale.

A resident-led initiative to improve patient safety event reporting in an internal medicine residency program

ABSTRACT Background Despite the Clinical Learning Environment Review’s recommendations of their use, patient safety event reporting systems are underutilized by residents. Objective We aimed to identify perceived barriers to event reporting amongst internal medicine residents and implement a targeted quality improvement initiative to address the identified barriers and increase overall resident event report rates. Methods A total of 94 Internal Medicine (IM) residents participated in the educational intervention in 2018. We measured residents’ perception of barriers to event reporting and employed the results of the questionnaire to create a skill-based educational workshop. We conducted the plan-do-study-act model to test a structured educational intervention and its effectiveness on pre-post IM residents’ event report rates and compared it to report rates of Non-Internal Medicine (Non-IM) residents. Additionally, we assessed pre-post intervention knowledge, skills, and attitudes in event reporting. Results 94/94 (100%) of IM residents had a significantly higher median percent of patient safety event reporting when compared to pre-intervention (23.6% compared to 5.88%, p-value = 0.0030) and when compared to Non-IM residents (23.6% compared to 5.31%, p-value = 0.0002). Residents performed better on the post-test compared to the pre-test (90% compared to 30%, p-value = 0.0001) for knowledge. 100% of the critical action items were completed and 90% of participants reported their perception of the event reporting process improved. Conclusions By elucidating common reasons why residents are not reporting patient safety events, a specific intervention can be created to target the identified impediments and improve resident event reporting. Abbreviations IM: Internal Medicine IM; Non-IM: Non-Internal Medicine; IOM: Institute of Medicine I; ACGME CLER: Accreditation Council for Graduate Medical Education Clinical Learning Environment Review; GME: Graduate Medical Education; IRB: Institutional Review Board; PDSA: Plan, Do, Study, Act

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities.

Developing Graduate Medical Education Partnerships in American Indian/Alaska Native Communities.

Preceptors' and nursing students' experiences of peer learning in a psychiatric context: A qualitative study

ObjectiveThe aim of this study was to investigate preceptors' and nursing students’ experiences of peer learning in a psychiatric context during their clinical education. DesignA qualitative research design was used in this study. Data were analysed with qualitative content analysis. The study was conducted in 2017 with 17 preceptors and 11 students, constituting four focus groups with preceptors and four focus groups with nursing students. ParticipantsThe preceptors were nurses and specialist nurses who worked in inpatient psychiatric care. Nursing students seeking their bachelor's degrees were placed in clinical settings at different psychiatric units for 4 weeks during the fourth semester. ResultsOne theme emerged: Knowledge acquisition as an interactive process from the two shared categories for students and preceptors: the importance of a supportive relationship and reciprocal learning by communication, doing and reflection. ConclusionsThe result of this study suggested that peer learning in clinical education in psychiatric care promoted the learning process for nursing students.

THE EFFECTIVENESS COMPARISON BETWEEN INQUIRY AND PROBLEM BASED LEARNING TOWARDS GEOGRAPHY LEARNING OUTCOMES

THE EFFECTIVENESS COMPARISON BETWEEN INQUIRY AND PROBLEM BASED LEARNING TOWARDS GEOGRAPHY LEARNING OUTCOMES