Non-clinical Topics Research Articles

Teaching non-clinical topics: lessons from a public health module for medical students

This article was migrated. The article was marked as recommended. BackgroundA new public health teaching for medical students in year four was introduced. This paper evaluates the planning and implementation of the first year of delivery.MethodsKern et al's six step approach to curriculum development was used as an evaluation framework:• Problem identification• Needs assessment• Goals and objectives• Educational strategies• Implementation• Evaluation and feedback The delivery of the programme was assessed by direct observation of teaching and the end of year teaching review meeting, plus data from student feedback questionnaires.ResultsProblem identification was based on student feedback and gap analysis of the medical school curriculum against the standards set out in the GMC's Outcomes for Graduates. The public health learning needs of the medical students were examined from the perspectives of the students, the medical school and the NHS. Goals and objectives were chosen using the Outcomes for Graduates set out by the GMC as a basis. The module used a mixture of face-to-face and online teaching using a range of pedagogic approaches. The teaching was very interactive throughout and emphasised the links between public health and clinical medicine. Students completed anonymous feedback questionnaires which were overwhelmingly positive. The student feedback, plus feedback from the student representative, was used to inform changes in the programme implemented the following academic year.ConclusionThis new public health module has successfully integrated into the clinical curriculum. Lessons learnt from the first year of implementation are transferable to the delivery of other non-clinical topics.

What I wish I'd learned at dental school.

Background Much concern appears to exist as to the scope and content of contemporary dental school programmes, with the oft-cited criticism being made that dental graduates are 'no longer as good as they used to be'.Aim The aim of this project was to survey the views of dentists - both new graduates and more established practitioners - on aspects of their own dental school training they felt had been deficient as well as commenting on what aspects of dental school education they would like to see improved/enhanced in current times.Methods An invitation to complete an Internet-based questionnaire was emailed to the Fellows and Members of the Faculty of General Dental Practice (UK). Topics in the questionnaire included the respondent's own dental education history, how well they felt their dental school training had covered certain clinical and non-clinical topics; and their opinions on areas they felt should be included in contemporary dental school programmes.Results Six hundred and forty-nine responses were received from 3,348 emailed invitations (response rate = 19.4%). Sixty-one percent (395) of respondents were qualified for 10 years or more. Among clinical skills and techniques, a majority of respondents reported they felt they had not had sufficient teaching/training in dental school in surgical endodontics (76%), conscious sedation (72%), root surface debridement (71%), fixed orthodontic appliances (68%), porcelain veneers (63%), implants (56%) and posterior composites (53%). If designing a new dental school programme, the most common topics respondents would seek to include/increase were business and practice management (21%), communication skills (including patient management and leadership skills) (10%), and increased clinical time and experience (8%).Conclusions The findings of this project are of interest and relevance to those working with student dentists and young dental practitioners. A greater emphasis is needed on the teaching of certain non-clinical subjects such as business and communication skills, while within clinical subjects there is need to refine and expand teaching in identified areas such as exodontia and endodontics.

Creating, curating, and sharing online faculty development resources: the medical education in cases series experience.

It is difficult to engage clinicians in continuing medical education that does not focus on clinical expertise. Evolving online technologies (e.g., massive open online courses [MOOCs]) are disrupting and transforming medical education, but few online nonclinical professional development resources exist. In August 2013, the Academic Life in Emergency Medicine Web site launched the Medical Education in Cases (MEdIC) series to engage clinicians in an online professional development exercise. Each month, a complex, realistic scenario featuring a nonclinical medical education dilemma is published with accompanying discussion questions. A weeklong discussion is moderated on Twitter and the Web site. This discussion is curated to create a community commentary, which is published alongside presolicited expert responses. Case resources are available for download. The first six MEdIC cases (published August 2013-January 2014) emphasized different CanMEDS and/or Accreditation Council on Graduate Medical Education competencies. Median reader engagement metrics (interquartile range 25%-75%) in the first week following publication were 861 (634-1,114) pageviews, 767 (518-953) unique visitors from 326 (218-405) cities in 45 (32-50) countries, 30 (24-39) comments, 52 (40-56) tweets, 17 (13-30) Facebook Likes, and 5 (5-7) Google Plus +1s. The MEdIC series is proof of concept that online activities can engage clinicians in nonclinical professional development. The early experience suggests the connectivist nature of MEdIC allows for crowdsourcing solutions to ill-defined problems via the wisdom of readers. This methodology may also be effective for other nonclinical and medical education topics.

Strengthening the foundation for the future of nursing through a Summer Study Hall program at an academic medical center.

The purpose of this article was to describe the development and implementation of an innovative Summer Study Hall program developed by clinical nurse specialists (CNSs)/clinical nurse educators (CNEs) in an urban academic medical center. The program was implemented as a strategy to give nursing students the opportunity to enhance their clinical skills. The chosen skills are considered high risk for hospitals and have major impact on the American Nurses Association National Database for Nursing Quality Indicators, such as ventilator-associated pneumonia and catheter-acquired urinary tract infections. The secondary purpose of the program is to provide a venue to be able to work with potential employees and determine if they have the potential to be promising employees. A group of 20 students voluntarily met with a CNS/CNE weekly for 4 weeks in a simulation laboratory to review and demonstrate skills such as Foley catheter insertion and suctioning. The program was very well received by participants as well as by the CNS/CNE faculty. The program will continue annually, and some modifications have been made to include nonclinical topics such as professional development skills (eg, interviewing skills and résumé preparation).

Defining Content for a Competency-based (CanMEDS) Postgraduate Curriculum in Ambulatory Care: A Delphi Study

Ambulatory training in internal medicine has been noted to be dysfunctional and inadequate. In this study, we developed a set of competency-based outcomes specific to ambulatory care to guide the design, implementation and evaluation of instructional events to ensure that societal needs are addressed. In 2007 a Delphi technique was used to reach consensus and define the priorities for competency-based training in ambulatory care for internal medicine residents. Four groups of stakeholders in Canada participated: program directors, members of the Canadian Society of Internal Medicine, recent graduates, and residents. Two rounds of the Delphi process were required to reach consensus on a set of sixty competency-based educational objectives in ambulatory care that were classified under the CanMEDS roles. The inclusion of recent graduates in this study resulted in the addition of non-clinical topics that would have otherwise been missed, falling under roles historically viewed as being challenging to teach and evaluate (Manager, Health Advocate). This study is the first time a Delphi-process has been used to define the priorities for ambulatory care training in internal medicine under a competency-based framework. The resulting compendium of competency-based objectives provides a foundation from which educators can design, evaluate and modify existing training experiences.

Twelve tips for running teaching programmes for newly qualified doctors

A teaching programme for newly qualified doctors is necessary for their continuing professional development and education. However, guidelines for the logistics and content of such teaching programmes are limited. These 12 tips provide advice and guidance for the creation and development of a successful programme. This article is intended for readers who are involved in teaching; programme directors, administrators, tutors and trainee doctors themselves. The principles included will also be useful for those involved in developing other types of teaching programmes. Engagement of trainees, the education department and other staff in the hospital is crucial for the success of teaching programmes. A culture of attendance and feedback may take time and effort to establish but is absolutely essential for long-term programme viability. Innovative approaches to teaching, a range of teaching staff and coverage of varied clinical and non-clinical topics, all contribute to a strong programme.

Clinician–trialist rounds: 2. Time-management of your clinical practice and teaching

In the previous Clinician–Trialist Round [1], I presented approaches to finding, protecting, and using time for generating first-authored publications, the ‘key criterion used to evaluate a person’s scientific achievement’ [2]. This round begins with the second important element of time-management: how clinician–trialists schedule their clinical activities. On the one hand, you want to maximize the delivery of high-quality care and high-quality clinical teaching. On the other hand, you want to avoid, or at least minimize, conflicts with the other elements of your academic career. Of course, your clinical work should complement your research. Indeed, your clinical observations, frustrations, and failures should be a major source of the questions you pose in your research. But both of them require adequate blocks of your full attention. Having to switch back and forth between them several times a week is a recipe for frustration and failure. Many successful clinician–trialists from in-patient disciplines solve this by devoting specific blocks (of, say, 1 month) of ‘on-service’ time to nothing but clinical service and teaching. When on-service, your total attention can be paid to the needs of your patients and clinical learners. No time is spent writing, travelling, attending meetings, or teaching non-clinical topics. This total devotion to clinical activities often will permit you to take on more night call and a greater number of patients and clinical learners. (For example, during each month ‘on’ my medical inpatient service at Oxford I took call 10 times, and my clinical team of up to 16 learners and visitors admitted about 230 patients. Moreover, in addition to our individual daily bedside teaching rounds, my two Fellows and I provided over 50 hours of extra, ‘learner-level’ clinical teaching.) When ‘off-service,’ however, your time and attention should shift as completely as possible to research and non-clinical teaching. Ideally, you should have no night-call when you are off-service. Moreover, you need not routinely see every discharged patient at a post-hospital out-patient follow-up visit (by ‘phoning my patients’ General Practitioners within 48 h after admission and again within 48 h before discharge, I reduced my outpatient follow-ups by >95%). If you are worried about getting rusty or out of date between your months on service, why not shadow the rounding teams on relevant services for a week just before reassuming command? (I alternated between the coronary care and intensive care units for my ‘warm-up’ weeks.) Surgeons coming off a period of full-time research may want to ‘warm-up’ by assisting at a few relevant operations before taking over. Like so many other elements of your academic success, this sort of time-management is fostered by the development of a team of like-minded individuals who spell one another in providing excellent clinical care. A survey of physicians in their second decade of clinical practice suggested that there needs to be at least three like-minded clinicians to make this strategy work [3]. Clinicians in other fields (e.g., intensive care and many of the surgical specialities) sometimes find it preferable to allocate time to in-patient clinical practice in units of 1 week. Another variant of scheduling is practiced by my former graduate students whose incomes are derived solely from private practice. They devote 3 weeks each month to intensive clinical practice, followed by a ‘free’

Hatch & Sumner’s Textbook of Paediatric Anaesthesia, 3rd Edition.

Hatch & Sumner’s Textbook of Paediatric Anaesthesia, 3rd Edition.

Teaching models in an ambulatory training program

Ambulatory care training is increasingly important in internal medicine. Such training centers on the practice where residents and faculty see their patients; thus, features of the practice model influence what residents learn. A resident-faculty group practice affiliated with a division of general internal medicine has many advantages. In such a practice, learning centers on resident-patient interactions, around which a comprehensive teaching program must be built. Major features of such a program include the mentoring of residents by faculty who work with them longitudinally and the presence of a well-balanced structured curriculum addressing clinical and nonclinical topics related to patient care. Teaching residents to interact and communicate with patients is crucial; approaches include role-modeling by faculty, use of videotaping, and role-playing and other innovative methods. Feedback is integral to learning and helps shape the attitudes and values that permeate residents' practices.

Attitudes of medical students and faculty toward cancer.

The Cancer Attitude Survey (CAS) was administered to second year students before, during, and after a year-long "Introduction to Clinical Medicine" course. The course contained a 14-hour oncology segment. Faculty of the Clinical Medicine Course and nonclinical faculty teaching oncology related topics also responded to the CAS. The CAS contains four scales: Attitudes toward: I, the patient's inner resources to cope with cancer; IIA, the value of early diagnosis; IIB, aggressive treatment; and III, personal immortality and preparation for and acceptance of death. At the beginning of the course, student attitudes were positive; there was no change in attitudes across the three testing periods. Among faculty, dedicated oncologists had the most positive attitudes; students and nononcology clinical faculty exhibited similar trends in attitudes; nonclinical faculty teaching oncology related material had least positive attitudes.

Clinical Medicine for the Occupational Physician

The title of this book is somewhat misleading, as less than half of it is devoted to clinical topics. The other topics, however, such as ethics, epidemiology, and health of travelers are all pertinent. It is not a comprehensive text on occupational medicine, as many pertinent clinical and nonclinical topics are not discussed, eg, toxicology, industrial hygiene, exposure standards, ergonomics, role of the occupational health nurse, identification of occupational causes of disease, bladder carcinoma, ionizing radiation, shiftwork, and many harmful agents found in the workplace. The chapters on epidemiology, the health of working women, cancer, dermatoses, stress, and mental illness are good summaries that relate well to occupational problems. Most of the other clinical topics are limited to six organ systems: pulmonary, gastrointestinal, cardiovascular, musculoskeletal, nervous, and ear, nose, throat. These are good general reviews of the topics, but the occupational components are small. For example, noise and its effect

Complete Transposition of the Great Arteries

This book results from Dr. Shaher's long interest in transposition of the great arteries, an interest that began at Guys Hospital, London, continued at the Hospital for Sick Children in Toronto, and more recently at Albany Medical Center, New York. The available data on 409 patients from these three institutions have been personally reviewed, the majority (336) having been seen in Toronto. This case material plus an extensive review of the literature is presented in 20 chapters. Twelve chapters (200 pages) deal with definitions, incidence, normal cardiac embryogenesis, the pathogenesis of transposition and other nonclinical topics; the final eight chapters (300 pages) deal with diagnosis and treatment. Wherever possible, the patient's data are correlated with the literature, and on debatable points Dr. Shaher's opinions are plainly stated. There are more than 1,000 references on a chapter by chapter basis with a final authors' index for crossreferencing. Detailed case data are