Patients In Inpatient Setting Research Articles

Academy for Quality and Safety Improvement (AQSI) project to improve diagnosis and documentation of malnutrition in a community hospital

BackgroundMalnutrition is a significant public health problem that affects many patients in inpatient settings. Timely identification and addressing malnutrition in an inpatient setting presents an opportunity to improve patient care...

Is there an association between out-of-pocket hospital costs, quality and care outcomes? A systematic review of contemporary evidence

BackgroundOut of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking.MethodsThe current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763).FindingsA total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes.InterpretationThe review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs.FundingThis study was funded by Medibank Better Health Foundation.

Exploring mental health nurses’ experiences of assault by patients in inpatient settings

Exploring mental health nurses’ experiences of assault by patients in inpatient settings

A Systematic Review and Bayesian Network Meta-Analysis Investigating the Effectiveness of Psychological Short-Term Interventions in Inpatient Palliative Care Settings.

This paper reviews and summarises the evidence of short-term psychosocial interventions (up to 12 sessions delivered within less than eight weeks) on anxiety, depression, and emotional distress in palliative patients in inpatient settings. We screened publications from the following five databases, Embase, PubMed, PsycINFO, Web of Science, and CINAHL, from their inception to 10 September 2021. The eligible studies included controls receiving standard palliative care, actively treated controls, and wait-list controls. Nine studies met the eligibility criteria and reported the effects of five psychosocial interventions in a total of N = 543 patients. We followed PRISMA-guidelines for outcome reporting and the Cochrane Risk of Bias Assessment Tool for assessing study quality. This paper used the network meta-analysis to compare multiple treatments by providing greater statistical power and the cross-validation of observed treatment effects, using the R package BUGSnet. Compared to control groups, the following psychosocial interventions in inpatient settings showed to be superior: life review interventions were the best ranked treatment for improving anxiety and distress, while the top ranked treatment for reducing depression was outlook intervention. The short-term psychosocial interventions investigated in this meta-analysis, especially life review intervention, are feasible and can potentially improve anxiety, depression, and distress in palliative inpatients and should therefore be offered in inpatient settings.

Misdiagnosis of pulmonary embolism and missed pulmonary embolism: A systematic review of the literature

Pulmonary embolism (PE) is a common and life-threatening condition. Misdiagnosis of PE is not uncommon as symptoms can overlap with other diagnoses and could cause potential harm. We conducted a systematic review to estimate rates of misdiagnosis and factors may be associated with misdiagnosis of PE. We searched MEDLINE and EMBASE for studies that evaluated the misdiagnosis of PE. The rate of misdiagnosis was pooled and results were narratively synthesized. A total of 18 studies were included which included 2,053 patients with a diagnosis of PE. Two different definitions were used for misdiagnosis of PE. The first refers to an initial diagnosis that is not PE and the patient is found to have PE. The second definition refers to patients who do not have a diagnosis of PE while they were alive and PE was subsequently found on autopsy. The pooled results across the studies suggest that in ED settings 27.5% of patients with PE are misdiagnosed initially and half of all patients in inpatient settings are misdiagnosed (53.6%). Among patients that die in intensive care who undergo autopsy 37.9% were found to have PE that was missed. The commonly diagnosed conditions instead of PE were respiratory infection, heart failure and acute coronary syndrome (ACS). Misdiagnosis in patients with an eventual diagnosis of PE is common. Clinicians should consider PE as differential diagnosis in patients who are initially suspected to have chest infection, heart failure or ACS who have negative diagnostic tests or poor response to treatment.

COVID-19 outbreak management in a mental healthcare setting.

Since the beginning of the novel coronavirus disease pandemic (COVID-19), inadvertent exposure of hospitalised patients and healthcare workers has been a major concern. Patients in inpatient settings with mental illnesses have also been impacted by the restrictions the pandemic has caused, with many having experienced the confines and loss of liberties that COVID-19 has brought. This article identifies the infection prevention and control measures required in a mental health setting during an outbreak of COVID-19. The focus is on the challenges of working in a mental health setting and identifies the difficulties in containing the infection within this ill-designed built environment and includes the additional pressures of managing this complex and diverse group of patients. Current guidance on outbreak measures is given with particular attention applied to the patients, the practices and the environment.

Effect of artificial intelligence technologies on the CT scan interpreting time in COVID-19 patients in inpatient setting

<h3></h3> Неоднократно описана практическая ценность компьютерной томографии (КТ) органов грудной клетки для диагностики пациентов с подозрением на коронавирусную инфекцию (COVID-19). В условиях высокой загруженности во время пандемии врачи-рентгенологи испытывают нехватку времени для интерпретации результатов исследований. Использование технологий искусственного интеллекта (ИИ) может повлиять на длительность формирования протокола описания КТ-исследований. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценить влияние алгоритма ИИ на скорость описания результатов КТ органов грудной клетки при подозрении на COVID-19 в стационарном звене городского здравоохранения. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Проведено ретроспективное исследование, протокол зарегистрирован в ClinicalTrials.gov (NCT04489992). Исследование выполнено на основе данных пациентов, прошедших КТ органов грудной клетки в период с 08.04.20 по 01.12.20 в 105 медицинских организациях стационарного звена городского здравоохранения. КТ органов грудной клетки проводили по стандартным протоколам сканирования. Врачи-рентгенологи анализировали исследования с помощью ИИ-сервиса «Гамма Мультивокс Ковирус» и без него. Формирование протоколов медицинских заключений проведено в Едином радиологическом информационном сервисе в составе Единой медицинской информационно-аналитической системы Москвы. <h3>РЕЗУЛЬТАТЫ</h3> Без применения ИИ проанализированы 3133 КТ-исследований с признаками COVID-19-ассоциированной пневмонии (1-я группа), с использованием ИИ — 63 379 (2-я группа). Медианная длительность описаний в 1-й и 2-й группах составила 103,0 и 46,0 мин соответственно. Анализ длительности интерпретации врачом-рентгенологом результатов КТ органов грудной клетки до и после внедрения ИИ выявил статистически значимые различия (<i>p</i>&lt;0,0001). Средняя длительность описания КТ органов грудной клетки при использовании ИИ уменьшилась на 29,4%. <h3>ЗАКЛЮЧЕНИЕ</h3> Внедрение технологии ИИ, направленной на диагностику изменений в легких при COVID-19 по данным КТ органов грудной клетки, в практическую работу отделений лучевой диагностики стационарного звена городского здравоохранения сокращает время подготовки протокола описания врачами-рентгенологами.

Initiation of Long-Acting Reversible Contraception in Hospitalized Adolescents in the United States.

To analyze factors associated with the initiation of long-acting reversible contraception (LARC) among adolescent patients in inpatient settings in the United States. This study is a secondary data analysis of the national Kids' Inpatient Database 2016 data (N = 4200 hospitals). Eligible patients were hospitalized girls 10 to 20 years old. The primary outcome was initiation of LARC (ie, subdermal implant and/or intrauterine device [IUD]) while hospitalized. Covariables included age, race or ethnicity, insurance type, postpregnancy status, geographic region, hospital type (rural or urban), hospital size, and children's hospital status. Bivariable statistics were calculated by using survey-weighted analysis, and a design-based logistic regression model was used to determine the adjusted odds of LARC initiation and of implant versus IUD initiation. LARC initiation occurred in 0.4% (n = 3706) of eligible hospital admissions (n = 874 193). There were differences in LARC initiation by patient age, insurance type, race or ethnicity, postpregnancy status, hospital type, and hospital status (all P < .01). In the adjusted model, older age, public insurance, nonwhite race or ethnicity, postpregnancy status, and urban, teaching or larger hospitals were independently associated with LARC initiation (all P < .01). Smaller hospital size and postpregnancy status increased the odds of implant versus IUD initiation after stratifying by hospital region. LARC initiation occurred in <1% of adolescent hospitalizations, with 90% of those occurring in postpregnancy adolescents. Addressing LARC capacity in rural, nonteaching, and smaller hospitals is important in increasing access. Future research is needed to identify and close gaps in the number of adolescents desiring and initiating LARC in hospital settings.

Vitamin D monitoring and management within men's secure services

AimsTo audit the investigation, identification and treatment of Vitamin D deficiency within Men's Secure Services.BackgroundVitamin D and/or vitamin D deficiency has been suggested to play a role in the pathogenesis of mental illness. There is evidence that Vitamin D inadequacy is pandemic among rehabilitation patients in inpatient settings. Patients within secure hospitals are similarly considered to be at high risk, due to their limited solar exposure during often lengthy admissions. It has been suggested that these patients should be considered an ‘at-risk’ cohort, for whom Vitamin D supplementation should be routine. Men's secure services in Birmingham comprise of two medium secure units and a low secure rehabilitation unit. Here we present an audit of Vitamin D monitoring and treatment completed in 2019.MethodA three year retrospective review of electronic patient records, for all inpatients admitted within men's secure services as of 1 September 2019 (n = 188). Standards were based on the Trust accepted guidelines for management of Vitamin D deficiency.ResultKey findings included:- The majority of inpatients were Caucasian (43%) and African-Caribbean (24%). Ages ranged from 18 to 70, with a mean age of 39.Approximately two-thirds (65%) had been in hospital for over a year, of which 44% had been admitted for more than 3 years. The average length of admission was 885 days.Only 47% of patients had their Vitamin D level checked within the study period.Of those checked, 24% were tested within 1 month of admission. The mean duration between admission and Vitamin D testing was 464 days.Results ranged from 10.3 to 118.5nmol/L. A high rate of Vitamin D deficiency was identified (54%), whilst a further 16% had ‘inadequate’ levels.23% of those identified as requiring treatment did not receive any supplementation, whilst 59% of those with sufficient Vitamin D were prescribed treatment.Only 48% had their levels rechecked following treatment; of these, only 59% now had an adequate Vitamin D status.ConclusionThis audit demonstrates limited Vitamin D monitoring within male forensic inpatients. There was a high prevalence of Vitamin D insufficiency in this population, yet a substantial proportion of patients with identified deficiency were not prescribed any treatment. Ongoing monitoring and review of treatment effectiveness was poor. We argue that more consideration should be given to this population, with robust guidelines introduced for the treatment of this specific ‘at-risk group’.

Quantitative association of educational status and effect of patient counseling among cancer patients: A cross-sectional analysis in a tertiary care hospital in South India.

Patient Counseling is desirable in chronic disease condition which is influenced by innumerable predictors. Educational status is one of the primary predictor which is usually ignored while considering the effect of patient counseling in cancer patients. Therefore, this study was aimed to determine the measure of association between education level and patient counseling among cancer patients. In the cross-sectional analysis, 90 cancer patients in inpatient setting at Oncology department of tertiary care hospital in South India were examined for a 24-week period through pharmacist-patient interview. The data were recorded in well-customized and validated data collection form. Bivariate analysis and linear regression analysis were performed using IBM SPSS Statistics 16.0, USA to assess the empirical relationship between the two determinants: education level and patient counseling. The study participants were aged between 11 to 80 years with 7:11 male to female ratio. Among 90 interviewed patients, 83.3% were counseled. Linear regression analysis demonstrated significant association between education status and patient counseling (p < 0.05). The study findings suggest that poor education status can be a barrier to patient's ability to seek and act on the counseling provided by the health care professionals. Thus, it recommends improvisation of counseling practice on patients from different educational divisions.

Improving risk-equalization in Switzerland: Effects of alternative reform proposals on reallocating public subsidies for hospitals

The Swiss healthcare financing system is on the verge of one of its largest reforms. The Swiss parliament is currently debating how to reallocate about 20 % of total health expenditures. Swiss cantons make substantial tax-funded contributions to health expenditures by paying 55 % of hospital inpatient costs. As health insurers are fully responsible for all outpatient costs, the present system may provide unintended incentives to treat patients in inpatient settings. This paper presents and evaluates three alternative reform proposals for the reallocation of the cantonal contribution. Two proposals are currently under consideration in the Swiss parliament, suggesting either partial cost-sharing (20 %) of all healthcare costs or inclusion of cantonal contributions into the risk-equalization fund. A third option is developed in this paper, which proposes using the cantonal funds to pay a share of insurer’s expenses above a high-cost threshold. The high-cost risk-sharing alternative is clearly superior: it mitigates the incentive to discriminate against sicker individuals, improves incentives for cost control, and reduces risk of loss for insurers. The paper adds results from Switzerland to an international literature on the properties of adding high-cost risk sharing to a risk equalization model.

Texas Tech University Health Sciences Center School of Medicine, Lubbock.

Texas Tech University Health Sciences Center School of Medicine, Lubbock.

Cannabis Withdrawal Syndrome Affects Nearly Half of Those Who Quit

Back to table of contents Previous article Next article Clinical & ResearchFull AccessCannabis Withdrawal Syndrome Affects Nearly Half of Those Who QuitTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:16 Jul 2020https://doi.org/10.1176/appi.pn.2020.6a4AbstractPrevalence of cannabis withdrawal syndrome is greatest among inpatients.iStock/pabloborcaNearly half of people who regularly use cannabis experience cannabis withdrawal syndrome when they try to stop, according to a meta-analysis published online in JAMA Network Open in April. The highest prevalence occurs among patients in inpatient settings, followed by those in outpatient settings. According to the DSM-5, symptoms of cannabis withdrawal syndrome may arise within seven days of quitting or reducing the use of cannabis and include irritability, aggression, nervousness, anxiety, problems with sleep, changes in appetite, depressed mood, and physical symptoms such as headaches, sweating, and nausea.“Cannabis withdrawal syndrome is clinically relevant and not something we should trivialize. It may be a reason people have difficulty quitting,” lead author Anees Bahji, M.D., a psychiatry resident at Queen’s University in Kingston, Ontario, told Psychiatric News. “The symptoms are terrible, which can set people up for a cycle where they try to make the symptoms go away by using cannabis again.”Bahji and his colleagues analyzed data from 47 studies that included a total of 23,528 participants. They found that the overall prevalence of cannabis withdrawal syndrome in people who used cannabis regularly and then tried to quit was 47%. When the researchers broke the data down according to setting, they found the prevalence of cannabis withdrawal syndrome was 87% among inpatients, 54% among outpatients, and 17% among people in the general population who used cannabis.Cannabis withdrawal syndrome may prompt patients to use cannabis again in an effort to stave off symptoms. —Anees Bahji, M.D.Bahji offered some possible reasons for the higher prevalence among inpatients, as it is unlikely that they are admitted because they are experiencing cannabis withdrawal.“This is speculation, but inpatients might be forced to withdraw from cannabis if they cannot continue to use it while admitted to hospital,” he said. “As well, people with other psychiatric conditions or substance use disorders might be more susceptible to cannabis withdrawal.”The researchers found that the prevalence of cannabis withdrawal syndrome was higher among people who also used tobacco or other substances compared with those who did not. Although the meta-analysis was not designed to determine why, Bahji said that it’s not uncommon for people who use cannabis to use other substances because co-occurring substance use tends to be the norm, rather than the exception.Bahji said that although cannabis withdrawal syndrome was first recognized in the fifth edition of DSM seven years ago, many health professionals and patients are not aware of it and that the study’s results should call attention to it as a medical condition.“A lot of people don’t get treatment because cannabis isn’t seen as a ‘hard drug.’ That does a disservice to them because even though the severity [of cannabis withdrawal] might be less than what we’d see with opioids or other drugs, the fact that there is such a high prevalence of it tells us that this might be a huge issue,” Bahji explained.He added that the results are noteworthy at a time when more and more states are legalizing cannabis use for medical and recreational use.“When something is made legal, it might be perceived as safe, and some people may go ahead and use it,” he said, adding that the impact of widespread legalization on cannabis use and public health may not be apparent until several years down the road. Yet he stopped short of dismissing cannabis for medical use entirely. “I’m interested in seeing where the research goes because part of me believes there may be a therapeutic use for cannabis. I just think it will take a long time to tease that out—what component of cannabis should be used, how much should be used, and who could benefit from it.”The authors reported no outside funding for this study. ■“Prevalence of Cannabis Withdrawal Symptoms Among People With Regular or Dependent Use of Cannabinoids: A Systemic Review and Meta-Analysis” is posted here. ISSUES NewArchived

Organizing inpatient services in a general hospital in times of COVID-19

COVID-19 is an unprecedented event and has affected patients with psychiatric disorders in multiple ways. Patients in inpatient settings are at high risk of exposure of getting COVID-19 infection. We reviewed the literature on the inpatient psychiatric facilities and measures regarding how to address COVID-19 in these settings. We then provide an experiential narrative of the strategies and improvisations to meet the challenges of COVID-19 so as to continue the inpatient services at a large public funded medical school and hospital in North India. Literature suggested that it is important to restrict hospitalization, expedite discharges, prohibit visit of the attendants, minimize group activities, provide psychological assistance, multidisciplinary teams to provide care, to tackle issue of stigma, have adequate means for practicing preventive measures, creating facility for isolation and have clear guidelines for diagnostic testing. The psychiatry ward in our hospital was designated non-COVID ward and substantial beds were reserved for surgical trauma patients. For organizing inpatient services, we created a multidisciplinary team. Some of the measures were institute-mandated, while others were intra-departmental measures to protect staff as well as patients in the psychiatry ward. It can be concluded that COVID-19 pandemic is still an evolving situation. The measures to prevent exposure to COVID-19 infection in the inpatient facilities continues to evolve as and when fresh challenges emerge.

Rate and associated factors of transient ischemic attack misdiagnosis.

Background and purposeThe goal of this study was to investigate the rate and associated factors of Transient Ischemic Attack (TIA) misdiagnosis.MethodsWe retrospectively analyzed consecutive patients with an initial diagnosis of TIA in the emergency department (ED) in a 9-month period. All hospitalized TIA patients were evaluated by a neurologist within 24 h and had at least one hospital discharge follow-up visit within three months. Patients' clinical data and neuroimaging were reviewed. The final diagnosis was independently verified by two stroke neurologists.ResultsOut of 276 patients with the initial diagnosis of TIA, 254 patients (mean age 68.7 ± 15.4 years, 40.9% male, 25.2% final diagnosis of TIA) were included in the analysis. Twenty-four patients (9.4%) were referred to our rapid-access TIA clinic. The rate of TIA misdiagnosis among TIA clinic referred patients was 45.8%. Among the 230 patients in inpatient setting, the rate of TIA misdiagnosis was 60.0%. A hospital discharge diagnosis of TIA was observed in 54.3% of hospitalized patients; however, only 24.8% had the final diagnosis of TIA. Among hospitalized patients, the univariate analysis suggests a significant difference (P < .05) between the two groups (correctly versus misdiagnosed patients) in terms of hospital discharge diagnosis, final diagnosis, history of diabetes mellitus, and coronary artery disease. In regression model hospital discharge diagnosis (P < .001), final diagnosis (P < .001), and diabetes mellitus (P = .018) retained independent association with TIA misdiagnosis.ConclusionOur study indicates a high rate of TIA misdiagnosis in the emergency department, hospital, and outpatient clinics.

Improving screening and counselling for second hand smoke exposure among pediatric asthma patients in inpatient settings : A QI Project

Improving screening and counselling for second hand smoke exposure among pediatric asthma patients in inpatient settings : A QI Project

Investigating the feasibility and acceptability of a cognitive behavioural suicide prevention therapy for people in acute psychiatric wards (the 'INSITE' trial): study protocol for a randomised controlled trial.

BackgroundSuicide is a major cause of preventable death, and suicidal behaviour is prevalent in acute psychiatric wards. People admitted to acute psychiatric wards often experience repeated episodes of suicidal behaviour, causing great distress and heavy use of NHS services. There is little research investigating effective psychological treatments for suicidal patients in inpatient settings although previous research has found support for psychological therapies which specifically target suicidal behaviour. This paper describes the protocol of a single blind RCT to investigate the acceptability and feasibility of a cognitive behavioural intervention targeting suicidality (CBSP) for suicidal people in acute psychiatric wards.Methods/DesignA single blind RCT comparing treatment as usual (TAU) to TAU plus Cognitive Behavioural Suicide Prevention (CBSP) therapy (TAU + CBSP). Sixty participants (aged 18–65 years) who are suicidal, or have been within the past 3 months, will be recruited from NHS trusts in the North West of England. Our primary objective is to determine whether CBSP is feasible, acceptable and efficacious when compared to patients who receive TAU alone. Secondary aims are the impact of CBSP on suicidal thinking, behaviours, functioning, quality of life, service use and psychological factors associated with suicide. Assessments take place at baseline, 6 weeks and 6 months (end of treatment). The analysis will report on the feasibility and acceptability of CBSP. Qualitative data from staff and service users will inform feasibility and acceptability data.DiscussionPsychiatric inpatients are a high-risk group and the use of psychological therapies in these settings is rare and requires evaluation. This study is essential to investigate the unique contextual challenges involved in delivering psychological therapy to suicidal inpatients and to identify any necessary modifications required within inpatient settings. The findings will inform a larger, definitive trial.Trial registration15 March 2012, PB-PG-1111-26026, NIHR ISRCTN17890126.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1192-9) contains supplementary material, which is available to authorized users.

Graying of the HIV epidemic: a challenge for inpatient medicine providers

Since the advent of anti-retroviral therapy, patients with HIV are living longer, and in the year 2015, over half of those infected with the virus will be older than age 50. Moreover, as the general aging population continues to grow, more elderly individuals will become newly infected with HIV. Older patients with HIV contribute to high numbers of initial and rehospitalizations, have longer lengths of hospital day stays, and are at increased risk of death compared to younger patients with HIV and those without HIV. Age-related comorbidities can be exaggerated in HIV-positive patients on and off therapy. Furthermore, signs and symptoms of HIV and AIDS may mimic features seen in the normal aging process of older adults. Internists caring for patients in inpatient settings will be expected to care for and diagnose increasing numbers of older patients with HIV. This will be critical for improving quality of patient care, reducing morbidity and mortality, and managing newly diagnosed patients earlier in the disease course while reducing spread of the virus. Internists should be central leaders in the development of targeted and non-targeted HIV screening efforts in inpatient general medicine wards.

Deutsche Übersetzung des Suicidal Patient Observation Charts (SPOC) – ein Instrument für die Praxis

Nursing of suicidal in-patients is a complex and responsible task. A direct and immediate intensive caring and therapeutic supervision, also known as special observation is still recommended in guidelines (DGPPN, 2012) and maybe one of the most used interventions in the caring of suicidal patients in inpatient settings. It involves many kinds to develop the relationship between the observer and the patient. The original SPOC was developed in Sweden with the aim to increase the quality of a systematically documentation during the supervision of suicidal patients. It is an instrument to ensure systematic documentation of observational behavior or noticeable mood during acute suicidal crisis, for example feelings like "worried, anxious" or other possible influencing factors like "sudden mood variation". By this means the SPOC can ensure the process of systematic documentation of special observation and increase its quality, i. e. who documented what at what time. Furthermore SPOC can facilitate a better communication of the observation process to the multidisciplinary team and to the patient as well. The SPOC includes the 28 items and covers 24 separate observation periods. The aim of this paper is to constitute the translation process from the English to the German SPOC version. The translation process followed a five step model. In the first step the English version was translated from two German native speakers. In the second step, the first two translation results where discussed by the Expert group (authors) and a new version was developed. In the third step the first german version was translated back (two English native Speakers) into English. The fourth step was taken, to review the results by the expert groups (authors) and set up the so called "pre version". The last step includes the proof of content validity by 52 nurses. The proof was able to identify a few misunderstandings and helped to enhance the tool in its final version. With the translation, the German-speaking nursing practice in psychiatry has a tool that can be used by psychiatric nurses regarding their complex interventions to be undertaken in this special group of patients.

Meeting the Students on Their Own Territory

Background Medical students receive communication skills training but there is little research into how effectively, or indeed whether, these skills can be transferred into clinical settings. This paper reflects upon a project aimed at supporting students in communicating with patients in clinical settings during their undergraduate years. Method During 2012, 36 year medical students were directly observed leading consultations with real patients in in-patient settings by a communications skills expert. Each observed session involved focused feedback on performance and agreeing areas for future practice involving a student peer and the member of faculty. Results and Discussion Students positively evaluated this work-based experience, specifically, valuing the authenticity of engaging with ‘real patients’ in ‘real settings’. They reported learning to deal with environmental issues such as noise, interruptions – the hallmark of busy clinical settings. They gained from observing the Communication Skills teacher model effective communication within the consultation process and receiving immediate focused one-to-one feedback. Moreover, they were able to maximise the feedback through immediately applying it to further consultations. The challenges of rolling out such a programme to more students are discussed. Implications Observed practice in work-based settings helps students to recontextualise knowledge learnt in the classroom setting. Their learning is greatly enhanced by having the supported opportunity to apply their skills in an authentic setting. However, implementing such a project can be resource intensive and logistically challenging.