Perceptions Of Clinical Teaching Research Articles

Primary Care Perspectives on Education Scholarship: A Qualitative Synthesis.

A significant portion of medical education takes place in primary care settings with family medicine clinician teachers that have variable backgrounds in teaching. Ernest Boyer's concept of education scholarship calls on faculty to systematically study and innovate their teaching practices. This meta-ethnographic review synthesizes the literature on primary care clinician teachers' perspectives and experiences of integrating education scholarship in practice. We conducted an electronic database search in PubMed/Medline, Scopus, ERIC, and Web of Science for primary research articles published between January 2000 and August 2021. In the included articles, researchers studied primary care physicians' and/or residents' perspectives of clinical teaching and reported qualitative results (eg, interviews, focus groups). Of the 1,454 articles found in the search, we included 33 in the final synthesis. We used line-by-line descriptive coding of the qualitative data to develop analytical themes. Four main themes emerged from our synthesis: (1) perceptions of clinical teaching (lack of confidence, presumed teaching competency, lack of formal recognition); (2) clinical teaching strategies (learner-centered teaching, ad hoc teaching, role modeling, mentorship); (3) benefits of clinical teaching (shared learning experience, networking, personal interest, career satisfaction); and (4) challenges of clinical teaching (inadequate time, compensation, conflicting responsibilities). Clinician teachers identified several common factors regarding their scholarly roles but had difficulty describing them in relation to education scholarship. Institutional support, resources, and awareness are needed to assist family medicine clinician teachers to further implement Boyer's concept of education scholarship in practice-specifically, to study, evaluate, and innovate current clinical teaching strategies.

Outpatient learning perspectives at a UK hospital.

Undergraduate students spend much of their training in the clinical workplace, increasingly in hospital outpatient settings; however, they report that this does not always yield the educational value that they expect. This study investigates ways in which outpatient learning can be enhanced from the perspectives of students and teachers, exploring which approaches may be most appropriate in different circumstances. We conducted 14 semi-structured interviews with medical students from one UK medical school and consultants (specialists) at a single teaching hospital. We explored their experiences and perceptions of clinical teaching and learning in this outpatient setting. Transcripts were analysed through a consensual qualitative research approach. An evaluation of established frameworks for outpatient teaching was conducted and strategies were matched to stakeholder needs. A total of 24 core ideas were identified, which were categorised into: individual factors (student, doctor and patient), interpersonal factors, team factors and organisational factors. Teaching strategies that address stakeholder needs included: student-led clinics, case-based discussions, one-minute preceptor, the SNAPPS tool (summarize, narrow differential, analyse, probe preceptor, plan and select issues for self-learning), advanced organisers and supplementing. There is a complex interplay between personal, interpersonal, team and organisational factors that contribute to the effectiveness of the outpatient setting as a learning environment. Strategies at the personal and interpersonal levels are unlikely to be successful or sustained without organisational resourcing and support. Further research is needed to implement and evaluate these suggested strategies.

Educating future practitioners through an Interdisciplinary Student Clinic

This article introduces a pilot clinic that has been designed and implemented at Portsmouth Law School in partnership with the School of Health Sciences. The benefits and challenges of interdisciplinary team working identified in the health science and legal education literature will be discussed. It looks at the rationale for this innovative development and speculates on the potential for a new professional curriculum that may emerge.The philosophy driving this pilot clinic is to contribute to breaking down silo thinking in professional students and build trust in the health and legal systems. This initiative will expose health professional and law students to holistic and therapeutic approaches to problem solving, teaching teamwork, collaboration and to breaking down the negative stereotypes of lawyers.The proposed pilot clinic at the University of Portsmouth will provide new opportunities for students studying law and adult nursing to explore how interdisciplinary practice might build bonds of trust between professionals. It will also enable those involved to see potential networks, signposts and links, in order to improve client outcomes.This new development, taking lessons from educational practice in health sciences, provides professional and teaching staff operating the clinic to build a new collaborative and dynamic joint curriculum. This new form of clinic, it is argued, provides an alternative to traditional perceptions of clinical teaching across multidisciplinary paradigms.

Integration of Mobile Devices to Facilitate Patient Care and Teaching During Family-Centered Rounds.

The increasing prevalence of mobile devices in clinical settings has the potential to improve both patient care and education. The benefits are particularly promising in the context of family-centered rounds in inpatient pediatric settings. We aimed to increase mobile device usage by inpatient rounding teams by 50% in 6 months. We hoped to demonstrate that use of mobile devices would improve access to patient care and educational information and to determine if use would improve efficiency and perceptions of clinical teaching. We designed a mixed-methods study involving pre- and post-implementation surveys to residents, families, and faculty as well as direct observations of family-centered rounds. We conducted rapid cycles of continual quality improvement by using the Plan-Do-Study-Act framework involving 3 interventions. Pre-intervention, the mobile computing cart was used for resident education on average 3.3 times per rounding session. After cycle 3, teaching through the use of mobile devices increased by ∼79% to 5.9 times per rounding session. On the basis of survey data, we determined there was a statistically significant increase in residents' perception of feeling prepared for rounds, receiving teaching on clinical care, and ability to teach families. Additionally, average time spent per patient on rounds decreased after implementation of mobile devices. Integration of mobile devices into a pediatric hospital medicine teaching service can facilitate patient care and perception of resident teaching by extending the utility of electronic medical records in care decisions and by improving access to knowledge resources.

A survey of senior medical students’ attitudes and awareness toward teaching and participation in a formal clinical teaching elective: a Canadian perspective

ABSTRACTBackground: To prepare for careers in medicine, medical trainees must develop clinical teaching skills. It is unclear if Canadian medical students need or want to develop such skills. We sought to assess Canadian students’ perceptions of clinical teaching, and their desire to pursue clinical teaching skills development via a clinical teaching elective (CTE) in their final year of medical school.Methods: We designed a descriptive cross-sectional study of Canadian senior medical students, using an online survey to gauge teaching experience, career goals, perceived areas of confidence, and interest in a CTE.Results: Students at 13 of 17 Canadian medical schools were invited to participate in the survey (4154 students). We collected 321 responses (7.8%). Most (75%) respondents expressed confidence in giving presentations, but fewer were confident providing bedside teaching (47%), teaching sensitive issues (42%), and presenting at journal clubs (42%). A total of 240 respondents (75%) expressed interest in participating in a CTE. The majority (61%) favored a two week elective, and preferred topics included bedside teaching (85%), teaching physical examination skills (71%), moderation of small group learning (63%), and mentorship in medicine (60%).Conclusion: Our study demonstrates that a large number of Canadian medical students are interested in teaching in a clinical setting, but lack confidence in skills specific to clinical teaching. Our respondents signaled interest in participating in an elective in clinical teaching, particularly if it is offered in a two-week format.

Perceived effectiveness of one-minute preceptor in microskills by residents in dental residency training at National Dental Centre Singapore

Background: The National Dental Centre Singapore (NDCS) has collaborated with the National University of Singapore’s Division of Graduate Dental Studies to provide supervised clinical training in the five dental specialties for residents since the early 1990s. Faculty were first introduced to the one-minute preceptor (OMP) in microskills through in-house workshops held from May to August 2014. Purpose: The aim of this study was to assess if a OMP faculty workshop impacts residents’ perceptions of clinical teaching in NDCS. Methods: First- and second-year residents were asked to rate their perceptions of the quantity and quality of clinical teaching, and the adequacy of the five OMP microskills performed by faculty before and one month after the OMP workshops. Data were analysed using descriptive statistics and non-parametric statistical tests. Results: A total of 37 NDCS clinical faculty participated in the OMP workshops and 34 residents participated in the pre- and post-workshop survey. The short-term impact of the OMP faculty workshop revealed minimal effect on residents’ perceptions of the clinical teaching in both quantity and quality. Conclusion: A one-time OMP workshop for faculty members does not substantially improve residents’ perceptions of the quality or quantity of clinical teaching. The results of this study indicate that the effort to improve clinical teaching by faculty must be a sustained effort. Future studies should investigate the barriers to faculty members’ performance of the OMP microskills.

Clinical teaching with minimal and indirect supervision

What problems were addressed? In medical education, the adequate supervision of medical students is known to result in improved patient outcomes. However, this presents a challenge in clinical clerkships, in which faculty supervisors need to balance their time and resources. As such, the ability to provide indirect supervision to students – particularly in a setting in which the faculty member is not directly managing the student–patient encounter – is an important skill. Although minimal supervision of students presents a feasible solution to challenges in faculty supervision, it is unclear how such practices are perceived by patients and how they affect the learning experiences of students. To investigate this issue, this study examined patient and medical student perceptions of clinical teaching in a setting with minimal faculty supervision. What was tried? We performed a cross-sectional study with a sequential sample of obstetrics patients at an antenatal out-patient clinic. Questionnaires focusing on perceptions of students’ performance during the consultation were administered preand post-student consultation. In addition, patients were asked to write three words representing what they felt before and after the consultation. Students’ selfperceptions of their performance while consulting with patients were obtained through a questionnaire administered at the end of the process. An openended question requested students to write five words representing what they felt after consulting with patients with minimal clinical supervision. What lessons were learned? Of the 95 pregnant women studied, 95% knew that the student would perform routine antenatal care and would receive feedback from the supervisor following the consultation. They acknowledged that it was important for students to perform prenatal care as part of their training (85%). Before the consultation, 22% were not sure if they felt comfortable being examined by a medical student and 20% were unsure whether they could trust a student. After the consultation, 97% of patients felt comfortable about the examination and 99% felt they trusted the students. Of the pre-consultation descriptor words, ‘anxiety’ was the most frequently used word. ‘Calm’ and ‘satisfaction’ were the most frequently used post-consultation descriptors. Of the 77 students, 56% were in Year 5 of medical school and 44% were in Year 6. Students agreed that the ambulatory format with minimal faculty supervision encouraged their participation and engagement (82%). They felt that case discussions with faculty staff were useful (90%) and contributed to their learning (88%). The words ‘trust’, ‘secure’, ‘responsibility’ and ‘autonomy’ were the most representative of those used by students to express their feelings about meeting patients by themselves, supported by the outside supervision of the preceptor. Students expressed interest in knowing the opinions of the pregnant women about their performance in providing supportive medical care (92%) and confirmed that they would feel comfortable about being assessed by patients (84%). We observed positive patient feedback, and the perceptions of finalyear students regarding this out-patient clinical teaching method with minimal faculty supervision reinforced the potential to expand their autonomy. These findings may support additional assessments that incorporate patient perspectives into the overall clinical evaluation of students, which may improve the validity of the clinical assessment system.

Contemporary Issues in Clinical Dental Teaching

This research project sought to explore the issue of what constitutes effective clinical teaching in the minds of both students and teachers. As stakeholders of the dental clinical setting, teachers and students have valuable practical insights to share with the academic and professional community as to what constitutes effective dental teaching. An explorative qualitative study of dental teachers' and students' perceptions of clinical teaching was carried out at the Faculty of Dentistry of Sydney University. Thirty-one clinical teachers and 12 students participated in this case study through an online questionnaire survey and a focus group, respectively. Responses were categorized in three major clusters, namely, instructional, curricular or organizational. The findings reveal that both groups hold similar opinions on what constitutes effective clinical instruction including a shared passion for learning and teaching, being clear and organized, demonstrating clinical competencies as well as engaging in professional self-reflection. Most of the issues fell into the instructional cluster where establishing a positive relationship with students including providing constructive feedback at the clinical session came up as key factors contributing to the student experience. There is a demand from both students and teachers to standardize clinical procedures and protocols as well as having a greater synchronization in time and content between lectures and clinical work.

Students' perceptions of clinical teaching and learning strategies: A Pakistani perspective

The complexity of the health care environment is increasing with the explosion of technology, coupled with the issues of patients' access, equity, time efficiency, and cost containment. Nursing education must focus on means that enable students to develop the processes of active learning, problem-solving, and critical thinking, in order to enable them to deal with the complexities. This study aims at identifying the nursing students' perceptions about the effectiveness of utilized teaching and learning strategies of clinical education, in improving students' knowledge, skills, and attitudes. A descriptive cross sectional study design was utilized using both qualitative and quantitative approaches. Data were collected from 74 students, using a questionnaire that was developed for the purpose of the study and analyzed using descriptive and non-parametric statistics. The findings revealed that demonstration was the most effective strategy for improving students' skills; reflection, for improving attitudes; and problem based learning and concept map for improving their knowledge. Students' responses to open-ended questions confirmed the effectiveness of these strategies in improving their learning outcomes. Recommendations have been provided based on the findings.

How Does Gender Interact With Clinical Teachers’ Perceptions of Clinical Teaching?

This study analyzed 816 medical professors’ perceptions of clinical teaching, as measured with the online version of the Clinical Teaching Perception Inventory, and examined difficulties that female professors faced in becoming the ideal clinical teacher. While describing themselves as a clinical teacher, female professors rated themselves lower than did their male counterparts on the stereotypical masculine characteristics “stimulating,” “well read,” “assured,” and “secure” and rated themselves higher on a stereotypical feminine characteristic “feeling.” It is possible that female medical professors underrate their actual behaviors as clinical teachers. Implications are discussed for future faculty development and the advancement of gender equity in medical education, where numbers of women have been steadily increasing. Recommendations for further research are offered.

Physicians’ Perceptions of Clinical Teaching: A Qualitative Analysis in the Context of Change

Change is ubiquitous. Current trends in both educational and clinical settings bring new challenges to clinicians and have the potential to threaten the quality of clinical teaching. To investigate hospital specialists' perceptions of clinical teaching in the context of change. Qualitative study using in-depth semi-structured interviews. Three hospital trusts in the United Kingdom associated with a new medical school. A purposive sample of 15 clinicians from each of the three participating hospitals was approached. A total of 13 participated in the in-depth interviews: three from hospital A, six from hospital B and four from hospital C. The two main themes of 'Characteristics of Good and Bad Teachers' and 'Clinical Teaching Approaches' emerged. These were underpinned by a number of sub-themes; including some seen by participants as potential barriers to teaching and learning, for example, organisational and personal issues. Potential barriers to teaching and learning, including why good clinical teachers may at times seen to be intimidating or to cause humiliation and problems of engaging with new educational practices, can be understood within the context of change resistance. Knowing more about how clinical teachers think about their task as educators is essential and this should underpin staff development and training programmes.

Teaching and learning in the clinical setting: a qualitative study of the perceptions of students and teachers.

To describe the perceptions of medical students and clinical teachers of teaching and learning in the clinical setting. Qualitative study of focus groups with undergraduate medical students and semistructured interviews with hospital consultant clinical teachers. The School of Medicine, University of Leeds and the Leeds Teaching Hospitals Trust, UK. Fourth year medical students and consultant clinical teachers. Analysis of narratives to identify students' perceptions of clinical teaching and consultants' views of their delivery of undergraduate clinical teaching. Students believed in the importance of consultant teaching and saw consultants as role models. However, they perceived variability in the quality and reliability of teaching between physicians and surgeons. Some traditional teaching venues, especially theatre, are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt under severe pressure from other commitments. They taught in a range of settings and used various teaching strategies, not all of which were perceived to be 'teaching' by students. While students and teachers are educational partners, they are not always in agreement about the quality, quantity, style or appropriate setting of clinical teaching. To enable teachers to provide more high quality teaching, there needs to be support, opportunities and incentives to understand curricular developments and acquire teaching skills.

An alternative approach to defining the role of the clinical teacher.

A number of studies have attempted to identify the components of the clinical teacher role by examining learners' numerical ratings of items on researcher-generated lists. Some of these studies have also compared different groups' perceptions of clinical teaching, but have not directly compared the perceptions of first- and third-year residents. This study addressed two questions: (1) What do residents consider important components of the clinical teacher role? (2) Do first- and third-year residents perceive this role similarly? A content analysis was performed on the comments written on evaluation forms by 268 residents about 490 clinical teachers over a five-year period (1980-81 through 1984-85) at a large family practice residency. Of 5,664 forms completed by the residents, 2,388 (42%) contained written comments; comments were on 1,024 (46%) of the first-year resident's forms, 701 (41%) of the second-year residents' forms, and 663 (39%) of the third-year residents' forms. Themes in these comments were coded into a coding dictionary of 157 categories, within 37 clusters, within four roles. The ten highest-ranked categories (Global; Teaching: General; Knowledgeable; Gives Resident Responsibility; Supportive; Miscellaneous; Interested in Teaching; Clinical Competence; Makes Effort to Teach; and Gives Resident Opportunity to Do Procedures) accounted for 41% of the themes coded. The first- and third-year residents differed in the clusters they used to describe their clinical teachers on evaluation forms (chi 2 = 149.86, df = 36, p < .0001). The results suggest that content analysis can be used to validly and reliably study residents' written evaluative comments about their teachers. This study contributes to the definition of the clinical teacher role, showing the relative importances of its components, and also supports Stritter's Learning Vector theory, finding the anticipated differences between the comments made by first- and third-year residents.

Changes in students' perceptions of clinical teaching as a result of general-practice clerkships.

This study investigated whether a 3-week clerkship for third-year medical students in general-practice doctors' offices changed the students' perceptions of clinical teaching. The Preceptor Evaluation Questionnaire was administered to 138 junior medical students before and after their clerkships. The result of the study indicated that the clerkship had a positive effect on the students' perceptions. This finding was not related to their experiences in other clerkships nor to the grades they received for the clerkship. The results indicate that the teaching relationship established between student and family doctor significantly affects students' perceptions of aspects of effective clinical teaching.