Clinical Practice Skills Research Articles

A pilot study to evaluate the effect of classroom-based high-fidelity simulation on midwifery students’ self-efficacy in clinical lactation and perceived translation of skills to the care of the breastfeeding mother-infant dyad

Background: Midwives are expected to provide timely and skilled support to breastfeeding mothers, yet it is not clear whether and how midwifery students receive training in clinical lactation. The primary objective of this pilot study was to evaluate the impact of a classroom-based breastfeeding simulation on nurse-midwifery students’ self-efficacy in lactation skills. The secondary objective was to describe students’ exposure to breastfeeding patients in the classroom and in clinical settings.Methods: A pilot study using a prospective cohort study design and convenience sampling was completed between September 2017 and April 2018. Two simulation-based workshops were developed for the classroom setting in alignment with breastfeeding-focused competencies for midwives and lactation professionals. The workshops were integrated into the nurse-midwifery curriculum at a US-based program. Two Self-Efficacy Surveys (defined, 7-point Likert Scale) were developed and used to measure baseline and continuing self-efficacy in breastfeeding skills among students. Two Practice Patterns instruments, adapted from the American Academy of Pediatrics breastfeeding curriculum, were used to define the setting, quantity, and types of nurse-midwifery students’ breastfeeding-related exposures. Students participated in a one-hour focus group upon completion of the study.Results: In this pilot study, nurse-midwifery student participants (N = 9) reported a 14% increase (P < .0001) in their perceived self-efficacy in basic and advanced clinical lactation skills after completing both workshops. The nurse-midwifery students reported dozens of encounters with diverse breastfeeding patients over a six-month period during which they performed a wide variety of clinical lactation skills. The focus group revealed most students (n = 5/9) would like more time to practice clinical lactation skills in a simulated environment and some indicated a desire to have more exposure to challenging versus common (n = 2/9) of breastfeeding concerns.Conclusions: In this work, we demonstrate the first high-fidelity lactation simulation in a classroom setting in a healthcare professional training program. Midwifery educators and researchers can adapt the framework and instruments presented in this pilot study to determine the effect of educational interventions on students’ translation of skills to breastfeeding mother-infant dyads. Likewise, this is the first study to define the number and type of breastfeeding-related clinical exposures among nurse-midwifery students.

The Role of Clinical Instructor in Nursing Clinic Practice

The rapid development of technology in the field work does not only require that college graduates have extensive knowledge, but also have professional skills that are ready to be used in the job field. The achievement of student skills in clinical practice cannot be separated from the role of clinical instructor. Clinical instructors have a responsibility to ensure students learn and gain clinical skills experience. The nurses who are appointed as clinical instructor have a dual role. They are not only as clinical instructor, but also carrying out roles as team leaders, room manager and implementing nurses. This can have an impact on the implementation of the role as clinical instructor. This research aims to determine the role of clinical instructor at St. Elizabeth Hospital Semarang. This type of research is qualitative research. The main informants in this study are clinical instructor, while the triangulation informants are students who carry out clinical practice at St. Elisabeth Hospital Semarang. Informants were taken by using purposive sampling technique. Data collection was carried out by in-depth interviews. The research resulted in 2 themes, the role as an educator and as a motivator.

Teaching clinical practical and communication skills of the clinical skills lab of the University of Veterinary Medicine Hannover, Foundation, Germany during the COVID-19 pandemic.

Objective: The aim of the project is to teach clinical practical and communication skills in the Clinical Skills Lab (CSL) of the University of Veterinary Medicine Hannover, Foundation (TiHo) during the COVID-19 pandemic.Methodology: As a measure to limit potential SARS-CoV2 infections, the CSL learning stations were digitised and made available on the Moodle learning platform of the TiHo. Online quiz stations were also developed, as well as improvisations that allowed students to practise practical skills at home using everyday materials. Courses for Practical Year (PY) students were digitised and again combined with classroom exercises throughout the year. The teaching formats could be evaluated by the students by means of a questionnaire using a Likert scale (1=agree; 4=disagree).Results: A total of 24.92% of students (n=1272) completed the learning stations with improvisations. The quiz stations were completed with a percentage of 75.08%. Students indicated that the improvisations were easily implementable from home (M=1.33) and assisted in learning the practical skills in question (M=1.89). The quiz stations were considered helpful (M=1.40) and complementary to previous CSL offers (M=1.13). The PY students found the amount of teaching materials adequate (M=1.76) and described communication with the lecturers as problem-free (compulsory electives=1.24).Conclusions: Digital teaching is suitable as a supplement to existing face-to-face courses at the CSL, but cannot replace on-site training under the guidance of trained personnel. The CSL will continue to strive for a combination of online and face-to-face courses for some learning stations in the future.

Adapting Medical Education Initiatives Through Team-Based e-Learning, Telemedicine Objective Structured Clinical Exams, and Student-Led Community Outreach During the COVID-19 Pandemic.

Although the COVID-19 pandemic has quickly prompted medical schools and students around the world to transition from their traditional classrooms to web-based learning, the global crisis has inspired the development of innovative e-learning solutions that use existing technology and other web-based tools to continue nurturing the education of medical students while ensuring the public health and safety of both students and faculty members alike. Through the perspective of medical students, we share how the COVID-19 pandemic has impacted and transformed small team–based learning in medical education; changed objective structured clinical exam evaluations and the practice of clinical skills through telemedicine; and nurtured nationwide, web-based, student-led initiatives for community outreach, telehealth, and medical services.

Continuing Education of Animal Health Professionals in Uganda: A Training Needs Assessment.

In Uganda, delivery of veterinary services is vital to animal health and productivity, and is heavily dependent on well-trained and skilled animal health professionals. The purpose of this study was to identify and prioritize areas for refresher training and continuous professional development of animal health professionals (veterinarians and veterinary paraprofessionals), with the overarching aim of improving veterinary service delivery in Uganda. A survey was administered electronically to 311 animal health professionals during the period November 14-30, 2019. Data were collected on relevant parameters including demographics, knowledge on preventive medicine, diagnostics, disease control and treatment, epidemiology, and One Health, as well as participants' opinions on training priorities, challenges faced, and constraints to veterinary service delivery. Most respondents were veterinarians 26-35 years old, were male, and worked in clinical practice. Lowest perceived knowledge was reported on subjects relating to laboratory diagnostics, antimicrobial resistance (AMR), and nutrition. Training topics considered to be of most benefit to respondents included laboratory diagnostics, treatment of common livestock diseases, AMR, and practical clinical skills in reproductive and preventive medicine. Participants preferred to receive training in the form of practical workshops, in-practice training, and external training. This study highlights the need to prioritize training in practical clinical skills, laboratory diagnostics, and AMR. Wet labs and hands-on practical clinical and laboratory skills should be incorporated to enhance training. Provision of targeted and successful trainings will be dependent on the allocation of adequate resources and support by relevant public and private stakeholders across the veterinary sector.

Exploring the Concept of Leadership from the Perspective of Physical Therapists in the United States.

Purpose: The purpose of this study was to examine the perceptions of physical therapists practising in the United States of the importance of leadership characteristics and of demographic traits and other factors that might be associated with perceptions of leadership in three contexts: workplace, health care system, and society. Method: An online questionnaire was distributed through snowball sampling to physical therapists practising in the United States over an 8-week period between October and November 2019. A total of 15 leadership characteristics were rated on a 5-point scale of importance. Results: A total of 278 physical therapists responded to the questionnaire. They rated communication and professionalism as the top two leadership characteristics across all settings. Self-awareness and business acumen were not perceived as important for leadership. No relationship was found between gender and self-declaration as a leader or between a participant's practice setting and their rating of the importance of leadership characteristics. Conclusions: Our results further the discussion of leadership in the physical therapy profession. They highlight a comprehensive acceptance of leadership characteristics as important regardless of context. Further work will be necessary to transition this declaration of the importance of leadership skills to identifying the essential leadership skills for physical therapist education and clinical practice.

Augmented reality simulator for CT-guided interventions

IntroductionCT-guided interventions are taught using a mentored approach on real patients. It is well established that simulation is a valuable training tool in medicine. This project assessed the feasibility and acceptance of replicating a CT-guided intervention using a bespoke software application with an augmented reality head-mounted display (ARHMD).MethodsA virtual patient was generated using a CT dataset obtained from The Cancer Imaging Archive. A surface mesh of a virtual patient was projected into the field-of-view of the operator. ChArUco markers, placed on both the needle and agar jelly phantom, were tracked using RGB cameras built into the ARHMD. A virtual CT slice simulating the needle position was generated on voice command. The application was trialled by senior interventional radiologists and trainee radiologists with a structured questionnaire evaluating face validity and technical aspects.ResultsSixteen users trialled the application and feedback was received from all. Eleven felt the accuracy and realism was adequate for training and twelve felt more confident about their CT biopsy skills after this training session.DiscussionThe study showed the feasibility of simulating a CT-guided procedure with augmented reality and that this could be used as a training tool.Key Points• Simulating a CT-guided procedure using augmented reality is possible.• The simulator developed could be an effective training tool for clinical practical skills.• Complexity of cases can be tailored to address the training level demands.

Feedback in clinical settings: Nursing students' perceptions at the district hospital in the southern part of Namibia.

BackgroundFeedback was the backbone of educational interventions in clinical settings. However, it was generally misunderstood and demanding to convey out effectively. Nursing students were not confident and did not feel free to practise clinical skills during practical placements because of the nature of the feedback they received whilst in these placements. Moreover, they experienced feedback as a barrier to completing practical workbooks.ObjectiveThe purpose of this article was to report on a qualitative study, which explored nursing students’ perceptions of the feedback they received in clinical settings, at a district hospital.MethodThis study was conducted at a district hospital located in southern Namibia. An explorative qualitative design with an interpretivist perspective was followed. A total of 11 nursing students from two training institutions were recruited by purposive sampling and were interviewed individually. All interviews were audio recorded with a digital voice recorder followed by verbatim transcriptions, with the participants’ permission. Thereafter, data were analysed manually by qualitative content analysis.ResultsThemes that emerged as findings of this study are feedback is perceived as a teaching and learning process in clinical settings; participants perceived the different nature of feedback in clinical settings; participants perceived personal and interpersonal implications of feedback and there were strategies to improve feedback in clinical settings.ConclusionNursing students appreciated the feedback they received in clinical settings, despite the challenges related to group feedback and the emotional reactions it provoked. Nursing students should be prepared to be more receptive to the feedback conveyed in clinical settings.

The functional roles of metacognitive judgement and emotion in predicting clinical reasoning performance with a computer simulated environment

ABSTRACT Monitoring one’s learning activities is a key component of self-regulated learning (SRL) leading to successful learning and performance outcomes across settings. Achievement emotions also play an important part in SRL and consequently student learning outcomes. However, there is little research on how specific types of monitoring (i.e. Feeling-of-Knowing, Judgement-of-Learning) and achievement emotions jointly affect performance in clinical reasoning within computer simulated environments. In this study, we explored the joint predictive value of monitoring judgements and achievement emotions in medical students’ ability to make accurate and efficient clinical diagnoses using BioWorld, a computer-based learning environment designed to help medical students practice clinical reasoning skills. Multiple types of data (log files, verbal protocols, self-report questionnaires) from 27 students were analyzed using text mining and linear mixed-effects models. We found that feeling-of-knowing judgements positively predicted diagnostic efficiency whereas judgement-of-learning and the achievement emotion of anger negatively predicted diagnostic efficiency. Achievement emotion of pride positively predicted confidence in diagnosing the case correctly. This study not only provides theoretical and methodological insights but also alert medical instructors to the many dimensions of diagnostic performances and effective intervention strategies in clinical reasoning.

Peer Mentoring as a Tool for Developing Soft Skills in Clinical Practice: A 3-Year Study.

Education currently focuses on improving academic knowledge and clinical skills, but it is also important for students to develop personal and interpersonal skills from the start of their clinical practice. The aim was to evaluate the effect of peer mentoring in third-year students and to gauge the evolution of non-technical skills (NTS) acquisition up to the fifth year. The study groups were selected between September 2015 and May 2018, based on the NTS training they had or had not received: (1) fifth-year students with no training (G1); (2) third-year students mentored in NTS (G2a); and (3) a small group of fifth-year students who became mentors (G2b). A total of 276 students who took part in this study were assessed using a 114-item self-evaluation questionnaire. Data were collected from seven surveys conducted between September 2015 and May 2018, and statistical analysis was performed using one-way ANOVA and Fisher’s post-hoc test. G2a improved their non-technical skill acquisition over three years of clinical training up to their fifth year. This group and G2b showed statistically significant differences compared to non-mentored students (G1). Peer mentoring at the beginning of clinical practice is a valid option for training students in non-technical skills.

Are people consistent when reading nonwords aloud on different occasions?

Tests of nonword reading have been instrumental in adjudicating between theories of reading and in assessing individuals’ reading skill in educational and clinical practice. It is generally assumed that the way in which readers pronounce nonwords reflects their long-term knowledge of spelling–sound correspondences that exist in the writing system. The present study found considerable variability in how the same adults read the same 50 nonwords across five sessions. This variability was not all random: Nonwords that consisted of graphemes that had multiple possible pronunciations in English elicited more intraparticipant variation. Furthermore, over time, shifts in participants’ responses occurred such that some pronunciations became used more frequently, while others were pruned. We discuss possible mechanisms by which session-to-session variability arises and implications that our findings have for interpreting snapshot-based studies of nonword reading. We argue that it is essential to understand mechanisms underpinning this session-to-session variability in order to interpret differences across individuals in how they read nonwords aloud on a single occasion.

Exploring the Motivational Learning Impact of a Contextually Adapted High-Fidelity Simulation Scenario on Nursing Students in the College of Nursing, in Kuwait

High-Fidelity Simulation, or Human Patient Simulation, is an educational strategy embedded within nursing and medical curricula throughout many healthcare educational institutions. With High-Fidelity Simulation, clinical situations can be created for students to practise clinical skills and apply theoretical knowledge in a simulated setting. Presently, nursing students in Kuwait rely on the allocation of clinical placements in order to test the skills and knowledge that they have acquired in the classroom. Therefore, nursing students in Kuwait did not have the opportunity to experience the benefits of High-Fidelity Simulation (HFS). In order to ensure that nurses in Kuwait receive the best standard of education, and thus patients receive the best standard of care, there is an urgent need to redesign nurse education. Given the known benefits of High-Fidelity Simulation in the development of nurse education and the need to introduce this approach for the first time in Kuwait, this study aims to explore if a scenario, can be culturally adapted for use in the education of nursing students in Kuwait, and the extent to which this scenario will enhance students’ motivation to learn. This study will apply the ARCS-V model as one of the most widely used interactionism models. Applying a sequential approach that reflects the action research process associated with the model, phase one will explore educational stakeholders’ perceived barriers and facilitators to High-Fidelity Simulation. Phase two will engage participants in the co-design of a United Kingdom nursing simulated scenario for implementation in College of Nursing, Kuwait. Phase three will pilot and evaluate the High-Fidelity Simulation scenario with undergraduate nursing students. Adaption of evidence based, authentic clinical High-Fidelity Simulation scenarios is a valued and unique step in redesigning nurse education.

Guidelines for Using Simulation for Online Teaching and Learning of Clinical Social Work Practice in the Time of COVID

Due to COVID 19, Monash University’s Social Work Department moved all clinical practice skills teaching in the Master of Social Work (graduate entry level) fully online using synchronous audio-visual conferencing platform Zoom for the first time from March to June 2020. The innovations associated with this move included the development of clinical practice laboratories (CPLs) to prepare 154 students for a modified version of an Objective Structured Clinical Examinations (OSCE) and their first field education practicum. The use of simulated clients to facilitate experiential learning of active listening skills, rapport-building and empathic communication in this mode of delivery is described in detail to encourage overcoming previous issues in teaching clinical practice skills to students located at a distance from campus.

One-on-one mentoring for final year medical students during the neurosurgery rotation

BackgroundMedical students show varying clinical practical skills when entering their final year clinical clerkship, which is the final period to acquire and improve practical skills prior to their residency. We developed a one-on-one mentoring program to allow individually tailored teaching of clinical practical skills to support final year students with varying skill sets during their neurosurgical clinical clerkship.MethodsEach participating student (n = 23) was paired with a mentor. At the beginning students were asked about their expectations, teaching preferences and surgical interest. Regular meetings and evaluations of clinical practical skills were scheduled every 2 weeks together with fixed rotations that could be individually adjusted. The one-on-one meetings and evaluations with the mentor gave each student the chance for individually tailored teaching. After completion of the program each student evaluated their experience.ResultsThe mentoring program was well received by participating students and acquisition or improvement of clinical practical skills was achieved by most students. A varying practical skill level and interest in the field of surgery was seen.ConclusionsA neurosurgical one-on-one mentoring program is well received by final year medical students and allows for individually tailored learning of clinical practical skills.

Sexual Well-Being Informed Social Work Practice: Harnessing the Power of Reflection and a Hallmark Experiential Sexuality Education Activity

Abstract Moving human sexuality beyond a specialty focus and establishing a sexuality discourse within social work’s foundation may be challenging. Group process and reflection, hallmarks of social work, may be a way to integrate this sometimes overlooked and often taboo conversation into social work coursework. Undergrad students from two Mid-western universities reflected on the usefulness of an established experiential sex education activity . Qualitative analysis of student narratives resulted in seven themes describing the usefulness of this activity including: (i) emotional intimacy; (ii) connection; (iii) power of personal stories; (iv) normalising; (v) healing; (vi) clinical profile and (vii) RE-storying. These themes demonstrate that this activity has clear benefits and enriches the overall learning of the topic of human sexuality. Further, these themes fit nicely within a social work pedagogy teaching clinical practice skills such as group process, rapport building and use of self. Implications for social work are discussed.

Nursing and Midwifery Students' Satisfaction with Their Clinical Rotation Experience: The Role of the Clinical Learning Environment.

Background The clinical learning environment and clinical rotation experience of students are integral to nursing curriculum and are a crucial component of nursing education which helps transform theoretical knowledge to clinical practical skills. Objective This study was aimed at assessing the role of the clinical learning environment on undergraduate nursing and midwifery students' satisfaction with their clinical rotation experience. Method The study employed a quantitative cross-sectional survey design. Data was collected from a sample of 240 undergraduate nursing and midwifery students of the University for Development Studies, Tamale, Ghana, using a structured questionnaire. Ethical approval was obtained from the University of Cape Coast Ethics Review Board. Descriptive analysis was displayed as frequencies and percentages. Inferentially, Fisher's exact test, linear regression, and Spearman's correlation tests were used to test for and quantify associations between independent and dependent variables at p ≤ 0.05. Results The level of students' satisfaction with both clinical rotation experience and the clinical learning environment was high (65.6% and 63.5%, respectively). A statistically significant association of the students' satisfaction with their clinical rotation experience was found. There was a statistically significant relationship between the clinical learning environment (χ2 (9, N = 224) = 80.665, p < 0.001), pedagogical atmosphere in the clinical area (rs = 0.379, p < 0.001), the leadership style of the ward manager (rs = 0.340, p < 0.001), the premises of nursing in the ward environment (rs = 0.501, p < 0.001), and the students' satisfaction with their clinical rotation experience. Conclusion These findings provide nurse educators and clinicians with meaningful understanding about areas to prioritise when planning clinical learning opportunities in such a way that skills learning and practice of nursing skills are successful and satisfactory for undergraduate student nurses and midwives.

Rural disability workforce perspective on effective inter-disciplinary training-A qualitative pilot study.

Inter-professional education is a growing area of importance that enables training of health care professionals and students to develop skills in collaborative clinical practice, a critical aspect of disability care. However, research is limited on appropriate on-site inter-professional training for the rural and remote disability workforce. This paper aims to explore the features of an effective inter-professional training approach for rural disability workforce. Riverland, South Australia. Clinical educators, allied health professionals, health and service providers and students. A qualitative-explorative research design, involving focus group discussion and a thematic analysis method were employed in this study. Participants of the focus group discussion completed a capacity building training program centred on inter-professional education, cultural-safety and the National Disability Insurance Scheme. National Disability Services Social Impact Measurement Tool was used to evaluate and explore the features of effective inter-professional training program for existing and emerging disability workforce in rural regions. Four themes emerged from data analysis: inter-professional education focus; structured inter-professional training; building collaborative learning environment; and culturally appropriate care practice. Inter-professional supervision was identified as a key enabler for capacity building in an area with limited health workforce. Inter-agency collaboration and professional network were identified as important elements to support disability health workforce retention and the transition from novice to practitioner. Prior knowledge about the needs of persons with disability and empathetic relationships influenced the quality of practice. In situ training programs, which provide real-life rural practice context and harness inter-agency collaboration, improve effectiveness of rural disability workforce readiness for practice.

Breast cancer-related upper limb lymphoedema: an overview.

Breast cancer-related lymphoedema can be commonly encountered within a community nurse's role. The severity of lymphoedema can range considerably, from those who are considered 'at risk' due to breast cancer treatment, to individuals with highly complex oedema from advanced disease. This article provides an overview of breast cancer-related lymphoedema, including the risk factors for developing lymphoedema and the impact lymphoedema has physically, psychologically and socially. The treatments for lymphoedema, including clinical practical advice and skills, are presented to support ongoing personal development. A collaborative approach between community nurses and lymphoedema clinics is recommended to ensure that patients receive the best care possible.

Designing and Implementing a Novel Virtual Rounds Curriculum for Medical Students' Internal Medicine Clerkship During the COVID-19 Pandemic.

IntroductionDuring the COVID-19 pandemic, third-year medical students were temporarily unable to participate in onsite clinical activities. We identified the curricular components of an internal medicine (IM) clerkship that would be compromised if students learned solely from online didactics, case studies, and simulations (i.e., prerounding, oral presentations, diagnostic reasoning, and medical management discussions). Using these guiding principles, we created a virtual rounds (VR) curriculum to provide IM clerkship students with clinical exposure during a virtual learning period.MethodsHeld three times a week for 2 weeks, VR consisted of three curricular components. First, clerkship students prerounded on an assigned hospitalized patient by remotely accessing the electronic health record and calling into hospital rounds. Second, each student prepared an oral presentation on their assigned patient. Third, using videoconferencing, students delivered these oral presentations to telemedicine VR small groups consisting of three to four students and three tele-instructors. Tele-instructors then provided feedback on oral presentations and taught clinical concepts. We assessed the effectiveness of VR by anonymously surveying students and tele-instructors.ResultsTwenty-nine students and 34 volunteer tele-instructors participated in VR over four blocks. A majority of students felt VR improved their prerounding abilities (86%), oral presentation abilities (93%), and clinical reasoning skills (62%). All students found small group to be useful.DiscussionVR allowed students to practice rounding skills in a supportive team-based setting. The lessons learned from its implementation could facilitate education during future pandemics and could also supplement in-person clerkship education.

The Effects of Electronic Feedback on Medical University Students’ Writing Performance

This study was designed to see whether electronic feedback positively affects medical students’ academic writing performance. Two groups of medical university students were randomly selected and participated in this study. In order to see whether the provision of electronic feedback for the compulsory academic writing course for medical students is effective, the researchers divided 50 medical students to the traditional (n=25) and intervention groups (n=25). Pre-test and post-test were conducted at the beginning and at the end of the semester. Electronic feedback was given to the medical students in the intervention group, while the medical students in the traditional group received the traditional pen and paper feedback. By comparing the scores of two written assignments at the beginning and the end of the semester, regarding the application of electronic feedback, the results showed that not only medical students’ overall writing performance improved after providing them electronic feedback, but every single writing component was also enhanced after the intervention. There was a significant difference in the post-test academic writing scores between the traditional and intervention groups (P &lt; 0.001). This difference was not significant in our control group who was given pen-and-paper feedback. In terms of specific writing components, the most affected components in this approach were content followed by organization, language use, vocabulary, and sentence mechanics, respectively. Although this study focused on medical students’ academic writing ability and reported the effect of electronic feedback on medical students’ writing performance, electronic feedback can be equally beneficial for enhancing student-practitioners’ practical clinical skills.