Does a brief clerkship change Hong Kong medical students’ ideas about general practice?

OBJECTIVES: This study examines the impact on students of a brief general practice clerkship, during a curriculum that is otherwise almost entirely hospital-based and in a practice environment that often does not encourage good primary care. DESIGN: 15 focus group discussions were held with a total of 110 students, as part of an action research project. Student responses were audiotaped, transcribed and then analysed for recurrent themes. SETTING: General Practice Unit, University of Hong Kong. SUBJECTS: Medical students RESULTS: There was evidence of pre-existing negative stereotypes of general practice, but in many cases these were dispelled by the relationships students developed during their attachment to general practitioners in the community. In an overcrowded curriculum, students ration their time and energy, focusing their learning pragmatically on subjects that have a high profile during examinations. CONCLUSIONS: Even in healthcare and medical school systems that are specialist-dominated, and in which the circumstances of practice do not always encourage high standards of care, the general practice clerkship can allow students to gain an understanding of the importance of primary care, and of the significance of the general practitioner's role in the healthcare system.     

What makes a quality occupational therapy practice placement? Students’ and practice educators’ perspectives

Background/aim: Practice placement experiences are crucial to enable students to integrate theory with practice, demonstrate professional and interpersonal skills and build confidence in their practice skills. This study addressed practice educators’ and students’ perspectives regarding quality practice placement experiences. Method: In total 29 students, 41 practice educators and eight practice education staff members across three Queensland universities participated in focus groups or individual interviews (N = 78) focusing on their views about quality learning experiences on placements. Results: Key themes described university preparation and processes, a welcoming learning environment, detailed orientation and clear expectations, graded program of learning experiences, quality modelling and practice, consistent approach and expectations, quality feedback, open and honest relationships and supervisor experience and skills. These findings were consistent with research previously undertaken in Australia and Canada that had investigated either student or practice educator perspectives. Conclusions: This article synthesises the perspectives of these stakeholder groups and has led to the development of quality indicators across the phases of placement establishment, preparation, maintenance and review. Although having sufficient placements can be challenging for university programmes, ensuring that the experiences provided are of high quality is also important and requires significant attention by university academics and practice education staff, practice educators, managers and practice organisations alike.     

Electives: isn’t it time for a change?

Objectives  Medical student electives are memorable learning experiences, of which approximately 40% are spent in developing countries. Students often have laudable motivation but are rarely helped to learn most effectively or contribute meaningfully whilst away. Each year an estimated 350 years of elective time is spent in developing countries (by students from the UK alone), which represents substantial opportunity.
Methods  We conducted a literature search prior to developing an alternative approach towards electives based upon educational and ethical principles.
Results  Despite their anecdotal value there has been little empirical research conducted into electives. From our review we identified four key learning domains (Clinical Knowledge and Skills, Attitudes, Global Perspectives, Personal and Professional Development) and two broader issues (Institutional Benefits and Moral/Ethical Considerations). Potentially beneficial and more structured alternatives are emerging and improvements appear possible through institutional collaborations and greater planning in order to maximise the educational experience, opportunities to contribute and minimise the risks involved in electives.
Conclusions  Electives are a highlight of clinical training but probably often represent missed opportunities. There are both educational and moral reasons for seeking more considered approaches to reduce the 'medical tourism' that can result from the current largely ad hoc arrangements.     

Does moral judgement improve in occupational therapy and physiotherapy students over the course of their pre-licensure training?

Healthcare professionals often encounter moral dilemmas in clinical practice that require increased responsibility and accountability for ethical decision-making. This paper reports the results of a 6-year longitudinal study that explored changes in moral judgement of five consecutive cohorts of occupational therapy (OT) and physical therapy (PT) students over the course of their professional training. The training programme included an ethics education component. The Defining Issues Test (DIT) developed at the University of Minnesota was used to measure moral judgement. A total of 548 students participated in the study. At entry into their professional training, the DIT scores of the OT and PT students were similar but higher overall than the norms established for college level students or for graduates from professional programmes in the DIT standardization sample. At the time of graduation, results showed no significant differences in moral judgement scores between males and females, their chosen programme of study (OT or PT), year of entry, or previous education. Comparing entry scores to exit scores from both programmes for 288 students who provided data at both times, we found that moral judgement scores increased significantly in both OT and PT students over the 2-year programme of study. No differences were found in scores across gender, programme, year of entry, or previous education. Implications are discussed for including a formal ethics education component in the curricula of all health professional training programmes. Recommendations for future research are outlined.     

What do Swedish occupational therapists feel about research? A survey of perceptions, attitudes, intentions, and engagement

The aim of this study was to identify Swedish occupational therapists' perceptions and attitudes to research-related activities as well as the therapists' present engagement in future plans for research. A follow up design was used, and the study was undertaken between 1997 and 2003. A total of 425 and 442 Swedish occupational therapists responded to a postal questionnaire (response rate 74.4% and 70.4%). Questions regarding research-related activities were measured on a Likert-type scale, whereas questions referring to attitudes towards research used a semantic differential scale. There were small differences between the two surveys. The result showed that occupational therapists considered research-related activities to be an important part of their development of the professional role and status. Reading research literature to update knowledge was the most important research activity and the second most important activity was applying research findings to improve occupational therapy practice. High workload and lack of time were the most commonly mentioned barriers to participation in research- related activities. Occupational therapists read a large variety of journals, preferably in Swedish. The barriers to participation in research-related activities did not change from 1997 to 2003. The fact that occupational therapists reported reading research as rating highly gives hope for the future development of the occupational therapy profession and practice.     

The medicine cabinet: what's in it, why, and can we change the contents?

The failure of the pharmaceutical industry to produce drugs for common chronic diseases, emerging diseases, and the potential threats of bioterrorism or the spread of tropical diseases contrasts sharply with the industry's output of lifestyle and "me-too" drugs. In this paper we review the decision-making process that resulted in our current portfolio of medicines and offer several alternatives to better align business incentives with medical need.     

Do specialty registrars change their attitudes,intentions and behaviour towards reporting incidents following a patient safety course?

Background  

Reporting incidents can contribute to safer health care, as an awareness of the weaknesses of a system could be considered as a starting point for improvements. It is believed that patient safety education for specialty registrars could improve their attitudes, intentions and behaviour towards incident reporting. The objective of this study was to examine the effect of a two-day patient safety course on the attitudes, intentions and behaviour concerning the voluntary reporting of incidents by specialty registrars.     

The impact of clerkships on students’ specialty preferences: what do undergraduates learn for their profession?

Objective  Clinical experiences and gender have been shown to influence medical students' specialty choices. It remains unclear, however, which aspects of experiences make students favour some specialties and reject others. This study aimed to clarify the effects of clerkships on specialty choice and to identify explanatory factors.
Methods  We carried out a longitudinal cohort study to collect data on career preferences and attitudes towards future careers among 3 cohorts of students before and after clerkships in surgery ( n  = 200), internal medicine ( n  = 277) and general practice ( n  = 184). Regression analyses were performed to identify the determinants of career choice and the role of gender.
Results  Exposure to clinical settings encourages students to opt for a career in the corresponding specialty. Men were more stimulated than women by the general practice clerkship. Gender had no clear role as a predictor of career preference. The major predictor of career choice in all 3 specialties was positive evaluation of work-intrinsic factors. A preference for working with acute patients and technology-oriented work, prestige orientation and insignificance of a controllable lifestyle were determinants of a preference for surgery. Students with a preference for general practice had almost opposite preferences. Those who chose internal medicine favoured a controllable lifestyle.
Discussion  Factors other than gender appear to drive specialty decisions. Work content, type of patients and lifestyle options play major roles. Consequently, along with teaching about the practice of medicine, the matching of specialty preferences with reality is an essential outcome of clerkships.     

Physicians’ communication and perceptions of patients: Is it how they look,how they talk,or is it just the doctor?

Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N=29) and patients (N=207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patient-centered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.     

Curriculum change and strategies, past and present: why is it taking so long?

For the last 30 years or more the old war songs of medical education (community orientation, active learning, etc.) have been repeatedly ventilated in meeting after meeting, article after article. But of the present 1642 medical schools on the planet, only about 100 members of The Network and a few other have put these principles into practice, more or less. Obstacles and constraints are known. Is it the system, or the leadership, or the university culture, or the accreditation rules, or all of the above that are responsible for this lack of progress? Still, some overcame the obstacles, some removed the constraints. It would be useful to be better informed about HOW it was done. I suggest that Education for Health: Change in Learning & Practice (EfH) should present more articles explaining HOW successful schools managed to DO IT or WHY they were NOT able to DO IT.