Attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care

Lack of nurse?physician collaboration in wound care may result in prolonged healing times for patients. In order to facilitate future professional collaboration, undergraduate learning activities in interprofessional education (IPE) have been proposed. The aim of this study was to investigate nursing and medical students’ attitudes and perceptions towards each other’s future professions and interprofessional collaboration in wound care. Nursing and medical students took part in an interprofessional learning activity about wound care. Data were collected using the Jefferson Scale of Attitudes towards Physician?Nurse Collaboration questionnaire to student groups before and after an IPE activity (pooled n = 221). Focus groups were conducted to deepen the knowledge about students’ attitudes and perceptions. The results showed high scores on the attitude scale (mean 53.2, possible maximum = 60) both before and after IPE, indicating positive attitudes towards nurse?physician collaboration. Nursing students scored higher than medical students both pre-IPE (p < 0.001) and post-IPE (p = 0.006). However, no difference on scale scores could be identified between pre- and post-IPE. The following themes emerged in the analysis of focus group discussions: “Approaching patient care from different perspectives,” “Need for collaboration and clear professional roles in practice,” “Structures hindering future collaboration,” and “IPE as a tool for professional practice and roles.” The shared learning activity provided insights into the other profession’s competence. This kind of learning activity may increase future interprofessional collaboration, and thus, improve wound care.     

Proceedings of the 2008 Annual Meeting of the Clerkship Directors in Internal Medicine (CDIM)

Background: Obesity is the second leading cause of preventable death in the United States. However, physicians feel poorly trained to address the obesity epidemic. This article examines effective training methods for overweight and obesity intervention in undergraduate medical education. Using indexing terms related to overweight, obesity, and medical student education, we conducted a literature searched PubMed PsycINFO, Cochrane, and ERIC for relevant articles in English. References from articles identified were also reviewed to located additional articles. Summary: We included all studies that incorporated process or outcome evaluations of obesity educational interventions for U.S. medical students. Of an initial 168 citations, 40 abstracts were retrieved; 11 studies were found to be pertinent to medical student obesity education, but only 5 included intervention and evaluation elements. Quality criteria for inclusion consisted of explicit evaluation of the educational methods used. Data extraction identified participants (e.g., year of medical students), interventions, evaluations, and results. These 5 studies successfully used a variety of teaching methods including hands on training, didactic lectures, role–playing, and standardized patient interaction to increase medical students’ knowledge, attitudes, and skills regarding overweight and obesity intervention. Two studies addressed medical student bias toward overweight and obese patients. No studies addressed health disparities in the epidemiology and bias of obesity. Conclusions: Despite the commonly cited “obesity epidemic,” there are very few published studies that report the effectiveness of medical school obesity educational programs. Gaps still exist within undergraduate medical education including specific training that addresses obesity and long-term studies showing that such training is retained.     

A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students

Abstract

Background: Narrative reasoning has been presented as a core component of the health professionals’ competencies.

Aim of the study: This study aimed to explore the students’ perspectives about the contribution of a narrative reasoning course to promote patient-centred practice.

Methods: An interpretative phenomenological analysis (IPA) was undertaken through focus groups. Eighteen volunteer final year students participated in three focus groups. Data analysis followed the IPA principles.

Findings: Three themes emerged: (1) “developing distinctive competencies”; (2) “shifting students’ focus” and (3) “challenging students’ professional identity”. In the first theme, students distinguished their capability to better understand patients’ experiences and needs and to be aware of the importance of a collaborative therapeutic relationship. In the second theme, students emphasized a shift from themselves as clinicians towards their patients. Finally, in the third theme participants shared the perspective that they have developed a different clinical profile, and that their reasoning and clinical actions have changed.

Conclusions: Students recognized the contribution of the course in developing competencies to facilitate patient-centred practice. Future research is needed to inform lecturers on how to best integrate narrative reasoning within the physiotherapy undergraduate curricula.     

The Impact of Trainee Nationality on Patient Acceptance of Obstetrics and Gynecology Care: A Chinese Study

Abstract

Phenomenon: China is a relatively homogenous nation where the majority of people are Han Chinese. In recent years, a large number of international students have begun to study medicine in China. Due to the privacy and intimacy associated with obstetrical and gynecological diseases, Chinese women’s acceptance toward international students’ involvement in their care has not been reported thus far. This survey aims (1) to determine Chinese women’s attitudes toward both Chinese and international medical student involvements in obstetrical and gynecological outpatient departments and (2) to investigate possible reasons, if any, for their rejection of the medical students. Approach: We conducted a cross-sectional survey study using a locally-developed questionnaire. The survey was conducted in the obstetrical and gynecological outpatient department of a tertiary hospital in a Chinese harbor city. We surveyed 600 patients for their attitudes towards the involvement of four groups of medical student in clinical practice: Chinese female, International female, Chinese male, and International male. Among the returned questionnaires, 501 satisfied the criteria for analysis. Findings: Patient’s acceptance rates of the four groups of students (Chinese female, International female, Chinese male, and International male) were 59.7%, 55.9%, 32.1%, and 25.9%, respectively. Analysis revealed that language barriers and lack of friendliness were the two main reasons leading to patients’ low acceptance rates of international students. Insights: Obstetrical and gynecological patients are more likely to accept female students over male students, regardless of their nationality, however International male students receive the least acceptance. For international students, improving their Chinese language skills and using more friendly expressions may facilitate their practice in China.     

The Community Preceptor Crisis: Recruiting and Retaining Community-Based Faculty to Teach Medical Students—A Shared Perspective From the Alliance for Clinical Education

Issue: Community-based instruction is invaluable to medical students, as it provides “real-world” opportunities for observing and following patients over time while refining history taking, physical examination, differential diagnosis, and patient management skills. Community-based ambulatory settings can be more conducive to practicing these skills than highly specialized, academically based practice sites. The Association of American Medical Colleges and other national medical education organizations have expressed concern about recruitment and retention of preceptors to provide high-quality educational experiences in community-based practice sites. These concerns stem from constraints imposed by documentation in electronic health records; perceptions that student mentoring is burdensome resulting in decreased clinical productivity; and competition between allopathic, osteopathic, and international medical schools for finite resources for medical student experiences. Evidence: In this Alliance for Clinical Education position statement, we provide a consensus summary of representatives from national medical education organizations in 8 specialties that offer clinical clerkships. We describe the current challenges in providing medical students with adequate community-based instruction and propose potential solutions. Implications: Our recommendations are designed to assist clerkship directors and medical school leaders overcome current challenges and ensure high-quality, community-based clinical learning opportunities for all students. They include suggesting ways to orient community clinic sites for students, explaining how students can add value to the preceptor's practice, focusing on educator skills development, recognizing preceptors who excel in their role as educators, and suggesting forms of compensation.     

Junior Medical Students’ Perceptions of an Introductory Hospice Experience

Introduction: The importance of palliative care education in the medical school curriculum is becoming more recognized. The purpose of this study was to assess medical students’ perceptions of an introductory hospice experience.

Methods: Forty-one second-year medical students took part in an introductory hospice experience in which they were acquainted with a wide range of hospice services provided to patients and families by an interdisciplinary team involved in hospice care. In addition, the students visited patients’ homes individually with an experienced hospice nurse or social worker. At the end of their experience, the students were asked to complete a multi-item evaluation questionnaire in order to share their perceptions of the hospice experience and their suggestions for improvement of the course.

Results: The students spent an average of four hours on their introductory hospice experience, and they indicated that all of their personal goals for their experience had been met. Suggestions for improvement of the course were to increase the amount of course time allotted and to provide further opportunity to see more patients. Overall, the students rated their experience as “above average” to “excellent.”

Conclusions: According to the medical students who participated, the introductory hospice experience was a worthwhile and valuable educational experience. An equal or increased amount of hospice time should be allotted in the education of future junior medical students. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: <getinfo@haworthpressinc.com>Website: <http://www.HaworthPress.com> © 2001 by the Haworth Press, Inc. All rights reserved.)     

Expectations,Experiences, and Attitude Change During Medical School: Through the Eyes of Polish Medical Students

Background: Pressures related to medical training influence individual experiences in the course of study, which in turn can lead to changes in students’ professional attitudes. Purposes: The aim of this investigation was to explore expectations, experiences, and attitude changes among Polish students as they progressed through a medical university. Methods: The study used a longitudinal approach in which the same cohort of students was surveyed over time, with the same questionnaire administered, at the end of Year 1 and Year 6. Results: The results showed that the disparity between students’ expectations about studying medicine and the reality increased between Year 1 and Year 6 (p <.0001). The biggest gap concerned “technical support” and “contacts with faculty”—the observed effect size was medium with the respective Cohen's d values 0.507 and 0.368. Students in Year 1 were most disappointed by the “lack of support from faculty and their lack of interest in teaching,” whereas, in Year 6, students were most concerned about an approach to teaching that equipped them in theoretical knowledge at the expense of practical skills. Students in Year 6 noticed more changes in themselves and their perception of the world as a result of medical training than students in Year 1. However, the proportion of positive changes to negative ones was 5.4:1 for Year 1 and 1.4:1 for Year 6 students. Conclusions: Our findings show that medical training constitutes a strong socializing experience, which has positive and negative impacts. Negative changes perceived by students include an increase in distrust and cynicism, whereas positive changes consist of enhanced maturity, self-confidence, and empathy, which are likely to have an impact on future doctors’ professional practice.     

Medical student/student doctor access to patients in an emergency department

Objectives: To determine the proportion of patients in a teaching hospital ED who are available to medical students; identify barriers to student access to patients; and determine whether patients are more likely to be accessible if the term student doctor is used rather than medical student. Methods: Repeated cross‐sectional study of the ED of a tertiary teaching hospital. Interviews were attempted with all patients in the ED during six 4 h periods. Outcome measures included: number of patients present and accessible to students; present but inaccessible, absent or unfit to be seen for clinical reasons; number of patients consenting to history, physical examination and certain procedures; and difference in patient consent between the terms ‘medical student’ and ‘student doctor’. Results: Overall, 180 of 450 (40.0%) patients completed the interview, 72 (16.0%) were able to be observed only, and 198 (44.0%) were not suitable for interview or observation. The common reasons for patient unsuitability were: physically not available (60%), being assessed by a health professional or undergoing a procedure (13.0%) altered mental status (7.4%), unstable or terminally ill (5.2%); refusal to participate in the study (4.8%), or dangerous or under arrest (4.1%). No significant differences were found in patient willingness to undergo clinical skills from ‘student doctors’ compared with ‘medical students’. Conclusion: A minimum 40% of patients in a tertiary ED are accessible for student learning, with high proportions of patients accepting of students practising supervised history‐taking, physical examination, and most less‐invasive procedural skills.     

Use of Mannequin-Based Simulation to Decrease Student Anxiety Prior to Interacting With Male Teaching Associates

Background: Previous studies have compared the usefulness of teaching associates versus mannequin trainers for learning physical exam skills. Little work has been done to assess the usefulness of mannequin trainers prior to students’ interaction with teaching associates. Purpose: We studied the effects of mannequin-based simulators on student comfort levels toward learning the male genitourinary examination. Methods: First-year medical students (N = 346) were surveyed before and after a mannequin-based curriculum to assess their comfort levels toward learning the male genitourinary examination. Results: The mannequin-based curriculum significantly increased (p < .001) student comfort levels toward the male genitourinary exam. However, the pre–post improvements were small, and on average students only progressed from being “very uncomfortable” to “somewhat comfortable.” The intimate nature of the examination was the top cause of anxiety toward learning the male genitourinary exam. Students were least comfortable with the digital rectal examination at the beginning of class. Conclusions: We suggest that mannequin-based simulators be used prior to students’ experience with male teaching associates when learning the male genitourinary exam.     

Is Consent “Informed” When Patients Receive Care from Medical Trainees?

Objectives: Medical care requires consent and consent requires information. Prior studies have shown that patients are poorly informed about the medical training hierarchy. The authors assessed the impact of “informed” on “consent,” by assessing willingness to be seen by trainees before and after information about trainee’s credentials. Methods: A convenience sample of patients in an urban emergency department (ED) waiting room was surveyed, ascertaining willingness to be seen before and after information about trainees credentials, using Likert scales. McNemar’s test, linear regression, and mixed models were used to assess statistical significance of information in changing preferences and patient characteristics predicting knowledge, willingness, and change in willingness to be seen with more information. Results: The authors approached 397 patients, and 199 (50%) English speakers participated. Initially, 45% of subjects knew the meaning of “medical student,” and 35%“intern” and “resident.” In a controlled multivariate linear regression, educational attainment (p < 0.0001) predicted more knowledge, Hispanic ethnicity predicted less (p = 0.03). Subjects were less willing to be seen by lower‐ranking trainees (p < 0.001). Information about trainees caused a significant increase in unwillingness to be seen by medical students (17% to 28%, p = 0.004) and interns (8% to 13%, p = 0.029). Conclusions: Substantial numbers of ED patients would prefer not to be seen by trainees. When patients are informed about trainees’ credentials, they become less willing to be seen by more junior trainees. Further research should clarify informed consent for care among non–English speakers and should address these issues in other medical settings.     

Physician Preceptor Satisfaction and Productivity Across Curricula: A Comparison Between Longitudinal Integrated Clerkships And Traditional Block Rotations

Abstract

Phenomenon: Physicians are under intense pressure to improve clinical productivity. High clinical load, limited availability, and decreased clinical efficiency are well-documented barriers to precepting medical students and threaten clinical productivity. In an era of increasing medical student enrollment, these barriers have already led to a decreased availability of clinical teachers and training sites across the United States. Improved preceptor satisfaction could have a great impact on recruitment and retention of medical student preceptors and is likely linked to changes in productivity. Curriculum structure could impact both preceptor productivity and satisfaction. Comparing productivity and satisfaction of physician preceptors teaching in longitudinal integrated clerkships (LICs) to those teaching in traditional block rotations (TBRs), or in both settings (LIC-TBR), could lead to a better understanding of the impact of curriculum structure on preceptor productivity and satisfaction. Approach: Data were collected through a quantitative cross-sectional survey of outpatient physician preceptors in North Carolina in 2017. Preceptor satisfaction and student influence on productivity-related aspects of practice were analyzed with bivariate chi-square statistics and multivariate logistic regression. Findings: Analyses included 338 physician preceptors: 79 LIC (23%), 50 LIC-TBR (15%), and 209 TBR preceptors (62%). LIC preceptors were more likely to indicate being “very satisfied” with precepting than either their LIC-TBR or TBR counterparts. There were no differences in perceived productivity-related aspects of practice across the different curricula, such as patient flow, income, or physician working hours. Logistic regressions controlling for potential confounding variables suggested that those teaching in LICs were almost 3 times more likely to be “very satisfied” relative to those teaching in LIC-TBR and TBR settings and that the negative influence of students on patient flow and physician working hours had an adverse effect on preceptor satisfaction. Insights: Preceptor satisfaction was high overall, though satisfaction was significantly higher among preceptors who teach in LICs. The perceived impact of students on clinical productivity was stable across the different curricula. In an era of increasing need for physician preceptors, the higher satisfaction of those who teach in LICs should be considered in curricular design and for preceptor recruitment and retention.     

An examination of students’ perceptions of their interprofessional placements in residential aged care

ABSTRACT

It is essential that health professionals are trained to provide optimal care for our ageing population. Key to this is a positive attitude to older adults along with the ability to work in teams and provide interprofessional care. There is limited evidence on the impact an interprofessional education (IPE) placement in a residential aged care facility (RACF) has on students. In 2015 in Western Australia, 51 students (30% male, median age 23 years), from seven professions, undertook a placement between 2 and 13 weeks in length at 1 RACF. Pre- and post-placement measurements of attitudes to the elderly were collected using the Ageing Semantic Differential (ASD) questionnaire and level of readiness for interprofessional learning with the Readiness for Interprofessional Learning Scale (RIPLS). A total of 47 students completed matched ASD and RIPLS surveys. The mean total score on the ASD survey decreased significantly from pre- to post-placement from 116.0 to 108.9 (p = 0.033), indicating attitudes became increasingly positive towards older adults. Significant differences post-placement were seen indicating better readiness for interprofessional learning, for two out of four subscales on the RIPLS, namely “teamwork & collaboration” (42.1–44.0; (p = 0.000)) and “positive professional identity” (18.2–19.3 (p = 0.001)). The degree of change is similar to findings from other settings. The results support IPE-focussed student placements within RACF positively influence student’s attitudes towards the older adult as well as increase student’s readiness for interprofessional learning, confirming RACF are valuable places for training health professionals.     

Do graduate entry nursing student’s experience ‘Imposter Phenomenon’?: An issue for debate

The recruitment of Graduates into the nursing profession is seen as advantageous in the academic literature. Conversely educated nurses are often portrayed in the media as “too posh to wash”. We would argue these conflicting discourses have a negative effect on graduate entry nurse education. Graduate nursing students may be particularly susceptible to “Imposter Phenomenon” a concept that describes an “internal experience of intellectual phoniness” exhibited by individuals who appear successful to others, but internally feel incompetent. We would like to encourage debate through the presentation of a small set of pilot data that established that 70% of the participants had frequent to intense experiences of Imposter Phenomenon. Students experienced feelings of failure despite consistent high achievement. Our findings and the prevalent negative rhetoric surrounding highly educated student nurses raise concerns regarding the impact of the anti-intellectualism on the Graduate entry student’s perception of self. Others may argue that this could simply be a ’natural’ or expected level of anxiety in a time of transition that has no lasting impact. We debate this issue in relation to the existing literature to encourage critical dialogue.     

Teaching medical students about communication in speech-language disorders: Effects of a lecture and a workshop

Purpose: This study aims to explore the effects of an interactive workshop involving speech-language pathology students on medical students’ knowledge about communication in relation to speech-language disorders.

Method: Fifty-nine medical students received a lecture about speech-language disorders. Twenty-six of them also participated in a workshop on communication with patients with speech-language disorders. All students completed a 12-item questionnaire exploring knowledge and attitudes towards communication before and after the lecture or the workshop. The results from the two groups’ self-ratings of confidence in knowledge were compared with expert-ratings of their ability to choose suitable communicative strategies.

Result: Both the lecture and the workshop increased the students’ confidence in knowledge about speech-language disorders and how to support communication. Only the workshop group also displayed a statistically significant increase in expert-rated ability and changed their attitude regarding responsibility for the communication in cases of speech-language disorders. There were no statistically significant correlations between the student’s own confidence ratings and the experts’ ratings of ability.

Conclusion: Increased confidence in knowledge from learning is not always reflected in actual knowledge in how to communicate. However, an interactive workshop proved to increase medical students’ expert-rated ability and attitudes related to communication in cases of speech-language disorders.     

Patient Perceptions of Having 1st- and 2nd-Year Medical Students Involved in Their Care

Background: Medical student education has shifted to earlier clinical experiences and increased use of ambulatory settings. Little is known about patient perceptions of having 1st- and 2nd-year medical students involved in their care. Purposes: The purpose of this article is to study patient perceptions of having 1st- and 2nd-year medical students involved in their care in an ambulatory setting. Methods: In 2011 we surveyed 314 patients seen in 2 primary care clinics who saw 1st- or 2nd-year medical students. The survey included questions regarding patient visit satisfaction and perception of overall quality of the visit, adequacy of visit time, benefit of having a student involved in their care, and willingness to see a student in clinic again. Comparisons were made for patients who saw a student and a preceptor (n = 201) and patients who saw only the preceptor (n = 113). Results: Overall visit satisfaction was very high for patients who saw students (83% very satisfied) and patients who saw only the preceptor (91% very satisfied). More than 95% of patients were satisfied with the visit time, and all patients rated the overall quality of their visit as good or excellent. Eighty-five percent of patients would want to see a student again or had no preference. Forty-three percent of patients felt the presence of a student added value to their visit. White patients were more likely than non-White patients to be very satisfied with their visit and rated the overall quality of the visit as excellent. There were no differences based on student gender or year of training. Conclusions: Our results suggest that 1st- and 2nd-year students can be successfully integrated into clinical settings while maintaining patient satisfaction and perceived value of the care they receive.     

Accuracy of Self-Assessed Spanish Fluency in Medical Students

Background: Non-English language fluency is increasingly important in patient care. Fluency self-assessment is easily obtained, but its accuracy is unknown. Purposes: The purpose is to determine accuracy of medical students' self-assessed Spanish fluency. Methods: Four matriculating classes assessed their own oral fluency as (“none”:“novice”;“intermediate”;“advanced”;“native-speaker”). Participants who rated themselves greater than “novice” and who expressed interest in medical Spanish coursework took a standardized fluency test (Spoken Language Evaluation, scaled 1–12). Using predetermined test categories (1–5 = novice, 6–8 = intermediate, 9–12 = advanced/native), we determined the predictive value of self-assessment for predicting the same or greater fluency on the test. Results: Of 102 participants, 12 (12%) tested below their self-assessed level, 77 (75%) tested at their self-assessed level, and 13 (13%) tested above. The predictive value of self-assessment for having at least that fluency level was 88% (95% CI = 80, 94). Conclusions: In medical students reporting greater than “novice” capability and interest in medical Spanish coursework, fluency self-assessment was a good indicator of scores on a standardized fluency test.