An innovative model for final-year students' skills training course in internal medicine: 'essentials from admission to discharge'

Clerkships are generally seen as a very favourable learning environment for final-year students. However, in recent years the clinical experience of final-year students has been reported to decline progressively. It was decided, therefore, to introduce an innovative skills training model in internal medicine. Sixty final-year students received four consecutive days of training during their first week, consisting of three-hour sessions on each day. The skills training course reflected a patient history from admission to discharge and included all required routine procedures, typical forms/files and computer interactions. Acceptability was measured with self-administered surveys post-intervention and again 16 weeks later; self-assessment was measured pre-/post-intervention. The skills training course was well accepted by the students and led to a significant improvement in self-assessment. It was considered to be very helpful for work on the wards in both the immediate and the long-term retrospective evaluation. The final-year skills training course allows students to learn how to handle specific tools and applications for their work on the ward. It possesses face validity and is easy to integrate.     

Teaching on the web: automated online instruction and assessment of residents in an acute care clinic

Time pressures negatively impact teaching and learning in ambulatory settings. Web-based (online) learning may help in meeting this challenge. Although online teaching is increasingly used in medical education, few reports have evaluated online learning in postgraduate training. A pre-test/post-test cohort study was undertaken in an academic medical center acute care clinic to determine whether internal medicine residents accept, learn with and continue to use a 'stand-alone' online curriculum. The participants were 56 first-year internal medicine residents. Eight evidence-based, symptom-oriented online modules in acute ambulatory medicine were completed by residents during a one-month rotation. Fifty residents completed all modules. Pre- and post-tests were administered and scored automatically by computer. Average test score improved from 70% to 95% (p < 0.001). Feedback was very positive, with 96% of residents recommending the curriculum continue and 88% listing the modules as one of the most helpful learning resources for the rotation. Some 74% of residents referred back to the curriculum while caring for patients. This 'stand-alone' online curriculum, with automated instruction and assessment, facilitated effective and satisfying learning without requiring faculty involvement. This method could easily be reproduced in other settings.     

Towards culture change in the operating theatre: Embedding a complex educational intervention to improve teamwork climate

Background: Changing teamwork climate in healthcare through a collective shift in attitudes and values may be a necessary precursor to establishing a positive teamwork culture, where innovations can be more readily embedded and sustained. A complex educational intervention was initiated across an entire UK Trust's surgical provision, and then sustained. Attitudes towards teamwork were measured longitudinally to examine if the intervention produced sustainable results. Aims: The research aimed to test whether sustaining a complex education intervention to improve teamwork would result in an incremental, longitudinal improvement in attitudes and values towards teamwork. The intervention's larger aim is to progress the historical default position of multi-professional work to authentic inter-professional teamwork, as a positive values climate translates in time into behavioural change defining a safety culture. Method: Attitudes were measured at three points across all surgical team personnel over a period of 4 years, using a validated Safety Attitudes Questionnaire with a focus on the 'teamwork climate' domain. Pre- and post-intervention 'teamwork climate' scores were compared to give a longitudinal measure as a test of sustainability. Results: Mean 'teamwork climate' scores improved incrementally and significantly following the series of educational interventions, showing that practitioners' valuing of teamwork activity can be improved and sustained. Conclusions: Longitudinal positive change in attitudes and values towards teamwork can be sustained, suggesting that a deliberate, designed complex intervention can shape a safety climate as a necessary prerequisite for the establishment of a sustainable safety culture.     

Opening our eyes to a critical approach to medicine: The humanities in medical education

This paper examines a recent medical graduate’s perspective on how undergraduate education tends to focus on imparting medical knowledge with little reference to the human aspects in clinical medicine. This is problematic because medicine is both about people and practiced by people. Students often have minimal exposure to the humanities prior to and in medical school and are frequently unaware of the societal trends that impact their view of medical practice. Familiarity with the humanities is a crucial means to understanding human nature, recognizing personal sociocultural biases, and practicing patient-centered medicine. This gap in knowledge may be due to the increase in medical information and optimistic ideologies related to medical progress. Philosophical paradigms and historical examples are considered to demonstrate the relevance of both fields in the humanities in understanding the role of moral human agents in applying medical knowledge. Educational changes in the humanities are proposed as a potential solution to our current deficits. Informal changes include mentorship relationships and shifting the general underpinning attitude in medical culture. Formal changes include specific courses teaching a critical approach to medicine. Changes in competency-based education and admissions are also suggested. These amendments are proposed to practice a fuller, truly human medicine.     

Change in attitudes to psychiatry and intention to pursue psychiatry as a career in newly qualified doctors: a follow-up of two cohorts of medical students

This follow-up study of 234 doctors examined whether improvements in attitudes to psychiatry following an undergraduate psychiatry attachment were maintained after graduation, and explored the relationship between attitudes to psychiatry and intention to pursue psychiatry as a career. Improvements in attitudes following undergraduate psychiatric attachment decayed over time but remained higher than pre-attachment levels. Attitudes of doctors who definitely intended to pursue psychiatry, however, increased at each stage. Attitudes of doctors were predicted by post-attachment attitudes, which in turn were predicted by encouragement from consultants and influences of specialist registrars during the attachment at medical school. There were no differences between a problem-based and a traditional psychiatry curriculum in attitude change. The findings suggest that encouragement during medical school from more senior doctors increases the numbers wanting to pursue psychiatry and may increase the number who subsequently pursue psychiatry as a career.     

Theories in medical education: towards creating a union between educational practice and research traditions

Despite the multiple changes that have happened in medical education over the last three decades, it is often speculated that these changes have been made in the absence of supportive theory, or at least by a poor understanding of educational theory. It is similarly expounded that the continuance of this change is not supported by either initial educational research or research into the effect of educational intervention. This commentary explains the background reasoning and intended structure of the new AMEE Guides in Medical Education Theories Series, in which it is intended to bring together the theories in education with both the practice and research activities, demonstrating the interactivity between the three and providing the reader with a sound theoretical basis for future development.     

Humans and machines: Moving towards a more symbiotic approach to learning clinical reasoning

Abstract

Artificial intelligence is a growing phenomenon that is driving major changes to how we deliver healthcare. One of its most significant and challenging contributions is likely to be in diagnosis. Artificial intelligence is challenging the physician’s exclusive role in diagnosis and in some areas, its diagnostic accuracy exceeds that of humans. We argue that we urgently need to consider how we will incorporate AI into our teaching of clinical reasoning in the undergraduate curriculum; students need to successfully navigate the benefits and potential issues of new and developing approaches to AI in clinical diagnosis. We offer a pedagogical framework for this challenging change to our curriculum.     

Breathless in houston: a political ecology of health approach to understanding environmental health concerns

A political ecology approach to the study of environmental health problems can provide a comprehensive analytical framework with which to understand geographical and social disparities in health status. To date, however, political ecology has remained limited in its application to health problems, and where health has been addressed, biomedical models have prevailed, with little attention to differing explanatory models of health and disease. By integrating political ecology with an interpretive critical medical anthropology, one can better understand the ways in which health and environment intersect, and the differing social responses to environmental practices that affect human health. In this paper I summarize these theoretical issues and then discuss how this theory can be applied toward an analysis of air quality and health in Houston, Texas. This research suggests that local understandings of respiratory health often contradict public health concepts of environmental health and, in turn, differentially shape people's interactions with the environment.     

How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic

Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student–Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.