Emma Bartle

A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26

Background: Traditionally, clinical learning for medical students consists of short-term and opportunistic encounters with primarily acute-care patients, supervised by an array of clinician preceptors. In response to educational concerns, some medical schools have developed longitudinal placements rather than short-term rotations. Many of these longitudinal placements are also integrated across the core clinical disciplines, are commonly termed longitudinal integrated clerkships (LICs) and often situated in rural locations. This review aimed to explore, analyse and synthesise evidence relating to the effectiveness of longitudinal placements, for medical students in particular to determine which aspects are most critical to successful outcomes. Method: Extensive search of the literature resulted in 1679 papers and abstracts being considered, with 53 papers ultimately being included for review. The review group coded these 53 papers according to standard BEME review guidelines. Specific information extracted included: data relating to effectiveness, the location of the study, number of students involved, format, length and description of placement, the learning outcomes, research design, the impact level for evaluation and the main evaluation methods and findings. We applied a realist approach to consider what works well for whom and under what circumstances. Findings: The early LICs were all community-based immersion programs, situated in general practice and predominantly in rural settings. More recent LIC innovations were situated in tertiary-level specialist ambulatory care in urban settings. Not all placements were integrated across medical disciplines but were longitudinal in relation to location, patient base and/or supervision. Twenty-four papers focussed on one of four programs from different viewpoints. Most evaluations were student opinion (survey, interview, focus group) and/or student assessment results. Placements varied from one half day per week for six months through to full time immersion for more than 12 months. The predominant mechanism relating to factors influencing effectiveness was continuity of one or more of: patient care, supervision and mentorship, peer group and location. The success of LICs and participation satisfaction depended on the preparation of both students and clinical supervisors, and the level of support each received from their academic institutions. Conclusion: Longitudinal placements, including longitudinal integrated placements, are gaining in popularity as an alternative to traditional block rotations. Although relatively few established LICs currently exist, medical schools may look for ways to incorporate some of the principles of LICs more generally in their clinical education programmes. Further research is required to ascertain the optimum length of time for placements depending on the defined learning outcomes and timing within the programme, which students are most likely to benefit and the effects of context such as location and type of integration.

Becoming a medical educator: motivation, socialisation and navigation

BackgroundDespite an increasing concern about a future shortage of medical educators, little published research exists on career choices in medical education nor the impact of specific training posts in medical education (e.g. academic registrar/resident positions). Medical educators at all levels, from both medical and non-medical backgrounds, are crucial for the training of medical students, junior doctors and in continuing professional development. We explored the motivations and experiences of junior doctors considering an education career and undertaking a medical education registrar (MER) post.MethodsData were collected through semi-structured interviews with junior doctors and clinicians across Queensland Health. Framework analysis was used to identify themes in the data, based on our defined research questions and the medical education workforce issues prompting the study. We applied socio-cognitive career theory to guide our analysis and to explore the experience of junior doctors in medical education registrar posts as they enter, navigate and fulfil the role.ResultsWe identified six key themes in the data: motivation for career choice and wanting to provide better education; personal goals, expectations and the need for self-direction; the influence of role models; defining one’s identity; support networks and the need for research as a potential barrier to pursuing a career in/with education. We also identified the similarities and differences between the MERs’ experiences to develop a composite of an MER’s journey through career choice, experience in role and outcomes.ConclusionsThere is growing interest from junior doctors in pursuing education pathways in a clinical environment. They want to enhance clinical teaching in the hospitals and become specialists with an interest in education, and have no particular interest in research or academia. This has implications for the recruitment and training of the next generation of clinical educators.

Provenance determination of oriental porcelain using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS).

ABSTRACT: The sale of fraudulent oriental ceramics constitutes a large proportion of the illegal artifact and antique trade and threatens to undermine the legitimate international market. The sophistication and skill of forgers has reached a level where, using traditional appraisal by eye and hand, even the most experienced specialist is often unable to distinguish between a genuine and fraudulent piece. In addition, current provenancing techniques such as energy‐dispersive X‐ray fluorescence (EDXRF) spectrometry and thermoluminescence (TL) dating can result in significant damage to the artifact itself. Laser ablation‐inductively coupled plasma‐mass spectrometry (LA‐ICP‐MS), a relatively nondestructive analytical technique, has been used for the provenance determination of materials based on geographical origin. The technique requires the production of a laser crater, c. 100 μm in diameter, which is essentially invisible to the naked eye. Debris from this crater is analyzed using ICP‐MS, with the results forming the basis of the provenance establishment protocol. Chinese, Japanese, and English porcelain shards have been analyzed using this protocol and generic isotopic distribution patterns have been produced that enable the provenance establishment of porcelain artifacts to their country of production. Minor variations between elemental fingerprints of artifacts produced in the same country also indicate that it may be possible to further provenance oriental ceramics to a specific production region or kiln site.

Attitudes of tertiary students towards a group project in a science unit

This study focused on the attitude of tertiary students, in a science discipline, towards completing collaborative learning tasks. Two samples of students, enrolled in different units across different tertiary institutions, were considered. Students in sample 1 were required to work in small groups to produce an information poster on an allocated chemistry topic. Students in sample 2 were given the task of producing a short iMovie on a science topic of their choice. A mixed methods approach was used to collect attitudinal data from students via pre- and post-surveys. Data collected were interpreted within the context of six key factors drawn from the literature on collaborative learning: level of interest in the task; familiarity with other group members; level of contact (related to the assignment) for completion of the task; strategy used to complete the task; students self-evaluation of their groups effectiveness and overall opinions on the use of collaborative learning tasks in science at a tertiary level. Student comments indicate that most considered these collaborative learning tasks a positive and motivating experience. Written open-response questions indicate that students recognize the importance of developing strong interpersonal skills during their tertiary studies, to enhance future employment prospects, and felt completion of a small group-based activity had contributed to the development of these. This study confirms that students highly value the use of collaborative learning tasks that provide an authentic learning experience and opportunity to learn subject matter in a relevant context.

The Effect of Environmental Conditions on the Persistence of Common Lubricants on Skin for Cases of Sexual Assault Investigation

The potential for lubricant trace evidence to be used as associative evidence is often overlooked in forensic investigations. Published studies in this area have focused on the identification of analytical techniques suitable for the detection of this evidence type. However, detection of trace lubricant is also dependent on the length of time it persists on skin and mucosal surfaces. The objective of this study was to investigate the effect of environmental conditions on the persistence of oil‐ and glycerol‐based lubricants on skin surfaces. Lubricated skin samples exposed to three different test environments were swabbed at regular intervals over a 24‐h period. Compounds of interest were extracted from the swabs and analyzed using gas chromatography–mass spectrometry (GC‐MS). The effect of glycerol derivatization prior to GC‐MS analysis was also investigated. In general, oil‐based lubricants persisted longer than glycerol‐based. Persistence on skin was greatest in lower temperature conditions away from direct sunlight exposure. The results of this investigation are relevant in the context of sexual assault investigations given the possible detection of lubricant on the skin of the external genitalia.

Utility of selection methods for specialist medical training: a BEME (best evidence medical education) systematic review: BEME guide no. 45

Abstract Background: Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments. Aim: To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training. Method: Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included. Results: Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings. Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment. Conclusions: While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.

Sustaining Institution-Wide Induction for Sessional Staff in a Research-Intensive University: The Strength of Shared Ownership.

Abstract The Tutors@UQ programme provides an example of a formalised, institution-wide, cross-discipline, academic development programme to enhance the quality of teaching that has been maintained for seven years despite a pattern of substantial organisational change. We present a case study of the programme framed around a four-phase model of educational change and interpreted through the lens of social network perspectives that explores the question: What factors enabled the programme to become successful and sustained over time? Shared responsibility for the creation, development, and on-going implementation achieved through collaborative partnerships emerged as a central factor for the sustainability of the tutor induction programme.

'Compassion, the first emotion ditched when I’m busy’. The struggle to maintain our common humanity

Introduction: A considerable body of literature has been built around the socialisation of medical students and junior doctors into the culture of medicine, yet our appreciation of how their affective learning is shaped through practice, over time, continues to challenge our understanding and subsequent educational practice. This study addresses this gap by using compassion as a lens to unpack affective learning. Methods: This research asked interns undertaking their first year of medical practice ‘‘What have been the main influences (positive and/or negative) in how you have learned to express compassion for your patients when working in the clinical context?” Their individual narratives, generated through reflective journals and unstructured interviews, when thematically analysed, told us how and why they struggled. Findings: The eight interns expressed their struggle to maintain their compassionate aspirations when confronted with the complexity and competing demands of their community of practice. Their emotional disquiet triggered their safety ethic resulting in their compassion, a prosocial moral emotion, being replaced by a more reductionist approach where patient care was reframed as patient management. Discussion: While neither inevitable nor static, the interns’ narratives tell a story where, after a year embedded in their community of practice, their increased self-efficacy, derived primarily from their perceived biomedical competence, enables them to revisit their original aspirations - to be both compassionate and competent - recognising that being a ‘good’ doctor does not have to eclipse being a kind and caring human being. Conclusions: The interns’ reflections uncovered a narrative of emotional vulnerability, where fearing failure and seeking perfection, contributed to a diminished self‑efficacy resulting in risk aversive behaviours protecting their doctor identity. In the recommendations the authors propose strategies for safe engaged connection, where self‑understanding replaces self‑criticism and self‑compassion is cultivated to guard against contempt and cynicism.

Evaluating the impact of early interprofessional learning experiences on student attitudes

This paper explores the impact of an early interdisciplinary clinical experience (ICE) on the attitudes of graduateentry medical students in Australia to interprofessional learning (IPL) and patientcentred care. The ICE was designed using social cognitive theory as a conceptual framework, and aimed to help students gain perspectives on professional roles, teamwork and interprofessional communication, patientcentred care, and the impact of these on quality and safety in health care. Students completed a 3week continuous placement with local qualifi ed health profession teams, under the supervision of a nonmedical health professional. The teams were chosen on the basis that they were providing chronic care to patients and could provide students with the opportunity to be part of an interdisciplinary team of health professionals working together to care for a patient.

Supporting the professional development of clinical educators

Early career medical educators (ECMEs) face unique challenges in their fi rst decade of career development, often having to navigate a fi eld that is very different from that of their original training for an MD or PhD. The authors, as the inaugural and current leaders of the ECME group in Canada, have actively sought to better understand these challenges via a literature review and surveys of their ECME members. The collected evidence has been synthesised into 12 tips that they suggest will support ECMEs as they strive for professional success.