Kirsty Foster

The impact of evidence‐based education on a perinatal capacity‐building initiative in Macedonia

Context  The perinatal mortality rate (PMR) in Macedonia is among the highest in Europe. The World Bank supported a consultant (HEJ) to collaborate with a Macedonian team to develop a national perinatal strategy with the goal of reducing the PMR. Education was given priority in the form of a hospital‐based initiative to develop the capacity of health professionals to introduce evidence‐based perinatal practice into 16 participating hospitals. A ‘train the teachers’ approach was used, with trainees introduced to modern education and clinical practice in Sydney and subsequently supported to train their colleagues in Skopje.

How we make good doctors into good teachers: A short course to support busy clinicians to improve their teaching skills

Background: Doctors are expected to teach but many are reluctant through lack of training. Busy clinicians have little time to attend faculty development initiatives. We wanted to increase clinical teaching capacity locally. What we did: In response to requests from doctors lacking confidence in their teaching skills, we developed a programme tailored to the needs of working clinical teachers. The emphasis is on teaching effectively in a busy clinical environment. There are five 90 min modules: bedside teaching, effective supervision and feedback, teaching physical examination and procedures, effective lectures and facilitating development of clinical reasoning skills. The course is practical, interactive and takes place in a supportive learning environment adjacent to the workplace. A total of 81 clinicians participated in the course. Evaluation: The main outcomes were increased confidence in bedside teaching, teaching more effectively on ward rounds and reduction in need for support with teaching. Participants reported a better understanding of basic educational theory and its relevance to clinical teaching. There is increased activity in clinical teaching among past participants. Conclusions: All clinical teachers require guidance and encouragement in developing their teaching skills. An accessible, practical focused teaching course run locally by colleagues with education expertise can improve clinicians’ skills and motivation to teach.

Neonatal resuscitation educational experience of staff in New South Wales and Australian Capital Territory hospitals.

Objective: There is international recognition that health personnel involved in deliveries should be adequately trained in neonatal resuscitation. A survey was carried out in New South Wales (NSW) and the Australian Capital Territory (ACT) to ascertain the type, frequency and availability of training in neonatal resuscitation to staff who may need to resuscitate an infant at birth. The survey included a self‐perception rating of confidence and competence in neonatal resuscitation.

Application of evidence‐based teaching in maternal and child health in remote Vietnam

To develop, implement, and evaluate an evidence‐based multidisciplinary teaching program to improve maternal and infant health in remote Vietnam.

Becoming a Professional Doctor

The chapter begins with a brief historical overview of medical education. This is followed by an examination of the current sociocultural climate in which medical practitioners work. This is a climate which has seen rapid change in the public perception of the medical profession as a result of high-profile cases of ‘bad doctors’, better educated patients as a result of information via the Internet, self-regulation successes and failures and the changing status of doctors. The chapter then highlights the key stages in the journey from a lay person to becoming a medical practitioner. The author identifies seven key stages in becoming a doctor: selection, medical studies, junior doctor, the hidden curriculum, mentors, working in a team and professional maturity. In a detailed examination of each of the stages, the author highlights issues such as medical elitism, theory and practice tensions and junior doctor status.

Workplace training for senior trainees: a systematic review and narrative synthesis of current approaches to promote patient safety

Background Preventable harm is one of the top six health problems in the developed world. Developing patient safety skills and knowledge among advanced trainee doctors is critical. Clinical supervision is the main form of training for advanced trainees. The use of supervision to develop patient safety competence has not been established. Objective To establish the use of clinical supervision and other workplace training to develop non-technical patient safety competency in advanced trainee doctors. Data sources Keywords, synonyms and subject headings were used to search eight electronic databases in addition to hand-searching of relevant journals up to 1 March 2014. Method Titles and abstracts of retrieved publications were screened by two reviewers and checked by a third. Full-text articles were screened against the eligibility criteria. Data on design, methods and key findings were extracted. Clinical supervision documents were assessed against components common to established patient safety frameworks. Findings from the reviewed articles and document analysis were collated in a narrative synthesis. Results Clinical supervision is not identified as an avenue for embedding patient safety skills in the workplace and is consequently not evaluated as a method to teach trainees these skills. Workplace training in non-technical patient safety skills is limited, but one-off training courses are sometimes used. Conclusions Clinical supervision is the primary avenue for learning in postgraduate medical education but the most overlooked in the context of patient safety learning. The widespread implementation of short courses is not matched by evidence of rigorous evaluation. Supporting supervisors to identify teaching moments during supervision and to give weight to non-technical skills and technical skills equally is critical.

Learning about médical professionalism : don't forget emotion!

‘P rofessionalism’ is a buzz word in medical education right now. Public expectation is that the medical profession will ensure high standards in its members, not only in knowledge and technical expertise, but also in integrity, compassion and ethical behaviour. In response, ‘professionalism’ has been introduced into curricula both at undergraduate and postgraduate levels. This presents a challenge because the values, beliefs, culture, and behaviours comprising medical professionalism are complex and dynamic. In the real world of medical practice, students begin a process of socialisation into the medical profession during which they learn about professionalism through experience and reflection. The clinical environment exposes medical students and trainees to a ‘community of practice’ of experienced health professionals, into which they gradually become acculturated. Learning during this process is largely the result of a ‘hidden curriculum’, which is unstructured, uncontrolled and often at odds with the principles taught in the classroom. Students and junior doctors look to more senior colleagues for guidance, and the strong influence of such role models on them, especially in relation to professionalism and professional behaviour, is well recognised. However, these role models may not always be exemplary in their behaviour, and the emotional aspect of these relationships is relatively underemphasised, both at undergraduate and postgraduate levels. Traditionally, emotionality has been regarded as antithetical with objective assessment and management of patients, resulting in the relegation of the ‘art’ of medicine in favour of the ‘science’.

The Balint group experience for medical students: a pilot project

Loss of empathy has been reported in medical students as they move through the clinical phases of their training. Several researchers have attempted to address this issue by exploring ways of heightening students’ awareness of the emotional, non-biomedical aspects of illness and the dynamics of the doctor–patient relationship, using a variety of reflective group discussion methods. This pilot project employed the specific group method developed by Michael Balint for general practitioners working in London after the Second World War. The pilot was based on one group of six third-year graduate students, meeting weekly over six weeks. Evaluation includes pre- and post-questionnaires, a 1000-word essay and leaders’ observations. The results suggest that the traditional Balint method needs to be modified for students at a point in their training where they have not yet been exposed to patients for long enough to develop meaningful patient relationships. Nevertheless, there was some evidence of a heightened awareness of the dynamics of doctor–patient relationships and the importance of psychological/emotional factors (including their own prejudices) when interacting with a patient. Balint-style groups could be an effective way of encouraging medical students to reflect on the importance of emotions in the doctor–patient relationship.

‘I do want to ask, but I can’t speak’: a qualitative study of ethnic minority women’s experiences of communicating with primary health care professionals in remote, rural Vietnam

BackgroundEthnic minority groups in Vietnam experience economic, social and health inequalities. There are significant disparities in health service utilisation, and cultural, interpersonal and communication barriers impact on quality of care. Eighty per cent of the population of Dien Bien Province belongs to an ethnic minority group, and poor communication between health professionals and ethnic minority women in the maternal health context is a concern for health officials and community leaders. This study explores how ethnic minority women experience communication with primary care health professionals in the maternal and child health setting, with an overall aim to develop strategies to improve health professionals’ communication with ethnic minority communities.MethodsWe used a qualitative focused ethnographic approach and conducted focus group discussions with 37 Thai and Hmong ethnic minority women (currently pregnant or mothers of children under five) in Dien Bien Province. We conducted a thematic analysis.ResultsEthnic minority women generally reported that health professionals delivered health information in a didactic, one-way style, and there was a reliance on written information (Maternal and Child Health handbook) in place of interpersonal communication. The health information they receive (both verbal and written) was often non-specific, and not context-adjusted for their personal circumstances. Women were therefore required to take a more active role in interpersonal interactions in order to meet their own specific information needs, but they are then faced with other challenges including language and gender differences with health professionals, time constraints, and a reluctance to ask questions. These factors resulted in women interpreting health information in diverse ways, which in turn appeared to impact their health behaviours.ConclusionsFostering two-way communication and patient-centred attitudes among health professionals could help to improve their communication with ethnic minority women. Communication training for health professionals could be included along with the nationwide implementation of written information to improve communication.

The Heroic and the Villainous: a qualitative study characterising the role models that shaped senior doctors’ professional identity

BackgroundThe successful development and sustaining of professional identity is critical to being a successful doctor. This study explores the enduring impact of significant early role models on the professional identity formation of senior doctors.MethodsPersonal Interview Narratives were derived from the stories told by twelve senior doctors as they recalled accounts of people and events from the past that shaped their notions of being a doctor. Narrative inquiry methodology was used to explore and analyse video recording and transcript data from interviews.ResultsRole models were frequently characterised as heroic, or villainous depending on whether they were perceived as good or bad influences respectively. The degree of sophistication in participants’ characterisations appeared to correspond with the stage of life of the participant at the time of the encounter. Heroes were characterised as attractive, altruistic, caring and clever, often in exaggerated terms. Conversely, villains were typically characterised as direct or covert bullies. Everyday events were surprisingly powerful, emotionally charged and persisted in participants’ memories much longer than expected. In particular, unresolved emotions dating from encounters where bullying behaviour had been witnessed or experienced were still apparent decades after the event.ConclusionThe characterisation of role models is an important part of the professional identity and socialisation of senior doctors. The enduring impact of what role models say and do means that all doctors, need to consistently reflect on how their own behaviour impacts the development of appropriate professional behaviours in both students and training doctors. This is especially important where problematic behaviours occur as, if not dealt with, they have the potential for long-lasting undesirable effects. The importance of small acts of caring in building a nurturing and supportive learning atmosphere at all stages of medical education cannot be underestimated.