Pamela Jane Harvey

Performance pressure: simulated patients and high-stakes examinations in a regional clinical school.

OBJECTIVE To investigate the effects and challenges of being a simulated patient (SP) in a high-stakes clinical examination context in a regional setting. DESIGN Mixed methods, using a written survey, focus groups, and a retrospective postal survey. SETTING A university clinical school in a Victorian regional city. PARTICIPANTS Nineteen SP volunteers (from an existing database of 55 people) who had been involved in mid-year, summative Objective Structured Clinical Examination (OSCE) role-play performances. MAIN OUTCOME MEASURES Challenges of the OSCE role-play experience and the reported effects on SPs. The implications of these factors have an impact on the sustainability of SP programs in regional settings. RESULTS Physical and emotional effects like exhaustion were reported, as well as empathy and concern for the medical students. The retrospective postal survey indicated that the SPs had no long-term negative effects from their high-stakes examination experiences. Participants also reported that a level of decision making and improvisation was needed in the performance of their OSCE role plays. CONCLUSIONS Our study reveals the complexity and demands on SPs in performing in high-stakes clinical examinations. The results highlight that SP roles involve more than the transfer of scripted information. SPs should be considered as members of the examination team when preparing and implementing high-stakes examinations to assist in maintaining standardised performance during and across OSCE role plays. Relationships between SPs and educational institutes need to be nurtured to ensure that the ability to continue high-stakes OSCEs in a regional setting is maintained.

Fitness-to-practice concerns in rural undergraduate medical education: a qualitative study

BackgroundSince July 2010, new reporting requirements have applied to registered Australian health practitioners who have a reasonable belief that a practitioner or student (of any registered discipline) is exhibiting “notifiable conduct”. A study of healthcare complaints reported that a small number of practitioners are over-represented in the majority of formal complaints brought against doctors. The impetus for conducting this research was a recognition that identifying and responding to particular behaviours early may prevent issues requiring mandatory reporting later on. As a first step, a better understanding of how fitness-to-practice (FTP) concerns are viewed was sought from stakeholders in a rural medical school.MethodsThis qualitative project used purposive and snowballing sampling. Thirteen participants from an Australian rural medical school were interviewed for the study about FTP concerns. Seven were university staff, including clinical educators, program co-ordinators and academic faculty. Six were medical students in the middle of their final year. Their de-identified interview transcripts were independently coded into themes and emergent data categories were refined through comparative analysis between the authors. Data collection ceased after theoretical saturation was achieved.ResultsAlthough students and faculty staff responded similarly in their recognition of FTP concerns, they varied in their assessment of their frequency, with students indicating that concerns were rare. Students and staff expressed reluctance to formally report students or colleagues with FTP concerns because of the complexity and uncertainty of medical practice. Both groups considered early recognition of problems and implementation of supportive mechanisms as important, but students generally did not want to contact the university about concerns for fear of stigmatisation.ConclusionEducation providers need to have clear processes for identifying and responding to FTP concerns in the pre-service years of medical training. Importantly, students need to feel that they can seek help for their own concerns and not be stigmatised in doing so. This is a difficult challenge in a profession that has a perceived culture of strength and a traditional hierarchy. Rural medical schools, with their smaller student groups, are well positioned for early response to issues of concern.

Written feedback and continuity of learning in a geographically distributed medical education program

Background: The provision of effective feedback on clinical performance for medical students is important for their continued learning. Written feedback is an underutilised medium for linking clinical performances over time. Aims: The aim of this study is to investigate how clinical supervisors construct performance orientated written feedback and learning goals for medical students in a geographically distributed medical education (GDME) programme. Methods: This qualitative study uses textual analysis to examine the structure and content of written feedback statements in 1000 mini-CEX records from 33 Australian undergraduate medical students during their 36 week GDME programme. The students were in their second clinical year. Results: Forty percent of mini-CEX records contained written feedback statements. Within these statements, 80% included comments relating to student clinical performance. The way in which written feedback statements were recorded varied in structure and content. Only 16% of the statements contained student learning goals focused on improving a students clinical performance over time. Very few of the written feedback statements identified forward-focused learning goals. Conclusion: Training clinical supervisors in understanding how their feedback contributes to a students continuity of learning across their GDME clinical placements will enable more focused learning experiences based on student need. To enhance student learning over time and place, effective written feedback should contain focused, coherent phrases that help reflection on current and future clinical performance. It also needs to provide enough detail for other GDME clinical supervisors to understand current student performance and plan future directions for their teaching.

Interventions for improving medical students' interpersonal communication in medical consultations

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects of interventions for medical students that aim to improve interpersonal communication in medical consultations.