Peter Gallagher

The clinical credibility of nurse educators: Time the debate was put to rest

The proverbial discussion surrounding the clinical credibility of nurse lecturers has almost become a preoccupation within the nursing literature and professional circles. It is not coincidental that it this has occurred alongside the cessation of hospital-based training and the associated reassignment of the responsibility for nurse education to institutes of higher education. This paper aims to put the debate to rest and proposes that the focus of the nurse lecturer should not be on establishing clinical credibility but on developing strong partnerships between academic and service areas. Such partnerships or communities of practice are more likely to facilitate high quality preparation of nursing students for future roles within a diverse and dynamic profession.

How well do medical students rate and communicate clinical empathy

Background: This article presents findings from a prospective, longitudinal cohort educational study investigating empathy communication in clinical consultations. It reports on changes in students’ self-report empathy during medical undergraduate training, investigates how well peers can assess student competence in motivational interviewing/brief interventions (MI/BI) skills and explores the relationship between students’ self-report empathy and peer- or tutor-assessments of competence. Methods: 72 medical students completed the Jefferson Scale of Physician Empathy at three time points: at the beginning of their fifth year medical training (Time 1), after a specific MI/BI training session during their fifth year medical training (Time 2) and 1 year later during a revision session in year 6. Competence in BI/MI consultation was assessed using the validated tool Behaviour Change Counselling Index. Results: A significant decline in medical students’ empathy scores was observed from year 5 to year 6, consistent with international findings. Peer assessments and tutor ratings of competence in MI/BI skills performance were moderately correlated, but peer assessments were negatively correlated with medical students’ self-rated empathy. Senior medical students who self-rated as more empathic received lower competence evaluations of MI/BI skills from their peers. Interventions to further investigate teaching and learning of empathy are discussed.

Problems with competence assessment as it applies to student nurses.

Nursing has enthusiastically embraced the concept of continuing competence as the key means of reassuring the public of the overall quality of the profession. There are many definitions of competence and a number of nursing regulatory bodies have put into operation, a definition which is reductionist rather then holistic in nature. Not surprisingly, and as a consequence many nurses, including nurse educators, think competence comprises a number of key competencies which can be isolated, accumulated and tallied. It is clear that both philosophically and practically these notions of competence have influenced the way that student nurses are currently educated. More specifically it is in preparation for their initial entry to practice that the approach to competence assessment of student nurses becomes problematic. In this paper it will be argued that the principles of continuing competence assessment, associated with the on going competence of experienced registered nurses, do not readily translate to students who are still in the process of learning. We suggest that solutions to this problem are three-fold and can be found by replicating for the student the conditions that apply to the assessment of continuing competence for registered nurses.

Simple truths from medical students: Perspectives on the quality of clinical learning environments

Background: The opportunity for students to learn whilst in a clinical placement is a central component of undergraduate medical education and an educationally conducive clinical environment is essential if the student is to optimise learning opportunities. Aim: This study, which was conducted by medical students, and amongst medical students aims to investigate the key conditions that students most value when placed in clinical settings. Methods: A qualitative approach was adopted in which a series of focus group discussions were conducted by senior medical students trained in the facilitation of focus group moderation. In total, 30 students contributed to four separate focus groups. Results: Whilst students identified some factors which were similar to previous studies, other factors considered important to learning in the clinical setting surfaced. Namely, the need for students to be self-motivated and the valuable contribution that other medical students can make to the learning of their peers. Conclusions: Our findings concur with other similar studies. However, our findings were generated by medical students and not subject to influence by university teachers during the data collection and analysis. This not only serves to reinforce previous studies but also supports the use of peer data collection from medical students.

Developing the One‐Minute Preceptor

Background:  Learning from experienced doctors in real clinical settings is very important for medical students. However, the busy and at times unpredictable nature of clinical work means that clinical work must take priority over teaching. What clinicians want is to be able to offer quality learning experiences for students without significant disruption to their clinical work.

An interprofessional community education project as a socially accountable assessment.

Abstract As part of a clinically based rotational undergraduate interprofessional programme, an assessment was devised which was construed as being socially accountable. An interprofessional programme, with cohorts of students from six different health professions, was evaluated in a number of ways. Students completed pre and post questionnaires about many aspects of the programme and also participated in focus groups. The social accountability of the key assignment emerged as important for both students and the community agencies that provided the clinical experience for students. Students implicitly and explicitly reported that their awareness of the need for health professionals to be socially accountable was heightened as a result of the assignment task. This article indicates that with creativity and perseverance an assessment can be devised that is relevant both to the student and the community, and is a powerful learning exercise for all involved.

The role of the assessor in the assessment of practice: An alternative view

Background: Traditionally, the assessment of the competent practical performance of student health professionals places a high level of confidence upon the ability of a second party to judge whether students are able to apply theory in practical contexts. More often than not, the specific assessment tool has a clear focus on the conduct of skills to explicit performance criteria. However, what has proven particularly problematic is the ability to devise a tool to assess the less overtly procedural qualities, such as professionalism, interpersonal skills, clinical reasoning and so forth. When such assessment tools are designed there is also particular challenge to counter the potential for conscious or unconscious bias on the part of the assessor. Aim: With direct reference to enactivist theory, and using illustrations from undergraduate medical, nursing and physiotherapy education, it is argued that in the conduct of any assessment the assessor is as much an integral part of the assessment as is the student. Conclusion: The enactivist perspective has clear implications for the role of the assessor in the preparation, conduct and outcome of the assessment of practice-related activities.

Researching in the community: the value and contribution of nurses to community based or primary health care research

AIM To describe the role, contribution and value of research nurses in New Zealand community-based or primary health care research. BACKGROUND Research nurses are increasingly recognised as having a key role in undertaking successful research in hospitals and clinical trial units however only limited work has been undertaken to examine their role in community-based research. Undertaking health research in the community has unique challenges particularly in relation to research design and recruitment and retention of participants. METHODS We describe four community-based research projects involving research nurses, each with particular recruitment, retention and logistical problems. Vignettes are used to illustrate the role, contribution and value of research nurses in a diverse range of community research projects. FINDINGS The knowledge and skills used by research nurses in these projects included familiarity with communities, cultural competence, health care systems and practice philosophies and in particular with vulnerable populations. Their research actions and activities include competence with a broad range of research methodologies, organisational efficiency, family-centred approach, along with advocacy and flexibility. These are underpinned by nursing knowledge and clinical expertise contributing to an ability to work autonomously. These four projects demonstrate that research nurses in community-based research possess specific attributes which facilitate successful study development, implementation and outcome.

The efficient use of movies in a crowded curriculum.

The undergraduate medical curriculum has earned a reputation for being overcrowded. The dilemma for educationalists is to determine what, if anything, can be jettisoned from a congested curriculum to accommodate new ideas or material.

What makes an interprofessional education programme meaningful to students? Findings from focus group interviews with students based in New Zealand

ABSTRACT It is important to understand what an interprofessional education (IPE) experience means to students and what makes it meaningful so that optimal use can be made of IPE opportunities and resources. This article reports qualitative data from a larger study evaluating an 11-hour IPE programme which focused on long-term condition management. Qualitative analysis aimed to explore students’ perspectives of the programme. Forty-one students from dietetics, medicine, physiotherapy, and radiation therapy were invited to participate in interprofessional focus groups. Data gathered from 34 students who participated in two focus groups were analysed inductively using thematic analysis. Three key themes emerged related to (i) learning, (ii) perceived long-term professional benefits, and (iii) the structure and content of the programme. Participants considered the programme to be a valuable learning opportunity with direct relevance to their future clinical careers. Findings indicated that providing students with an opportunity to learn about each other should be prioritised within IPE programmes and that this process should be student-led. This may help students to effectively learn with and from each other. Students perceived active learning activities, including interviewing a patient in their home and presenting findings to their peers, to be particularly valuable.