Pirashanthie Vivekananda-Schmidt

Lessons from medical students’ perceptions of learning reflective skills: A multi-institutional study

Background: A core competency during undergraduate medical training is the development of reflective learning. The current literature is limited to demonstrating how reflective learning has been implemented or the approaches to its development. There is a lack of insight into students’ perceptions of reflection and the factors that support development of reflective practice. Bridging this gap may provide insight into how reflective learning within the curriculum can be better developed to increase engagement from learners. Methods: Eight focus group interviews with second year students from four UK medical schools were held. Results were thematically analysed. Key findings: Students have a high level of understanding of the purpose of reflection in practice but they perceive that there is a tension between public and private reflections. Assessment of the reflective process was perceived to be useful for developing reflective skills but grading of their reflective writing was not considered to be useful. Staff who champion the development of reflective skills and mentor students were perceived to play key roles in aiding the development of reflective skills. Appropriate experiences were seen to be a key part of developing reflective skills. Conclusion: These findings highlight potential ways to revise and improve engagement with the reflective learning components of undergraduate courses.

The development and evaluation of a Professional Self Identity Questionnaire to measure evolving professional self-identity in health and social care students

Background: Professional self-identity is a ‘state of mind’ – identifying ones-self as a member of a professional group. Delayed professional self-identity is a barrier to successful transition from student to professional. Current trends in medical education limit student doctors’ legitimate peripheral participation and may retard their developing professional self-identity compared with other health and social care students. Aims: Develop a tool to monitor the development of professional self-identity to operate across the different health and social care professions and evaluate the tool with student doctors before wider data collection. Method: Content analysis of relevant curricula, mapped to professional standards documents, defined initial content. Field tests across 10 professional groups refined questionnaire items. A cross-sectional study on 496 student doctors evaluated validity on the basis of internal structure and relationships with external variables. Results: The 9-item questionnaire indicates a three-factor structure reflecting ‘interpersonal tasks’, ‘generic attributes’ and ‘profession-specific elements’. Students with greater previous experience of health or social care roles, and students with a more positive attitude to qualification had significantly more advanced scores than their peers. Scores advanced through the curriculum showing step changes after the start of clinical attachments. Conclusions: The data provides sufficient evidence of validity with student doctors to justify wider data collection.

Validation of MSAT : an instrument to measure medical students' self-assessed confidence in musculoskeletal examination skills

Context  Self‐assessment promotes reflective practice, helps students identify gaps in their learning and is used in curricular evaluations. Currently, there is a dearth of validated self‐assessment tools in rheumatology. We present a new musculoskeletal self‐assessment tool (MSAT) that allows students to assess their confidence in their skills in and knowledge of knee and shoulder examination.

A model of professional self-identity formation in student doctors and dentists: a mixed method study

BackgroundProfessional self-identity [PSI] can be defined as the degree to which an individual identifies with his or her professional group. Several authors have called for a better understanding of the processes by which healthcare students develop their professional identities, and suggested helpful theoretical frameworks borrowed from the social science and psychology literature. However to our knowledge, there has been little empirical work examining these processes in actual healthcare students, and we are aware of no data driven description of PSI development in healthcare students. Here, we report a data driven model of PSI formation in healthcare students.MethodsWe interviewed 17 student doctors and dentists who had indicated, on a tracking questionnaire, the most substantial changes in their PSI. We analysed their perceptions of the experiences that had influenced their PSI, to develop a descriptive model. Both the primary coder and the secondary coder considered the data without reference to the existing literature; i.e. we used a bottom up approach rather than a top down approach.ResultsThe results indicate that two overlapping frames of reference affect PSI formation: the students’ self-perception and their perception of the professional role. They are ‘learning’ both; neither is static. Underpinning those two learning processes, the following key mechanisms operated: [1] When students are allowed to participate in the professional role they learn by trying out their knowledge and skill in the real world and finding out to what extent they work, and by trying to visualise themselves in the role. [2] When others acknowledge students as quasi-professionals they experience transference and may respond with counter-transference by changing to meet expectations or fulfil a prototype. [3] Students may also dry-run their professional role (i.e., independent practice of professional activities) in a safe setting when invited.ConclusionsStudents’ experiences, and their perceptions of those experiences, can be evaluated through a simple model that describes and organises the influences and mechanisms affecting PSI. This empirical model is discussed in the light of prevalent frameworks from the social science and psychology literature.

A single generic multi-source feedback tool for revalidation of all UK career-grade doctors: does one size fit all?

Background: The UK Department of Health is considering a single, generic multi-source feedback (MSF) questionnaire to inform revalidation. Method: Evaluation of an implementation pilot, reporting: response rates, assessor mix, question redundancy and participants’ perceptions. Reliability was estimated using Generalisability theory. Results: A total of 12,540 responses were received on 977 doctors. The mean time taken to complete an MSF exercise was 68.2 days. The mean number of responses received per doctor was 12.0 (range 1–17) with no significant difference between specialties. Individual question response rates and participants’ comments about questions indicate that some questions are less appropriate for some specialities. There was a significant difference in the mean score between specialities. Despite guidance, there were significant differences in the mix of assessors across specialties. More favourable scores were given by progressively more junior doctors. Nurses gave the most reliable scores. Conclusions: It is feasible to electronically administer a generic questionnaire to a large population of doctors. Generic content is appropriate for most but not all specialties. The differences in mean scores and the reliability of the MSF between specialties may be in part due to the specialty differences in assessor mix. Therefore the number and assessor mix should be standardised at specialty level and scores should not be compared across specialties.

Learning decision making through serious games

In Serious Games (SGs), educational content is integrated into a game so that learning is intrinsic to play, thereby motivating players and improving engagement. SGs enable learning by developing situated understanding in users and by enabling players to practise safe clinical decision making; however, the use of SGs in medical education is not well established.

Teaching clinical reasoning and decision-making skills to nursing students: Design, development, and usability evaluation of a serious game

BACKGROUND Serious games (SGs) are a type of simulation technology that may provide nursing students with the opportunity to practice their clinical reasoning and decision-making skills in a safe and authentic environment. Despite the growing number of SGs developed for healthcare professionals, few SGs are video based or address the domain of home health care. AIMS This paper aims to describe the design, development, and usability evaluation of a video based SG for teaching clinical reasoning and decision-making skills to nursing students who care for patients with chronic obstructive pulmonary disease (COPD) in home healthcare settings. METHODS A prototype SG was developed. A unified framework of usability called TURF (Task, User, Representation, and Function) and SG theory were employed to ensure a user-centered design. The educational content was based on the clinical decision-making model, Blooms taxonomy, and a Bachelor of Nursing curriculum. A purposeful sample of six participants evaluated the SG prototype in a usability laboratory. Cognitive walkthrough evaluations, a questionnaire, and individual interviews were used for the usability evaluation. The data were analyzed using qualitative deductive content analysis based on the TURF framework elements and related usability heuristics. RESULTS The SG was perceived as being realistic, clinically relevant, and at an adequate level of complexity for the intended users. Usability issues regarding functionality and the user-computer interface design were identified. However, the SG was perceived as being easy to learn, and participants suggested that the SG could serve as a supplement to traditional training in laboratory and clinical settings. CONCLUSIONS Using video based scenarios with an authentic COPD patient and a home healthcare registered nurse as actors contributed to increased realism. Using different theoretical approaches in the SG design was considered an advantage of the design process. The SG was perceived as being useful, usable, and satisfying. The achievement of the desired functionality and the minimization of user-computer interface issues emphasize the importance of conducting a usability evaluation during the SG development process.

Do assessor comments on a multi-source feedback instrument provide learner-centred feedback?

Free‐text comments in multi‐source feedback are intended to facilitate change in the assessees practice. This study was designed to utilise a large dataset of free‐text comments obtained in a national pilot study in order to investigate how helpful these free‐text comments may be to assessees.

Student assistantships: bridging the gap between student and doctor

In 2009, the General Medical Council UK (GMC) published its updated guidance on medical education for the UK medical schools – Tomorrow’s Doctors 2009. The Council recommended that the UK medical schools introduce, for the first time, a clinical placement in which a senior medical student, “assisting a junior doctor and under supervision, undertakes most of the duties of an F1 doctor”. In the UK, an F1 doctor is a postgraduation year 1 (PGY1) doctor. This new kind of placement was called a student assistantship. The recommendation was considered necessary because conventional UK clinical placements rarely provided medical students with opportunities to take responsibility for patients – even under supervision. This is in spite of good evidence that higher levels of learning, and the acquisition of essential clinical and nontechnical skills, depend on students participating in health care delivery and gradually assuming responsibility under supervision. This review discusses the gap between student and doctor, and the impact of the student assistantship policy. Early evaluation indicates substantial variation in the clarity of purpose, setting, length, and scope of existing assistantships. In particular, few models are explicit on the most critical issue: exactly how the student participates in care and how supervision is deployed to optimize learning and patient safety. Surveys indicate that these issues are central to students’ perceptions of the assistantship. They know when they have experienced real responsibility and when they have not. This lack of clarity and variation has limited the impact of student assistantships. We also consider other important approaches to bridging the gap between student and doctor. These include supporting the development of the student as a whole person, commissioning and developing the right supervision, student-aligned curricula, and challenging the risk assumptions of health care providers.

Student doctors taking responsibility.

Background:  New guidelines require all undergraduate medical students to undertake at least one period of assistantship where they assume most of the responsibilities of a first‐year graduate doctor (FY1 doctor in the UK) under supervision.