The clinical teacher最新文献

{"title":"Characterising ableism to promote inclusivity within clinical teaching.","authors":"Megan E. L. Brown, Gabrielle M Finn","doi":"10.1111/tct.13785","DOIUrl":"https://doi.org/10.1111/tct.13785","url":null,"abstract":"","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":"33 6","pages":"e13785"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When technology fails during simulation: Time for reflection?","authors":"Catriona Neil, Daniel Slack, Jean Ker, Catherine Paton","doi":"10.1111/tct.13446","DOIUrl":"https://doi.org/10.1111/tct.13446","url":null,"abstract":"Simulation-based education has been a key development in health care education, providing a safe learner-centred educational environment. It is a valuable tool, giving learners the opportunity to develop their knowledge and skills, engage in deliberate practice, think about team processes and develop non-technical skills. Simulation-based education allows learners to work towards curriculum competencies in a safe environment where mistakes are expected with no detrimental impact on patient care. This is thought to have an impact on patient safety in the clinical environment when learners take these skills forward into clinical practice. As technology has evolved, it has increasingly been incorporated into simulation-based education. Faculty can use audio-visual technology for remote observation of learners within the simulated environment, allowing faculty the option of video-assisted debriefs. These facilitated debriefs are key to supporting learners to get the greatest benefit from simulation-based education. They allow learners to gain knowledge of their practice and reflect on events guided by facilitators. This style of learner-centred debriefing focuses on the collaborative process between learners and facilitators, with facilitators supporting learners to derive meaning from their experiences. In Lanarkshire, audio-visual technology has been used in simulation-based education since 2010. Faculty use instructor-driven simulators within scenarios, while observing learners in the simulated environment through the audio-visual system. We developed a new immersive simulation course focusing on interprofessional clinical reasoning. The interprofessional team consisted of a medical student, nursing student, pre-registration pharmacist, physiotherapy student and occupational therapy student in their final or penultimate year of study. The simulation was set within an acute medical receiving ward, followed by a facilitated team debrief for learners (Figure 1). While piloting this course, the audio-visual technology failed. This left faculty unable to observe learners during the simulation. Faculty were concerned how they would debrief safely and effectively if they were unaware how learners had performed through observing. Learners were oblivious to the technical issues while immersed within the simulated environment, and this was only disclosed during the debrief. Facilitators became aware of how the simulation had unfolded when learners recounted events as part of the debrief. When facilitators disclosed that they had been unable to see or hear anything, learners laughed and appeared to relax. The apparent pressure they felt, due to being watched, evaporated. Their response appeared to play a part in post simulation decompression, reducing the learner–facilitator power imbalance. This disclosure supported everyone in creating a psychologically safe team which the facilitators became integrated into. The learners observed the discomfort and vulner","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":" ","pages":"55-56"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39715711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"'Comfort Club': Student-run volunteering on the neonatal intensive care unit.","authors":"Rachel Thompson, Georgina Jones, Kathryn Beardsall","doi":"10.1111/tct.13448","DOIUrl":"https://doi.org/10.1111/tct.13448","url":null,"abstract":"Comfort Club is an initiative coordinated by medical students and staff at the Rosie Hospital, in Cambridge, whereby student volunteers are trained to provide positive touch and support for infants on the neonatal intensive care unit (NICU). In this Insights article, we reflect on our experiences as student volunteers (R.E.T., G.M.J.), the student coordinator (G.M.J.) and lead consultant (K.B.) and consider the learning opportunities we identified from these three perspectives. Taking inspiration from volunteer comforting initiatives in NICUs in the United States, Comfort Club was founded in 2017 to fulfil unmet needs of students, infants, parents and staff on the NICU. For students at the University of Cambridge, neonatology experience is limited to 2 half-days of a 4-week paediatrics placement. Although other volunteering initiatives such as ‘Teddy Bear Hospital’ allow students to work with children, none provide experience with neonates. Comfort Club addresses this by enabling students to gain early, high-volume exposure to neonatology, improving their confidence and potentially positively influencing career choice. For infants on the NICU, positive touch has been shown to benefit pain tolerance, length of hospital stay and long-term neurodevelopment. With time constraints on busy staff and on parents who often have to travel long distances to a specialist unit each day, Comfort Club volunteers help increase provision of positive touch, supporting infants’ developmental needs. Similar schemes have found that parents report decreased anxiety at times when they are unable to visit the NICU if reassured a volunteer can support their infant. Finally, the scheme also supports staff, providing an extra pair of hands at busy times. Comfort Club volunteers help increase provision of positive touch, supporting infants’ developmental needs.","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":" ","pages":"59-62"},"PeriodicalIF":0.0,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39927794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Video-mediated breaking bad news simulation.","authors":"Emily Burke Rivet,&nbsp;Renee Cholyway,&nbsp;Cherie Edwards,&nbsp;Matthew Wishnoff,&nbsp;Omar Raza,&nbsp;Susan Haynes,&nbsp;Moshe Feldman","doi":"10.1111/tct.13387","DOIUrl":"https://doi.org/10.1111/tct.13387","url":null,"abstract":"<p><strong>Background: </strong>Communication between clinicians, patients, and families is a core component of medical care that requires deliberate practice and feedback to improve. In March 2020, the COVID-19 pandemic caused a sudden transformation in communication practices because of new physical distancing requirements, necessitating physicians to communicate bad news via telephone and video-mediated communication (VMC). This study investigated students' experience with a simulation-based communications training for having difficult conversations using VMC.</p><p><strong>Methods: </strong>Thirty-eight fourth-year medical students preparing for their surgical residency participated in a simulated scenario where students discussed a new COVID-19 diagnosis with a standardised family member (SFM) of a sick patient via VMC. Learners were introduced to an established communications model (SPIKES) by an educational video. After the simulation, SFM and course facilitators guided a debrief and provided feedback. Learners completed surveys evaluating reactions to the training, preparedness to deliver bad news, and attitudes about telehealth.</p><p><strong>Results: </strong>Twenty-three students completed evaluation surveys (response rate=61%). Few students had prior formal training (17%) or experience communicating bad news using telehealth (13%). Most respondents rated the session beneficial (96%) and felt they could express empathy using the VMC format (83%). However, only 57% felt ready to deliver bad news independently after the training and 52% reported it was more difficult to communicate without physical presence. Comments highlighted the need for additional practice.</p><p><strong>Conclusion: </strong>This pilot study demonstrated the value and feasibility of teaching medical students to break bad news using VMC as well as demonstrating the need for additional training.</p>","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":"18 4","pages":"424-430"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tct.13387","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39005184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coffee & Cases: Peer learning in prehospital care.","authors":"Jonathan Martin,&nbsp;Joyce Kam,&nbsp;Shadman Aziz","doi":"10.1111/tct.13326","DOIUrl":"https://doi.org/10.1111/tct.13326","url":null,"abstract":"The prehospital care programme (PCP) at King's College London Medical School is a student-run programme that arranges for medical and nursing students to shadow clinicians from the London Ambulance Service. The programme aims to increase interprofessional understanding of the roles and expertise within prehospital medicine, as well as observing the patient journey and the prehospital clinical environment. As the programme's organisers, we recognise that whilst creating excellent learning opportunities, there is an additional emotional burden on students, particularly when they are exposed to complex or distressing prehospital patient cases.1 Students in a prehospital environment, compared to hospital settings, may be more likely to sustain ‘moral injury’,1 a term which describes the transgression of moral codes. Therefore, it has been suggested that more debriefing opportunities should be made available to these students.1 Where there is a lack of formal debriefing opportunities, informal near-peer debriefing can potentially play a protective role against moral injury. However, we felt that creating a rigid or overly formal debriefing process could discourage students who would otherwise engage well, as they may shy away for fear of apparent authority.2 In addition, traditional case discussions at nursing and medical schools focus mainly on the clinical aspects of a case, without time being spent looking at either the emotional burden on those involved, or considering the interprofessional relationships during the incident. In recognition of this need to review, learn and reflect, during the academic year of 2019–20 we started ‘Coffee and Cases’ (C&C), a monthly peer-led case review group for PCP students. The aim was to create an informal environment of case discussion, run by nearpeers also on the PCP programme, at differing stages of their medical education. We hoped that C&C would become an opportunity for students to reflect on the more challenging patient presentations and learn from this as shown in Figure 1. The small meeting of up to 15 students took inspiration from a Balint group: a structured forum to discuss the patient's treatment and emotions arising from the experience. One student would share their experience in detail and after clarifying questions, the other members of the group would reflect and discuss the events.3 This reflection focussed on both the emotional understanding of the encounter and learning from the actions of the prehospital clinician.We hoped that C&C would become an opportunity for students to reflect on the more challenging patient presentations One of the main objectives of C&C is to allow the PCP team to check on students’ well-being, especially if they attended to patients in situations which may need further debriefing such as road traffic collisions, mental health crises and deaths. The depth of discussion and willingness of students to contribute indicated C&C to be a safe platform. We noted with inter","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":"18 4","pages":"370-371"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tct.13326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38795163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A remote access mixed reality teaching ward round.","authors":"Laksha Bala,&nbsp;James Kinross,&nbsp;Guy Martin,&nbsp;Louis J Koizia,&nbsp;Angad S Kooner,&nbsp;Gideon J Shimshon,&nbsp;Thomas J Hurkxkens,&nbsp;Philip J Pratt,&nbsp;Amir H Sam","doi":"10.1111/tct.13338","DOIUrl":"https://doi.org/10.1111/tct.13338","url":null,"abstract":"<p><strong>Background: </strong>Heterogeneous access to clinical learning opportunities and inconsistency in teaching is a common source of dissatisfaction among medical students. This was exacerbated during the COVID-19 pandemic, with limited exposure to patients for clinical teaching.</p><p><strong>Methods: </strong>We conducted a proof-of-concept study at a London teaching hospital using mixed reality (MR) technology (HoloLens2™) to deliver a remote access teaching ward round.</p><p><strong>Results: </strong>Students unanimously agreed that use of this technology was enjoyable and provided teaching that was otherwise inaccessible. The majority of participants gave positive feedback on the MR (holographic) content used (n = 8 out of 11) and agreed they could interact with and have their questions answered by the clinician leading the ward round (n = 9). Quantitative and free text feedback from students, patients and faculty members demonstrated that this is a feasible, acceptable and effective method for delivery of clinical education.</p><p><strong>Discussion: </strong>We have used this technology in a novel way to transform the delivery of medical education and enable consistent access to high-quality teaching. This can now be integrated across the curriculum and will include remote access to specialist clinics and surgery. A library of bespoke MR educational resources will be created for future generations of medical students and doctors to use on an international scale.</p>","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":"18 4","pages":"386-390"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tct.13338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25547615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spirituality in medical education and COVID-19.","authors":"Seyed-Hasan Adeli,&nbsp;Morteza Heidari,&nbsp;Akram Heidari","doi":"10.1111/tct.13331","DOIUrl":"https://doi.org/10.1111/tct.13331","url":null,"abstract":"","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":"18 4","pages":"372-373"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tct.13331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38834858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The paradox of teaching wellness: Lessons from a national obstetrics and gynaecology resident curriculum.","authors":"Abigail Ford Winkel,&nbsp;Laura E Fitzmaurice,&nbsp;Stacie A Jhaveri,&nbsp;Sigrid B Tristan,&nbsp;Mark B Woodland,&nbsp;Helen Kang Morgan","doi":"10.1111/tct.13360","DOIUrl":"https://doi.org/10.1111/tct.13360","url":null,"abstract":"<p><strong>Background: </strong>In response to high rates of burnout among trainees, educators in obstetrics and gynaecology introduced a six-session wellness curriculum that improved professional fulfilment and resident burnout in participants with greater attendance. The implementation of the curriculum varied based on local variables and contextual factors.</p><p><strong>Objective: </strong>To analyse the reactions of participants and curriculum leaders across the diverse settings of the pilot experience in order to identify the best practices for implementation of a wellness curriculum.</p><p><strong>Methods: </strong>Twenty-five US OBGYN residency programmes completed the curriculum in the 2017-2018 academic year. OBGYN residents in all the years of training participated. Faculty members and fellows were workshop facilitators and course leaders. All participants completed post-intervention surveys. A qualitative, descriptive thematic analysis explored free-text responses from residents and workshop facilitators.</p><p><strong>Results: </strong>Among 592 eligible resident participants, 387 (65%) responded to the post-intervention survey. Workshop facilitators submitted 65 surveys (47% response) on curriculum elements, rating the activities as 'good' or 'excellent' in 90.8% of cases. Qualitative analysis of workshop facilitators' and resident comments pointed to three themes, namely disagreement about the purpose of the curriculum, the social value of the curriculum in the residency programme and the need to open a broader discussion and take action to address structural barriers to wellness.</p><p><strong>Conclusions: </strong>Residents and faculty members involved in a wellness curriculum pilot had polarised reactions. While participants found value in learning skills and connecting to colleagues, efforts to promote wellness skills should be accompanied by communication and action to address drivers of burnout.</p>","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":"18 4","pages":"417-423"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tct.13360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38885814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching data science to medical trainees.","authors":"Ryan Wee,&nbsp;Ernest Soh,&nbsp;Dominic Giles","doi":"10.1111/tct.13391","DOIUrl":"https://doi.org/10.1111/tct.13391","url":null,"abstract":"Data science broadly refers to the endeavour of extracting knowledge from data. There is currently an explosion of data in health care, from the use of electronic health care record systems to complex datasets such as genomics. These scenarios present tremendous opportunities for health professionals— including doctors, nurses, medical students and allied health staff— to innovate their practice by harnessing, analysing and extracting insights from data. Furthermore, understanding data science will allow health professionals to be critical users of the literature. Reflecting the need for future doctors to be familiar with data science methods, our university (University College London) recently introduced a module titled ‘Doctor As Data Scientist’. This programme aims to educate medical students about critical appraisal and data science in medicine, and there are calls for more universities to implement a similar approach.1 There is also an increasing demand amongst medical students for data science skills to be incorporated into their training.2 However, several challenges remain in teaching data science to medical students:","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":"18 4","pages":"384-385"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tct.13391","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39073068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The chicken dance technique for teaching the instrument tie.","authors":"Shaan Sadhwani,&nbsp;Anna Cho,&nbsp;NamHee Kim,&nbsp;Syeda B Owais,&nbsp;Antonio Bernardo,&nbsp;Alexander I Evins","doi":"10.1111/tct.13319","DOIUrl":"https://doi.org/10.1111/tct.13319","url":null,"abstract":"Suturing and knot tying are essential skills and a mainstay of medical education, however, there remains a lack of detailed literature on effective methods for teaching new learners.1,2 Over the previous decade of teaching suturing, our team of surgical educators, led by an experienced academic neurosurgeon, has noticed a typical pattern of errors made by new learners, characterized by rigidity and a narrow working area, that result in wasted motions, pulling out the tail of the suture, and loosely tied knots. To combat this, we developed a novel teaching technique using the Chicken Dance that emphasizes visuospatial awareness and the importance of the elbows in knot tying while allowing students to learn the fundamental motions in an unconstricted space. Students are divided into small instructor-led groups, spaced 1 meter apart and positioned perpendicular to the wound. The suture needle is advanced through each end of the wound using a needle driver and forceps, with supination of the wrist, and the suture is pulled leaving a 2–3 cm tail. The needle is removed from the driver, the forceps are palmed, and the long end of the suture is grasped by the non-dominant hand, securing the needle. The Chicken Dance technique is then taught using the following steps. 1. Starting Position: Start by imitating chicken wings—abduct the arm at the shoulder to bring the elbows to 75–90° and flex the elbow to bring the wrists to the sternum while holding the suture with the non-dominant hand behind the needle driver in the dominant hand (Figure 1A). Place the hands approximately 10 cm in front of the chest and at least 10 cm above the wound to maximize the working area. 2. Wing Flapping: With the suture held behind the needle driver, begin the wrapping of the suture around the driver by flapping your “chicken wings”—moving both elbows superiorly from the starting position (Figure 1B-C) and then inferiorly below the starting position (Figure 1C), wrapping the suture around the driver once. Repeat to wrap the suture around the driver a second time (Figure 1D-E), keeping both wrists relatively still and each arm moving in concert so that one arm is not moving more than the other. The flapping motion of the elbows results in the suture wrapping around the needle driver without creating tension on the suture. 3. First Square Knot: Once the suture is wrapped around the needle driver, supinate the dominant hand to prevent the suture from slipping off and grasp the tip of the tail with the driver (Figure 1F). The non-dominant hand is then extended to pull the suture off the driver and create and tighten a knot (Figure 1G). This is performed with minimal movement of the driver to prevent elongation of the tail during tightening. Perpendicular force should then be applied using both hands. 4. Additional Throws: Repeat steps 1–4 with one wrap of the suture around the needle driver, alternating the direction of the wrap with each throw of the knot until the desired number ","PeriodicalId":74987,"journal":{"name":"The clinical teacher","volume":"18 4","pages":"365-366"},"PeriodicalIF":0.0,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/tct.13319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38733151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}