What Have Medical Students Learned from Bedside Learning in Hospices?

<p>Aim: We investigated what medical students learned on the clinical clerkship in our hospice and how their images of hospice care were changed, with self-reported questionnaires. Methods: Descriptions given in the contents were analyzed using a content analysis method based on Berelson’s methodology. A total of 20 students who participated in the program responded. Results: From their responses, 212 descriptions were extracted and 59 codes elicited. The codes were inductively classified and categorized based on content similarities. Eleven categories were generated: “care for quality of life of patients and families,” “characteristics and effects of palliative care” “practical approaches to end-of-life medicine,” “hospices’ positions in the healthcare system” “development of trust-based relationships with patients and their families,” “cooperation among healthcare professionals,” “appropriate attitudes toward patients and their families,” “being with patients when they pass away,” “opinions of patients and their families,” “characteristics and threats of cancer,” and “mental health for healthcare workers.”The students were found to have acquired a more positive image of hospices. Conclusion: They reported gaining valuable experience from the direct encounters with patients and their family, and that they had acquired behavior appropriate for physicians, as well as knowledge and skills about the basic palliative care.</p>

Evaluating a Palliative Medicine Education Program for Undergraduate Medical Students at a Regional Hospice

<p>Background: There is increasing demand for clinical clerkships in palliative medicine, though conventional medical education has focused only on providing students with sufficient medical knowledge and skills. In Japan, there is no standard program for palliative medicine in undergraduate medical education. Our hospice, in cooperation with a clinical clerkship for palliative medicine launched by Tokyo Medical and Dental University, has developed its own comprehensive bedside learning curriculum. Aim: This study aimed to evaluate the efficacy of the program. Methods: The curriculum involves not only experience in hospice care, ward rounds, and interviews with terminally ill patients, it also provides each medical student with educational sessions moderated by certified hospice nurses and pharmacists. We conducted a self-administered five-point scale questionnaire (with a higher score indicating higher satisfaction) to assess students’ satisfaction and understanding of the program. We also conducted a questionnaire on basic palliative medicine knowledge before and after the program. Results: Twenty students took part in the program. Ratios of scores of 4 or 5 for satisfaction and understanding of the program were 100% and 95%, respectively. Mean rates of correct answers on the pre-program and post-program test were 51% and 85%, respectively; showing a marked increase and emphasizing the educational significance of our curriculum. Students evidently benefit from the experience of bedside learning, and 95% reported having recommended the program to their juniors. Conclusion: These outcomes suggest the program is effective toward developing a standard education program in palliative medicine.</p>

Training in physical examination using a cardiac patient simulator for medical students during bedside learning / 医学教育

Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.<br>1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.<br>2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.<br>3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.<br>4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.<br>Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.

Comparison of student Self-Evaluations and Teacher Evaluations During Pediatric Bedside Learning / 医学教育

Student self-evaluations in pediatric bedside learning based on a problem-oriented system (POS) were compared with teacher evaluations of the same items. Self-evaluations were also compared with two different methods: unsigned and signed submissions. Students evaluated themselves poorly in the ability to recall pediatric knowledge and highly in the ability to investigate and summarize suggested topics. They evaluated themselves more highly on signed submissions than on unsigned submissions left in a box. Evaluations by teachers were higher than or equal to student self-evaluations. There were few critical evaluations or complaints about POS-bedside learning, but the ratio of criticism was four-fold higher on unsigned submissions. Bedside learning based on POS was accepted willingly by students.

Analysis and Evaluation of Problem Lists During Pediatric Bedside Learning / 医学教育

We analyzed and evaluated problem lists compiled by students during bedside learning. Ninety percent of the items on problem lists were medical problems, 4% were psychological problems, and 6% were social problems. Among medical problems, items related to laboratory data were most prominent, followed by data from physical examination, symptoms, and complications. Highly evaluated problem lists contained items related to psychological problems and social problems, while poorly evaluated lists did not include such items. Students with good scores on problem lists also achieved good scores in problem-oriented system fields other than compiling problem lists. It was extremely useful for students to write problem lists on problem-oriented system bedside learning.

Evaluation by Students of Bedside Learning in the Department of Pediatric Surgery / 医学教育

We evaluated bedside learning in the department of pediatric surgery by conducting a questionnaire survey of senior medical students at Chiba University School of Medicine. We obtained responses from 70 of 95 students (74%). Although 84% of students responded by making lists of patients' problems. Many students indicated insufficient knowledge about diseases and insufficient technical skills for medical treatment as the reasons they could not solve these problems. This finding indicates that students do not have sufficient basic knowledge and clinical skills for bedside learning. These skills must be acquired and evaluated before bedside learning can be started.

Analysis of Student Self-evaluations on Bedside Learning and Comparison with Teacher Evaluations / 医学教育

The learning of problem-solving skills at the bedside in our department was investigated by comparing the results of student self-evaluations with teacher evaluations before and after the bedside learning (BSL) course. Students evaluated their behavior highly in terms of 1) positiveness, 2) motivation, and 3) bedside manner. However, they evaluated their medical competence poorly in terms of the ability to 4) perform physical examinations, 5) analyze medical histories and clinical findings, 6) interpret ECG and X-ray films, and 7) gather data, and 8) recall medical knowledge.<BR>The results of the student self-evaluations on items 5) to 8) were compared to those of the teacher evaluations before the BSL course (term examination in the fourth year) and after the BSL course. The student self-evaluations were not correlated with the two teacher evaluations, but there was a very close correlation between the two teacher evaluations.

Evaluation of Medical Records Written by Students During Pediatric Bedside Learning / 医学教育

Participation of students in the management of patients was evaluated by analyzing medical records written by the students. Sixty-four percent of the students wrote in the medical chart everyday, however the amount of data was on average only 5.6 lines per day. Descriptions of subjective data were scant. Physical complaints were described for 65% of patients, but were insufficient in detail. Psychic and social complaints were rarely described. Objective data on the physical examination comprised the main body of chart notes recorded by the students, although only 37% of these were judged to be sufficient. Laboratory and radiological data were described less thoroughly than data from the physical examination, and were completely absent from 64% of charts. Assessments were incomplete, and patient problems were not clearly elucidated for most patients. These undergraduate students failed in their assessment of patient problems during their one week of bedside learning.