Core components of clinical education: a qualitative study with attending physicians and their residents

Introduction: In medical education, particularly in residency courses, most of the training occurs in real clinical environments. Workplace-based learning profoundly affects students' knowledge, attitudes, and practice; therefore, it should be properly planned. Due to the extensiveness of the clinical environment and its importance in training residents, investigating how residents learn in these environments and detecting factors that influence effectiveness will help curriculum designers to promote residents' learning by improving their learning environment. Therefore, our qualitative content analysis study, aimed to examine the experiences and perspectives of internal and surgical residents and their attending physicians about learning in clinical settings

Methods: This qualitative content analysis study was conducted through purposeful sampling. Semi-structured interviews were conducted with 15 internal and surgical residents and 15 of their attending physicians at educational hospitals of Tehran University of Medical Sciences

Results: The main categories explored in this study were hidden curriculum, learning resources, and learning conditions. In the context of clinical environment and under its individual culture, residents learn professionalism and learn to improve their communication skills with patients and colleagues. Because of clinical obligations such as priority of treating the patients for education or workload of the attending physicians, residents acquire most of their practical knowledge from colleagues, fellows, or follow-up patients in different learning conditions [such as: educational rounds, morning reports and outpatient clinics] They see some of their attending physicians as role models

Conclusion: Changing cultural and contextual factors is of prime importance to promote a learning-oriented environment in a clinical setting. The present findings will help curriculum planners and attending physicians to improve residents' learning by means of appropriate workplace planning and by considering the components involved in clinical learning

[ effect of employing "Standardized Patient" on history taking skills of medical students]

Introduction: Using Standardized Patient [SP] in teaching history taking provides medical students with an opportunity to learn how to communicate with patients. A Standardized Patient is a person who has been carefully coached to simulate an actual patient so accurately. This study was performed to assess the effect of using SP on improving history taking skill of third year medical students

Methods: In a quasi-experimental study, 95 students of "Introduction to Clinical Medicine" were divided into two experiment and control groups in 2007-2008. The control group received instruction on history taking skills through usual method of lecture. The experiment group was instructed using SP. At the end of the course, the students' history taking skills were evaluated through an Objective Structured Clinical Examination [OSCE] and the mean scores of the two groups were compared. Also the students' viewpoints were investigated using a researcher-made reliable and valid questionnaire

Results: Although no significant difference was observed between the scores of individual items of checklist in the two groups, the total mean score of the experiment group [7.03 +/- 1.349] was significantly higher than that of the control group [5.8 +/- 1.473] [P<0.004]. Most students [86.5%] preferred using SP for their instruction compared to lecture method

Conclusion: Standardized patient provides an appropriate opportunity for new medical students to experience and learn history taking and communication skills. It is highly recommended to use SP not only in teaching history taking and communication skills but also in physical examination course