How do universities support communication skills for clinical placements with culturally and linguistically diverse students? A scoping review.

AIM: The aim of this scoping review was to examine and synthesise contemporary research on clinical communication interventions for tertiary students from a culturally and linguistically diverse background enrolled in a health professional qualification. BACKGROUND: Clinical communication competence is essential to high quality healthcare and thus is a critical component of all health professional education. The rise in tertiary students from non-English speaking backgrounds in Australia and many other countries has escalated concern over the communication skills required for success in clinical placements and future practice as a health professional. DESIGN: A scoping review was conducted using Arskey and O'Malley's methodological framework. METHODS: The search targeted journal articles published in English between 2010 and 2022 in the databases Medline, CINAHL, ProQuest, Scopus, and Google Scholar. A total of 105 full texts were independently reviewed by the team of researchers, and hand-searching of the references in these studies was conducted. Eighteen articles were eligible for inclusion. RESULTS: The majority of studies involved a small scale (<30 participants) intervention with nursing students in Australian universities. A small number of studies involved medical, physiotherapy and dentistry students. Most interventions were a voluntary face-to-face workshop(s) focused on experiential learning of either literacy-based skills (reading and writing) or communication skills for specific clinical procedures. Self-reported outcomes were the most commonly cited outcome measure. CONCLUSIONS: While a critical appraisal was not conducted, concerns over the quality of the research were highlighted, and most interventions were not replicable due to the lack of detail provided. Further research to address the gaps in current knowledge identified in this review is warranted.

The VOTIS, part 2: Using a video-reflexive assessment activity to foster dispositional learning in interprofessional education.

Effective interprofessional collaborative practice (IPCP) requires a new way of working characterized by distributed leadership skills, shared decision-making, and the adoption of uniprofessional and interprofessional identities. Health professional educators are tasked with preparing clinicians for IPCP through interprofessional education (IPE). Numerous IPE teaching interventions have been developed, ranging in length from hours to semesters, designed to introduce students to interprofessional ways of working - usually evaluated in terms of student satisfaction, perceptions of other disciplines and conceptual knowledge. However, working interprofessionally also requires integrating dispositional knowledge into one's emerging interprofessional habits and values. In this paper, we describe a learning activity, inspired by a new video-reflexive methodology, designed to foster dispositional learning of interprofessional skills using a video-based assessment tool: the Video Observation Tool for Interprofessional Skills (VOTIS). Based on focus group and interview data, we suggest the activity's usefulness in fostering conceptual, procedural and dispositional knowledge, as well as reflexive feedback literacy. Overall, our qualitative evaluation of the VOTIS suggests the merits of drawing on video-reflexive methodology and pedagogical theory to re-imagine IPE as a dynamic process, requiring the development of interprofessional skills that must be appropriated into students' emerging (inter)professional identities.

The VOTIS, part 1: development and pilot trial of a tool to assess students' interprofessional skill development using video-reflexive ethnography.

This paper explores the development and evaluation of the video Observation Tool for Interprofessional Skills (VOTIS). We describe the development of an authentic interprofessional assessment tool that incorporates video reflection and allows formative and summative assessment of individual learners' interprofessional skills within an authentic interprofessional context. We then investigate its validity and reliability. The VOTIS was developed using a modified Delphi technique. The tool was piloted with 61 students and 11 clinical educators who completed the VOTIS following team meetings where students interacted about their interprofessional clinical work. The following were calculated: internal consistency; students' proficiency levels; inter-rater reliability between students and clinical educators; and inter-rater reliability between clinical educators and an independent rater. Results indicate that the VOTIS has acceptable internal consistency and moderate reliability and has value in evaluating students' interprofessional skills. Study outcomes highlight the need for more explicit wording of tool content and instructions and further clinical educator training to increase the utility and reliability of the VOTIS as a learning and assessment tool.

Clinical supervisors' reflections on their role, training needs and overall experience as dental educators.

OBJECTIVES: The aims of this study were to understand the views of clinical supervisors overseeing final year dental students and investigate their perceived role, level of support and training available, and ways to improve the supervisory experience. METHODS: Clinical supervisors who oversaw fifth-year dental students in 2019 were invited to participate in an online survey. Respondents who indicated their willingness to participate were contacted for a semi-structured interview which were analysed using Constant Comparative Methodology. RESULTS: Sixteen supervisors completed the survey, with a response rate of 73%. Respondents reported low levels of formal training in clinical supervision (38%) and most (75%) felt further training would be beneficial for their role. While nearly all (94%) reported they had developed as a dental professional through supervision, most (63%) were not positively encouraged to develop a career as a supervisor, with tensions between health service delivery and academia identified as a key challenge. The driving motivator to supervise was a desire to teach (62.5%). Seven (44%) participants completed the semi-structured interview. Participants' perception of their role varied depending on career stage and clinic location. Lack of recognition and defined career pathways were the biggest challenges reported by participants. CONCLUSION: Retention and morale of supervisors may increase with better-defined career pathways and meaningful professional development opportunities. There is a need to develop tailored training programs for supervisors that enable them to teach critical thinking and clinical judgement while ensuring patient safety.

Mentorship availability and needs for junior faculty members at the United States and Australian dental schools.

OBJECTIVES: The aims of this study were to understand the experiences junior faculty have during their professional socialisation as educators and how they perceive the need and value of mentorship. METHODS: A cross-sectional qualitative study design was used. Data were collected in 2019 through a pre-survey and focus groups with junior faculty (defined as 0-5 years) across four institutions in Australia and the United States of America. Framework analysis was used to identify themes in the data, based on our defined research questions, and socio-cognitive career theory was applied to guide our analysis. RESULTS: A total of 22 junior faculty participated in the study. Only one of the four institutions had a formal mentoring programme for junior dental faculty. At this institution, 83% of participants indicated they were likely/extremely likely to remain in dental education. Across the three institutions where formal mentoring for junior dental faculty was not available, only 40% of participants indicated they were likely/extremely likely to remain in dental education. We identified five themes in the qualitative data: motivation for career choice, the importance of relationships, personal goals and the need for self-direction, expectations of the role, and institutional effects. CONCLUSION: Our findings suggest that mentoring is a critical factor in a junior faculty member's experience entering and socialising into a career in dental education. The perceived value of mentoring emerged across all themes, both from the perspective of participants who had received formal mentoring and those who had not.

Touch in health professional practice: a review.

BACKGROUND: The appropriate use of touch is central to effective and compassionate care in the clinical environment; however, in a time of the #MeToo movement, and with heightened awareness of child and elder abuse, the notion of physical contact is frequently viewed negatively, and may be associated with gender and power divides. The use of touch in the clinical context has increasing layers of complexity and is highly context specific. … in a time of the #MeToo movement … the notion of physical contact is frequently viewed negatively … METHODS: We reviewed relevant literature, including textbooks, and have drawn on our own experiences to explore the concept and use of touch across medicine, nursing and dentistry. RESULTS: In the context of learning and teaching in health we recognised two types of physical touch: expressive and procedural. DISCUSSION: Our review legitimises the importance of learners and educators being equipped to consider the role and nuances of touch when engaging in professional behaviour. We provide suggestions for how this complex concept may be embedded into entry-to-practice curricula and approached in faculty development.

Depression, anxiety and stress in a cohort of Australian dentistry students.

INTRODUCTION: Dentistry students face a challenging academic and clinical curriculum that can result in depression and anxiety. While studies usually report sources of stress for dentistry students, there is less information on levels of stress. This study used the Depression, Anxiety and Stress Scale (DASS-21), to report perceived levels of depression, anxiety and stress in a cohort of Australian undergraduate dentistry students. METHODS: Students enrolled in years 1-4 of the Bachelor of Dental Science (Honours) program at The University of Queensland were invited to complete the DASS-21 using an online questionnaire. Students completed the same questionnaire 1 year later. RESULTS: At baseline, the mean DASS-21 scores for this cohort (n = 179; females = 56%) were in the normal range for depression (4.69, SD 3.87) and stress (5.50, SD 3.65), and mild range for anxiety (4.25, SD 3.21). Overall, 24% (n = 42), 44% (n = 78) and 11% (n = 20) of students had moderate or above levels of depression, anxiety and stress, respectively. At 1-year follow-up, DASS-21 scores were not significantly different. CONCLUSIONS: Dental students have higher levels of depression, anxiety or stress than the general population, indicating they may be at risk for greater psychological distress. The information from this study should guide curriculum and learning environment design, as well as interventions to support students through this challenging degree.

Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45.

BACKGROUND: Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments. AIM: To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training. METHOD: Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included. RESULTS: Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings. Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment. CONCLUSIONS: While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.

'Compassion, the first emotion ditched when I'm busy'. The struggle to maintain our common humanity.

This article was migrated. The article was marked as recommended. Introduction A considerable body of literature has been built around the socialisation of medical students and junior doctors into the culture of medicine, yet our appreciation of how their affective learning is shaped through practice, over time, continues to challenge our understanding and subsequent educational practice. This study addresses this gap by using compassion as a lens to unpack affective learning. Methods This research asked interns undertaking their first year of medical practice "What have been the main influences (positive and/or negative) in how you have learned to express compassion for your patients when working in the clinical context?" Their individual narratives, generated through reflective journals and unstructured interviews, when thematically analysed, told us how and why they struggled. Findings The eight interns expressed their struggle to maintain their compassionate aspirations when confronted with the complexity and competing demands of their community of practice. Their emotional disquiet triggered their safety ethic resulting in their compassion, a prosocial moral emotion, being replaced by a more reductionist approach where patient care was reframed as patient management. Discussion While neither inevitable nor static, the interns' narratives tell a story where, after a year embedded in their community of practice, their increased self-efficacy, derived primarily from their perceived biomedical competence, enables them to revisit their original aspirations - to be both compassionate and competent - recognising that being a 'good' doctor does not have to eclipse being a kind and caring human being. Conclusions The interns' reflections uncovered a narrative of emotional vulnerability, where fearing failure and seeking perfection, contributed to a diminished self­efficacy resulting in risk aversive behaviours protecting their doctor identity. In the recommendations the authors propose strategies for safe engaged connection, where self­understanding replaces self­criticism and self­compassion is cultivated to guard against contempt and cynicism.

Becoming a medical educator: motivation, socialisation and navigation.

BACKGROUND: Despite an increasing concern about a future shortage of medical educators, little published research exists on career choices in medical education nor the impact of specific training posts in medical education (e.g. academic registrar/resident positions). Medical educators at all levels, from both medical and non-medical backgrounds, are crucial for the training of medical students, junior doctors and in continuing professional development. We explored the motivations and experiences of junior doctors considering an education career and undertaking a medical education registrar (MER) post. METHODS: Data were collected through semi-structured interviews with junior doctors and clinicians across Queensland Health. Framework analysis was used to identify themes in the data, based on our defined research questions and the medical education workforce issues prompting the study. We applied socio-cognitive career theory to guide our analysis and to explore the experience of junior doctors in medical education registrar posts as they enter, navigate and fulfil the role. RESULTS: We identified six key themes in the data: motivation for career choice and wanting to provide better education; personal goals, expectations and the need for self-direction; the influence of role models; defining one's identity; support networks and the need for research as a potential barrier to pursuing a career in/with education. We also identified the similarities and differences between the MERs' experiences to develop a composite of an MER's journey through career choice, experience in role and outcomes. CONCLUSIONS: There is growing interest from junior doctors in pursuing education pathways in a clinical environment. They want to enhance clinical teaching in the hospitals and become specialists with an interest in education, and have no particular interest in research or academia. This has implications for the recruitment and training of the next generation of clinical educators.

A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26.

BACKGROUND: Traditionally, clinical learning for medical students consists of short-term and opportunistic encounters with primarily acute-care patients, supervised by an array of clinician preceptors. In response to educational concerns, some medical schools have developed longitudinal placements rather than short-term rotations. Many of these longitudinal placements are also integrated across the core clinical disciplines, are commonly termed longitudinal integrated clerkships (LICs) and often situated in rural locations. This review aimed to explore, analyse and synthesise evidence relating to the effectiveness of longitudinal placements, for medical students in particular to determine which aspects are most critical to successful outcomes. METHOD: Extensive search of the literature resulted in 1679 papers and abstracts being considered, with 53 papers ultimately being included for review. The review group coded these 53 papers according to standard BEME review guidelines. Specific information extracted included: data relating to effectiveness, the location of the study, number of students involved, format, length and description of placement, the learning outcomes, research design, the impact level for evaluation and the main evaluation methods and findings. We applied a realist approach to consider what works well for whom and under what circumstances. FINDINGS: The early LICs were all community-based immersion programs, situated in general practice and predominantly in rural settings. More recent LIC innovations were situated in tertiary-level specialist ambulatory care in urban settings. Not all placements were integrated across medical disciplines but were longitudinal in relation to location, patient base and/or supervision. Twenty-four papers focussed on one of four programs from different viewpoints. Most evaluations were student opinion (survey, interview, focus group) and/or student assessment results. Placements varied from one half day per week for six months through to full time immersion for more than 12 months. The predominant mechanism relating to factors influencing effectiveness was continuity of one or more of: patient care, supervision and mentorship, peer group and location. The success of LICs and participation satisfaction depended on the preparation of both students and clinical supervisors, and the level of support each received from their academic institutions. CONCLUSION: Longitudinal placements, including longitudinal integrated placements, are gaining in popularity as an alternative to traditional block rotations. Although relatively few established LICs currently exist, medical schools may look for ways to incorporate some of the principles of LICs more generally in their clinical education programmes. Further research is required to ascertain the optimum length of time for placements depending on the defined learning outcomes and timing within the programme, which students are most likely to benefit and the effects of context such as location and type of integration.

The effect of environmental conditions on the persistence of common lubricants on skin for cases of sexual assault investigation.

The potential for lubricant trace evidence to be used as associative evidence is often overlooked in forensic investigations. Published studies in this area have focused on the identification of analytical techniques suitable for the detection of this evidence type. However, detection of trace lubricant is also dependent on the length of time it persists on skin and mucosal surfaces. The objective of this study was to investigate the effect of environmental conditions on the persistence of oil- and glycerol-based lubricants on skin surfaces. Lubricated skin samples exposed to three different test environments were swabbed at regular intervals over a 24-h period. Compounds of interest were extracted from the swabs and analyzed using gas chromatography-mass spectrometry (GC-MS). The effect of glycerol derivatization prior to GC-MS analysis was also investigated. In general, oil-based lubricants persisted longer than glycerol-based. Persistence on skin was greatest in lower temperature conditions away from direct sunlight exposure. The results of this investigation are relevant in the context of sexual assault investigations given the possible detection of lubricant on the skin of the external genitalia.

Provenance determination of oriental porcelain using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS).

The sale of fraudulent oriental ceramics constitutes a large proportion of the illegal artifact and antique trade and threatens to undermine the legitimate international market. The sophistication and skill of forgers has reached a level where, using traditional appraisal by eye and hand, even the most experienced specialist is often unable to distinguish between a genuine and fraudulent piece. In addition, current provenancing techniques such as energy-dispersive X-ray fluorescence (EDXRF) spectrometry and thermoluminescence (TL) dating can result in significant damage to the artifact itself. Laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS), a relatively nondestructive analytical technique, has been used for the provenance determination of materials based on geographical origin. The technique requires the production of a laser crater, c. 100 microm in diameter, which is essentially invisible to the naked eye. Debris from this crater is analyzed using ICP-MS, with the results forming the basis of the provenance establishment protocol. Chinese, Japanese, and English porcelain shards have been analyzed using this protocol and generic isotopic distribution patterns have been produced that enable the provenance establishment of porcelain artifacts to their country of production. Minor variations between elemental fingerprints of artifacts produced in the same country also indicate that it may be possible to further provenance oriental ceramics to a specific production region or kiln site.