Anatomy by Whole Body Dissection as an Elective: Student Outcomes.

BACKGROUND: Anatomy education has long been considered fundamental to the medical profession. Recently, Australasian medical schools have favored prosected human material, models and medical imaging in their anatomy curriculum with only 3 medical schools offering whole-body dissection. The aim of this study was to explore the knowledge acquisition and perceptions of an elective anatomy by whole body dissection (AWBD) course for senior medical students. METHODS: In the 2017 AWBD course, 53 self-selected senior medical students carried out dissections over an 8-week period. Students were assessed via true/false questions and practical tests involving the identification of structures on anatomical images at precourse, mid-course and end-course. In addition, at completion of the course, students completed a questionnaire using a 5-point Likert scale and 2 open-ended questions. Quantitative data analysis was conducted on test scores and questionnaire data using a paired-sample t-test and descriptive statistics. Qualitative data were coded and categorised into themes. RESULTS: There was a significant improvement (p < 0.0001) in student test scores from pre-course (mean 34.1 ± 12.9%) to mid-course (mean 74.8 ± 9.4%) and end-course (mean 75.4 ± 9.8%). Analysis of the questionnaire data showed strongly favorable perceptions of the course, highlighting dissection, complemented by Structure, Clinical, Objective-Referenced, Problem-Based, Integrated and Organized (SCORPIO) teaching, frequent testing and senior surgeon supervision as beneficial teaching methods. CONCLUSIONS: Dissecting in small groups has been shown to be an effective part of anatomy learning. Our study suggests complementary teaching methods as possible augmenters to a well-structed, small group AWBD course. We have presented a framework suitable for an intensive AWBD course within medical curricula, that was valued by participants, and improved students' knowledge of anatomy.

Introduction to the Peer Teacher Training in health professional education supplement series.

Skills in supervision, teaching, facilitation, assessment and feedback, leadership and interprofessional teamwork are required graduate attributes for health professionals. Despite this, the opportunity for learning these skills is rarely embedded within undergraduate and postgraduate health professional training curricula. Additionally, there are limited examples of interprofessional delivery of teaching programs. Since teaching skills can be learned, healthcare faculties play an important role in improving the teaching abilities of their students. At the University of Sydney, we developed and implemented interprofessional, blended learning teacher training programs for health professional students, and junior health professionals: The Peer Teacher Training (PTT) program, and the Clinical Teacher Training (CTT) program. Based on our successful programs, this paper provides an introduction to our Peer Teacher Training supplement. Namely, 11 articles designed to assist those who work and teach in a clinical context; address key challenges; and provide practical tips and frameworks to assist in teaching, assessment, and feedback.

Key tips for teaching in the clinical setting.

Teaching with real patients in the clinical setting lies at the heart of health professional education, providing an essential component to clinical training. This is true of all the health disciplines - particularly medicine, nursing, dentistry, physiotherapy, and dietetics. Clinical tutorials orientate students to the culture and social aspects of the healthcare environment, and shape their professional values as they prepare for practice. These patient-based tutorials introduce students to the clinical environment in a supervised and structured manner, providing opportunities to participate in communication skills, history taking, physical examination, clinical reasoning, diagnosis and management. It is only through participation that new practices are learnt, and progressively, new tasks are undertaken. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and key tips for teaching in the clinical setting. Although there are many competencies developed by students in the clinical setting, our tips for teaching focus on the domains of medical knowledge, interpersonal and communication skills, and professionalism.

Feedback in the clinical setting.

Provision of feedback forms an integral part of the learning process. Receipt of feedback enriches the learning experience, and helps to narrow the gap between actual and desired performance. Effective feedback helps to reinforce good practice, motivating the learner towards the desired outcome. However, a common complaint from learners is that the receipt of feedback is infrequent and inadequate. This paper briefly explores the role of feedback within the learning process, the barriers to the feedback process, and practical guidelines for facilitating feedback.

Leadership in healthcare education.

Effective leadership is a complex and highly valued component of healthcare education, increasingly recognised as essential to the delivery of high standards of education, research and clinical practice. To meet the needs of healthcare in the twenty-first century, competent leaders will be increasingly important across all health professions, including allied health, nursing, pharmacy, dentistry, and medicine. Consequently, incorporation of leadership training and development should be part of all health professional curricula. A new type of leader is emerging: one who role models the balance between autonomy and accountability, emphasises teamwork, and focuses on improving patient outcomes. Healthcare education leaders are required to work effectively and collaboratively across discipline and organisational boundaries, where titles are not always linked to leadership roles. This paper briefly considers the current theories of leadership, and explores leadership skills and roles within the context of healthcare education.

Planning, preparing and structuring a small group teaching session.

A structured approach is critical to the success of any small group teaching session; preparation and planning are key elements in ensuring the session is systematic and effective. Learning activities guide and engage students towards the achievement of agreed learning outcomes. This paper introduces the central concepts of planning and preparing a small group teaching session. It provides an overview of key theoretical principles in lesson planning, delivery, and how to provide effective feedback in this setting.

Team-based learning: design, facilitation and participation.

Team-based learning (TBL) provides an active, structured form of small group learning, that can be applied to large classes. Student accountability is achieved through the specific steps of TBL, including pre-class preparation, readiness assurance testing, problem-solving activities, and immediate feedback. Globally, a growing number of healthcare faculties have adopted TBL in a variety of combinations, across diverse settings and content areas. This paper provides a succinct overview of TBL and guidance for teachers towards successful design and implementation of TBL within health professional education. It also offers guidance for students participating in TBL. The paper is informed by both educational theory, and the extensive, seven year experience of the first and last authors in designing, implementing, facilitating and evaluating TBL at a large medical school.

Facilitating small group learning in the health professions.

There is now good evidence that small group teaching provides a fruitful academic environment, which optimises learning, particularly in the healthcare setting, and especially when compared to lectures. An individual student's understanding of knowledge is increased when they are able to actively compare and build on their own understanding in conjunction with their peers. Small group teaching provides opportunities for learners to work collaboratively, and promotes team-building skills - skills that are essential to work within healthcare settings. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and tips to improve learner engagement when facilitating small groups.

Tips for teaching procedural skills.

The teaching of procedural skills required for clinical practice remains an ongoing challenge in healthcare education. Health professionals must be competent to perform a wide range of clinical skills, and are also regularly required to teach these clinical skills to their peers, junior staff, and students. Teaching of procedural skills through the use of frameworks, observation and provision of feedback, with opportunities for repeated practice assists in the learners' acquisition and retention of skills. With a focus on the teaching of non-complex skills, this paper explores how skills are learned; ways to improve skill performance; determining competency; and the provision of effective feedback.

Teaching clinical handover with ISBAR.

Clinical handover is one of the most critical steps in a patient's journey and is a core skill that needs to be taught to health professional students and junior clinicians. Performed well, clinical handover should ensure that lapses in continuity of patient care, errors and harm are reduced in the hospital or community setting. Handover, however, is often poorly performed, with critical detail being omitted and irrelevant detail included. Evidence suggests that the use of a structured, standardised framework for handover, such as ISBAR, improves patient outcomes. The ISBAR (Introduction, Situation, Background, Assessment, Recommendation) framework, endorsed by the World Health Organisation, provides a standardised approach to communication which can be used in any situation. In the complex clinical environment of healthcare today, ISBAR is suited to a wide range of clinical contexts, and works best when all parties are trained in using the same framework. It is essential that healthcare leaders and professionals from across the health disciplines work together to ensure good clinical handover practices are developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of health professional students and health professionals to ensure good quality handover practice. Using ISBAR as a framework, the purpose of this paper is to highlight key elements of effective clinical handover, and to explore teaching techniques that aim to ensure the framework is embedded in practice effectively.

Planning peer assisted learning (PAL) activities in clinical schools.

Peer Assisted Learning (PAL) is well accepted as an educational method within health professional education, involving a process of socialisation among students. PAL activities provide a framework whereby students are permitted to practice and develop their healthcare and teaching skills. However, the success of PAL activities is dependent upon two key factors: the "agency" of the individual students, that is, their willingness to participate; and importantly, the "affordance" of the activity, that is, the invitational quality provided by the clinical school. The purpose of this paper is to assist healthcare educators and administrators responsible for curriculum design, course co-ordination, and educational research, in developing their own PAL activities. Health professional students and junior health professionals leading or participating in PAL activities may also find the paper useful. Based on the authors' collective experience, and relevant literature, we provide practical tips for the design, implementation and evaluation of PAL activities.

Interprofessional education: tips for design and implementation.

Interprofessional education (IPE) is a critical approach for preparing students to enter the health workforce, where teamwork and collaboration are important competencies. IPE has been promoted by a number of international health organisations, as part of a redesign of healthcare systems to promote interprofessional teamwork, to enhance the quality of patient care, and improve health outcomes. In response, universities are beginning to create and sustain authentic and inclusive IPE activities, with which students can engage. A growing number of health professionals are expected to support and facilitate interprofessional student groups. Designing interprofessional learning activities, and facilitating interprofessional groups of students requires an additional layer of skills compared with uniprofessional student groups. This article outlines the key points for planning and practicing interprofessional facilitation within the classroom and clinical setting.

"A Taste of Real Medicine": Third Year Medical Students' Report Experiences of Early Workplace Encounters.

INTRODUCTION: Medical students extend their preparatory learning on entering the clinical work environment, by joining their clinical team as peripheral participants and start to care for "real" patients. This learning is situated, experiential, varied, mainly unstructured, highly dependent on clinical opportunities (affordances), and students' motivation to learn (learner agency). Students ideally contribute to workplace activities, which allow their practical skills, confidence and professional identity to evolve. This study sought to investigate senior students' perspectives in their early stages of workplace learning, by using social learning theory as a framework. The focus is on team integration, practical skills performance, professional development and their evolving professional identity. METHODS: Between 2015 and 2018, we conducted five focus groups, with a total of 36 volunteers, out of a possible 200 (18% Stage 3 (Year 3)) medical students. Each focus group session was audio recorded and transcribed verbatim. Participants were de-identified, and framework analysis used the theoretical frameworks of communities of practice, and workplace affordances to gain insight into their work-place learning experience during the first two months of their clinical rotation. RESULTS: Thirty-six students out of 200 (18%) attended focus groups over a four-year period. The results are presented using the theoretical frameworks of community of practice and workplace affordances and presented as themes of: meaning, "learning as experience", practice, "learning as doing" community, "learning as belonging", and identity, "learning as becoming". DISCUSSION: Participants reported many positive examples of workplace learning while dealing directly with patients. Students were also exposed to ethical dilemmas and unexpected risks in the workplace. These included lack of site orientation, unsupportive teams, lack of supervision, and students' inability to initiate agency, all of which contributed to their workplace uncertainty. Performing manageable tasks for their team provided a role in their community of practice, strengthening their identity as evolving doctors. Exposure to both positive and negative role models allowed students to reflect on ethical issues, further extending their own professional identities. SUMMARY: Participants were quick to observe and report workplace dynamics as they were exposed to the positive and negative aspects of the hidden curriculum. This allowed them to reflect on patient safety, and ethical concerns promoting the development of their professional identity.

How to choose your study design.

Research designs are broadly divided into observational studies (i.e. cross-sectional; case-control and cohort studies) and experimental studies (randomised control trials, RCTs). Each design has a specific role, and each has both advantages and disadvantages. Moreover, while the typical RCT is a parallel group design, there are now many variants to consider. It is important that both researchers and paediatricians are aware of the role of each study design, their respective pros and cons, and the inherent risk of bias with each design. While there are numerous quantitative study designs available to researchers, the final choice is dictated by two key factors. First, by the specific research question. That is, if the question is one of 'prevalence' (disease burden) then the ideal is a cross-sectional study; if it is a question of 'harm' - a case-control study; prognosis - a cohort and therapy - a RCT. Second, by what resources are available to you. This includes budget, time, feasibility re-patient numbers and research expertise. All these factors will severely limit the choice. While paediatricians would like to see more RCTs, these require a huge amount of resources, and in many situations will be unethical (e.g. potentially harmful intervention) or impractical (e.g. rare diseases). This paper gives a brief overview of the common study types, and for those embarking on such studies you will need far more comprehensive, detailed sources of information.

The role of reverse mentoring in medical education: current insights.

Reverse mentoring is a relatively contemporary concept that relies on the reversal of the traditional roles of mentor and mentee and the abolition of the mentorship model as an apprenticeship or hierarchy. Typically, a younger specialist takes on the role of mentor and an older, more experienced specialist the role of mentee. Reverse mentoring is founded in learning and social theories of mentorship and has been practically applied in information technology, business and education fields. However, there is a role for reverse mentoring in medical education and the health sciences, particularly with the inclusion of new technologies in a changing health landscape, and the emphasis on interdisciplinary teamwork and improved workplace culture. Further investigation and analysis of reverse mentoring is warranted, with a particular focus on the implementation of the reverse mentor model in the field of medical education and the health sciences. To assist those considering implementation of mentorship programs in their workplace, this article provides an overview of recent literature, with suggested applications of "reverse mentoring" in the medical education context.

Team-based learning (TBL): a community of practice.

BACKGROUND: Rapid changes in medical practice have a large impact on the demands faced by educators in preparing students for future participation in a multifaceted healthcare workforce. Competencies required by today's medical graduates encompass the ability to effectively collaborate, communicate and problem solve. The learning needs of medical students have also changed over time. Today's medical students are highly interconnected, enjoying teamwork and collaborative practice, and desire continuous, explicit feedback. They want structured learning activities, with clear expectations, and enjoy a sense of accomplishment on their achievements. The conflation of these issues has seen many medical schools adopt the model of Team-based learning (TBL). Using the conceptual framework of communities of practice, we sought to qualitatively explore students' and teachers' experience of TBL in Year 1 of a graduate entry medical program. METHODS: Convenience sampling was used to select 169/350 (48%) Year 1 students who completed three TBL sessions. Each TBL session was facilitated by three senior clinicians. Following participation in the TBLs, students were invited to attend focus groups, and all facilitators (n = 9) were invited to attend interviews. A coding framework was developed to code the entire dataset, using the theoretical lens of communities of practice. RESULTS: 34/169 (20%) of students attended focus groups. Three facilitators (3/9, 33%) were interviewed. Students and facilitators felt the structure and organisation of TBL made students accountable for their learning and team contributions. The combined expertise and clinical experience of facilitators, with immediate feedback helped groups to work both independently and collaboratively. Facilitators found working with their peers in the TBLs to be a rewarding experience. CONCLUSIONS: The community of practice found in the TBL classes, provided an enriching and rewarding learning environment that motivated students to build on their basic knowledge and apply what had been learnt. The interactions of experienced, senior clinicians as facilitators, sharing their expertise within a clinical context, prompted effective student engagement in learning and understanding. Our change in curriculum design and pedagogy will assist in preparing medical students for demands of the increasingly complex healthcare systems in which they will work.

Faculty development for junior health professionals.

BACKGROUND: The need for faculty development programmes designed to help junior health professionals fulfill their multiple roles, across various institutions, is widely acknowledged. Such programmes are usually logistically difficult for hospital clinicians to access, however, and are discipline based. In 2017, we collaborated with four health care faculties to develop a blended learning, interprofessional faculty development programme that was up to date, relevant, and accessible to clinicians working in the hospital and university settings. The purpose of our study was to explore participants' perceptions of the structure, processes and outcomes of the programme, using the conceptual framework of communities of practice. METHODS: The Clinical Teacher Training (CTT) programme included eight modules delivered using a blended learning format. Participants were provided with education literature, online activities and videos, plus in-class opportunities for active participation in small interprofessional learning groups and large group sessions. Quantitative data were collected from participants by questionnaire, and then analysed using descriptive statistics. Qualitative data were collected by focus group. Framework analysis was used to code the data set using 'communities of practice' as a conceptual framework. [Faculty development] programmes are usually logistically difficult for hospital clinicians to access and are discipline based FINDINGS: Participants felt able to achieve most of the CTT programme learning outcomes through active participation, formative assessment and feedback. Participants felt that their learning was enriched through the blended learning platform, and through delivery within an interprofessional context; however, participants suggested it would be beneficial if more content was delivered through face-to-face sessions, particularly regarding 'Journal Club' and 'Mentorship' modules. Although participants felt well prepared to teach students, they felt less well prepared for assessment activities.

The impact on internship of a tailored intern preparation package.

INTRODUCTION: On commencing internship, new medical graduates (new interns) are often required to perform core procedural skills under differing levels of supervision. This variability of knowledge and experience with procedural skills can place patient safety at risk. Consequently, in 2012, we developed a targeted, intensive, 3-day training course for our pre-intern (PrInt) students. The aim of this study was to evaluate the intern preparation package by exploring interns' self-reported knowledge, confidence, and experience in key procedural skills during the early months of internship. METHODS: Between 2012 and 2016, 5 cohorts of PrInt students (n=223) participated in our course. In the following years 2013-2017, the same 5 cohorts, at 4-5 months into their internship, were surveyed anonymously and invited to attend focus groups. Descriptive statistics and thematic analysis were used to analyze data. RESULTS: Of the 223 interns, 91 (41%) responded. Of the 91, 82 (93%) agreed that the intern preparation package provided during PrInt had been beneficial to their practice as an intern. Awareness of potential risks to patient safety was high, ranging from infection control at 89/89 (100%) to 87/90 (97%) for patient identification. Confidence in performing procedural skills varied from moderate in identifying nasogastric tube placement on X-ray (66/89; 85%), to equal least confidence in managing cardiac-related emergencies (53/90; 59%) and identifying the correct placement of peripherally inserted central catheter lines on X-ray (52/89; 58%). MAJOR QUALITATIVE FINDINGS: The preparation package had refreshed interns' procedural skills ability and awareness of risks to patient safety. Integration into the clinical team was positive, but requests to perform procedural skills on day 1 was unexpected. CONCLUSION: Interns reported that they had gained substantial benefit from their preparation package, and they performed practical procedures from day 1, further highlighting the need for an intensive preparation course immediately prior to entering internship.

Implementation of modified team-based learning within a problem based learning medical curriculum: a focus group study.

BACKGROUND: While Problem Based Learning (PBL) has long been established internationally, Team-based learning (TBL) is a relatively new pedagogy in medical curricula. Both PBL and TBL are designed to facilitate a learner-centred approach, where students, in interactive small groups, use peer-assisted learning to solve authentic, professionally relevant problems. Differences, however, exist between PBL and TBL in terms of preparation requirements, group numbers, learning strategies, and class structure. Although there are many similarities and some differences between PBL and TBL, both rely on constructivist learning theory to engage and motivate students in their learning. The aim of our study was to qualitatively explore students' perceptions of having their usual PBL classes run in TBL format. METHODS: In 2014, two iterations in a hybrid PBL curriculum were converted to TBL format, with two PBL groups of 10 students each, being combined to form one TBL class of 20, split into four groups of five students. At the completion of two TBL sessions, all students were invited to attend one of two focus groups, with 14 attending. Thematic analysis was used to code and categorise the data into themes, with constructivist theory used as a conceptual framework to identify recurrent themes. RESULTS: Four key themes emerged; guided learning, problem solving, collaborative learning, and critical reflection. Although structured, students were attracted to the active and collaborative approach of TBL. They perceived the key advantages of TBL to include the smaller group size, the preparatory Readiness Assurance Testing process, facilitation by a clinician, an emphasis on basic science concepts, and immediate feedback. The competitiveness of TBL was seen as a spur to learning. These elements motivated students to prepare, promoted peer assisted teaching and learning, and focussed team discussion. An important advantage of PBL over TBL, was the opportunity for adequate clinical reasoning within the problem solving activity. CONCLUSION: Students found their learning experience in TBL and PBL qualitatively different. There were advantages and disadvantages to both. This suggests a hybrid approach utilising the strengths of both methods should be considered for wide scale implementation.