Preparedness for a first clinical placement in nursing: a descriptive qualitative study.

BACKGROUND: A first clinical placement for nursing students is a challenging period involving translation of theoretical knowledge and development of an identity within the healthcare setting; it is often a time of emotional vulnerability. It can be a pivotal moment for ambivalent nursing students to decide whether to continue their professional training. To date, student expectations prior to their first clinical placement have been explored in advance of the experience or gathered following the placement experience. However, there is a significant gap in understanding how nursing students' perspectives about their first clinical placement might change or remain consistent following their placement experiences. Thus, the study aimed to explore first-year nursing students' emotional responses towards and perceptions of their preparedness for their first clinical placement and to examine whether initial perceptions remain consistent or change during the placement experience. METHODS: The research utilised a pre-post qualitative descriptive design. Six focus groups were undertaken before the first clinical placement (with up to four participants in each group) and follow-up individual interviews (n = 10) were undertaken towards the end of the first clinical placement with first-year entry-to-practice postgraduate nursing students. Data were analysed thematically. RESULTS: Three main themes emerged: (1) adjusting and managing a raft of feelings, encapsulating participants' feelings about learning in a new environment and progressing from academia to clinical practice; (2) sinking or swimming, comprising students' expectations before their first clinical placement and how these perceptions are altered through their clinical placement experience; and (3) navigating placement, describing relationships between healthcare staff, patients, and peers. CONCLUSIONS: This unique study of first-year postgraduate entry-to-practice nursing students' perspectives of their first clinical placement adds to the extant knowledge. By examining student experience prior to and during their first clinical placement experience, it is possible to explore the consistency and change in students' narratives over the course of an impactful experience. Researching the narratives of nursing students embarking on their first clinical placement provides tertiary education institutions with insights into preparing students for this critical experience.

Assessing a Capstone Research Project in Medical Training: Examiner Consistency Using Generic Versus Domain-Specific Rubrics.

Rubrics are utilized extensively in tertiary contexts to assess student performance on written tasks; however, their use for assessment of research projects has received little attention. In particular, there is little evidence on the reliability of examiner judgements according to rubric type (general or specific) in a research context. This research examines the concordance between pairs of examiners assessing a medical student research project during a two-year period employing a generic rubric followed by a subsequent two-year implementation of task-specific rubrics. Following examiner feedback, and with consideration to the available literature, we expected the task-specific rubrics would increase the consistency of examiner judgements and reduce the need for arbitration due to discrepant marks. However, in contrast, results showed that generic rubrics provided greater consistency of examiner judgements and fewer arbitrations compared with the task-specific rubrics. These findings have practical implications for educational practise in the assessment of research projects and contribute valuable empirical evidence to inform the development and use of rubrics in medical education.

Assessing Diagnostic Reasoning Using a Standardized Case-Based Discussion.

BACKGROUND: Development of diagnostic reasoning (DR) is fundamental to medical students' training, but assessing DR is challenging. Several written assessments focus on DR but lack the ability to dynamically assess DR. Oral assessment formats have strengths but have largely lost favour due to concerns about low reliability and lack of standardization. Medical schools and specialist medical colleges value many forms of oral assessment (eg, long case, Objective Structured Clinical Examination [OSCE], viva voce) but are increasingly searching for ways in which to standardize these formats. We sought to develop and trial a Standardized Case-Based Discussion (SCBD), a highly standardized and interactive oral assessment of DR. METHODS: Two initial cohorts of medical students (n = 319 and n = 342) participated in the SCBD as part of their assessments. All students watch a video trigger (based on an authentic clinical case) and discuss their DR with an examiner for 15 minutes. Examiners probe students' DR and assess how students respond to new standardized clinical information. An online examiner training module clearly articulates expected student performance standards. We used student achievement and student and examiner perceptions to gauge the performance of this new assessment form over 2 implementation years. RESULTS: The SCBD was feasible to implement for a large student cohort and was acceptable to students and examiners. Most students and all examiners agreed that the SCBD discussion provided useful information on students' DR. The assessment had acceptable internal consistency, and the associations with other assessment formats were small and positive, suggesting that the SCBD measures a related, yet novel construct. CONCLUSIONS: Rigorous, standardized oral assessments have a place in a programme of assessment in initial medical training because they provide opportunities to explore DR that are limited in other formats. We plan to incorporate an SCBD into our clinical assessments for the first year of clinical training, where teaching and assessing basic DR is emphasized. We will also explore further examiners' understanding of and approach to assessing DR.

Motivations & Experiences of Postgraduate Anatomy Training.

This article was migrated. The article was marked as recommended. Background: Anatomy teaching at medical schools has undergone significant changes in philosophy, and reduction in content, in recent years. Senior clinicians and speciality training Colleges have raised concerns regarding these changes and questioned their impact on 'anatomical competence' and adequacy of training for safe clinical practice. The literature on the perceptions of medical school anatomy teaching among those preparing to enter post-graduate training (i.e. towards a specialist qualification) is sparse. Aim: To assess the motivations for study, and experiences of training, in junior doctors undertaking an intensive post-graduate anatomy training program. Methods: A sample of candidates (13/119, 10%) undertaking the University of Melbourne Graduate Diploma in Surgical Anatomy were recruited for interview. These interviews were recorded, transcribed and then analysed using a combination of thematic and contextual approaches. Key themes were identified and explored. Results: Participant responses fell into two broad categories - motivations for enrolling into the course and their actual experiences of the course. The primary motivation for enrolling into the course was the perceived career requirement to do so, with participants asserting that attending such courses was perceived as mandatory for success in specialty training. Once enrolled, participants valued the teaching and learning and enjoyed the academic pursuit of high-level anatomy study. These benefits, however, were offset by a range of undesirable outcomes associated with undertaking the course. Participants identified the financial cost of the course, the unwillingness of employers to provide rostered study leave and the negative impact on work-life balance as the most significant challenges. Conclusions: Understanding the concerns and expectations of junior doctors preparing for a speciality training program by increasing their anatomy knowledge has implications for both Colleges and medical educators. The participants in this study recognised the limitations in their anatomy knowledge and actively sought additional training at significant financial and personal cost to themselves. This was counterbalanced by the perceived benefits to their career, and an opportunity to enter a specialist training program, by completing additional study.

Conducting patient assessments as a medical student: frequency, barriers, and facilitators.

BACKGROUND: Opportunities for medical students to engage in deliberate practice through conducting patient assessments may be declining, but data on the numbers of patients assessed by students during training are lacking. PURPOSES: The study described relationships between the frequency of patient assessments, student confidence, belief they had seen sufficient patients, and their perceptions of barriers and facilitators of seeing patients. METHODS: We employed survey methodology to estimate the number of patient assessments conducted across 6 rotations in the 1st year of clinical training, gather ratings of confidence and student belief they had conducted sufficient patient assessments, and barriers and facilitators of seeing patients. RESULTS: Rotations focused on general medicine and surgery provided more opportunities for patient assessments than specialist rotations (all p < .001). Students conducting more than 10 patient assessments rated confidence in conducting patient assessments and belief they had seen enough patients for their clinical learning, higher than students who saw 10 or fewer patients (all p < .001). CONCLUSIONS: Our study demonstrated variation in the frequency of patient assessments, and weak relationships between numbers of assessments, student confidence, and barriers to seeing patients. Further investigation is warranted of the impact of fewer opportunities for deliberate practice of skills for expertise development.

Working with young people: evaluation of an education resource for medical trainees.

AIM: Many health professionals report interest in consulting more effectively with young people but have unmet training needs. We set out to evaluate a teaching resource in adolescent health and medicine that was designed for Australian trainees in specialist medicine. METHODS: Thirty-two paediatric and adult trainees of the Royal Australasian College of Physicians completed a pre-evaluation questionnaire to assess attitudes and confidence in working with young people. They were then provided with a training resource and, 6 weeks later, completed a post-evaluation questionnaire. Repeated-measures anovas were used to assess changes in attitudes, self-reported knowledge and confidence by trainee type. χ(2) -tests were used to compare variation in the use of and opinions about the resource. RESULTS: Trainees' awareness of the health issues that affect young people, confidence in working with young people and confidence in their knowledge greatly improved after using the resource. Beforehand, adult medicine trainees scored lower than paediatric trainees. A relatively higher rate of improvement resulted in similar scores between trainee types after using the resource, which was rated equally highly by the different groups of trainees. CONCLUSIONS: As a result of significant gains in the confidence of specialist medicine trainees after access to the resource, it will now be made available for Australian trainees in specialist medicine.

Clinical assessment performance of graduate- and undergraduate-entry medical students.

BACKGROUND: Recent evidence suggests that graduate-entry medical students may have a marginal academic performance advantage over undergraduate entrants in a pre-clinical curriculum in both bioscience knowledge and clinical skills assessments. It is unclear whether this advantage is maintained in the clinical phase of medical training. AIM: The study aimed to compare graduate and undergraduate entrants undertaking an identical clinical curriculum on assessments undertaken during clinical training in the medical course. METHODS: Clinical assessment results for four cohorts of medical students (n = 713) were compared at the beginning and at the end of clinical training for graduate and undergraduate entrants. RESULTS: Results showed that graduate- and undergraduate-entry medical students performed similarly on clinical assessments. Female students performed consistently better than male students. CONCLUSION: The findings of this study suggest that any academic performance advantage held by graduate-entry medical students is limited to the early years of the medical course, and is not evident during clinical training in the later years of the course.

First-year medical students' willingness to participate in peer physical examination.

BACKGROUND: There is little research on student attitudes toward participating in peer physical examination (PPE). PURPOSE: This study explored first-year medical students' attitudes toward PPE and their willingness to participate in PPE before they had experience with PPE as part of their course. METHODS: First-year medical students (n = 119) rated their willingness to participate in PPE for 15 body regions, with male or female peers, and when examining or being examined by others. Attitudes toward participating in PPE were also assessed. RESULTS: Low-sensitivity examinations (e.g., hands, head) in PPE were generally accepted by male and female students. Significant variation in willingness across different body regions was, however, evident for male and female students depending on the type of examination and their examination partner's gender. Students generally held positive attitudes toward participating in PPE as part of the course. Moreover, students with more positive attitudes provided higher ratings of willingness to participate in PPE for all examination types. CONCLUSIONS: Findings suggest high levels of willingness to participate in PPE for low-sensitivity examinations of the kind employed in university teaching contexts. Nonetheless, gender effects appear more complex than previously described, and for some regions of the body, there are subtle preferences for particular examination types, in particular performing examinations, rather than being examined.

Comparing the academic performance of graduate- and undergraduate-entry medical students.

OBJECTIVE: This study compared the academic performance of graduate- and undergraduate-entry medical students completing the same pre-clinical curriculum and assessment at a large metropolitan university. Arguments have been made for the relative merits of both graduate- and undergraduate-entry medical programmes. However, data on the academic performance of graduate and undergraduate entrants are relatively scarce. METHODS: This retrospective study adopted a quasi-experimental design to compare data from assessments of bioscience knowledge and clinical skills undertaken across 2 years for four cohorts of medical students (who commenced their studies between 2002 and 2005). Percentage final results for four bioscience knowledge subjects and four clinical skills assessments (based on objective structured clinical examination [OSCE] results) were compared for 240 graduates and 464 undergraduates using multivariate analysis of variance (manova). RESULTS: Graduate-entry students performed marginally better than undergraduate-entry students on all four bioscience knowledge assessments (partial eta-squared [n(p)(2)], n(p)(2)=0.04) and also on early clinical skills assessments (n(p)(2)=0.06). CONCLUSIONS: Graduate-entry students had a marginal academic performance advantage during the early years of this medical course. Most graduate-entry students had a first degree in a science discipline; thus their advantage may be explained by prior bioscience knowledge. Their performance advantage in clinical skills is less easily attributed to prior learning. Instead, this result provides some evidence for a possible advantage related to age. The marginal differences in early academic and clinical performance probably suggest that both graduate and undergraduate entry should exist in parallel to preserve multiple points of entry to the medical profession.

Initial investigation of organisational factors associated with the implementation of active support.

BACKGROUND: Active support (AS) has been shown to increase the amount of time that residents in shared residential settings are involved in purposeful activities. The organisational processes required to implement AS have been less well researched. METHOD: Staff in community houses answered questions about the occurrence of organisational activities and processes thought to assist AS implementation (e.g., training and teamwork), their understanding of engagement, and their experience of changes in staff practice consistent with AS (including implementation problems). Non-house-based managers were also interviewed about their role in AS implementation. RESULTS: Reported occurrence of organisational activities and processes (e.g., training and teamwork) and understanding of engagement were associated with more reports of changes in staff practice and fewer staff reports of implementation problems. Staff reports on the role of non-house-based managers were not associated with reports of changes in staff practice or with reports of fewer AS implementation problems. Non-house-based managers' reports overestimated their role in AS implementation when compared with reports from house-based staff groups. CONCLUSION: While there are limitations in the research design (including the reliance on staff reports), the findings support the importance of wider organisational factors (beyond training programs for direct support staff) as integral to the implementation of AS. There is a need for further research on AS implementation.