The use of peer physical examination in undergraduate health professions education: Exploring the perceptions of students and educators in a multicultural, multiracial institution

Teaching clinical skills is core content of the medical and allied health curricula of the Faculty of Health Sciences (FoHS) at the University of the Free State (UFS) in South Africa. A major pedagogical tool used for this purpose across the faculty is peer physical examination (PPE). Objective. To investigate the lived experience and perceptions of students and educators on the use of PPE in undergraduate health professions education at a multicultural and multiracial institution. Suggestions on guidelines for a PPE policy for the FoHS at the UFS were also obtained from the participants.Methods. This research was designed as a qualitative study that used focus group interviews involving 26 participants (19 students and 7 educators) to obtain verbal statements that described their experience and perceptions of the use of PPE in undergraduate health professions education. Results. Participants reported that PPE was useful to create a safe learning environment and to prepare students for the clinical aspects of their training. Enhancing students' empathy, competency and clinical confidence were among the advantages attributed to using PPE; it also encouraged peer-assisted learning. Some of the disadvantages ascribed to PPE were that it made it difficult to maintain classroom discipline, and that it could promote memorisation over understanding. Finally, participants suggested that a guideline for PPE policy should address matters of consent, confidentiality, participation and gender, cultural, religious and racial considerations.Conclusions. The findings of this study reveal that PPE is an acceptable and useful learning strategy for the majority of students and educators. Issues relating to consent, confidentiality and cultural, religious and racial considerations are some of the potential problems associated with the use of PPE at the UFS. We believe that the suggestions given by the participants of this study will inform the establishment of a PPE policy for the FoHS of the UFS

Diversity matters: the other doctor within the Dutch academic healthcare system.

INTRODUCTION: Over the past year, there has been a worldwide increase in the focus on systemic discrimination and inequitable practices within different societies, particularly concerning race and ethnicity. The inherent (experience of) inequity in racism is notonly limited to individuals but also found in different domains of societal structures, including healthcare and academia. In academia and healthcare organisations, junior Black and Minority Ethnic (BAME) doctors and students regularly find themselves caught between the leaky pipeline phenomenon and hierarchically dependent positions in academic healthcare settings. Voicing their experiences after such encounters is neither an option nor a choice they can do without repercussions. The prejudices, stigmas, implicit biases present within these environments result in segregated practices, where BAME doctors become the 'other' doctor (otherism), and based on their religion, ethnicity, migrant background or physical features are boxed into a specific group or category. REFLECTIONS & RECOMMENDATIONS: The outcome of this exercise (re-) emphasised that more improvement in the Dutch healthcare systems concerning stigmas and biases towards race and ethnicity are needed to promote the inclusion of future BAME doctors and students. A pivotal turn is urgently needed to repair the racial stigmas and biases that have distorted the image of BAME doctors/students, limiting their academic and professional progress. By structurally implementing focused strategies to promote inclusivity, the current gap within healthcare and the participation between non- BAME and BAME-doctors/students can be bridged, inevitably leading to better healthcare services, safer learning environments and a balanced representation of our multicultural societies in healthcare.We argue that increased self-reflection from such critical inquiry will ultimately result in clear and objective understandings of (pre) existent inequitable practices in our societies.

[Pectus excavatum: not just a cosmetic problem]. / Trechterborst: niet alleen een cosmetisch probleem.

Pectus excavatum is the most common deformity of the anterior chest wall. Nevertheless, awareness amongst physicians is lacking and consequences of the diagnosis are often underestimated. Symptoms include cardiopulmonary symptoms such as palpitations, fatigue and exercise intolerance. Moreover, patients often have psychosocial problems and suffer from poor body image and lower quality of life. A multidisciplinary approach is recommended for diagnostic work-up and treatment, involving dedicated paediatricians, cardiologists and surgeons. Treatment can be non-surgical or surgical. Conservative options include physiotherapy and vacuum bell therapy. In symptomatic patients, surgical treatment is warranted from the age of 12-14 years. Minimally invasive repair with the Nuss bar technique is considered the gold standard for adolescents. Patients who are unsuitable for minimally invasive repair can be treated with open surgical correction, for example, via a modified Ravitch procedure. Early referral to a specialised centre is recommended.

Hypnotherapy or transcendental meditation versus progressive muscle relaxation exercises in the treatment of children with primary headaches: a multi-centre, pragmatic, randomised clinical study.

Many children suffer from headaches. Since stress may trigger headaches, effective techniques to cope with stress are needed. We investigated the effectiveness of two mind-body techniques, transcendental meditation (TM) or hypnotherapy (HT), and compared them with progressive muscle relaxation (PMR) exercises (active control group). Children (9-18 years) suffering from primary headaches more than two times per month received either TM (N = 42), HT (N = 45) or PMR (N = 44) for 3 months. Primary outcomes were frequency of headaches and ≥ 50% reduction in headaches at 3 and 9 months. Secondary outcomes were adequate relief, pain coping, anxiety and depressive symptoms, somatisation and safety of treatment. Groups were comparable at baseline. Headache frequency was significantly reduced in all groups from 18.9 days per month to 12.5 and 10.5 at respectively 3 and 9 months (p < 0.001), with no significant differences between the groups. Clinically relevant headache reduction (≥ 50%) was observed in 41% and 47% of children at 3 and 9 months respectively, with no significant differences between the groups. No differences were observed in secondary outcome measures between the intervention groups. No adverse events were reported.Conclusion: All three techniques reduced primary headache in children and appeared to be safe.Trial registration: NTR 2955, 28 June 2011 ( www.trialregister.nl ) What is Known: • Stress may be an important trigger for both tension type headache and migraine in children. • Good data are lacking on the effect of transcendental meditation, hypnotherapy or progressive muscle relaxation as possible stress-reducing therapies in children with primary headaches. What is New: • Three non-pharmacological techniques, i.e., transcendental meditation, hypnotherapy and progressive muscle relaxation exercises, all result in a clinically significant reduction of headaches and use of pain medication. • No large differences between the three techniques were found, suggesting that children can choose either one of the three techniques based on personal preferences.

How Dutch medical specialists perceive the competencies and training needs of medical residents in healthcare management.

BACKGROUND: The Dutch postgraduate medical training has been revised to focus on seven competencies. The role as manager is one of these competencies. Recent studies show that this competency receives little attention during the residency training. In an earlier study, we discovered that residents perceived their competency as managers to be moderate. AIM: In this study, we investigated how medical specialists perceived the managerial competencies of medical residents and their need for management education. METHODS: In September 2010, a 46-item questionnaire was designed which examined medical specialists' perceptions of the competency and needs of residents in the field of medical management. Two hundred ninety-eight specialists were invited via email to participate. RESULTS: Hundred twenty-nine specialists (43.3%) responded to our survey. They rated the residents' competencies in contract negotiating skills, knowledge of the healthcare system, and specialist department poorly. They felt that residents were competent in updating their medical knowledge. Ninety-four percent reported a need for training in management among residents. Preferred topics were time management and healthcare organization. The preferred training method was a workshop given during residency by an extramural expert. CONCLUSION: Dutch medical specialists perceive the management competencies of residents in some areas to be inadequate. They feel that training in medical management during residency is necessary.

Optimizing chronic HIV care in the Dutch Caribbean: a questionnaire based study on experience and perception of healthcare workers.

OBJECTIVE: Human immunodeficiency virus (HIV) infection has become a chronic disorder for which adaptation of current healthcare practices is needed. In Curaçao, a new organization of chronic HIV care is being set up based on task shifting in which healthcare workers (HCWs) will deliver HIV care more prominently within the primary healthcare system. In preparation for implementation of the proposed task-shifting model, we investigated the perception of HCWs regarding existing HIV care in Curaçao and the need for training in HIV/AIDS among HCWs. SUBJECTS AND METHODS: An in-depth questionnaire based study was used. Nineteen HCWs of seven different cadres were interviewed. The questionnaire constituted four sections: quality of existing HIV care, respondents own knowledge and willingness to be trained, need for training in HIV/AIDS and preferred educational approaches. RESULTS: Quality of existing HIV services in Curaçao is considered acceptable but needs improvement mainly to facilitate integration of chronic HIV care. All respondents indicated that training in HIV/AIDS is needed among HCWs in Curaçao, especially for nurses and general practitioners. All were willing to participate in training with varying amounts of time to be spent. Training should be tailored to the level of expertise of HCWs and to the role a HCW is expected to have in the new healthcare delivery framework. CONCLUSION: There is need for training to ensure the effective integration of chronic HIV care into the existing healthcare delivery system in Curaçao.There is a willingness and need in all cadres for training with e-learning as a preferred educational tool.

A case study of the implementation of a competency-based curriculum in a Caribbean teaching hospital.

OBJECTIVE: Several teaching hospitals are currently modifying their curriculum to comply with the changing demands in medical education. As a result, we decided to evaluate whether a competency-based curriculum implemented in a Caribbean teaching hospital fulfilled the requirements as defined by the CanMEDS framework. METHODS: We made use of a triangulation method in the survey to obtain information on the educational process. Two separate methods were used consisting of site visits by visiting professors and a medical educator. The focus was on the structure, content and assessments of the educational activities. RESULTS: Major recommendations included increased involvement of medical specialists in the educational activities in the clinical workplace. There was need for improvement of communication between medical specialists, patients, nurses, trainees and residents. Overall, improvements were observed in the structure of clinical rotations and content of the training programme. CONCLUSION: The implemented assessment programme provided necessary information for effective evaluation of the competency-based curriculum. We were able to identify new and feasible methods for improving the curriculum in our educational setting.

Educating doctors in the clinical workplace: unraveling the process of teaching and learning in the medical resident as teacher.

In recent years, higher medical education has witnessed major changes in the structure and content of postgraduate medical training. Seven professional competencies have been described that address the medical doctors' ability to effectively communicate and transfer medical information, interact effectively and professionally, and demonstrate a good grasp of clinical knowledge and skills. Proficiency in didactic skills, however, is an important competency that has not received prominent attention. In the clinical setting, attending-physicians and medical residents are responsible for teaching. Consequently, several medical institutions have proposed the need for teacher training programs to improve the teaching skills of attending doctors and medical residents. The supporters of these programs believe that through teaching, medical doctors improve their individual professional and clinical problem-solving abilities. Hence, it is logical to assume that didactic skills' training would contribute to the professional development of doctors. In this paper, we re-examine the underlying theory of the didactic proficiency, how it relates to the clinical setting, and why it may be beneficial for the professional training of medical residents.

[Prevention and treatment of congenital syphilis]. / Preventie en behandeling van congenitale syfilis.

Due to uncertainties about the treatment of their mothers' syphilis infections, in three neonates congenital syphilis was suspected. The mother of the first newborn, a girl, had treated herself for a syphilis infection. The second mother, who gave birth to a son, was treated adequately for her infection, but there was no record of this available at the time of birth. The third mother, who gave birth to a girl, had also been treated for syphilis, but within the month before delivery. None of the neonates had any clinical manifestations of congenital syphilis. These obscurities resulted in serological examination of all three neonates and in treatment in the first and third cases. The reported increase in the incidence of syphilis infections in The Netherlands poses a risk of more cases of congenital syphilis infection in newborns. It is crucial to be aware of the consequences of syphilis infection in the neonate and fetus, and also of the various measures available for its prevention and treatment. In The Netherlands, screening for syphilis is routinely carried out during pregnancy. If a pregnant woman is found to be infected, the therapy of choice is penicillin. The Treponema pallidum agglutination test (TPA) and the venereal disease research laboratory (VDRL) test should be performed on the mother and the newborn after birth. All infants born to seropositive but insufficiently treated mothers require careful physical examinations. Infants with proven infection or with a high index of suspicion should be treated with aqueous crystalline penicillin G for a total of 10 days. After discharge, all infants should be followed up with physical and serological examinations up to the first year of life.

Quality of clinical supervision as perceived by specialist registrars in a university and district teaching hospital.

BACKGROUND: Clinical supervision promotes the professional development of specialist registrars (SpRs). Our objective was to investigate and compare the perceived quality of supervision (PQS) in a university teaching hospital (UTH) and a district teaching hospital (DTH) and to identify aspects of supervision that could be improved. METHODS: The Cleveland Clinic's teaching effectiveness instrument (CCTEI) was used to measure the quality of supervision of attending doctors. Fifteen items reflecting good teaching ability were rated on a 5-point Likert-scale (1-5 = poor-excellent). RESULTS: SpRs rated 47 attending doctors using the CCTEI. A total of 416 ratings were obtained. Overall, the mean PQS was 3.85 (SD = 0.29) in the DTH and 3.56 (SD = 0.44) in the UTH (P = 0.02). A significant difference in PQS was found in 6 items. The supervisors in the DTH scored better on all these items. The best predictor of PQS was the item 'Organises time to allow for both teaching and care giving'. CONCLUSIONS: Overall, PQS was better in the DTH compared to the UTH. In both settings, generating a good learning environment and respecting the autonomy of the SpRs scored favourably. Supervisory roles focusing on improving cost-effective practice and communicative skills need more emphasis.

Why residents should teach: a literature review.

Resident doctors contribute significantly to the quality of undergraduate medical training and it is assumed that by participating in the process, they also improve their own professional competency. We decided to investigate whether there is evidence to support this assumption. Our hypothesis, the physician-as-teacher rule, stated that "A skilled teacher has an increased likelihood of becoming a competent clinician, than a skilled clinician has of becoming a competent teacher". We conducted a literature review to search for evidence to confirm or refute this assumption. Twenty-four articles written after 1990 were identified as relevant from 132 references we generated by searching Medline. The identified articles were qualitatively reviewed to identify key research conclusions and/or main discussion points. The findings from the review were collated and discussed. None of the studies showed specific evidence of how teaching results in improved professional competence. However, there was evidence that teaching ability correlated positively with the perception of clinical competency. There was also need for improved supervision and training programmes for residents in teaching skills. The review provided evidence that teaching influenced the perceived professional competency of physicians positively. Physicians who were perceived as competent were those who taught effectively, and who had a basic understanding of teaching and learning. The review shows that training in teaching is essential for physicians, and that further research is still needed to demonstrate the effect of good teaching on professional competency.

Comparative study of medical education as perceived by students at three Dutch universities.

Objective. The aim of the present study was to identify the differences that may exist in professional satisfaction and skills (clinical patient management and psychosocial skills) in students and graduates from two traditional medical schools and their counterparts from a problem-based medical school in the Netherlands. Also their satisfaction for their training was investigated. Method. Questionnaires were designed containing items reflecting the earlier mentioned differences between the students. Following an initial pilot study, the questionnaire used in this study was constructed accordingly. Sample. The questionnaires were sent to 180 near and recent graduates of these three schools. Results. A total of 127 questionnaires were returned (response rate of 70.5%). The students of the PBL curriculum felt better prepared in psychosocial and interpersonal skills. They felt more satisfied with their training, but were less enthusiastic with the profession. The results also suggest that in their own opinion students and graduates from the three schools do not differ in clinical patient management skills acquired in medical school. Conclusion. A limitation of this study lies in the fact that results are based on actual self-assessment of the students. One must be aware that self-assessment does not always provide for objective information. However, since this limitation applied equally to respondents of all three medical schools, the differences between the schools can be considered indicative of the effects resulting from the different curricula.