The vulnerability and jubilation of publication; a reflection on publishing with MedEdPublish.

This article was migrated. The article was marked as recommended. Promoting your research findings to the broader academic and clinical community requires publication dependent on peer review. This opinion piece is a short reflection on the author's journey as she completes her PhD and traverses the fickle world of peer review and publication. Feeling deflated after a poor journal review, the author briefly explores the vulnerability of rejection, and the rewarding consequences of publishing on-line with MedEdPublish, as an open access journal, where post-publication reviews are transparent and there is an opportunity to engage in a shared dialogue with members of the community of practice.

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.

Ten years of medical education registrars: Value added?

OBJECTIVE: There is a paucity of any long-term follow up of trainees' career pathways or organisational outcomes from medical education registrar posts in emergency medicine training. We report on the experience of a selected group of medical education trainees during and subsequent to their post and reflect on the value added to emergency medical education at three institutions. METHODS: We conducted an online survey study, examining quantitative outcomes and qualitative reflections, of emergency physicians who had previously undertaken a medical education registrar post. Descriptive statistics were used to summarise responses to Likert items. The authors independently analysed and interpreted the reflective responses to identify key themes and sub-themes. RESULTS: Nineteen of 21 surveys were completed. Most respondents were in formal educational roles, in addition to clinical practice. The thematic analysis revealed that the medical education registrar experience, and the subsequent contribution of these trainees to medical education, is significantly shaped by external factors. These include the extent of faculty support, and the value placed on medical education by hospitals/departments/leaders. Acquisition of knowledge and skills in medical education was only part of a broader developmental journey and transitioning of identity for the trainees. CONCLUSIONS: Our findings suggest that medical education trainees in emergency medicine progress to educational roles, and most respondents attribute their career progression to the medical education training experience. We recommend that medical education registrar programmes need to be valued within the clinical service, supported by faculty and a 'community of practice', to support trainees' transition to clinician educator leadership roles.

Exploring tutor perceptions and current practices in facilitating diagnostic reasoning in preclinical medical students: Implications for tutor professional development needs.

This article was migrated. The article was marked as recommended. Introduction: This study explores tutors' experience of teaching diagnostic reasoning (DR) - a key component of clinical reasoning - to build understanding into the use of explicit strategies in facilitating development of DR skills in preclinical medical students. Methods: A qualitative, interpretive study was undertaken with 14 preclinical problem-based learning tutors who participated in semi-structured interviews. A thematic analysis was conducted to identify key factors that influence students' learning of diagnostic reasoning. Results: Tutor dispositions towards facilitating learning of DR were variable in this study. Explicit strategies to teach DR were thought to exert positive influences on the development of DR skills, through improving student knowledge and reducing potential error. The advantages of using explicit strategies to teach DR outweighed the perceived difficulties identified in this context. Explicit strategies may need modification for preclinical students and the focus should be on building knowledge of classic presentations and developing metacognitive awareness. Conclusion: The use of explicit educational strategies will contribute to facilitating preclinical student learning of DR skills. Tutor professional development is a key component in the successful implementation of these strategies.

'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.

Intern underperformance is detected more frequently in emergency medicine rotations.

OBJECTIVE: To determine the frequency and nature of intern underperformance as documented on in-training assessment forms. METHODS: A retrospective review of intern assessment forms from a 2 year period (2009-2010) was conducted at a tertiary referral hospital in Brisbane, Queensland. The frequency of interns assessed as 'requiring substantial assistance' and/or 'requires further development' on mid- or end-of-term assessment forms was determined. Forms were analysed by the clinical rotation, time of year and domain(s) of clinical practice in which underperformance was documented. RESULTS: During 2009 and 2010 the overall documented incidence of intern underperformance was 2.4% (95% CI 1.5-3.9%). Clinical rotation in emergency medicine detected significantly more underperformance compared with other rotations (P < 0.01). Interns predominantly had difficulty with 'clinical judgment and decision-making skills', 'time management skills' and 'teamwork and colleagues' (62.5%, 55% and 32.5% of underperforming assessments, respectively). Time of the year did not affect frequency of underperformance. A proportion of 13.4% (95% CI 9.2-19.0%) of interns working at the institution over the study period received at least one assessment in which underperformance was documented. Seventy-six per cent of those interns who had underperformance identified by mid-term assessment successfully completed the term following remediation. CONCLUSION: The prevalence of underperformance among interns is low, although higher than previously suggested. Emergency medicine detects relatively more interns in difficulty than other rotations.

Mini-CEX as a workplace-based assessment tool for interns in an emergency department--does cost outweigh value?

BACKGROUND: The mini-clinical evaluation exercise (mini-CEX) has been proposed as a method to address the deficiencies of in-training assessment for junior doctors. AIM: Our study aimed to determine the feasibility and value of adding mini-CEX assessments to the existing assessment processes for an intern cohort in the emergency department (ED). METHODS: Interns undertook four mini-CEX assessments with senior ED medical officers, in addition to their standard in-training assessment processes. Assessment results and time taken to perform the mini-CEX assessments were recorded. Interns and assessors completed a survey regarding their perceptions of the mini-CEX assessment process. RESULTS: The total time taken for mini-CEX assessments during the study period was 36.51 h. If extrapolated over a year this would represent an additional direct cost to the ED of more than $A 80,000 per year. No additional interns were identified as underperforming through the addition of the mini-CEX. The mini-CEX assessment process was perceived as generally positive. Both interns and assessors felt that it provided a valid assessment of intern performance, and enabled timely and specific feedback. Significant practical difficulties in arranging and conducting mini-CEX assessments in the workplace were identified. CONCLUSION: There was a significant cost to the ED as a result of adding mini-CEX encounters to interns' performance assessment. No change in summative outcome occurred for this study cohort.