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.

Preparedness for dental practice in Australia: a qualitative study on the experiences of final-year students and new graduates.

BACKGROUND: Limited data exists regarding the perspectives of newly graduated dental practitioners (NGDPs) and final-year students (FYS) about their preparedness for dental practice. This information is crucial to inform developments in ongoing professional development for newly qualified dental practitioners and future reviews and development of accreditation standards, policies, and the professional competencies of newly qualified dental practitioners. Thus, the primary goal of this paper was to describe the perceptions of preparedness for dental practice of NGDPs and FYSs. METHODS: Individual semi-structured interviews were conducted between March and July 2020. All interviews were audiotaped, transcribed, and analysed using a thematic analysis. RESULTS: Eighteen NGDPs and four FYS from across Australia participated in the qualitative interviews. A strong theme from the data was that respondents believed they were well prepared for common challenges in dental practice and patient care. A second prominent theme was participants' awareness of specific areas of limitation in their knowledge and specific skills including (list them). This data highlights a high level of self-awareness and potential for self-directed learning of NGDPs. It also provides specific content areas for future curriculum developers. CONCLUSIONS: Newly graduated dental practitioner and final-year student participants were satisfied with the theoretical and evidence-based information in their formal learning and teaching activities to begin practicing as dental practitioners. In some areas, NGDPs felt underprepared, mostly attributed to limited clinical treatment exposure, and other contextual elements of clinical practice, and thought transitional support may be required. The research reinforces the value of seeking and learning from students' and NGDPs' perspectives.

Accreditation Approaches for Professional Education Programs: Towards Best Practice.

Accreditation has a central role in the quality assurance of professional education programs, but research on the effectiveness of different models of accreditation is limited. The purpose of this study was to rapidly appraise the evidence for the effectiveness, impact, and feasibility of different accreditation approaches, in order to inform best practices for the accreditation of professional education programs. The study focused on accreditation for programs which produce practice-ready graduates, including for veterinary programs. The authors searched several databases for articles published from 2000 to 2020, using search terms identified during a scoping phase, and applied a "rapid review" methodology in line with contextual, time, and resource requirements. Relevant articles which were classed as empirical or conceptual were included in the study, while papers appraised as solely commentaries or descriptive were excluded from the evidence base. The full-text review included 32 articles. We identified a clear transition in the literature from input- and process-based models (pre- and early 2000s) to outcomes-based models (in the 2000s and early 2010s). Continuous quality improvement and targeted models (including risk-based and thematic) represent more recent approaches in accreditation practice. However, as noted by other scholars, we identified limited empirical evidence for the relative effectiveness of different accreditation approaches in professional education, although evidence for the more recent accreditation approaches is emerging. In terms of best practice in view of the current lack of definitive evidence for the adoption of any specific model of accreditation, we argue that accrediting authorities adopt a contextual approach to accreditation which includes clearly articulating the purpose and focus of their regulatory activities, and selecting and implementing accreditation methods that are consistent with their underlying principles.

Preparedness for practice of newly qualified dental practitioners in the Australian context: an exploratory study.

BACKGROUND: The current study explored the perspectives of preparedness for dental practice from a range of relevant stakeholders (i.e., educators, employers, final-year students, graduates, practitioners, and professional associations) using an anonymous online survey in which participants described either their preparedness for practice, or the preparedness of graduates they have encountered, across six domains. RESULTS: A total of 120 participants completed the survey. Participants were from several Australian states and territories; regional, rural, and urban locations; and working in the public and private sector. Students and new graduates generally felt prepared for activities in all the identified domains. Stakeholders reported consistently that the knowledge of dental profession graduates was at the required level to enter practice in Australia in a safe way. Activities involving the knowledge of clinical entrepreneurship and financial solvency were the dimensions where students and graduates felt least prepared (e.g., explaining fees, negotiating finances). In the domains involving clinical and technical competencies, students and new graduates self-assessed as less prepared around managing dental trauma and medical emergencies. On the other hand, activities around social and community orientation, and to a lesser extent professional attitudes and ethical judgements, were the dimensions where students and graduates felt the most prepared. CONCLUSIONS: Present findings indicate that there appear to be good standards of preparedness for practice for graduate dental professionals. This exploratory study provides insights into the nature of preparedness for Australian dental professionals and provides a basis for targeting education and professional development to address areas of need.

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.

Medical students value-adding to general practice.

BACKGROUND AND OBJECTIVES: Medical students can make valuable contributions to patient care during clinical placements. The aim of this study was to investigate student perceptions of the value of general practice placements for their learning, and their sense of contribution during their placements. METHOD: The study used a qualitative design to gather in-depth student perspectives on learning and contributions, using focus groups of final-year medical students on general practice placement. RESULTS: Thirteen students participated in one of three focus groups. Students reported valuable learning affordances in general practice and identified contributions to improved workflow, rapport-building, patient education, encouraging clinician reflection and shared learning between general practitioner and student. DISCUSSION: Student perspectives of value-adding on general practice placements, and a deeper understanding of these learning environments, may enable general practice supervisors to facilitate placements that maximise these benefits.

Influence of Vibrational Excitation and Nuclear Dynamics in Multiphoton Photoelectron Circular Dichroism of Fenchone.

We report photoelectron circular dichroism of S-(+)-fenchone enantiomers recorded with state-state vibrational level resolution using picosecond laser (2 + 1) resonance enhanced multiphoton ionization via 3s and 3p Rydberg intermediate states. The 3p state decays to the 3s state on a picosecond time scale so that, above the 3p Rydberg excitation threshold, ionization of vibrationally hot 3s states competes with direct 3p-1 ionization. Complex vibronic dynamics of the 3p → 3s internal conversion weaken the Rydberg Δv = 0 propensity rule in both the 3p-1 and 3s-1 ionization channels. Large variations of the forward-backward chiral asymmetry factors are observed between the Δv = 0 and Δv > 0 vibrational transitions, including dramatic swings from up to ±17%. Such changes of sign indicate complete reversal of the preferred direction for photoelectron emission in the laboratory frame, associated with vibrational motion. These asymmetry switches easily exceed the amplitude and frequency of such vibrationally induced flips previously observed in single photon ionization.

Incorporating aspects of programmatic assessment into examinations: Aggregating rich information to inform decision-making.

CONTEXT: A programmatic approach to assessment entails gathering and aggregating 'rich information' on candidates to inform progress decisions. However, there is little guidance on how such an approach might be implemented in practice. OBJECTIVE: We describe an approach to aggregating rich information across assessment formats to inform committee decision-making in a specialist medical college. METHODS: Each item (n = 272) for every examination was blueprinted to 15 curriculum modules and 7 proficiencies. We developed a six-point holistic rating scale with detailed rubrics outlining expected performance standards for every item. Examiners used this rating scale in making judgements for each item, generating rich performance data for each candidate. RESULTS: A colour-coded 'mosaic' of patterns of performance across modules and proficiencies was generated along with frequency distributions of ratings. These data allowed examiners to easily visualise candidate performance and to use these data to inform deliberations on borderline candidates. Committee decision-making was facilitated by maintaining the richness of assessment information throughout the process. Moreover, the data facilitated detailed and useful feedback to candidates. CONCLUSIONS: Our study demonstrates that incorporating aspects of programmatic thinking into high-stakes examinations by using a novel approach to aggregating information is a useful first step in reforming an assessment program.

Fully online OSCEs: A large cohort case study.

This article was migrated. The article was marked as recommended. Objective Structured Clinical Examinations (OSCEs) are extensively used for clinical assessment in the health professions. However, current social distancing requirements (including on-campus bans) at many universities have made the co-location of participants for large cohort OSCEs impossible. While there is a developing literature on remote OSCEs, particularly in response to the COVID-19 pandemic, this is dominated by approaches dealing with small participant numbers. This paper describes our recent large scale (n = 361 candidates) implementation of a remotely delivered 2 station OSCE. The planning for this OSCE was extensive and involved comprehensive candidate, examiner and simulated patient orientation and training. Our processes were explicitly designed to develop platform familiarity for all participants and included building on remote tutorial experiences and device testing. Our remote OSCE design and logistics made use of using existing enterprise solutions including videoconferencing, survey and collaboration platforms and allowed extra time between candidates in case of technical issues. We describe our process in detail including examiner, simulated patient, and candidate perspectives to provide precise detail, hopefully assisting other institutions to understand and adopt our approach. Although logistically complex, we have demonstrated that it is possible to deliver a remote OSCE assessment involving a large student cohort with a limited number of stations using commonly available enterprise solutions. We recognise it would be ideal to sample more broadly across stations and examiners, yet given the constraints of our current COVID-19 impacted environment, we believe this to be an appropriate compromise for a non-graduating cohort at this time.

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.

Identifying complex Fermi resonances in p-difluorobenzene using zero-electron-kinetic-energy (ZEKE) spectroscopy.

The vibrations of the ground state cation ( X̃2B2g) of para-difluorobenzene (pDFB) have been investigated using zero-electron-kinetic-energy (ZEKE) spectroscopy. A comprehensive set of ZEKE spectra were recorded via different vibrational levels of the S1 state (<00 + 1300 cm-1). The adiabatic ionization energy for pDFB was measured as 73 869 ± 5 cm-1. Use of different intermediate levels allows different cationic vibrational activity to be obtained via the modification of the Franck-Condon factors for the ionization step, allowing the wavenumbers of different vibrational levels in the cation to be established. In addition, assignment of the vibrational structure in the ZEKE spectra allowed interrogation of the assignments of the S1 ← S0 transition put forward by Knight and Kable [J. Chem. Phys. 89, 7139 (1988)]. Assignment of the vibrational structure has been aided by quantum chemical calculations. In this way, it was possible to assign seventeen of the thirty vibrational modes of the ground state pDFB+ cation. Evidence for complex Fermi resonances in the S1 state, i.e., those that involve more than two vibrations, was established. One of these was investigated using picosecond time-resolved photoelectron spectroscopy. In addition, we discuss the appearance of several symmetry-forbidden bands in the ZEKE spectra, attributing their appearance to a Rydberg state variation of an intrachannel vibronic coupling mechanism.

Accessing the molecular frame through strong-field alignment of distributions of gas phase molecules.

A rationale for creating highly aligned distributions of molecules is that it enables vector properties referenced to molecule-fixed axes (the molecular frame) to be determined. In the present work, the degree of alignment that is necessary for this to be achieved in practice is explored. Alignment is commonly parametrized in experiments by a single parameter, [Formula: see text], which is insufficient to enable predictive calculations to be performed. Here, it is shown that, if the full distribution of molecular axes takes a Gaussian form, this single parameter can be used to determine the complete set of alignment moments needed to characterize the distribution. In order to demonstrate the degree of alignment that is required to approach the molecular frame, the alignment moments corresponding to a few chosen values of [Formula: see text] are used to project a model molecular frame photoelectron angular distribution into the laboratory frame. These calculations show that [Formula: see text] needs to approach 0.9 in order to avoid significant blurring to be caused by averaging.This article is part of the theme issue 'Modern theoretical chemistry'.

The effectiveness of the internship in meeting established learning objectives: A qualitative study.

OBJECTIVE: To identify and explore variations in intern (Postgraduate Year 1 doctors) exposure to clinical activities defined by an established early postgraduate curriculum within the contemporary health service environment. METHODS: A mixed methods study was undertaken in seven health services comprising (1) a questionnaire regarding interns' exposure to a range of clinical activities within a two-year early post-graduate curriculum and (2) group interviews with intern supervisors and managers to explore barriers and facilitators of interns' clinical exposure. RESULTS: One hundred and eleven interns completed the questionnaire and seventeen intern supervisors and managers participated in group interviews. Interns' exposure to early postgraduate curriculum activities varied significantly, with participation in patient emergency management and procedures being undertaken less frequently than interns wished. These findings were consistent across different regional settings. Of three mandatory terms, exposure to curriculum activities was greater in medicine and emergency medicine than in surgery. CONCLUSIONS: Junior doctors' participation within the complex contemporary health service environment is constrained by barriers relating to clinical governance frameworks and health system performance, particularly in high-risk clinical activities. Solutions will require structural approaches to internship reform to ensure that placements provide the necessary safe clinical experiences required for intern training.

Probing the origins of vibrational mode specificity in intramolecular dynamics through picosecond time-resolved photoelectron imaging studies.

We have studied the intramolecular dynamics induced by selective photoexcitation of two near-isoenergetic vibrational states in S1p-fluorotoluene using picosecond time-resolved photoelectron imaging. We find that similar dynamics ensue following the preparation of the 13111 and 7a111 states that lie at 1990 cm-1 and 2026 cm-1, and that these dynamics are mediated by a single strongly coupled doorway state in each case. However, the lifetimes differ by a factor of three, suggesting an influence of the vibrational character of the modes involved. Our results clearly show the contribution of torsion-vibration coupling to the dynamics; this is further corroborated by comparison with the 7a111 state in S1p-difluorobenzene, which lies at 2068 cm-1. We invoke a model in which van der Waals interactions between methyl hydrogen atoms and nearby ring carbon and hydrogen atoms leads to mixing of the vibrational and torsional states. This model predicts that enhanced torsion-vibration coupling occurs when mode 7a is excited, consistent with our observations.

Taking OSCE examiner training on the road: reaching the masses.

BACKGROUND: To ensure the rigour of objective structured clinical examinations (OSCEs) in assessing medical students, medical school educators must educate examiners with a view to standardising examiner assessment behaviour. Delivering OSCE examiner training is a necessary yet challenging part of the OSCE process. A novel approach to implementing training for current and potential OSCE examiners was trialled by delivering large-group education sessions at major teaching hospitals. METHODS: The 'OSCE Roadshow' comprised a short training session delivered in the context of teaching hospital 'Grand Rounds' to current and potential OSCE examiners. The training was developed to educate clinicians about OSCE processes, clarify the examiners' role and required behaviours, and to review marking guides and mark allocation in an effort to standardise OSCE processes and encourage consistency in examiner marking behaviour. A short exercise allowed participants to practise marking a mock OSCE to investigate examiner marking behaviour after the training. RESULTS: OSCE Roadshows at four metropolitan and one rural teaching hospital were well received and well attended by 171 clinicians across six sessions. Unexpectedly, medical students also attended in large numbers (n=220). After training, participants' average scores for the mock OSCE clustered closely around the ideal score of 28 (out of 40), and the average scores did not differ according to the levels of clinical experience. CONCLUSION: The OSCE Roadshow demonstrated the potential of brief familiarisation training in reaching large numbers of current and potential OSCE examiners in a time and cost-effective manner to promote standardisation of OSCE processes.

Medical students developing confidence and patient centredness in diverse clinical settings: a longitudinal survey study.

BACKGROUND: Medical student clinical confidence and positive attitudes to patient centredness are important outcomes of medical education. The clinical placement setting is regarded as a critical support to these outcomes, so understanding how the setting is influential is important. The aim of this study was to compare students' attitudes towards patient-centredness and clinical confidence as they progressed through their medical course, and understand the influence of diverse clinical placement zones. METHODS: Students at one Australian medical school completed a questionnaire at the beginning of second year and at the end of their third year of medical training. The questionnaire measured attitudes to patient centred care, clinical confidence, role modelling experiences and clinical learning experiences. Descriptive analyses investigated change in these attitudes over time. Repeated measures analysis of variance was used to assess the influence of placement location on each variable of interest. Responses to two open-ended questions were also coded by two researchers and themes were identified. RESULTS: Student confidence increased over the course of two years of clinical training (p < 0.001), but attitudes to patient centredness (p = 0.933) did not change. The location of clinical placements (urban, outer urban and rural) was unrelated to levels of confidence or patient centredness. Students had positive attitudes towards patient-centredness throughout, and noted its importance in contributing to quality care. Patient-centred care was encouraged within the clinical placements, and was influenced by positive and negative role modelling, direct teaching, and opportunities to practise patient-centred care. CONCLUSIONS: A new generation of doctors with a strong patient-centred focus is emerging. Medical schools have a responsibility to facilitate clinical placements that will support the acquisition and maintenance of skills in patient centred care through positive role modelling.

A resource for teaching emergency care communication.

BACKGROUND: Communication in emergency departments (EDs), often between several health professionals and patients and relatives, is a major cause of patient complaint and error; however, communication-skills teaching for medical students largely focuses on individual clinician-patient interactions. CONTEXT: We developed and implemented an evidence-informed online resource, Communication for Health in Emergency Contexts (CHEC; http://www.chec.meu.medicine.unimelb.edu.au/resources) to raise medical students' awareness of the challenges of communication in the ED, and to provide students with communication strategies for addressing these challenges. The foundation of the CHEC resource was the findings and data from a large research project conducted at five emergency departments in Australia over the period 2006-2009. From this, we developed ED scenarios and teaching vignettes using authentic communication data. The project included a nationwide medical curriculum scoping phase, involving interviews with medical students and educators, on ED communication curriculum needs in order to inform the educational activities. INNOVATION: The CHEC resource provides students with the opportunity to follow real-life scenarios through all stages of the ED journey, whereas insights from ED medical and nursing staff provide learning opportunities about interprofessional communication for medical students. Evaluation suggests that students find the resource useful, and that the resource has been successfully embedded in medical and junior doctor training on communication and quality and safety. IMPLICATIONS: The CHEC resource enhances the capacity of busy clinical educators to raise students' awareness of the communication needs of emergency health care by focusing on communication in high-stress, time-pressured settings using a web format. The CHEC resource provides students with the opportunity to follow real-life scenarios through all stages of the ED journey.