Do teaching strategies matter? Relationships between various teaching strategies and medical students' wellbeing during clinical workplace training.

Introduction: In the later years of medical school, medical students learn through clinical rotations at medical institutions. Using cognitive apprenticeships as the theoretical reference for teaching strategies, this study aimed to assess how clinical teaching strategies benefit medical students' wellbeing in the workplace.Methods: Our target population comprised two cohorts of medical students in the seventh year of a 7-year medical education program in Taiwan, undergoing clinical training at a tertiary medical center between August 2012 and May 2014. After informed consent was obtained, participants were regularly mailed a validated, structured, and self-administered questionnaire to evaluate their clinical teachers' teaching strategies and their personal wellbeing at the end of individual specialty rotations, and medical students' were freely permitted to respond to each invitation. Eighty-seven medical students returned 1364 responses, which were included in the structural equation modeling.Results: We determined that the Inspiring teaching strategy, characterized by articulation, reflection, and exploration, was related to reduced burnout among medical students and an increased sense of compassion satisfaction; the Directing teaching strategy, characterized by modeling, coaching, and scaffolding, was related only to reduced burnout among medical students but not to compassion satisfaction during the clinical training.Conclusions: Clinical teaching strategies were demonstrated to affect, to various extents, medical students' wellbeing with respect to factors such as burnout and compassion satisfaction in the workplace. Clinical teachers and educators should increase efforts to develop Inspiring teaching skills to shift the balance of responsibility and to support students in the teaching and learning relationship.

Adaptation of Medical Students During Clinical Training: Effects of Holistic Preclinical Education on Clerkship Performance.

THEORY: Taiwan's medical undergraduate program at a university or medical center is a continuation of 12 years of compulsory citizenship education rooted in holistic philosophies. Students acquire both technical knowledge and nontechnical attributes, which are necessary for success in further work and life. The early clinical learning experiences of medical students are primarily acquired through clerkships. These clerkships require medical students to apply and extend what they learned during their preclinical education; however, previous studies have explored this issue through examining fragmentary factors such as preclinical course grades and traits but not undertaking comprehensive, whole-person investigations. HYPOTHESES: To account for the potential benefits of a holistic approach in medical students' learning, we propose three hypotheses: Medical students' preclinical performance on Taiwan's technical and nontechnical higher education assessments are positively associated with their clinical competence (Hypothesis 1) and psychological well-being (Hypothesis 2) during clerkships, and medical students' psychological well-being during clerkships is positively associated with their clinical competence (Hypothesis 3). METHOD: We studied a cohort of 65 medical students engaged in clerkships from September 2013 to April 2015. Their preclinical technical knowledge scores-formal curricular grades received from course instructors-were obtained from their medical school's archival dataset. Their nontechnical attributes-moral and social performance scores received from student mentors and physical performance scores received from course instructors-were also obtained from the school's archival data set. The medical students' competence in their 2-year clinical clerkships was measured using the objective structured clinical examination scores from the end of both clerkship years. The medical students' psychological well-being during their 2-year clerkships was measured according to burnout level, which was determined using routine online surveys that employed validated, structured, and self-administered questionnaires at each specialty rotation. Multiple regressions and linear mixed-effects model were employed for statistical analysis. RESULTS: Our study revealed that higher preclinical technical knowledge predicted superior clinical competence and a higher level of burnout during clerkships. By contrast, higher preclinical nontechnical attributes (i.e., higher preclinical moral, social, and physical performance) predicted lower level of burnout. However, no relationship was discovered between clerkship burnout and the clinical competence of the medical students. CONCLUSIONS: Our study verified the value of a holistic education that encompasses both technical knowledge and nontechnical attributes during the preclinical learning stage for medical students. Our findings can serve as a reference for medical educators designing preclinical educational programs for medical students.