BMC medical education
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BMC medical education · Jan 2014
Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators.
Clinical reasoning is fundamental to all forms of professional health practice, however it is also difficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we present an approach for teaching clinical reasoning based on making expert thinking visible and accessible to students. ⋯ We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use.
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BMC medical education · Jan 2014
On death and dying - an exploratory and evaluative study of a reflective, interdisciplinary course element in undergraduate anatomy teaching.
Teaching in palliative care aims not only at providing students with specialized knowledge in symptom therapy in advanced disease, but also at developing a professional attitude consistent with the principles and philosophy of palliative care. Reflecting about one's own or the patient's death and dying is considered essential for empathic patient care. In medical education the dissection course is often the first encounter with the issue of death and dying and represents a significant emotional challenge to many medical students.Against this background we implemented a new course element in preparation for the dissection course, offering opportunity to reflect own experiences with death and dying and providing support in finding a balance between authentic empathy and pragmatic action towards deceased persons. We discuss issues such as dignity and professional distance and reason whether guided support for medical students regarding these issues might influence their future attitude as doctors caring for their patients. ⋯ This new course element successfully assisted medical students during the dissection room experience and gave opportunity to reflection and discussion on death and dying. The accompanying research confirmed the demand for support and gave insight into experiences, emotions and attitudes of medical students.
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BMC medical education · Jan 2014
Randomized Controlled TrialDoes clinical teacher training always improve teaching effectiveness as opposed to no teacher training? A randomized controlled study.
Teacher training may improve teaching effectiveness, but it might also have paradoxical effects. Research on expertise development suggests that the integration of new strategies may result in a temporary deterioration of performance until higher levels of competence are reached. In this study, the impact of a clinical teacher training on teaching effectiveness was assessed in an intensive course in emergency medicine. As primary study outcome students' practical skills at the end of their course were chosen. ⋯ At the end of a structured intensive course in emergency medicine, students of trained clinical teachers performed worse in 2 of 4 practical SCE domains compared to students of untrained teachers. In addition, subjective evaluations of teaching quality were worse in the group of trained teachers. Difficulties in integrating new strategies in their teaching styles might be a possible explanation.
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BMC medical education · Jan 2014
Specialization training in Malawi: a qualitative study on the perspectives of medical students graduating from the University of Malawi College of Medicine.
There is a critical shortage of healthcare workers in sub-Saharan Africa, and Malawi has one of the lowest physician densities in the region. One of the reasons for this shortage is inadequate retention of medical school graduates, partly due to the desire for specialization training. The University of Malawi College of Medicine has developed specialty training programs, but medical school graduates continue to report a desire to leave the country for specialization training. To understand this desire, we studied medical students' perspectives on specialization training in Malawi. ⋯ Graduating medical students in Malawi have mixed views of specialization training in their own country and still desire to leave Malawi to pursue further training. Training institutions in sub-Saharan Africa need to understand the needs of the country's healthcare workforce and the needs of their graduating medical students to be able to match opportunities and retain graduating students.
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BMC medical education · Jan 2014
ReviewBuilding continuity in handovers with shorter residency duty hours.
As junior doctors work shorter hours in light of concerns about the harmful effects of fatigue on physician performance and health, it is imperative to consider how to ensure that patient safety is not compromised by breaks in the continuity of care. By reconceptualizing handover as a necessary bridge to continuity, and hence to safer patient care, the model of continuity-enhanced handovers has the potential to allay fears and improve patient care in an era of increasing fragmentation. "Continuity-enhanced handovers" differ from traditional handovers in several key aspects, including quality of information transferred, greater professional responsibility of senders and receivers, and a different philosophy of "coverage." Continuity during handovers is often achieved through scheduling and staffing to maximize the provision of care by members of the primary team who have first-hand knowledge of patients. ⋯ However, because maximizing team continuity is not always possible, other strategies such as cultivating high-performance teams, making handovers active learning opportunities, and monitoring performance during handovers are also important. Medical educators and clinicians should work toward adopting and testing principles of continuity-enhanced handovers in their local practices and share successes so that innovation and learning may spread easily among institutions and practices.