"The consultation is the central act of medicine, and as such, it deserves to be understood." So begins chapter 1 of the excellent text,The Consultation: An Approach to Learning and Teaching. To the British, the word "consultation" refers to the medical interview, rather than to the solicited report of a medical subspecialist. This book is designed to improve medical interviewing skills for primary care personnel at all levels of training: undergraduate, postgraduate, and continuing medical education. The text is well written, succinct, well organized, and comprehensive. Those looking for a simple "cookbook" approach to medical interviewing should not purchase this book, but those who are interested in developing their interviewing skills or the skills of the practitioners they teach would do well to read it. The first few chapters lay the theoretical groundwork for an understanding of the medical consultation. This includes a brief review of the general approaches

The Consultation: An Approach to Learning and Teaching

Medical school mentoring programs incorporate a wide range of objectives. Clinical mentoring programs help to develop students' clinical skills and can increase interest in under-subscribed specialties. Those that focus on teaching professionalism are integrated into medical school curriculums in order to overcome the "hidden curriculum". Positive mentoring plays a part in reversing the decline of academic medicine, by sparking interest through early research experiences. It also has an important role in encouraging recruitment of under-represented minority groups into the medical profession through widening access programs. The aim of our review of the literature, is to analyze current trends in medical student mentoring programs, taking into account their objectives, execution, and evaluation. We outline the challenges encountered, potential benefits, and key future implications for mentees, mentors, and institutions.

/pdf/medical-student-mentoring-programs-current-insights-5djikvgykv.pdf

Medical student mentoring programs: current insights.

/pdf/simulation-in-medical-education-169rdu7fxh.pdf

Simulation in Medical Education

Objective:To investigate the relationship between variability in surgical ward round (WR) quality and clinical outcomes.Background:Evidence increasingly suggests that ward-based care plays a key role in surgical outcomes. The WR is the focal point of surgical inpatient care. Assimilating various sou

Surgical ward round quality and impact on variable patient outcomes.

Simulation is the technique of imitating a process or situation for education, training, modelling of an uncommon or risky scenario, or testing systems when new elements are introduced (such as a new protocol).1

Simulation training is not new to medicine. Anatomical models were created in ancient times, and in the 1960s the Norwegian toy manufacturer Laerdal pioneered simulation to practise cardiopulmonary resuscitation and critical event drills.2 Early models were crude, but they were widely adopted. The HARVEY cardiovascular simulator was one of the first manikins developed which was computer driven and provided replication of anatomy with palpable pulses and auscultatable areas. This allowed medical students to experience some of the findings from clinical examination for the first time in a standardized setting.3

More recently, with advances in technology, there has been a rapid expansion in simulating other aspects of healthcare, with increasing sophistication. Modern computing power allows the recreation of complex anatomical and physiological systems programmed to respond to inputs from the user. There have also been advances in manikins and devices to physically replicate the steps of performing complex procedures.

Fidelity is the degree of accuracy with which a simulation replicates a clinical scenario. This is defined in terms of the realism of the environment in which the simulation takes place, the equipment used and the psychological engagement of the learner. It is not necessarily synonymous with the technology of the simulator.4–6. Indeed, evidence suggests that the indiscriminate use of high-technology simulators alone is unlikely to be more effective than other methods.7,8 The ability to use realistic clinical environments (or practice in situ ), using equipment which closely replicates the look, feel and feedback of clinical situations will facilitate the immersion of the learner into the simulation, but it is …

/pdf/simulation-in-cardiology-state-of-the-art-2bq8rrce35.pdf

Simulation in cardiology: state of the art

SummaryBackground
The transition from senior medical student to working safely and effectively as a new junior doctor is one of the biggest challenges that a new graduate will face. In 2014 the General Medical Council published The state of medical education and practice in the UK, reporting that some new doctors continue to struggle with increased responsibilities. We classify these instances as a ‘performance gap’, describing occasions in clinical practice where an individual exceeds their performance capacity. The Medical Mentorship Programme addressed identified performance gaps through a structured curriculum of simulation-based education and facilitated clinical practice. 

Methods
Programme content was based on the experiences of the authors and their peers in graduating from their undergraduate training programme and becoming junior doctors. A questionnaire was disseminated to junior doctors in their first clinical rotation. The questionnaire asked doctors to describe instances where they experienced a performance gap. These data informed the development of the Medical Mentorship Programme. The effect of this programme was then evaluated via focus group discussion.

Results
The Medical Mentorship Programme has been shown to be an effective conduit for supporting the transfer of learning needed to address performance gaps in students. The programme increased the confidence of students in preparation for clinical practice and allowed junior doctors to reflect on their professional development. The programme combined complementary teaching techniques – mentorship, simulation and direct clinical experience – to aid the professional development of both students and mentors.

Some new doctors continue to struggle with increased responsibilities

The value of mentorship in medical education.

This article describes the findings from a pilot study undertaken to identify the potential benefits of a ward simulation exercise in developing the capabilities of newly qualified nurses. Eight newly qualified nurses were recruited to participate in this pilot study which was based in the Clinical Skills Centre, Ninewells Hospital, Dundee. This pilot study was performed in conjunction with NHS Tayside Practice Education Facilitators and the University of Dundee. Data collection methods involved reflective learning logs which were reviewed independently by an expert group of teachers and practitioners. A focus group session was also undertaken to understand the lived experience of the newly qualified nurse during the ward simulation exercise. Core themes (listed in order of importance) related to the professional development of newly qualified nurses that were identified through this pilot study were: an increase in confidence, development of stress management skills, improved management of the acutely unwell patient, the transfer of skills learnt in simulation to the clinical setting, development of communication skills and reflection skills. Participants in this pilot study demonstrated increased levels of confidence in their communication skills, their ability to prioritize care and to engage in collaborative teamworking.

The benefits of a ward simulation exercise as a learning experience.

Summary

Background: A small percentage of medical trainees will have performance concerns identified within their clinical practice. These trainees require specific interventions to address these concerns. The Postgraduate Ward Simulation Exercise (PgWSE) was developed as a joint collaboration between the University of Dundee and NHS Education for Scotland (NES).



Context:  The PgWSE takes around 90 minutes to complete. It allows assessors to directly observe the performance of trainees within a simulated ward environment. Trainees are assessed individually on their ability to prioritise competing demands, work as part of a team and make safe informed clinical decisions.



Innovation:  The PgWSE is the first specific national intervention to support the assessment and remediation of trainee doctors in difficulty. Nine PgWSE scenarios have been developed to reflect clinical practice: three in general surgery, four in general medicine and two in medicine for the elderly. To enhance realism, simulated patients (SPs) are recruited and trained for each exercise.



Standardised assessment tools were developed and validated for assessors to make individual and consensus judgements regarding a trainee’s performance. Self-assessment of performance is used to disengage trainees from the simulated activity and to prepare them for constructive feedback.



Implications:  The PgWSE has been shown to be a valuable tool for the management of trainee doctors in difficulty in Scotland. Although the PgWSE is time and resource intensive, it has been shown to have a positive impact on the remediation of trainees and in the provision of objective, detailed and comprehensive feedback to the referring deanery. Within NES there are four geographical centres led by a postgraduate dean with responsibility for supervision of postgraduate medical education.

Using simulation to support doctors in difficulty.

Summary

Background: The use of simulated patients (SPs) in undergraduate medical curricula is now an accepted norm. SPs play an important role in the delivery of feedback to medical students. In Dundee, SPs are used in clinical skills teaching sessions from year 1 onwards. Currently SPs provide open feedback to students during communication skills sessions. Rather than giving balanced feedback, SPs can sometimes focus on the negative aspects of a student’s performance.



Method:  This research study developed a closed-feedback tool to be used by SPs to provide constructive feedback to final-year medical students after they have undertaken the Final Year Ward Simulation Exercise (FYWSE). The Simulated Patient Candidate Evaluation (SPaCE) tool was evaluated using a convenience sample of SPs who rated the applicability of the tool by reviewing three previous FYWSE videos.



Results:  The SPs were able to engage with the SPaCE tool, agreeing that it helped them to identify differences between student’s performances. Correlations were shown between the SP’s assessment and the marks awarded by the assessment panel.



Discussion:  The SPaCE tool is a structured, standardised feedback tool that SPs can complete easily and quickly. The SpaCE tool encourages SPs to provide feedback from specific interactions they have had with students during the FYWSE. In the SP’s opinion, good interaction and good interpersonal skills are the determinants of good performance.

Achieving 360o student feedback using SPaCE

The reliability and validity of the OSCE as an assessment of capability within advanced practitioner curricula.

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