Involving patients as educators: adding value to clinical experience

Patsy Stark, Martin Hague, Nigel Bax

Simulated and standardised patients have contributed to medical education for over 40 years. Building on this principle, patients are now becoming more involved with teaching, providing feedback and assessing healthcare students and contributing to curriculum design. Involving patients in the education of healthcare students offers wide ranging benefits to students, provides the patients with greater understanding of their illness and affords them the opportunity to contribute to the education and training of future healthcare professionals. In this paper the Patient as Educator programme at the University of Sheffield is described and the evaluation of one format of educational engagement is presented.

Development of an undergraduate medical student theatre etiquette course

C Kellett, K Stirling, R McLeod, J Dent, P Boscainos

A recent infection control review in NHS Tayside commented that medical students who have no formal training in theatre etiquette could pose a significant infection risk to patients undergoing total joint arthroplasty. Medical students currently have no formal teaching in scrubbing and gowning for theatre. The students report high levels of stress when they are asked to scrub and gown for theatre.

We have planned to implement a new theatre etiquette course for the medical students in which they learn scrubbing, gowning and gloving for theatre.

The new theatre etiquette course would be added to the end of year 3 student timetable. This would include teaching in small groups to scrub, gown and glove. A video of these skills would be used to provide consistency in teaching.

This paper demonstrates how 160 students can be taught theatre etiquette in one day with minimal resources and staff.

Interprofessional teaching using a computerised patient simulator: what do students learn and how?

Stephen Abbott, Margot Buckwell, Val Dimmock, Celia Goreham, Jeshen Lau

This paper reports the findings of a qualitative study of how medical and nursing students experienced learning by enacting clinical scenarios using a computerised patient simulator. Students valued what they had learnt about team roles, communication and leadership. They also valued learning by doing, which represented a step forward from classroom learning; and in the case of medical students, from placement learning. The drama of the scenarios created engagement, anxiety and a sense of responsibility. For these reasons the sessions were regarded as more useful than previous interprofessional learning. The design of the sessions may be understood as ‘scaffolding’, to support learning in Vygotsky’s ‘zone of proximal development’; the demands placed on students were emotionally challenging but contained within the frameworks of knowledge and cognitive understanding used throughout their training.

Nursing students’ perceptions of learning vital signs in a clinical skills laboratory

Jill Murphy, Liz Kingston

Background: the use of the clinical skills laboratories (CSL) has become increasingly popular within nurse education internationally and the role of simulation within clinical skills teaching has grown more sophisticated and complex. As students are afforded an opportunity to perfect their ability to perform clinical skills within the clinical skills laboratory, there are reports that patients can be the beneficiaries of improved care. This study focuses on Bachelor of Nursing Science (BSc) student’s perceptions of using an intermediate-fidelity simulator in the University’s Clinical Skills Laboratory to learn the skill of blood pressure.

Aim: to explore nursing student’s perceptions of learning vital signs in a clinical skills laboratory.

Method: using a quantitative approach, a sample (n=50) from the population of first year nursing students completed a questionnaire following two clinical skills teaching sessions, and then prior to their first clinical placement.

Findings: research results were positive. Over 80% strongly agreed that CSL facilitated a setting where learning and teaching could occur. Confidence, practice and learning from mistakes were some of the concepts highlighted in the study.

Conclusion: these findings are in line with international research and demonstrate that the clinical skill laboratories provide a realistic environment for practice.

A simple method to assess hip flexibility in the presence of a fixed flexion knee deformity

Alun Yewlett, Gareth Roberts, James Brown, Andy Weaver

Thomas’s test was originally described by Hugh Thomas more than a century ago, but it still remains in widespread clinical use today. It is an examination technique that allows the examiner to detect a fixed flexion deformity of the hip by having the patient lying flat on a bed. The fact that it is still used today more than one hundred years on from its inception is a tribute to its reliability and usefulness. However, there are some pitfalls to trap the unwary which we aim to highlight together with our preferred method of overcoming them.

The OSCE: A marathon, not a sprint

Rashmeet Chhabra, Edna Gunaratnam

The Objective Structured Clinical Examination, or the OSCE as it is commonly known, was introduced during the late 1970s to measure the clinical competence of medical students. The OSCEs have now been incorporated into most medical school curricula worldwide.

Students are likely to encounter the OSCE as early as the first year of medicine. However, even at the final year OSCE, students are equally, if not more anxious. This article is written to alleviate the fears of those preparing for the OSCEs and to help students demonstrate their clinical competencies in a potentially stressful situation. It includes a summary of what the OSCE entails, suggestions on how to prepare for the OSCE and some tips on tackling the actual exam.

Confirmation of death

Muhammad Akunjee, Hafiz Syed

Death is often an emotional ordeal for family and friends of the deceased, as well as for the junior doctor involved, who is often overlooked in this situation. Despite the circumstances, it is important that a thorough examination of the patient is conducted in order to complete relevant documentations, such as the death certificate and cremation forms, and avoid unnecessary delays in funeral preparations which could cause needless and perpetuating grief for the family.

Examination of the cardiovascular system

Tom Stockmann, Neel Burton

This article details a thorough routine for examining the cardiovascular system that is appropriate both for day-to-day clinical practice and for sitting undergraduate Objective Structured Clinical Examination (OSCE) type exams. The emphasis is on the steps involved in examining the cardiovascular system, rather than on specific signs. For these, refer to other cited articles and references. This article is consistent with the ‘Principles of Clinical Examination’.

Cultural barriers to the spread of clinical skills teaching methods

Toshio Sato, Debra Patten, John McLachlan

The transferability of clinical skills teaching methods from one culture to another are explored through a case study comparing anatomy teaching methods in Japan and the UK, since attitudes to the body are critical to clinical skills teaching, and anatomy is the most direct method of experiencing the body encountered in medical school prior to patient contact.

Current admission practices, the structure of medical school curricula and the demographic make up of medical students in each country are explored. Teaching methods are compared between each country. Cultural attitudes to death, nakedness and innovation are then contrasted.

It is concluded that, while attitudes to death between the two cultures differ significantly in philosophical principle, the practical differences are slighter. However, attitudes to nakedness and the living body are significantly different, and are likely to act as a deterrent to introduction of extensive use of methods such as peer physical examination in Japan. Attitudes to change and innovation may also differ significantly between the two cultures, suggesting that it is not sufficient to analyse merely the merits of proposed changes, but also the cultural field into which they will be introduced.

Emergency department ultrasound: experience in a Malaysian teaching hospital

Abdul Rashid Abdul Kader, Husyairi Harunarashid, Nurul Ain Kamaruddin, Noraliza Mohd Ariffin, Ismail Mohd Saiboon, Teodoro Herbosa

The use of ultrasound by emergency physicians (EP’s) staffing the emergency department (ED) in a hospital is relatively new in Malaysia. This paper presents the initial experience of clinical ultrasound (US) in the ED performed by EP’s, to arrive at appropriate clinical decisions quickly and reliably. The experiences documented in this paper occurred after the implementation of an initial ultrasound course for the EP’s called ‘Basic Emergency Ultrasound for Trauma’ (BEST).

This study shows the immediate impact of EP performed ultrasound when performed in the emergency setting. We validated the usefulness of clinical US skills among EP’s in diagnostic skills and decision making in emergency cases seen in a University teaching hospital ED. Three cases documented here illustrate experiences in using the newly acquired clinical skill of ED ultrasound.

Learning styles: teaching medical ethics to students with tendency to pragmatism

Atef Markos

The scarcity of research on learning styles for medical students clouds the vision of whether learning should be consistent and the same for the group or modified according to individual learners’ situations. There is realisation that positive interpersonal relationships between teachers and learners increase the quality of learning. The balance between the teaching style and the learning style is evidently proved to affect and enhance the learning process. We wish to share our approach of linking our teaching style to the learning needs of trainees who may exhibit tendency to pragmatism.

Challenges encountered during development of scenarios for a management simulation exercise for undergraduate student nurses

Colette Lyng, Susan Hourican, Mary McGrath, Daniela Lehwaldt

Scenario development is an essential part of any simulation design, yet the published literature on this topic is limited. A group of School of Nursing staff from Dublin City University in collaboration with clinical colleagues from partner services recently developed, implemented and evaluated a ward based simulation exercise with the primary aim of helping students to consolidate their knowledge and skills in relation to providing care for a group of patients. This required the development of a selection of realistic patient scenarios that would run simultaneously and could be enacted in the Clinical Education Centre in the School of Nursing. The scenarios incorporated many nursing skills required to manage a caseload of patients including communication skills, individual psychomotor skills such as removal of an indwelling urinary catheter and cognitive skills such as problem solving, prioritising care and decision making. This proved to be one of the most challenging aspects of the project. In this paper we will share our experiences and discuss the challenges encountered while developing a bank of scenarios for use in a simulated ward. This will include identification of learning outcomes, choosing and developing appropriate scenarios, identifying required resources, synchronising scenarios and script writing.

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