Hello COMSEP!
Today is Children’s Day in India. What better day to focus on improving the lives of children through pediatric education?
Each of our reviews this week involve a curricular innovation that involves thinking ‘outside the box’. Hopefully they inspire you to think broadly about how to shake up things a little in your educational world.
Enjoy,
Karen, Amit and Jon
Working and learning in the hospital system
Hale, A. J., Bartsch, J., Stapleton, R. D., et al.. How the Hospital Works: An Interdisciplinary, Systems-Based Practice Medical Student Elective. Journal of Medical Education and Curricular Development, (2023), 10. https://doi.org/10.1177/23821205231203908
Reviewed by: Patricia Pichilingue-Reto
What was the study question?
Will a fourth-year medical student elective based on immersion with hospital non-physician staff increase knowledge in systems-based practice?
How was the study done?
The researchers created a 2-week elective for fourth-year medical students at a single institution. This elective was run twice a year with 1 to 3 students per iteration. It consisted of interprofessional experiences with non-physician patient care and administrative staff within the hospital system including environmental services, food services, and patient and family advocacy among others. Authors obtained pre- and post-elective surveys using Likert scales on systems-based knowledge and interprofessional communications from all student participants. They also obtained surveys from staff on a volunteer basis. Pre-elective and post-elective Likert scale results were compared using paired t-tests.
What were the results?
A total of 14 students completed this elective from 2019 to 2022 and they all completed the surveys. There were statistically significant gains in knowledge in all categories assessed by the questionnaires. This included understanding the different roles of interprofessional staff, understanding how the services offered by interprofessional staff complemented those offered by physicians, ability to communicate with interprofessional staff, and feeling comfortable approaching them. Out of 22 interprofessional staff, 17 completed the surveys. Results suggest that staff believed having medical students interacting with them was an important experience and they also perceived a personal benefit from the elective.
How can this be applied to my work in education?
This kind of elective experience could be beneficial for medical students at other institutions and it should be considered as a useful course for medical school curricula as it offer insights into the types of interprofessional skills medical students must gain before becoming physicians who will be part of bigger systems where they need to interact with other types of professionals.
Editor’s Note: The benefits of these interprofessional interactions are clear. I would be interested to know more about the students who chose to take this elective--what motivated them and how they compared to their peers in specialty choice and demographic characteristics. (JG)
Buddy Lessons
Nayman C, Do J, Goodbaum A, Eady K, and Moreau K. The perceptions and experiences of medical students in a pediatric buddy program: a qualitative study. BMC Med Educ. 2022 Apr 4;22(1):240. https://doi.org/10.1186/s12909-022-03306-w
Reviewed by Maya Neeley
What was the study question?
What are the perceptions and experiences of medical students who participate in a pediatric buddy program?
How was the study done?
This study was a qualitative exploration of student perspectives of a voluntary partnership program aimed at fostering nurturing relationships between pediatric oncology patients and pre-clerkship medical students. Pre-clerkship students were matched with pediatric oncology patients as “buddies” based on personality traits, interests, and primary language. Students and their buddies met, on average, weekly, and participated in a wide range of activities, depending on the interests and capabilities of the buddies. Semi-structured interviews were conducted targeting students' perceptions, experiences, and interactions with the pediatric patients at three distinct timepoints: before their entrance into the program, after 4 months, and at the completion of their time with the program. Thematic analysis of interview data was undertaken to identify common themes.
What were the results?
Of 328 first and second-year students eligible for the program, 51 applied. Of these, 15 students were matched with a buddy based and all agreed to participate in the program. None had worked with children with cancer. All students participated in interviews before their entrance into the program, 13 students participated in interviews at 4 months, and 8 participated in interviews at program completion. Four themes were identified: (a) providing social and emotional support to their buddies, as well as providing respite support for families was important; (b) providing care to children with serious illnesses is emotionally difficult; (c) developing deep connections with buddies and their families is rewarding; (d) gaining empathy and personal fulfillment from buddies and their families is inevitable. Overall, students felt that the program was a valuable learning experience; it highlighted the importance of empathy in clinical practice, and encouraged them to consider how to apply empathy into their future patient encounters.
How can this be applied to my work in education?
This study demonstrates the value students may gain from patient-student partnership programs. Such experiences may play an important role in medical education as related to humanistic care. As we continue to explore methods to promote empathy, these types of programs may have lasting benefits for students.
Editor’s Note: One of the nice things about this study was the exploration of student experiences with this program over time. Even at 4 months into the program, students were able to confirm their anticipated perceptions and experiences, and establish meaningful connections with their buddies, further strengthened after completion of the program. As we aim to train humanistic physicians, meaningful connections are likely to be found in such longitudinal experiences that start early in training. (KFo)
Early (virtual) clinical encounters
Roberts, J. K., Sullivan, M., Atwater, S., Desai, K., Prabhu, N. K., Hertz, J. T., Buhr, G. T., Peyser, B., & Weigle, N. (2023). Use of virtual interactive patient encounters to prepare first-year medical students for clinical practice. Academic Medicine, 98(10), 1146–1153. https://doi.org/10.1097/acm.0000000000005286
Reviewed by Folami N. Duncan, MD
What was the study question?
Does integration of Virtual Interactive Patient (VIP) encounters into the pre-clerkship curriculum enhance clinical skillset?
How was the study done?
First-year medical students in fall 2021 were enrolled in a 2-week clinically integrated biomedical science course. During the first week, the course used a hybrid approach of team-based learning and large group lecture to provide the clinical context for the concurrent biomedical science topics. During the second week, the VIP encounter was implemented; the encounter integrated biomedical science topics and assessed clinical reasoning and documentation skills. At the end of VIP encounters, course faculty evaluated students’ responses using a 4-level scoring scale. Students provided feedback on the tool using a 5-level scoring scale and open-ended narrative feedback.
What were the results?
Seven VIP encounters were assigned to 124 students (mean response rate 98.5%). Most students were able to achieve a high score level when writing the patient care plan, addressing social determinants of health, writing relevant problem representation statements, and performing clinical reasoning skills. The narrative feedback from students was overall positive and highlighted strong alignment with the biomedical curriculum, the ability to apply current medical knowledge to patient care, and the opportunity to practice clinical documentation through a formative activity. Key constructive feedback from students was that the VIP tool took longer than anticipated, and the two more general, complex VIP encounters were overwhelming.
How can I apply this to my work in education?
The study findings demonstrate that virtual clinical scenarios can be used to optimize medical education during the pre-clerkship years by integrating biomedical and clinical content. Although the development of the VIP tool requires meticulous construction and coordination with the basic science curriculum, the tool can be valuable in preparing early medical students for clinical rotations. The early application of basic science knowledge to clinical scenarios can prove beneficial in improving medical student performance, confidence and familiarity with clinical practice
Editor’s Note: This is an interesting way to have clinical correlations during the nonclinical portions of the curriculum. While it may take a while to set up, the videos can be used by multiple students for several years. I do wonder how this will change performance for students during clinical clerkships. (AKP)