Becoming ‘ward smart’ medical students

Abstract

Summary Background A small number of medical students elect to work as health care assistants (HCAs) during or prior to their undergraduate training. There is a significant body of evidence in the literature regarding the impact of HCA experience on student nurses; however, little research has examined the effects of such experience on medical students. Methods All fourth‐year medical students with self‐declared experience as HCAs from a single UK medical school were invited to participate in focus groups to explore their experiences and perceptions. Ten students from the year group took part. Results Participants felt that their experience as HCAs enhanced their learning in the workplace through becoming ‘ward smart’, helping them to become socialised into the world of health care, providing early meaningful and humanised patient interaction, and increasing their understanding of multidisciplinary team (MDT) members’ roles. Discussion Becoming ‘ward smart’ and developing a sense of belonging are central to maximising learning in, from and through work on the ward. Experience as a HCA provides a range of learning and social opportunities for medical students, and legitimises their participation within clinical communities. HCA experience also seems to benefit in the ‘hard to reach’ dimensions of medical training: empathy; humanisation of patient care; professional socialisation; and providing a sense of belonging within health care environments.

Understanding the ward environment: a mixed-methods exploratory study of factors determining medical students’ ‘ward smarts’.

“…We could also use background research to inform our planned interventions combined with these preliminary findings: interprofessional ward placements have been demonstrated as effective in improving elements of ward smarts such as teamwork and communication, and would be an ideal and common-sense intervention in terms of involving students as participating members of an interprofessional team in a ward environment, thereby enhancing their ward smarts through situated learning. 2,3,12,15 The desire for more interprofessional learning opportunities was a strong theme in our thematic analysis, and this would therefore be ideal to implement: medical students, nursing students, healthcare assistants (HCAs), and perhaps some specialised ward-based teachers could all collaborate on such a project. 24 However, on a practical level, an additional placement would be extremely difficult to incorporate into the existing curriculum: a more watered-down version involving an interprofessional ward-based training day at the start of the clinical phase would be a more achievable goal.…”

“…observations), having knowledge of jargon used in hospitals, and an understanding of roles within the multidisciplinary allied health team. 2 Such knowledge is not only important for patient care, but also helps medical students feel less 'alien' or 'in the way' on the ward: students who feel as though they are a useful part of the team are more able to take advantage of situated (clinical) learning opportunities and their educational outcomes tend to reflect this. [2][3][4] This raises the question of when and where students should acquire ward smarts: formal teaching on ward environments is often neglected, with students feeling unprepared for clinical placement and being left to 'pick up' ward smarts as they go along.…”

“…2 Such knowledge is not only important for patient care, but also helps medical students feel less 'alien' or 'in the way' on the ward: students who feel as though they are a useful part of the team are more able to take advantage of situated (clinical) learning opportunities and their educational outcomes tend to reflect this. [2][3][4] This raises the question of when and where students should acquire ward smarts: formal teaching on ward environments is often neglected, with students feeling unprepared for clinical placement and being left to 'pick up' ward smarts as they go along. [3][4][5] Furthermore, ward opportunities and quality of teaching can vary greatly between individual placements and hospital trusts -for example at Nottingham Medical School, undergraduate students have a Ward Simulation day but this opportunity is not offered to graduate entry students, while those in Queen's Medical Centre for Paediatrics have a 'ward smart day', but no other departments or placements run this session.…”

“…Both this and the fact that each individual student has their own starting point, having varied levels of previous experience in secondary care, introduces significant variation into students' understanding of the ward environment. 2 Being 'ward smart' is key for many aspects of medicine: it can be the difference between having a smooth transition to new placements or taking weeks trying to familiarise oneself, and could therefore lead to reduced time for effective learning. 3,6 As being 'ward smart' has only recently been defined, there is a gap in the literature related to this specific term, but many of the aspects of ward smarts have been studied in isolation or as part of 'professionalism': for example, there is evidence to suggest that there are deficits in medical students' ward smarts in specific areas such as paperwork and documentation, 7 teamwork and interprofessional communication, 8 awareness of others healthcare professionals' roles, 9 understanding of terminology or jargon used in hospitals, 10 and managing common ward environment distractions.…”

Becoming ‘ward smart’ medical students: a response

“…W e read with interest the article by Walker et al, highlighting the perceived benefi ts to medical students of working as health care assistants (HCAs) in the UK. 1 It is unsurprising, as senior medical students ourselves, to read that those undertaking such work developed a greater understanding of roles within multidisciplinary teams (MDTs). The article left us refl ecting on the scarce interactions between HCAs and doctors that we have witnessed in practice.…”