Boosting clinical performance: The impact of enhanced final year placements

Williams, Dougal; Reid, Anne-Marie; Homer, Matt

doi:10.1080/0142159x.2017.1291925

Cited by 3 publications

(6 citation statements)

References 26 publications

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“…18 26 Medical schools and their placement providers must ensure that adequate training and protocols are provided to the wider clinical team to indicate when it is safe and appropriate to contact the medical student as the first clinician. 36 Students attending patients as the first clinician must also have adequate supervision and support to do so safely.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, having the appropriate organisational practices in place is crucial in implementing assistantship models 11. A successful assistantship is able to provide students with the opportunity to practise relevant skills for the delivery of care for real patients, creating a sense of clinical responsibility, which can be difficult to mimic elsewhere in the curriculum 9 17–20…”

Section: Introductionmentioning

confidence: 99%

“…The emphasis of the 3-week student assistantship was to provide opportunities for medical students to take on clinical responsibility in a supervised environment and manage clinical tasks such as clinical prioritisation, managing acutely unwell patients under supervision and recommending prescriptions; rather than furthering clinical or specialty knowledge 12 17 19…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals

et al. 2022

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ObjectivesStudent assistantships are recommended to prepare medical graduates for clinical practice. Traditionally, assistantships have consisted of longer placements, often up to 15 weeks. However, within the constraints of the final year, medical schools need to carefully balance the time required for specialty placements, assessments and the risk of student burnout. We set out to evaluate the effectiveness of shorter, personalised student assistantships.DesignAn evaluative study on the changes in final year student confidence in preparedness for practice after a 3-week assistantship with defined learning objectives and learning needs assessment.SettingEight hospitals affiliated with Imperial College School of Medicine.OutcomesStudent confidence in 10 learning outcomes including organising ward rounds, documentation, communication with colleagues, communication with patients and relatives, patient handover, practical procedures, patient management, acute care, prioritisation and out-of-hours clinical work.ResultsTwo hundred and twenty final year medical students took part in the student assistantship, of whom 208 completed both the pre-assistantship and post-assistantship confidence rating questionnaires (95% completion rate). After the assistantship, 169 (81%) students expressed increased confidence levels in one or more learning objectives. For each individual learning objective, there was a significant change in the proportion of students who agreed or strongly agreed after the assistantship (p<0.0001).ConclusionOverall, the focused 3-week, personalised student assistantships led to significant improvement across all learning objectives related to preparedness for practice. The use of the pre-assistantship confidence rating questionnaire allowed students to identify and target areas of learning needs during their assistantship.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals

et al. 2022

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“…Support should be offered to increase rotation sites’ readiness to supervise DTY-AC students. 27 Faculty development sessions providing tailored training on how supervisors can contribute to the learning of students by exploiting learning opportunities potentially improve the quality of delivery and may improve the involvement of supervisors. Such sessions would provide networking opportunities as well.…”

Section: Discussionmentioning

confidence: 99%

An elective entrustable professional activity-based thematic final medical school year: an appreciative inquiry study among students, graduates, and supervisors

Jonker

Booij

Otte

et al. 2018

AMEP

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PurposeThe transition from undergraduate to postgraduate training can be facilitated by offering electives that focus on increased patient care responsibilities. This transitional year model in the Netherlands has recently been expanded to offer packages of electives geared to specific residencies and was called “dedicated transitional year” (DTY). At University Medical Center Utrecht, an entrustable professional activity (EPA)-based multidisciplinary DTY in acute care (DTY-AC), rooted in self-determination theory (SDT), has been implemented. The current study aimed to understand strengths and challenges regarding the implementation of this specific DTY.MethodsAn explorative qualitative study among students, graduates, and faculty was conducted using an appreciative inquiry methodological approach. We gathered first-hand accounts of experiences with the DTY-AC in focus groups and interviews with students and interviews with graduates, supervisors, and mentors. Transcripts were analyzed with a directed content analysis approach.ResultsParticipants found the DTY-AC to focus learning, offering coherence by clear learning objectives, aligned assessment, and teaching sessions and offering a congenial learning community. However, EPAs were not the focal point of workplace assessment and evaluation. Providing sufficient hands-on student engagement in actual acute care situations was another challenge.ConclusionThe concept of the thematic DTY is embraced, and it seems to help in meeting the SDT needs. Enhancing delivery in the workplace by improving formal implementation with information and faculty development, expanding EPA-focused workplace assessment, and extending hands-on experience of students could further unlock the potential of this final medical school year design. Our lessons learned may help in the development and implementation of similar programs, other models of DTYs, and final-year redesigns.

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“…The status and responsibility conferred on new doctors trigger a transformation in personal perspective and identity, for which it is, arguably, not possible to fully prepare 8 32–36. This new responsibility can be overwhelming and contributes to the significant cognitive challenges faced on commencing work 37 38.…”

Section: Introductionmentioning

confidence: 99%

Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study

et al. 2023

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ContextFactors contributing to the stressful transition from student to doctor include issues with preparedness for practice, adjusting to new status and responsibility, and variable support. Existing transitional interventions provide inconsistent participation, responsibility and legitimacy in the clinical environment. Enhanced support by near peers for new doctors may ease the transition. Irish medical graduates of 2020 commenced work early, creating an unprecedented period of overlap between new graduates and the cohort 1 year ahead.ObjectiveTo explore the experience of commencing practice for these new doctors with this increased near-peer support.DesignWe used interpretive phenomenological analysis as our methodological approach, informed by the cognitive apprenticeship model, to explore the experience of enhanced near-peer support at the transition to practice. Participants recorded audio diaries from their commencement of work, and a semistructured interview was conducted with each, after 3 months, concerning their experience of their overlap with the previous year’s interns.SettingUniversity College Cork, one of six medical schools in Ireland.ParticipantsNine newly qualified medical doctors.Main outcome measuresAn exploration of their experience of transition to clinical practice, in the context of this enhanced near-peer support, will inform strategies to ease the transition from student to doctor.ResultsParticipants felt reassured by having a near-peer in the same role and safe to seek their support. This empowered them to gradually assume increasing responsibility and to challenge themselves to further their learning. Participants perceived that commencing work before the annual change-over of other grades of doctor-in-training enhanced their professional identities and improved patient safety.ConclusionsEnhanced near-peer support for new doctors offers a potential solution to the stressful transition to practice. Participants were legitimate members of the community of practice, with the status and responsibility of first-year doctors. Furthermore, this study reinforces the benefit of asynchronous job change-over for doctors-in-training.

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Boosting clinical performance: The impact of enhanced final year placements

Cited by 3 publications

References 26 publications

Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals

Effectiveness of short, personalised student assistantships: an evaluative study across eight London hospitals

An elective entrustable professional activity-based thematic final medical school year: an appreciative inquiry study among students, graduates, and supervisors

Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study

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