Education Research: Positive effect of scheduled faculty modeling on clerkship student bedside skills exposure and learning

Abstract

Objective: To evaluate the effect of scheduled bedside skills modeling for third-year medical students on their neurology clerkship.Methods: During the 2012-2014 academic years, 56 third-year medical students participated in a curricular pilot program involving a scheduled bedside skills modeling experience during the first week of their neurology clerkship, whereas 131 students underwent the typical rotation. The experience consisted of observing a faculty member conduct a comprehensive encounter on a new outpatient. To promote active learning, students were provided an observation guide to document questions and observations. An anonymous survey was conducted at the end of each clerkship block assessing student exposure to bedside skills modeling. Using qualitative thematic analysis, observation guide statements were transcribed and coded into emergent learning themes.Results: A total of 57.4% (95% confidence interval [CI] 43.3%-71.5%) of students in the modeling group reported observing both a comprehensive history and neurologic examination vs 37.5% (95% CI 28.2%-46.8%) in the nonmodeling groups (p 5 0.023). A total of 253 observation statements were transcribed and coded from the observation guides. The most common learning themes included (1) strategies for performing a neurologic examination, (2) techniques for eliciting a neurologic history, and (3) importance of detail and thoroughness of the history and examination.Conclusions: Our study demonstrated that there was a significant increase in structured observation by students of neurologic bedside skills with the inclusion of a scheduled modeling experience, and we provide a qualitative description of the most common learning themes associated with this experience. Neurology ® 2017;88:e236-e239 GLOSSARY CI 5 confidence interval.In the modern medical era, bedside skills have become devalued with increased reliance on medical technological advances and the electronic health record. Numerous editorial and opinion articles have been published in recent years highlighting the decline in bedside skills education for medical trainees and the effect of this on patient care.1-4 Despite this knowledge, it is currently estimated that only 8%-19% of learning is done in the presence of the patient.5 Barriers to bedside teaching include devaluation of teaching and inadequate faculty development to promote bedside teaching skills among faculty.6,7 Modeling of clinical encounters has been shown to improve both physical examination and procedural skills, and can be effective for teaching humanism and professionalism values. 8-10The aim of this study was to evaluate whether a scheduled modeling experience for third-year medical students starting their neurology clerkship increased overall student exposure to clinical skills modeling during the clerkship. In addition, we intended to discover using qualitative thematic analysis what specific learning points were acquired during the experience. Dentistry third-year neurology clerks participated in a pilot aimed at ...

Neurophobia: why, how much, consequences and solutions

“…As regards practical study, bedside learning is useful if each student has a role in the medical team (responsibilities should be distributed between students and residents), and knows the patients (which will involve follow-up); otherwise students lose interest and feel left out ( Thompson Stone et al , 2017 ). As we mentioned, contact solely with inpatients, with especially severe or rare disorders, may encourage neurophobia.…”

“…As we mentioned, contact solely with inpatients, with especially severe or rare disorders, may encourage neurophobia. It would be recommendable for students to rotate to outpatient clinics and so to be exposed to the common neurological pathologies which they will have to deal with at the end of their medical courses ( Thompson Stone et al , 2017 ).…”

“LEARN”, a novel teaching method for Chinese clinical clerkship: A cross-sectional study

“…The most widely implemented transition model implemented in China is a clerkship rotation. Specifically, a clerkship is a stage when medical students enter the clinic and learn basic bedside skills by observation ( 9 ), instead of actual practice which usually begins during the fourth year of the 5-year clinical medicine program. Moreover, in consideration of the intense relationship between doctors and patients in China ( 10 , 11 ), the clerkship period, which exposes medical students to the clinical environment, equips them with essential practical skills and provides students with opportunities to communicate with patients ( 12 ), certainly brings growth for future doctors in both their professionalism and communication skills.…”