Integrating patient management, reflective practice, and ethical decision-making in an emergency medicine intern boot camp

Abstract

Background Integration of clinical skills, ethical decision-making, and reflection skills have emerged as cornerstones of clinical teaching in medical schools. This study aimed to detect whether a multimodal learning environment approach consisting of lectures, a drill, post-drill video debriefing, and written reflection in an emergency medicine rotation boot camp improves interns’ patient management skills, ethical decision-making, and reflection skills. Methods A multimodal learning environment was created by the collaboration of emergency medicine, ethics, and medical education specialists. Multiple educational techniques involving lectures, case discussions, and role-playing a crisis scenario were applied. Pre-test and post-test, debriefing on performances on video records, video-recorded performance assessment, and reflective essays about their own and group’s performances were used to assess various aspects of the student performances. Additionally, a meeting was organized with the presence of the authors to create qualitative data obtained through the program evaluation meeting conducted on three themes: influences of teaching methods, students’ performances, and common achievements and mistakes of students. Results 133 students participated. Post-test multiple-choice question (MCQ) test scores were slightly higher than pre-test. A low and medium correlation was detected among pre-test and post-test patient management problem (PMP) and reflection scores, which was more prominent for female students. Multiple linear regression showed that pre-test and post-test PMP scores significantly contributed to reflection scores. These results might support that better patient management predicts more robust reflective practice. Teachers observed that students appreciated being inspired by well-performing peers, particularly noting the empathic needs of patients, companions, and other health professionals. However, students overlooked summoning forensic or social services and were inhibited by the pressure of the contextual traits of the drill. Conclusion The multimodal learning environment created by multidisciplinary collaboration contributed to the improvement of components of situational awareness of the interns: patient management skills, ethical decision-making, and reflective practice. During this research, we created a toolbox better to capture the richness and diversity of student interactions. Considering the scarcity of context-specific assessment methods and widespread use of MCQs or generic scales for higher-order thinking skills in medicine, this study might be regarded as a step forward in that context.

A systematic scoping review of reflective writing in medical education

“…From a personal perspective, RW increases self-awareness [ 114 , 127 , 137 , 161 , 166 , 179 , 185 , 202 , 216 ], self-advancement [ 9 , 131 , 134 , 150 , 168 , 174 , 195 , 205 , 217 , 229 ], facilitates understanding of individual strengths, weaknesses and learning needs [ 112 , 119 , 150 , 152 , 170 , 218 , 219 ], promotes a culture of self-monitoring, self-improvement [ 130 , 172 , 173 , 185 , 193 , 198 , 201 , 210 , 211 ], developing critical perspectives of self [ 193 , 223 ] and nurtures resilience and better coping [ 154 , 160 , 206 ]. RW also guides shifts in thinking and perspectives [ 148 , 149 , 156 , 203 , 207 , 208 ] and focuses on a more holistic appreciation of decision-making [ 37 , 118 , 126 , 174 , 177 , 194 , 196 , 199 , 200 , 224 – 226 ] and their ramifications [ 37 , 112 , 116 , 130 , 13...…”

Pre-practice boot camps to increase retention of new graduate nurses

“…The goal of each boot camp was to prepare students for real-life situations in healthcare. Student learning was addressed through a variety of methods and variable durations 10-14…”

“…However, of all the articles reviewed, only one boot camp was entirely virtual; it was the longest, with a duration of 2 weeks comprised of 2-hour daily sessions 13. The in-person boot camps ranged from a few hours to 5 days; the shorter ones focused on specific tasks instead of a broad range of items and virtual and in-person options 10-12,14. Virtual learning consisted of a pre-learning exercise that included informational videos and virtual reality airway models 11,14…”

“…New nurse attrition, or the exit from the nursing field by NGNs during their first year of practice, predates the COVID-19 pandemic. 2,3,5,7,9,10 An average of 60% of NGNs intend to leave the profession during their first year of practice. 2 Other studies estimated the rate to be as high as 74.4%.…”

“…13 Other boot camps were comprised of an 8-hour nursing obstetrical boot camp with simulation; a 3-day boot camp that used simulation-based mastery learning to address procedural skill learning; and a 5-day camp that addressed patient manage-ment, ethical decision-making, and reflective practice in emergency medicine. 10,12,14 Boot camp experiences researched by this paper' s authors could be used as the basis for a boot camp for NGNs.…”