Student assistantships

An extended assistantship for final-year students Amy Hawkins, Andrew Stanton and Karen Forbes Faculty of Medicine, University of Bristol, Bristol, UK

SUMMARY Background: Many students feel unprepared for clinical practice after completing their medical school training. There is evidence that a brief shadowing period improves student confidence and patient safety, but there is currently little evidence on the impact of a longer shadowing period. A 10–week student assistantship (SA) for final-year students was implemented for Year 5 undergraduates at the University of Bristol in 2011. This study investigated the impact of the SA on student confidence. Methods: All final-year medical students at the University of

Bristol in the academic year 2012–13 (n = 248) were contacted with an online questionnaire at the start of the SA. They were asked about confidence in a range of domains. Further questionnaires were sent at the end of the SA, and again once the students had qualified as foundation doctors. Descriptive statistical analysis was performed. Results: A total of 37 students responded to the pre-assistantship questionnaire, 62 to the post-assistantship questionnaire, and 13 to the questionnaire sent once students had qualified. Self-assessed

confidence improved in all areas when the pre- and post-assistantship scores were compared, in particular prescribing, assessing and managing unwell patients, and aspects of death and dying. Discussion: Our findings suggest that a prolonged assistantship period improves knowledge and skills in a range of domains relevant to becoming a junior doctor, and could be considered within medical schools as a way to address established areas of poor confidence in new graduates. Larger studies are needed to provide more robust evidence for these initial findings.

Many students feel unprepared for clinical practice

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Students are expected to take part in on-call commitments, including weekends and night shifts

INTRODUCTION

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n 2012, the General Medical Council (GMC) and Medical Education England (MEE) introduced a compulsory minimum period of 4 days shadowing (observing and learning from junior doctors) for newly qualified doctors before beginning their foundation year 1 (intern) posts.1 This was to reduce the so-called ‘August effect’: the observed rise in in–patient mortality on the first day in August after newly qualified doctors start working.2 A pilot study has suggested that error rates were halved amongst foundation doctors who completed the shadowing programme, compared with those who did not.3

There is widespread evidence to suggest that medical students feel underprepared for clinical practice on completion of their medical school training.4–7 Key areas in which students report particularly low levels of preparedness are prescribing, procedures and completing cremation forms after a patient’s death.6,7 There is, however, little research examining the impact of longer shadowing programmes on medical students’ clinical confidence. In 2011–2012, a 10–week student assistantship (SA) programme was introduced for final-year medical students at the University of Bristol as the core activity within the newly created Year 5 Preparing for Professional Practice (PPP) unit. Previous cohorts had shadowed for 2 weeks only. By the start of this unit, students had completed the majority of their summative assessments required for finals. The aim of this study was to determine whether the programme improved students’ confidence in a range of areas relevant to commencing work as a foundation programme doctor.

Aims: 1. To prepare you for the transition from student to F1 doctor through the practical clinical experience of assisting a junior doctor 2. To consolidate your practical knowledge, skills and attitudes essential for beginning the foundation programme Learning objectives: 1. 2. 3. 4. 5. 6. 7. 8. 9.

To understand the roles and responsibilities of the F1 doctor To identify and reflect on the clinical skills needed by F1 doctors To consolidate the communication skills required of a F1 doctor To consider how to prioritise clinical and administrative work To become familiar with relevant administrative procedures To appreciate the nature of team work in the health professions To appreciate the roles and responsibilities of other professionals caring for patients, and to identify areas of interface with the F1 doctor role To consider when, how and whom to ask for help

Figure 1. Aims and learning objectives of the student assistantship

METHODS The student assistantship The SA is a 10–week programme divided between attachments in medicine and surgery. Students are attached to one junior doctor. During the SA, students are either allocated a number of patients for whom they are largely responsible or they function as a foundation year–1 (F1) doctor, and the junior doctor assists and oversees the student. Students are supervised by a clinical teaching fellow and consultant programme leads. Students are expected to take part in on-call commitments, including weekends and night shifts. During the SA, students also undertake a 2–week primary care attachment that improves their knowledge and understanding of general practice and the primary–secondary care interface. This assistantship model is an example of experiential learning, as outlined in Kolb’s experiential learning cycle.8 Through initial reflective observation, students progress to abstract conceptualisation, active experimentation and concrete experience. The unit includes minimal didactic teaching to maximise learning opportunities in the ward environment. The curriculum has been designed to encompass the skills outlined in the GMC’s Duties of a

doctor.9 The aims and objectives of the SA are outlined in Figure 1. The questionnaire All final-year Bristol medical students in the academic year 2012– 13 (n = 248) were contacted at the start of the assistantship in January 2013 with a link to an online survey (Appendix S1). Students were asked about their initial confidence in a range of areas, including prescribing, procedures, patient management, communication and aspects of palliative care. These items were selected based upon evidence suggesting particular areas where newly qualified doctors felt poorly prepared.7 A reminder e-mail was sent 1 week later. Questions comprised semantic differential scales (1–7: 1, not at all; 7, greatly) and free-text boxes. Between January and March 2013, each student undertook a 10–week SA. Once the students had completed the SA, we sent another questionnaire to assess their confidence (Appendix S2). As a result of an administrative error, a semantic differential scale of 1–5 was used, rather than the 1–7 scale used in the initial questionnaire. A reminder was sent to the year group 1 week later. We also sent a third questionnaire in August 2013 once the students had qualified and were working as junior doctors.

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Percentage increase in confidence

50 45 40 35 30 25 20 15 10 5 0

45 40.28 35.3

34.23 34.85

30.82 31.77

28.56

32.18 30.18 26.25

25.06

Consent and ethical approval Consent was gained from each participant for their anonymised feedback to be analysed and used for publication. Full ethical approval was granted by the University of Bristol Ethics Committee. All data were stored and analysed anonymously.

Students reported feeling well prepared to take up their F1 posts

RESULTS Figure 2. Relative percentage change in confidence scores before and after the assistantship (areas with an increase in confidence of ≥30% are highlighted in orange; areas with an increase in confidence of

An extended assistantship for final-year students.

Many students feel unprepared for clinical practice after completing their medical school training. There is evidence that a brief shadowing period im...
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