Editorial

Similar but different: the importance of context

W

hen I first moved to Australia in 2003 and began working 1 day per week as a general practitioner (GP) my initial thoughts were that the ‘job’ was very similar to the role I had been used to in the UK. In both countries GP surgeries are commonly the main first point of contact for people seeking advice about their health and illnesses. A GP referral is required to access hospital specialists, excepting access via emergency departments. The range of health care professionals is similar, and includes practice and community nurses, pharmacists, physiotherapists, midwives, etc. I soon noticed, however, both obvious and subtle differences, becoming aware that the funding and philosophy of a health service affects the way that professionals work, both individually and collaboratively. This is not something that we necessarily teach our students. In my experience medical students,

for example, are not that interested in the organisation and governance of their own national health services, let alone those of other countries. To be honest, taken out of the context of immediate health care delivery, the subject can be rather dry; however, it is important that learners understand the culture of their future workplace and the people within it. Over the last few months I have been travelling a fair bit as the guest of various medical schools and faculties of health around the world. What is striking, but perhaps not surprising, is that the concerns expressed and questions raised by health professional educators are very similar, whatever country and system they are working in. Specific curricula may vary, however, and people are struggling with assessment, quality assurance of teaching and dwindling resources, in terms of

the number of clinical teachers and clinical placements, at a time of rising student numbers and the demand for more intensive postgraduate supervision. Governments are grappling with rising health care costs while students are facing higher tuition fees in a background of the need for cost-effectiveness. One solution to the lack of suitably trained facilitators able to give feedback is the use of teledebriefing, which has educational potential when trainees are dispersed across wide areas for clinical attachments. The method is described in this issue in relation to simulation,1 although I know of a similar process used with ‘real’ consultations remote from the supervisor’s location. It complements the rise of telehealth as a means of access to specialists in rural and underserved communities. Elsewhere, clinical teachers are grappling with the need to

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role model team-based care and prepare learners to not only be work-ready on graduation, but also to be competent to provide care for the next 40 years. The future is unpredictable, but one UK medical school is helping students think about sustainability and recycling in clinical practice because of the potential impact of climate change during their careers.2 The solutions to clinical teaching problems need to be informed by local and regional customs and constraints, and be feasible and acceptable within their own contexts. When you read of successful innovations in clinical education in The Clinical Teacher, it is necessary to consider whether your situation would support a similar process or if it would need to be adapted to meet your specific circumstances. For example, linking radiographic signs with familiar objects as described by Foye and colleagues is a useful teaching strategy, as long as the signs chosen are locally appropriate.3 And although it is good to read that the presence of medical students is acceptable to patients in gynaecology clinics in Australia,4 this may not be the case in other countries and for other patients. In other words, you, the reader, need to consider how generalisable certain findings are to your situation. Globally, variations on the objective structured clinical examination (OSCE) are still prevalent, but greater attention is focusing on work-based assessment (WBA). All examples of WBA are labour-intensive, whether they require focused observation and feedback, such as with the mini clinical evaluation exercise (mini-CEX) and direct observation of procedural

skills (DOPS), or longer-term judgments, such as with multisource feedback (MSF). One method of direct observation is the one-way mirror,5 an elegant solution in some situations but not in others, where the required infrastructure is not available. WBA relies on motivated clinical teachers, many of whom are already struggling with increasing workloads arising from their clinical commitments, administration, continuing professional development (and revalidation in the UK for medical doctors) and supervision/mentoring of junior staff.

implement interprofessional case presentations,7 and the role of expert patients in longitudinal interprofessional placements.8

There is also increasing interest in interprofessional education (IPE) and interprofessional practice for team-based care delivery and workforce shortages. The theme of the International Medical University’s (IMU) annual conference that I attended in Kuala Lumpur in March was IPE, and a similar national day of discussion took place in Yogyakarta, Indonesia, a few days later. The delegates are all struggling with the familiar areas of assessment (of teamwork), how to ensure that clinical teachers from all professions are able to facilitate and assess interprofessional activities and, of course, the logistics of a large number of students from different schools having the opportunity to learn and work together. I learned of other challenges. For example, in Germany, nursing and allied health programmes are not degree courses and are not university based, so bringing students together for common courses is difficult. The articles on IPE presented this month look at interprofessional learning in relation to prescribing and patient safety,6 how to

REFERENCES

The range and scope of articles in the journal continues to increase. We are very keen to read work from all areas of the globe – highlighting the similarities and the differences that make clinical education such a fascinating enterprise.

Jill Thistlethwaite Co-Editor in Chief

1.

Ahmed R, King-Gardner A, Atkinson S, Gable B. Teledebriefing: connecting learners to faculty members. Clin Teach 2014;11:270–273.

2.

Bajgoric S, Appiah J, Wass V, Shelton C. Sustainability in clinical skills teaching. Clin Teach 2014;11:243–246.

3.

Foye P, Abdelshahed D, Shounuck P. Musculoskeletal pareidolia in medical education. Clin Teach 2014;11:251–253.

4.

Yang J, Black K. Medical students in gynaecology clinics. Clin Teach 2014;11:254–258.

5.

Sehgal R, Hardman J, Haney E. Observing trainee encounters via a one-way mirror. Clin Teach 2014;11:247–250.

6.

Hardisty J, Chandler S, Pearson P, Powell S, Scott L. Interprofessional learning for medication safety. Clin Teach 2014;11:290–296.

7.

Gilbee A, Baulch J, Leech M, Levinson M, Kiegaldie D, Hood K. A guide for interprofessional case presentations. Clin Teach 2014;11:297–300.

8.

Towle A, Brown H, Hofley C, Kerston RP, Lyons H, Walsh C. The expert patient as teacher: an interprofessional Health Mentors programme. Clin Teach 2014;11:301–306.

doi: 10.1111/tct.12274

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Similar but different: the importance of context.

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