really good stuff of collaborative learning, students would gain a better understanding of their future roles, which would aid interdisciplinary working relationships. What was tried? Selected medical students on a paediatric attachment and final-year pharmacy students were placed in mixed groups of approximately 30 students per group. Over the academic year, we conducted six 3-hour workshops on theoretical and practical aspects of prescribing. Students were split into smaller mixed groups and together worked through realistic prescribing scenarios. A workbook of scenarios and an accompanying slide show were prepared. These resources were developed by the present authors to allow the course to be taught by a variety of instructors, thereby improving its sustainability. The session was run in a teaching room in the medical school by a doctor and a pharmacist. At the end of each session, students were asked to complete a feedback form. We ran two mixed focus groups to allow students to comment on the usefulness of the teaching and resources. What lessons were learned? Both groups of students had little prior teaching on practical prescribing. All of the medical students (n = 43) and 86.6% of the pharmacy students (71/82) found the session relevant. Both sets wanted more prescribing teaching in their courses. The majority of those who did not consider the session relevant found it to be overly geared towards medical students. One of the challenges involved adjusting the curriculum to meet the needs of both student sets. Another difficulty involved the coordination of the teaching staff, students and administrators of two different courses. Numerous logistical difficulties arose. The drive of the authors helped to overcome this to some degree, but the issue creates problems in integrating the course into the curriculum on a long-term basis. Pharmacy students (91.7%) and medical students (94.6%) found it useful to learn in an interdisciplinary group, which represented a new experience for both sets of students. Students had little prior knowledge of one another’s roles. Some students revealed prejudices about the other group; some pharmacy students said they perceived doctors as ‘being intimidating’, and some medical students considered pharmacists to be overly oriented on ‘fault-finding’. The students felt the relaxed nature of the session helped to dispel stereotypes and considered it would improve future working relationships. Overall, the students felt the mixed sessions gave them a unique opportunity to work with other disciplines and understand the roles of different health
professionals. We were surprised by the extent to which student perceptions were altered by the session. Although there are logistical difficulties, this is a worthwhile endeavour and should be continued and integrated as a formal part of the joint undergraduate curriculum in this area and others. Correspondence: Kathleen J Birley, Flat 57, Vogans Mill Wharf, 17 Mill Street, London SE1 2BZ, UK. Tel: 07747873040; E-mail: [email protected] doi: 10.1111/medu.12447
Transgender history taking through simulation activity Richard E Greene, Ann R Garment, Allison Avery & Chelsea Fullerton What problem was addressed? Eliciting a thorough sexual history can be an intimidating experience for medical students, especially when it comes to transgender patients. Furthermore, most students do not encounter transgender patients until they are alone in an examination room or in the emergency department. In these high-pressure settings, students often become flustered and have difficulty applying classroom knowledge. Because of this, it is essential to build a realistic encounter in the preclinical years to prepare students to interact with transgender patients in a culturally competent manner. A clinical librarian conducted a comprehensive literature search; at the time of this writing, no such programme had been described. What was tried? As part of a larger simulation (SIM) activity about taking a sexual history, we piloted a case with standardised patients (SPs) who portrayed transgender patients coming in for general check-ups. The 18 students participating in the SIM were enrolled in their first course at medical school. Our intent was to give students a low-risk opportunity to take a sexual history from a transgender patient by removing obstacles such as patient distress or uncontrolled medical conditions. Students were asked to take a thorough sexual history in 10 minutes. In the case instructions, students were informed that the patient was transgender (some were male-to-female, others female-to-male) and had already agreed to talk with the student. We intentionally sought actors who identified as transgender and coached them prior to the SIM on the history of the patient in the case, the structure of a sexual history, and how to react to students who were struggling. Additionally, we instructed the
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
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really good stuff actors to portray the patient as someone who was not easily offended and to correct students kindly if they made inappropriate remarks. Students received a reading about sexual history taking and attended a 30-minute sexual history lecture before the SIM, although neither included content specific to transgender health. Following the SIM, students participated in a debriefing with faculty members and SPs. What lessons were learned? Overall, the case was well-received by students, who described the experience as personally and clinically constructive. Although some students froze, felt unsure of what to ask and even became tearful, all rated the SIM as one of the most useful in their education thus far. The actors can be credited with part of this success as they performed at a high level, remained nonjudgemental throughout the encounter, and offered constructive feedback. They also expressed appreciation for their inclusion in the formative education of future health care providers. Since the initial SIM, clinical-level students have been given a more challenging version of the case with the addition of chronic medical conditions that can be affected by hormone use. In the future, we plan to publish more information gathered about students’ performance on this activity and its impact on their knowledge, skills and attitudes. Additionally, we will conduct similar SIMs for housestaff. We are confident that, through data collection and analysis, we can improve and expand this valuable learning experience. Correspondence: Chelsea Fullerton, Office of Diversity Affairs, New York University School of Medicine, 545 First Avenue, Suite 5R-C, New York, New York 10016, USA. Tel: 00 1 212 263 3879; E-mail: [email protected] doi: 10.1111/medu.12439
Facilitating the clerkship transition through nearpeer-led ‘student reports’ Caroline A Nelson, Zachary Frosch, Jennifer Lapin & Jennifer R Kogan What problems were addressed? The transition into clinical clerkships is often challenging for medical students, who are required to assimilate new skills and social behaviours in an unfamiliar learning environment. Nicholson’s transition cycle theory contends that preparation for new role requirements and prior role socialisation experiences facilitate a successful transition.1 We developed an optional ‘student report’ curriculum for pre-clerk-
532
ship students aimed at strengthening clinical reasoning skills using near-peer mentors. What was tried? Five ‘student reports’ took place at our institution between January and May 2013. Four reports were developed and taught by postclerkship students. They consisted of mock clinical cases presented in an interactive case conference format. For each case, pre-clerkship students generated an initial differential diagnosis, elicited history, physical examination and diagnostic data to identify the most important clinical information, prioritised the differential, and developed a concise summary statement. Paper surveys, distributed before and after each of the four reports and matched using self-generated identification codes, assessed pre-clerkship students’ self-perceived competence in these clinical reasoning skills using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Differences in self-perceived competence before and after each report were determined using two-tailed, paired-sample t-tests (a = 0.05). Standardised effect sizes were measured using Cohen’s d. Pre-clerkship students attending at least one report were sent a 26-item, web-based survey. Six questions focused on preferences, and the advantages and disadvantages of the near-peer format. Quantitative data were analysed using descriptive statistics; open-ended responses were independently coded by two authors to identify emerging themes. The University of Pennsylvania Institutional Review Board approved the study. What lessons were learned? Of 163 pre-clerkship students, 61 attended at least one report. A total of 149 paper surveys were obtained from 44 students (mean number of reports attended: 2.20; range: 1–5). The exclusion of unmatched surveys yielded 140 surveys for analysis. Participants’ selfperceived competence in each clinical reasoning skill significantly increased for all reports (p < 0.0058) with large effect sizes (Cohen’s d: 0.80–2.15). A total of 25 of 61 students completed the web-based survey (mean number of reports attended: 2.48; range: 1–5). Overall, 72% of respondents preferred near-peer to faculty preceptors. The majority agreed or strongly agreed that near-peers gave helpful advice (72%) and provided role modelling (60%). Identified advantages of near-peer teaching included the provision of advice, relating basic science to clinical care, role modelling, a safe learning environment, and teaching at an appropriate level. One disadvantage, the possession of less knowledge relative to faculty staff, was identified by 24% of respondents. When asked to indicate the most valuable aspect of
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
professionals. We were surprised by the extent to which student perceptions were altered by the session. Although there are logistical difficulties, this is a worthwhile endeavour and should be continued and integrated as a formal part of the joint undergraduate curriculum in this area and others. Correspondence: Kathleen J Birley, Flat 57, Vogans Mill Wharf, 17 Mill Street, London SE1 2BZ, UK. Tel: 07747873040; E-mail: [email protected] doi: 10.1111/medu.12447
Transgender history taking through simulation activity Richard E Greene, Ann R Garment, Allison Avery & Chelsea Fullerton What problem was addressed? Eliciting a thorough sexual history can be an intimidating experience for medical students, especially when it comes to transgender patients. Furthermore, most students do not encounter transgender patients until they are alone in an examination room or in the emergency department. In these high-pressure settings, students often become flustered and have difficulty applying classroom knowledge. Because of this, it is essential to build a realistic encounter in the preclinical years to prepare students to interact with transgender patients in a culturally competent manner. A clinical librarian conducted a comprehensive literature search; at the time of this writing, no such programme had been described. What was tried? As part of a larger simulation (SIM) activity about taking a sexual history, we piloted a case with standardised patients (SPs) who portrayed transgender patients coming in for general check-ups. The 18 students participating in the SIM were enrolled in their first course at medical school. Our intent was to give students a low-risk opportunity to take a sexual history from a transgender patient by removing obstacles such as patient distress or uncontrolled medical conditions. Students were asked to take a thorough sexual history in 10 minutes. In the case instructions, students were informed that the patient was transgender (some were male-to-female, others female-to-male) and had already agreed to talk with the student. We intentionally sought actors who identified as transgender and coached them prior to the SIM on the history of the patient in the case, the structure of a sexual history, and how to react to students who were struggling. Additionally, we instructed the
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
531
really good stuff actors to portray the patient as someone who was not easily offended and to correct students kindly if they made inappropriate remarks. Students received a reading about sexual history taking and attended a 30-minute sexual history lecture before the SIM, although neither included content specific to transgender health. Following the SIM, students participated in a debriefing with faculty members and SPs. What lessons were learned? Overall, the case was well-received by students, who described the experience as personally and clinically constructive. Although some students froze, felt unsure of what to ask and even became tearful, all rated the SIM as one of the most useful in their education thus far. The actors can be credited with part of this success as they performed at a high level, remained nonjudgemental throughout the encounter, and offered constructive feedback. They also expressed appreciation for their inclusion in the formative education of future health care providers. Since the initial SIM, clinical-level students have been given a more challenging version of the case with the addition of chronic medical conditions that can be affected by hormone use. In the future, we plan to publish more information gathered about students’ performance on this activity and its impact on their knowledge, skills and attitudes. Additionally, we will conduct similar SIMs for housestaff. We are confident that, through data collection and analysis, we can improve and expand this valuable learning experience. Correspondence: Chelsea Fullerton, Office of Diversity Affairs, New York University School of Medicine, 545 First Avenue, Suite 5R-C, New York, New York 10016, USA. Tel: 00 1 212 263 3879; E-mail: [email protected] doi: 10.1111/medu.12439
Facilitating the clerkship transition through nearpeer-led ‘student reports’ Caroline A Nelson, Zachary Frosch, Jennifer Lapin & Jennifer R Kogan What problems were addressed? The transition into clinical clerkships is often challenging for medical students, who are required to assimilate new skills and social behaviours in an unfamiliar learning environment. Nicholson’s transition cycle theory contends that preparation for new role requirements and prior role socialisation experiences facilitate a successful transition.1 We developed an optional ‘student report’ curriculum for pre-clerk-
532
ship students aimed at strengthening clinical reasoning skills using near-peer mentors. What was tried? Five ‘student reports’ took place at our institution between January and May 2013. Four reports were developed and taught by postclerkship students. They consisted of mock clinical cases presented in an interactive case conference format. For each case, pre-clerkship students generated an initial differential diagnosis, elicited history, physical examination and diagnostic data to identify the most important clinical information, prioritised the differential, and developed a concise summary statement. Paper surveys, distributed before and after each of the four reports and matched using self-generated identification codes, assessed pre-clerkship students’ self-perceived competence in these clinical reasoning skills using a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree). Differences in self-perceived competence before and after each report were determined using two-tailed, paired-sample t-tests (a = 0.05). Standardised effect sizes were measured using Cohen’s d. Pre-clerkship students attending at least one report were sent a 26-item, web-based survey. Six questions focused on preferences, and the advantages and disadvantages of the near-peer format. Quantitative data were analysed using descriptive statistics; open-ended responses were independently coded by two authors to identify emerging themes. The University of Pennsylvania Institutional Review Board approved the study. What lessons were learned? Of 163 pre-clerkship students, 61 attended at least one report. A total of 149 paper surveys were obtained from 44 students (mean number of reports attended: 2.20; range: 1–5). The exclusion of unmatched surveys yielded 140 surveys for analysis. Participants’ selfperceived competence in each clinical reasoning skill significantly increased for all reports (p < 0.0058) with large effect sizes (Cohen’s d: 0.80–2.15). A total of 25 of 61 students completed the web-based survey (mean number of reports attended: 2.48; range: 1–5). Overall, 72% of respondents preferred near-peer to faculty preceptors. The majority agreed or strongly agreed that near-peers gave helpful advice (72%) and provided role modelling (60%). Identified advantages of near-peer teaching included the provision of advice, relating basic science to clinical care, role modelling, a safe learning environment, and teaching at an appropriate level. One disadvantage, the possession of less knowledge relative to faculty staff, was identified by 24% of respondents. When asked to indicate the most valuable aspect of
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
