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Biomedical subjects

Debra Nestel

Publications and source records attributed to Debra Nestel.

16 recordsLinked to original sources
PubMed2004

Evaluation of an inter-professional workshop to develop a psychosocial assessment and child-centred communication training programme for paediatricians in training.

BACKGROUND: The quality of psychosocial assessment of children in consultations varies widely. One reason for this difference is the variability in effective mental health and communication training at undergraduate and post-qualification levels. In recognition of this problem, the Royal College of Paediatrics and Child Health in the United Kingdom have developed the Child in Mind Project that aims to meet this deficit in medical training. This paper describes the evaluation of a workshop that explored the experiences and expectations of health care professionals in the development of a training programme for doctors. METHODS: The one-day inter-professional workshop was attended by 63 participants who were invited to complete evaluation forms before and immediately after the workshop. RESULTS: The results showed that the workshop was partially successful in providing an opportunity for an inter-professional group to exchange ideas and influence the development of a significant project. Exploring the content and process of the proposed training programme and the opportunity for participants to share experiences of effective practice were valued. Participants identified that the current culture within many health care settings would be an obstacle to successful implementation of a training programme. Working within existing training structures will be essential. Areas for improvement in the workshop included clearer statement of goals at the outset and a more suitable environment for the numbers of participants. CONCLUSIONS: The participants made a valuable contribution to the development of the training programme identifying specific challenges. Inter-professional collaborations are likely to result in more deliverable and relevant training programmes. Continued consultation with potential users of the programme - both trainers and trainees will be essential.

Adolescent↗
PubMed2004

Facilitating reflection in an undergraduate medical curriculum.

A reflective practitioner is one of the desired outcomes of medical education. This paper describes the introduction of a reflective assignment in the first year of a medical curriculum. Students completed written reflective assignments for which individual and group feedback was provided. Tutors reflected on their roles throughout the development and implementation of this new assignment. The majority of students completed the assignments and while some students became highly involved in the task others worked at a surface level. Tutors found the process time consuming and less enjoyable than working directly with students who need to be supported in the development of skills necessary for reflective practice.

Australia↗
PubMed2004

Teaching and learning about written communications in a United Kingdom medical school.

CONTEXT: Written communications have a long history in medicine. Today, doctors spend a significant part of their work time completing paper work. Although the importance of accurate written communications is acknowledged, medical curricula rarely include focused teaching on this topic. OBJECTIVES: The aim of this paper is to assess the feasibility of a teaching session for second-year medical students aimed at raising their awareness of written communications in the context of health care. METHODS: Immediately after the session, students and tutors completed written evaluations of their experiences. Four months after the session the entire cohort completed a knowledge test, and scores of attendees and non-attendees were compared. FINDINGS: Three of four learning objectives were completely met by at least half of the students and the exercises were rated as helpful. Students' and tutors' comments identified specific aspects of the session that require improvement, in particular, developing the exercise on patient-centred written communications. Students who attended the session scored significantly higher in a relevant knowledge test than non-attendees. DISCUSSION: The session provided students with the knowledge to identify patient-centred written communications and other features of effective writing in the context of medical care. CONCLUSIONS: Introducing the topic early in the medical curriculum may prove valuable in establishing effective practice. Providing students with opportunities to revisit this important topic throughout their medical education may also be beneficial. The long-term impact of the session needs to be evaluated.

Curriculum↗
PubMed2004

Making patient safety the focus: crisis resource management in the undergraduate curriculum.

BACKGROUND: This paper examines the role of high fidelity simulation and crisis resource management in bridging the gap between theory and practice. Patient safety is fundamental to healthcare professional practice and is a common goal for healthcare providers. It provides a focus to motivate practitioners. Patient safety issues are not a priority in undergraduate curricula. Raising the profile at this level is crucial to improving the safety and quality of healthcare delivery. This paper explores the role of simulation in providing a realistic, safe environment for participants with different levels of experience to manage evolving crises in the context of their work environment. METHODS: The Southern Health Simulation and Skills Centre uses a patient safety focus in delivering a specialised educational programme adapted from aviation to healthcare. The programme, crisis resource management, enables participants to consolidate knowledge, attitudes and skills to achieve a deeper understanding of how their performance impacts on patient safety and the quality of healthcare provided. Self-reported written evaluation data was collected from participants of three different courses at Southern Health. RESULTS: Participants consistently report that these courses offer unique learning experiences that address aspects of workplace learning in ways that have not previously been possible. A video-assisted reflective process powerfully reinforces learning. CONCLUSION: Crisis resource management courses demonstrate the value of simulation in bridging the gap between 'knowing' and 'doing' and keeping the focus on patient safety. Recommendations are made for ways in which the core elements of crisis resource management philosophy can influence the conceptualization of a new medical curriculum.

Clinical Competence↗
PubMed2003

Teaching and learning about skills in minor surgery.

The aim of this study was to assess the feasibility of a scenario-based approach to learning minor surgery skills. After learning component technical skills for ellipse excision and wound closure, nurses were provided with an opportunity to integrate these skills with communication skills and contextual factors in a quasi-clinical environment. Feasibility was assessed using observation of procedures and a group interview with participants, simulated patients and tutors. The scenario-based approach to teaching and learning about technical and communication skills proved feasible and was valued by participants in this course on minor surgery. Although all participants expressed anxiety about integrating skills in the quasi-clinical setting, they valued the opportunity to undergo a formative assessment prior to working in supervised settings with real patients. Learners valued highly the opportunity to reflect on their performance and to receive feedback on technical and communication skills. Future courses should include focused teaching on communication skills prior to the scenario-based exercise. Limitations of the study centre on the small numbers of participants and the novelty of the course. Repeating the evaluations on a subsequent course will provide insight into the ways in which nurses acquire and integrate new skills.

Clinical Competence↗
PubMed2003

Peer tutoring in patient-centred interviewing skills: experience of a project for first-year students.

Peer tutoring is a potentially valuable resource in higher education. There are few published accounts of the impact of peer tutoring in medical education. College-wide experience of peer tutoring together with difficulties recruiting medical teachers for a communication programme led to the development of a peer-tutoring project. This paper reports the impact on first-year medical students of peer tutoring in patient-centred interviewing. After attending a preparatory workshop, third-year medical students co-facilitated their first-year colleagues in a session:Interviewing a Simulated Patient. First-year students completed written evaluations immediately after the session and two months later randomly selected students were assessed in patient-centred interviews. The impact of the peer-tutoring experience was evaluated by comparing these outcomes for students in groups co-facilitated by peer tutors with those who worked in groups facilitated by medical teachers. The eight learning objectives were completely met by more than 56% of students. However, there were statistically significant differences for four objectives with more students in groups facilitated by medical teachers completely meeting these objectives. Although the seven educational techniques used in the session were rated favourably by all students, two were rated as more effective in achieving the learning objectives by students in groups facilitated by medical teachers. Free-text comments revealed no differences between groups. Two months after the session, there were no differences between students in terms of interviewing skills as rated by trained observers and simulated patients, whilst simulated patients were more satisfied with interviews from students facilitated by peer tutors (p <0.02). Peer tutors can support the acquisition of basic patient-centred interviewing skills in first-year medical students when contributing to one session of a structured programme. First-year students were receptive and willing to learn from their senior colleagues.

Communication↗
PubMed2002

An innovative model for teaching and learning clinical procedures.

CONTEXT: Performing a clinical procedure requires the integration of technical clinical skills with effective communication skills. However, these skills are often taught separately. OBJECTIVES: To explore the feasibility and benefits of a new conceptual model for integrated skills teaching. : Design A qualitative observation and interview-based study of undergraduate medical students. METHODOLOGY: Medical students performed technical and communication skills in realistic clinical scenarios (urinary catherization and wound closure), using latex models connected to simulated patients (SPs). Procedures were observed, videorecorded and assessed by tutors from an adjoining room. Students received immediate feedback from tutors and SPs, before engaging in a process of individual feedback through private review of their videotapes. Group interviews explored the response of students, SPs and tutors. Data were analysed using standard qualitative techniques. SUBJECTS: Fifty-one undergraduate students were recruited from the Faculty of Medicine, Imperial College, London. RESULTS: The scenarios provided a realistic simulation of two common clinical situations and proved feasible in terms of time, facilities and resources within this institution. Students found the opportunity to integrate communication and technical skills valuable, challenging and an appropriate learning experience. Immediate feedback was especially highly valued. Some students found difficulty integrating technical and communications skills, but benefited from conducting two procedures in the same session. CONCLUSION: The integrated model was feasible and was perceived to be valuable. Benefits include the opportunity to integrate, within a safe environment, skills which are often taught separately. Promoting reflective practice may enable the successful transfer of these integrated skills to other procedures.

Clinical Competence↗
PubMed2002

Modelling the lay expert for first-year medical students: the actor-patient as teacher.

Actors are widely used in medical education as simulated patients. In this session, the role of actors was extended to 'simulated students' and facilitators in an introductory communication session. After an initial activity with the entire cohort of first-year students, groups of 20 students worked with either an actor or medical teacher in three activities. The activities aimed to raise students' awareness of the range of communication challenges in medical education and practice. After the session, students completed evaluation forms based on their experiences in the session. The results revealed no difference between students who were facilitated by actors or medical teachers in relation to meeting the learning objectives and their ratings of the usefulness of the activities to support learning. The actors who participated in this session were experienced in working with medical students. Their enhanced role provides students with an opportunity to identify with and reflect on the expertise of a lay teacher and to consider extending their definition of a learning opportunity to more informal encounters.

Communication↗
PubMed2001

Evaluation of a communication skills course: cultural relevance of the patient-centred interview in a Hong Kong Chinese setting.

Evidence for the use of a patient-centred model for interviewing is well established in the West. There is much less evidence for the application of the model in other cultural settings. This paper describes the impact of a communication skills (CS) course for doctors (n = 32) working in government outpatient clinics in Hong Kong. Emphasis is placed on the cultural relevance of the patient-centred interview (PCI) and educational techniques. Knowledge scores increased immediately after the course and again 8 weeks later (p < 0.001). Participants held favourable attitudes at the outset of the course and these were largely maintained. Qualitative data suggests that the doctors' competence in CS increased. The PCI model was perceived as relevant to the practices of these doctors. Barriers preventing the implementation of this approach related to organizational rather than cultural factors. The educational strategies were well received, suggesting that adult Chinese learners are not dissimilar to their Western counterparts in approaches to learning.

Journal Article↗