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Biomedical subjects

Tim Dornan

Publications and source records attributed to Tim Dornan.

At least 19 recordsLinked to original sources
PubMed2007

Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning.

OBJECTIVE: To develop a model linking the processes and outcomes of workplace learning. METHODS: We synthesised a model from grounded theory analysis of group discussions before and after experimental strengthening of medical students' workplace learning. The research was conducted within a problem-based clinical curriculum with little early workplace experience, involving 24 junior and 12 senior medical students. RESULTS: To reach their ultimate goal of helping patients, medical students must develop 2 qualities. One is practical competence; the other is a state of mind that includes confidence, motivation and a sense of professional identity. These 2 qualities reinforce one another. The core process of clinical workplace learning involves 'participation in practice', which evolves along a spectrum from passive observation to performance. Practitioners help students participate by being both supportive and challenging. The presentation of clear learning objectives and continuous periods of attachment that are as personal to the student(s) and practitioner(s) as possible promote workplace learning. CONCLUSIONS: The core condition for clinical workplace learning is 'supported participation', the various outcomes of which are mutually reinforcing and also reinforce students' ability to participate in further practice. This synthesis has 2 important implications for contemporary medical education: any reduction in medical students' participation in clinical practice that results from the patient safety agenda and expanded numbers of medical students is likely to have an adverse effect on learning, and the construct of 'self-directed learning', which our respondents too often found synonymous with 'lack of support', should be applied with very great caution to medical students' learning in clinical workplaces.

Attitude of Health Personnel↗
PubMed2006

Student evaluation of the clinical 'curriculum in action'.

AIM: To examine how students' evaluations of the environment, process and outcome of clinical learning interrelated and correlated with assessment results. METHOD: A post hoc study in the 3rd of 5 years in a student-centred, horizontally integrated, objective-based medical curriculum. In the last week of each module, students evaluated what they had learned and how they had learned it using a previously validated, web-based scale. The interrelationships between scale variables and their relationships with summative assessment results were tested using factor analysis, correlation analysis and stepwise multiple regression analysis. RESULTS: Student evaluation yielded 4 summary measures: 2 reflected learning outcomes ('real patient learning' and 'curriculum coverage'), 1 reflected process ('quality of instruction') and 1 reflected environment ('conditions for learning'). They fitted a causal model according to which instruction, conditions for learning and curriculum coverage favoured real patient learning. Real patient learning was rated higher in women than men, and the measures were associated more strongly in women. Performance in end-of-year summative assessments was predicted strongly by mid-year performance but by no other measure. CONCLUSIONS: Students' evaluations of their learning environment and instructional processes correlated with their assessments of 2 outcomes of the curriculum in action: curriculum coverage and real patient learning. There was little shared variance between those measures and students' performance in summative assessments. Given its formative potential, students' evaluation of their curriculum in action could play a useful part in learner-centred clinical education. There is a possibility, which needs further research, that women's evaluations have greater predictive validity than men's. Assessment performance should be regarded not as a solitary gold standard but as just 1 measure of educational outcome.

Attitude of Health Personnel↗
PubMed2005

Early practical experience and the social responsiveness of clinical education: systematic review.

OBJECTIVES: To find how early experience in clinical and community settings ("early experience") affects medical education, and identify strengths and limitations of the available evidence. DESIGN: A systematic review rating, by consensus, the strength and importance of outcomes reported in the decade 1992-2001. DATA SOURCES: Bibliographical databases and journals were searched for publications on the topic, reviewed under the auspices of the recently formed Best Evidence Medical Education (BEME) collaboration. SELECTION OF STUDIES: All empirical studies (verifiable, observational data) were included, whatever their design, method, or language of publication. RESULTS: Early experience was most commonly provided in community settings, aiming to recruit primary care practitioners for underserved populations. It increased the popularity of primary care residencies, albeit among self selected students. It fostered self awareness and empathic attitudes towards ill people, boosted students' confidence, motivated them, gave them satisfaction, and helped them develop a professional identity. By helping develop interpersonal skills, it made entering clerkships a less stressful experience. Early experience helped students learn about professional roles and responsibilities, healthcare systems, and health needs of a population. It made biomedical, behavioural, and social sciences more relevant and easier to learn. It motivated and rewarded teachers and patients and enriched curriculums. In some countries, junior students provided preventive health care directly to underserved populations. CONCLUSION: Early experience helps medical students learn, helps them develop appropriate attitudes towards their studies and future practice, and orientates medical curriculums towards society's needs. Experimental evidence of its benefit is unlikely to be forthcoming and yet more medical schools are likely to provide it. Effort could usefully be concentrated on evaluating the methods and outcomes of early experience provided within non-experimental research designs, and using that evaluation to improve the quality of curriculums.

Attitude of Health Personnel↗
PubMed2005

Rapid application design of an electronic clinical skills portfolio for undergraduate medical students.

The aim was to find how to use information and communication technology to present the clinical skills content of an undergraduate medical curriculum. Rapid application design was used to develop the product, and technical action research was used to evaluate the development process. A clinician-educator, two medical students, two computing science masters students, two other project workers, and a hospital education informatics lead, formed a design team. A sample of stakeholders took part in requirements planning workshops and continued to advise the team throughout the project. A university hospital had many features that favoured fast, inexpensive, and successful system development: a clearly defined and readily accessible user group; location of the development process close to end-users; fast, informal communication; leadership by highly motivated and senior end-users; devolved authority and lack of any rigidly imposed management structure; cooperation of clinicians because the project drew on their clinical expertise to achieve scholastic goals; a culture of learning and involvement of highly motivated students. A detailed specification was developed through storyboarding, use case diagramming, and evolutionary prototyping. A very usable working product was developed within weeks. "SkillsBase" is a database web application using Microsoft Active Server Pages, served from a Microsoft Windows 2000 Server operating system running Internet Information Server 5.0. Graphing functionality is provided by the KavaChart applet. It presents the skills curriculum, provides a password-protected portfolio function, and offers training materials. The curriculum can be presented in several different ways to help students reflect on their objectives and progress towards achieving them. The reflective portfolio function is entirely private to each student user and allows them to document their progress in attaining skills, as judged by self, peer and tutor assessment, and examinations. Training materials include web links and materials developed locally using pedagogic principles developed by the SkillsBase team. Although the usability of SkillsBase has been proven, uptake of software that has arisen 'bottom-up' from within the curriculum has proved slow. We plan to incorporate the SkillsBase services into a more comprehensive virtual managed learning environment, anticipating that presenting the functionality in an environment that is routinely used by students and teachers will increase uptake and use.

Clinical Competence↗
PubMed2005

Clinical teachers and problem-based learning: a phenomenological study.

AIM: To explore how clinicians perceive their roles in problem-based medical education, and how closely those perceptions link to the curriculum they teach. METHOD: All 14 general physicians in a teaching hospital took part in 6 semistructured discussions, which were analysed phenomenologically. RESULTS: Third year clinical teaching was described in terms that bore little relation to problem-based learning (PBL). Teachers placed great importance on the social dimension of professional learning. They expressed strongly positive affects towards learners and their learning that they found hard to express as PBL tutors. Their narratives of education were remarkably divorced from modern day clinical practice. CONCLUSIONS: Problem-based method lacked some important conditions for professional teaching and learning. Traditional apprenticeship is unsustainable under present day conditions of practice. There is a need for new educational methods that help the learner to build a professional identity through social interaction with practitioners.

Curriculum↗
PubMed2005

How can medical students learn in a self-directed way in the clinical environment? Design-based research.

AIM: This study aimed to establish whether and under what conditions medical students can learn in a self-directed manner in the clinical environment. METHOD: A web-based learning management system brought 66 placement students, in a problem-based learning (PBL) medical curriculum, into closer touch with their clinical learning objectives and ways of achieving them. Free response comments from 16 of them during the 7 weeks they used it, transcripts of group discussions before and after the period of use, and responses from all 66 students to a questionnaire were analysed qualitatively. RESULTS: Students were rarely fully autonomous or subservient. They valued affective and pedagogic support, and relied on teachers to manage their learning environment. With support, they were motivated and able to choose how and when to meet their learning needs. The new system was a useful adjunct. CONCLUSIONS: Self-direction, interpreted literally, was a method of learning that students defaulted to when support and guidance were lacking. They found "supported participation" more valuable. Learning in the clinical environment was a social process with as many differences from, as similarities to, PBL.

Computer-Assisted Instruction↗
PubMed2005

How should trainees be taught to open a clinical interview?

AIM: To characterise the opening of secondary care consultations. METHOD: We audio-taped 17 first consultations in medical clinics, transcribed them verbatim, and analysed verbal interactions from when the doctor called the patient into the consulting room to when she or he asked clarifying questions. RESULTS: The interviews did not open with the sequence, reported by previous researchers, of 'doctor's soliciting question, patient's opening statement, interruption by the doctor'. Doctors (1) called the patient to the consultation; (2) greeted them; (3) introduced themselves; (4) made a transition to clinical talk; and (5) framed the consultation. They used a referral letter, the case notes, computer records and their prior knowledge of the patient to help frame the consultation, and did so informally and with humour. CONCLUSION: These 5 steps could help trainees create a context for active listening that is less prone to interruption.

Clinical Competence↗
PubMed2004

What can experience add to early medical education? Consensus survey.

OBJECTIVE: To provide a rationale for integrating experience into early medical education ("early experience"). DESIGN: Small group discussions to obtain stakeholders' views. Grounded theory analysis with respondent, internal, and external validation. SETTING: Problem based, undergraduate medical curriculum that is not vertically integrated. PARTICIPANTS: A purposive sample of 64 students, staff, and curriculum leaders from three university medical schools in the United Kingdom. RESULTS: Without early experience, the curriculum was socially isolating and divorced from clinical practice. The abruptness of students' transition to the clinical environment in year 3 generated positive and negative emotions. The rationale for early experience would be to ease the transition; orientate the curriculum towards the social context of practice; make students more confident to approach patients; motivate them; increase their awareness of themselves and others; strengthen, deepen, and contextualise their theoretical knowledge; teach intellectual skills; strengthen learning of behavioural and social sciences; and teach them about the role of health professionals. CONCLUSION: A rationale for early experience would be to strengthen and deepen cognitively, broaden affectively, contextualise, and integrate medical education. This is partly a process of professional socialisation that should start earlier to avoid an abrupt transition. "Experience" can be defined as "authentic human contact in a social or clinical context that enhances learning of health, illness or disease, and the role of the health professional."

Attitude↗
PubMed2004

A technology using feedback to manage experience based learning.

The aim was to establish how ICT could apply feedback principles to experience based learning. Based on a survey of student and staff requirements, we developed a personalized educational technology ('iSUS') that: (1) Made students clear what they should learn; (2) Helped them meet appropriate real patients; (3) Encouraged reflective feedback; (4) Calculated benchmarks from accumulated feedback; (5) Compared individual students' feedback against those benchmarks; (6) Matched clinical activities to curriculum objectives; (7) Gave feedback to teachers and course leads. Bench testing proved the system usable. During seven weeks of real time use, a whole year group of 111 students feedback on 1183 learning episodes. Five hundred and forty-one (46%) of feedback episodes were self initiated. We have successfully prototyped an application of feedback principles to experience based learning that students seem to find useful.

Computer-Assisted Instruction↗
PubMed2003

A web-based presentation of an undergraduate clinical skills curriculum.

AIMS: The aim of this study was to use information and communications technology to present a curriculum of clinical skills in a user-friendly format. SETTING: A UK undergraduate medical school with a problem-based curriculum and a strong emphasis on proficiency in clinical skills. STUDY DESIGN: Case study describing the qualitative analysis of users' requirements and development of a web-based learning portfolio. EVALUATION: The study involved direct observation of users during a 'think-aloud' protocol, a validated software users' measurement inventory and a 17-item questionnaire designed to test whether 'SkillsBase' met its users' requirements. RESULTS: Students wanted a clear and flexible presentation of their skills curriculum that was easy to navigate, offered instructional material and standards for self- and peer assessment, offered useful Internet links, allowed them to compare their progress with school standards and peer norms, and could be used as a learning portfolio. During the think-aloud protocol, students made very few errors in data interpretation or navigation, and found SkillsBase easy to learn and aesthetically pleasing to use. They rated it higher on all measures of usability than standard commercial software. The questionnaire showed that it met most aspects of its design specification, although many students were doubtful that they would use its reflective function. It is available for inspection at http://www.skillsbase.man.ac.uk/. CONCLUSIONS: SkillsBase meets the design specification for a training and reflective aid to learning clinical skills and is very usable.

Clinical Competence↗
PubMed2003

Self-directed, integrated clinical learning through a sign-up system.

AIM: To help students in a self-directed, problem-based learning (PBL) curriculum learn from a breadth of hospital experience. METHODS: Clinical units were asked to identify what clinical activities they could make available to interested students on a 'first-come, first-served' basis. A centralised, electronic system was developed that allowed students to book a fair, but not excessive, share of those learning opportunities. This web-based programme evolved into a comprehensive timetabling system that managed activities for whole classes of students as well as 'sign-ups' booked by individuals. RESULTS: The sign-up system offered 1792 hours/week, or 6 hours/student/week, to the hospital's 291 students of learning opportunities additional to firm-based teaching and learning. There were sign-ups in all major specialties and they included rounds, clinics, theatre/investigation sessions and conferences. Students accessed the system as commonly from outside the hospital as within it, and used it to view their timetables as well as to book learning opportunities. The system was used particularly heavily when examinations were imminent, indicating that students found it supportive to their learning. CONCLUSIONS: We have developed an innovative way of providing experience that is relevant to problem-based, integrative clinical education. Students, as judged by their heavy use of it, value the system.

Clinical Competence↗
PubMed2003

Towards valid measures of self-directed clinical learning.

AIM: To compare the validity of different measures of self-directed clinical learning. METHODS: We used a quasi-experimental study design. The measures were: (1) a 23-item quantitative instrument measuring satisfaction with the learning process and environment; (2) free text responses to 2 open questions about the quality of students' learning experiences; (3) a quantitative, self-report measure of real patient learning, and (4) objective structured clinical examination (OSCE) and progress test results. Thirty-three students attached to a single firm during 1 curriculum year in Phase 2 of a problem-based medical curriculum formed an experimental group. Thirty-one students attached to the same firm in the previous year served as historical controls and 33 students attached to other firms within the same module served as contemporary controls. After the historical control period, experimental group students were exposed to a complex curriculum intervention that set out to maximise appropriate real patient learning through increased use of the outpatient setting, briefing and supported, reflective debriefing. RESULTS: The quantitative satisfaction instrument was insensitive to the intervention. In contrast, the qualitative measure recorded a significantly increased number of positive statements about the appropriateness of real patient learning. Moreover, the quantitative self-report measure of real patient learning found high levels of appropriate learning activity. Regarding outpatient learning, the qualitative and quantitative real patient learning instruments were again concordant and changed in the expected direction, whereas the satisfaction measure did not. An incidental finding was that, despite all attempts to achieve horizontal integration through simultaneously providing community attachments and opening up the hospital for self-directed clinical learning, real patient learning was strongly bounded by the specialty interest of the hospital firm to which students were attached. Assessment results did not correlate with real patient learning. CONCLUSIONS: Both free text responses and students' quantitative self-reports of real patient learning were more valid than a satisfaction instrument. One explanation is that students had no benchmark against which to rate their satisfaction and curriculum change altered their tacit benchmarks. Perhaps the stronger emphasis on self-directed learning demanded more of students and dissatisfied those who were less self-directed. Results of objective, standardised assessments were not sensitive to the level of self-directed, real patient learning. Despite an integrated curriculum design that set out to override disciplinary boundaries, students' learning remained strongly influenced by the specialty of their hospital firm.

Clinical Competence↗
PubMed2002

Involving users in the design and usability evaluation of a clinical decision support system.

AIM: To design and evaluate a clinical decision support system (CDSS) to support cardiovascular risk prevention in type 2 diabetes. METHODS: A preliminary requirements specification and three prototype CDSS interface designs were developed. Seven patients and seven clinicians conducted 'usability tests' on five different task scenarios with the CDSS prototypes to test its effectiveness, efficiency and 'user-friendliness'. Structured, qualitative questions explored their preferences for the different designs and overall impressions of clinical usefulness. RESULTS: Patients and clinicians were enthusiastic about the CDSS and used it confidently after a short learning period. Some patients had difficulty interpreting clinical data, but most were keen to see the CDSS used to help them understand their diabetes, provided a clinician explained their results. Clinicians' main concern was that the CDSS would increase consultation times. Changes suggested by users were incorporated into the final interface design. CONCLUSION: We have successfully incorporated patients' and clinicians' views into the design of a CDSS, but it was an arduous process.

Cardiovascular Diseases↗
PubMed2002

An electronic learning portfolio for reflective continuing professional development.

OBJECTIVES: These were to measure the uptake and use of an electronic learning portfolio to support reflective continuing professional development, and to characterize attitudes towards its use and obstacles to its adoption. DESIGN: Uncontrolled, longitudinal intervention study with quantitative and qualitative evaluation. PARTICIPANTS: Physicians with a specialty interest in endocrinology and diabetes mellitus, registered for continuing professional development with the Royal College of Physicians, London. INTERVENTION: All registered consultants were offered a 1-year free trial of PC Diary. Those who accepted were offered a training workshop. MAIN OUTCOME MEASURES: Quantitative and qualitative responses to a simple questionnaire. Two researchers independently used a template approach to analyse free-text responses and jointly agreed a final system of coding. RESULTS: 22% of registered consultants applied to participate; 14% attended training workshops. Of registered participants, 94% returned the questionnaire. PC Diary was used by 34%, but only 10% used it regularly. Among the registrants, 54% asked to continue their subscription for a second year, and 40% asked for further training. There were emotive expressions of both like and dislike, often coupled with statements about the individual's learning style. Time pressures and lack of computer access, literacy and support were dominant obstacles to adoption. CONCLUSIONS: There was considerable support for reflective learning using an electronic portfolio. Acceptability and use were influenced by individual learning style, resources, training and technical support, and these were often inadequate. The balance for consultants between workload demands and support provided did not favour a reflective type of learning.

Attitude to Computers↗
PubMed2002

Building confidence for work as house officers: student experience in the final year of a new problem-based curriculum.

INTRODUCTION: Newly qualified doctors require an appropriate level of confidence for their new roles. Development of this confidence was a key objective in the final year of a new integrated course with an emphasis on student self-direction. CONTEXT: There are 5 placements in the final year course. Students use a Learning Planner to help them choose suitable placements and objectives to serve their learning needs. Educational supervision focuses on helping students determine their objectives and assessing them against these. METHODS: Course evaluation was by means of a questionnaire during final assessments. Cohorts of 310 and 316 students in successive years completed the evaluation. The interrelationship between variables was explored using logistic regression. RESULTS: 220/310 students in the 2000 cohort and 214/316 in the 2001 cohort agreed they felt confident with their prospective role as a pre-registration house officer (PRHO). Confidence was significantly associated with confidence in their clinical skills, belief in their ability to cope with uncertainty and feeling able to work as a team member. The experience of the 2 hospital placements and (in 2000 only) the elective was associated with increased confidence. In all placements helpful educational supervision and the achievement of the self-directed learning plan was associated with increased confidence as a potential doctor. CONCLUSION: Students perceive a relationship between learning experiences in the final year of a self-directed course and development of confidence for their future role. Whilst further elucidation of the nature of this relationship is required, this provides encouragement to curriculum planners to promote self-direction.

Clinical Competence↗
PubMed2002

"You can't cure it so you have to endure it": the experience of adaptation to diabetic renal disease.

In this study, the experience of adaptation to diabetic renal disease was examined from a phenomenological perspective. Twenty patients attending a diabetic renal clinic were interviewed in depth. Through the use of a template analysis approach, a set of strong themes relating to changes in lifestyle was identified: changes in the nature of involvement with the medical system, coping strategies, and hopes, fears, and expectations. Almost all participants attempted to construct a "good adaptation" in the face of the uncertainties surrounding their condition by adopting a stoic and fatalistic stance. This is discussed in the context of the claim that contemporary society holds emotional self-expression rather than stoical endurance to be the appropriate response to suffering.

Adaptation, Psychological↗