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33 muster2014 Owen

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33 muster2014 Owen

  1. 1. Learning trajectories in longitudinal rural medical school placements Cathy Owen, Amanda Barnard and Jill Bestic, Rural Clinical School, Australian National University Medical School, Canberra, Australia MUSTER 2014
  2. 2. Hard working rural stream students
  3. 3. Our setting • longitudinal clinical placement for 40 weeks in a rural setting (on average 120 kms from main campus largely in towns <10,000 people) • Learning opportunities are both structured (e.g. with planned teaching sessions) and opportunistic, with progressively entrusted activities in GP and rural hospitals • Student placements differ in patient mix, load and opportunity for independent practice
  4. 4. Other learning signposts • End of placement learning goals • Portfolio of required learning activities • Little structured guidance on performance expectation at points along an extended program • End of year assessment
  5. 5. What is a learning trajectory? • Contextual map to guide a learning pathway • Shouldn’t assume all students learn in the same way • Should offer sufficient flexibility to be adapted to individual student-supervisor needs • Should adapt to the developing student supervisor relationship
  6. 6. Why use a learning trajectory? • To maximise learning opportunities • To “hit the ground running” in a strange learning environment • To support the lost student or for that matter the “lost” supervisor • To reference the notion of adequate performance on placement assisting feedback
  7. 7. How did we make one? • Ethics approval • Emailed requests for students and supervisors to document key learning achievements at quarter half and full time in key areas: – skills development – knowledge acquisition – professional experiences – level of responsibility • Workshopped at supervisor meetings
  8. 8. Response
  9. 9. Response Students • n = 23 • Early 11 – Skills focused • Mid 11 – Confidence & sensitive communication • Late 8 – Exams focused Supervisors • n =25 • Early 5 – History taking & behaviour focused • Mid 5 – High expectations of useful well integrated care • Late 1
  10. 10. Feedback Students • Given draft at end of year to review – items not commonly achieved removed • Important but not universal items retained e.g. independent practice, with explanatory notes Supervisors • Discussed at supervisor meetings: some concern about “lowest common denominator effect” • Most found useful for orientation and feedback
  11. 11. Examples Skills you aim to develop Taking a good focussed history for a range of common conditions. Getting confident in basic system examinations. Writing in medical records. Basic skills e.g. aseptic technique, hand washing, venepuncture and cannulation Becoming more methodical at focused history and physical examinations. Presenting long cases in a more professional & problem-based manner Increased confidence in basic skills plus new skills e.g. spirometry Doing all histories, examinations, consultations, procedures and case presentations with a better order/flow and confidence. All skills in the 3rd year portfolio completed with supervisor feedback Content knowledge you aim to be able to answer a written exam question on Case based questions, with a history, provisional and differential diagnosis, examination, investigations and management for common disorders e.g. acute abdomen, diabetes, asthma Common surgical and medical scenarios covered in structured teaching session so far Deeper understanding of common presentations in General Practice, indications and complications of common surgeries and identifying the unwell child and other important conditions in paediatrics. Have practised and become more confident writing sample exam questions
  12. 12. Professional experiences you aim to have undertaken Familiarising self with the everyday running of rural hospitals and general practices. Basic general practice consultations. Some independent consulting (history and examination) with supervisor review. Contributing to discussions about patient care and consulting other health professionals (e.g. pharmacists & radiographers) regarding patient care Better able to consult in terms of time management, talking about preventative health issues and ability to discuss basic management plans with patients, before bringing the supervising doctor into the consultation. To write discharge summaries using the clinical notes. To assist in surgical procedures performing excisions/biopsies etc. To contribute to health professional teaching sessions In consultations able to initiate investigations, suggest lifestyle modification, write referral letters for patients (all under supervisor guidance). Assist in theatre, on call and can help workup patients in emergency. The level of responsibility you may have in your practice setting Observe consultations in various practice settings. Start to see patients initially alone on wards rounds and in the GP setting and then review with supervisor. Undertake basic investigations or management within level of teaching. Observe procedures Increased confidence in discussing management options with patients with supervisor approval. Responsible for note taking. Expected to take a history, do an examination and formulate a management plan in GP and ED settings, then execute plan with supervisor approval. Assistant in GP procedures and theatre
  13. 13. Helpful thoughts from previous rural stream students At this stage in the year I was able to take histories off patients but I felt a bit shy talking to patients as they were 'real' and I was really conscious of trying not to 'mess things up' and was self-conscious about taking a history I felt much more comfortable at this stage doing GP consults at my own - I felt confident calling out patients names in the waiting room and felt confident introducing myself to doctors at the hospital and surgeons. I felt part of the team . I felt better skilled at talking with patients about their treatment including when drugs were not required. Wrote better quality referral letters. I felt most confident answering exam questions on medical conditions or scenarios I have witnessed throughout the year as I tend to remember these better than just rote learning lecture material
  14. 14. Three key learning objectives • Three key learning objectives • Existing students and supervisors on longitudinal learning placements can identify key incremental learning goals by time to display as a learning trajectory • Variations in medical practices means that timing of learning goals may vary • The developed learning trajectory is useful for student and new supervisor orientation

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