Otago Medical School

Year medical students in their first year of clinical training doing their surgical attachment. Previously, the authors have argued that medical curricula constitute normalising technologies of self that aim to create a certain kind of doctor. Here, they argue that a key mechanism through which these normalising technologies are exercised in the workplace is Etienne Wenger's communities of practice. In the clinical environment the authors identify communities of clinical practice (CoCP) as groups of health professionals that come together with the specific and common purpose of patient care. Fourth Year medical students join these transient communities as participants who are both peripheral and legitimate. Communities of clinical practice are potent vehicles for student learning. They learn and internalise the normative professional values and behaviours that they witness and experience within the disciplinary block of the medical school and teaching hospital; specifically, the authors suggest, it is through their participation in communities of clinical practice that medical students learn how to 'be one of us'.

Experiencing the death of a patient can be one of the most challenging aspects of clinical medicine for medical students. Exploring what student's learn from this difficult experience may contribute to our understanding of how medical students become doctors, and provide insights into the role a medical school may play in this development. This research examined medical students' reposes of being involved personally in the death of a patient.

AIM: Development of proficient procedural skills is vital to the training of young doctors. The aim of this project was to investigate the prevalence of different ways that medical students practise clinical procedures and the relationship with professional development. METHODS: A survey was made available online to the cohort of years 4–6 medical students at the Otago Medical School, University of Otago. Quantitative and qualitative data were collected and analysed. Statistical methods and qualitative content analysis were employed in order to categorise and infer student responses. RESULTS: Two hundred and eighty-four of 816 (35%) students responded to the survey. A total of 23 categories of procedural skills were reported, demonstrating procedures with varying complexity and degrees of invasiveness. A small proportion, 5%, indicated they had performed invasive procedures on themselves, with a majority of these reported to be unsupervised. 77% of students reported being directly observed when performing procedures on patients for the first time, while 32% reported being supervised when practising on peers. CONCLUSION: Students practise clinical procedures on patients, peers and in some cases themselves. Our findings suggest a need for clearer guidelines in the support and management of the safe practice of students, be it on patients, other students or on themselves.

Background: Student bullying in clinical practice persists, and poor outcomes continue: for learning, academic achievement and career goals, for their mental and physical health and potentially affecting all staff and patients in a clinical workplace. We describe an emergent framework for the strategic design of a bullying intervention, presented as a staff development opportunity.

Methods: CAPLE (Creating A Positive Learning Environment) was a bullying intervention designed around current best evidence about ameliorating student bullying in the clinical environment. CAPLE was also an action research project delivered in two eight- week cycles, one in 2016 & another in 2017. CAPLE’s primary practical foci were to offer clinical staff in two separate hospital wards an opportunity to develop their clinical teaching skills and to guide them in reflection and cultivation of values around students and learning. Research foci were: 1. to gain insight into staff experiences of CAPLE as a development process and 2. to evaluate how CAPLE might best help staff reflect on, discuss and develop values around student learning, to include bullying. Staff undertook five active learning workshops combined with supportive contact with one researcher over the research period. Data include individual interviews, staff and researchers’ reflective journals and a paper survey about staff experiences of the 2017 intervention.

Results: We confirm the effectiveness of best evidence from the literature and also that a strategic four-part framework of approach, process, content and person can further enhance a bullying intervention by increasing the likelihood of participant engagement, learning and values change."

Conclusions: This research aggregates and adds weight to the current literature about student bullying and adds important pragmatic detail about best practice for bullying intervention design and delivery. Ultimately, this emergent framework offers insight to help move past some persistent barriers encountered by those wishing to improve workplace behaviour.

Keywords: Bullying, Mistreatment, Intervention, Clinical environment, Engagement, Staff development"

Background: Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effective. With this narrative review about student bullying interventions in the clinical learning environment, we examine and draw together the available, but patchy, information about 'what works' to inform better practice and further research. Methods: We initially followed a PICO approach to obtain and analyse data from 38 articles from seven databases. We then used a general inductive approach to form themes about effective student bullying intervention practice, and potential unintended consequences of some of these, which we further developed into six final themes. Results: The diverse literature presents difficulties in comparison of intervention efficacy and substantive guidance is sparse and inconsistently reported. The final analytical approach we employed was challenging but useful because it enabled us to reveal the more effective elements of bullying interventions, as well as information about what to avoid: an interventionist and institution need to, together, 1. understand bullying catalysts, 2. address staff needs, 3. have, but not rely on policy or reporting process about behaviour, 4. avoid targeting specific staff groups, but aim for saturation, 5. frame the intervention to encourage good behaviour, not target poor behaviour, and 6. possess specific knowledge and specialised teaching and facilitation skills. We present the themed evidence pragmatically to help practitioners and institutions design an effective program and avoid instigating practices which have now been found to be ineffective or deleterious. Conclusions: Despite challenges with the complexity of the literature and in determining a useful approach for analysis and reporting, results are important and ideas about practice useful. These inform a way forward for further, more effective student bullying intervention and research: an active learning approach addressing staff needs, which is non-targeted and positively and skilfully administered. (331w).

Professional identity formation, the process of transformation from lay person to doctor, is at the heart of medical education. Medical student cohorts can include students who enter medicine from a previous career, i.e. with developed professional identities and who are usually older and more mature. Students with previously developed professional identities may have specific challenges in negotiating their new 'doctor' identity. This study examined the development of professional identity in mature medical students who had a variety of previous careers prior to entering medical school. A narrative inquiry was undertaken using interviews of mature medical students with backgrounds that included physiotherapy, clinical physiology, public health and nutrition, and the armed forces. A narrative analysis was conducted combining both thematic and structural perspectives using linguistics and positioning theory as interpretive tools. Three main themes emerged that portray the development processes that arise in this cohort as they develop their medical professional identity: holding back aspects of the previous self; foregrounding aspects of the previous self; and developing new aspects towards forming a 'new' self. These themes and their implications are discussed in the context of current literature, highlighting some of the specific challenges that this cohort faces in developing their medical identity. We argue that dedicated faculty and student development be offered, exploring how professional identity formation in mature medical students can be facilitated and supported, so staff and students are better equipped to engage and shape mature students' professional identity in a meaningful way.

You can access the journal article here (just copy and paste the URL below in your browser): http://search.informit.com.au/fullText;dn=562923250696356;res=IELHEA Research looking at the general practice workforce shortage has been predominantly from a quantitative perspective. The present research examined medical students’ views about general practice using a qualitative approach. Medical students in their second-year and final year of study (trainee interns, or ‘TIs’) were interviewed. Second-year students described general practice as concerned with non-challenging minor problems and characterised by relationships with individuals and communities and that general practice lifestyle was one of structured hours and an easier workload. Further impressions were that general practice has a low status within the medical hierarchy, is considered an easy default option and is not considered to be a specialty. TIs offered perceptions based on experiences working directly with general prac...

Student bullying in clinical practice remains a concern, and evidence regarding what works to specifically help the student appears rather piecemeal. At the same time, emergent literature indicates that some bullying interventions can be ineffective for behaviour change, or even deleterious to the staff which they target. Considering the potentially sizeable financial and personal costs associated with continued bullying and undertaking an intervention, it would seem sensible that any selected intervention method avoids those shown to be potentially ineffective or deleterious. Such avoidance would likely help to move the student bullying research forward, prevent further suffering and reduce the waste of valuable taxpayer resources.

Background: Student bullying in clinical practice persists, and poor outcomes continue: for learning, academic achievement and career goals, for their mental and physical health and potentially affecting all staff and patients in a clinical workplace. We describe an emergent framework for the strategic design of a bullying intervention, presented as a staff development opportunity. Methods: CAPLE (Creating A Positive Learning Environment) was a bullying intervention designed around current best evidence about ameliorating student bullying in the clinical environment. CAPLE was also an action research project delivered in two eight-week cycles, one in 2016 & another in 2017. CAPLE's primary practical foci were to offer clinical staff in two separate hospital wards an opportunity to develop their clinical teaching skills and to guide them in reflection and cultivation of values around students and learning. Research foci were: 1. to gain insight into staff experiences of CAPLE as a development process and 2. to evaluate how CAPLE might best help staff reflect on, discuss and develop values around student learning, to include bullying. Staff undertook five active learning workshops combined with supportive contact with one researcher over the research period. Data include individual interviews, staff and researchers' reflective journals and a paper survey about staff experiences of the 2017 intervention. Results: We confirm the effectiveness of best evidence from the literature and also that a strategic four-part framework of approach, process, content and person can further enhance a bullying intervention by increasing the likelihood of participant engagement, learning and values change. Conclusions: This research aggregates and adds weight to the current literature about student bullying and adds important pragmatic detail about best practice for bullying intervention design and delivery. Ultimately, this emergent framework offers insight to help move past some persistent barriers encountered by those wishing to improve workplace behaviour.

In order to foster positive student experiences in the clinical learning environment, we wanted to better understand which teaching practices they regard highly. Methods: In 2016, the authors undertook a paper 'exemplar' survey (ES) of all fifth year medical students at one tertiary teaching site. Students had experienced all assigned clinical rotations over a two year period. Following a 66% response rate, we identified two clear exemplar clinical areas (ECAs). Over 2016-7, six focus groups with multidisciplinary staff members from these clinical areas were held, with the aim to identify, discuss and understand their specific teaching practices in more detail. Results: The authors present descriptions of positive student experiences and related staff practices, in five themes. Themes emerged around foundational logistic and personal factors: central to student and staff data is that 'welcome' on a daily, and ongoing basis, can be foundational to learning. Central to ECA staff data are universal practices by which all staff purposefully work to develop a functional staff-student relationship and play a part in organising/teaching students. Students and ECA staff groups both understood teacher values to be central to student learning and that cultivating a student's values is one of their major educational tasks.

Background: Student bullying in the clinical environment continues to have a substantial impact, despite numerous attempts to rectify the situation. However, there are significant gaps in the literature about interventions to help students, particularly a lack of specific guidance around which to formulate an intervention program likely to be effective. With this narrative review about student bullying interventions in the clinical learning environment, we examine and draw together the available, but patchy, information about 'what works' to inform better practice and further research. Methods: We initially followed a PICO approach to obtain and analyse data from 38 articles from seven databases. We then used a general inductive approach to form themes about effective student bullying intervention practice, and potential unintended consequences of some of these, which we further developed into six final themes. Results: The diverse literature presents difficulties in comparison of intervention efficacy and substantive guidance is sparse and inconsistently reported. The final analytical approach we employed was challenging but useful because it enabled us to reveal the more effective elements of bullying interventions, as well as information about what to avoid: an interventionist and institution need to, together, 1. understand bullying catalysts, 2. address staff needs, 3. have, but not rely on policy or reporting process about behaviour, 4. avoid targeting specific staff groups, but aim for saturation, 5. frame the intervention to encourage good behaviour, not target poor behaviour, and 6. possess specific knowledge and specialised teaching and facilitation skills. We present the themed evidence pragmatically to help practitioners and institutions design an effective program and avoid instigating practices which have now been found to be ineffective or deleterious. Conclusions: Despite challenges with the complexity of the literature and in determining a useful approach for analysis and reporting, results are important and ideas about practice useful. These inform a way forward for further, more effective student bullying intervention and research: an active learning approach addressing staff needs, which is non-targeted and positively and skilfully administered. (331w).

Honesty and integrity are key characteristics expected of a doctor, although academic misconduct among medical students is not new. 1 A survey of 428 American students in 1980 found that 58% reported cheating during medical school. 2 We assessed students' attitudes and behaviours on "cheating" and aimed to raise awareness of academic misconduct.

Objectives: This study aimed to determine attitudinal and self reported behavioural variations between medical students in different years to scenarios involving academic misconduct. Design: A cross-sectional study where students were given an anonymous questionnaire that asked about their attitudes to 14 scenarios describing a fictitious student engaging in acts of academic misconduct and asked them to report their own potential behaviour. Setting: Dundee Medical School. Participants: Undergraduate medical students from all five years of the course. Method: Questionnaire survey. Main measurements: Differences in medical students' attitudes to the 14 scenarios and their reported potential behaviour with regards to the scenarios in each of the years. Results: For most of the scenarios there was no significant difference in the response between the years. Significant differences in the responses were found for some of the scenarios across the years, where a larger proportion of year one students regarded the scenario as wrong and would not engage in the behaviour, compared to other years. These scenarios included forging signatures, resubmitting work already completed for another part of the course, and falsifying patient information. Conclusion: Observed differences between the years for some scenarios may reflect a change in students' attitudes and behaviour as they progress though the course. The results may be influenced by the educational experience of the students, both in terms of the learning environment and assessment methods used. These differences may draw attention to the potential but unintentional pressures placed on medical students to engage in academic misconduct. The importance of developing strategies to engender appropriate attitudes and behaviours at the undergraduate level must be recognised.