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Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers' strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher's strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty's use of teaching policy incentives.

Policy initiatives that aim to elevate the position of medical teaching to that of medical research could influence the satisfaction of three basic psychological needs related to motivation for medical teaching. To explore relations between the satisfaction of three basic psychological needs towards medical teaching and two policy initiatives for medical teaching: (Junior) Principal Lecturer positions [(J)PL positions] and Subsidized Innovation and Research Projects in Medical Education (SIRPMEs). An online questionnaire was used to collect data about medical teaching in the setting of a university hospital. We adapted the Work-related Basic Need Satisfaction scale (Van den Broeck et al. in J Occup Organ Psychol, 83(4):981-1002, 2010), in order to measure feelings of autonomy, competence, and relatedness in teaching. We examined the relations between (J)PL positions and SIRPMEs and the satisfaction of three basic psychological needs. A total of 767 medical teachers participated. The initiatives appear to be related to different beneficial outcomes in terms of feelings of autonomy, competence, and relatedness in medical teaching. Either a (J)PL position is obtained by teachers who feel competent and related towards medical teaching, or obtaining a (J)PL position makes teachers feel more competent and related towards teaching, or these relations could be interacting. Also, either a SIRPME is obtained by teachers who feel competent and autonomous towards medical teaching, or obtaining a SIRPME makes teachers feel more competent and autonomous towards teaching, or these relations could be interacting. Additional research needs to scrutinize the causal or interacting relations further and to determine optimal conditions for these policy initiatives more specifically. Implications for future research are discussed.

Providing clinical teachers with feedback about their teaching skills is a powerful tool to improve teaching. Evaluations are mostly based on questionnaires completed by residents. We investigated to what extent characteristics of residents, clinical teachers, and the clinical environment influenced these evaluations, and the relation between residents' scores and their teachers' self-scores. The evaluation and feedback for effective clinical teaching questionnaire (EFFECT) was used to (self)assess clinical teachers from 12 disciplines (15 departments, four hospitals). Items were scored on a five-point Likert scale. Main outcome measures were residents' mean overall scores (MOSs), specific scale scores (MSSs), and clinical teachers' self-evaluation scores. Multilevel regression analysis was used to identify predictors. Residents' scores and self-evaluations were compared. Residents filled in 1,013 questionnaires, evaluating 230 clinical teachers. We received 160 self-evaluations. 'Planning Teaching' and 'Personal Support' (4.52, SD .61 and 4.53, SD .59) were rated highest, 'Feedback Content' (CanMEDS related) (4.12, SD .71) was rated lowest. Teachers in affiliated hospitals showed highest MOS and MSS. Medical specialty did not influence MOS. Female clinical teachers were rated higher for most MSS, achieving statistical significance. Residents in year 1-2 were most positive about their teachers. Residents' gender did not affect the mean scores, except for role modeling. At group level, self-evaluations and residents' ratings correlated highly (Kendall's τ 0.859). Resident evaluations of clinical teachers are influenced by teacher's gender, year of residency training, type of hospital, and to a lesser extent teachers' gender. Clinical teachers and residents agree on strong and weak points of clinical teaching.

Dealing with emotions is a critical feature of professional behaviour. There are no comprehensive theoretical models, however, explaining how medical students learn about emotions. We aimed to explore factors affecting their emotions and how they learn to deal with emotions in themselves and others. During a first-year nursing attachment in hospitals and nursing homes, students wrote daily about their most impressive experiences, explicitly reporting what they felt, thought, and did. In a subsequent interview, they discussed those experiences in greater detail. Following a grounded theory approach, we conducted a constant comparative analysis, collecting and then interpreting data, and allowing the interpretation to inform subsequent data collection. Impressive experiences set up tensions, which gave rise to strong emotions. We identified four 'axes' along which tensions were experienced: 'idealism versus reality', 'critical distance versus adaptation', 'involvement versus detachment' and 'feeling versus displaying'. We found many factors, which influenced how respondents relieved those tensions. Their personal attributes and social relationships both inside and outside the medical community were important ones. Respondents' positions along the different dimensions, as determined by the balance between attributes and tensions, shaped their learning outcomes. Medical students' emotional development occurs through active participation in medical practice and having impressive experiences within relationships with patients and others on wards. Tensions along four dimensions give rise to strong emotions. Gaining insight into the many conditions that influence students' learning about emotions might support educators and supervisors in fostering medical students' emotional and professional development.

Many students in Biomedical Sciences have difficulty understanding biomechanics. In a second-year course, biomechanics is taught in the first week and examined at the end of the fourth week. Knowledge is retained longer if the subject material is repeated. However, how does one encourage students to repeat the subject matter? For this study, we developed 'two opportunities to practice per day (TOPday)', consisting of multiple-choice questions on biomechanics with immediate feedback, which were sent via e-mail. We investigated the effect of TOPday on self-confidence, enthusiasm, and test results for biomechanics. All second-year students (n = 95) received a TOPday of biomechanics on every regular course day with increasing difficulty during the course. At the end of the course, a non-anonymous questionnaire was conducted. The students were asked how many TOPday questions they completed (0-6 questions [group A]; 7-18 questions [group B]; 19-24 questions [group C]). Other questions included the appreciation for TOPday, and increase (no/yes) in self-confidence and enthusiasm for biomechanics. Seventy-eight students participated in the examination and completed the questionnaire. The appreciation for TOPday in group A (n = 14), B (n = 23) and C (n = 41) was 7.0 (95 % CI 6.5-7.5), 7.4 (95 % CI 7.0-7.8), and 7.9 (95 % CI 7.6-8.1), respectively (p < 0.01 between A and C). Of the students who actively participated (B and C), 91 and 80 % reported an increase in their self-confidence and enthusiasm, respectively, for biomechanics due to TOPday. In addition, they had a higher test result for biomechanics (p < 0.01) compared with those who did not actively participate (A). In conclusion, the teaching method 'TOPday' seems an effective way to encourage students to repeat the subject material, with the extra advantage that students are stimulated to keep on practising for the examination. The appreciation was high and there was a positive association between active participation, on the one hand, and self-confidence, enthusiasm, and test results for biomechanics on the other.

Background: Physicians play a crucial role in teaching residents in clinical practice. Feedback on their teaching performance to support this role needs to be provided in a carefully designed and constructive way., Aims: We investigated an evaluation system for evaluating supervisors and providing formative feedback., Method: In a design based research approach, the 'Evaluation and Feedback For Effective Clinical Teaching System' (EFFECT-S) was examined by conducting semi-structured interviews with residents and supervisors of five departments in five different hospitals about feedback conditions, acceptance and its effects. Interviews were analysed by three researchers, using qualitative research software (ATLAS-Ti)., Results: Principles and characteristics of the design are supported by evaluating EFFECT-S. All steps of EFFECT-S appear necessary. A new step, team evaluation, was added. Supervisors perceived the feedback as instructive; residents felt capable of providing feedback. Creating safety and honesty require different actions for residents and supervisors. Outcomes include awareness of clinical teaching, residents learning feedback skills, reduced hierarchy and an improved learning climate., Conclusions: EFFECT-S appeared useful for evaluating supervisors. Key mechanism was creating a safe environment for residents to provide honest and constructive feedback. Residents learned providing feedback, being part of the CanMEDS and ACGME competencies of medical education programmes.

Many studies report on the validation of instruments for facilitating feedback to clinical supervisors. There is mixed evidence whether evaluations lead to more effective teaching and higher ratings. We assessed changes in resident ratings after an evaluation and feedback session with their supervisors. Supervisors of three medical specialities were evaluated, using a validated instrument (EFFECT). Mean overall scores (MOS) and mean scale scores were calculated and compared using paired T-tests. 24 Supervisors from three departments were evaluated at two subsequent years. MOS increased from 4.36 to 4.49. The MOS of two scales showed an increase >0.2: 'teaching methodology' (4.34-4.55), and 'assessment' (4.11-4.39). Supervisors with an MOS <4.0 at year 1 (n = 5) all demonstrated a strong increase in the MOS (mean overall increase 0.50, range 0.34-0.64). Four supervisors with an MOS between 4.0 and 4.5 (n = 6) demonstrated an increase >0.2 in their MOS (mean overall increase 0.21, range -0.15 to 53). One supervisor with an MOS >4.5 (n = 13) demonstrated an increase >0.02 in the MOS, two demonstrated a decrease >0.2 (mean overall increase -0.06, range -0.42 to 0.42). EFFECT-S was associated with a positive change in residents' ratings of their supervisors, predominantly in supervisors with relatively low initial scores., (© 2013. The Author(s).)

Purpose: To develop an instrument that could be used at different medical schools to assess the performance of individual simulated patients (SPs) on their ability to role-play and provide feedback, including feedback on medical students' communication skills and medical knowledge., Method: In 2011, the authors sought to develop and validate a new instrument to achieve these goals. During Phase 1, one of the authors conducted semistructured interviews with medical students, medical psychologists, physicians, and experts to explore what was required of SPs. During Phase 2, the authors assessed the reliability and feasibility of the instrument that they had developed during Phase 1, using a principal components analysis with varimax rotation. During Phase 3, they performed a confirmatory factor analysis on the items in the final instrument., Results: During Phase 1, the authors constructed the Nijmegen Evaluation of the Simulated Patient (NESP), which included three components-role-play, process of feedback, and application of feedback rules. They then determined that approximately 8 to 20 completed instruments per SP led to satisfactory to excellent reliability estimates. In Phase 3, their confirmatory analysis confirmed the three components that they had determined in Phase 2. Reliability estimates for each component (role-play, process of feedback, application of feedback rules) and the final NESP as a whole were 0.86, 0.83, 0.79, and 0.92, respectively., Conclusions: The authors concluded that the NESP is a feasible, valid, and reliable instrument that could be used at different medical schools to assess the performance of individual SPs.

Objective: To describe a program with integrated learning of communication and consultation skills developed with the intention of preventing deterioration of communication skills, and to present student evaluation data., Methods: Description and evaluation of the program through: (1) monthly student evaluations; (2) questionnaire on student perceptions about the integrated curriculum; (3) a questionnaire about the value of one specific integrated training preceding the pediatric clerkship., Results: Key components of training throughout years 3-6 are reinforcement throughout the clinical years, adapting communication training to the clinical context of clerkships using a sandwich model with cycles of preparation, clerkship, and reflection., Evaluation: response rates were 69%, 93% and 93%, respectively. Students value practicing integration of communication and medical content with SPs who represent the population of their next clerkships. They appreciate the multisource feedback during the training, feedback by clerkship specific specialists and SPs is valued most., Conclusions: This description shows an example of an integrated curriculum that helps students to feel well prepared for their communication tasks in subsequent clerkships., Practice Implications: Designing and implementing communication curricula to address the issue of integration is feasible. The effects of such integrated programs should be subject to future studies., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Literature shows that faculty development programmes are not organizationally embedded in academic hospitals. This leaves medical teaching a low and informal status. The purpose of this article is to explore how organizational literature can strengthen our understanding of embedding faculty development in organizational development, and to provide a useful example of organizational development with regards to medical teaching and faculty development. Constructing a framework for organizational development from the literature, based on expert brainstorming. This framework is applied to a case study. A framework for organizational development is described. Applied in a context of medical teaching, these organizational insights show the process (and progress) of embedding faculty development in organizational development. Organizational development is a necessary condition for assuring sustainable faculty development for high-quality medical teaching. Organizational policies can only work in an organization that is developing. Recommendations for further development and future research are discussed.

Context: During early clinical exposure, medical students have many emotive experiences. Through participation in social practice, they learn to give personal meaning to their emotional states. This meaningful social act of participation may lead to a sense of belonging and identity construction., Objectives: The aim of this study was to broaden and deepen our understanding of the interplay between those experiences and students' identity development. Our research questions asked how medical students give meaning to early clinical experiences and how that affects their professional identity development., Methods: Our method was phenomenology. Within that framework we used a narrative interviewing technique. Interviews with 17 medical students on Year 1 attachments to nurses in hospitals and nursing homes were analysed by listening to audio-recordings and reading transcripts. Nine transcripts, which best exemplified the students' range of experiences, were purposively sampled for deeper analysis. Two researchers carried out a systematic analysis using qualitative research software. Finally, cases representing four paradigms were chosen to exemplify the study findings., Results: Students experienced their relationships with the people they met during early clinical experiences in very different ways, particularly in terms of feeling and displaying emotions, adjusting, role finding and participation. The interplay among emotions, meaning and identity was complex and four different 'paradigms' of lived experience were apparent: feeling insecure; complying; developing, and participating., Conclusions: We found large differences in the way students related to other people and gave meaning to their first experiences as doctors-to-be. They differed in their ability to engage in ward practices, the way they experienced their roles as medical students and future doctors, and how they experienced and expressed their emotions. Medical educators should help students to be sensitive to their emotions, offer space to explore different meanings, and be ready to suggest alternative interpretations that foster the development of desired professional identities., (© Blackwell Publishing Ltd 2012.)

Background: Providing clinical teachers in postgraduate medical education with feedback about their teaching skills is a powerful tool to improve clinical teaching. A systematic review showed that available instruments do not comprehensively cover all domains of clinical teaching. We developed and empirically test a comprehensive instrument for assessing clinical teachers in the setting of workplace learning and linked to the CanMEDS roles., Methods: In a Delphi study, the content validity of a preliminary instrument with 88 items was studied, leading to the construction of the EFFECT (evaluation and feedback for effective clinical teaching) instrument. The response process was explored in a pilot test and focus group research with 18 residents of 6 different disciplines. A confirmatory factor analyses (CFA) and reliability analyses were performed on 407 evaluations of 117 supervisors, collected in 3 medical disciplines (paediatrics, pulmonary diseases and surgery) of 6 departments in 4 different hospitals., Results: CFA yielded an 11 factor model with a good to excellent fit and internal consistencies ranged from 0.740 to 0.940 per domain; 7 items could be deleted., Conclusion: The model of workplace learning showed to be a useful framework for developing EFFECT, which incorporates the CanMEDS competencies and proved to be valid and reliable.

Background: Medical students learn professional communication through formal training and in clinical practice. Physicians working in clinical practice have a powerful influence on student learning. However, they may demonstrate communication behaviours not aligning with recommendations in training programs., Aims: This study aims to identify more precisely what differences students perceive between role model communication behaviour during clerkships and formal training., Method: In a cross-sectional study, data were collected about physicians' communication performance as perceived by students. Students filled out a questionnaire in four different clerkships in their fourth and fifth year., Results: Just over half of the students reported communication similar to formal training. This was especially true for students in the later clerkships (paediatrics and primary care). Good examples were seen in providing information corresponding to patients' needs and in shared decision making, although students often noted that in fact the doctor made the decision. Bad examples were observed in exploring cognitions and emotions, and in providing information meeting patient's pace., Conclusions: Further study is needed on actual physician behaviour in clinical practice. From our results, we conclude that students need help in reflecting on and learning from the gap in communication patterns they observe in training versus clinical practice.

Context: Early clinical experience is thought to contribute to the professional development of medical students, but little is known about the kind of learning processes that actually take place. Learning in practice is highly informal and may be difficult to direct by predefined learning outcomes. Learning in medical practice includes a socialisation process in which some learning outcomes may be valued, but others neglected or discouraged., Objectives: This study describes students' learning goals (prior to a Year 1 nursing attachment) and learning outcomes (after the attachment) in relation to institutional educational goals, and evaluates associations between learning outcomes, student characteristics and place of attachment., Methods: A questionnaire containing open-ended questions about learning goals and learning outcomes was administered to all Year 1 medical students (n = 347) before and directly after a 4-week nursing attachment in either a hospital or a nursing home. Two confirmatory focus group interviews were conducted and data were analysed using qualitative and quantitative content analyses., Results: Students' learning goals corresponded with educational goals with a main emphasis on communication and empathy. Other learning goals included gaining insight into the organisation of health care and learning to deal with emotions. Self-reported learning outcomes were the same, but students additionally mentioned reflection on professional behaviour and their own future development. Women and younger students mentioned communication and empathy more often than men and older students. Individual learning goals, with the exception of communicating and empathising with patients, did not predict learning outcomes., Conclusions: Students' learning goals closely match educational goals, which are adequately met in early nursing attachments in both hospitals and nursing homes. Learning to deal with emotions was under-represented as a learning goal and learning outcome, which may indicate that emotional aspects of medical students' professional development are neglected in the first year of medical education., (© Blackwell Publishing Ltd 2011.)

Publications on anatomy in medical education appear to be largely anecdotal. To explore this, we investigated the literature on anatomy in medical education, aiming first to evaluate the contribution of the literature on anatomy in medical education to "best evidence medical education" (BEME) and second to evaluate the development of this literature toward more "best evidence" between 1985 and 2009. Four databases were searched for publications on anatomy in medical education published between 1985 and 2009, resulting in 525 references. Hundred publications were characterized by five variables (journal category, paper subject, paper category, author perspective, and paper perspective). Statements from these publications were characterized by two variables (category and foundation). The publications contained 797 statements that involved the words "anatomy," "anatomical," or "anatomist." Forty-five percent of the publications contained no explicit research question. Forty percent of the statements made were about "teaching methods" and 17% about "teaching content," 8% referred to "practical value," and 10% to "side effects" of anatomy education. Ten percent of the statements were "positional," five percent "traditional," four percent "self-evident," and two percent referred to "quality of care." Fifty-six percent of the statements had no foundation, 17% were founded on empirical data, and 27% by references. These results substantiated the critical comments about the anecdotal nature of the literature. However, it is encouraging to see that between 1985 and 2009 the number of publications is rising that these publications increasingly focus on teaching methods and that an academic writing style is developing. This suggests a growing body of empirical literature about anatomy education., (Copyright © 2011 American Association of Anatomists.)

Ninety percent of medical students' training is comprised of working and learning in the clinical setting. Good training is the responsibility of the physicians who also work in that setting. It is important that these physicians are aware of what is expected of them in this role. We defined 7 domains for clinical teachers: being a role model, task allocation, planning, providing feedback, teaching methodology, assessment, and personality. There are several feedback instruments for measuring the quality of a clinical teacher, each addressing these seven domains differently. When providing clinical teachers with feedback, written evaluation alone is not sufficient to induce change. Dialogue between residents and their clinical teacher leads to mutual understanding and enhances the effect of feedback. This is beneficial to the individual trainer, training team and the residents.

Background: Collaborative group sessions in Nijmegen include 15 students who work all together on a group assignment. Sometimes, the group is split-up in three and every subgroup elaborates a part of the assignment. At the end, they peer-teach each other. It is believed that the split-up enhances participation and therefore learning gain., Aims: To establish the effect of group size and structure of the assignment on the perceived participation, the satisfaction and learning gain of collaborative group sessions., Methods: In this study, 27 groups of 15 students were equally divided into: A-group: all 15 students working on the complete assignment. B-group: subgroups of 5 students working on the complete assignment. C-group: subgroups of 5 students working on a smaller part, and peer-teaching each other at the end of the group session. All students took a pre-test, a post-test and a follow-up test and completed a questionnaire. Questionnaires were analyzed with a one-way analysis of variance (ANOVA) and post hoc by multiple comparisons. Learning gain was analyzed using a repeated measures ANOVA., Results: A group size effect is observed in favor of working in subgroups. Perceived participation of the students differs between A and B (p ≤ 0.001) and between A and C (p ≤ 0.001), but not between B and C. Also, an assignment effect is found in favor of the smaller assignment combined with peer-teaching. The students' satisfaction differs between A and C (p ≤ 0.003) and between B and C (p ≤ 0.001), but not between A and B. The C-group also shows higher test results (p ≤ 0.043)., Conclusions: The students prefer smaller groups as well as smaller assignments including peer-teaching. A possible larger learning gain of this format needs to be re-investigated.

Background: Entering medicine for the first time is highly impressive for students, but we know little about the actual emotional learning processes taking place., Aims: We aimed to get more insight into expectations, experiences and emotions of students during their first clinical experiences in a hospital compared to a nursing home., Methods: We carried out a qualitative and a quantitative survey by administering questionnaires about expectations, impressive experiences and learning activities within two cohorts of first-year medical students before and after a 4-week nursing attachment., Results: Despite different expectations, students reported similar experiences and learning activities for the nursing home and the hospital. Most impressive events were related to patient care, being a trainee, or professional identities being challenged. Students in nursing homes most often referred to their own relationships with patients. Students expressed different emotions, and frequently experienced positive and negative emotions at the same time., Conclusions: Rewarding experiences (not only difficult or stressful events) do matter for medical professional development. Students need to learn how to deal with and feel strengthened by the emotions evoked during clinical experiences, which should be supported by educators. The nursing home and the hospital seem to be equally suited as learning environments.

Background: Learning in a clinical environment differs from formal educational settings and provides specific challenges for clinicians who are teachers. Instruments that reflect these challenges are needed to identify the strengths and weaknesses of clinical teachers., Objective: To systematically review the content, validity, and aims of questionnaires used to assess clinical teachers., Data Sources: MEDLINE, EMBASE, PsycINFO and ERIC from 1976 up to March 2010., Review Methods: The searches revealed 54 papers on 32 instruments. Data from these papers were documented by independent researchers, using a structured format that included content of the instrument, validation methods, aims of the instrument, and its setting., Results: Aspects covered by the instruments predominantly concerned the use of teaching strategies (included in 30 instruments), supporter role (29), role modeling (27), and feedback (26). Providing opportunities for clinical learning activities was included in 13 instruments. Most studies referred to literature on good clinical teaching, although they failed to provide a clear description of what constitutes a good clinical teacher. Instrument length varied from 1 to 58 items. Except for two instruments, all had to be completed by clerks/residents. Instruments served to provide formative feedback ( instruments) but were also used for resource allocation, promotion, and annual performance review (14 instruments). All but two studies reported on internal consistency and/or reliability; other aspects of validity were examined less frequently., Conclusions: No instrument covered all relevant aspects of clinical teaching comprehensively. Validation of the instruments was often limited to assessment of internal consistency and reliability. Available instruments for assessing clinical teachers should be used carefully, especially for consequential decisions. There is a need for more valid comprehensive instruments.

Small heat shock proteins (sHsps) are characteristically observed in glial cell inclusion bodies in a variety of neurodegenerative diseases. The small Hsp27 (HspB1) is stress inducible and participates in the defence against misfolded proteins. Under normal conditions, it forms oligomeric structures with molecular masses ranging from 50 to 800 kDa. These structures are highly dynamic and their dynamic organization is regulated by phosphorylation, which has been suggested to be a crucial factor in modulating the activity of the protein. To investigate the responses of Hsp27 to stress induced by proteasomal inhibition, and its state of phosphorylation and oligomerization during aggregate formation, three oligodendroglial cell lines stably expressing Hsp27 were established: OLN27 wild type, OLN27DDD expressing triple mutant Hsp27 in its phosphorylation mimicking form, and OLN27AAA, expressing non-phosphorylatable Hsp27. Our data show that the proteasomal inhibitor MG-132 promotes Hsp27 phosphorylation by activation of p38 mitogen activated protein kinase and leads to the formation of small oligomers. However, Hsp27 is recruited to aggresomes independently of its state of phosphorylation. After 24 h of treatment, all three cell lines had formed protein accumulations in the vicinity of the centrosome, but in cells over-expressing Hsp27, aggresome formation was delayed in comparison with OLN-93 oligodendroglial cells not expressing Hsp27.

Objectives: The importance of early clinical experience for medical training is well documented. However, to our knowledge there are no studies that assess the influence of very early nursing attachments on the professional development and identity construction of medical students. Working as an assistant nurse while training to be a doctor may offer valuable learning experiences, but may also present the student with difficulties with respect to identity and identification issues. The aim of the present study was to describe first-year medical students' perceptions of nurses, doctors and their own future roles as doctors before and after a nursing attachment., Methods: A questionnaire containing open questions concerning students' perceptions of nurses, doctors and their own future roles as doctors was administered to all Year 1 medical students (n=347) before and directly after a 4-week nursing attachment in hospitals and nursing homes. We carried out two confirmatory focus group interviews. We analysed the data using qualitative and quantitative content analyses., Results: The questionnaire was completed by 316 students (response rate 91%). Before starting the attachment students regarded nurses as empathic, communicative and responsible. After the attachment students reported nurses had more competencies and responsibilities than they had expected. Students' views of doctors were ambivalent. Before and after the attachment, doctors were seen as interested and reliable, but also as arrogant, detached and insensible. However, students maintained positive views of their own future roles as doctors. Students' perceptions were influenced by age, gender and place of attachment., Conclusions: An early nursing attachment engenders more respect for the nursing profession. The ambivalent view of doctors needs to be explored further in relation to students' professional development. It would seem relevant to attune supervision to the age and gender differences revealed in this study.

We present a simple method to determine the persistence length of short submicrometer microtubule ends from their stochastic trajectories on kinesin-coated surfaces. The tangent angle of a microtubule trajectory is similar to a random walk, which is solely determined by the stiffness of the leading tip and the velocity of the microtubule. We demonstrate that even a single-microtubule trajectory suffices to obtain a reliable value of the persistence length. We do this by calculating the variance in the tangent trajectory angle of an individual microtubule. By averaging over many individual microtubule trajectories, we find that the persistence length of microtubule tips is 0.24 +/- 0.03 mm.

Context: In their postgraduate educational programs, residents are immersed in a complex workplace. To improve the quality of the training program, it is necessary to gain insight into the factors that influence the process of learning in the workplace., Methods: An exploratory study was carried out among 56 nursing home physicians in training (NHPT) and 62 supervisors. They participated in semi-structured group interviews, in which they discussed four questions regarding workplace learning. Qualitative analysis of the data was performed to establish a framework of factors that influence workplace learning, within which framework comparisons between groups could be made., Results: A framework consisting of 56 factors was identified. These were grouped into 10 categories, which in turn were grouped into four domains: the working environment, educational factors in the workplace, NHPT characteristics and supervisor characteristics. Of the factors that influence workplace learning, social integration was cited most often. Supervisors more often reported educational factors and NHPTs more frequently reported impediments., Conclusion: The educational relationship may be improved when supervisors explicitly discuss the learning process and learning conditions within the workplace, thereby focusing on the NHPT needs. Special attention should be paid to the aspects of social integration. A good start could be to answer the question regarding how to establish a basic feeling of 'knowing where you are' and 'how to go about things' to make residents feel comfortable enough to focus on the learning process.

The transition from undergraduate medical education to learning in clinical clerkships can be difficult for students. Learning in clinical practice requires awareness of learning opportunities and goals, active elaboration and reflection. Staff should provide students with guidance to learn from their experiences. A new Introductory Clerkship was designed to facilitate the start of goal-oriented, active and reflective work-based learning. This four-week clerkship is a result of the cooperation of six major specialties in the university hospital. The innovations included explicitly formulated goals, a description of the student's activities in daily practice and of the staff's role, group meetings, a logbook, a halfway formative interview and a final summative interview. The aim of this study was to investigate to what extent the innovations of the new Introductory Clerkship were implemented and how students and residents valued them. Two questionnaires were constructed: one was administered to students (n = 54) and the other to residents (n = 27). Students considered participation in daily practice very instructive, although more observations of history taking and physical examination are wanted. The interviews and group meetings promote students' learning. Use of the logbook needs improvement. Residents perceived a shortage of time and would appreciate more participation of staff members, as well as a better preparation for supervising tasks. Overall, the study demonstrates that it is possible to introduce innovations in clinical clerkships to improve the learning environment of work-based learning.