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Medical imaging is integrated across all years in the medical programs at the Medical School, in our country. Little is known about this pedagogical approach from the perspective of those who participate in it. This study investigated how students and educators experience an integrated medical imaging curriculum.One-on-one interviews were conducted with nine educators and three undergraduate medical students and analyzed using a reflexive thematic approach. Educators included radiologists, non-radiologists clinicians, and scientists and health professionals from the medical program.The integrated medical imaging curriculum appears to be incoherently experienced by educators and students as learning opportunities that were 'everywhere and nowhere'. Teaching events were 'repetitive and patchy' and featured a transmission-oriented pedagogy emphasizing 'exposure and absorption'. Educators expressed paradoxical views of their responsibility for teaching medical imaging reflected in this sentiment: 'I don't teach medical imaging… (but I do)'.When medical imaging is integrated into learning resources and course work across the undergraduate program, it may lose its visibility and importance as a distinct learning area despite its crucial role in medical practice. An integrated curriculum may inadvertently separate knowing about medical imaging from learning to apply medical imaging knowledge in clinical practice.Further work is required to construct an integrated medical imaging curriculum that explicitly emphasizes medical imaging learning outcomes, so they are experienced coherently and consistently by medical students and those who prepare them for practice as doctors.

Background Simulation scenarios can be used to identify staff and patient safety issues in healthcare services. Methods A systems thinking approach was used to analyze qualitative data from five simulation reports and five interviews with facilitators and participants in a hospital setting. Results Infection prevention measures created delays in providing timely patient care due to altered roles for staff and constraints imposed by hospital equipment and physical structure. Conclusions Systems thinking can be used to analyze the outcomes of simulation scenarios and may help healthcare professionals better understand and work with the affordances and constraints of their healthcare service.

Practical advice is offered for a positive and productive supervisory relationship. Tips to get started include suggestions to consider about possible reasons, assumptions, and expectations for engaging in education research. Once a relationship is established, we emphasise the importance of constructing appropriate research questions, understanding the use of theory, and developing time management strategies. We consider the practicalities of initiating a research project and the reflexivity required to maintain shared expectations. We address potential challenges which may disrupt the research process. Finally, we present a set of reflective prompts for supervisors and students to consider before starting a project together.

Objective: The study aimed to examine if an active learning approach used in a pharmaceutical science laboratory would enhance pharmacy students’ learning of foundation pharmaceutical science knowledge when conducting an experiment. Method: A pre-post-test study design was used to collect data from third-year undergraduate pharmacy students with two approaches to performing an experiment (active learning, and traditional). Results: Assessment data from 95 students (73% response rate) were analysed quantitatively and qualitatively. The active learning approach to performing an experiment resulted in significantly higher (p

Background Therapeutic decision-making is a core element of pharmacy practice, however, little has been documented about how it is enacted in practice and how it can be theorised. Objective(s) This study aims to contribute to pharmacy education and practice theory by investigating the correspondence between explanations from primary care pharmacists in clinical practice roles about how they make decisions related to medicines therapy and a theoretical model of therapeutic decision-making. Methods In this qualitative study, interview data from 10 pharmacists in primary care settings were analysed using a general inductive approach. The emergent themes were compared to a theoretical model of therapeutic decision-making. Results Eight themes were identified from the explanations of how participants were making therapeutic decisions in practice. The themes were found to correspond to at least one of the four steps of therapeutic decision-making in the model. Themes corresponding to the information gathering step were described most vividly, whereas, the themes corresponding to the reasoning, judgement, and decision steps were less well-articulated. Conclusions These findings suggest that the theoretical model can be useful to interpret empirical data about therapeutic decision-making in practice. These findings might provide a means for pharmacists to adopt language to better describe the steps in their therapeutic decision-making process to others, and especially, their colleagues and patients. Findings can be used by pharmacy educators to design learning opportunities for students about therapeutic decision-making.

Phenomenon: Professionalism can be characterized by a particular set of attributes that clinicians demonstrate in practice. Although much has been described on those attributes that define acceptable professionalism, the characteristics that define distinction in professionalism have not yet been well defined. Approach: In this exploratory project, qualitative methods were used to triangulate three sources of data collected from three campuses of one medical school: student assessment summaries, teacher interviews, and an institutional policy. Findings: One hundred-thirty student assessment summaries, eight teacher interviews, and one institutional policy were analyzed. Three characteristics emerged that define distinction in professionalism: improvement of oneself, helping others learn, and teamwork. These characteristics are in addition to students demonstrating a clear minimum standard in all other aspects of professionalism. Insights: Findings from this project offer a first step toward a definition of distinction in professionalism for assessing student performance. The characteristics can be demonstrated by students to varying degrees of proficiency and are potentially achievable by all students. Finally, the characteristics would be required in addition to demonstrating a clear minimum standard of performance in all other aspects of professionalism and cannot be inferred by the absence of negative or unprofessional behaviors. Recognizing that conceptions of professionalism have contextual and cultural influences, the characteristics of distinction identified by this project expand the language available for teachers and learners to discuss professionalism. Teachers may use these characteristics to help inform their teaching, learning, and feedback practices. Students will gain clarity about the expectations regarding their professional behavior.

Clinical decision-making is arguably the most important and underappreciated skill in pharmacy. It can be described as four discrete steps: information gathering, clinical reasoning and judgement and, the decision process. The information gathering and decision negotiation steps and to some extent clinical reasoning are addressed either implicitly or explicitly by practitioners and educators. Clinical judgement, however, remains a largely unexplored concept for clinical decision-making in healthcare therapeutics. It defines how practitioners arrive at a favourable treatment strategy and, due to the often complicated benefit:risk evaluations, is often linked with concepts relating to ambiguity. In this article, we use game theory to explore the judgement stage of clinical decision-making. Game theory allows us to provide a quantitative evaluation of clinical judgement and explore concepts such as ambiguity and its sources in healthcare. Clarifying the elements involved in the judgement stage of clinical decision-making will enable a better understanding of how pharmacists contribute patient care in healthcare teams.

Background: Threshold skills are defined as new ways of thinking about and performing in a discipline. They represent transformed ways of thinking and doing that are pivotal to learners’ progress. ...

Introduction: Online resources are available to enhance emergency medicine training programmes. The aim of this study was to evaluate the feasibility of using online case-based resources created in the United States in a New Zealand emergency medicine training programme. Methods: Evaluation data were collected from junior doctors and educators after they participated in the programme. Data sources included research notes and questionnaire responses. The data were analysed qualitatively using a general inductive approach. Results: Evaluation feedback from 19 junior doctors and 14 educators was interpreted to suggest that the online resource, with minor adaptations, was feasible to use in a New Zealand emergency medicine training programme. Findings indicated that educators were able to modify the materials to modify to meet local requirements, however, the opportunity to include a cultural component was missed. Participants appreciated the case-based format and felt that they established a safe and encouraging learning environment with each other. Participants were able to develop a systematic approach to emergency situations and identify red flags related to deteriorating patients. Discussion and Conclusion: Evaluation findings indicate that adapting an online-sourced curriculum is feasible to educators and acceptable to junior doctors and educators participating in a single New Zealand based Emergency Medicine training program. Educators in other international training settings may find the lessons learned helpful when adapting online resources to address the learning needs of their junior doctors. Next steps are to evaluate the impact of this resource on the knowledge and skills learned by junior doctors and any changes in their care for patients in emergency medicine situations.

Universal faculty is a term we use to describe all individuals who impact a medical student’s learning journey. Universal faculty include full-time academic staff (who identify themselves as medica...

Background Interprofessional education initiatives can be used as effective means to influence students' perceptions of their own and others' roles and interactions as health professionals. There is a need to better understand how interprofessional education learning outcomes are appreciated by students. Aim The aims of this study were to describe and compare evaluation feedback from students in undergraduate nursing and medicine programmes about the learning outcomes of an interprofessional education initiative. Methods A mixed methods pre-post-study design was used to collect data using evaluation questions about the initiative and two interprofessional learning outcomes: communication and teamwork. Ratings were analysed with a two-way repeated measures analysis of variance or a t-test. Written responses were analysed using a general inductive approach. Results Data from 30 nursing students and 12 medical students were analysed. A noteworthy finding was a significantly higher average rating for nursing students than medicine students before and after the session for the statement about valuing interprofessional learning. Three themes represented comments from both groups: positive experiences, relevance to practice, and learning design issues. Discussion Findings were interpreted to indicate that students from both programmes valued the learning outcomes session and was greater at the end of the session. Notably, the perceived value of interprofessional learning was higher for nursing students than medical students before and after the session. This finding may be related to the familiarity nursing students may have with the teaching methods used in the initiative. Further exploration of this finding is needed so educators can better understand how they can provide optimal learning experiences for all students who participate in interprofessional education. Conclusion Nursing and medicine students appear to value the interprofessional learning outcomes in an undergraduate health professional initiative. However, differences between these two groups of students are an area for further exploration.

Rationale, aims, and objectives Uncertainty is a complex and constant phenomenon in clinical practice. How medical students recognize and respond to uncertainty impacts on their well-being, career choices, and attitudes towards patients. It has been suggested that curricula should do more to prepare medical students for an uncertain world. In order to teach medical students about uncertainty, we need to understand how uncertainty has been conceptualized in the literature to date. The aim of this article is to explore existing models of uncertainty and to develop a framework of clinical uncertainty to aid medical education. Method A scoping literature review was performed to identify conceptual models of uncertainty in healthcare. Content and inductive analyses were performed to explore three dimensions of clinical uncertainty: sources of uncertainty, subjective influencers and responses to uncertainty. Results Nine hundred one references were identified using our search strategy, of which, 24 met our inclusion criteria. It was possible to classify these conceptual models using one or more of three dimensions of uncertainty; sources, subjective influencers, and responses. Exploration and further classification of these dimensions led to the development of a framework of uncertainty for medical education. Conclusion The developed framework of clinical uncertainty highlights sources, subjective influencers, responses to uncertainty, and the dynamic relationship among these elements. Our framework illustrates the different aspects of knowledge as a source of uncertainty and how to distinguish between those aspects. Our framework highlights the complexity of sources of uncertainty, especially when including uncertainty arising from relationships and systems. These sources can occur in combination. Our framework is also novel in how it describes the impact of influencers such as personal characteristics, experience, and affect on perceptions of and responses to uncertainty. This framework can be used by educators and curricula developers to help understand and teach about clinical uncertainty.

(1) Background: The processes and skills required to make decisions about drug therapy have been termed &ldquo, therapeutic decision-making&rdquo, in pharmacy practice. The aim of this study was to evaluate a tool constructed to measure the development of therapeutic-decision-making skills by practicing pharmacists undertaking a university-based continuing professional development program. (2) Methods: A pre- and post-intervention crossover study design was used to investigate the qualitative and quantitative features of practicing pharmacists&rsquo, responses to two clinical vignettes designed to measure the development of therapeutic-decision-making skills. The vignettes were assigned a score using a five-point scale and compared pre- and post-intervention. (3) Results: There was a median increase in score of 2 units on the five-point scale in the post-intervention scores compared to pre-intervention (p &lt, 0.0001). (4) Conclusions: The results were interpreted to suggest that the participants&rsquo, responses to the vignettes are a reasonable measure of student learning. Therefore, we infer that the teaching and learning intervention successfully enabled the development of therapeutic-decision-making skills by practicing pharmacists.

Objective. To conduct a survey of practicing pharmacists in which best-worst choice methodology was used to prioritize pharmacy practice skills for inclusion in a pharmacy curriculum in New Zealand. Methods. A literature search and review of pharmacy curricula were conducted, and the findings were used to develop a best-worst choice survey instrument regarding inclusion of pharmacy practice skills in the pharmacy curriculum. The survey was sent to registered pharmacists and intern pharmacists in New Zealand. Participants were asked to prioritize 16 skills in terms of their importance and relevance to pharmacy practice. Results. Of the 3836 pharmacists invited to participate in the survey, 388 completed the questionnaire. Comprehensive chronic disease management, specialty medications, and medicines use review were the top three prioritized skills. Injections, independent prescribing, and specialty compounding were the skills ranked as having the lowest priority. The pharmacists’ gender, age, practice setting, and ethnicity all influenced their skill prioritization. The pharmacists emphasized skills required in their current practice but deemphasized some skills that were emerging professional responsibilities. Conclusion. If curricular reform is to include new skills that are largely unfamiliar to or deemed unimportant by practicing pharmacists, quality assurance of students’ experiential education will be needed. Furthermore, preceptor education about changing expectations for pharmacy graduates’ skill sets must be adequately developed and implemented to ensure that preceptors provide students with opportunities to practice the full range of skills they will need in practice and provide them with accurate assessment and helpful feedback.

Pharmacy has a long history of providing products and services for healthcare. In the last century, these roles have taken a strong focus on clinical care with the provision of medicines review, medicines optimisation, and prescribing services being at the forefront. The profession, however, is diverse. Pharmacists operate across a wide range of healthcare practices that often embrace both historic and contemporary roles simultaneously. The purpose of this article is to provide an overarching philosophical framework for pharmacy that encompasses roles that the modern pharmacist may assume. In doing this, we explore how pharmacy services align with healthcare and how different services require different approaches to clinical decision making.

We explored the relationships between social contexts and factors that promoted and inhibited curriculum change at two universities. Thirty interviews were analysed using a general inductive approach to identify factors and forces in three social contexts (lecturer, departmental, and institutional). Curriculum change was characterised by six forces: ownership, resources, identity, leadership, students, and quality assurance, each composed of factors that differed in their direction (enabling or inhibiting) and/or intensity (strong or weak). Academic developers should find the approach and lessons learned useful for planning interventions and identifying where they may encounter resistance or enablers in the process of change.

Background Students find learning clinical reasoning skills challenging. Viewing how students learn clinical reasoning skills from a sociocultural perspective, however, may allow helpful and unhelpful descriptions to be interpreted as experiences that promote or inhibit their participation in and opportunities to co-construct their clinical reasoning skills. Methods This interview study was conducted with 25 Year-6 undergraduate medical students. Interview data were first analysed thematically, and then the findings were analysed with the concepts of participation and co-construction. Results The themes identified were: (1) practising with undifferentiated patients; (2) teachers who were willing to make thinking explicit; (3) a lack of independence and involvement; (4) a lack of communication and feedback; and (5) confusion from different sources of information. When further analysed, the themes could be represented as points along a continuum of participating in, and co-constructing, clinical reasoning skills. Discussion Clinical educators will find the themes identified from students' experiences learning in a workplace environment helpful for understanding why some students may struggle to develop their clinical reasoning skills. An interpretation of findings from a sociocultural perspective offers a different approach for understanding students' difficulties when learning clinical reasoning: one where students are able to increase their participation in, and co-construction of, clinical reasoning in the context of working collaboratively to provide patient care. Students find learning clinical reasoning skills challenging.

This article was migrated. The article was not marked as recommended. Introduction: Therapeutic decision-making is offered as a term to describe the responsibility that pharmacists have as medicines experts for making decisions about drug therapy for individual patients. There is a lack of research describing how pharmacy students learn to make therapeutic decisions. Methods: Qualitative methods were used to interview twelve final-year undergraduate pharmacy students. Data were analysed inductively to identify the steps in the process, the definition, and attitudes students learned about therapeutic decision-making. Results: According to these pharmacy students, the process and definition involve four steps; identifying medicines related problems via differential diagnosis, exploring treatment options, weighing up the options, and making a recommendation. Attitudes were confidence, open-mindedness, and bias awareness. Discussion: These findings align with a proposed model for therapeutic decision-making in pharmacy practice, however, this study did not determine if the students could apply the model in practice. Conclusion: These findings can be used as a benchmark for enhancing the pharmacy curriculum to include decision-making skills about drug therapy for future practice settings.

This article was migrated. The article was marked as recommended. Introduction. In the health professional education literature, there is a need for information about the teaching and learning of medical laboratory sciences for clinical practice. The goal of this reflection-on-practice is to describe how an orofacial pathology interprofessional education (IPE) initiative was designed and implemented. Innovation. The designers of this initiative were teachers from dentistry, oral health, and medical laboratory science. The designers used six interprofessional competencies (patient-centred care, role clarification, team functioning, collaborative leadership, communication, and cultural practice) to guide their construction of teaching and learning resources. The initiative required students to work collaboratively with a given patient case to develop a differential diagnosis, prepare a treatment plan, present their case to classmates and staff members, and describe how they worked together to address the orofacial pathology in their case. Evaluation. The designers collected and considered evaluation information including the learning resources used, logistical arrangements for the initiative, and evaluation data from students via an anonymous 10-item questionnaire. Students rated statements that addressed the six interprofessional competencies and provided written comments about the initiative. Outcomes. In general, the 18 students agreed strongly with all statements except for cultural practice. Written comments about the initiative were positive and indicated that students appreciated learning about their own discipline and that of other professionals in the context of providing oral healthcare involving orofacial pathology. What next? Given the acceptability of this initiative to the designers, facilitators, and students, the next step is to consider the feasibility of scaling-up this small voluntary IPE initiative into a permanent component of the dentistry, oral health, and medical laboratory science programmes. Aspects to consider include staffing, scheduling, assessment, and cultural perspectives.

There is increasing evidence that students at different levels of training may benefit from different methods of learning clinical reasoning. Two of the common methods of teaching are the "whole - case" format and the "serial cue" approach. There is little empirical evidence to guide teachers as to which method to use and when to introduce them.We observed 23 students from different stages of training to examine how they were taking a history and how they were thinking whilst doing this. Each student interviewed a simulated patient who presented with a straightforward and a complex presentation. We inferred how students were reasoning from how they took a history and how they described their thinking while doing this.Early in their training students can only take a generic history. Only later in training are they able to take a focused history, remember the information they have gathered, use it to seek further specific information, compare and contrast possibilities and analyze their data as they are collecting it.Early in their training students are unable to analyze data during history taking. When they have started developing illness scripts, they are able to benefit from the "serial cue" approach of teaching clinical reasoning.

Clinical decision-making skills are recognized as a central component of professional competency but are under-developed in pharmacy compared to other health professions. There is an urgent need for a comprehensive understanding of how pharmacists can best develop and use therapeutic decision-making skills in clinical practice. The aims of this commentary are to define clinical decision-making in pharmacy practice, and to present a model for clinical decision-making that aligns with a philosophical framework for pharmacy practice. The model has utility in education programs for pharmacists and provides a framework for understanding patient-facing clinical services in practice.

Affordances of contemporary communications technology challenge the unquestioned assumptions and rationale of lectures. Furthermore, as students have changed their patterns of engagement with learning, universities have begun to reconsider their tradition of offering students lectures. These circumstances have prompted a group of teachers in one department to develop an alternative lectures: the bite-size mobile learning initiative. The initiative involved replacing some of the lectures with short video recordings of course material, “video-clips”, that could be watched by students at their convenience then elaborated and used to stimulate discussions in subsequent tutorials. We found that close to one-half of all respondents agreed or strongly agreed that video-video-clips worked as a learning tool, either alone or in combination with the tutorials; however, only 35% of respondents agreed or strongly agreed that they enjoyed watching the video-video-clips. The overwhelming majority of respondents agreed on one aspect: shorter is better.

With continuing pressure to publish or perish, interventions such as writing groups are increasingly part of the academic landscape. In this paper, we discuss our writing group's experiment with collaborative writing, which came unstuck as simmering concerns led to a mutiny within the group. The mutiny provided insights into tensions that are inevitably present in writing groups and collaborative writing exercises but are seldom written about. We explore these tensions via a collaborative autoethnography, drawing on published literature on writing groups and collaborative writing. The mutiny revealed three key dynamics. Experienced voices can have an important role to play but these voices need to be moderated so that other voices might be recognised and valued. Pleasure and productivity are two necessary components for sustaining writing groups and writing collaborations. Finally, hierarchies in the academic context are inescapable but they can be renegotiated so that more enabling power relations can be...

This article was migrated. The article was marked as recommended. Introduction: Dual process theory and script theory have been used to understand and explain how students learn clinical reasoning. This study used these tools to interpret how experienced teachers described their definitions of clinical reasoning, their own history learning about clinical reasoning, and their methods of teaching clinical reasoning. Methods: Interview data from 14 senior clinicians were investigated thematically using a general inductive approach then interpreted using principles and concepts associated with dual process theory and script theory, including the concept of deliberate practice and script consciousness. Results and Discussion: Senior clinicians' definitions of clinical reasoning were consistent with the literature. Few of them recalled being explicitly taught clinical reasoning. They identified teaching as a way to further develop their own clinical reasoning. They taught it opportunistically using an apprenticeship and role-modelling approach in clinical contexts. Their teaching techniques included supervised practice, reflection, think aloud, focused data collection guided by the clinical presentation, and iterative reasoning. Conclusion: Dual process theory, script theory, and the concepts of mindful practice and deliberate practice were found to be useful tools to understand how senior clinicians taught and learned clinical reasoning. These findings are guiding our clinical reasoning curriculum and faculty development programme.