No abstract

The four initial questions of the NRS 2002 robustly identify nutritional risk and were strong predictors of hospitalisation, morbidity and most importantly mortality among hospitalised patients. Thus, these simpler and short questions are robust indicators for subsequent poor outcomes.

Nutritional risk was most common among patients with high age, low BMI, more comorbidity, and with infections, cancer or pulmonary diseases, and patients who were discharged to nursing homes. However, the highest number of patients at nutritional risk had BMI in the normal or overweight range, were 60-80 years old, and were found in departments of general medicine or surgery. Importantly, younger patients and overweight patients were also affected. Thus, nutritional risk screening should be performed in the total patient population in order to identify, within this heterogeneous group of patients, those at nutritional risk.

Dyad practice is more efficient and thus more cost-effective than individual practice and can be used for costly virtual reality simulator training. However, dyad practice may not apply to clinical training involving real patients because learning from errors and overt communication, both keys to dyad practice, do not transfer to clinical practice.

Three interrelated factors appeared to influence the perceived value of assessment in postgraduate education: (1) the link between patient safety and individual practice when assessment is used as a licence to practise without supervision rather than as an end-of-training examination; (2) its benefits to educators and learners as an educational process rather than as merely a method of documenting competence, and (3) the attitude and rigour of assessment practice.

The aim of this study was to explore how medical students perceive the experience of learning from patient instructors (patients with rheumatism who teach health professionals and students) in the context of coupled faculty-led and patient-led teaching session. This was an explorative study with a qualitative approach based on focus group interviews. Analysis was based on a prior developed model of the characteristics of learning from patient instructors. The authors used this model as sensitizing concepts for the analysis of data while at the same time being open to new insights by constant comparison of old and new findings. Results showed a negotiation both between and within the students of the importance of patients' experiential knowledge versus scientific biomedical knowledge. On one hand students appreciated the experiential learning environment offered in the PI-led sessions representing a patient-centred approach, and acknowledged the importance of the PIs' individual perspectives and experiential knowledge. On the other hand, representing the scientific biomedical perspective and traditional step-by step teaching, students expressed unfamiliarity with the unstructured experiential learning and scepticism regarding the credibility of the patients' knowledge. This study contributes to the understanding of the complexity of involving patients as teachers in healthcare education and initiates a discussion on how to complement faculty-led teaching with patient-led teaching involving varying degrees of patient autonomy in the planning and delivering of the teaching.

This study indicates that, in terms of power relations, the PI-student relationship differs from those between faculty teachers and students, and students and patients in the clinic. The formation of a professional identity by students may clash with the fulfilment of their learning tasks in the clinical environment. The study indicates that patient-centredness can be fostered in the PI-student relationship. This is probably supported by the absence of faculty staff involvement in PI teaching sessions. However, further empirical research is required on what, how and why students learn from patients in different learning contexts.

Structured curricula for senior house officers have often been lacking. The aim of this study was to trial a person-task-context model in designing a curriculum and in-training assessment (ITA) programme for SHOs in internal medicine. A working group designed the programme based on triangulation of information from interviews with trainees and programme directors, analysis of patient case mix and national quality assurance data. The interview data showed that the main difference currently between trainee levels was in expected degree of responsibility for patient management rather than in actual tasks. Key learning needs were how to take a structured approach to the tasks and get an overview of situations. SHOs expressed a need for explicit learning goals and standards of performance. SHOs requested formal teaching in non-medical aspects of competence such as communication, interpersonal skills and professionalism. This article points out how consideration of the type of trainees involved, the tasks they must do and learn, and the context in which they work are important in designing postgraduate curricula. The person-task-context model can be used to tailor curricula and ITA that support learning and may be especially beneficial in promoting learning in non-dominant areas of a specialty.