Medical students need experience not just competence

Dornan, Tim; Gillespie, Hannah; Armour, Dakota; Reid, Helen; Bennett, Deirdre

doi:10.1136/bmj.m4298

Cited by 21 publications

(24 citation statements)

References 10 publications

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“…Despite significant improvements in preparedness since the introduction of the student assistantship, 33% of UK graduates in 2019 still did not feel prepared for practice, leading to calls for longer periods of 'hands-on' experience. 12,13 Assistantships are currently only offered to final-year students, but our results suggest that medical students of all years can fulfil this role, and making this available to students in earlier years of study would provide them with the practical experience they need. The majority of respondents in this study agreed with this proposal; 68% of medical student CAs and 47% of clinicians wanted to see the integration of a CA role into the first-to fourth-year medical school curriculum, and an additional 25% of clinicians wanted the CA role to become a part-time job for medical students.…”

Section: Discussionmentioning

confidence: 86%

A review of the clinical assistant workforce at a district general hospital during the COVID-19 pandemic

Brown

Moshtael

Rogers

et al. 2021

Future Healthcare Journal

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a new workforce of clinical assistants (CAs), comprising predominantly of medical students, began work at Northampton General Hospital. Clinical-years students had a role similar to final-year student assistants; preclinical students were offered a healthcare assistant role. This research aimed to evaluate both CAs' and clinicians' perceptions of this programme. MethodsSeparate questionnaires were developed for CAs and clinicians, assessing the scheme's successes and failures. Data analysis was carried out using MS Excel and SPSS. Results and discussionForty-nine CAs and 60 clinicians responded. CAs of all years were completing the higher-level role. They were perceived to improve continuity of care (74% CA agreement; 88% clinician agreement), reduce clinician workload (90% clinician agreement) and felt significantly more confident with practical and administrative tasks. Sixty-eight per cent of CAs and 72% of clinicians believed the role should be available to students before their final year.

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Section: Discussionmentioning

confidence: 86%

A review of the clinical assistant workforce at a district general hospital during the COVID-19 pandemic

Brown

Moshtael

Rogers

et al. 2021

Future Healthcare Journal

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“…Work-life balance is influencing trainees' choice of subspecialty (Douglas et al 2018). Trainees' poor psychosocial health, which causes sickness absences and career breaks, (West and Coia 2019;Dornan et al 2020; Practice points Doctors' demotivation and poor psychological health are becoming serious threats to healthcare safety. Doctors' complex mix of attributes provides the human touch, which makes healthcare much greater than a series of correct actions.…”

Section: The Need For Reform In Medical Educationmentioning

confidence: 99%

Acting wisely in complex clinical situations: ‘Mutual safety’ for clinicians as well as patients

et al. 2021

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The hope that reliably testing clinicians' competencies would improve patient safety is unfulfilled and clinicians' psychosocial safety is deteriorating. Our purpose was to conceptualise 'mutual safety', which could increase benefit as well as reduce harm. Methods: A cultural-historical analysis of how medical education has positioned the patient as an object of benefit guided implementation research into how mutual safety could be achieved. Results: Educating doctors to abide by moral principles and use rigorous habits of mind and scientific technologies made medicine a profession. Doctors' complex attributes addressed patients' complex diseases and personal circumstances, from which doctors benefited too. The patient safety movement drove reforms, which reorientated medical education from complexity to simplicity: clinicians' competencies should be standardised and measurable, and clinicians whose 'incompetence' caused harm remediated. Applying simple standards to an increasingly complex, and therefore inescapably risky, practice could, however, explain clinicians' declining psychosocial health. We conducted a formative intervention to examine how 'acting wisely' could help clinicians benefit patients amidst complexity. We chose the everyday task of insulin therapy, where benefit and harm are precariously balanced. 247 students, doctors, and pharmacists used a thought tool to plan how best to perform this risky task, given their current clinical capabilities, and in the sometimes-hostile clinical milieus where they practised. Analysis of 1000 commitments to behaviour change and 600 learning points showed that addressing complexity called for a skills-set that defied standardisation. Clinicians gained confidence, intrinsic motivation, satisfaction, capability, and a sense of legitimacy from finding new ways of benefiting patients. Conclusion: Medical education needs urgently to acknowledge the complexity of practice and synergise doctors' and patients' safety. We have shown how this is possible.

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“…Dornan and colleagues suggest the importance of experience over competence and the risks that can arise if this is forgotten 1. This year, thousands of final year medical students graduated early to act as interim foundation year 1 doctors, and students in other years had their studies disrupted by covid-19 2.…”

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confidence: 99%

Reforming medical education: student experience during the covid-19 pandemic

Collaborative

2021

BMJ

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Medical students need experience not just competence

Cited by 21 publications

References 10 publications

A review of the clinical assistant workforce at a district general hospital during the COVID-19 pandemic

A review of the clinical assistant workforce at a district general hospital during the COVID-19 pandemic

Acting wisely in complex clinical situations: ‘Mutual safety’ for clinicians as well as patients

Reforming medical education: student experience during the covid-19 pandemic

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