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Authors | Institution |
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Bianca Schuh Alexandra Schmid Christoph Gisinger Anita Rieder |
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| The positive side effects of early authentic experience |
According to literature, early patient contact in a clinical setting has positive effects on the professional development of medical students (1, 2 and 3). At the Medical University of Vienna, a 30-hour course in a modern long-term care hospital is mandatory for all 740 freshmen each year. The learning goals of the course are the development of professional attitudes toward care recipients and toward non-medical health professionals.
The course consists of the following parts. The video shows impressions of each part.
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Seminar (7 hours):
- Theoretical basis
- Preparation for the practical part including "Instant ageing", a simulation of age- and disease-related physical limitations
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Clinical experience (16 hours spread over 5 weeks)
- Main emphasis of the course
- In a modern long term care hospital
- Mainly with elderly people, sometimes with disabled people
- One student cares for one patient
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Tasks in the clinical setting
- Like visiting service
- No nursing or medical activities
- To build a relationship to the patients
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Documentation and reflection report (counting as 3 hours)
- Documentation of clinical experience
- Reflection on the encounters with patients and staff of the teaching hospital
- Creation based on guideline
- To be written in parallel to the clinical experience, due before final reflection in class
- Average length: about five pages
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Final reflection in class (4 hours)
- Reflection and discussion of the experiences in small groups on the basis of the reports
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Assessment
- Full attendance in class
- Active participation in class
- Written report
The intended learning outcomes are:
- Acquiring professional attitudes and behaviour in dealing with patients and non-medical healthcare professionals
- Gaining awareness for the major contribution of non-medical healthcare professionals to the health system
- Gaining appreciation for elderly people
There are scarcely empirical studies that try to analyse additional consequences of early authentic experience other than the intended (4 quoted in 5; one example is 6). To get a better idea of early authentic experience, the unintended learning outcomes should be addressed (7). The purpose of this study is to identify the intended and unintended learning outcomes of the course, with the main focus on the additional positive and negative side effects.
About 740 students (divided in groups of ten) attended the course. All of them had to write a reflection report. One report was randomly drawn from each of the 74 small groups. 52 reports were analysed for this study. Students with attested experience (about one third, e.g. paramedic) did not need to do the clinical experience. The reports of those students were not considered.
The written reflections were analysed with regard to the question which intended and unintended learning outcomes the students report. A qualitative content analysis according to Mayring (3) was performed through inductive category building.
- Dornan, T., Littlewood, S., Margolis, S.A., Scherpbier, A., Spencer, J. & Ypinazar, V. (2006). How can experience in clinical and community settings contribute to early medical education? A BEME systematic review. Medical Teacher, 28, 1, 3-18.
- Scavenius, M., Schmidt, S. & Klazinga, N. (2006). Genesis of the professional-patient relationship in early practical experience: qualitative and quantitative study. Medical Education, 40, 1037-1044.
- Yardley, S., Littlewood, S., Margolis, S. A., Scherpbier, A., Spencer, J., Ypinazar, V. & Dornan, T. (2010). What has changed in the evidence for early experience? Update of a BEME systematic review. Medical Teacher, 32, 740-746.
- Yardley, S. (2011). Understanding authentic early experience in undergraduate medical education. Doctorate ed. Keele, Keele University.
- Yardley, S., Teunissen, P. W, Dornan, T. (2012). Experiential learning: AMEE guide No. 63. Medical Teacher, 34, e102-e115.
- Helmich, E, Bolhuis, S., Laan, R, Koopmans, R. (2011). Early clinical experience: do students learn what we expect? Medical Education, 45, 731-740.
- Yardley, S., Brosnan, C., Richardson, J., Hays, R. (2012). Authentic early experience in Medical Education: a socio-cultural analysis identifying important variables in learning interactions within workplaces. Advances in Health Sciences Education, DOI 10.1007/s10459-012-9428-2.
- Mayring, P. (2010). Qualitative Inhaltsanalyse. Grundlagen und Techniken. 11. Auflage. Weinheim, Beltz.
Seven main categories emerged from inductive analysis, see below. For each main category and for each sub-category the number of times mentioned in the analysed reports is given in brackets.
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Experience in interaction with care recipients (90)
- Experience in the interaction with patients and/or elderly people (31)
- Experience how care recipients benefit from time spent together and receiving attention (31)
- Experience in interacting with care recipients having issues in communication (23)
- Experience in handling strong emotions of and difficult situations with care recipients (5)
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Recognizing important factors for successful interaction with care recipients (47)
- Respecting the opinion and wishes of people in every situation of life (9)
- Showing an interest in the patient's individual personality (8)
- Patience as important factor (5)
- Openness as important factor (4)
- Empathy as important factor (4)
- Listening as important factor (4)
- Motivating the patient as important factor (4)
- Recognizing boundaries and setting limits (3)
- Non-judgemental demeanour (2)
- Non-verbal communication as important factor (1)
- Making eye contact (1)
- Taking enough time (1)
- An element of easiness (1)
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Understanding the perspectives and needs of care recipients (47)
- Understanding the perspectives of elderly people and appreciation for elderly people (19)
- Observing that people have retained their enjoyment for life despite various health restrictions (10)
- Learned to empathise with patients (10)
- Gained insight into patient's needs (8)
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Reflection of one’s own capabilities (43)
- Recognition of one’s own strengths and weaknesses in interaction with care recipients (31)
- More confidence in one’s own capabilities (12)
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Appreciation for non-medical health professionals’ work (38)
- Appreciation for non-medical health professionals’ work (30)
- Gained insight into the daily activities of non-medical health professionals (7)
- Increased understanding of different diseases and their mental components (11)
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Others (14)
- Students enjoyed visits themselves (3)
- Supervision and exchange of experiences is important (2)
- Thinking of what is important in life (2)
- Getting to know various therapies (3)
- Confirmation that becoming a physician is the right thing to do (2)
- Learnt to help a person in a wheelchair (2)
You find exemplary citations from the reflection reports for each of the seven main categories below and under "more details":
Category 1: "I think that the most important insight for me is that I have learned how to behave towards care-dependent people and that it is important to invest much time to get to know them better, to take away their fear and build trust in them. I think this insight will also be helpful to me in my later life, since I shall be working mainly with elderly or care-dependent people, and I will always remember how important it is to take time and not to rush as fast as possible from one patient to the next."
Additional unintended learning outcomes were identified in the randomly drawn reports, mainly in the categories 4 “Reflection of one’s own capabilities”, 6 “Increased understanding of different diseases” and 7 “Others”. Thus, besides the intended learning outcomes, there are positive side effects of early authentic experience. No negative effects could be identified.
Still, the study has several limitations. One is the non-research-led purpose of the analysed reports. The reports were submitted for assessment, not for research purposes. Biases are also possible because of the pre-set questions in the report-guideline and socially desirable responses.
Side effects of early authentic experience need to be taken into account for controlling actual learning outcomes.