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Authors Institution
Ong N.
Healy C.
Ginsburg G.
Burnett S.
Prent M.
Jones A.
Graduate School of Medicine, University of Wollongong
Department of Community Paediatrics, South West Sydney Local Health District
Child Health and Family Nursing, Illawarra and Shoalhaven Local Health District
Theme
Curriculum Planning / Community Oriented Medical Education
Assessing the experience of Child and Family Nurse community paediatric placements for medical students.
Background

 

The Graduate School of Medicine (GSM), University of Wollongong was set up in 2007 to address existing critical shortage of doctors in regional, rural and remote Australia by developing a comprehensive hospital and community- based curriculum of medical education. The GSM offers a graduate program for the Bachelor of Medicine and Surgery degree which is divided into 4 phases.

Phase 3 consists of a 40 week longitudinal placement in a GP practice spread over 30 sites across NSW particularly in regional – rural areas. Feedback from previous years' students reveal that learning of community paediatrics was variable depending on the demographic population serviced by the GP practice they were assigned to. In addition, many “new morbidity” cases eg. developmental and behavioural conditions, often present in the community and consist of a significant proportion of paediatric practice not seen in the acute hospital setting.

Across the state in the community, Child and Family Nurses provide comprehensive health and developmental surveillance for infants and young children aged 0- 5 years across specific age periods. Many of them are based within Early Childhood Centres accross the state and provide home visits and run mother and infant clinics.

PRIMARY AIM:

To ascertain if student placements with Child and Family Health Nurses could provide a community based learning environment to well child health and development.

SECONDARY AIM:

To identify within the Child and Family Nurse clinical setting, opportunities to enhance their clinical skills,  learn practical aspects of developmental surveillance and familiarise themselves to the interface between Child and Family Nursing with other community based paediatric health services.

  

Summary of Work

This is an evaluation of a pilot student placement program at the Child and Family Nurse setting conducted between November 2011 to June 2012.

A participant information sheet, consent form, pre and post placement MCQs were completed by the participants and control students. Ten participants and 8 controls were recruited. Each participant spent 6 x weekly placements at Warilla, Corrimal and Nowra Early Childhood Centres or Family Care Cottages supervised by senior nursing managers.

An introduction to the placements and learning resources in the form of the UoW Maternal and Child health manual,  UoW Phase 3 Child and Adolescent Health handbook, Child and Family Nurse service information, Safe Start policy, relevant sections of the child Personal Health Record and reading list of common early childhood issues were provided to enhance self- directed learning during the clinical placement.

Evaluation of the program involved analysis of the pre and post placement MCQ scores between the participant and control students, nursing supervisor assessment of each student's knowledge and clinical skills pre- and post placement and a focus group session with the participants and nursing supervisors.

Summary of Results

PRE AND POST MCQ ASSESSMENTS

MCQ scores

   
 

Pre

Post

 

Participants

Pre 43.20/ 64

Post 52.75/ 64

Controls

Pre 44.87/ 64

Post 43.62/ 64

 

NURSING SUPERVISOR EVALUATIONS

All students evaluated (5) had upward shifts on a 6 point Likert Scale from poor/ fair/ good to very good/ excellent for their knowledge and skills on:

  • the role of Child and Family Health services
  • taking a clinical history and examination
  • providing support and advice on common maternal and child health issues
  • infant health and development
  • use of developmental screening tools
  • ability to identify issues relating to the mother and child 
  • application of knowledge with little guidance

FOCUS GROUP RESULTS

Range of experience. It was found that the range of experiences were different for each student, but generally allowed good exposure to a variety of maternal and infant health issues.

Opportunities to practice clinical skills in the context of well child checks. There were many opportunities to take clinical histories, practice examining babies and learn about common issues such as infant feeding, sleeping and development. There were not as many opportunities to use the developmental screeners as most of the babies were < 6 months. Detecting pathology (except for 1 student) was unusual as most babies were normal with no significant concerns from the mothers.

Range of exposure to community programs and health services for mothers and young children. There was an interesting range of program exposure eg. Community Paediatric Registrar clinics, Familiy Care Cottage clinics, CHAIN mother's group (for vulnerable mothers), home visits etc.

Learning about the role of the Child and Family Nursing Service. The program gave a good overview of the role of CHFNs and enhanced knowledge of services in the community.

Limitations. The length of the program was considered a limitation. It was felt that more time was required to develop more confidence in clinical skills and greater depth of experience in maternal and infant health issues.

Suggestions for improvement. It was suggested that an "intensive" week including a range of community paediatric settings would further enhance clinical exposure, competency and experience. This could be applied to other specialities which do not feature highly in General Practice.

Conclusion

Medical student placements within the Child and Family Nurse settings provide good opportunities for students to develop knowledge and clinical skills about well child health, learn about Child and Family Nursing and health referral pathways within the community. A longer and more intensive program may assist in enhancing the program and provide ease of organisation.

Take-home Messages

Child and Family Nurses as clinical supervisors for medical students are an underutilised educational resource.

A comprehensive paediatric curriculum requires clinical exposure to hospital and community based paediatrics.

Longitudinal programs are instrumental in confidence building and promotes a deeper form of learning experience. 

Students would like a greater variety of clinical exposure in the community to experience a wider spectrum of paediatric presentations.

Acknowledgement

Special acknowledgement to the 2011-2012 Phase 3 cohort for their participation, Dr Carl Mahfouz and Associate Professor David Garne for their support of the project.

References

1. O'Keefe M, White D, Spurrier N, Fox N. An inter-university community child health clinical placement programme for medical students. Medical Education 2001 Apr;35(4):384-90.


2. Anderson ES, Lennox A, Petersen SA. New opportunities for nurses in medical education: facilitating valuable community learning experiences. Nurse Education in Practice 2004 Jun;4(2):135-42.


3. Riesenberg LA, Little BW, Wright V. Nonphysician medical educators: a literature review and job description resource. Academic Medicine 2009 Aug;84(8):1078-88. 


4. Mathastein N, Klingenberg M. Medical Students working with nurses. Medical Edcuation 2010; 44:1117-1147.


5. Elms SA, Chumley H. Nursing faculty teaching basic skills to medical students. Medical Teacher 2006; 28 (4): 341-4.



 

 

 


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Background

 

Summary of Work

Summary of Results

Conclusion
Take-home Messages
Acknowledgement
References
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