Rapid Implementation of a Novel Embedded Senior Medical Student Program, as a Response to the Educational Challenges of COVID-19
DOI:
https://doi.org/10.18552/ijpblhsc.v9i2.736Keywords:
Assistants in Medicine, COVID-19 impact, generalism, longitudinal placement, work-based assessmentAbstract
As with many OECD countries, graduating medical students have been choosing specialist careers at a greater rate than ever before. Generalism in the form of family (general practice) and more generalist medical specialties have been trending down resulting in distributional geographic challenges. With the advent of COVID-19 in March 2020, medical schools and in particular the Joint Medical Program situated in a regional and rural area in NSW Australia had the unique opportunity to rethink the penultimate year curriculum when the previous rapid rotation model through numerous medical specialities became untenable. The need to vision a new practical pragmatic curriculum spurred a rapid revaluation of assessment, placement length and model with a pivot to an “embedded senior student placement” agnostic of discipline and supported by a competency-based learning portfolio. This article explores the barriers and enablers and identifies the potential elements of this type of placement which can be adapted to community and smaller rural sites. The positive student and supervisor experience also enabled an employment model to be woven into the students learning and ensured on hand medical student workforce for hospitals throughout the rural footprint. The capacity of these placements to celebrate variation in experience and support students to learn on the job have now caused a revision of the penultimate year with expectation of gains in students’ satisfaction and in employability. It has also opened up options to deliver and increase the inherent value of generalist placements with likely long term workforce benefit.
References
Albritton, W., Bates, J., Brazeau, M., Busing, N., Clarke, J., Kendel, D., McClean, K., Saucier, D., Waddington, A., Walker, D., & Gray, J. (2006). Generalism versus subspecialization: Changes necessary in medical education. Canadian Journal of Rural Medicine, 11(2), 126-128. https://pubmed.ncbi.nlm.nih.gov/16630441/
Australian Medical Association. (2021). Doctors 4 Doctors. https://www.drs4drs.com.au/
Australian Medical Council. (2020). Accreditation and Covid-19. https://www.amc.org.au/accreditation-and-covid-19/
Australian Medical Student Association. (2018). Mental health and Wellbeing policy. https://www.amsa.org.au/sites/amsa.org.au/files/Mental%20Health%20and%20Wellbeing%20Policy%20%282018%29.pdf
Australian Qualifications Framework. (2013). AQF levels. Australian Qualifications Council https://www.aqf.edu.au/sites/aqf/files/aqf-2nd-edition-january-2013.pdf
Boud, D. (2015). Feedback: Ensuring that it leads to enhanced learning. The Clinical Teacher, 12(1), 3-7. https://doi.org/10.1111/tct.12345
Brown, M. E. L., & Finn, G. M. (2020). Intra‐COVID collaboration: Lessons for a post‐COVID world. Medical Education, 55(1), 122-124. https://doi.org/10.1111/medu.14366
Dornan, T., Conn, R., Monaghan, H., Kearney, G., Gillespie, H., & Bennett, D. (2019). Experience based learning (ExBL): Clinical teaching for the twenty-first century. Medical Teacher, 41(10), 1098-1105. https://doi.org/10.1080/0142159x.2019.1630730
Dudek, N., Marks, M., & Regehr, G. (2005). Failure to fail: The perspectives of clinical supervisors. Academic Medicine, 80(10 Supplement), S84-S87. https://doi.org/10.1097/00001888-200510001-00023
Frank, J. R., Snell, L. S., Ten Cate, O., Holmboe, E. S., Carraccio, C., Swing, S. R., Harris, P., Glasgow, N. J., Campbell, C., Dath, D., Harden, R. M., Iobst, W., Long, D. M., Mungroo, R., Richardson, D. L., Sherbino, J., Silver, I., Taber, S., Talbot, M., & Harris, K. A. (2010). Competency-based medical education: Theory to practice. Medical Teacher, 32(8), 638-645. https://doi.org/10.3109/0142159X.2010.501190
Fraser, S. W., & Greenhalgh, T. (2001). Coping with complexity: Educating for capability. British Medical Journal, 323(7316), 799-803. https://doi.org/10.1136/bmj.323.7316.799
Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., Fineberg, H., Garcia, P., Ke, Y., Kelley, P., Kistnasamy, B., Meleis, A., Naylor, D., Pablos-Mendez, A., Reddy, S., Scrimshaw, S., Sepulveda, J., Serwadda, D., & Zurayk, H. (2010). Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. The Lancet, 376(9756), 1923-1958. https://doi.org/10.1016/S0140-6736(10)61854-5
Holliday, V., O'Mara, P., & Watts, A. (2015). The Miroma Bunbilla Pre-entry to Medicine program for Aboriginal and Torres Strait Islander people. LIME Good Practice Case Studies, 3, 24-30. http://www.limenetwork.net.au/wp-content/uploads/2018/12/HOLLIDAY-GPCS-3.pdf
Kaufman, D. (2019). Teaching and learning in medical education: How theory can inform practice. In T. Swanwick, K. Forrest, & B. O’Brien (Eds.), Understanding Medical Education (3rd ed., pp. 37-69). John Wiley & Sons.
Kemp, S., Hu, W., Bishop, J., Forrest, K., Hudson, J., Wilson, I., Teodorczuk, A., Rogers, G., Roberts, C., & Wearn, A. (2019). Medical student wellbeing–A consensus statement from Australia and New Zealand. BMC Medical Education, 19, Article Number 69, 1-8. https://doi.org/10.1186/s12909-019-1505-2
Medical Board of Australia (AHPRA). (2020). Supervised practice for international medical graduates. https://www.medicalboard.gov.au/Codes-Guidelines-Policies/Supervised-practice-guidelines.aspx
Medical Deans Australia and New Zealand. (2020). Medical Schools Outcomes Database -National Data Report 2020, 2015-2019 Data from Final Year Medical Students at Australian medical Schools. https://medicaldeans.org.au/md/2020/08/2020-MSOD-National-Data-Report_2015-2019-Full-report.pdf
Medical Deans Australia and New Zealand. (2021). Working Groups of the Medical Education Collaboration Committee, Assessment Projects Working Group https://medicaldeans.org.au/priorities/medical-education
Nair, B. R., Moonen‐van Loon, J. M. W., Parvathy, M., Jolly, B. C., & van der Vleuten, C. P. M. (2017). Composite reliability of workplace‐based assessment of international medical graduates. Medical Journal of Australia, 207(10), 453-453. https://doi.org/10.5694/mja17.00130
New South Wales Health (NSW). (2021). Assistants in Medicine Evaluation Report. https://www.health.nsw.gov.au/workforce/medical/Pages/aim-evaluation-report.aspx
Nixon, L. J., Gladding, S. P., & Duffy, B. L. (2016). Describing failure in a clinical clerkship: Implications for identification, assessment and remediation for struggling learners. Journal of General Internal Medicine, 31(10), 1172-1179. https://doi.org/10.1007/s11606-016-3758-3
Norcini, J., & Burch, V. (2007). Workplace-based assessment as an educational tool: AMEE Guide No. 31. Medical Teacher, 29(9-10), 855-871. https://doi.org/10.1080/01421590701775453
Norcini, J., & Holmboe, E. (2010). Work based assessment. In P. Cantillon & D. Wood (Eds.), ABC of Learning and Teaching in Medicine (2nd pp. 48-51). Blackwell Publishing.
Parboosingh, J. T. (2002). Physician communities of practice: Where learning and practice are inseparable. Journal of Continuing Education in the Health Professions, 22(4), 230-236. https://doi.org/10.1002/chp.1340220407
Playford, D., May, J. A., Ngo, H., & Puddey, I. B. (2020). Decline in new medical graduates registered as general practitioners. Medical Journal of Australia, 212(9), 421-422. https://doi.org/10.5694/mja2.50563
Powis, D. A., & Rolfe, I. (1998). Selection and performance of medical students at Newcastle, New South Wales. Education for Health, 11(1), 15.
School of Medicine and Public Health. (2019). Wellbeing Principles for Embedded Senior Medical Students. University of Newcastle, Australia.
Schuwirth, L. W., & Van der Vleuten, C. P. (2011). Programmatic assessment: From assessment of learning to assessment for learning. Medical Teacher, 33(6), 478-485. https://doi.org/10.3109/0142159X.2011.565828
Snell, L. S., & Frank, J. R. (2010). Competencies, the tea bag model, and the end of time. Medical Teacher, 32(8), 629-630. https://doi.org/10.3109/0142159X.2010.500707
Ten Cate, O., Tobin, S. A., & Stokes, M.-L. (2017). Bringing competencies closer to day-to-day clinical work through entrustable professional activities. Medical Journal of Australia, 206(1), 14-16. https://doi.org/10.5694/mja16.00481
van der Vleuten, C. P., Schuwirth, L. W., Driessen, E. W., Dijkstra, J., Tigelaar, D., Baartman, L. K., & van Tartwijk, J. (2012). A model for programmatic assessment fit for purpose. Medical Teacher, 34(3), 205-214. https://doi.org/10.3109/0142159X.2012.652239
Van Schalkwyk, S. C., Hafler, J., Brewer, T. F., Maley, M. A., Margolis, C., McNamee, L., Meyer, I., Peluso, M. J., Schmutz, A. M., Spak, J. M., & Davies, D. (2019). Transformative learning as pedagogy for the health professions: A scoping review. Medical Education, 53(6), 547-558. https://doi.org/10.1111/medu.13804
Wass, V., Van der Vleuten, C., Shatzer, J., & Jones, R. (2001). Assessment of clinical competence. The Lancet, 357(9260), 945-949. https://doi.org/10.1016/s0140-6736(00)04221-5
Wilcha, R. -J. (2020). Effectiveness of virtual medical teaching during the COVID-19 crisis: Systematic review. JMIR Medical Education, 6(2), e20963. https://doi.org/10.2196/20963
Worley, P., Couper, I., Strasser, R., Graves, L., Cummings, B.-A., Woodman, R., Stagg, P., Hirsh, D., & the Consortium of Longitudinal Integrated Clerkships (CLIC) Research Collaborative. (2016). A typology of longitudinal integrated clerkships. Medical Education, 50(9), 922-932. https://doi.org/10.1111/medu.13084
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