Prediction of emotional exhaustion over the course of the COVID-19 pandemic in primary care dental staff: an intensive longitudinal study

ObjectiveTo investigate the fatigue trajectory during a 6-month duration of the COVID-19 pandemic for dental health professionals in primary dental care and for those in training.DesignA longitudinal intensive panel diary was conducted (July–December 2020) assessing weekly self-ratings of emotional fatigue.SettingDental care services in Scotland.ParticipantsDental trainees and primary dental care staff (N=53). These data were merged with respondents’ replies to a cross-sectional baseline survey (Humphris et al). Recruitment was through ‘Portal’, an online tool administered by National Health Service Education for Scotland. Questback software was employed for data collection.Primary and secondary outcome measuresThe diary questionnaire, consisted of a three-item fatigue scale and, from the baseline survey, three multi-item scales including: preparedness (14 items of the Dental Professional Preparedness for Practice Scale), the 22-item Impact of Event Scale-Revised and depressive symptomatology using the Patient Health Questionnaire-2. Statistical analysis included estimating the variability of fatigue over the study duration using a multilevel linear growth model. In addition, a path analysis was performed to determine the ability of preparedness and COVID-19 pandemic trauma to predict fatigue trajectories directly, or mediated through depressive symptomatology.ResultsA large variation of fatigue trajectories (p<0.001) was found from staff who completed a mean of 11 weekly uploads of their diary (diary uploads: minimum 4–maximum 24). The average slope was positive (standardised estimate=0.13, 95% CI: 0.07 to 0.19, p<0.001). Slope variation was modelled successfully from baseline data showing direct and indirect effects from preparedness, trauma and depressive symptoms.ConclusionStaff who volunteered to participate over a significant period of the COVID-19 pandemic in Scotland displayed a highly significant variety of individual trajectories. The results show some consistency with a job demands-resources model of burnout development. Suitable resource structures are indicated for staff over periods of extensive public service change.

Kan en felles læringsarena gi sykepleiestudenter økt klinisk kompetanse?

Studiens hensikt var å finne ut om samarbeidsdager mellom studenter, praksisveiledere og praksislærere kan gi læring som har betydning for studentenes utvikling av klinisk kompetanse. Stedet, rommet og sosiale samspill har betydning for læreprosesser, ifølge Etienne Wenger og Kari Martinsen. «Det tredje rommet» er brukt som en metafor om rommet der mennesker med kompetanse i teoretisk kunnskap og praksiskunnskap møtes sammen med studenter. Samarbeidsdager mellom studenter, praksisveiledere og praksislærere ble gjennomført for fire andreårs studentgrupper (N=23). Fokusgruppeintervju ble brukt for å samle inn data. De transkriberte intervjuene ble analysert gjennom meningsfortetning basert på Amedeo Giorgis fenomenologiske analysemetode. Essensen fra studentenes erfaringer fra samarbeidsdagene er at «Det tredje rommet» er en trygg arena der studentenes kliniske kompetanse ble stimulert og økt. Fire temaer beskriver studentenes erfaring: praksisforberedthet, trygghet, refleksjon og samarbeidslæring. Et styrket samarbeid mellom akademia og helseforetak gjennom arbeidsfellesskap i «Det tredje rommet» kan fremme sykepleiestudenters læring. Abstract Is a common learning arena a "Room of Possibility” that gives nursing students increased clinical competence? The aim of the study was to find out whether collaboration days between students, practice supervisors and nurse teachers can provide learning that facilitates students' development of clinical competence. The place, space and social interaction are important for learning processes, according to Etienne Wenger and Kari Martinsen. "The Third Room" is used as a metaphor about the room where people with competence in theoretical knowledge and practical knowledge collaborate with students. Collaboration days between students, practical nurse supervisors and nurse teachers were conducted for four second-year student groups (N=23). Focus groups were used to collect data. The transcribed interviews have been analyzed through meaning condensation. An essential structure of the students 'experiences from the collaboration days describes The Third Room as a good arena where the students' clinical competence was stimulated and increased. Four themes describe the student’s experiences; preparedness for practice, confidence, reflection and collaborative learning. A strengthened collaboration between universities and hospitals through working communities in The Third Room can facilitate nursing students' learning.

An Interprofessional E-Learning Resource to Prepare Students for Clinical Practice in the Operating Room—A Mixed Method Study from the Students’ Perspective

The operating room is a challenging learning environment for many students. Preparedness for practice is important as perceived stress and the fear of making mistakes are known to hamper learning. The aim was to evaluate students’ perspectives of an e-learning resource for achieving preparedness. A mixed methods design was used. Students (n = 52) from three educational nursing and medical programs were included. A questionnaire was used to explore demographics, student use of the e-learning resource, and how the learning activities had helped them prepare for their clinical placement. Five focus group interviews were conducted as a complement. Most students (79%) stated that the resource prepared them for their clinical placement and helped them to feel more relaxed when attending to the operating room. In total, 93% of the students recommended other students to use the e-learning resource prior to a clinical placement in the operating room. Activities containing films focusing on practical procedures were rated as the most useful. We conclude that an e-learning resource seems to increase students’ perceived preparedness for their clinical practice in the operating room. The development of e-learning resources has its challenges, and we recommend student involvement to evaluate the content.

A Spaced-Repetition Approach to Enhance Medical Student Learning and Engagement in Pharmacology

Background: Pharmacology is a cornerstone of medical education as it underlies safe prescribing practices. However, medical students have reported unease regarding their perceived proficiency in clinical pharmacology. Despite the significant impetus to improve student outcomes, there is little analysis available of the techniques used by medical students to learn, retain and apply pharmacology knowledge.Methods: A mixed methods, student-focused approach was conducted to design and refine specific resources developed to address gaps in pharmacology education. This methodology comprised an anonymised scoping survey, followed by structured focus group interviews. We developed a relevant and time efficient resource to support long-term revision for academic and clinical success. These resources were released to a cohort of 100 graduate preclinical medical students who were invited at the end of year to evaluate the intervention via a subsequent anonymous survey.Results: The scoping survey received 103 complete responses. Surveys and focus group interviews revealed that only 50% of students engage in ongoing revision. The analysis identified in-semester revision of pharmacology as a significant predictor of strategic and deep learning methods and improved quiz performance (a 5% higher score on average), compared to superficial learning methods. Amongst our cohort, we identified that the evidence-based technique of spaced-repetition was particularly well regarded. Hence, we developed and evaluated a bespoke resource utilising AnkiTM, an open-source, spaced-repetition flashcard program. A total of 1208 flashcards spanning 156 distinct classes of drugs with supplementary summary tables, diagrams and explanatory video and summary guides were created. Designed as a strategic revision tool to reinforce learning, evaluation showed students greatly appreciated the “comprehensive” and “well formatted” AnkiTM resource that supported existing teaching modalities, with a global rating of 3.8 out of 5. Conclusions: Strategic and personalised techniques for pharmacology learning that assist with in-semester revision and long-term retention are highly valued amongst students for examination preparation and preparedness for practice. Collectively, these results define a novel approach to identifying and addressing weaknesses in existing teaching methodologies in a manner that is inclusive of, and acceptable to, medical students.

Does simulation training in final year make new graduates feel more prepared for the realities of professional practice?

IntroductionThe transition from medical student to doctor has long been a source of concern, with widespread reporting of new graduates’ lack of preparedness for medical practice. Simulation has been suggested as a way to improve preparedness, particularly due to the difficulties in allowing full autonomy for patient care for undergraduate medical students. Few studies look at simulation alone for this purpose, and no studies have compared different simulation formats to assess their impact on preparedness.MethodsThis mixed-method study looked at two different simulation courses in two UK universities. Data were collected in two phases: immediately after the simulation and 3–4 months into the same students’ postgraduate training. Questionnaires provided quantitative data measuring preparedness and interviews provided a more in-depth analysis of experiential learning across final year and how this contributed to preparedness.ResultsThere were no significant differences between the two courses for overall preparedness, stress or views on simulation, and no significant differences in opinions longitudinally. Although the study initially set out to look at simulation alone, emergent qualitative findings emphasised experiential learning as key in both clinical and simulated settings. This inter-relationship between simulation and the student assistantship prepared students for practice. Longitudinally, the emphasis on experiential learning in simulation was maintained and participants demonstrated using skills they had practised in simulation in their daily practice as doctors. Nevertheless, there was evidence that although students felt prepared, they were still scared about facing certain scenarios as foundation doctors.DiscussionThe results of this study suggest that simulation may positively affect students’ preparedness for practice as doctors. Simulation will never be a replacement for real clinical experience. However, when used prior to and alongside clinical experience, it may have positive effects on new doctors’ confidence and competence, and, therefore, positively impact patient care.