Clinical training

Introduction: This qualitative study explores the experiences of undergraduate radiation
therapy students who have English as a second language (ESL) in the clinical environment,
as well as the experiences of staff members who teach these students. Specific study
aims were to increase understanding of the issues faced by this subset of students, including
identifying potential barriers to clinical learning.
Methods and design: A qualitative methodology was utilized with focus groups as the data collection
tool to gain insights from students/recent graduates whose primary language was not English,
as well as from staff members who educate this group of students in the clinical
environment. Two focus groups were conducted; Group 1 (n Z 6) consisted of ESL graduates/
students and Group 2 (n Z 5) consisted of radiation therapy staff members and clinical coordinators
who are actively involved in the education of ESL students. Comparative data analysis of
the transcribed discussions was carried out using content analysis and categorized according to
the emergent themes.
Results: Three overarching themes were identified for both groups, ‘‘Communication’’, ‘‘Differences’’
and ‘‘Dealing with it.’’ The primary barrier for ESL students was seen as proficiency in
English, which manifested in a number of ways. This resulted in a lack of confidence and a subsequent
sense of alienation. External challenges identified were unfamiliarity with Canadian systems
and cultural differences. Support strategies identified included the use of mentorship,
professional development and external support for teaching staff and journaling, among others.
Conclusions: There are identified challenges for ESL students in the clinical environment, thus it
is important to provide support for this population to improve learning outcomes. Recommendations
for practice, arising from the study as well as the available literature included: allowing

This study assessed the effect of knowledge of psychopathology and psychological testing on the ability to feign schizophrenia on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Two groups of clinically trained participants-psychiatric residents and fellows (n = 26) and clinical psychology graduate students (n = 28)-and a group of undergraduate students with no clinical training (n = 24) completed the MMPI-2 under instructions to feign schizophrenia. A sample of outpatients with schizophrenia (n = 51) responded under standard instruction. Scores from the clinical scales and several validity indicators were compared. Although all participants asked to malinger had validity indicator scores indicating faking, the clinically trained participants produced generally lower scores on the clinical scales and validity indicators than did the undergraduate students. In particular, the scores for the clinical scales 6 (Paranoia) and 8 (Schizophrenia) were higher for all groups asked to feign schizophrenia when compared with the schizophrenic sample. The validity indicators F and the F-K index produced the largest effect sizes.

Recent calls to action for competency-based training, evaluation, and credentialing of mental health professionals focus heavily on instilling the knowledge and skills needed for performing evidence-based assessment and treatment. We propose the content of a companion training curriculum in clinical decision-making that reflects the pervasive and indispensible role of causal reasoning in clinical practice. Contents of the proposed curriculum include review and discussion of the following areas: (a) domains in which practitioners are routinely required to make and evaluate causal inferences; (b) definitions of key concepts related to causality and errors in causal reasoning; (c) guidelines for evaluating the internal and external validity of findings in empirical studies; (d) guidelines for formulating and evaluating working theories of the origin and/or maintenance of client presenting problems; and (e) methods for planning, targeting, and evaluating interventions. This curriculum is designed to help mental health practitioners use causal modeling to enhance case conceptualization, develop intervention objectives, and prioritize and target foci of interventions that use evidence-based treatments or practice elements. Practitioners who use causal modeling to guide clinical practice are, in effect, deliberately generating causal hypotheses, implementing causal experiments, and evaluating outcomes as they monitor client response to intervention. Causal reasoning competencies may be enhanced through application of causal modeling diagrams to clinical case examples. Development and implementation of a causal reasoning curriculum will provide a basis for “value-added” research regarding its benefit to practitioners in terms of enhanced clinical competencies, decisions, and improved client outcomes.

Note: This paper is the first time we discuss the Double Check Heuristic, our information-gathering/case formulation/treatment planning tool.

Recommended keywords:  causal reasoning, clinical judgment, clinical skills training, evidence-based practice, mental health, clinical knowledge, clinical decision-making, clinical theory building, Core Curriculum on Childhood Trauma

Clinical teaching and training in medical colleges face number of challenges when different related educational activities are compared to innovative criteria like integration and systematic approach. The traditional discipline-based rotation of the medical students’ groups in their first year of clinical phase (year4 medical study) is deficient. What is taught in different disciplines is largely opportunistic and usually based on unpredicted clinical situation and on patients’ availability and on interest of the staff concerned. In a planned and systematic teaching and training, all students cover all core and essential curriculum components. The described newly implemented "curriculum" in 1992  is based on clinical discepline rather than on disease categorization.

Purpose: Empathy levels have been observed to often decrease when medical undergraduates move to the clinical years, particularly in the Western countries. However, empathy either remains similar or increases in many Asian medical schools. This study investigated the longitudinal empathy profile of medical students in Singapore. Methods: Two cohorts of medical students who enrolled in 2013 and 2014 to the National University of Singapore were tracked for 5 years. The Jefferson Scale of Empathy-student version was used. Analyses on the mean of the empathy level and individual factors, year-wise and gender comparison were conducted. Results: Average response rates for cohort 1 and 2 were 68.1% (n=181-263) and 55.4% (n=81-265), respectively. For both cohorts, there was no significant change across year of study in the mean empathy score. Average scores for both cohorts were 113.94 and 115.66. Though not significant, we observed mean empathy to be lowest at the end of year 5 (112.74) and highest in year 2 (114.72) for cohort 1 while for cohort 2, the lowest level of empathy was observed in year 5 (114.20) and highest in year 4 (118.42). Analysis of subcomponents of empathy only showed a significant difference for cohort one factor 1 (perspective taking) and factor 3 (standing in patients' shoes) across the study years. Conclusion: No significant change in empathy score was observed during the transition from pre-clinical to clinical years, unlike many Western and Far-Eastern studies. This might be due to the curriculum and influence of the Asian values.

Clinical classes are the milestones that help pharmacy students gain clinical competency and prepare them for their professional life. Although didactic methods provide theoretical knowledge, the retention rate of information is relatively low when compared with problem based teaching methods. Simulators such as high-fidelity mannequins or standardized simulated patients are often preferred by clinical teachers in schools that teach health profession. High and low fidelity mannequins, and computerized simulators require a cost and dedicated space, which can be a disadvantage. On the other hand, standardized patients are advantageous to develop communication skills. Hence, use of simulation based methods in clinical training are useful in general, because they lead students to self-directed learning strategies, critical thinking and rational decision-making. Therefore, dissemination of simulation techniques is important to improve clinical skills.