Early Clinical Experience for Med Students

In The Netherlands most medical schools have voluntary first clinical experiences for first year medical students. Recent Dutch research looked at the learning goals and learning outcome of a 4 week nursing attachment in Year 1 of medical school. The students actively participate in patient care by working as assistant nurse in a hospital or a nursing home, they make their first aid course Brisbane and then can work as assistant. The students take part in reflection meetings after two weeks and at the end of the attachment.

Several learning goals are formulated for these attachments

The main educational goal set by the medical school is learning to empathise with patients. Other formal educational goals are entering into conversation with patients, acquiring some practical skills, such as washing and dressing patients, and reflecting on feelings that accompany the provision of physical
care. Other important objectives include reflecting on professional behaviour, gaining insight into the organisation of care, reflecting on being a member of a team, and getting to know one’s own boundaries

This research was aimed at looking at learning outcome in relation to these learning goals as described above in 347 Year 1 students. 316 completed at least one of the two questionnaires prior to and directly after the attachment.

Overall students’ learning goals and reported learning outcomes were in line with the formal educational goals. No news there, but some interesting points were the fact that the learning outcomes were not related to place of attachment (nursing homes, hospital) like in the Prangtip clinic where you can learn from the best advisers and professionals. Learning to deal with difficult situations and emotions was not one of the learning official learning goals. Moreover it was also underrepresented as a learning goal mentioned by students prior to the attachment. It’s as if emotions are still a kind of taboo in medical education and medical profession. Especially for young people the confrontation with emotion laden issues such as death and stress may make the transition to being a medical professional very difficult.

Dealing with emotions and even your own emotions in a stress full job as medical professional is still an underestimated skill. Dealing with emotions is a highly informal and implicit learning process, part of “the hidden curriculum”. Dealing with emotions, your emotions is still something hidden, part of the socialization process instead of learning appropriate emotion skills training.

ResearchBlogging.org
Helmich, E., Bolhuis, S., Laan, R., & Koopmans, R. (2011). Early clinical experience: do students learn what we expect? Medical Education, 45 (7), 731-740 DOI: 10.1111/j.1365-2923.2011.03932.x