Melbourne Medical School Collected Works - Theses
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ItemWhat is the clinical placement experience of prevocational doctors in Victorian health services compared with the defined curriculum, and how may this have been shaped by contemporary healthcare delivery?( 2015)Medical training in Australia and comparable countries internationally is based on an apprenticeship model of training. However this has been challenged by contemporary healthcare practices as well as the limited training capacity of the acute care settings where medical training is largely undertaken. While this impacts all phases of medical training, it is the prevocational phase in Australia that is most vulnerable as its training outcomes are poorly defined and not routinely measured. Similarly, while a twelve‐month rotation‐based internship has existed in Australia for decades, the effectiveness of this model in providing core training and clinical competencies for prevocational doctors has not been rigorously evaluated, and is currently being questioned. This research seeks to better understand the clinical placement experience of prevocational doctors in Victorian Health Services, and to consider how this may be affected by contemporary healthcare delivery. The research has been designed as a mixed –methods study, where data obtained from a broad‐based survey of exposure to a range of clinical curriculum‐based activities of junior doctors from seven Victorian health services was explored by groups of junior doctor supervisors and managers. These research findings have concurred with limited previous literature, noting that prevocational trainees have limited exposure to a number of curriculum areas, particularly within the curriculum domains of procedures and emergency management, as well as teaching and learning activities, and other more complex patient management and interaction activities. It has identified that particular intern core terms and PGY2 clinical streams may provide better access to curriculum experiences than others, and that there may be particular curriculum strengths and weaknesses of prevocational training in metropolitan versus regional areas. It has also suggested that the current prevocational curriculum framework is variably understood by health service supervisors and managers, and that these findings have potentially significant implications for the trainees themselves, for length of training, and for the confidence and competence of the end practitioner. Essentially a key finding from this research is that acute health services are increasingly performing high‐risk activities within constrained environments, resulting in changes to healthcare teams and individual roles – and the legitimate peripheral participation of junior doctors in clinical care has decreased in proportion to the acuity and specialisation of the activity involved. While local educational initiatives to overcome this challenge are currently being variably utilised by health services, they do not ensure ongoing repeated curriculum exposure and therefore curriculum mastery. Instead, system‐wide issues require to be addressed by a system wide approach. Lave and Wanger’s Situated Learning theory (1991) provided a framework through which the research results were viewed, and provides a lens through which recommendations can be conceptualised. Essentially, this thesis recommends reform of prevocational training ‐ that redefines its role; that addresses curriculum ambiguity; that enhances junior doctor access to legitimate peripheral participation; and that re‐establishes communities of practice. These medical training reforms need to be undertaken within a clear, integrated governance model, and supported by ongoing evaluation and innovation.
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ItemExploring the use of eLearning resources and preparedness of medical students transitioning to hospital internship( 2015)The increasing use of online technology in medical education and junior doctor training raises questions about the efficacy of this approach to improve the preparedness of medical students transitioning to internship. This study examined the use of eOrientation resources for hospital and ward orientation by medical students during transition from medical school to internship, with the aim of determining what attributes make an online resource useful and what effect an eOrientation program can have on preparedness for hospital practice. More specifically, the research questions focussed on how intern preparedness changed following implementation of eOrientation, which resources were most and least used, which were found to be most and least useful and what common themes could be found with respect to the type of resources interns found most useful. A mixed method case study approach was used to explore the use of eLearning resources and preparedness of medical students transitioning to internship. The Preparation for Hospital Practice questionnaire was administered to a cohort of 74 interns at a metropolitan teaching hospital before they had undertaken any form of hospital orientation. The questionnaire was then readministered at the conclusion of their second hospital unit rotation. Learning management system data was used to examine resource usage, supplemented by personal interviews to extract detail rich information regarding which resources were found most useful. The study found that interns initially felt well prepared for internship with a minor increase in preparedness over time. Resources which were interactive, role relevant and assisted in application of identity formation tasks were deemed most useful. eOrientation was found to be a useful supplement to the suite of teaching and learning methods used for transition to internship. Findings from the study suggest that the value of eOrientation can be further enhanced when resources are directed to interns, interactive and role relevant while also considering the temporality of a resource. Resources made by or with input from interns were also found to be particularly useful, leading to a recommendation of utilising instructional designers in medical education teams in order to assist in managing stakeholder input, assess content suitability across the transition curriculum and design interactive resources. eOrientation can be an effective teaching and learning method if a considered and holistic approach to transitional curriculum development is adopted.