Analysis of Medical Views of First Psychiatry Rotation--论文代写范文精选

在过去二十年，医学教育的内容已经从传统的快速变化中变革。这些改革有许多相关的原因,特别是需要改变医疗实践的本质,快速增加医学知识,都是独立的学习者的需要。下面的essay代写范文进行详述。

Abstract
Objective: The importance of student’s perspectives in informing curricula and pedagogy has long been recognised. However, student’s perspectives are rarely reported in the academic literature. Therefore this study explores and reports on medical student’s perspectives of their first psychiatry clinical rotation in a ‘new’ era medical school in Australia. Method: Seventy-three graduate entry medical students completed a semi-structured questionnaire about their experiences during a mental health rotation. The responses were analysed and coded into thematic categories. Results: The following thematic categories were evident; staff, breadth of experience, attitudes towards mental health, course materials and structure, and professional development. Conclusion: The results are discussed in the context of the current academic recommendations for the teaching of psychiatry and behavioural science to medical students. Although the use of student feedback is recommended by the literature, pragmatically it is rarely utilised and if it is utilised it is not reported in the academic literature. It is recommended that educators embrace the use of student’s perspectives to evaluate and inform their teaching. 
Key Words: Medical education; Student perspectives; Psychiatry

Introduction
In the past two decades the content and delivery of medical education both in Australia and abroad has been rapidly changing from its traditional past.(1-3) These reforms have been instigated for a number of related reasons notably through necessity due to the changing nature of medical practice, rapid increases in medical knowledge and the need for graduands that are independent learners.(3) That is contemporary models of medical delivery have moved to a more community based model.(2,3) The additional imperative that has shaped this reform is the continuing expansion of medical knowledge hence students cannot rote learn all the necessary knowledge.(3) Rather they need to be equipped with the ability to be able to independently learn and solve problems. (3) 

The importance of student’s perspectives in informing curricula and pedagogy has long been recognised (1,4), however pragmatically student’s viewpoints are under-utilised. If students perspectives are drawn on; this knowledge is utilised on an institutional basis and is rarely disseminated in the academic literature. The importance of student’s perspectives and experiences was highlighted by Ludwig Eichna who after retiring from his Chair in 1974 in the Department of Medicine at the State University of New York undertook the medical course in order to inform the evolution of the curricula.(5) 

Eichna’s (5) view is summarised in a quotation below. “...curricula, the basis of education, are devised by committees of faculty members according to their own concept of what is best, from their own outlook and their own level of knowledge...Little thought is given to what students go through – people who are one-third to one-half the age of the faculty, differently educated, from a different culture, with different goals. No one on the faculty experiences what students go through."(5) Within the sphere of psychiatry education the published literature predominantly focuses upon students attitudes.(6,7) Although this is an important area of inquiry it does little to inform us of how the students broadly experience the educational process in psychiatry. Thus in the context of the rapid changes that have taken place in medical education such knowledge will assist in both evaluating and evolving educational strategies. Further Prideaux (8) ascertains that curriculum is comprised of three distinctive components; what is planned and intended for the students to learn, what is taught and delivered to the students and lastly what the students actually experience. This final component is the focus of the current study and is often referred to as the hidden or informal curriculum.(9-11) Therefore this study explores medical student’s experiences and perspectives of their first clinical psychiatry rotation in a ‘new’ era medical school in Australia.

Methodology 
Background: The University of Wollongong’s (UoW) Graduate School of Medicine (GSM) is a new medical school that provides a 4 year graduate entry degree. The school employs an integrated curriculum. Specifically students receive psychiatry training within each of the three phases. Namely students learn the neurobiological basis of psychiatry in the first phase, mental health presentations in a hospital based rotation in the second phase and in the final phase learning is centred on primary care psychiatry. This study pertains to phase two of the curriculum where students take part in a mandatory hospital based rotation and non-mandatory option however highly recommended option to further their experience through exposure to other psychiatric services.(12) 

Participants: Seventy-three of a possible 79 graduate entry Phase 2 medical students participated in this study, a response rate of 92%. Of which 40 are female and 33 are male; with a mean age of 26.5 years(sd= 3.4). Procedure: Upon completion of their first Psychiatry HospitalBased Clinical Rotation the students completed a brief openended questionnaire about their experiences and views of the rotation. An open-ended questionnaire was utilised as we did not wish for the students responses to be limited by a forced choice methodology. Students were asked to comment on their experiences pertaining to each of the areas outlined in Table 1 below. Completion of the questionnaire was voluntary.

Results 
The results of the study indicated five thematic categories namely; staff, breadth or range of experience, course materials and structure, attitudes towards mental health or illness and professional development. An overview of these themes and the frequency with which they were represented in the qualitative data set is illustrated in Figure 1 below. The two most prominent themes being staff and breadth of experience are illustrated at the bottom of the pyramid. Each of these thematic categories is described below and illustrated with excerpts that represent both positive and negative viewpoints. The theme at the base of the pyramid was the mostly frequently citied and the remaining themes frequency is indicated by the level they are represented on in the pyramid.

Breadth of Experience 
The other most prominent theme that was evident in the analysis pertained to the amount of exposure the students had to patients with different conditions and the opportunity to acquire and practice different mental health skills. Most students reported being exposed to a range of patients with different conditions however some students reported that their experiences were limited, as illustrated in the excerpts below.

Discussion 
It is evident from the results of this study that the most important aspects of the student’s educational experiences in their first psychiatry clinical rotation pertained to the staff and range of experiences they had the opportunity to partake in. The next most significant theme related to the course structure and materials. The other two themes that were the least evident in the student’s perspectives were attitudes towards mental health and professional development. Interestingly it is apparent that the themes identified within the current study reflect the current academic recommendations for educating medical students generally as well as in psychiatry specifically. Also the themes’ evident reflect previous empiric findings about the nature of the hidden or informal curriculum.(9-11) 

The results are discussed in the context of the academic literature. The most prevalent theme identified; staff is well recognised in the academic literature. With the notion of enthusiastic teaching academics and clinicians being evident in our findings. Furthermore it was also apparent within the staff theme that the student’s felt supported in their learning, thus highlighting the commitment of staff to the teaching of psychiatry. This perception of support is imperative with the recent paradigm shift to student centred learning where academics and clinicians act as facilitators as oppose to subject matter authorities.(4) 

In addition the quality of teaching staff and their commitment to teaching are known to be strongly influential on psychiatry recruitment rates; with the field of psychiatry currently suffering from workforce shortages.(13-15) Further the importance of enthusiastic teaching has also been highlighted as an influential factor in recruitment into psychiatry.(13,14) Recently Hoschl and van Niekerk (14) reported that the commitment and enthusiasm of staff are the most important factors impacting upon recruitment levels into psychiatry. Thus quality teaching staff, both academic and clinical are imperative in overcoming the current workforce shortages in psychiatry. The importance of quality, supportive staff has also been highlighted in prior research into the hidden curriculum.(9,11) 

A study conducted by Lempp and Seale (11) found that medical students experiences of personal encouragement and support provided by staff is a fundamental component of the informal medical curriculum. Further this qualitative investigation found it was important to medical students who had benefitted from staff support as well as those whose experiences had lacked staff support.(11) Gaufberg and colleagues (9) in their study found that staff as role models, both positive and negative, were rated as highly influential by students for their learning. The next theme breadth of experience pertains to the range of conditions and the amount of experiential learning the student’s had the opportunity to partake in during the rotation. O’Connor and colleagues (16) conducted a review of psychiatry medical education in Australia and New Zealand finding a vast difference between the amount and content taught in undergraduate psychiatry. Furthermore O’Connor and colleagues (16) found a significant disparity in the amount of time spent in the acquisition and practice of important mental health skills. 

This lack of consistency in the psychiatry curriculum content and the proportionate amount of time devoted to psychiatry education and skill development is also evident internationally.(18) The majority of students reported being exposed to a variety of conditions and having plenty of opportunity to practice specific skills such as mental state exams and history taking. Thus it is encouraging to determine that the majority of students had good access to patients with distinct conditions as well as the opportunity to practice specific skill sets. Furthermore it should be noted that students had the option of furthering their experiences outside of the hospital ward. However these experiences were not mandatory instead they were highly recommended. 

However; the vast majority of students opted to participate in the additional, mostly community-based experiences. Prior research has highlighted the importance of community-based education for medical students.(2-4,6,17) Since medical care is now routinely delivered in a community-based setting.(2,4,6,17) The next most prominent theme pertained to course materials and structure. Overall the students enjoyed the clarity of the handbook and objectives. Recently McLean and Gibbs (4) emphasized the importance of clear explicit learning outcomes within learner-centred curricula. Further a study conducted by Henning and colleagues (19) found that clearer more decisive learner objectives were one of the most prominent issues identified by medical students that could improve the quality and usability of the curricula.

Conclusion 
it is apparent that student’s perspectives can offer a valuable contribution; to the development of curricula, clinical placements as well as an understanding of the hidden or informal curriculum. It is suggested that student perspectives be utilised to understand the experiences of medical students and the hidden curriculum and thus inform the development and delivery of the curriculum. Furthermore it is recommended that academics look beyond their specific discipline and utilise student feedback from other specialities as well as share their students’ experiences with their colleagues. In our case we have utilised some of the general feedback for example regarding clarity of learning objectives and the rotation guide book to inform clinical rotations in other disciplines.（essay代写)

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