How to be a good clerk on the clinical teaching team: a scoping review
DOI:
https://doi.org/10.36834/cmej.77264Abstract
Background: As medical institutions shift towards Competency Based Education, more effort is being directed towards understanding how healthcare teams' function competently. While many have studied the competencies required to be a successful clerk, few have examined this question within the context of team function and integration. Our primary objective is to identify how medical clerks successfully integrate and contribute to clinical teaching teams.
Methods: We performed a scoping review of the literature using the Ovid MEDLINE database. Data was extracted and thematically analysed in accordance with Arksey and O'Malley's (2005) approach to descriptive analysis.
Results: Out of 1368 papers returned by our search, 12 studies were included in this review. Seven main themes were identified amongst the included studies: (1) Communication (2) Taking Responsibility and Appropriate Autonomy (3) Humility and Knowing When to Ask for Help (4) Identity as a Team Member, (5) Self-Efficacy (6) Rapport and Relationship Building (7) Patient Advocacy
Conclusion: Analysis of these themes revealed four major findings: (i) The importance of documentation skills and communication towards team contribution (ii) The important connection between professional identity development and self-efficacy (iii) The impact of rapport on the reciprocity of trust between team members (iv) The role of clerks as patient advocates is poorly understood. This review also illustrates that there is a relative dearth of literature in this area. Future studies are needed to develop clear guidance on how clerks should perform these competencies in the context of team function and integration.
Metrics
References
Brown MEL, Coker O, Heybourne A, Finn GM. Exploring the hidden curriculum's impact on medical students: professionalism, identity formation and the need for transparency. Med Sci Educ. 2020 Sep 1;30(3):1107-21. https://doi.org/10.1007/s40670-020-01021-z DOI: https://doi.org/10.1007/s40670-020-01021-z
Holmes CL, Harris IB, Schwartz AJ, Regehr G. Harnessing the hidden curriculum: a four-step approach to developing and reinforcing reflective competencies in medical clinical clerkship. Adv Health Sci Educ. 2015 Dec;20(5):1355-70. https://doi.org/10.1007/s10459-014-9558-9 DOI: https://doi.org/10.1007/s10459-014-9558-9
Jarvis-Selinger S, Macneil KA, Costello GRL, Lee K, Holmes CL. Understanding professional identity formation in early clerkship: a novel framework. Acad Med. 2019 Oct 1;94(10):1574-80. https://doi.org/10.1097/ACM.0000000000002835 DOI: https://doi.org/10.1097/ACM.0000000000002835
Sawatsky AP, Huffman BM, Hafferty FW. Coaching versus competency to facilitate professional identity formation. Acad Med. 2020;1511-4. https://doi.org/10.1097/ACM.0000000000003144 DOI: https://doi.org/10.1097/ACM.0000000000003144
Cruess RL, Cruess SR, Steinert Y. Amending Miller's pyramid to include professional identity formation. Acad Med. 2016 Feb 1;91(2):180-5. https://doi.org/10.1097/ACM.0000000000000913 DOI: https://doi.org/10.1097/ACM.0000000000000913
Gaufberg EH, Batalden M, Sands R, Bell SK. The hidden curriculum: What can we learn from third-year medical student narrative reflections? Acad Med. 2010;85(11):1709-16. https://doi.org/10.1097/ACM.0b013e3181f57899 DOI: https://doi.org/10.1097/ACM.0b013e3181f57899
Cook AF, Arora VM, Rasinski KA, Curlin FA, Yoon JD. The prevalence of medical student mistreatment and its association with burnout. Acad Med. 2014;89(5):749. https://doi.org/10.1097/ACM.0000000000000204 DOI: https://doi.org/10.1097/ACM.0000000000000204
Rose GL, Rukstalis MR, Schuckit MA. Informal mentoring between faculty and medical students a case example of mentoring. Acad Med. 2005 Apr;80(4):344-8. https://doi.org/10.1097/00001888-200504000-00007 DOI: https://doi.org/10.1097/00001888-200504000-00007
Kenny NP, Mann K V, Macleod H. Role modeling in physicians' professional formation: reconsidering an essential but untapped educational strategy. Acad Med. 2003 Dec;78(12):1203-10. https://doi.org/10.1097/00001888-200312000-00002. DOI: https://doi.org/10.1097/00001888-200312000-00002
Kennedy TJT, Regehr G, Baker GR, Lingard LA. 'It's a cultural expectation…' The pressure on medical trainees to work independently in clinical practice. Med Educ 2009 Jul 1;43(7):645-53. https://doi.org/10.1111/j.1365-2923.2009.03382.x DOI: https://doi.org/10.1111/j.1365-2923.2009.03382.x
Kennedy TJT, Regehr G, Baker GR, Lingard L. Preserving professional credibility: grounded theory study of medical trainees' requests for clinical support. BMJ. 2009 Feb 9;338:b128. https://doi.org/10.1136/bmj.b128 DOI: https://doi.org/10.1136/bmj.b128
Klasen JM, Lingard LA. The butterfly effect in clinical supervision. Perspec Med Educ. 2021 10:3; 2021 Mar 22;10(3):145-7. https://doi.org/10.1007/S40037-021-00659-8 DOI: https://doi.org/10.1007/S40037-021-00659-8
Lingard L, Garwood K, Schryer CF, Spafford MM. A certain art of uncertainty: case presentation and the development of professional identity. Soc Sci Med. 2003 Feb 1;56(3):603-16. https://doi.org/10.1016/S0277-9536(02)00057-6 DOI: https://doi.org/10.1016/S0277-9536(02)00057-6
World Health Organisation (WHO). Topic 4: being an effective team player. WHO patient safety curriculum guide for medical schools. 2009. Available from: https://www.who.int/patientsafety/activities/technical/who_ps_curriculum.pdf
Babiker A, El Husseini M, Al Nemri A, et al. Health care professional development: working as a team to improve patient care. Sudan J Paediatr. 2014;14(2):9.
The Royal College of Physicians and Surgeons of Canada CanMEDS Framework. Available from: https://www.royalcollege.ca/rcsite/canmeds/canmeds-framework-e
Wood V, Flavell A, Vanstolk D, Bainbridge L, Nasmith L. The road to collaboration: developing an interprofessional competency framework. J Interprofess Care. 2009 Nov; 23(6):621-9. https://doi.org/10.3109/13561820903051477 DOI: https://doi.org/10.3109/13561820903051477
Apramian T, Reynen E, Berlin N. Interprofessional education in Canadian medical schools. 2015. Available from: https://cfms.org/files/position-papers/2015%20CFMS%20Interprofessional%20Education.pdf
Matson CC, Stearns JA, Defer T, Greenberg L, Ullian JA. Prerequisite competencies for third-year clerkships: an interdisciplinary approach. Fam Med. 2007 Jan;39(1):38-42.
Leung WC. Competency based medical training: review. BMJ. 2002 Sep 28;325(7366):693. https://doi.org/10.1136/bmj.325.7366.693 DOI: https://doi.org/10.1136/bmj.325.7366.693
Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Intern J Soc Res Methodol. 2007 Feb;8(1):19-32. https://doi.org/10.1080/1364557032000119616 DOI: https://doi.org/10.1080/1364557032000119616
Veritsas Health inovation. Covidence systematic review software. Melbourne, Australia: www.covidence.org; 2022.
Kennedy TJT, Regehr G, Baker GR, Lingard L. Point-of-care assessment of medical trainee competence for independent clinical work. Acad Med. 2008;83(10 Suppl). https://doi.org/10.1097/ACM.0b013e318183c8b7 DOI: https://doi.org/10.1097/ACM.0b013e318183c8b7
Cadieux DC, Goldszmidt M. It's not just what you know: junior trainees' approach to follow‐up and documentation. Med Educ. 2017 Aug 1; 51(8):812. https://doi.org/10.1111/medu.13286 DOI: https://doi.org/10.1111/medu.13286
Birden H, Barker J, Wilson I. Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship. Med Teach. 2016 Sep 1;38(9):946-56. https://doi.org/10.3109/0142159X.2015.1114594 DOI: https://doi.org/10.3109/0142159X.2015.1114594
Herrera LN, Khodadadi R, Schmit E, et al. Which student characteristics are most important in determining clinical honors in clerkships? A teaching ward attending perspective. Acad Med. 2019 Oct 1; 94(10):1581-8. https://doi.org/10.1097/ACM.0000000000002836 DOI: https://doi.org/10.1097/ACM.0000000000002836
Carrie Chen H, McNamara M, Teherani A, Cate O Ten, O'Sullivan P. Developing Entrustable Professional Activities for entry into clerkship. Acad Med. 2016 Feb 1; 91(2):247-55. https://doi.org/10.1097/ACM.0000000000000988 DOI: https://doi.org/10.1097/ACM.0000000000000988
Oza SK, Boscardin CK, Wamsley M et al. Assessing 3rd year medical students' interprofessional collaborative practice behaviors during a standardized patient encounter: A multi-institutional, cross-sectional study. Med Teach. Jan 1; 37(10):915-25. https://doi.org/10.3109/0142159X.2014.970628 DOI: https://doi.org/10.3109/0142159X.2014.970628
Gonzalo JD, Dekhtyar M, Hawkins RE, Wolpaw DR. How can medical students add value? identifying roles, barriers, and strategies to advance the value of undergraduate medical education to patient care and the health system. Acad Med. 2017 Sep 1; 92(9):1294-301. https://doi.org/10.1097/ACM.0000000000001662 DOI: https://doi.org/10.1097/ACM.0000000000001662
Dornan T, Boshuizen H, King N, Scherpbier A. Experience-based learning: a model linking the processes and outcomes of medical students' workplace learning. Med Educ 2007 Jan 1; 41(1):84-91 https://doi.org/10.1111/j.1365-2929.2006.02652.x DOI: https://doi.org/10.1111/j.1365-2929.2006.02652.x
Bharamgoudar R, Sonsale A. Twelve tips for medical students to make the best use of ward-based learning. Med Teach. 2017 Nov 2; 39(11):1119-22. https://doi.org/10.1080/0142159X.2017.1327707 DOI: https://doi.org/10.1080/0142159X.2017.1327707
Perkins GD, Barrett H, Bullock I, et al. The Acute Care Undergraduate TEaching (ACUTE) Initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom. Intensive Care Med 2005 Dec 21; 31(12):1627-33. https://doi.org/10.1007/s00134-005-2837-4 DOI: https://doi.org/10.1007/s00134-005-2837-4
Jaye C, Egan A (Tony), Smith-Han K, Thompson-Fawcett M. Teaching and learning in the hospital ward. N Z Med J. 2009 Oct 9;122:13-22.
Touchie C. AFMC Entrustable Professional activities for the transition from medical school to residency. The AFMC EPA working group FMEC PG Transition Group. Association of Faculties of Medicine of Canada. 2016;
De Fer TM, Fazio SB, Goroll A, Friedman E, Henry DA. CDIM/SGIM core medicine clerkship curriculum guide version 3.0 (2006) update task force. Task Force Leaders Special Advisor Task Force Members.
Head BA, Furman CD, Lally AM, Leake K, Pfeifer M. Medicine as it should be: teaching team and teamwork during a palliative care clerkship. J Palliat Med. 2018 May 1; 21(5):638-44. https://doi.org/10.1089/jpm.2017.0589 DOI: https://doi.org/10.1089/jpm.2017.0589
Kennedy TJT, Regehr G, Baker GR, Lingard LA. Progressive independence in clinical training: a tradition worth defending? Acad Med. 2005;80(10 Suppl). https://doi.org/10.1097/00001888-200510001-00028 DOI: https://doi.org/10.1097/00001888-200510001-00028
Franzone JM, Kennedy BC, Merritt HM, Casey JT, Austin MC, Daskivich TJ. Progressive independence in clinical training: perspectives of a national, multispecialty panel of residents and fellows. J Grad Med Educ 2015 Dec 1;7(4):700. https://doi.org/10.4300/JGME-07-04-51 DOI: https://doi.org/10.4300/JGME-07-04-51
Jarvis-Selinger S, Pratt DD, Regehr G. Competency is not enough: integrating identity formation into the medical education discourse. Acad Med. 2012 ;87(9):1185-90. https://doi.org/10.1097/ACM.0b013e3182604968 DOI: https://doi.org/10.1097/ACM.0b013e3182604968
Schatte DJ, Piemonte N, Clark M. "I started to feel like a 'real doctor'": medical students' reflections on their psychiatry clerkship. Acad Psychiatry. 2015 Jun 11; 39(3):267-74. https://doi.org/10.1007/s40596-014-0276-7 DOI: https://doi.org/10.1007/s40596-014-0276-7
Singh H, Thomas EJ, Petersen LA, Studdert DM. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007 Oct 22;167(19):2030-6. https://doi.org/10.1001/archinte.167.19.2030 DOI: https://doi.org/10.1001/archinte.167.19.2030
Wener P, Leclair L, Fricke M, Brown C. Interprofessional Collaborative Relationship-Building Model in Action in Primary Care: A Secondary Analysis. Frontiers Rehabil Sci. 2022 May 31;3:890001. https://doi.org/10.3389/fresc.2022.890001 DOI: https://doi.org/10.3389/fresc.2022.890001
Karp NC, Hauer KE, Sheu L. Trusted to learn: a qualitative study of clerkship students' perspectives on trust in the clinical learning environment. J Gen Intern Med. 2019 May 15;34(5):662-8. https://doi.org/10.1007/s11606-019-04883-1 DOI: https://doi.org/10.1007/s11606-019-04883-1
Hardy C, Boulos ME, Bhargava S, et al. Longitudinal advocacy training for medical students: a virtual workshop series. Can Med Educ J. 2022 Apr 16;13(3):67-9. https://doi.org/10.36834/cmej.73640 DOI: https://doi.org/10.36834/cmej.73640
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Jordan Lively, Majid Gasim, Qingfan Liu, Lorelei Lingard
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher.
Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.