Visualising learning

Changes to health care systems and working hours have fragmented residents' clinical experiences with potentially negative effects on their development as professionals. Investigation of off-site supervision, which has been implemented in isolated rural practice, could reveal important but less overt components of residency education. Insights from sociocultural learning theory and work-based learning provided a theoretical framework. In 2011-2012, 16 family physicians in Australia and Canada were asked in-depth how they remotely supervised residents' work and learning, and for their reflections on this experience. The verbatim interview transcripts and researchers' memos formed the data set. Template analysis produced a description and interpretation of remote supervision. Thirteen Australian family physicians from five states and one territory, and three Canadians from one province, participated. The main themes were how remoteness changed the dynamics of care and supervision; the importance of ongoing, holistic, nonhierarchical, supportive supervisory relationships; and that residents learned "clinical courage" through responsibility for patients' care over time. Distance required supervisors to articulate and pass on their expertise to residents but made monitoring difficult. Supervisory continuity encouraged residents to build on past experiences and confront deficiencies. Remote supervision enabled residents to develop as clinicians and professionals. This questions the supremacy of co-location as an organizing principle for residency education. Future specialists may benefit from programs that give them ongoing and increasing responsibility for a group of patients and supportive continuity of supervision as residents.

BackgroundAn essential characteristics of clinical education is the need to learn a large number of practical and communication skills along with theoretical knowledge. It is challenging to design learning opportunities (LOs) for clinical setting. We aimed to determine optimal learning opportunities from the viewpoint of Medical curriculum planners, to determine the gap between the current condition and the optimal condition in medical schools, and to present feasible tactic for clinical learning opportunities.MethodsThis study comprised of three sub-studies and was conducted using triangulation. The first sub-study was performed using the Modified Delphi method with a view to identifying optimal learning opportunities. Data was collected by online focus group discussion and a questionnaire. The second sub-study was conducted with the aim of comparing the current condition and the optimal condition. Data was collected from nine medical schools across Iran using a checklist, available documents, observation, and interview. The third sub-study was conducted using an expert panel comprising of seven curriculum planners of the M.D. program. The goal of this phase was to provide feasible tactic to improve clinical education in medical schools.ResultsIn the first sub-study, the participants determined all items, including student-centered learning, non-threatening learning environment, and record and management system of clinical learning opportunities as implementable learning opportunities with over 70% consensus. However, in the second sub-study, student-centered teaching methods were practiced in 33% of medical schools and the non-threatening learning environment in 67% of the schools, while the record and management system of learning opportunities was not launched in any of the schools. From the viewpoint of the expert panel members, learning opportunities adapted to clinical contents, specification of content-based learning opportunities, and continuous supervision on learners to achieve the expected learning outcomes were among clinical learning opportunities with over 70% consensus.ConclusionsStudent-centered clinical learning practices, together with virtual learning methods, can lead to clinical enhancement. Opportunities such as interactive and participatory practices should gain further consideration. Also assigning responsibility to learners and monitoring them are strategies for enhancement.

Disruption to healthcare settings can present a significant challenge to traditional, face-to-face models of learning in medical education. Reductions in undergraduate medical students’ clinical exposure, whether due to periods of increased healthcare demand, localised service changes or infectious disease outbreaks, are likely to result in fewer opportunities to develop key clinical and practical skills. Proficiency in these skills is often essential to progression and future practice, creating a broad incentive for students to develop techniques to maintain and refine their clinical skills during disrupted placements. These tips, based on our experiences as senior medical students, are intended to help students on disrupted placements to engage in reflective practice, discover ways to facilitate further opportunities for clinical skills learning, and to make the most of clinical skills learning opportunities that they do receive.

This study examined the clinical learning evaluation, self-efficacy, and practice readiness of nursing students in a selected school in Quezon City and determined the relationships among these variables. Anchored on Benner’s Novice to Expert Theory, Roy’s Adaptation Model, and Bandura’s Social Learning Theory, the study viewed nursing readiness as a product of clinical exposure, adaptation to learning demands, and confidence in one’s capabilities. A quantitative descriptive-comparative design was used. The respondents were 293 second-, third-, and fourth-year nursing students officially enrolled during the second semester of academic year 2024–2025. Data were gathered through a self-administered questionnaire covering profile characteristics, clinical learning evaluation, competency self-efficacy, and practice readiness, and were analyzed using frequency, percentage, weighted mean, standard deviation, t-test, one-way ANOVA, and Pearson r. The findings showed that the respondents had highly positive evaluations of their clinical learning environment, particularly in learning experiences, availability of learning objectives, and effectiveness of clinical learning. Self-efficacy in the clinical learning environment was rated high, with strongest confidence observed in respect, patient advocacy, safety principles, and teamwork. Practice readiness was rated positively in clinical problem-solving, learning techniques, and professional identity, while trials and tribulations yielded an undecided result, indicating continuing difficulties in areas such as electronic documentation, ethical concerns, prioritization, and recognition of patient changes. The study further revealed strong to very strong statistically significant relationships between practice readiness and clinical learning evaluation, and between practice readiness and self-efficacy. The study concludes that a supportive, structured, and feedback-rich clinical learning environment strengthens nursing students’ confidence and readiness for professional practice. It recommends enhancing simulation and skills-based training, reflective practice, digital health competencies, mentorship, and curriculum review to better align academic preparation with clinical realities. The study supports SDG 3, SDG 4, and SDG 8 by promoting safe healthcare practice, quality nursing education, and readiness for professional work. Its sustainability impact lies in strengthening educational quality, institutional responsiveness, and the long-term preparedness of the nursing workforce.

Clinical & Experimental OphthalmologyVolume 49, Issue 8 p. 783-783 COMMITTEES The Royal Australian and New Zealand College of Ophthalmologists 52nd Annual Scientific Congress First published: 23 November 2021 https://doi.org/10.1111/ceo.14005Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume49, Issue8The Royal Australian and New Zealand College of Ophthalmologists 52nd Annual Scientific Congress 25 February – 1 March 2022November 2021Pages 783-783 RelatedInformation

The Italian nursing programs, the need to introduce tools evaluating the quality of the clinical learning as perceived by nursing students. Several tools already exist, however, several limitations suggesting the need to develop a new tool. A national project aimed at developing and validating a new instrument capable of measuring the clinical learning quality as experience by nursing students. A validation study design was undertaken from 2015 to 2016. All nursing national programs (n=43) were invited to participate by including all nursing students attending regularly their clinical learning. The tool developed based upon a) literature, b) validated tools already established among other healthcare professionals, and c) consensus expressed by experts and nursing students, was administered to the eligible students. 9606 nursing in 27 universities (62.8%) participated. The psychometric properties of the new instrument ranged from good to excellent. According to the findings, the tool consists in 22 items and five factors: a) quality of the tutorial strategies, b) learning opportunities; c) safety and nursing care quality; d) self-direct learning; e) quality of the learning environment. The tool is already used. Its systematic adoption may support comparison among settings and across different programs; moreover, the tool may also support in accrediting new settings as well as in measuring the effects of strategies aimed at improving the quality of the clinical learning.

The lockdown of schools in Spain to confront the effects of COVID-19 caused an enormous impact at both societal and educational levels. Schools and families had to react rapidly to a new teaching and learning scenario without the benefit of previous planning or government guidelines. In this context, some schools were better able to adapt to the new circumstances than others. Likewise, the structure and size of families’ economic, social and cultural capital produced significant differences in the learning opportunities for children from different backgrounds. This article assesses the impact of the school lockdown on the learning gap between children from different social backgrounds in Catalonia. Based on 35,419 responses to an online survey administered between 26 and 30 March 2020 to families with children aged between 3 and 18, the authors’ analysis shows that learning opportunities varied significantly. Middle-class families were able to maintain higher standards of education quality in a critical context, while children from socially disadvantaged families had few learning opportunities both in terms of time and learning experiences (schoolwork and maintenance of after-school activities). Results differed by type of school (public/private) where students were enrolled, family economic, social and cultural capital, and family living conditions. In the final part of the article, the authors highlight the importance of the role of the school in ensuring learning opportunities for children from low socioeconomic backgrounds, and they discuss some policy implications of their findings.

AimsManaging pediatric emergencies is a core competency for medical learners, however clinical exposure varies widely during training. Thus, the Hospital for Sick Children established a standardized simulation-based Junior Mock Code...

Onward and Upward: Introducing the Healthcare Simulation Standards of Best PracticeTM

To provide guidance for the optimal administration of repetitive transcranial magnetic stimulation, based on scientific evidence and supplemented by expert clinical consensus. Articles and information were sourced from existing guidelines and published literature. The findings were then formulated into consensus-based recommendations and guidance by the authors. The guidelines were subjected to rigorous successive consultation within the RANZCP, involving the Section of ECT and Neurostimulation (SEN) Committee, its broader membership and expert committees. The RANZCP professional practice guidelines (PPG) for the administration of rTMS provide up-to-date advice regarding the use of rTMS in clinical practice. The guidelines are intended for use by psychiatrists and non-psychiatrists engaged in the administration of rTMS to facilitate best practice to optimise outcomes for patients. The guidelines strive to find the appropriate balance between promoting best evidence-based practice and acknowledging that evidence for rTMS use is a continually evolving. The guidelines provide up-to-date advice for psychiatrists and non-psychiatrists to promote optimal standards of rTMS practice.

Objective: To provide an overview, for trainees and fellows, of the Extended Matching Question, a new question type recently introduced in the Royal Australian and New Zealand College of Psychiatrists written examination. The characteristics, technical aspects and construction of these question types are discussed. Some pointers for candidates and those setting questions are outlined. Conclusions: Extended Matching Questions are now commonly used to test medical knowledge in many areas of medicine, including psychiatry. They represent a transparent, evidence-based approach to the assessment of medical knowledge, which lends itself to electronic marking and statistical analysis. These questions facilitate the development of question banks and provide an easily accessible oversight of what areas of the curriculum have been examined.

Objective: To describe the procedure adopted by the Ethics Committee of the Royal Australian and New Zealand College of Psychiatrists in revising its 1992 foundational code of ethics and to outline the substantial changes agreed upon and subsequently ratified by the College's General Council. Method: The members of the Ethics Committee reviewed their experience of revising the code by monitoring the process as we went along, examining all relevant documents that emerged over the 18 months it took, and discussing both procedure and outcome with the benefit of hindsight. Results and Conclusion: The revision process comprised two consultative stages, three face to face meetings of the committee and a presentation to General Council for its consideration. The second consultation, in which an advanced draft was circulated to various arms of the College and to pertinent community organisations, yielded a highly satisfactory response compared to the first consultation's desultory results. The most notable change is the introduction of an entirely new principle which addresses directly the power differential in the psychiatrist–patient relationship and its potential for exploitation of the patient. Sexual exploitation is explicitly and emphatically cited, in that sexual relations between psychiatrist and patient, including a former patient, are always unethical. Other forms of exploitation, such as on the grounds of age, gender, race, ethnicity, sexual orientation, creed, disability, religion and political affiliation, are carefully spelled out. One specific form of exploitation, sexual harassment, is entirely new; its scope is outlined and examples provided. The new code pays more attention than its predecessor to the role of the family and other carers in a patient's life, as well as to the fact that many features of the family are culturally specific. The final principle, covering responsibilities psychiatrists have to society overall, has been modified in several ways. All the principles and their respective annotations have been brought up to date. The new code pertains to affiliates and trainees as well as to Fellows.

Venous thromboembolism (VTE), presenting either as deep vein thrombosis or as pulmonary embolism, is one of the leading causes of maternal morbidity and mortality. The aim of this study was to review and compare the most recently published international guidelines providing recommendations on the prevention of VTE in pregnancy and the puerperium. A comparative review of guidelines by the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynecologists of Canada, the American College of Chest Physicians, the European Society of Cardiology, and the American Society of Hematology on VTE was conducted. There is an overall agreement among the reviewed guidelines regarding the optimal anticoagulation and dosage choice, the management of low-molecular-weight heparin relating to neuraxial blockade, the importance of implementing risk assessment scores in every individual, and certain indications for obstetric thromboprophylaxis. On the other hand, controversy exists regarding management of unfractionated heparin before and after regional anesthesia, cases where calf compression stockings are suitable and indications where thrombophilia screening is required. Moreover, discrepancies exist in relation to management strategies in women with specific inherited thrombophilias. Notably, specific risk assessment scores are presented only by the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada. As VTE remains a significant factor affecting maternal morbidity and mortality, worldwide, developing consistent international algorithms is of utmost importance to safely guide clinical practice and consequently improve pregnancy outcomes.

Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes. The aim of this study was to review and compare the most recently published guidelines on antenatal care. A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted. There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage. Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.

In 2001 the ACPSEM published a position paper on quality assurance in screen film mammography which was subsequently adopted as a basis for the quality assurance programs of both the Royal Australian and New Zealand College of Radiologists (RANZCR) and of BreastScreen Australia. Since then the clinical implementation of digital mammography has been realised and it has become evident that existing screen-film protocols were not appropriate to assure the required image quality needed for reliable diagnosis or to address the new dose implications resulting from digital technology. In addition, the advantages and responsibilities inherent in teleradiology are most critical in mammography and also need to be addressed. The current document is the result of a review of current overseas practice and local experience in these areas. At this time the technology of digital imaging is undergoing significant development and there is still a lack of full international consensus about some of the detailed quality control (QC) tests that should be included in quality assurance (QA) programs. This document describes the current status in digital mammography QA and recommends test procedures that may be suitable in the Australasian environment. For completeness, this document also includes a review of the QA programs required for the various types of digital biopsy units used in mammography. In the future, international harmonisation of digital quality assurance in mammography and changes in the technology may require a review of this document. Version 2.0 represented the first of these updates and key changes related to image quality evaluation, ghost image evaluation and interpretation of signal to noise ratio measurements. In Version 3.0 some significant changes, made in light of further experience gained in testing digital mammography equipment were introduced. In Version 4.0, further changes have been made, most notably digital breast tomosynthesis (DBT) testing and QC have been addressed. Some additional testing for conventional projection imaging has been added in order that sites may have the capability to undertake dose surveys to confirm compliance with diagnostic reference levels (DRLs) that may be established at the National or State level. A key recommendation is that dosimetry calculations are now to be undertaken using the methodology of Dance et al. Some minor changes to existing facility QC tests have been made to ensure the suggested procedures align with those most recently adopted by the Royal Australian and New Zealand College of Radiologists and BreastScreen Australia. Future updates of this document may be provided as deemed necessary in electronic format on the ACPSEM's website ( https://www.acpsem.org.au/whatacpsemdoes/standards-position-papers and see also http://www.ranzcr.edu.au/quality-a-safety/radiology/practice-quality-activities/mqap ).