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• W3118958960 abstract "The prehospital care programme (PCP) at King's College London Medical School is a student-run programme that arranges for medical and nursing students to shadow clinicians from the London Ambulance Service. The programme aims to increase interprofessional understanding of the roles and expertise within prehospital medicine, as well as observing the patient journey and the prehospital clinical environment. As the programme's organisers, we recognise that whilst creating excellent learning opportunities, there is an additional emotional burden on students, particularly when they are exposed to complex or distressing prehospital patient cases.1 Students in a prehospital environment, compared to hospital settings, may be more likely to sustain ‘moral injury’,1 a term which describes the transgression of moral codes. Therefore, it has been suggested that more debriefing opportunities should be made available to these students.1 Where there is a lack of formal debriefing opportunities, informal near-peer debriefing can potentially play a protective role against moral injury. However, we felt that creating a rigid or overly formal debriefing process could discourage students who would otherwise engage well, as they may shy away for fear of apparent authority.2 In addition, traditional case discussions at nursing and medical schools focus mainly on the clinical aspects of a case, without time being spent looking at either the emotional burden on those involved, or considering the interprofessional relationships during the incident. In recognition of this need to review, learn and reflect, during the academic year of 2019–20 we started ‘Coffee and Cases’ (C&C), a monthly peer-led case review group for PCP students. The aim was to create an informal environment of case discussion, run by near-peers also on the PCP programme, at differing stages of their medical education. We hoped that C&C would become an opportunity for students to reflect on the more challenging patient presentations and learn from this as shown in Figure 1. The small meeting of up to 15 students took inspiration from a Balint group: a structured forum to discuss the patient's treatment and emotions arising from the experience. One student would share their experience in detail and after clarifying questions, the other members of the group would reflect and discuss the events.3 This reflection focussed on both the emotional understanding of the encounter and learning from the actions of the prehospital clinician. We hoped that C&C would become an opportunity for students to reflect on the more challenging patient presentations One of the main objectives of C&C is to allow the PCP team to check on students’ well-being, especially if they attended to patients in situations which may need further debriefing such as road traffic collisions, mental health crises and deaths. The depth of discussion and willingness of students to contribute indicated C&C to be a safe platform. We noted with interest that what junior medical students found distressing was not what we expected, for instance, complicated patient-family relations and difficult communications with patients and their families. One of the main objectives of C&C is to allow the PCP team to check on students’ well-being. We also believe C&C acted as a learning tool for the participating students. This peer-led learning model involved using knowledge and skills to engage with another student and potentially stimulates deeper engagement with learning for the entire group. Such benefit may be explained by a concept called ‘cognitive congruence’, which means peers share a similar knowledge base and can share knowledge using language that they would easily understand.4 The benefits of C&C were particularly evident at times when students found elements of the medical care particularly confusing, as more experienced peers helped break down the event with the whole group. This was a slightly different format to a traditional Balint group but worked to help answer clinical questions. It has also been shown that acting as peer tutors may aid development of personal attributes, including communication skills, and the understanding of knowledge.5 These qualities are key to becoming a good clinician. All the participating students acted as both peer tutors and peer-learners and were involved in the facilitation of the learning process. The development of teaching, presentation and listening skills was also greatly encouraged. Topics discussed were not confined to medical diagnoses and management, but also included crew resource management, interprofessional working relationships and career options in emergency medicine for both medical and nursing students. Most cases also involved medical ethics and reflection of students being clinicians, learners and teachers. Although we have received positive informal feedback from students participating in C&C, it would be useful to more formally evaluate the benefits of such a peer-led learning model for the PCP. We would like to explore whether students felt supported enough to learn in the prehospital environment and identify what they learn from the PCP shadowing experience and subsequent peer discussions. We hope that through C&C, students can learn to be reflective clinicians early on in their careers, which is vital in both medicine and nursing professional development. We hope that through C&C, students can learn to be reflective clinicians early on in their careers." @default.
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• W3118958960 date "2021-01-07" @default.
• W3118958960 modified "2023-09-23" @default.
• W3118958960 title "Coffee & Cases: Peer learning in prehospital care" @default.
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• W3118958960 doi "https://doi.org/10.1111/tct.13326" @default.
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