Increasing clinical teaching capacity in Tasmanian general practice via a one-week clerkship in residential aged care

Clerkships are obligatory experiences for all Australian medical students graduating with a medical degree. General practices provide clerkships for Australian medical students as one of six mandated specialities that students must experience before they graduate from their medical degree. However, the capacity of a general practice to offer a clerkship to students may be limited by such factors as physical space, and the ability of general practitioners to act as clinical supervisors. The overarching aim of this study was to increase the capacity of Tasmanian general practice to provide clinical learning opportunities for University of Tasmania medical students. This was achieved via an innovative clerkship based in residential aged care facilities. The study had two stages to address the broad aim. The first stage was a review of the current and future clerkship capacity in Tasmanian general practices. A mixed method approach was used to assess the capacity of Tasmanian general practices and supervising general practitioners to provide clerkships to medical students and clinical placements for other medical learners, and to identify the enablers and barriers to increasing that capacity. The study found a major impediment to increasing medical student clerkships was lack of consulting room space. The second stage in the study involved the design and evaluation of a novel curriculum to deliver a clerkship for senior medical students based in residential aged care facilities. The initial curriculum was based on published lists of learning outcomes aimed at those in more advanced stages of medical training. The initial curriculum was also designed to engage students in work-integrated learning that was based on valued clinical care, deliverable within a residential aged care facility. This was an opportunity to increase general practice clerkship capacity under the clinical supervision of general practitioners but outside of the traditional general practice consulting room. The innovative curriculum used a range of contemporary curriculum theories to conceptualise various aspects of the residential aged care clerkship. Couched in critical-exploratory curriculum theory the one-week clerkship was designed to meet society‚ÄövÑv¥s challenging need, in this case the care of elderly frail people, often with dementia. A deliberative approach to curriculum design was used to refine the initial curriculum. Part of the deliberative approach involved gathering feedback from students about their experience of the delivered curriculum. Written feedback from students was used to define the documented curriculum couched in terms of competencies and the attainment of a level of entrustment to care for frail elderly people. A realist evaluation of individual student and focus group data led to an elaboration of an established, experience-based learning theoretical framework, and the proposal of a realist theory of experience-based learning. The evaluation found that the highly structured curriculum delivered many positive outcomes for students such as practise in improving management of end-of-life and dementia care, improved understanding of how residential aged care facilities function, and a chance to participate in interprofessional practice. The context also challenged some students who struggled to see the relevance of the clerkship in relation to their personal and/or professional identities. The findings of this study will be of interest to medical educators dealing with general practice as a provider of clinical placements for medical learners, those wishing to deliver medical student clerkships in Australian residential aged care facilities, and those wishing to use contemporary curriculum and experience-based learning theories in their practice. The study expands medical education‚ÄövÑv¥s traditional research perspective by using curriculum theories more traditionally used in higher education to conceptualise a clerkship. The study also adds the perspective of the person who is the student, and their professional identity formation, to a previous theory of experience-based learning. The study also proposes a realist theory of experience-based learning that may prove useful in a wide range of medical education research and practice context.