International medical students: Enhancing clinical communication in context

In the MBBS course a cohort of students arrive from that place (IMU, Malaysia) to this place (UTAS School of Medicine) mid-way through their course. New to Australia, they are not familiar with socio-culturalcontextual and communication issues affecting teaching and learning within the Australian healthcare context, such as local accents, everyday Australian English and slang as well as the cultural rules and conventions that apply in Australian health settings, another cultural space. This cohort experiences challenges in communicative practices which have a direct impact on their performances during assessments. This project engages the user-centred design and action research approach to identify aspects of support that are useful and meaningful to students. This student-centred approach is a tool to understand socio-cultural and contextual issues in order to derive and implement interventions to assist students in their transition to this place. Through this process, the project aims to develop a conceptual model to better understand the sociocultural and contextual aspects of international medical students’ UTAS experience. Thus the C4 project has two broad aims:

• a research project to develop insights into socio-cultural and contextual factors associated with learning within the Australian healthcare setting
• a responsive student-centred support program addressing identified issues.

The support program includes peer support, opportunities for enhanced learning with the medical content of the degree, sessions with a drama professional and a series of parallel clinical communication workshops. The workshops are focussed on clinical communication with patients in an authentic hospital setting.

Collaboration between different spaces within and outside of the university is a key part of the C4 project. Internal collaborators include clinical teaching staff, central support staff and the students themselves, and external collaborators include RHH staff and patients.

This project adopts a multi-modal evaluation framework, addressing Kirkpatrick’s four level learning evaluation objectives. The evaluation methods include:

• Focus groups
• Anonymous surveys
• Networking for informal information gathering
• Analysis of students’ OSCE performance in summative assessment
• Input from other teaching staff
• Observation of students (e.g., in ward sessions)

Data analysis techniques utilised include descriptive statistics and qualitative data analysis adopting the principles of grounded theory.

The data collected thus far demonstrated good achievement for all four level of Kirkpatrick’s evaluation framework. Satisfaction surveys showed that sessions were well received (level 1). Direct observation and feedback from colleagues demonstrated good learning of communication skills from workshops (level 2). Focus group and video recording have shown that students have applied the knowledge and skills learnt from their sessions into clinical practice as well as during assessments (level 3). Finally, students have performed better in their degree since this program was introduced, positing the possibility that strengthening confidence in clinical communication allows students to maximise their learning in the clinical context. Further data collection, especially longitudinal data will be helpful in order to understand the duration of impact of this program on student learning.