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Table 3 Student motivation and preferences for learning. The first four themes relate to student motivations for learning and the latter four themes relate to student preferences for learning

From: Whole consultation simulation in undergraduate surgical education: a breast clinic case study

Theme Sub-theme Code(s) Example Excerpts
Fear of failure   Avoidance of failure
Avoiding mistakes on placement
Ex. 1: “I felt more confident to ask questions and get things wrong because obviously it wasn’t a real patient [...] this is the place to make mistakes rather than on the wards”
Ex. 2: “But then if you do get it wrong in this [“simulated clinic”] setting then you’ve got a smaller group where you’re not disturbing too many people if you get it wrong”
Becoming clinically competent Practical skills Becoming competent at practical skills
Practicing practical skills
Understanding / practicing practical aspects of clinical practice
Ex. 3: “The breast clinic session is useful because we need to know the practical elements.”
Ex. 4: “They [“simulated clinic tutors”] also made us do stuff like examinations too. For me this helps me remember stuff a bit more.”
Communication & professionalism Practicing communication skills
Developing professional skills
Knowing when to escalate and ask for help
Generating good habits
Temporal changes in motivation
Ex. 5: “A lot of it is skills based like being able to speak to your patient properly and then understand what they’re saying.”
Ex. 6: “Just knowing the principles of history taking doesn’t actually help you that much when you come to taking a history because if you can’t make a patient feel comfortable, they won’t open up to you or talk to you.”
Ex. 7: “The point of the session as well was when to ask for help and like how to do that. [...] There’s no other way really to learn about it in a textbook.”
Ex. 8: “This [simulated clinic] builds your practical skills a lot better, and I feel like it gives you better information for like the history taking part.”
Ex. 9: “I feel like when you get to sixth year [...] finals are approaching but then you’re also like oh a couple months after that I’m going to be the F1 and I’m going to be doing nights and covering all the wards. [...] It’s different pressures at different stages.”
Application of clinical knowledge Clinical reasoning
Real-life practices vs textbook
Having confidence in applying clinical knowledgea
Ex. 10: “In textbooks [...] they’ll have like a billion investigations, so you don’t necessarily know which one is the one that you’ll use first in the hospital. Whereas by doing simulated clinics you’ll see [...] this is the first line, this is what you progress to because its got better specificity.”
Ex. 11: “It’s one thing to know what the symptoms are supposed to be and another thing to recognise them on a patient, even a simulated one.”
Ex. 12: “Learning things like differentials, you probably get more of that in the tutorial but recognising them is an entirely different scenario.”
Acquisition of core medical knowledge   Covering the medical curriculum
Acquisition of medical knowledge
Learning facts
Ex. 13: “The history taking part [of the simulated clinic session] was amazing, like I personally thought that the history taking part was so useful, but actually knowing specifically about the disease and all the different investigations and symptoms and everything that can come with it can only really be well taught in a classroom environment.”
Ex. 14: “We got roughly the same information out of each session (tutorials and clinic) but it was just a different way of doing it.”
Ex. 15: “I wouldn’t teach about disease this [simulated clinic] way but as far as examination goes it probably makes sense to teach it this way.”
Passing examinationsb   Passing examinations
Passing non-written exams
Passing written exams
Temporal changes in motivationa
Ex. 16: “The tutorials are more like more for exams and the tutorials are more for OSCES”
Ex. 17: “I think simulated clinic sessions make use a lot more competent as a junior doctor, rather than focus on helping us pass exams.”
Ex. 18: “To be honest prioritising my exams is probably my priority at the moment.”
Ex. 19: “The simulated sessions are useful for both competencies as a doctor as well as practical things like passing our OSCE.”
Ex. 20: “If all our teaching was done in a simulated environment then I don’t think we’d feel as prepared to pass our exams.”
Ex. 21: “I think at this stage, our main priority if we’re being realistic about it is to pass our exams. We can be the most competitive junior doctor, but if we haven’t passed our exams, then you know...”
Active learning techniques Maintaining active interest during teaching exercise Interactive teaching
Active discussion
Active recall / learning
Assessment throughout teaching / factual recall
Interactivity of the teaching session
Engagement with teaching exercise
Ex. 22: “In a big group you’re less likely to put your hand up to answer a question.”
Ex. 23: “It’s good to be put on the spot as well, because I think just a tutorial is quite passive and so you could be like ‘I could do that, I can do all these things’ but then when you actually go to do it in a simulated environment you’re like ‘oh wait hang on a minute.’”
Ex. 24: “I think having a tutorial like a week ago not knowing what the topic is today, is probably the best thing because you learn some stuff in the tutorial, you forget about it, and then you have to use active recall to remember the info.”
Ex. 25: “I learn more from practical sessions. In lunchtime tutorials there is just a lot of information so sometimes it just feels too much and it is hard to remember stuff until you actually put it to use and do it.”
Aiding long-term memory recall Consolidation of knowledge
Forming long-lasting learning memories
Memorable teaching frameworks
Application of knowledge
Feeling prepared for the teaching session
Ex. 26: “I think having a tutorial like a week ago not knowing what the topic is today, is probably the best thing because you learn some stuff in the tutorial, you forget about it, and then you have to use active recall to remember the info.”
Ex. 27: “We already had that [tutorial] session then afterwards we came and consolidated that session a few days later with this [simulated clinic].”
Ex. 28: “I think they [tutorial and simulated clinic] were both very good because i feel like the first one was more like our actual learning outcomes like our conditions that we need to know and to have a clear image of what the differentials could be and then the second one was like how would you use all this knowledge in practice.”
Teaching environment   Safety of learning environment
Small group learning
Suitability of learning technique
Realism of clinical setting
Being able to ask questions
Having confidence in applying clinical knowledgea
Learning through mistakesa
Ex. 29: “I feel more at ease [...] in this environment than doing it on the ward.”
Ex. 30: “I think the simulated clinic, it’s pretty much what they do in the breast clinic, so its like very much what we’ll have to do as a doctor, so I feel like in terms of that respect, this is more useful than a normal tutorial.”
Ex. 31: “I felt like both [the tutorial and the simulated clinic] were useful in their own way, and in fact I felt doing this after the tutorial was actually better because it consolidated all of the stuff that we did in the tutorial so I think they both kind of go hand in hand which is kind of a good thing, but maybe just look at it as an adjuvant rather than one or the other.”
Learning through simulation   Exposure to rare learning experiences
Simulated learning environment
Simulation of real-life scenario
Learning through mistakesa
Recognising clinical presentations
Pure enjoyment / interactivity of the session
Working on weaknessesa
Human factors
Ex. 32: “I don’t think well have the chance to sit in on all the clinics so this would be the place to do it to learn about things that we haven’t been able to see.”
Ex. 33: “I guess it’s also [...] more time for us to go through it because it’s very rare that you see a patient from presentation to future investigations and maybe we wouldn’t have had the chance to do that on the ward.”
Ex. 34: “I feel like they are making us do the stuff, like it identifies what we actually do know and what we’ve retained and what we don’t.”
Ex. 35: “I feel it kind of does prepare us for the exams, but also kind of [sic] tests our professionalism and maturity.”
Ex. 36: “[...] understanding your patient manner as well, and with sensitive things like breast cancer to learn how you’d approach it because you have to be more sensitive.”
Supervised and feedback-driven learning event   Feedback-led session
Having time and exposure to learning experiences
Quality of tutors
Supervision during learning events
Identify weaknesses
Working on weaknesses
Ex. 37: “I think because we’re in small groups in this session it makes it easier to get quick feedback compared to in a larger tutorial.”
Ex. 38: “I guess it’s also [...] more time for us to go through it because its very rare that you see a patient from presentation to future investigations and maybe we wouldn’t have had the chance to do that on the ward.”
Ex. 39: “It’s more intimate, you can talk to people better and voice your concerns.”
Ex. 40: “I feel like they are making us do the stuff, like it identifies what we actually do know and what we’ve retained and what we don’t.”
  Integration of SECO with existing experiences Ex. 41: “I think having a tutorial is a good pre-session for this [simulated Clinic].”
Ex. 42: “I think having a tutorial like a week ago not knowing what the topic is today, is probably the best thing because you learn some stuff in the tutorial, you forget about it, and then you have to use active recall to remember the info.”
Ex. 43: “I think we would definitely still want some tutorials, like a balance is useful rather than all of one.”
Ex. 44: “I would want both, but if I could only have one I’d select this because the book stuff you can just look it up on your own time whereas you can’t recreate this by yourself.”
Ex. 45: “A nice idea would be to have two sessions a week, the first as classroom based and then later on that week would be simulated clinical environment to consolidate that.”
  1. Most excerpts were tagged with multiple codes, and where it was deemed pertinent, some excerpts have been used as example excerpts more than once
  2. a Denotes code that was felt to be part of multiple themes
  3. b The authors acknowledge that examinations also act as a fear