Participants
All students at St. Marianna University School of Medicine who were first-year students, either in 2016 (n = 128) or 2017 (n = 121), participated in the early exposure program and were included in the study.
Summary of Early Exposure
The exposure is divided into two parts: phase 1 and phase 2. Phase 1 exposure involves students riding along in ambulances and shadowing clinicians in the university hospital, whereas phase 2 exposure is extramural. Phase 2 exposure is geared mainly toward real-life situations, i.e., students participate in 2-week rotations at maternity clinics, nursery schools, kindergartens, other types of clinics, and nursing and welfare facilities (Figure 1). The objective is to instill in these students an interest in regional medical care, nursing, welfare, and preventive medicine while they learn about the early, transitional, and late phases of patients’ life cycle. Other objectives are to give students opportunities to observe fellow students and engage with them and to reflect on their own behavior and emotions, to explore means of communication, and to establish relationships with personnel in various disciplines, and for each student to formulate a mental image of himself/herself as a doctor.
Figure 1: Early exposure to life cycle stages
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The second- and third-year students are exposed to facilities for severely handicapped children and adults, regional comprehensive care facilities, and medical clinics, and they also interview practicing clinicians. The aim is to help these students understand the various roles played by physicians, building on the knowledge they acquired during their first-year exposure.
Training Facilities
Facilities close to the university had been asked to act as training facilities, and most were hospitals or medical facilities founded or staffed by alumni. A total of 65 agreed to participate, including 13 hospitals with a maternity clinic; 21 general clinics and private practices; 17 kindergartens; 7 nursing homes, 3 long-term care facilities for the elderly, and 1 short-stay center; 6 facilities for severely handicapped children or adults; and 16 regional comprehensive care facilities.
Training Methods
As part of the exposure program, the students document (in writing) each of their exposures. Before their participation in an exposure, they note their behavioral target(s), which are based on the targets for achievement outlined in the syllabus (Table 1). They then participate in the exposure, note the details, and reflect upon their experience.
Table 1: Achievement targets of the early exposure program
Maternity clinic
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Develop an appreciation for the wonderfulness of the creation of life and consideration toward parents by looking back on their own birth and on their maternity/paternity.
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1
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Learn health management and health guidance according to each term of pregnancy.
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2
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Learn about the function of local obstetric care facilities.
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3
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Learn about support and assistance needed by pregnant women/newborns.
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4
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Learn about appropriate attitudes and about giving consideration by observing how medical staff deal with pregnant women and their families.
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Kindergarten
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Experience the child care environment and child care in practice.
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1
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Understand concretely the function of kindergartens/nursery schools.
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2
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Understand the flow of the daily child care routine and participate in the activities.
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3
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Understand the development of young children through observation and engagement.
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4
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Talking to children and feeling the enjoyment of nursing care, leading to further learning.
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5
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Understand safety and disease prevention.
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Hospital/clinic
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Experience medical care in a real-life setting.
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1
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Understand and sympathize with patients deeply.
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2
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Understand the function and role of long-term care services.
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3
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Understand the job types and practical roles of facility staff; understand the need for cooperation between staff members, especially with respect to nursing care, regardless of job category.
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4
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Understand the mechanism of medical care and importance of collaboration by observing or assisting doctors, medical paraprofessionals and other health care providers in their work.
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5
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Understand the objectives of medical students, understand ethical standards, and experience transformative learning by incorporating new knowledge and practice.
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Nursing and welfare facilities
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Understand the social role, collaborations, and function of workers in welfare facilities.
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1
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Understand the feelings of elderly persons and caregivers in welfare facilities.
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2
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Understand the function and role of long-term care services.
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3
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Understand the job types and practical roles of facility staff; understand the need for cooperation between staff members, especially with respect to nursing care, regardless of job category.
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4
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Communicate with residents and establish relationships of trust.
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5
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Learn about assisting the elderly with activities of daily life.
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Exposure is executed in accordance with the task schedule provided before each exposure, so in the maternity clinics, the students observe outpatient services, surgery, and delivery. In the kindergartens, the students guide the children into the school and participate in actual child care and discussions with the teaching staff. In the hospitals and clinics, the students observe outpatient care, surgery, and home-visit medical treatment, whereas in the elderly care facilities, they perform nursing care and interact with newly admitted patients.
Evaluation
As part of the exposure program, each first-year student creates a portfolio, and students’ portfolios are evaluated by selected St. Marianna University School of Medicine faculty members according to a rubric formulated in line with the program goals. The study participants did this, and they also invited the instructors they had met with at specific facilities to a poster session that was held at the end of the academic year. Further, they discussed their experiences with these instructors, with each other, and with their St. Marianna instructors. The poster presentations were evaluated by faculty members in terms of the presentation itself, the poster design, and the poster contents.
Questionnaires
Once a student completes an exposure at a particular facility, he or she fills out a questionnaire covering their satisfaction with the experience, adding any personal comments they wish. The questionnaire is returned to the Student Affairs Office, where data from the questionnaires are compiled and analyzed.