Understanding the ward environment: a mixed-methods exploratory study of factors determining medical students’ ‘ward smarts’.

Abstract BackgroundMedical students are expected to know how to function on hospital wards and to be at ease within the ward environment. Such ward-based knowledge indicates that a student is ‘ward smart’: levels of ward smarts vary between students (e.g. based on prior work experience and opportunities offered by placements). However, formal teaching in this area seems to be somewhat neglected, with students being left to ‘pick up’ this knowledge as they go along, which can have an impact on their clinical education. MethodsData were collected via an online questionnaire comprising both closed and open questions designed to assess students’ ward smarts, focusing on knowledge of the ward environment (routines, equipment, and terminology used), relevant clinical knowledge, and communication/roles of other members of the multi-disciplinary team. Multiple regression was used to identify factors influencing students’ scores (i.e. demographics, work experience). Thematic analysis was used to explore medical students’ opinions on how their ward understanding could be improved.ResultsIn our sample of 53 medical students, 96% did not know how to turn on a hearing aid and only 31% knew what a Waterlow score was. Furthermore, 88% did not know how to read an oxygen flowmeter, and only 57% knew where the CPR lever on the bed was situated.Multiple regression showed that ward smarts can be predicted by previous hospital-based work and year group, both of which may represent time spent on wards. Thematic analysis suggested that students felt their understanding of wards would benefit from more ward time and shadowing allied healthcare professionals on the wards.ConclusionsThis suggests that students may not be prepared to work in a ward environment. We propose, based on training implemented in other medical schools, that a specific ward-based interprofessional learning placement or experience should be added to the medical curriculum. As an initial step, specific teaching and/or practical sessions for students centred around patient communication and understanding the ward environment would be beneficial.