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Durling P, Henni J, Mrozowich D, Rankin J, Barlow A, Grimminck R. A Mixed-Methods Realist Analysis of an Interdisciplinary Simulation Intervention for Psychiatry Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:95-105. [PMID: 34613598 PMCID: PMC8493779 DOI: 10.1007/s40596-021-01524-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 08/10/2021] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Simulation research in postgraduate psychiatry remains limited, with minimal studies on interdisciplinary involvement and mechanisms of change. To address these gaps, the authors implemented a mixed-methods realist analysis of an interdisciplinary simulation intervention administered to psychiatry residents. METHODS The University of Calgary implemented a simulation intervention for psychiatry residents. Eight junior residents participated in or observed 4 scenarios and eighteen senior residents participated in or observed 8 scenarios. Scenarios lasted 15 minutes with a pre-simulation orientation and post-scenario debrief. Most scenarios involved interdisciplinary staff. Scenarios included agitated and suicidal patients; treatment-related emergencies; and challenging conversations. All residents completed pre- and post-simulation surveys reporting confidence levels. Changes in confidence were analyzed using paired t tests and differences between junior and senior residents' confidence using ANOVA. Eleven residents participated in 2 focus groups. Transcripts were analyzed using a constant comparative model to identify contexts, mechanisms, outcomes, and the relationship between these realist categories. Key themes were extracted using generic theme analysis. RESULTS Aggregated survey data demonstrated statistically significant improvements in self-reported confidence for 7 of 8 proposed scenarios, with variations in confidence outcomes between junior and senior residents. Four themes emerged: (1) How Simulations Facilitate Learning, (2) The Role of Pre-simulation Instructions, (3) Factors Facilitating Confidence, (4) Positive Effects of Interdisciplinary Involvement. CONCLUSIONS This study identifies possible mechanisms for residents' self-reported improvements in learning and confidence, which may help programs tailor interventions. Furthermore, this study suggests there may be benefits to interdisciplinary simulations, with self-reported outcomes of improved collaboration and safety planning.
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Ward K, Stanyon M, Ryan K, Dave S. Power, recovery and doing something worthwhile: A thematic analysis of expert patient perspectives in psychiatry education. Health Expect 2022; 25:549-557. [PMID: 35076965 PMCID: PMC8957736 DOI: 10.1111/hex.13375] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 01/31/2023] Open
Abstract
Background Objective Design Results Conclusion Patient Contribution
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Affiliation(s)
- Katie Ward
- Derbyshire Healthcare NHS Foundation Trust Derbyshire UK
| | - Miriam Stanyon
- Derbyshire Healthcare NHS Foundation Trust Derbyshire UK
| | - Karl Ryan
- Derbyshire Healthcare NHS Foundation Trust Derbyshire UK
| | - Subodh Dave
- Derbyshire Healthcare NHS Foundation Trust Derbyshire UK
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Yardley S, Williams H, Bowie P, Edwards A, Noble S, Donaldson L, Carson-Stevens A. Which human factors design issues are influencing system performance in out-of-hours community palliative care? Integration of realist approaches with an established systems analysis framework to develop mid-range programme theory. BMJ Open 2022; 12:e048045. [PMID: 34980606 PMCID: PMC8724735 DOI: 10.1136/bmjopen-2020-048045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To develop mid-range programme theory from perceptions and experiences of out-of-hours community palliative care, accounting for human factors design issues that might be influencing system performance for achieving desirable outcomes through quality improvement. SETTING Community providers and users of out-of-hours palliative care. PARTICIPANTS 17 stakeholders participated in a workshop event. DESIGN In the UK, around 30% of people receiving palliative care have contact with out-of-hours services. Interactions between emotions, cognition, tasks, technology and behaviours must be considered to improve safety. After sharing experiences, participants were presented with analyses of 1072 National Reporting and Learning System incident reports. Discussion was orientated to consider priorities for change. Discussions were audio-recorded and transcribed verbatim by the study team. Event artefacts, for example, sticky notes, flip chart lists and participant notes, were retained for analysis. Two researchers independently identified context-mechanism-outcome configurations using realist approaches before studying the inter-relation of configurations to build a mid-range theory. This was critically appraised using an established human factors framework called Systems Engineering Initiative for Patient Safety (SEIPS). RESULTS Complex interacting configurations explain relational human-mediated outcomes where cycles of thought and behaviour are refined and replicated according to prior experiences. Five such configurations were identified: (1) prioritisation; (2) emotional labour; (3) complicated/complex systems; (4a) system inadequacies and (4b) differential attention and weighing of risks by organisations; (5) learning. Underpinning all these configurations was a sixth: (6a) trust and access to expertise; and (6b) isolation at night. By developing a mid-range programme theory, we have created a framework with international relevance for guiding quality improvement work in similar modern health systems. CONCLUSIONS Meta-cognition, emotional intelligence, and informal learning will either overcome system limitations or overwhelm system safeguards. Integration of human-centred co-design principles and informal learning theory into quality improvement may improve results.
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Affiliation(s)
- Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central & North West London NHS Foundation Trust, London, UK
| | - Huw Williams
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Bowie
- Medical Directorate, NHS Education for Scotland, Edinburgh, UK
- Safety, Skills and Improvement Research Collaborative, NHS Education for Scotland, Edinburgh, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Health and Social Care, Staffordshire University, Stafford, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Liam Donaldson
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Opsomer S, Lauwerier E, De Lepeleire J, Pype P. Resilience in advanced cancer caregiving. A systematic review and meta-synthesis. Palliat Med 2022; 36:44-58. [PMID: 34986698 PMCID: PMC8796166 DOI: 10.1177/02692163211057749] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Close relatives provide much of the care to people with cancer. As resilience can shield family caregivers from mental health problems, there has been a burgeoning interest in resilience-promoting interventions. However, the evidence necessary for the development of these interventions is scant and unsynthesized. AIM To create an overall picture of evidence on resilience in cancer caregiving by a theory-driven meta-synthesis. DESIGN In this systematically constructed review a thematic synthesis approach has been applied. The original findings were coded and structured deductively according to the theoretical framework. Consequently, the codes were organized inductively into themes and subthemes. DATA SOURCES Through September 2019, five electronic databases were searched for qualitative studies on resilience in cancer caregiving. The search was extended by a supplementary hand search. Seventeen studies met the eligibility criteria. RESULTS The elements of resilience, as described in the pre-defined theoretical framework of Bonanno, are reflected in the lived experiences of family caregivers. The resilience process starts with the diagnosis of advanced cancer and may result in mental wellbeing, benefit finding, and personal growth. The process is influenced by context elements such as individual history, sociocultural background, caregiver characteristics, and the behavior of the supportive network. A repertoire of coping strategies that caregivers use throughout the caregiving process moderates the resilience process. CONCLUSION This review and theoretical synthesis reveal key elements of resilience in the process of cancer caregiving, including influencing factors and outcomes. Implications and avenues for further research are discussed.
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Affiliation(s)
- Sophie Opsomer
- Academic Centre for General Practice, Catholic University of Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Emelien Lauwerier
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Jan De Lepeleire
- Academic Centre for General Practice, Catholic University of Leuven, Leuven, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,End-of-Life Care Research Group, Ghent University, Ghent, Belgium
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Cash-Gibson L, Martinez-Herrera E, Benach J. What key conditions and mechanisms generate health inequalities research in different contexts? Study protocol for two realist explanatory case studies. EVALUATION AND PROGRAM PLANNING 2021; 89:101986. [PMID: 34390924 DOI: 10.1016/j.evalprogplan.2021.101986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Evidence on health inequalities has grown in recent decades, however, the capacity to generate health inequalities research is uneven, worldwide. A recent bibliometric analysis found notable inequalities of the global production of health inequalities scientific research across countries. What determines the capacity to produce high volumes of health inequalities scientific research, in different settings? What mechanisms are involved? To answer these questions requires in-depth knowledge on the health inequalities research production process, in different settings. We plan to conduct two realist explanatory case studies, to understand why and how particular settings (e.g. the United Kingdom and the city of Barcelona) have generated high volumes of health inequalities research over past decades, and identify the potential key contextual conditions and causal mechanisms involved. This study protocol outlines the rationale and methodology involved, highlights the strengths and limitations of the approach, and provides guidance on how to overcome certain operational challenges and ensure validity of research findings. Valuable learning may be derived from these case experiences, with implications for research, policy and practice. This work can serve as a tool for researcher and planners to guide the development of further case studies to evaluate health inequalities research capacities in other settings.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain.
| | - Eliana Martinez-Herrera
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain; Research Group of Epidemiology, National School of Public Health 'Héctor Abad Gómez', University of Antioquia, Medellín, Colombia.
| | - Joan Benach
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain; Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma, Madrid, Spain.
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Bingham A, O'Sullivan B, Couch D, Cresser S, McGrail M, Major L. How rural immersion training influences rural work orientation of medical students: Theory building through realist evaluation. MEDICAL TEACHER 2021; 43:1398-1405. [PMID: 34280328 DOI: 10.1080/0142159x.2021.1948520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
AIM To develop theory about how contexts and mechanisms interact to contribute to openness to future rural practice by medical students undertaking immersive rural training. METHODS A realist evaluation based on RAMESES II protocol. We interviewed 23 students exploring Contexts (C) which were external (place-based) and internal (the student's characteristics), Mechanisms (M) (that drive a response) and Outcomes (O) (openness to rural work). RESULTS 'Openness to rural work' related to: a desire to live rurally, work in rural medicine, or consider this as a possibility. This was triggered by responses to experience in rural places of an aspirational, intellectual and emotional nature (mechanisms). Students most affected were those with a strong motivation to help others and who value teamwork. Students with clearly envisaged career paths suited to metropolitan areas, or those retaining/prioritising strong social and community ties in metropolitan areas were less likely to commit to future rural work. CONCLUSION Our theory indicates multi-level stimuli activates openness. Implications are that rural immersion programs could select students with an orientation towards teamwork, without pre-set professional ideation, and with a strong commitment to helping others. Experiencing rural immersion will trigger aspirational, intellectual and emotional responses leading to rural work openness for such students.
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Affiliation(s)
- Amie Bingham
- School of Rural Health, Monash University, Clayton, Australia
| | | | - Danielle Couch
- School of Rural Health, Monash University, Bendigo, Australia
| | | | - Matthew McGrail
- Rural Clinical School, University of Queensland, Rockhampton, Australia
| | - Laura Major
- School of Rural Health, Monash University, Clayton, Australia
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Waslowski J, Paton M, Freymond M, Patel S, Brownrigg T, Olesovsky S, Nyhof-Young J. Evaluation of a pilot rural mentorship programme for and by pre-clerkship medical students. CANADIAN JOURNAL OF RURAL MEDICINE : THE OFFICIAL JOURNAL OF THE SOCIETY OF RURAL PHYSICIANS OF CANADA = JOURNAL CANADIEN DE LA MEDECINE RURALE : LE JOURNAL OFFICIEL DE LA SOCIETE DE MEDECINE RURALE DU CANADA 2021; 26:176-185. [PMID: 34643557 DOI: 10.4103/cjrm.cjrm_82_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction While medical school interventions can help address rural physician shortages, many urban Canadian medical students lack exposure to rural medicine. The Rural Mentorship Programme (RMP) is a 4-month pilot initiative designed by medical students to bridge this gap by pairing preclerkship medical students at an urban medical school with rural physician mentors to provide exposure to rural careers. Methods A realist-influenced methodology evaluated perceived benefits and challenges of RMP, assessed how RMP influenced mentee perceptions and intentions towards rural careers, and investigated factors leading to success. Quantitative and qualitative data were collected through evaluative pre-, post-, and 4-month post intervention surveys, mentor interviews and a mentee focus group. Likert scales assessed satisfaction, attainment of objectives and mentee changes in perceptions and intentions. Results 18/23 mentees and 11/15 mentors completed at least 1 survey; 5 mentees joined the focus group and 3 mentors were interviewed. Most mentees were of non-rural backgrounds and initially neutral about pursuing rural practice. RMP helped mentees better understand rural careers. They especially valued the mandatory community clinical visit and forming relationships with mentors. Mentors enjoyed teaching, reflecting on their careers and demonstrating the merits of rural practice. Transportation and scheduling were major programme challenges. Conclusions This pilot suggests that structured mentorship programmes can improve understanding of, and provide exposure to, careers in rural medicine for urban medical students. Results will inform future programme development.
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Affiliation(s)
- Jasmine Waslowski
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Morag Paton
- Department of Leadership, Higher and Adult Education, OISE, University of Toronto, Toronto, ON, Canada
| | - Mary Freymond
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Emergency Medicine, Alberta Health Services and the Cumming School of Medicine, Calgary, AB, Canada
| | - Sagar Patel
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Tristan Brownrigg
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Department of Family Medicine, Queen's University School of Medicine, Kingston, ON, Canada
| | - Shelby Olesovsky
- MD Program, Temerty Faculty of Medicine, University of Toronto; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Joyce Nyhof-Young
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto; Office of Education Scholarship, Department of Family & Community Medicine, Temerty Faculty of medicine, University of Toronto, Toronto, ON, Canada
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Kerr A, Kelleher C, Pawlikowska T, Strawbridge J. How can pharmacists develop patient-pharmacist communication skills? A realist synthesis. PATIENT EDUCATION AND COUNSELING 2021; 104:2467-2479. [PMID: 33726988 DOI: 10.1016/j.pec.2021.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To understand how pharmacists develop patient-pharmacist communication skills. METHODS A realist synthesis approach was used to understand how educational interventions work to improve patient-pharmacist communication. Initial programme theories were developed through a scoping search and stakeholder focus groups (faculty, students, patients and public). A systematic search was then conducted for evidence to test initial theories. Included papers were assessed for relevance and rigour. Extracted data was synthesised to refine the initial programme theories and develop modified programme theories. RESULTS Forty-seven papers were included in the final synthesis. Role-play with simulated patients and peers, video recording and lectures were the most widely reported interventions. Repeated practice, feedback, reflection and confidence were among the mechanisms by which interventions work. Modified programme theories relating to interactions of role-play, experiential learning, video recording, self-assessment and workshops were developed. CONCLUSIONS Outcomes of communication education interventions are influenced by the level of learner. Educational interventions that promote reflection are particularly useful. PRACTICAL IMPLICATIONS There are a wide range of theory-informed interventions, which should be used in a programmatic approach to communications education. A longitudinal programme of communication skills training, with intervention choice based on level of learning, is important.
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Affiliation(s)
- Aisling Kerr
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Caroline Kelleher
- Department of Psychology, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Teresa Pawlikowska
- Health Professions Education Centre (HPEC), RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Judith Strawbridge
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Price T, Wong G, Withers L, Wanner A, Cleland J, Gale T, Prescott-Clements L, Archer J, Bryce M, Brennan N. Optimising the delivery of remediation programmes for doctors: A realist review. MEDICAL EDUCATION 2021; 55:995-1010. [PMID: 33772829 DOI: 10.1111/medu.14528] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 05/15/2023]
Abstract
CONTEXT Medical underperformance puts patient safety at risk. Remediation, the process that seeks to 'remedy' underperformance and return a doctor to safe practice, is therefore a crucially important area of medical education. However, although remediation is used in health care systems globally, there is limited evidence for the particular models or strategies employed. The purpose of this study was to conduct a realist review to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety. METHOD We conducted a realist literature review consistent with RAMESES standards. We developed a programme theory of remediation by carrying out a systematic search of the literature and through regular engagement with a stakeholder group. We searched bibliographic databases (MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL, ERIC, ASSIA and DARE) and conducted purposive supplementary searches. Relevant sections of text relating to the programme theory were extracted and synthesised using a realist logic of analysis to identify context-mechanism-outcome configurations (CMOcs). RESULTS A 141 records were included. The majority of the studies were from North America (64%). 29 CMOcs were identified. Remediation programmes are effective when a doctor's insight and motivation are developed and behaviour change reinforced. Insight can be developed by providing safe spaces, using advocacy to promote trust and framing feedback sensitively. Motivation can be enhanced by involving the doctor in remediation planning, correcting causal attribution, goal setting and destigmatising remediation. Sustained change can be achieved by practising new behaviours and skills, and through guided reflection. CONCLUSION Remediation can work when it creates environments that trigger behaviour change mechanisms. Our evidence synthesis provides detailed recommendations on tailoring implementation and design strategies to improve remediation interventions for doctors.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care, Health Sciences, University of Oxford, Oxford, UK
| | | | - Amanda Wanner
- NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Tom Gale
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Faculty of Medicine, Nursing and Healthcare, Monash University, Melbourne, Vic., Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
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Sinclair S, Kondejewski J, Jaggi P, Roze des Ordons AL, Kassam A, Hayden KA, Harris D, Hack TF. What works for whom in compassion training programs offered to practicing healthcare providers: a realist review. BMC MEDICAL EDUCATION 2021; 21:455. [PMID: 34454489 PMCID: PMC8403363 DOI: 10.1186/s12909-021-02863-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Patients and families want their healthcare to be delivered by healthcare providers that are both competent and compassionate. While compassion training has begun to emerge in healthcare education, there may be factors that facilitate or inhibit the uptake and implementation of training into practice. This review identified the attributes that explain the successes and/or failures of compassion training programs offered to practicing healthcare providers. METHODS Realist review methodology for knowledge synthesis was used to consider the contexts, mechanisms (resources and reasoning), and outcomes of compassion training for practicing healthcare providers to determine what works, for whom, and in what contexts. RESULTS Two thousand nine hundred ninety-one articles underwent title and abstract screening, 53 articles underwent full text review, and data that contributed to the development of a program theory were extracted from 45 articles. Contexts included the clinical setting, healthcare provider characteristics, current state of the healthcare system, and personal factors relevant to individual healthcare providers. Mechanisms included workplace-based programs and participatory interventions that impacted teaching, learning, and the healthcare organization. Contexts were associated with certain mechanisms to effect change in learners' attitudes, knowledge, skills and behaviors and the clinical process. CONCLUSIONS In conclusion this realist review determined that compassion training may engender compassionate healthcare practice if it becomes a key component of the infrastructure and vision of healthcare organizations, engages institutional participation, improves leadership at all levels, adopts a multimodal approach, and uses valid measures to assess outcomes.
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Affiliation(s)
- Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
- Division of Palliative Medicine Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada.
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Priya Jaggi
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Amanda L Roze des Ordons
- Department of Critical Care Medicine and Division of Palliative Medicine Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Office of Postgraduate Medical Education, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - K Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Daranne Harris
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Thomas F Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 99 Curry Place, Winnipeg, Manitoba, R3T 2M6, Canada
- Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Room CR3018, 369 Taché Ave, Winnipeg, Manitoba, R2H 2A6, Canada
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van Braak M, Giroldi E, Huiskes M, Diemers AD, Veen M, van den Berg P. A participant perspective on collaborative reflection: video-stimulated interviews show what residents value and why. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:865-879. [PMID: 33590384 PMCID: PMC8338865 DOI: 10.1007/s10459-020-10026-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/23/2020] [Indexed: 05/28/2023]
Abstract
The potential of reflection for learning and development is broadly accepted across the medical curriculum. Our understanding of how exactly reflection yields its educational promise, however, is limited to broad hints at the relation between reflection and learning. Yet, such understanding is essential to the (re)design of reflection education for learning and development. In this qualitative study, we used participants' video-stimulated comments on actual practice to identify features that do or do not make collaborative reflection valuable to participants. In doing so, we focus on aspects of the interactional process that constitute the educational activity of reflection. To identify valuable and less valuable features of collaborative reflection, we conducted one-on-one video-stimulated interviews with Dutch general practice residents about collaborative reflection sessions in their training program. Residents were invited to comment on any aspect of the session that they did or did not value. We synthesized all positively and negatively valued features and associated explanations put forward in residents' narratives into shared normative orientations about collaborative reflection: what are the shared norms that residents display in telling about positive and negative experiences with collaborative reflection? These normative orientations display residents' views on the aim of collaborative reflection (educational value for all) and the norms that allegedly contribute to realizing this aim (inclusivity and diversity, safety, and efficiency). These norms are also reflected in specific educational activities that ostensibly contribute to educational value. As such, the current synthesis of normative orientations displayed in residents' narratives about valuable and less valuable elements of collaborative reflection deepen our understanding of reflection and its supposed connection with educational outcomes. Moreover, the current empirical endeavor illustrates the value of video-stimulated interviews as a tool to value features of educational processes for future educational enhancements.
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Affiliation(s)
- Marije van Braak
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands.
| | | | - Mike Huiskes
- Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - Agnes D Diemers
- University Medical Center Groningen, Groningen, The Netherlands
| | - Mario Veen
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands
| | - Pieter van den Berg
- Erasmus Medical Center, Dr. Molewaterplein 40, P.O. Box 2040, 3015 GD, Rotterdam, The Netherlands
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Thomas A, Bussières A. Leveraging knowledge translation and implementation science in the pursuit of evidence informed health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1157-1171. [PMID: 33651210 DOI: 10.1007/s10459-020-10021-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/17/2020] [Indexed: 06/12/2023]
Abstract
Evidence informed approaches to health professions education can ensure accountability to learners and society in providing meaningful and effective education and helping resource strained systems via streamlined and cost-efficient practices. Knowledge translation and implementation science are two areas of study originally developed in clinical medicine in response to concerns that health care practices were incongruent with the scientific evidence. Two decades of research have led to important advances in our understanding of the nature and magnitude of research-practice gaps, the factors that support or impede adoption of evidence in clinical decision-making, and in the design and evaluation of theory driven interventions to reduce gaps. This paper borrows concepts from knowledge translation and implementation science to further our thinking about how health professions education can 'truly' be evidence informed. The article is organised in four sections: a discussion of the impetus for the evidence informed health professions education movement; a description of the origins of knowledge translation and implementation science; a discussion on how knowledge translation and implementation science can be leveraged to advance the evidence informed health professions education agenda; and suggestions for future discussion and research. An example is used to illustrate the application of the underpinning principles of knowledge translation and implementation science. The authors suggest a theory driven, staged and systematic approach that integrates knowledge translation principles and processes and involves key stakeholders interested in promoting the application of educational research of evidence.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada.
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Huang CD, Jenq CC, Liao KC, Lii SC, Huang CH, Wang TY. How does narrative medicine impact medical trainees' learning of professionalism? A qualitative study. BMC MEDICAL EDUCATION 2021; 21:391. [PMID: 34289848 PMCID: PMC8296619 DOI: 10.1186/s12909-021-02823-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/09/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Narrative medicine (NM) is an approach involving narrative skills and is regarded as a model for medical humanism and effective medical practice. This study aims to explore how NM impacts medical trainees' learning of professionalism during a clerkship in a Taiwanese clinical setting. METHODS A qualitative interview study adopting a purposive sampling method was undertaken. Thirty medical trainees participated in this study, including five fifth-year medical students (MSs), ten sixth-year MSs, nine seventh-year MSs, and six postgraduate year (PGY) trainees. Thematic framework analysis was applied, and a modified realist evaluation approach was further used to analyse the interview data. RESULTS We identified self-exploration, reflection, and awareness of professional identity as mechanisms explaining how NM impacted professionalism learning in our participants. Furthermore, empathy, communication, doctor-patient relationship and understanding patients were identified as the outcomes of the NM intervention for trainees' learning of professionalism. CONCLUSIONS NM facilitates medical trainees' self-exploration, reflection, and awareness of professional identity, thereby affecting their learning of professionalism in clinical settings. Adopting NM as an educational intervention in undergraduate medical education could play an important role in professionalism learning, as trainees can thereby be supported to gradually develop self-exploration and reflection capabilities and heightened awareness of professional identity reflectively through a narrative process.
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Affiliation(s)
- Chien-Da Huang
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tun Hua N. Rd., Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chang-Chyi Jenq
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tun Hua N. Rd., Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Kuo-Chen Liao
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 199 Tun Hua N. Rd., Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
- Department of General Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Shu-Chung Lii
- Department of Medical Humanities and Social Sciences, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chi-Hsien Huang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
| | - Tsai-Yu Wang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan
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Gibson Smith K, Alexander K, Cleland J. Opening up the black box of a Gateway to Medicine programme: a realist evaluation. BMJ Open 2021; 11:e049993. [PMID: 34261690 PMCID: PMC8280889 DOI: 10.1136/bmjopen-2021-049993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES A Gateway to Medicine programme, developed in partnership between a further and higher education setting and implemented to increase the socioeconomic diversity of medicine, was examined to identify precisely what works within the programme and why. DESIGN This study employed realist evaluation principles and was undertaken in three phases: document analysis and qualitative focus groups with widening access (WA) programme architects; focus groups and interviews with staff and students; generation of an idea of what works. SETTING Participants were recruited from a further/higher education setting and were either enrolled or involved in the delivery of a Gateway to Medicine programme. PARTICIPANTS Twelve staff were interviewed either individually (n=3) or in one of three group interviews. Nine focus groups (ranging from 5 to 18 participants in each focus group) were carried out with Gateway students from three consecutive cohorts at 2-3 points in their Gateway programme year. RESULTS Data were generated to determine what 'works' in the Gateway programme. Turning a realist lens on the data identified six inter-relating mechanisms which helped students see medicine as attainable and achievable and prepared them for the transition to medical school. These were academic confidence (M1); developing professional identity (M2); financial support/security (M3); supportive relationships with staff (M4) and peers (M5); and establishing a sense of belonging as a university student (M6). CONCLUSIONS By unpacking the 'black box' of a Gateway programme through realist evaluation, we have shown that such programmes are not solely about providing knowledge and skills but are rather much more complex in respect to how they work. Further work is needed to further test the mechanisms identified in our study in other contexts for theory development and to identify predictors of effectiveness in terms of students' preparedness to transition.
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Affiliation(s)
- Kathrine Gibson Smith
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kirsty Alexander
- Research Department of Medical Education, University College London, London, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Kerr A, Strawbridge J, Kelleher C, Barlow J, Sullivan C, Pawlikowska T. A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training. BMC MEDICAL EDUCATION 2021; 21:325. [PMID: 34092216 PMCID: PMC8180382 DOI: 10.1186/s12909-021-02776-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/07/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training. METHODS A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men's and women's health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories. RESULTS Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated. CONCLUSIONS SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.
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Affiliation(s)
- Aisling Kerr
- School of Pharmacy and Biomolecular Sciences, RCSI School of Medicine and Health Sciences, RCSI University of Medicine and Health Sciences, 1st floor Ardilaun House Block B, 111 St, Stephen's Green, Dublin 2, Ireland.
| | - Judith Strawbridge
- School of Pharmacy and Biomolecular Sciences, RCSI School of Medicine and Health Sciences, RCSI University of Medicine and Health Sciences, 1st floor Ardilaun House Block B, 111 St, Stephen's Green, Dublin 2, Ireland
| | - Caroline Kelleher
- Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - James Barlow
- Department of Chemistry, RCSI University of Medicine and Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland
| | - Clare Sullivan
- Department of Simulation, RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
| | - Teresa Pawlikowska
- Health Professions Education Centre (HPEC), RCSI University of Medicine and Health Sciences, 123 St Stephen's Green, Dublin 2, Ireland
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O'Malley G, Beima-Sofie KM, Roche SD, Rousseau E, Travill D, Omollo V, Delany-Moretlwe S, Bekker LG, Bukusi EA, Kinuthia J, Barnabee G, Dettinger JC, Wagner AD, Pintye J, Morton JF, Johnson RE, Baeten JM, John-Stewart G, Celum CL. Health Care Providers as Agents of Change: Integrating PrEP With Other Sexual and Reproductive Health Services for Adolescent Girls and Young Women. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:668672. [PMID: 36303982 PMCID: PMC9580786 DOI: 10.3389/frph.2021.668672] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/22/2021] [Indexed: 10/07/2023] Open
Abstract
Background: Successful integration of pre-exposure prophylaxis (PrEP) with existing reproductive health services will require iterative learning and adaptation. The interaction between the problem-solving required to implement new interventions and health worker motivation has been well-described in the public health literature. This study describes structural and motivational challenges faced by health care providers delivering PrEP to adolescent girls and young women (AGYW) alongside other SRH services, and the strategies used to overcome them. Methods: We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) with HCWs from two demonstration projects delivering PrEP to AGYW alongside other SRH services. The Prevention Options for the Women Evaluation Research (POWER) is an open label PrEP study with a focus on learning about PrEP delivery in Kenyan and South African family planning, youth mobile services, and public clinics at six facilities. PrIYA focused on PrEP delivery to AGYW via maternal and child health (MCH) and family planning (FP) clinics in Kenya across 37 facilities. IDIs and FGDs were transcribed verbatim and analyzed using a combination of inductive and deductive methods. Results: We conducted IDIs with 36 participants and 8 FGDs with 50 participants. HCW described a dynamic process of operationalizing PrEP delivery to better respond to patient needs, including modifying patient flow, pill packaging, and counseling. HCWs believed the biggest challenge to sustained integration and scaling of PrEP for AGYW would be lack of health care worker motivation, primarily due to a misalignment of personal and professional values and expectations. HCWs frequently described concerns of PrEP provision being seen as condoning or promoting unprotected sex among young unmarried, sexually active women. Persuasive techniques used to overcome these reservations included emphasizing the social realities of HIV risk, health care worker professional identities, and vocational commitments to keeping young women healthy. Conclusion: Sustained scale-up of PrEP will require HCWs to value and prioritize its incorporation into daily practice. As with the provision of other SRH services, HCWs may have moral reservations about providing PrEP to AGYW. Strategies that strengthen alignment of HCW personal values with professional goals will be important for strengthening motivation to overcome delivery challenges.
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Affiliation(s)
- Gabrielle O'Malley
- Department of Global Health, University of Washington, Seattle, WA, United States
| | | | - Stephanie D. Roche
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Elzette Rousseau
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Danielle Travill
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Victor Omollo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Elizabeth A. Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Departments of Obstetrics and Gynecology, University of Washington, Seattle, WA, United States
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Research & Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Gena Barnabee
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Julie C. Dettinger
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anjuli D. Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jennifer F. Morton
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Rachel E. Johnson
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Connie L. Celum
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
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de la Perrelle L, Cations M, Barbery G, Radisic G, Kaambwa B, Crotty M, Fitzgerald JA, Kurrle S, Cameron I, Whitehead C, Thompson J, Laver K. How, why and under what circumstances does a quality improvement collaborative build knowledge and skills in clinicians working with people with dementia? A realist informed process evaluation. BMJ Open Qual 2021; 10:bmjoq-2020-001147. [PMID: 33990392 PMCID: PMC8127967 DOI: 10.1136/bmjoq-2020-001147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022] Open
Abstract
In increasingly constrained health and aged care services, strategies are needed to improve quality and translate evidence into practice. In dementia care, recent failures in quality and safety have led the WHO to prioritise the translation of known evidence into practice. While quality improvement collaboratives have been widely used in healthcare, there are few examples in dementia care. We describe a recent quality improvement collaborative to improve dementia care across Australia and assess the implementation outcomes of acceptability and feasibility of this strategy to translate known evidence into practice. A realist-informed process evaluation was used to analyse how, why and under what circumstances a quality improvement collaborative built knowledge and skills in clinicians working in dementia care. This realist-informed process evaluation developed, tested and refined the programme theory of a quality improvement collaborative. Data were collected pre-intervention and post-intervention using surveys and interviews with participants (n=28). A combined inductive and deductive data analysis process integrated three frameworks to examine the context and mechanisms of knowledge and skill building in participant clinicians. A refined program theory showed how and why clinicians built knowledge and skills in quality improvement in dementia care. Six mechanisms were identified: motivation, accountability, identity, collective learning, credibility and reflective practice. These mechanisms, in combination, operated to overcome constraints, role boundaries and pessimism about improved practice in dementia care. A quality improvement collaborative designed for clinicians in different contexts and roles was acceptable and feasible in building knowledge, skills and confidence of clinicians to improve dementia care. Supportive reflective practice and a credible, flexible and collaborative process optimised quality improvement knowledge and skills in clinicians working with people with dementia. Trial registration number ACTRN12618000268246.
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Affiliation(s)
- Lenore de la Perrelle
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Gaery Barbery
- Health Services Management School of Medicine, Griffith University, Nathan, Queensland, Australia
| | - Gorjana Radisic
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Janna Anneke Fitzgerald
- Business Strategy and Innovation, Griffith University Faculty of Health, Gold Coast, Queensland, Australia
| | - Susan Kurrle
- Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian Cameron
- Rehabilitation Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Craig Whitehead
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
| | - Jane Thompson
- NNIDR Consumer Involvement Reference Group, NHMRC CDPC, Hornsby, New South Wales, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders University, Flinders University, Adelaide, South Australia, Australia
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Lefroy J, Walters B, Molyneux A, Smithson S. Can learning from workplace feedback be enhanced by reflective writing? A realist evaluation in UK undergraduate medical education. EDUCATION FOR PRIMARY CARE 2021; 32:326-335. [PMID: 33988088 DOI: 10.1080/14739879.2021.1920472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Doctors and medical students in the UK are currently required to provide evidence of learning by reflective writing on (among other things) feedback from colleagues. Although the theoretical value of reflecting-on-action is clear, research is still needed to know how to realise the potential of written reflection in medical education. This study arose out of efforts to improve medical student engagement with a reflective writing exercise. We used realist methodology to explain the disinclination of the majority to do written reflection on workplace feedback, and the benefits to the minority.Method: Realist evaluation is a suitable approach to researching complex interventions which have worked for some and not for others. Focus groups were held over a three-year period with year 3 and 4 students. Focus group transcripts were coded for context-mechanism-outcome configurations (the realist approach to analysing data) explaining students' choice not to write a reflection, to write a 'tick-box' reflection or to write for learning. A sub-set of eight students' reflections were also analysed to ascertain evidence of learning through reflection.Results and discussion: 27 students participated in 4 focus groups. Three summary theories emerged showing the importance of context. Firstly, written reflection is effortful and benefits those who invest in it for intrinsic reasons in situations when they need to think more deeply about a learning event. Secondly, following a reflective feedback discussion writing a reflection may add little because the learning has already taken place. Thirdly, external motivation tends to result in writing a 'tick-box' reflection.
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Affiliation(s)
| | - Ben Walters
- Keele University School of Medicine, Keele, UK
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Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J, Bryce M. Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.
Objectives
To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Design
A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.
Review methods
Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.
Results
A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.
Limitations
Limitations were the low quality of included literature and limited number of UK-based studies.
Future work
Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.
Study registration
This study is registered as PROSPERO CRD42018088779.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amanda Wanner
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Medicine, Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, VIC, Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
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Agrawal S, Kalocsai C, Capponi P, Kidd S, Ringsted C, Wiljer D, Soklaridis S. "It was great to break down the walls between patient and provider": liminality in a co-produced advisory course for psychiatry residents. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:385-403. [PMID: 32920699 DOI: 10.1007/s10459-020-09991-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 08/24/2020] [Indexed: 05/21/2023]
Abstract
Although rhetoric abounds about the importance of patient-, person- and relationship-centered approaches to health care, little is known about how to address the problem of dehumanization through medical and health professions education. One promising but under-theorized strategy is to co-produce education in collaboration with health service users. To this end, we co-produced a longitudinal course in psychiatry that paired people with lived experience of mental health challenges as advisors to fourth-year psychiatry residents at the University of Toronto. The goal of this study was to examine this novel, relationship-based course in order to understand co-produced health professions education more broadly. Using qualitative interviews with residents and advisors after the first iteration of the course, we explored how participants made meaning of the course and of what learning, if any, occurred, for whom and how. We found that the anthropological theory of liminality allowed us to understand participants' complex experiences and illuminated how this type of pedagogy may work to achieve its effects. Liminality also helped us understand why some participants resisted the course, and how we could more carefully think about co-produced, humanistic education and transformative learning.
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Affiliation(s)
- Sacha Agrawal
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Csilla Kalocsai
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- The Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, ON, Canada.
| | - Pat Capponi
- , Voices from the Street, Toronto, ON, Canada
| | - Sean Kidd
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Charlotte Ringsted
- Centre for Health Sciences Education, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - David Wiljer
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- The Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- The Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, ON, Canada
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Magola E, Willis SC, Schafheutle EI. The development, feasibility and acceptability of a coach-led intervention to ease novice community pharmacists' transition to practice. Res Social Adm Pharm 2021; 18:2468-2477. [PMID: 33994115 DOI: 10.1016/j.sapharm.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite reported benefits of transition support programmes for other healthcare professionals, no evidence-based support interventions exist to ease newly-registered novice community pharmacists' (NCPs) transition into practice. OBJECTIVES To develop an intervention to provide psychosocial support, support the development of professional behaviours and skills of novice pharmacists in community pharmacy and conduct an evaluation. METHODS The Medical Research Council (MRC) guidance for developing complex interventions was applied to develop a 17-week, pharmacist coach-led intervention, using a social media group, a face-to-face introductory workshop, two webinars, weekly case studies, portfolios (reflective logs and development plans) and a handbook. Twelve newly-registered NCPs participated. A coach log and semi-structured interviews collected data on feasibility, acceptability and perceived impact. RESULTS Findings suggest the intervention was feasible and highly acceptable to NCPs, who perceived the coach and social media group to be the most valuable components. The coach was described as non-judgemental, approachable and collaborative. Provision of guided one-to-one reflection was viewed as useful for debriefing, feedback and meaningful reflection, and supported development of reflection-in-action. The face-to-face workshop was considered important for establishing rapport and trust. The social media group was most valued for providing an accessible, confidential and responsive support network, in which NCPs felt psychologically safe to learn. This component was reported to present opportunities for developmental discourse and shared reflection with peers, thus reducing the sense of professional isolation. NCPs reported that the intervention led to increases in meaningful learning, confidence, critical reasoning, self-awareness and self-reflection. The webinars and handbook were identified as the least valuable components. CONCLUSIONS A transition-support intervention using an experienced pharmacist coach, delivered within a safe, supportive, albeit online facilitated learning environment, appeared feasible and valuable in supporting guided reflection and developmental discourse. This facilitates transformative learning, and supports NCPs to gain proficiency and become independent reflective practitioners.
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Affiliation(s)
- Esnath Magola
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Sarah C Willis
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Ellen I Schafheutle
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
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Gupta M, Rahman A, Dutta NC, Saha AK, Zwi A, Ivers RQ, Jagnoor J. Implementing a crèche-based community drowning programme in rural Bangladesh: a process evaluation. Inj Prev 2021; 28:23-31. [DOI: 10.1136/injuryprev-2020-044066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/03/2022]
Abstract
BackgroundLiving and environmental conditions in rural Bangladesh expose children to drowning. The Anchal programme protects children through crèche-based supervision in an enclosed space run by locally recruited carers. It is unclear under what conditions the programme best operates to maximise protection. We conducted a process evaluation of Anchal to determine enabling factors and challenges to implementation.MethodsQuantitative programme data were analysed to calculate metrics including child participation and fidelity of implementation to defined processes. Qualitative data collection with programme participants and implementers provided insights into barriers and enablers of implementation. Analysis was guided by the UK Medical Research Council’s process evaluation framework.ResultsAnchal operated 400 centres with an average of 22.2 children enrolled, as per target. However, daily attendance averaged lower than the 80% target. Children aged 1–2 years old, who are most at risk of drowning, were least likely to enrol and attend regularly due to low engagement with activities and parental concerns for safety. Greater distances and lower educational attainment in some regions reduced attendance and increased carer attrition.ConclusionsThe Anchal programme met most programme delivery targets. However, programme success could be improved through increasing supervision, providing communication training for implementing staff, designing programmes for children aged 1–2 years old, encouraging community ownership and providing child pick-up services. These contextual solutions can be adapted to similar programmes operating through grassroots-level engagement and recruitment of community health workers, to maximise their effectiveness and sustainability.
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Browne F, Hannigan B, Harden J. A realist evaluation of a safe medication administration education programme. NURSE EDUCATION TODAY 2021; 97:104685. [PMID: 33310699 DOI: 10.1016/j.nedt.2020.104685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Continuing professional education (CPE) for nurses is deemed an essential component to develop, maintain and update professional skills. However, there is little empirical evidence of its effectiveness or factors which may influence its application into practice. OBJECTIVE This paper explores a continuing professional education programme on the safe administration of medication and how new knowledge and skills are transferred into clinical practice. DESIGN Realist evaluation provided the framework for this study. Realist evaluation stresses the need to evaluate programmes within "context," and to ask what "mechanisms" are acting to produce which "outcomes." This realist evaluation had four distinct stages. Firstly, theories were built as conjectured CMO configurations (Stage 1 and 2), then these cCMO were tested (Stage 3) and they were then refined (Stage 4). METHODS Data was collected through document analysis and interviews (9) to build and refine CMOs. The conjectured CMOs were tested by clinical observation, interview (7), analysis of further documents and analysis of data from reported critical incidents and nursing care metric measurements. RESULTS This study has shown the significant role of the ward manager in the application of new learning from the education programme to practice. Local leadership was found to enable a patient safety culture and the adoption of a quality improvement approach. The multi-disciplinary team at both organisation and local level was also found to be a significant context for the application of the education programme into practice. Reasoning skills and receptivity to change were identified to be key mechanisms which were enabled within the described contexts. CONCLUSION The findings from this study should inform policy and practice on the factors required to ensure learning from CPE is applied in practice. The realist evaluation framework should be applied when evaluating CPE programmes as the rationale for such programmes is to maintain and improve patient care.
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Affiliation(s)
- Freda Browne
- School of Nursing Midwifery and Health Systems, University College Dublin, Belfield, Dublin 4 353 1 7166402, Ireland.
| | - Ben Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, Wales, United Kingdom of Great Britain and Northern Ireland.
| | - Jane Harden
- Wales Centre for Evidence Based Care, School of Healthcare Sciences, Cardiff University, Cardiff, Wales, United Kingdom of Great Britain and Northern Ireland.
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Webster J, Krishnaratne S, Hoyt J, Demissie SD, Spilotros N, Landegger J, Kambanje M, Pryor S, Moseti E, Marcus S, Gnintoungbe M, Curry D, Hamon JK. Context-acceptability theories: example of family planning interventions in five African countries. Implement Sci 2021; 16:12. [PMID: 33435959 PMCID: PMC7805098 DOI: 10.1186/s13012-020-01074-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Family planning (FP) can lengthen birth intervals and potentially reduce the risk of foetal death, low birthweight, prematurity, and being small for gestational age. Effective FP is most easily achieved through access to and acceptability of modern contraceptive methods (MCMs). This study aimed to identify mechanisms of acceptability and the contexts in which they are triggered and to generate theories to improve the selection and implementation of effective interventions by studying an intervention integrating FP with childhood immunisation services. METHODS Qualitative interpretative synthesis of findings from realist evaluations of FP interventions in five African countries was guided by an analytical framework. Empirical mechanisms of acceptability were identified from semi-structured interviews and focus group discussions with key stakeholders (N = 253). The context in which these mechanisms were triggered was also defined. Empirical mechanisms of acceptability were matched to constructs of a theoretical framework of acceptability. Context-acceptability theories (CATs) were developed, which summarised constructs of acceptability triggered for specific actors in specified contexts. Examples of interventions that may be used to trigger acceptability for these actors were described. RESULTS Seven CATs were developed for contexts with strong beliefs in religious values and with powerful religious leaders, a traditional desire for large families, stigmatisation of MCM use, male partners who are non-accepting of FP, and rumours or experiences of MCM side effects. Acceptability mechanisms included alignment with values and beliefs without requiring compromise, actors' certainty about their ability to avoid harm and make the intervention work, and understanding the intervention and how it works. Additionally, acceptability by one group of actors was found to alter the context, triggering acceptability mechanisms amongst others. CONCLUSIONS This study demonstrated the value of embedding realist approaches within implementation research. CATs are transferable theories that answer the question: given the context, what construct of acceptability does an intervention need to trigger, or more simply, what intervention do we need to apply here to achieve our outcomes? CATs facilitate transfer of interventions across geographies within defined contexts.
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Affiliation(s)
- Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - Shari Krishnaratne
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Jenna Hoyt
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | | | | | | | | | - Jessie K Hamon
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
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Goodyear P, Carvalho L, Yeoman P. Activity-Centred Analysis and Design (ACAD): Core purposes, distinctive qualities and current developments. EDUCATIONAL TECHNOLOGY RESEARCH AND DEVELOPMENT : ETR & D 2021; 69:445-464. [PMID: 33456288 PMCID: PMC7799871 DOI: 10.1007/s11423-020-09926-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 05/31/2023]
Abstract
This paper provides a summary account of Activity-Centred Analysis and Design (ACAD). ACAD offers a practical approach to analysing complex learning situations, in a way that can generate knowledge that is reusable in subsequent (re)design work. ACAD has been developed over the last two decades. It has been tested and refined through collaborative analyses of a large number of complex learning situations and through research studies involving experienced and inexperienced design teams. The paper offers a definition and high level description of ACAD and goes on to explain the underlying motivation. The paper also provides an overview of two current areas of development in ACAD: the creation of explicit design rationales and the ACAD toolkit for collaborative design meetings. As well as providing some ideas that can help teachers, design teams and others discuss and agree on their working methods, ACAD has implications for some broader issues in educational technology research and development. It questions some deep assumptions about the framing of research and design thinking, in the hope that fresh ideas may be useful to people involved in leadership and advocacy roles in the field.
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Affiliation(s)
- Peter Goodyear
- Centre for Research on Learning and Innovation, Sydney School of Education and Social Work, The University of Sydney, Sydney, NSW Australia
| | - Lucila Carvalho
- Institute of Education, Massey University, Wellington, New Zealand
| | - Pippa Yeoman
- Educational Innovation, Deputy Vice Chancellor (Education) Portfolio, The University of Sydney, Sydney, NSW Australia
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McKenney S, Reeves TC. Educational design research: Portraying, conducting, and enhancing productive scholarship. MEDICAL EDUCATION 2021; 55:82-92. [PMID: 32564385 PMCID: PMC7754301 DOI: 10.1111/medu.14280] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 05/04/2023]
Abstract
CONTEXT Solutionism is the all-too-common human propensity to jump to a solution before adequately understanding the nature of a problem. Solutionism has long been prevalent in efforts to improve education at all levels, including medical education. THESIS Educational design research (EDR) is a genre of research that features the gaining of in-depth understanding of a problem before any prototype solution is designed and tested. It is different from other forms of scientific inquiry because it is committed to the simultaneous development of both theoretical insights and practical solutions, together with stakeholders. This approach is powerful for theory building because it privileges ecologically valid studies that embrace the complexity of investigating learning in authentic (as opposed to laboratory) settings. When conducted well, both the research process and its outcomes generate valuable contributions to practice. PREVIEW This article constitutes an expository essay on EDR, comprised of three movements. First, the approach is defined, its origins are presented, and its characteristics are described. Second, a generic model for conducting EDR is offered, and illustrated with examples from the field of medical education. Third, pathways towards advancing this form of inquiry are discussed, including ways to address inherent challenges and limitations, as well as recommendations for the medical education community. Although EDR is no panacea, this article illustrates how it can serve medical education research in a wide variety of geographic and disciplinary contexts.
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Affiliation(s)
- Susan McKenney
- Department of Teacher Development (ELAN)Faculty of Behavioural, Management and Social SciencesUniversity of TwenteEnschedethe Netherlands
| | - Thomas C. Reeves
- Department of Career and Information StudiesCollege of EducationUniversity of GeorgiaAthensGeorgiaUSA
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Huang CD, Tseng HM, Jenq CC, Ou LS. Active learning of medical students in Taiwan: a realist evaluation. BMC MEDICAL EDUCATION 2020; 20:487. [PMID: 33272263 PMCID: PMC7713042 DOI: 10.1186/s12909-020-02392-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why. METHODS Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the 'context-mechanism-outcome' (CMO) configurations. RESULTS Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers' guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes). CONCLUSIONS We identified three CMO configurations of Taiwanese medical students' active learning. The connections among hierarchical culture, fear, teachers' guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.
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Affiliation(s)
- Chien-Da Huang
- Chang Gung Medical Education Research Centre, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
- Department of Medical Education, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, 199 Tun Hua N. Rd, Taipei, Taiwan
| | - Hsu-Min Tseng
- Department of Health Care Management, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Chang-Chyi Jenq
- Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Liang-Shiou Ou
- Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
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Onyura B. Useful to whom? Evaluation utilisation theory and boundaries for programme evaluation scope. MEDICAL EDUCATION 2020; 54:1100-1108. [PMID: 32564380 DOI: 10.1111/medu.14281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/29/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Programme evaluation is perpetually mandated in health professions education. Correspondingly, there has been an expansion in prescriptive methodological guides about 'how' to engage in various best practices in evaluation. However, what has gained less attention is an examination of the 'value' that different stakeholders seek to gain from programme evaluation. Evaluation utilisation theory and research can help us understand the diversity in both the driving forces for and the impact of programme evaluation. Awareness of the heterogeneity of evaluation utilisation priorities has implications for evaluation practices, including both methodological choices and understanding of the impact of programme evaluation in our field. METHODS In this article, I expound on the concept of evaluation utilisation by drawing on evaluation theory and research. 'Evaluation utilisation' refers to the application of programme evaluation processes and findings to influence thinking and action. Herein, different forms of 'evaluation utilisation' (including instrumental, conceptual, process and persuasive (symbolic and legitimative) utilisation) are discussed, as well as the related concept of 'evaluation misuse'. Furthermore, how the prioritisation of different forms of 'evaluation utilisation' can influence the scope and impact of evaluation scholarship are also discussed. CONCLUSIONS Programme evaluation is a form of inquiry that requires more than the exercise of robust methodological techniques. Rather, it necessitates attention to the, sometimes divergent, priorities of different stakeholder groups. Although there is scant research on evaluation practices in health professions education, evaluation utilisation theory can inform critical examination of evaluation practices and impact in our field. Critically, understanding this body of work can help inform those engaged in evaluation about what they are (or should be) prioritising when they conduct programme evaluation, and better align evaluation methodologies with their scholarly, curricular and administrative intentions. Implications for future research and high-quality, transparent evaluation scholarship are presented.
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Affiliation(s)
- Betty Onyura
- Centre for Faculty Development, Faculty of Medicine, University of Toronto, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Suryavanshi T, Lambert S, Lal S, Chin A, Chan TM. Entrepreneurship and Innovation in Health Sciences Education: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2020; 30:1797-1809. [PMID: 34457846 PMCID: PMC8368672 DOI: 10.1007/s40670-020-01050-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND PURPOSE This scoping review aimed to explore the connection between health education and entrepreneurship and to identify gaps in the current literature, educational models, and best practices regarding teaching medical professionals about entrepreneurship and innovation. METHODS The methodology for this review was based on the principles of Arksey and O'Malley's (2005) model for scoping review design. Results from Embase, MEDLINE, PsycINFO, Emcare, AMED, PubMed, and Google Scholar were scanned, filtered, and mapped. RESULTS Fifty-nine unique papers were found and mapped. The papers discussed common themes, including the entrepreneurial environment (n = 29), career planning and skill development (n = 3), and various skills crucial for the health entrepreneur. The satisfaction was high for most programs, but few reported more fulsome outcomes. The teaching techniques used to engage trainees or physicians in entrepreneurship were also fairly limited. CONCLUSION Though some programs are described, few have demonstrated efficacy. More attention should be paid towards faculty-level recruitment, development and reward, so that they may in turn teach these approaches. Those involved with educational planning can help close this gap.
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Affiliation(s)
- Tanishq Suryavanshi
- Department of Family Medicine, Queen’s University, Kingston, Canada
- Michael G. DeGroote School of Medicine and Emerging Health Leaders, McMaster University, Hamilton, Canada
| | - Sam Lambert
- Department of Family Medicine, University of Toronto, Toronto, Canada
- Michael G. DeGroot School of Medicine, McMaster University, Hamilton, Canada
| | - Sarrah Lal
- Department of Medicine, Division of Education & Innovation, McMaster University, Hamilton, Canada
- Michael G. DeGroote Health Innovation, Commercialization & Entrepreneurship, McMaster University, Hamilton, Canada
| | - Alvin Chin
- Royal College of Physicians and Surgeons of Canada Emergency Medicine Training Program, McMaster University, Hamilton, Canada
| | - Teresa M. Chan
- Department of Medicine, Division of Education & Innovation, McMaster University, Hamilton, Canada
- Program for Faculty Development, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, Division Emergency Medicine, McMaster University, Hamilton, Canada
- McMaster Education Research, Innovation, and Theory, Hamilton, Canada
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Kilbertus F, Ajjawi R, Archibald D. Harmony or dissonance? The affordances of palliative care learning for emerging professional identity. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:350-358. [PMID: 32856171 PMCID: PMC7718354 DOI: 10.1007/s40037-020-00608-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Patient demographics demand physicians who are competent in and embrace palliative care as part of their professional identity. Published literature describes ways that learners acquire knowledge, skills and attitudes for palliative care. These studies are, however, limited by their focus on the individual where learning is about acquisition. Viewing learning as a process of becoming through the interplay of individual, social relationships and cultures, offers a novel perspective from which to explore the affordances for professional identity development. METHODS Qualitative narrative methods were used to explore 45 narratives of memorable learning (NMLs) for palliative care recounted by 14 graduating family medicine residents in one family medicine residency program. Thematic and narrative analyses identified the affordances that support and constrain the dynamic emergence of professional identity. RESULTS Participants recounted affordances that supported and/or constrained their learning acting on personal (e.g. past experiences of death), interpersonal (e.g. professional support) and systemic (e.g. patient continuity) levels. Opportunities for developing professional identity were dynamic: factors acted in harmony, were misaligned, or colliding to support or constrain an emerging professional identity for palliative care practice. CONCLUSION Findings highlight how individual factors interplay with interpersonal and structural conditions in the workplace in dynamic and emergent ways that may support or constrain the emergence of professional identity. Viewing learning as a process of becoming allows teachers, curriculum developers and administrators to appreciate the complexity and importance of the interplay between the individual and the workplace affordances to create environments that nurture professional identity for palliative care practice.
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Affiliation(s)
- Frances Kilbertus
- Division of Clinical Science, Northern Ontario School of Medicine, Mindemoya, Ontario, Canada.
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
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O’Brien BC, Teherani A, Boscardin CK, O’Sullivan PS. Pause, Persist, Pivot: Key Decisions Health Professions Education Researchers Must Make About Conducting Studies During Extreme Events. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1634-1638. [PMID: 32496292 PMCID: PMC7288761 DOI: 10.1097/acm.0000000000003535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
When extreme events occur, some research becomes a clear priority, but what becomes of all other research? Does it stop indefinitely, or can it be paused with plans to resume, persist with modifications, or pivot to address new priorities? Facing this dilemma and witnessing it among their fellow health professions education researchers, the authors recognized a need for guidance. This Invited Commentary presents a framework, organized as key questions related to the research stage and process, to assist health professions education researchers in making decisions about how to proceed with research that was planned or in progress when an extreme event occurred. Although at the time of this writing, the COVID-19 pandemic was the extreme event at hand, the authors intentionally created questions and discussed considerations that can be helpful for thinking through decisions in a variety of disruptions in health professions education research-many of which require similar difficult decisions and creative solutions to carry important research forward and maintain high quality.
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Affiliation(s)
- Bridget C. O’Brien
- B.C. O’Brien is professor, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0001-9591-5243
| | - Arianne Teherani
- A. Teherani is professor, Department of Medicine, education scientist, Center for Faculty Educators, and director of program evaluation, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0003-2936-9832
| | - Christy K. Boscardin
- C.K. Boscardin is associate professor, Department of Medicine and Anesthesia, and education scientist, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0002-9070-8859
| | - Patricia S. O’Sullivan
- P.S. O’Sullivan is professor, Department of Medicine and Surgery, endowed chair of surgical education, and director of research and development, Center for Faculty Educators, University of California, San Francisco, San Francisco, California; ORCID: http://orcid.org/0000-0002-8706-4095
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Brown A, Lafreniere K, Freedman D, Nidumolu A, Mancuso M, Hecker K, Kassam A. A realist synthesis of quality improvement curricula in undergraduate and postgraduate medical education: what works, for whom, and in what contexts? BMJ Qual Saf 2020; 30:337-352. [PMID: 33023936 DOI: 10.1136/bmjqs-2020-010887] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/11/2020] [Accepted: 08/29/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND With the integration of quality improvement (QI) into competency-based models of physician training, there is an increasing requirement for medical students and residents to demonstrate competence in QI. There may be factors that commonly facilitate or inhibit the desired outcomes of QI curricula in undergraduate and postgraduate medical education. The purpose of this review was to synthesise attributes of QI curricula in undergraduate and postgraduate medical education associated with curricular outcomes. METHODS A realist synthesis of peer-reviewed and grey literature was conducted to identify the common contexts, mechanisms, and outcomes of QI curricula in undergraduate and postgraduate medical education in order to develop a programme theory to articulate what works, for whom, and in what contexts. RESULTS 18854 records underwent title and abstract screening, full texts of 609 records were appraised for eligibility, data were extracted from 358 studies, and 218 studies were included in the development and refinement of the final programme theory. Contexts included curricular strategies, levels of training, clinical settings, and organisational culture. Mechanisms were identified within the overall QI curricula itself (eg, clear expectations and deliverables, and protected time), in the didactic components (ie, content delivery strategies), and within the experiential components (eg, topic selection strategies, working with others, and mentorship). Mechanisms were often associated with certain contexts to promote educational and clinical outcomes. CONCLUSION This research describes the various pedagogical strategies for teaching QI to medical learners and highlights the contexts and mechanisms that could potentially account for differences in educational and clinical outcomes of QI curricula. Educators may benefit from considering these contexts and mechanisms in the design and implementation of QI curricula to optimise the outcomes of training in this competency area.
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Affiliation(s)
- Allison Brown
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada .,Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kyle Lafreniere
- Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - David Freedman
- Department of Psychiatry, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Aditya Nidumolu
- Department of Psychiatry, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Matthew Mancuso
- Undergraduate Medical Education, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Kent Hecker
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Aliya Kassam
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.,Department of Postgraduate Medical Education, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Thomas A, Lubarsky S, Varpio L, Durning SJ, Young ME. Scoping reviews in health professions education: challenges, considerations and lessons learned about epistemology and methodology. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:989-1002. [PMID: 31768787 DOI: 10.1007/s10459-019-09932-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 10/14/2019] [Indexed: 05/21/2023]
Abstract
Scoping reviews are increasingly used in health professions education to synthesize research and scholarship, and to report on the depth and breadth of the literature on a given topic. In this Perspective, we argue that the philosophical stance scholars adopt during the execution of a scoping review, including the meaning they attribute to fundamental concepts such as knowledge and evidence, influences how they gather, analyze, and interpret information obtained from a heterogeneous body of literature. We highlight the principles informing scoping reviews and outline how epistemology-the aspect of philosophy that "deals with questions involving the nature of knowledge, the justification of beliefs, and rationality"-should guide methodological considerations, toward the aim of ensuring the production of a high-quality review with defensible and appropriate conclusions. To contextualize our claims, we illustrate some of the methodological challenges we have personally encountered while executing a scoping review on clinical reasoning and reflect on how these challenges could have been reconciled through a broader understanding of the methodology's philosophical foundation. We conclude with a description of lessons we have learned that might usefully inform other scholars who are considering undertaking a scoping review in their own domains of inquiry.
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Affiliation(s)
- Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, 3654 Sir William Osler, Room 45, Montreal, QC, H3G 1Y5, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada.
| | - Stuart Lubarsky
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
- Department of Neurology, Faculty of Medicine, Montreal, QC, Canada
| | - Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Steven J Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Meredith E Young
- Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
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84
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Yardley S, Kinston R, Lefroy J, Gay S, McKinley RK. 'What do we do, doctor?' Transitions of identity and responsibility: a narrative analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:825-843. [PMID: 31960189 PMCID: PMC7471202 DOI: 10.1007/s10459-020-09959-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 01/14/2020] [Indexed: 05/09/2023]
Abstract
Transitioning from student to doctor is notoriously challenging. Newly qualified doctors feel required to make decisions before owning their new identity. It is essential to understand how responsibility relates to identity formation to improve transitions for doctors and patients. This multiphase ethnographic study explores realities of transition through anticipatory, lived and reflective stages. We utilised Labov's narrative framework (Labov in J Narrat Life Hist 7(1-4):395-415, 1997) to conduct in-depth analysis of complex relationships between changes in responsibility and development of professional identity. Our objective was to understand how these concepts interact. Newly qualified doctors acclimatise to their role requirements through participatory experience, perceived as a series of challenges, told as stories of adventure or quest. Rules of interaction within clinical teams were complex, context dependent and rarely explicit. Students, newly qualified and supervising doctors felt tensions around whether responsibility should be grasped or conferred. Perceived clinical necessity was a common determinant of responsibility rather than planned learning. Identity formation was chronologically mismatched to accepting responsibility. We provide a rich illumination of the complex relationship between responsibility and identity pre, during, and post-transition to qualified doctor: the two are inherently intertwined, each generating the other through successful actions in practice. This suggests successful transition requires a supported period of identity reconciliation during which responsibility may feel burdensome. During this, there is a fine line between too much and too little responsibility: seemingly innocuous assumptions can have a significant impact. More effort is needed to facilitate behaviours that delegate authority to the transitioning learner whilst maintaining true oversight.
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Affiliation(s)
- Sarah Yardley
- Keele University School of Medicine, Keele, UK.
- Palliative Care Service, Central and North West London NHS Foundation Trust, St Pancras Hospital, 5th Floor South Wing, 4 St. Pancras Way, London, NW1 0PE, UK.
| | | | | | - Simon Gay
- University of Leicester School of Medicine, Leicester, UK
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Thistlethwaite JE, Anderson E. Writing for publication: increasing the likelihood of success. J Interprof Care 2020; 35:784-790. [PMID: 32811231 DOI: 10.1080/13561820.2020.1798899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this paper is to help writers at all levels improve their likelihood of success in having papers accepted by academic peer-reviewed journals, including the Journal of Interprofessional Care. We discuss the importance of reading both in your own discipline and also more widely across disciplines and fields of study. There are sections on the attributes of good authors, how to choose a journal, types of articles that are published and the structure of these, the contrast between research and evaluation, and how to plan a paper. We stress the importance of reading and complying with a journal's author guidelines and answering the 'so what' question by the end of the article. There is more detail about the main elements of a paper and what should be included in the introduction, methods, results (findings) and discussion to improve the quality of the reporting. As well as content we also focus on the style of writing. We finish with a discussion of the submission and review processes, why papers may be rejected and how to manage decisions on papers. Dissemination of scholarly work is paramount to the advancement of the interprofessional field; we invite authors to consider our advice and in so doing help strengthen the quality and rigor of interprofessional scholarship.
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Affiliation(s)
| | - Elizabeth Anderson
- Leicester Medical School, College of Life Sciences, University of Leicester, Leicester, UK
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Roncallo HR, Ray JM, Kulacz RC, Yang TJ, Chmura C, Evans LV, Wong AH. An Interprofessional Simulation-Based Orientation Program for Transitioning Novice Nurses to Critical Care Roles in the Emergency Department: Pilot Implementation and Evaluation. Jt Comm J Qual Patient Saf 2020; 46:640-649. [PMID: 32919910 DOI: 10.1016/j.jcjq.2020.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The emergency department (ED) relies on high-functioning teams to deliver consistent and safe patient care. Experts recommend that both emergency physicians and ED nurses participate in team training. However, there are currently no nationally accepted curricula for either profession to embed this training in their professional development, particularly for health workers who are novice or transitioning into critical care roles. METHODS An interprofessional educator team designed and embedded a series of simulation scenarios within a novel orientation program for novice nurses transitioning to critical care roles in the ED to teach clinical and teamwork skills for conjoint groups of resident physician and novice nurse learners. The team created four interprofessional simulations to represent the acuity and breadth of patient populations in the ED critical care bays. INTERVENTION/REFINEMENT To date, the team has conducted 24 two-week orientation sessions for 48 nurses and 51 resident physicians. Overall mean scores for the Debriefing Assessment for Simulation in Healthcare (DASH) instrument from nursing participants in the first 18 sessions were high. Qualitative evaluation data from both nurses and physicians demonstrated a positive impact of the simulations and provided insight into respective roles, identities, and priorities across professions. Participant feedback led to iterative steps in refinement of the simulations, including adjustments in debriefings and logistics of the orientation program. IMPLICATIONS FOR PRACTICE A team-based interprofessional simulation program was found to be feasible and acceptable for practicing novice physicians and nurses as part of a nursing critical care orientation program in the ED. Future work will assess the program's long-term impact on teamwork and safety in the actual clinical environment.
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87
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Sullivan GM. Medical Education Scholarship During a Pandemic: Time to Hit the Pause Button, or Full Speed Ahead? J Grad Med Educ 2020; 12:379-383. [PMID: 32879670 PMCID: PMC7450750 DOI: 10.4300/jgme-d-20-00715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Rees CE, Lee SL, Huang E, Denniston C, Edouard V, Pope K, Sutton K, Waller S, Ward B, Palermo C. Supervision training in healthcare: a realist synthesis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:523-561. [PMID: 31691182 PMCID: PMC7359165 DOI: 10.1007/s10459-019-09937-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 10/22/2019] [Indexed: 05/09/2023]
Abstract
Supervision matters: it serves educational, supportive and management functions. Despite a plethora of evidence on the effectiveness of supervision, scant evidence for the impact of supervision training exists. While three previous literature reviews have begun to examine the effectiveness of supervision training, they fail to explore the extent to which supervision training works, for whom, and why. We adopted a realist approach to answer the question: to what extent do supervision training interventions work (or not), for whom and in what circumstances, and why? We conducted a team-based realist synthesis of the supervision training literature focusing on Pawson's five stages: (1) clarifying the scope; (2) determining the search strategy; (3) study selection; (4) data extraction; and (5) data synthesis. We extracted contexts (C), mechanisms (M) and outcomes (O) and CMO configurations from 29 outputs including short (n = 19) and extended-duration (n = 10) supervision training interventions. Irrespective of duration, interventions including mixed pedagogies involving active and/or experiential learning, social learning and protected time served as mechanisms triggering multiple positive supervisor outcomes. Short-duration interventions also led to positive outcomes through mechanisms such as supervisor characteristics, whereas facilitator characteristics was a key mechanism triggering positive and negative outcomes for extended-duration interventions. Disciplinary and organisational contexts were not especially influential. While our realist synthesis builds on previous non-realist literature reviews, our findings extend previous work considerably. Our realist synthesis presents a broader array of outcomes and mechanisms than have been previously identified, and provides novel insights into the causal pathways in which short and extended-duration supervision training interventions produce their effects. Future realist evaluation should explore further any differences between short and extended-duration interventions. Educators are encouraged to prioritize mixed pedagogies, social learning and protected time to maximize the positive supervisor outcomes from training.
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Affiliation(s)
- Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, 27 Rainforest Walk (Building 15), Clayton Campus, Clayton, VIC, 3800, Australia.
| | - Sarah L Lee
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, 27 Rainforest Walk (Building 15), Clayton Campus, Clayton, VIC, 3800, Australia
| | - Eve Huang
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, 27 Rainforest Walk (Building 15), Clayton Campus, Clayton, VIC, 3800, Australia
| | - Charlotte Denniston
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, 27 Rainforest Walk (Building 15), Clayton Campus, Clayton, VIC, 3800, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Vicki Edouard
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, 27 Rainforest Walk (Building 15), Clayton Campus, Clayton, VIC, 3800, Australia
| | - Kirsty Pope
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Keith Sutton
- Monash Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Warragul, VIC, Australia
| | - Susan Waller
- Monash Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Warragul, VIC, Australia
| | - Bernadette Ward
- Monash Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Bendigo, VIC, Australia
| | - Claire Palermo
- Monash Centre for Scholarship in Health Education (MCSHE), Monash University, 27 Rainforest Walk (Building 15), Clayton Campus, Clayton, VIC, 3800, Australia
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Richmond A, Cooper N, Gay S, Atiomo W, Patel R. The student is key: A realist review of educational interventions to develop analytical and non-analytical clinical reasoning ability. MEDICAL EDUCATION 2020; 54:709-719. [PMID: 32083744 DOI: 10.1111/medu.14137] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/19/2020] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Clinical reasoning refers to the cognitive processes used by individuals as they formulate a diagnosis or treatment plan. Clinical reasoning is dependent on formal and experiential knowledge. Developing the ability to acquire and recall knowledge effectively for both analytical and non-analytical cognitive processing has patient safety implications. This realist review examines the way educational interventions develop analytical and non-analytical reasoning ability in undergraduate education. A realist review is theory-driven, seeking not only to identify if an intervention works, but also understand the reasons why, for whom, and in what circumstances. The aim of this study is to develop understanding about the way educational interventions develop effective analytical and non-analytical clinical reasoning ability, when they do, for whom and in what circumstances. METHODS Literature from a scoping search, combined with expert opinion and researcher experience was synthesised to generate an initial programme theory (IPT). Four databases were searched and articles relevant to the developing theory were selected as appropriate. Factors affecting educational outcomes at the individual student, teacher and wider organisational levels were investigated in order to further refine the IPT. RESULTS A total of 28 papers contributed to the overall programme theory. The review predominantly identified evidence of mechanisms for interventions at the individual student level. Key student level factors influencing the effectiveness of interventions included an individual's self-confidence, self-efficacy and pre-existing level of knowledge. These contexts influenced a variety of educational interventions, impacting both positively and negatively on educational outcomes. CONCLUSIONS Development of analytical and non-analytical clinical reasoning ability requires activities that enhance knowledge acquisition and recall alongside the accumulation of clinical experience and opportunities to practise reasoning in real or simulated clinical environments. However, factors such as pre-existing knowledge and self-confidence influence their effectiveness, especially amongst individuals with 'low knowledge.' Promoting non-analytical reasoning once novices acquire more clinical knowledge is important for the development of clinical reasoning in undergraduate education.
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Affiliation(s)
- Anna Richmond
- Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nicola Cooper
- Department of Acute Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Simon Gay
- School of Medicine, University of Leicester, Leicester, UK
| | - William Atiomo
- Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rakesh Patel
- Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
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van Woezik TE, Oosterman JP, Reuzel RP, van der Wilt GJ, Koksma JJ. Practice-based learning: an appropriate means to acquire the attitude and skills for evidence-based medicine. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:140-145. [PMID: 32710724 PMCID: PMC7874920 DOI: 10.5116/ijme.5ee0.ab48] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate a practice-based, self-directed EBM-course in an undergraduate medical curriculum in terms of EBM attitude and motivation beliefs. METHODS This study was conducted in a 4-week course of the first-year undergraduate medical curriculum, which takes place twice in an academic year. One group of students (n=210) received a normal EBM-module in November. A practice-based EBM-module was implemented in January for another group of students (n=130). We approached all students following the courses for participation in our research project. In a quasi-experimental design, a validated survey was used to assess students' EBM task value and self-efficacy on a 7-point Likert-scale. In the experimental group, complementary qualitative data were gathered on attitude and motivation by open evaluative questions. RESULTS Overall response rate was 93,5%, resulting in 191 students in the control group and 127 students in the experimental group. We did not find differences between the groups in terms of EBM task value and self-efficacy. However, the experimental group showed a higher increased perception of the importance of EBM in decision making in clinical practice (60.0% vs 77.2%; χ2(1, N=318) = 8.432, p=0.004). These students obtained a better understanding of the complexities and time-consuming nature of EBM in medical practice. CONCLUSIONS The practice-based EBM-course helps students to reflect on practice and knowledge critically. Our findings indicate that integrating clinical practice in the undergraduate learning environment fosters attitude and motivation, suggesting that practice-based learning in EBM education may advance student development as a critically reflective practitioner.
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Affiliation(s)
| | | | - Rob P.B. Reuzel
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Jur J. Koksma
- Radboud University Medical Centre, Nijmegen, the Netherlands
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91
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Klatte IS, Lyons R, Davies K, Harding S, Marshall J, McKean C, Roulstone S. Collaboration between parents and SLTs produces optimal outcomes for children attending speech and language therapy: Gathering the evidence. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:618-628. [PMID: 32383829 PMCID: PMC7383473 DOI: 10.1111/1460-6984.12538] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/12/2020] [Accepted: 03/28/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Collaboration between parents and speech and language therapists (SLTs) is seen as a key element in family-centred models. Collaboration can have positive impacts on parental and children's outcomes. However, collaborative practice has not been well described and researched in speech and language therapy for children and may not be easy to achieve. It is important that we gain a deeper understanding of collaborative practice with parents, how it can be achieved and how it can impact on outcomes. This understanding could support practitioners in daily practice with regard to achieving collaborative practice with parents in different contexts. AIMS To set a research agenda on collaborative practice between parents and SLTs in order to generate evidence regarding what works, how, for whom, in what circumstances and to what extent. METHODS & PROCEDURES A realist evaluation approach was used to make explicit what collaborative practice with parents entails. The steps suggested by the RAMESES II project were used to draft a preliminary programme theory about collaborative practice between parents and SLTs. This process generates explicit hypotheses which form a potential research agenda. DISCUSSION & CONCLUSIONS A preliminary programme theory of collaborative practice with parents was drafted using a realist approach. Potential contextual factors (C), mechanisms (M) and outcomes (O) were presented which could be configured into causal mechanisms to help explain what works for whom in what circumstances. CMO configurations were drafted, based on the relevant literature, which serve as exemplars to illustrate how this methodology could be used. In order to debate, test and expand our hypothesized programme theory for collaborative practice with parents, further testing against a broader literature is required alongside research to explore the functionality of the configurations across contexts. This paper highlights the importance of further research on collaborative practice with parents and the potential value of realist evaluation methodology. What this paper adds Current policy in education, health and social care advocates for family-centred care and collaborative practice with parents. Thereby, collaborative practice is the preferred practice for SLTs and parents. In this paper, we explore collaborative practice and use a realist evaluation approach to achieve the aim of setting a research agenda in this area. Researchers use realist evaluation, a methodology originally developed by Pawson and Tilley in the 1990s, to explore the causal link between interventions and outcomes, summarized as what works, how, for whom, in what circumstances and to what extent. Realist evaluation provides a framework to explore configurations between contexts (C), mechanisms (M) and outcomes (O). We used this methodology to take a first step at making explicit what collaborative practice is and how it might be achieved in different contexts. We did this by drafting a preliminary programme theory about collaborative practice, where we made explicit what context factors and mechanisms might influence outcomes in collaborative practice between parents and SLTs. Based on this programme theory, we argue for the need to develop a research agenda on collaborative practice with parents of children with speech, language and communication needs. The steps between a programme theory and a research agenda could entail exploring each CMO, or step in the programme theory, and evaluating it against the existing literature-both within and beyond speech and language therapy-to see how far it stands up. In this way, gaps could be identified that could be converted into research questions that would stimulate debate about a research agenda on collaborative practice. Understanding how collaborative practice can be achieved in different contexts could support SLTs to use mechanisms to optimise collaborative practice intentionally and tailor interventions to the specific needs of families, thereby enhancing collaborative practice between parents and SLTs.
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Affiliation(s)
- Inge S. Klatte
- HU University of Applied Sciences UtrechtUtrechtthe Netherlands
| | - Rena Lyons
- Discipline of Speech and Language Therapy, School of Health Sciences, College of Medicine, Nursing and Health SciencesNational University of Ireland (NUI)GalwayIreland
| | - Karen Davies
- NIHR Greater Manchester Patient Safety Translational Research CentreUniversity of ManchesterManchesterUK
| | - Sam Harding
- Bristol Speech & Language Therapy Research Unit, North Bristol NHS TrustSouthmead Hospital BristolBristolUK
| | - Julie Marshall
- Health Professions DepartmentManchester Metropolitan UniversityBirley Fields CampusManchesterUK
- Honorary Research Fellow, School of Health SciencesUniversity of KwaZuluNatalSouth Africa
| | - Cristina McKean
- School of Education, Communication & Language SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Sue Roulstone
- Bristol Speech & Language Therapy Research Unit, North Bristol NHS TrustSouthmead Hospital BristolBristolUK
- Faculty of Health and Applied SciencesUniversity of the West of EnglandBristolUK
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92
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Johnston J, Barrett A, Stenfors T. How to … synthesise qualitative data. CLINICAL TEACHER 2020; 17:378-381. [DOI: 10.1111/tct.13169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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93
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Buckley S. The case for national standards for the development, management and delivery of interprofessional education. CLINICAL TEACHER 2020; 17:231-233. [PMID: 32463588 PMCID: PMC7283820 DOI: 10.1111/tct.13172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sharon Buckley
- Senior Lecturer in Medical Education, University of Birmingham, Birmingham, UK
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Meum TT, Slettebø Å, Fossum M. Improving the Use of Simulation in Nursing Education: Protocol for a Realist Review. JMIR Res Protoc 2020; 9:e16363. [PMID: 32347808 PMCID: PMC7221641 DOI: 10.2196/16363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/14/2020] [Accepted: 02/08/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nursing education has evolved in line with societal needs, and simulation-based learning (SBL) is increasingly being used to bridge the gap between practice and education. Previous literature reviews have demonstrated the effectiveness of using SBL in nursing education. However, there is a need to explore how and why it works to expand the theoretical foundation of SBL. Realist reviews are a theory-based approach to synthesizing existing evidence on how complex programs work in particular contexts or settings. OBJECTIVE This review aims to understand how, why, and in what circumstances the use of simulation affects learning as part of the bachelor's program in nursing. METHODS A realist review will be conducted in accordance with the realist template for a systematic review. In particular, we will identify and explore the underlying assumption of how SBL is supposed to work, that is, identify and explore program theories of SBL. The review will be carried out as an iterative process of searching, appraising, and synthesizing the evidence to uncover theoretical concepts that explain the causal effects of SBL. In the final section of the review, we will involve stakeholders in the Norwegian community in a web-based Delphi survey to ensure that the emerging theoretical framework derived from the published literature aligns with stakeholders' experience in practice. RESULTS The Norwegian Centre for Research Data (project number 60415) has approved the study. We have performed an initial literature search, whereas quality appraisal and data extraction are ongoing processes. CONCLUSIONS The final outcome of the review is anticipated to extend the theoretical foundation for using simulation as an integrated component of the bachelor's program in nursing. Furthermore, the findings will be used to produce a briefing document containing guidance for national stakeholders in the community of simulation-based nursing education. Finally, the review findings will be disseminated in a peer-reviewed journal as well as national and international conferences. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16363.
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Affiliation(s)
| | - Åshild Slettebø
- Department of Health and Nursing Science, University of Agder, Grimstad, Norway
| | - Mariann Fossum
- Department of Health and Nursing Science, University of Agder, Grimstad, Norway
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Oandasan I, Martin L, McGuire M, Zorzi R. Twelve tips for improvement-oriented evaluation of competency-based medical education. MEDICAL TEACHER 2020; 42:272-277. [PMID: 30757939 DOI: 10.1080/0142159x.2018.1552783] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The shift to competency-based medical education (CBME) requires a new approach to program evaluation. CBME implementers need to embed evaluation in their programs to ensure their CBME adapts to the changing demands of the healthcare system. This 12 tips paper proposes that those advancing CBME use an improvement-oriented, utilization-focused approach to program evaluation. This will yield information that can help CBME implementers to continually examine the context, process and early outcomes of their programs. The paper uses examples from the College of Family Physicians of Canada's (CFPC's) evaluation of the implementation of the Triple C Competency-based curriculum in family medicine residency programs across Canada. These practical tips will be useful to medical educators looking to integrate evaluation into their CBME programs and to those considering other curriculum reform in health professions education.
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Affiliation(s)
- Ivy Oandasan
- Division of Academic Family Medicine, College of Family Physicians of Canada, Mississauga, Canada
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Barnes E, Bullock A, Chestnutt IG, Cowpe J, Moons K, Warren W. Dental therapists in general dental practice. A literature review and case-study analysis to determine what works, why, how and in what circumstances. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:109-120. [PMID: 31618492 DOI: 10.1111/eje.12474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION In the United Kingdom, policy and guidance changes regarding the role of dental therapists (DTs) were implemented in recent years with a view to changing dental care to a more preventive-focussed, teamwork approach. However, success in the adoption of this model of working has been varied. AIMS Adopting a realist approach, our aim was, to examine the use of DTs in general dental practices in Wales, exploring what works, why, how and in what circumstances. MATERIALS AND METHODS The research comprised two stages. (a) A structured literature search, dual-coding papers for high-level factors describing the conditions or context(s) under which the mechanisms operated to produce outcomes. From this, we derived theories about how skill-mix operates in the general dental service. (b) Six case studies of general dental practices (three with a dental therapist/three without a dental therapist) employing a range of skill-mix models incorporating semi-structured interviews with all team members. We used the case studies/interviews to explore and refine the theories derived from the literature. RESULTS Eighty-four papers were coded. From this coding, we identified seven theories which reflected factors influencing general dental practices within three broad contexts: the dental practice as a business, as a healthcare provider and as a workplace. We tested these theories in interviews with 38 dental team members across the six care studies. As a result, we amended five of the theories. CONCLUSION Our analysis provides theory about outcomes that DTs may facilitate and the mechanisms that may assist the work of DTs within different contexts of general dental practice.
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Affiliation(s)
- Emma Barnes
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) Cardiff University, Cardiff, UK
| | - Ivor G Chestnutt
- College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Cardiff, UK
| | - Jonathan Cowpe
- College of Biomedical and Life Sciences, Cardiff University School of Dentistry, Cardiff, UK
| | - Kirstie Moons
- The Dental Postgraduate Section, Health Education and Improvement Wales, Cardiff, UK
| | - Wendy Warren
- Aneurin Bevan University Health Board, Cardiff, UK
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97
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Wong BM, Baum KD, Headrick LA, Holmboe ES, Moss F, Ogrinc G, Shojania KG, Vaux E, Warm EJ, Frank JR. Building the Bridge to Quality: An Urgent Call to Integrate Quality Improvement and Patient Safety Education With Clinical Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:59-68. [PMID: 31397709 DOI: 10.1097/acm.0000000000002937] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Current models of quality improvement and patient safety (QIPS) education are not fully integrated with clinical care delivery, representing a major impediment toward achieving widespread QIPS competency among health professions learners and practitioners. The Royal College of Physicians and Surgeons of Canada organized a 2-day consensus conference in Niagara Falls, Ontario, Canada, called Building the Bridge to Quality, in September 2016. Its goal was to convene an international group of educational and health system leaders, educators, frontline clinicians, learners, and patients to engage in a consensus-building process and generate a list of actionable strategies that individuals and organizations can use to better integrate QIPS education with clinical care.Four strategic directions emerged: prioritize the integration of QIPS education and clinical care, build structures and implement processes to integrate QIPS education and clinical care, build capacity for QIPS education at multiple levels, and align educational and patient outcomes to improve quality and patient safety. Individuals and organizations can refer to the specific tactics associated with the 4 strategic directions to create a road map of targeted actions most relevant to their organizational starting point.To achieve widespread change, collaborative efforts and alignment of intrinsic and extrinsic motivators are needed on an international scale to shift the culture of educational and clinical environments and build bridges that connect training programs and clinical environments, align educational and health system priorities, and improve both learning and care, with the ultimate goal of achieving improved outcomes and experiences for patients, their families, and communities.
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Affiliation(s)
- Brian M Wong
- B.M. Wong is associate professor of medicine, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, and associate director, Centre for Quality Improvement and Patient Safety (C-QuIPS), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. K.D. Baum is professor of medicine and adjunct professor, School of Public Health, and associate chief medical officer, University of Minnesota, Minneapolis, Minnesota. L.A. Headrick is professor emerita of medicine, University of Missouri School of Medicine, Columbia, Missouri. E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois. F. Moss is dean, Royal Society of Medicine, and academic lead for collaboration, learning and partnerships, North West London Collaboration for Leadership in Applied Health Research and Care, London, United Kingdom. G. Ogrinc is professor of medicine, Dartmouth Institute, and senior associate dean for medical education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire. K.G. Shojania is professor and vice chair of quality and innovation, Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, and director, Centre for Quality Improvement and Patient Safety (C-QuIPS), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. E. Vaux is consultant nephrologist, Royal Berkshire National Health Service Foundation Trust, Reading, and vice president of education and training, Royal College of Physicians, London, United Kingdom. E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID: https://orcid.org/0000-0002-6088-2434. J.R. Frank is associate professor, Department of Emergency Medicine, University of Ottawa, and director, Specialty Education, Strategy and Standards, Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
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98
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Bibliometric Review of the Knowledge Base on Healthcare Management for Sustainability, 1994–2018. SUSTAINABILITY 2019. [DOI: 10.3390/su12010205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In response to the United Nations’ (UN) Sustainable Development Goals (SDGs), health care organizations throughout the world have adopted management initiatives designed to increase their sustainability. This review of research used bibliometric methods to analyze a dataset comprised of 477 documents extracted from the Scopus database. The review sought to document research on sustainable healthcare management (SHM) that has accumulated over the past 25 years. Results indicated that the intellectual structure of this body of knowledge is comprised of three schools of thought: (1) sustainable change in health care services, (2) innovations in managing health care operations, and (3) prioritizing and allocating resources for sustainability. The review also highlighted the recent topical focus of research in this literature. Key topics were linked to organization and management of health care services, quality of patient care, and sustainability of health care delivery.
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99
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Mavrot C, Hadorn S, Sager F. Mapping the mix: Linking instruments, settings and target groups in the study of policy mixes. RESEARCH POLICY 2019. [DOI: 10.1016/j.respol.2018.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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100
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Hurst H, Griffiths J, Hunt C, Martinez E. A realist evaluation of the implementation of open visiting in an acute care setting for older people. BMC Health Serv Res 2019; 19:867. [PMID: 31752862 PMCID: PMC6873458 DOI: 10.1186/s12913-019-4653-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 10/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open visiting refers to the principle of unrestricted visiting hours in the hospital setting to enable relatives, families and carers to visit at any time. There has been recognition that open visiting supports the principle of patient and family supported care and improves communication. Despite this there has been difficulty in implementing open visiting and barriers identified. The aims of this study were therefore to evaluate the implementation of open visiting, the barriers to implementation, sustainability and the impact of open visiting on communication between health care professionals, families and carers. METHODS The study was conducted on two large acute wards for the older person. Realist evaluation methods were used to understand 'what works well, how, for whom and to what extent.' Mixed methods were employed including qualitative interviews and descriptive analyses of routine data sets. Following the methodology of realist evaluation, programme theories were identified a long with the context, mechanisms and outcomes of implementation, to better understand the implementation process. RESULTS The results of this study identified some key findings, demonstrating that open visiting does improve communication and can help to build trusting relationships between families/carers and health care professionals (HCP). Barriers to implementation were based on the belief that it would impinge on routines within the ward setting. To achieve the principles of patient and family/carer centred care, the key mechanisms are the confidence and skills of individual nurses and health care assistants to engage with relatives/carers, whilst retaining a sense of control, particularly when care is being delivered to other patients. CONCLUSION In summary, open visiting creates a positive culture which fosters better relationships between families/carers and HCPs. Involving families/carers as partners in care does not happen automatically in an environment where open visiting is the policy, but requires engagement with staff to encourage and support relatives/carers.
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Affiliation(s)
- Helen Hurst
- Colloboration For Leadership in Applied Health Research Greater Manchester (NIHR), Greater Manchester, UK. .,The University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK. .,Elderly Health, Manchester Universter NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
| | - Jane Griffiths
- Colloboration For Leadership in Applied Health Research Greater Manchester (NIHR), Greater Manchester, UK.,The University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Carrie Hunt
- Colloboration For Leadership in Applied Health Research Greater Manchester (NIHR), Greater Manchester, UK.,The University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ellen Martinez
- The University of Manchester, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
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