What does it mean to be a good teacher and clinical supervisor in medical education?

Becoming a general practice supervisor: A longitudinal multi-case study exploring key supportive factors

INTRODUCTION

Supervision of trainees in the health care professions is recognised internationally as core to safe and effective patient care. A supervisor workforce in general practice (GP) is critical to the profession and to the communities where they work and can be demanding as general practitioners incorporate workplace-based education and support of their trainees into their daily consulting work. Little is known about how this is experienced by new supervisors; therefore, this research sought to understand factors that play a significant role in the first semester of becoming a supervisor.

METHODS

An exploratory multi-case study design was used; new general practice supervisors were the unit of analysis. Four data sources were captured longitudinally: semi-structured interviews at the beginning and end of the semester, audio diaries throughout and a mid-semester focus group. Template analysis was used, sensitised by a community of practice theoretical framework.

RESULTS

Seven new supervisors participated. Five interdependent key factors played a significant role in general practitioners becoming supervisors: (1) making meaning of the role, (2) reconciling multiple roles, (3) building a relationship with the trainee, (4) receiving support from the training practice and the training programme and (5) joining peer communities of new and experienced supervisors.

CONCLUSION

Becoming a general practice supervisor is situated in the context of a workplace delivering clinical services, a training programme and personal life circumstances. It can be challenging and rewarding. Insufficient support may result in unintended attrition. Learning in this role is facilitated by enabling the new supervisor to find meaning in the role; structured allocation of time to engage effectively; a positive trainee-supervisor relationship; administrative support by practices; information, advice and remuneration from the training programme; and interactions with new and experienced supervisor peers.

Supervisory knowing in practice across medical specialities

Clinical supervisors play key roles in facilitating trainee learning. Yet combining that role with patient care complicates both roles. So, we need to know how both roles can effectively co-occur. When facilitating their trainees' learning through practice, supervisors draw on their skills - clinical and supervisory - and available opportunities in their practice. This process can be conceptualised as supervisory knowing in practice (or contextual knowing) and offers ways to elaborate on how facilitating trainees' learning can be optimised. The practice-based study presented and discussed here examined clinical supervisors' knowing in practice related to facilitating trainee learning, across three medical specialities. Nineteen clinical supervisors from emergency medicine, internal medicine and surgery, were interviewed about their roles and engagement with trainees. Interview transcripts were analysed in two stages. Firstly, a framework analysis, informed by interdependent learning theory was conducted, focussing on affordances and individual engagement. Secondly, drawing on practice theory, a further layer of analysis was undertaken interrogating supervisors' knowing in practice. We identified two common domains of supervisor practice used to facilitate trainee learning: (1) orientating and assessing trainees' readiness (or capabilities), (2) sequencing and enriching pedagogic practices. Yet across the speciality groups the supervisors' knowing in practice differed and were shaped by a trio of: (i) disciplinary practices, (ii) situational requirements and (iii) clinician preference. Overall, we offer a new reading of clinical supervision as practice differences generated distinct supervisory knowing in practice. These findings emphasise clinical supervision as fundamentally entwined in the speciality's practice; and reinforce alignments with patient care.

Differences in Supervision on Peer Learning Wards: A Pilot Survey of the Supervisor's Perspective

Introduction

Multiple students are placed on clinical wards simultaneously due to increasing student numbers. This has the potential to create stress for the supervisor and reduce quality of student learning. Peer learning as a pedagogical framework to supervise multiple students has been widely shown to have advantages for the students by developing teaching skills, team collaboration, and independence. However, whether peer learning impacts the characteristics of supervision and the experience of the supervisor is less understood. It is unknown whether wards that use peer learning as a pedagogical framework (peer learning wards) are any different compared to wards that do not (non-peer learning wards), from the supervisor's perspective.

Methods

We aimed to develop and pilot test a questionnaire to compare peer-learning wards and non-peer learning wards from the supervisor's perspective. We used the AMEE 7-step guide to develop questions investigating supervision, the learning environment and satisfaction. We piloted the questionnaire with 46 nurse supervisors working on inpatient hospital wards in Stockholm, Sweden. We compared answers from peer learning with non-peer learning wards. We used Orthogonal Projections to Latent Structures (OPLS) discriminant analysis to show what differed between the wards.

Results

Peer learning wards compared to non-peer learning wards had more student-centred activities, the physical space had more adaptations for students, more support available to the supervisor, and supervisors perceived greater overall satisfaction with the quality of education and with the ward as a whole. The variables that had most influence on the discrimination between the two ward types related to peer learning activities and perceptions (p=0.0034).

Conclusion

This pilot study shows that peer learning wards differ compared to non-peer learning wards regarding peer learning activities and perceptions among supervisors. Our questionnaire needs to be distributed on a larger scale to validate our findings and explore further the way in which the pedagogical framework and peer learning can affect supervision and satisfaction.

Maturing through awareness: An exploratory study into the development of educational competencies, identity, and mission of medical educators

PURPOSE

Faculty development in learning-centred medical education aims to help faculty mature into facilitators of student learning, but it is often ineffective. It is unclear how to support educators' maturation sustainably. We explored how and why medical educators working in learning-centred education, more commonly referred to as student-centred education, mature over time.

METHODS

We performed a qualitative follow-up study and interviewed 21 senior physician-educators at two times, ten years apart. A hierarchical model, distinguishing four educator phenotypes, was employed to deductively examine educators' awareness of the workplace context, their educational competencies, identity, and 'mission,' i.e. their source of personal inspiration. Those educators who grew in awareness, as measured by advancing in educator phenotype, were re-interviewed to inductively explore factors they perceived to have guided their maturation.

RESULTS

A minority of the medical educators grew in awareness of their educational qualities over the 10-year study period. Regression in awareness did not occur. Maturation as an educator was perceived to be linked to maturation as a physician and to engaging in primarily informal learning opportunities.

CONCLUSIONS

Maturation of medical educators can take place, but is not guaranteed, and appears to proceed through a growth in awareness of, successively, educational competencies, identity, and mission. At all stages, maturation is motivated by the task, identity, and mission as a physician.

Teacher, Gatekeeper, or Team Member: supervisor positioning in programmatic assessment

Competency-based assessment is undergoing an evolution with the popularisation of programmatic assessment. Fundamental to programmatic assessment are the attributes and buy-in of the people participating in the system. Our previous research revealed unspoken, yet influential, cultural and relationship dynamics that interact with programmatic assessment to influence success. Pulling at this thread, we conducted secondary analysis of focus groups and interviews (n = 44 supervisors) using the critical lens of Positioning Theory to explore how workplace supervisors experienced and perceived their positioning within programmatic assessment. We found that supervisors positioned themselves in two of three ways. First, supervisors universally positioned themselves as a Teacher, describing an inherent duty to educate students. Enactment of this position was dichotomous, with some supervisors ascribing a passive and disempowered position onto students while others empowered students by cultivating an egalitarian teaching relationship. Second, two mutually exclusive positions were described-either Gatekeeper or Team Member. Supervisors positioning themselves as Gatekeepers had a duty to protect the community and were vigilant to the detection of inadequate student performance. Programmatic assessment challenged this positioning by reorientating supervisor rights and duties which diminished their perceived authority and led to frustration and resistance. In contrast, Team Members enacted a right to make a valuable contribution to programmatic assessment and felt liberated from the burden of assessment, enabling them to assent power shifts towards students and the university. Identifying supervisor positions revealed how programmatic assessment challenged traditional structures and ideologies, impeding success, and provides insights into supporting supervisors in programmatic assessment.

How learning-centred beliefs relate to awareness of educational identity and mission: An exploratory study among medical educators

INTRODUCTION

Although learning-centred education would be most effective if all medical educators held learning-centred beliefs, many educators still hold teaching-centred beliefs. A previously developed theoretical model describes a relationship between beliefs, educational identity and 'mission,' meaning that which inspires and drives educators. To increase our understanding of why educators hold certain beliefs, we explored the empirical relationship between educators' beliefs and their awareness of their educational identity and mission.

METHODS

A qualitative study was conducted using in-depth interviews with medical educators. We performed a deductive thematic analysis employing two existing models to examine educators' beliefs about teaching and learning and their awareness of their educational identity and mission.

RESULTS

Educators demonstrated both teaching-centred and learning-centred beliefs, which aligned with an awareness of their educational identity and mission. While educators who were unaware of both their identity and mission displayed teaching-centred beliefs, educators aware of their identity and mission displayed learning-centred beliefs. Those who were aware of their identity, but not their mission, displayed either teaching- or learning-centredness.

CONCLUSIONS

Medical educators' awareness of identity and mission are related to their beliefs about education. Further research is needed into whether beliefs can change over time by increasing identity and mission awareness.

Neurophobia: A Side Effect of Neuroanatomy Education?

Neuroanatomy in the medical curriculum tends to be challenging for both lecturers and students. Students and lecturers perceive the relevance and importance of neuroanatomy differently. If not taught sufficiently, students develop a dislike or fear (termed neurophobia) for the subject. This fear prevents them from being receptive to the teaching and consequently applying the neuroanatomy knowledge in the clinical environment. Information on the approach and perception of undergraduate neuroanatomy lecturers in South Africa regarding neuroanatomy in the medical curriculum is scarce and inconclusive. A study was undertaken to explore the attitudes and perceptions of neuroanatomy lecturers towards the relevance of neuroanatomy, as well as the teaching techniques and approach thereof, in the medical curriculum. In order to determine whether the lecturers' teaching approach and attitudes could be a contributing factor to neurophobia. In a cross-sectional qualitative study, neuroanatomy lecturers from the nine South African medical schools were invited to complete an anonymous online questionnaire. Results were thematically analysed and grouped. Lecturing staff from seven of the medical schools participated in this study and included fourteen respondents. The respondents classified themselves mainly as either proficient (78.6%) or experts (15.8%) in their neuroanatomy teaching experience. All the respondents acknowledged that neuroanatomy is important in their students' medical training. A lecturer's perceptions and attitude towards the subject or content, greatly affect the facilitation approaches and techniques used. This might have far- reaching consequences for students as it might impact on their attitude towards the content.

Teaching the Teacher: Assessing Barriers to Identity Formation of Clinical Teachers in a Developing Country

PHENOMENON

Clinical teachers' identity formation is understudied in developing countries like Pakistan. Despite producing thousands of international medical graduates per year, Pakistani medical education is still in its infancy. The application of Western medical education methods and theories is beset by unique socio-cultural challenges. These must be identified and addressed to ease our physicians' transition from clinician to teacher and maximize their teaching output in a resource-limited setting.

APPROACH

Eight clinical teachers were interviewed from Combined Military Hospital Kharian, Punjab, Pakistan in July 2020. Semi-structured questionnaires were used, and interviews were audio-taped to generate transcripts. These were analyzed qualitatively and coded, developing themes regarding barriers to identity formation.

FINDINGS

Six themes reflected possible barriers to identity formation and fell under two domains: individual and systemic issues. At the individual level these themes were: conflicting priorities, lack of autonomy, and language barriers. Systemic issues were found to be: disconnect between educationists and teachers, the absence of incentives, and lack of institutional support.

INSIGHT

Identifying barriers to identity formation can aid clinical teachers' development and encourage discourse around providing increased institutional support to teachers to overcome said barriers. Both the individual and the institute are stakeholders in the process of identity formation and dialogue between the two can lead to improved teaching outcomes.

Characteristics of good clinical teachers in anesthesiology from medical students' perspective: a qualitative descriptive study

PURPOSE

Learning needs are influenced by the stage of learning and medical specialty. We sought to investigate the characteristics of a good clinical teacher in anesthesiology from the medical students' perspective.

METHODS

We conducted a qualitative descriptive study to analyze written comments of medical students about their clinical teachers' performances. Our analysis strategy was the inductive content analysis method. The results are reported as a descriptive summary with major themes as the final product.

RESULTS

Our study identified four themes. The first theme, teachers' individual characteristics, includes characteristics that are usually more related to students' subjective experiences and feelings. The second theme, teachers' characteristics that advance student learning, seems to be one of the most important contributions to learning because it increases the practice of procedural skills. The third theme, teachers' characteristics that prepare students for success, shows characteristics that facilitate students' learning by promoting a healthy and safe environment. Lastly, the fourth theme, characteristics related to teaching approaches, includes characteristics that can guide clinical teachers more objectively.

CONCLUSION

Our analysis of the written comments of medical students identified many characteristics of a good clinical teacher that were organized in four different themes. These themes contribute to expand on existing understandings of clinical teaching in the anesthesiology clerkship environment, and add new interpretations that can be reflected upon and explored by other clinical educators.

Evaluating Clinical Educators' Competence in an East Asian Context: Who Values What?

Background

How to evaluate clinical educators is an important question in faculty development. The issue of who are best placed to evaluate their performance is also critical. However, the whos and the hows of clinical educator evaluation may differ culturally. This study aims to understand what comprises suitable evaluation criteria, alongside who is best placed to undertake the evaluation of clinical educators in medicine within an East Asian culture: specifically Taiwan.

Methods

An 84-item web-based questionnaire was created based on a literature review and medical educational experts' opinions focusing on potential raters (i.e., who) and domains (i.e., what) for evaluating clinical educators. Using purposive sampling, we sent 500 questionnaires to clinical educators, residents, Post-Graduate Year Trainees (PGYs), Year-4~6/Year-7 medical students (M4~6/M7) and nurses.

Results

We received 258 respondents with 52% response rate. All groups, except nurses, chose “teaching ability” as the most important domain. This contrasts with research from Western contexts that highlights role modeling, leadership and enthusiasm. The clinical educators and nurses have the same choices of the top five items in the “personal qualities” domain, but different choices in “assessment ability” and “curriculum planning” domains. The best fit rater groups for evaluating clinical educators were educators themselves and PGYs.

Conclusions

There may well be specific suitable domains and populations for evaluating clinical educators' competence in East Asian culture contexts. Further research in these contexts is required to examine the reach of these findings.

A step in the right direction: Delphi consensus on a UK and Australian paediatric podiatry curriculum

BACKGROUND

Previous research shows considerable variation in pre-registration paediatric podiatry curricula, and thus the clinical skills realised prior to graduation. Whilst pre-registration training is guided by regulatory bodies, these high level principles only refer briefly to standards in paediatric practice. An estimated 9% of podiatry caseloads in the United Kingdom (UK) and Australia are dedicated to paediatric service provision. Therefore, it is imperative that curricula support the consistent development of paediatric practice enabling newly registered podiatrists to work safely and effectively with children. Given that the global healthcare work force provides unique opportunities to explicitly align international curricula, the aim of this study was to determine the priorities for a UK and Australian binational pre-registration paediatric podiatry curriculum.

METHODS

A four round modified Delphi design was employed to ascertain consensus and agreement of a panel of experts with a special interest in paediatrics working in the UK and Australia. Round 1 contained open questions designed to promote diverse responses on the broad topics of lecturer experience and curriculum organisation and delivery. The answers from Round 1 were developed, through content analysis, into a series of statements presented to the panel for agreement in Rounds 2, 3 and 4.

RESULTS

Of the 297 statements generated following Round 1, 183 were accepted and 114 rejected by the end of Round 4. 109 of the accepted statements related to curriculum content. Participants also agreed on areas relating to lecturer experience, clinical education, and assessment of paediatric skills.

CONCLUSIONS

This study is the first of its kind to describe elements of a curriculum for pre-registration podiatry training. The recommendations highlight opportunities that education providers can work towards during curriculum design. They also emphasise the collaboration that is needed between professional bodies, clinicians and higher education institutions when defining guidelines and expectations for paediatric specific skills.

Teaching Gerontology in Transcultural Academics: A Phenomenographic Study of Thai and Swedish Nurse Educators' Conceptions of Gerontological Nursing

INTRODUCTION

There is an urgent need for registered nurses with gerontological competence within long-term care (LTC) of older adults. Despite increases of life expectancy, LTC for older adults is not emphasized in nursing curricula in neither Sweden nor Thailand. Thus, the aim was to explore conceptions on gerontological nursing (GN) among Swedish and Thai nurse educators.

METHOD

A qualitative phenomenographic method, based on open-ended interviews with five Thai and nine Swedish nurse educators was conducted.

RESULTS

The results indicate a paradox between the educators' knowledge about the implications of global aging, their hope of own aging, and LTC. The ethical responsibility of being credible and a source of inspiration in teaching about aging are focused, while GN seem to be less important.

DISCUSSION

To increase students' interest in GN, measures need to be taken within the educational arenas, where the educators' own conceptions toward GN, cultural aspects of aging, and LTC are discussed.

Conceptions of clinical learning among stakeholders involved in undergraduate nursing education: a phenomenographic study

BACKGROUND

To prepare nursing students to become critical, autonomous members of the workforce, an agreement among stakeholders on how this can be achieved in the clinical setting is needed. However, a critical discussion of the clinical learning process in relation to actual and desirable outcomes is lacking in the nursing education literature. This study aimed to map conceptions of the desired process and outcomes of clinical learning among stakeholders involved in undergraduate clinical nursing education.

METHODS

Twenty-five semi-structured interviews about their understanding of clinical learning were conducted with nursing students, supervisors, clinical educators and higher education institute professionals involved in clinical nursing education in a Dutch academic medical center. Data were analyzed using a phenomenographic approach.

RESULTS

Four conceptions were identified: clinical learning as a process to 1) meet curricular demands, 2) learn to deliberately deliver patient care, 3) learn to deliver patient care within the larger (healthcare) context, and 4) become a continuously developing professional. Conceptions 3 and 4 represented a broader, more inclusive perspective on clinical learning than conception 1 and 2. Conceptions were distinguished by five dimensions: role of guidelines from the school; learning opportunities, focus of supervisor; focus of reflection; desirable outcomes of clinical learning.

CONCLUSIONS

Those directly involved in clinical learning in nursing may have qualitatively different understandings of its desired nature and outcomes. Two patterns across conceptions could be discerned: a) a shift in focus from learning as following standards, to following an individualized learning trajectory and b) a shift in focus from increasing patient load, to understanding oneself and the patient within the healthcare context. To prepare nursing students for the future workforce, a flexible, social form of self-regulated learning is warranted, as well as an understanding of one's own role within the healthcare system and a critical attitude towards healthcare. Schools and hospitals should collaborate to integrate these values in the curriculum. The current study adds different ways of applying self-regulated learning as a relevant dimension in understanding clinical learning to the literature. Through the phenomenographic approach we identified conceptions that can be a basis for training and policy development.

Psychometric Properties of Visual Indicators of Teaching and Learning Success "VITALS" Instrument for Evaluation of Clinical Teachers

PURPOSE

We have previously developed an instrument for students' evaluation of clinical teachers that we called Visual Indicators of Clinical Teaching and Learning Success (VITALS). This study measures the reliability of VITALS as an instrument for student evaluation of clinical tutors. Additionally, the study explores the minimum number of student raters necessary for an acceptable reliability, and provides evidence of construct validity of the evaluation scores.

MATERIALS AND METHODS

This retrospective study included 1825 evaluation forms completed by medical students evaluating clinical tutors using the VITALS instrument. Reliability was measured by applying generalizability theory (G-theory) analysis using a two-facet design (raters and items). A D-study was used to determine the minimum number of raters required to achieve a reliability ≥0.80. Face validity was tested by measuring tutors' degree of agreement with the items of the study instrument.

RESULTS

The overall G-coefficient was 0.89. The subject of measurement (clinical tutors' scores) represented 15.8% of the variance across all tutors and items. The variance due to the interaction between raters (students) and tutors contributed to 43.5%, while the variance due to items was negligible. The remaining 40% of the variance was due to unexplained sources of error. The D-study demonstrated that a minimum of 12 raters (students) are required to achieve a reliability of 0.80. Finally, most of the clinical tutors agreed that all items in the instrument were appropriate.

CONCLUSION

We demonstrate that VITALS exhibits good psychometric properties. There should be at least 12 students rating each clinical tutor to have an acceptable level of reliability for the study instrument. Face validity of the study instrument was evidenced by its high level of approval among clinical tutors.

What about the supervisor? Clinical supervisors' role in student nurses' peer learning: A phenomenographic study

INTRODUCTION

Peer learning is increasingly used for healthcare students in the clinical setting. However, as peer learning between students involves students taking a teaching role, it is unclear what the supervisor's role then becomes. It is vital to determine the role of the supervisor in student peer learning to ensure high quality learning and patient safety.

METHODS

Semi-structured interviews were performed with 15 student nurse supervisors (nurses and assistant nurses) from two hospital wards that practice peer learning to investigate the different ways clinical supervisors view their role in students' peer learning. Transcribed data were coded and analysed using a phenomenographic approach.

RESULTS

Four hierarchical levels of the supervisor's understanding of their role in students' peer learning were identified: the teacher; the facilitator; the stimulator; and the team player. These categories represent an increasingly inclusive view of which people present on the ward play a role in enabling effective peer learning.

CONCLUSIONS

The various understandings of supervisor roles have implications for how supervision of peer learning could be implemented in the future.

Medical educators' beliefs about teaching, learning, and knowledge: development of a new framework

BACKGROUND

The educational beliefs of medical educators influence their teaching practices. Insight into these beliefs is important for medical schools to improve the quality of education they provide students and to guide faculty development. Several studies in the field of higher education have explored the educational beliefs of educators, resulting in classifications that provide a structural basis for diverse beliefs. However, few classification studies have been conducted in the field of medical education. We propose a framework that describes faculty beliefs about teaching, learning, and knowledge which is specifically adapted to the medical education context. The proposed framework describes a matrix in which educational beliefs are organised two dimensionally into belief orientations and belief dimensions. The belief orientations range from teaching-centred to learning-centred; the belief dimensions represent qualitatively distinct aspects of beliefs, such as 'desired learning outcomes' and 'students' motivation'.

METHODS

We conducted in-depth semi-structured interviews with 26 faculty members, all of whom were deeply involved in teaching, from two prominent medical schools. We used the original framework of Samuelowicz and Bain as a starting point for context-specific adaptation. The qualitative analysis consisted of relating relevant interview fragments to the Samuelowicz and Bain framework, while remaining open to potentially new beliefs identified during the interviews. A range of strategies were employed to ensure the quality of the results.

RESULTS

We identified a new belief dimension and adapted or refined other dimensions to apply in the context of medical education. The belief orientations that have counterparts in the original Samuelowicz and Bain framework are described more precisely in the new framework. The new framework sharpens the boundary between teaching-centred and learning-centred belief orientations.

CONCLUSIONS

Our findings confirm the relevance of the structure of the original Samuelowicz and Bain beliefs framework. However, multiple adaptations and refinements were necessary to align the framework to the context of medical education. The refined belief dimensions and belief orientations enable a comprehensive description of the educational beliefs of medical educators. With these adaptations, the new framework provides a contemporary instrument to improve medical education and potentially assist in faculty development of medical educators.

Extending the use of the conceptions of learning and teaching (COLT) instrument to the postgraduate setting

BACKGROUND

Several studies have shown that conceptions of teachers on teaching and learning can influence the teaching practices and behavior in higher education. This association is also found in undergraduate medical education but not yet established in postgraduate medical setting. An instrument, Conceptions of Learning and Teaching (COLT) was developed to measure conception of teachers in undergraduate medical education. COLT is a 3-factor 18-item questionnaire. The objective of this study is to evaluate if COLT is valid for postgraduate medical education.

METHODS

We invited postgraduate clinical faculty from 3 hospitals in the Netherlands to fill out the COLT. Confirmatory and exploratory factor analysis were performed to evaluate the fit of the postgraduate clinical faculty data to the COLT. Analysis of variance was done to evaluate if there was difference among the 3 hospitals in terms of the response by the clinical faculty.

RESULTS

Confirmatory factor analysis showed that the postgraduate faculty data had a 2 factor structure after removal of five items. These factors were Teacher Centeredness (TC) and combined Appreciation of Active Learning and Orientation to Professional Practice (A-P) and were considered as comparable to the factors in the original COLT, expressing the post-graduate learning and teaching setting. As several items were removed, the fit was suboptimal, yet did suggest validity for use of the COLT for postgraduate medical education.

CONCLUSION

The modified COLT can be used to measure conceptions of teaching and learning in postgraduate medical education. We recommend further study to improve the factor structure of the modified COLT.

Use of phenomenography in nursing education research

Objective

Phenomenography is a qualitative research method used to explore the different ways individuals experience phenomena. Over the last few decades, use of the research method grew in various higher education disciplines; however, use of the method for nursing education research was limited until early in the 21st century.Therefore, the purpose of this article is to describe the main ideas of phenomenography methodology and provide a simplified integrative review of the contributions to nursing education research.

Methods

Whittemore and Knafl (2005) five-step integrative review process was used to guide the literature search and evaluate findings of published works between 2009 and 2019.

Results

Thirteen articles, including one comprehensive literature review, were identified in the literature search.

Conclusion

Findings illustrated phenomenography methodology was used to evaluate and improve teaching and learning principles, complex faculty and student issues, curriculum and professional development, and educational practices within nursing education. Phenomenography research can be instrumental in providing a more realistic worldview of individual differing experiences of nursing education phenomena.

"Starting from a higher place": linking Habermas to teaching and learning clinical reasoning in the emergency medicine context

Teaching clinical reasoning in emergency medicine requires educators to foster diagnostic accuracy and judicious decision-making amidst chaotic ambient factors including clinician fatigue, high cognitive load, and diverse patient expectations. The current study applies the early work of Jurgen Habermas and his knowledge-constitutive interests as a lens to explore an educational approach where physician-educators were asked to make their expert reasoning visible to emergency medicine trainees, to more deliberately make visible and accessible the context-specific thinking that emergency physicians routinely use. An action research methodology was used. The 'making thinking visible' teaching approach was introduced to five emergency medicine educators working in large public hospital emergency departments. Participants were asked to trial this teaching method and document its impact on student learning over two reporting cycles. Based on written reports of trialing the teaching approach, participants identified a need to change from: (1) introducing thinking structures to cultivating enquiry; and, (2) providing explanations based on cognitive thinking routines towards encouraging the learner to see the relevance of the clinical context. Educators described how they developed a more diagnostic and reflexive approach to learners, recognized the need to cultivate independent thinking, and valued the opportunity to reflect on their usual teaching. Teaching clinical reasoning using the 'making thinking visible' approach prompted educators to decrease the emphasis on providing technical information to assisting learners to understand the purposes and meanings behind clinical reasoning in emergency medicine. The knowledge-constitutive interests work of Jurgen Habermas was found to provide a robust framework supporting this emancipatory teaching approach.

Measuring and assessing the competencies of preceptors in health professions: a systematic scoping review

BACKGROUND

In healthcare, preceptors act as a role model and supervisor, thereby facilitating the socialisation and development of the preceptee into a professional fit to practice. To ensure a consistent approach to every preceptorship experience, preceptor competencies should be measured or assessed to ensure that the desired outcomes are achieved. Defining these would ensure quality management and could inform development of an preceptor competency framework. This review aimed to evaluate the evidence for preceptor competencies and assessment in health professions.

METHODS

This study followed the PRISMA ScR scoping review guidelines. A database search was conducted in Embase, Medline, CINAHL and IPA in 2019. Articles were included if they defined criteria for competency, measured or assessed competency, or described performance indicators of preceptors. A modified GRADE CERQual approach and CASP quality assessment were used to appraise identified competencies, performance indicators and confidence in evidence.

RESULTS

Forty one studies identified 17 evidence-based competencies, of which 11 had an associated performance indicator. The competency of preceptors was most commonly measured using a preceptee completed survey (moderate to high confidence as per CERQual), followed by preceptor self-assessment, and peer-assessment. Preceptee outcomes as a measure of preceptor performance had good but limited evidence.

CONCLUSIONS

Competencies with defined performance indicators allow for effective measurement and may be modifiable with training. To measure preceptor competency, the preceptor perspective, as well as peer and preceptee assessment is recommended. These findings can provide the basis for a common preceptor competency framework in health professions.

From critic to inspirer: four profiles reveal the belief system and commitment to educational mission of medical academics

BACKGROUND

The educational beliefs of medical academics influence how they act in class and thus influence student learning. One component of these are beliefs academics hold about the qualities of teachers themselves. These teacher qualities range from behaviours and competencies to more personal attributes such as the teacher's identity and mission. However, it is unclear what medical academics believe to be key teacher qualities. Therefore, this study explored the variety of medical academics' beliefs about 'teacher qualities', aiming to identify and characterise profiles of academics with similar beliefs.

METHODS

We interviewed 26 expert academics from two medical schools to explore their beliefs about teacher qualities. A concentric onion-model focusing on teacher qualities was used to analyse and categorise the data deductively. Within each theme we developed subthemes inductively. To gain insight into the variety of beliefs we then clustered the participants into teacher profiles according to the themes. To better understand each of the profiles we carried out a quantitative study of the differences between profiles regarding subthemes, contextual and personal factors, and analysed statistical significance using Fisher's exact- and Student's t-tests for categorical and continuous data, respectively.

RESULTS

Four profiles of medical academics were identified, corresponding to the most central theme that each participant had reflected on: the 'Inspirer', 'Role-model', 'Practitioner', and 'Critic'. The focus of the profiles varied from external constraining factors within the 'Critic' profile to affective personal qualities within the 'Role-model' and 'Inspirer' profiles. The profiles could be regarded as hierarchically ordered by inclusiveness. Educational institute was the only significant factor related to the profiles.

CONCLUSIONS

Besides the relevance of affective teacher qualities, the 'Inspirer' profile demonstrates the importance of developing a clear mission as a teaching academic, centred around student learning and professional development. In our view, academics who inspire their students continue to be inspired themselves. The practical implications are described for faculty development programmes, and for the potential value of using these profiles within medical schools. In the discourse on educational beliefs, the authors argue that more attention should be paid to affective qualities, in particular to explicating the educational mission of academics.

Conceptions of teaching: an illustrated review

BACKGROUND

Asking teachers what the term 'teaching' means to them can be a useful first activity in a faculty development session, as it typically leads to an engaging and enlightening discussion for participants and facilitators. Mapping their responses to 'conceptions of teaching' (sets of assumptions, knowledge and beliefs about teaching) in the literature seems particularly helpful in illuminating the inconsistencies, gaps and additional ways of thinking about teaching that participants may wish to consider.

LITERATURE REVIEW

At least 25 conceptions of teaching can be identified in the literature. Each of these are briefly described and illustrated in this article, along with detailed examples and suggestions of how conceptions of teaching can be explored in faculty development. There is evidence that a teacher's conceptions of teaching affect the way that they approach their teaching, which in turn can affect learner learning. There is also some evidence that helping teachers examine and develop their conceptions of teaching may be more effective and have more impact on learner learning than other forms of faculty development.

TAKE-HOME MESSAGES

Different conceptions of teaching seem to be more or less appropriate in different teaching situations and contexts. It is likely that the more ways in which teachers can conceptualise and reflect on what they are doing, and why, the more adaptable, responsive and effective their teaching will be. Teachers have much to gain from learning more about themselves, their values and assumptions, and how these can influence their practice. This article offers a practical approach aimed at helping them to achieve this. A teacher's conceptions of teaching affect the way that they approach their teaching.

Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study

OBJECTIVES

To optimise medical students' early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students' perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture.

DESIGN AND SETTING

Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice.

PARTICIPANTS

21 medical students and 30 supervisors participated.

RESULTS

Two themes were identified: Nervousness and curiosity-students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified. Invited and involved-students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives.

CONCLUSIONS

This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways.

How Residents Develop Trust in Interns: A Multi-Institutional Mixed-Methods Study

PURPOSE

Although residents trust interns to provide patient care, little is known about how trust forms.

METHOD

Using a multi-institutional mixed-methods study design, the authors interviewed (March-September 2014) internal medicine (IM) residents in their second or third postgraduate year at a single institution to address how they develop trust in interns. Transcript analysis using grounded theory yielded a model for resident trust. Authors tested (January-March 2015) the model with residents from five IM programs using a two-section quantitative survey (38 items; 31 rated 0 = not at all to 100 = very much; 7 rated 0 = strongly disagree to 100 = strongly agree) to identify influences on how residents form trust.

RESULTS

Qualitative analysis of 29 interviews yielded 14 themes within five previously identified factors of trust (resident, intern, relationship, task, and context). Of 478 residents, 376 (78.7%) completed the survey. Factor analysis yielded 11 factors that influence trust. Respondents rated interns' characteristics (reliability, competence, and propensity to make errors) highest when indicating importance to trust (respective means 86.3 [standard deviation = 9.7], 76.4 [12.9], and 75.8 [20.0]). They also rated contextual factors highly as influencing trust (access to an electronic medical record, duty hours, and patient characteristics; respective means 79.8 [15.3], 73.1 [14.4], and 71.9 [20.0]).

CONCLUSIONS

Residents form trust based on primarily intern- and context-specific factors. Residents appear to consider trust in a way that prioritizes interns' execution of essential patient care tasks safely within the complexities and constraints of the hospital environment.

Community of practice and student interaction at an acute medical ward: An ethnographic study

BACKGROUND

A deeper understanding is needed of the acute medical care setting as a learning environment for students.

AIM

To explore workplace culture of an acute medical ward and students' interactions within this community.

METHOD

An ethnographic design was applied. Medical and nurse students' interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers' "Community of practice" theory.

RESULTS

We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups.

CONCLUSION

The culture shaped a pattern for, and created prerequisites that challenged students' adaptation and created a space for learning. Students' task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.

Critical Review of Data Evaluation in Teaching Clinics of Traditional Chinese Medicine Outside China: Implications for Education

OBJECTIVES

The increasing acceptance of traditional Chinese medicine (TCM) worldwide has highlighted the importance of ensuring the provision of high-quality TCM clinical education. This clinical training should be partly guided by a robust assessment of patient data outcomes in TCM teaching clinics. We undertook a comprehensive literature review to examine the data evaluation in TCM teaching clinics outside China and its implications for TCM education.

METHODS

Literature was retrieved via MEDLINE (from 1946 to January 2015), EMBASE (from 1980 to February 2015), and Google Scholar for studies conducted outside China. The search was restricted to English articles reporting empirical findings related to the assessments of patient data in TCM teaching clinics, with implications for TCM education in countries other than China.

RESULTS

Only seven articles from six studies met the inclusion criteria. The characteristics and main symptoms of patients who received any TCM treatment in the context of teaching clinics among all included studies were similar. Symptom relief as well as a high level of patient satisfaction with TCM treatment were found in TCM teaching clinics. Conventional healthcare providers and other complementary practitioners were not the main source of referral to TCM practitioners but rather patients׳ friends/relatives. Patients received acupuncture treatment more frequently than treatments utilizing Chinese herbal medicine in teaching clinics. A standardized and consistent framework for patient records within TCM teaching clinics is currently lacking. There was no robust study which "translated" TCM clinic data evaluation findings into implications for TCM education and clinical training.

CONCLUSIONS

Recognizing that TCM evolves over time and its practice varies in different settings, there is an urgent need to conduct large-scale, rigorous evaluations of TCM clinic data to address the findings of our review, with the purpose of better informing TCM education and clinical training in countries beyond China. Expansions for scientific efforts supporting TCM education are essential to ensure that qualified TCM practitioners are able to provide safe, efficacious, and cost-effective TCM treatment modalities.

Medical Teachers' Humanistic Perspective on Pedagogy: A New Starting Point for Faculty Development

INTRODUCTION

This study investigated the perspectives on pedagogy held by medical teachers in hospitals.

METHODS

The teachers were interviewed after they had been observed in both clinical and classroom settings.

RESULTS

The study showed the teachers' reliance on the relational aspects of pedagogy more than on technical pedagogical knowledge. Teachers referred to their aims and approaches as "interactive," but this does not refer to any deliberate pedagogical design or acts. Asking questions was the technique used most commonly but not always skillfully, and they cited influences from the past rather than the present or the future.

DISCUSSION

This research suggests the pedagogic approach of these medical teachers is "humanistic." It emphasizes personal and interpersonal factors, meaningful learning, and the affective, as well as cognitive aspects of clinical knowledge. It also captures a commitment to nonthreatening, nonhumiliating environments. Acknowledgment of this particular pedagogical perspective, it is argued, could better connect the health professional teachers with the education and development missions of universities, professional bodies, and governments. The teachers' expressed values and goals offer a new starting point for faculty development. Their reliance on the relational over the technical and on their own biographical experience, could be more respectfully valued and addressed to advance a more productive balance with the technical pedagogical elements that often concern educationalists, researchers, and administrators.

[Needs assessment for developing teaching competencies of medical educators]

PURPOSE

This study conducted a needs assessment for developing teaching competencies of medical educators by assessing their perceived ability to perform teaching competencies as well as their perceived importance of these competencies. Additionally, this study examined whether there were any differences in needs assessments scores among three faculty groups.

METHODS

Hundred and eighteen professors from Dong-A University College of Medicine were surveyed, and the data from 44 professors who answered all the questions were analyzed using IBM SPSS 21. The needs assessment tool measured participants' perceived ability to perform teaching competencies and perceived importance of these competencies. The Borich formula was used to calculate needs assessment scores.

RESULTS

The most urgent needs for faculty development were identified for the teaching competencies of "diagnosis and reflection," followed by "test and feedback," and "facilitation." Additionally, two, out of 51, items with the highest needs assessment scores were "developing a thorough course syllabus" and "introducing students to the course syllabus on the first day of class." The assistant professor group scored significantly higher on educational needs related to "facilitation," "affection and concern for students," and "respect for diversity" competencies than the professor group. Furthermore, the educational needs scores for all the teaching competencies except "diagnosis and reflection," "global mindset," and "instructional management" were higher for the assistant professor group than the other two faculty groups.

CONCLUSION

Thus, the educational needs assessment scores obtained in this study can be used as criteria for designing and developing faculty development programs for medical educators.

Faculty development for clinical teachers in dental education

Dental education has been reviewed, and suggestions for further enhancement include the implementation of faculty development activities to enhance teaching and learning environments.

PURPOSE

The aim of this study was to gain insight into the participants' perceptions of outcomes of faculty development for clinical teachers and clinical learning environments as well as into the sustainability of such outcomes.

METHODS

The program was organized in the form of (i) a 2-day seminar; (ii) collegial supervision and development projects; and (iii) a 1-day follow-up seminar. The participants' perceptions from the five-first programs were studied. A Web-based questionnaire was sent to all participants, that is 3-27 months after completion of the program (follow-up survey).

RESULTS

The outcomes of the program (response rate 70%) indicate a strong impact of the program on the clinical teachers' competence and on the clinical learning environments. The teachers report that they think more about what their students really learn, have become more conscious about how they supervise and have been stimulated to become better teachers. The learning environment as well as collaboration, and calibration between teachers have improved. The novice teachers report greater benefits than do the experienced teachers. The participants initiated a variety of development projects during the program. The majority of the participants continued the development activities.

CONCLUSIONS

The faculty development program presented confirms that faculty development activities for clinical teachers based on theories of learning and experiences documented in the literature can be implemented with positive outcomes for individual teachers and for the learning environments.

Conceptions of how a learning or teaching curriculum, workplace culture and agency of individuals shape medical student learning and supervisory practices in the clinical workplace

The role of workplace supervisors in the clinical education of medical students is currently under debate. However, few studies have addressed how supervisors conceptualize workplace learning and how conceptions relate to current sociocultural workplace learning theory. We explored physician conceptions of: (a) medical student learning in the clinical workplace and (b) how they contribute to student learning. The methodology included a combination of a qualitative, inductive (conventional) and deductive (directed) content analysis approach. The study triangulated two types of interview data from 4 focus group interviews and 34 individual interviews. A total of 55 physicians participated. Three overarching themes emerged from the data: learning as membership, learning as partnership and learning as ownership. The themes described how physician conceptions of learning and supervision were guided by the notions of learning-as-participation and learning-as-acquisition. The clinical workplace was either conceptualized as a context in which student learning is based on a learning curriculum, continuity of participation and partnerships with supervisors, or as a temporary source of knowledge within a teaching curriculum. The process of learning was shaped through the reciprocity between different factors in the workplace context and the agency of students and supervising physicians. A systems-thinking approach merged with the "co-participation" conceptual framework advocated by Billet proved to be useful for analyzing variations in conceptions. The findings suggest that mapping workplace supervisor conceptions of learning can be a valuable starting point for medical schools and educational developers working with changes in clinical educational and faculty development practices.

Program directors in their role as leaders of teaching teams in residency training

BACKGROUND

Program directors have a formal leading position within a teaching team. It is not clear how program directors fulfill their leadership role in practice. In this interview study we aim to explore the role of the program director as strategic leader, based on the research-question: What are the experiences of program directors with strategic leadership?

METHOD

We conducted an interview study using the principles of phenomenography to explore program directors' experiences. In the period June 2012-May 2013, 16 program directors from different hospital organisations were invited to participate in an interview study. Iterative data collection and analysis were based on strategic leadership: (1) developing collective mindset, (2) focusing on collaborative learning and (3) designing teaching organisation.

RESULTS

Fourteen program directors participated in this study. We identified four leadership profiles: (1) captains, (2) carers, (3) professionals and (4) team-players. The 'team-players' come closest to integrally applying strategic leadership. For all four profiles there seems to be a preference for developing collectivity by means of providing information. Program directors have less experience with promoting collaborative learning and the designing of teaching organisation is task-oriented.

CONCLUSION

Promoting collaborative learning is the most important challenge for developing leadership within the teaching team.

Challenges and responsibilities of clinical teachers in the workplace: an ethnographic approach

This study aimed to explore the complex role of the clinical teacher in the workplace, with a view to identifying effective teaching practices. An ethnographic case-study approach was taken, including participant observations and semi-structured interviews with three participants that were selected from two participating veterinary institutions. The clinical teacher has several responsibilities, such as establishing a rapport with learners and maximizing the use of case-based learning opportunities to provide instruction and support to individual learners in a safe but challenging environment. Associated difficulties include balancing the competing demands of students' learning needs and patients' welfare, as well as maximizing the learning opportunities within available case material. Participants in this study demonstrated a reflective approach, adjusting their teaching approach "in action" and "on action" as appropriate.

Qualities of an effective teacher: what do medical teachers think?

BACKGROUND

Effective teaching in medicine is essential to produce good quality doctors. A number of studies have attempted to identify the characteristics of an effective teacher. However, most of literature regarding an effective medical teacher includes student ratings or expert opinions. Furthermore, interdisciplinary studies for the same are even fewer. We did a cross-sectional study of the characteristics of effective teachers from their own perspective across medicine and dentistry disciplines.

METHODS

A questionnaire comprising of 24 statements relating to perceived qualities of effective teachers was prepared and used. The study population included the faculty of medicine and dentistry at the institution. Respondents were asked to mark their response to each statement based on a 5-point Likert scale ranging from strongly disagree to strongly agree. These statements were grouped these into four main subgroups, viz. Class room behaviour/instructional delivery, interaction with students, personal qualities and professional development, and analysed with respect to discipline, cultural background, gender and teaching experience using SPSS v 13.0. For bivariate analysis, t-test and one way ANOVA were used. Multiple linear regression for multivariate analysis was used to control confounding variables.

RESULTS

The top three desirable qualities of an effective teacher in our study were knowledge of subject, enthusiasm and communication skills. Faculty with longer teaching experienced ranked classroom behaviour/instructional delivery higher than their less experienced counterparts. There was no difference of perspectives based on cultural background, gender or discipline (medicine and dentistry).

CONCLUSION

This study found that the faculty perspectives were similar, regardless of the discipline, gender and cultural background. Furthermore, on review of literature similar findings are seen in studies done in allied medical and non-medical fields. These findings support common teacher training programs for the teachers of all disciplines, rather than having separate training programs exclusively for medical teachers. Logistically, this would make it much easier to arrange such programs in universities or colleges with different faculties or disciplines.

Qualitative study about the ways teachers react to feedback from resident evaluations

BACKGROUND

Currently, one of the main interventions that are widely expected to contribute to teachers' professional development is confronting teachers with feedback from resident evaluations of their teaching performance. Receiving feedback, however, is a double edged sword. Teachers see themselves confronted with information about themselves and are, at the same time, expected to be role models in the way they respond to feedback. Knowledge about the teachers' responses could be not only of benefit for their professional development, but also for supporting their role modeling. Therefore, research about professional development should include the way teachers respond to feedback.

METHOD

We designed a qualitative study with semi-structured individual conversations about feedback reports, gained from resident evaluations. Two researchers carried out a systematic analysis using qualitative research software. The analysis focused on what happened in the conversations and structured the data in three main themes: conversation process, acceptance and coping strategies.

RESULTS

The result section describes the conversation patterns and atmosphere. Teachers accepted their results calmly, stating that, although they recognised some points of interest, they could not meet with every standard. Most used coping strategies were explaining the results from their personal beliefs about good teaching and attributing poor results to external factors and good results to themselves. However, some teachers admitted that they had poor results because of the fact that they were not "sharp enough" in their resident group, implying that they did not do their best.

CONCLUSIONS

Our study not only confirms that the effects of feedback depend first and foremost on the recipient but also enlightens the meaning and role of acceptance and being a role model. We think that the results justify the conclusion that teachers who are responsible for the day release programmes in the three departments tend to respond to the evaluation results just like human beings do and, at the time of the conversation, are initially not aware of the fact that they are role models in the way they respond to feedback.

A phenomenographic approach to research in medical education

CONTEXT

Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research.

METHODS

This paper introduces phenomenography as a viable qualitative approach for use in medical education research.

RESULTS

A phenomenographic study maps the qualitatively different ways in which people experience a phenomenon. This type of study can have an important impact on, for example, patient communication, clinical practice and health care education.

CONCLUSION

We suggest that a phenomenographic approach can be used to explore many medical education research issues, and can facilitate more solid links between research and educational development and change.

Nurses’ dilemmas concerning support of relatives in mental health care

Relatives of persons with severe mental illness face a straining life situation and need support. Exclusion of relatives in mental health care has long been reported. The aim of this study was to describe conceptions of nurses in mental health care about supporting relatives of persons with severe mental illness. Focus group interviews with nurses from all levels of mental health care in Norway were performed. A phenomenographic approach was used. The nurses found that their responsibility first and foremost was the patient, especially to develop an alliance with him or her. Additional premises for supporting relatives were the context framing the nursing care, aspects of the actors, and relational concerns between them. Competing or contradictory demands were found within these premises. Two paths were identified concerning the nurses’ support of relatives: seeing the relative in the shadow of the patient or as an individual person.