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Bolander Laksov K, Knez R, Steingrimsson S, El Alaoui S, Sörman K. Beyond theoretical courses - A study of Swedish psychiatric residents' collegial learning through conversations in the workplace. Nord J Psychiatry 2024; 78:440-447. [PMID: 38669224 DOI: 10.1080/08039488.2024.2340665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Collegial conversations are important for sustainable learning to last beyond a course. Research on collegial conversations and peer learning in the workplace during psychiatric residency courses remains sparse, however. In this study, the aim was to explore residents' opportunities for collegial conversations during and after national courses in psychiatry. METHODS Residents in psychiatry completed an online survey including questions on opportunities for collegial conversations in their workplaces. Logistic regression was used for multivariate analysis and thematic content analysis was used for the open-ended answers where a theoretical framework of communities of practice was employed for the interpretation of the findings. RESULTS The survey was completed by 112 residents out of 725 (15,4%). The participants reported few structured forums for collegial discussion. The results of multivariate analysis suggest that more women than men feel it is advantageous to attend courses with others from the same workplace or from the same group of residents, described here as a team. The analysis of qualitative data identified how opportunities for collegial conversations differ across contexts and the type of values that are attached to team participation in residency courses. CONCLUSIONS This study highlights the importance of collegial conversations as a way to sustain the learning from residency courses into the workplace. By learning about residents' perceptions of collegial conversations during and after courses, teachers and directors may be more able to support residents' lifelong learning and professional development.
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Affiliation(s)
- Klara Bolander Laksov
- Department of Education, Stockholm University, Stockholm, Sweden
- Centre for Engineering Education, Lund University, Lund, Sweden
| | - Rajna Knez
- The School of Health Sciences, University of Skövde, Skövde, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Samir El Alaoui
- Centre for Psychiatry Research, Department of Clinical Neuroscience, & Stockholm Health Care Services, Region Stockholm, Karolinska Institution, Stockholm, Sweden
| | - Karolina Sörman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, & Stockholm Health Care Services, Region Stockholm, Karolinska Institution, Stockholm, Sweden
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Noble C, Hilder J, Billett S, Teodorczuk A, Ajjawi R. Supervisory knowing in practice across medical specialities. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:107-128. [PMID: 37310524 DOI: 10.1007/s10459-023-10251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
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.
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Affiliation(s)
- Christy Noble
- Academy for Medical Education, Medical School, The University of Queensland, Herston, Queensland, Australia.
| | - Joanne Hilder
- Department of Allied Health Services, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Stephen Billett
- School of Education and Professional Studies, Griffith University, Brisbane, Queensland, Australia
| | - Andrew Teodorczuk
- Academy for Medical Education, Medical School, The University of Queensland, Herston, Queensland, Australia
- The Prince Charles Hospital, Metro North Mental Health, Brisbane, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
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Stalmeijer RE, Varpio L. Do you see what I see? Feeding interprofessional workplace learning using a diversity of theories. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1657-1660. [PMID: 37126095 DOI: 10.1007/s10459-023-10221-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/26/2023] [Indexed: 06/19/2023]
Abstract
In this Commentary, Stalmeijer and Varpio highlight the importance of using different theoretical frameworks to make visible the potential of and need for research into interprofessional learning and guidance during workplace-based learning in the health professions.
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Affiliation(s)
- Renée E Stalmeijer
- School of Health Professions Education, Department of Educational Development and Research, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Lara Varpio
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Liljedahl M, Björck E, Bolander Laksov K. How workplace learning is put into practice: contrasting the medical and nursing contexts from the perspective of teaching and learning regimes. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:811-826. [PMID: 36459259 PMCID: PMC10356663 DOI: 10.1007/s10459-022-10195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Health professions education places significant emphasis on learning in the clinical environment. While experiences of workplace learning have been extensively investigated, practices of workplace learning explored through field work have been less utilized. The theoretical framework of teaching and learning regimes acknowledges aspects of power and conflict in its consideration of what guides teachers and learners in their practice of workplace learning. This study aimed to explore practices of workplace learning in the two adjacent healthcare professions; medicine and nursing. We adopted an ethnographic qualitative design. Field observations and follow-up interviews were performed in three clinical departments and the data set comprised 12 full days of observations and 16 formal follow-up interviews. Thematic analysis was performed deductively according to the theoretical framework. Four teaching and learning regimes were found in the data. In the medical context, workplace learning was either practiced as reproduction of current practice or through stimulation of professional development. In the nursing context, workplace learning was either based on development of partnership between student and supervisor or on conditional membership in a professional community. The medical and nursing contexts demonstrated varying underpinnings and assumptions relating to teaching and learning. The respective practices of workplace learning in the medical and nursing context appear to hold substantial differences which might have implications for how we understand practices of workplace learning. We further conclude that the theoretical framework of teaching and learning regimes in this study proved useful in exploring workplace learning.
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Affiliation(s)
- Matilda Liljedahl
- Department of Oncology, The Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Erik Björck
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
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Barradell S. Reimagining Preparedness of Health Professional Graduates Through Stewardship. TEACHING AND LEARNING IN MEDICINE 2023; 35:486-495. [PMID: 36520110 DOI: 10.1080/10401334.2022.2148108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/01/2022] [Indexed: 06/17/2023]
Abstract
Issue: Preparing health professional students for practice matters and is an important objective of health professional education. But although health professional courses grow in number and continue to graduate entry-level practitioners annually, there are signs that health professional education is not quite hitting the "purpose" mark. Preparedness is a term encountered often in health professional education, but it is besieged with challenges. Those challenges relate to whether graduates are prepared for their future careers and how preparedness for practice is understood; understandings of preparedness influence what curriculum, teaching, and learning prepares graduates about and for. Evidence: There is a wealth of the literature that suggests that graduates are not prepared for practice or believe they are not. This literature tends to grow rather than diminish, with arguments about preparedness materializing time and again. Preparedness means different things to students, academics, and practitioners and this creates misunderstanding as well as lessening the construct's value to research, education, and practice. What it means to be prepared is in fact not a static construct but changes in response to the needs of individuals and communities and broader societal context. When preparedness is defined as competence in skills or knowledge, graduates will be ill equipped to operate in the chaotic, ambiguous times we now face as competencies tend to oversimplify and reduce the demands of practice. Implications: Preparedness is only one purpose that could be attached to the educational formation of university graduates. It is time we expand our thinking about what is valuable and necessary to learn in order to become health professionals equipped to address the health and social care problems now and to come. Furthermore, continuing to address the challenges of preparedness for practice in the same ways as we have done for decades will not result in change; new and different educational approaches are required to meaningfully reimagine health professional education. We need to value education as a scholarly field in its own right, as much as we do evidence-based healthcare. A concept that prompts us to think and act in these reinvigorated ways is stewardship, which I offer as an expansive way to think about the purposes and desired outcomes of health professional education. Stewardship is an idea that sustains and cares for the professions, and therefore is highly relevant to the preparation of healthcare practitioners.
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Affiliation(s)
- Sarah Barradell
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Kjær LB, Nielsen KJS, Christensen MK, Strand P. Patient-centred learning in practice. A mixed methods study of supervision and learning in student clinics. PATIENT EDUCATION AND COUNSELING 2023; 112:107717. [PMID: 37001486 DOI: 10.1016/j.pec.2023.107717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Patient-centred learning (PCL) allows medical students to practice a patient-centred approach; however, didactic characteristics of PCL have yet to be fully elucidated. Clinical placements structured as a student clinic (SC) enable authentic student-patient learning relations through enhanced student responsibility and can serve as examples of PCL. We explored the didactic characteristics of supervision and learning in SCs to provide recommendations for PCL-oriented medical education. METHODS Triangulation mixed methods study based on qualitative data collected from in-depth interviews with clinical teachers and quantitative data collected from student evaluations of supervision and learning in the SCs. RESULTS Supervision and learning in SCs were characterized by 1) a focus on student-patient compatibility and patient needs and resources, which indicated PCL, 2) person-centred explorative supervision to adjust challenges to students' needs and resources, and 3) support of student autonomy to take responsibility for patient treatment. CONCLUSION PCL was facilitated by clinical teachers through a dual person-centred didactic approach combined with autonomy-supportive didactic practice. This enabled the integration of patients' and students' needs and resources in clinical teaching. PRACTICE IMPLICATIONS Clinical teachers can stimulate student-patient learning relations by selecting patients, exploring students' needs and resources, and supporting student autonomy through reflective practice and backup.
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Affiliation(s)
- Louise Binow Kjær
- Centre for Educational Development, Aarhus University, Aarhus, Denmark.
| | | | | | - Pia Strand
- Centre for Teaching and Learning, Lund University, Faculty of Medicine, Lund, Sweden
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Kjær LB, Strand P, Christensen MK. 'Making room for student autonomy' - an ethnographic study of student participation in clinical work. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1067-1094. [PMID: 35896868 DOI: 10.1007/s10459-022-10131-9] [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: 06/11/2021] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
Participation in clinical work is important for medical students' professional development. However, students often report that they experience a passive observer role, and further research on contextual factors that influence student participation is needed. The theory of practice architectures contributes a new perspective to this challenge by elucidating how cultural-discursive, material-economic, and social-political arrangements enable and constrain student participation in clinical work. The aim of this study was to explore how practice architectures in clinical learning environments enable and constrain medical students' participation. The study was designed as an ethnographic field study in three student clinics: 106 h of observation. Analysis comprised ethnographic analysis followed by application of the theory of practice architectures. The ethnographic analysis resulted in six themes: setting the scene, when to call for help, my room - my patient, getting in a routine, I know something you don't, and my work is needed. Applying the theory of practice architectures showed that material-economic arrangements, such as control of the consultation room and essential artefacts, were crucial to student participation and position in the clinical workplace. Furthermore, co-production of a student mandate to independently perform certain parts of a consultation enabled a co-productive student position in the hierarchy of care-producers. The findings offer a conceptually generalisable model for the study of material and social dimensions of clinical learning environments. Although not all clinical learning environments may wish to or have the resources to implement a student clinic, the findings offer insights into general issues about the arrangements of student participation relevant to most clinical teaching contexts.
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Affiliation(s)
- Louise Binow Kjær
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C, Denmark.
| | - Pia Strand
- Faculty of Medicine, Centre for Teaching and Learning, Lund University, Margaretavägen 1B, 222 40, Lund, Sweden
| | - Mette Krogh Christensen
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C, Denmark
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Stabel LS, McGrath C, Björck E, Elmberger A, Laksov KB. Navigating Affordances for Learning in Clinical Workplaces: A Qualitative Study of General Practitioners' Continued Professional Development. VOCATIONS AND LEARNING 2022; 15:427-448. [PMID: 35818439 PMCID: PMC9261199 DOI: 10.1007/s12186-022-09295-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Medical specialists' lifelong learning is essential for improving patients' health. This study identifies affordances for learning general practitioners (GPs) engage in, and explores what influences engagement in those affordances. Eleven GPs were interviewed and the interview transcripts were analysed thematically. Stephen Billett's theoretical framework of workplace participatory practices was used as an analytical lens to explore the topic. Challenging patient cases were identified as the main trigger for engagement in learning. Local, national and international colleagues from the same and other specialties, were found to be an important affordance for learning, as was written material such as websites, journals and recommendations. Other inputs for learning were conferences and courses. Workplace aspects that were essential for GPs to engage in learning related to: place and time to talk, relevance to work, opportunity for different roles, organisation of work and workload, and working climate. Importantly, the study identifies a need for a holistic approach to lifelong learning, including spontaneous and structured opportunities for interaction over time with colleagues, establishment of incentives and arenas for exchange linked to peer learning, and acknowledgement of the workplace as an important place for learning and sufficient time with patients. This study contributes with a deepened understanding of how GPs navigate existing affordances for learning both within and outside their workplaces.
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Affiliation(s)
- Linda Sturesson Stabel
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Cormac McGrath
- Department of Education, Stockholm University, Stockholm, Sweden
| | - Erik Björck
- Department of Clinical Genetics, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Agnes Elmberger
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Klara Bolander Laksov
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Education, Stockholm University, Stockholm, Sweden
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Milos Nymberg V, Jakobsson U. How Do Clinical Supervisors and Managers in Swedish Primary Care Perceive Their Opportunities to Meet the Learning Needs of Medical Students? ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:521-533. [PMID: 35607515 PMCID: PMC9123911 DOI: 10.2147/amep.s348012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/12/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Primary health care centers (PHCCs) in Sweden are struggling to maintain a balance between increasing demands of service and supervision and learning activities for a growing number of students. We sought a deeper understanding of primary care physicians and managers behavioral intention towards supervising, and their perceptions of the structural preconditions and support needed. METHODS The study combines two theoretical approaches, the Theory of Planned Behavior (TPB) and Social Practice Theory. A questionnaire with 22 items including an open-ended question was designed to collect quantitative and qualitative data and sent to clinical supervisors and managers at PHCCs in Southern Sweden. The aim was to map a) participants' behavioral intention and perceived capacity to act to improve supervision and b) their perceptions of structural prerequisites and support needed to sustain and develop clinical supervision practice. RESULTS A total of 181 questionnaires were returned, with a total response rate of 60.7%. Behavior predictors (attitudes, subjective norms, and perceived behavioral control) were positively correlated to behavioral intention towards supervising and building supervising competence. Three themes emerged from the content analysis of the qualitative data: "Time and distribution", "Improved communication and support systems" and "Elimination of structural barriers.". DISCUSSION The manager and supervisor reports suggest that the intentions and capacity of individuals (individuals' agency) is not a strong barrier to high-quality supervising and teaching in PHCC. Organizational preconditions for sustaining and developing supervision practice exist, and structural barriers for exercising agency could be eliminated according to PHCC managers and supervisors. However, a conclusion of our study from a practice theory perspective is that how and to what degree primary care physicians engage in supervision and competence building is determined by how the workplace - and the medical school - afford participation in supervision-related workplace activities. Improved communication between medical school, managers and supervising physicians and on-site faculty development integrated in daily clinical work were described as important facilitators of a favorable supervision and learning environment.
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Affiliation(s)
| | - Ulf Jakobsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Stoffels M, van der Burgt SME, Stenfors T, Daelmans HEM, Peerdeman SM, Kusurkar RA. Conceptions of clinical learning among stakeholders involved in undergraduate nursing education: a phenomenographic study. BMC MEDICAL EDUCATION 2021; 21:520. [PMID: 34607586 PMCID: PMC8491399 DOI: 10.1186/s12909-021-02939-7] [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: 04/13/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Malou Stoffels
- Faculty of Medicine, Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Amsterdam UMC, Amstel Academy, Institute for Education and Training, Amsterdam, The Netherlands.
- LEARN! research institute for learning and education. Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
| | | | - Terese Stenfors
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Amsterdam, The Netherlands
| | - Hester E M Daelmans
- Faculty of Medicine, Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Faculty of Medicine, Department of skills training, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia M Peerdeman
- Faculty of Medicine, Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- AmsterdamUMC, Location AMC, Institute for education and training, Amsterdam, The Netherlands
- Department of Neurosurgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Faculty of Medicine, Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! research institute for learning and education. Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Polansky MN, Herrmann D, Dolmans DHJM, Govaerts M, Koch U, Berger J, Stalmeijer RE. Exploring residents' perceptions of PA and NP roles and barriers to collaboration. JAAPA 2021; 34:42-50. [PMID: 33906208 DOI: 10.1097/01.jaa.0000742972.71042.72] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Developing competencies for interprofessional collaboration, including understanding other professionals' roles on interprofessional teams, is an essential component of medical education. This study explored resident physicians' perceptions of the clinical roles and responsibilities of physician assistants (PAs) and NPs in the clinical learning environment. METHODS Using a constructivist grounded theory approach, semistructured interviews were conducted with 15 residents in one academic setting. Transcripts were analyzed using an iterative approach to inductive coding. RESULTS Participants typically perceived PAs' and NPs' roles as being "like a resident," less commonly as independent clinicians, and rarely as collaborators. Barriers to understanding PA and NP roles and perceiving them as collaborators included the lack of preparatory instruction about PAs and NPs, the hierarchical structure of medical education, and inadequate role modeling of interprofessional collaboration. CONCLUSIONS This study suggests that barriers in the clinical learning environment and the structure of medical education itself may impede residents' learning about PAs and NPs and how to collaborate with them.
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Affiliation(s)
- Maura N Polansky
- Maura N. Polansky is an associate professor in the PA program at George Washington University in Washington, D.C. Debra Herrmann is an Assistant Professor, Department of Physician Assistant Studies at George Washington University in Washington, D.C. In the Department of Educational Development and Research and School of Health Professions Education at Maastricht University in Maastricht, the Netherlands, D.H.J.M. Dolmans is a professor, and Marjan Govaerts is an associate professor. Ulrich Koch is an assistant professor in the Department of Clinical Research and Leadership at George Washington University. Jeffrey Berger is a professor in the Department of Anesthesiology and Critical Care Medicine at George Washington University. R.E. Stalmeijer is an assistant professor in the Department of Educational Development and Research and School of Health Professions Education at Maastricht University. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Noble C, Young J, Hourn E, Sheehan D. Becoming clinical supervisors: identity learnings from a registrar faculty development program. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:125-129. [PMID: 33369714 PMCID: PMC7952496 DOI: 10.1007/s40037-020-00642-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/10/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
This article shares our experiences and surprises as we developed, implemented and evaluated a 12-week faculty development program for registrars as clinical supervisors over three cohorts. The program has consistently been rated highly by participants. Yet, following a comprehensive curriculum review, we were surprised that our goal of encouraging identity development in clinical supervisors seemed to be unmet. Whilst our evaluation suggests that the program made important contributions to the registrars' knowledge, application and readiness as clinical supervisors, challenges linked to developing a supervisor identity and managing the dual identity of supervisor and clinician remain. In this article we describe our program and argue for the importance of designing faculty development programs to support professional identity formation. We present the findings from our program evaluation and discuss the surprising outcomes and ongoing challenges of developing a cohesive clinical educator identity. Informed by recent evidence and workplace learning theory we critically appraise our program, explain the mechanisms for the unintended outcomes and offer suggestions for improving curricular and pedagogic practices of embedded faculty development programs. A key recommendation is to not only consider identity formation of clinical supervisors from an individualist perspective but also from a social perspective.
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Affiliation(s)
- Christy Noble
- Faculty of Medicine and School of Pharmacy, The University of Queensland, Herston, Australia.
| | | | - Ellen Hourn
- Gold Coast Health, Southport, Australia
- School of Medicine, Griffith University, Southport, Australia
| | - Dale Sheehan
- The University of Canterbury, Canterbury, New Zealand
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Pacifico JL, van Mook W, Donkers J, Jacobs JCG, van der Vleuten C, Heeneman S. Extending the use of the conceptions of learning and teaching (COLT) instrument to the postgraduate setting. BMC MEDICAL EDUCATION 2021; 21:32. [PMID: 33413352 PMCID: PMC7792289 DOI: 10.1186/s12909-020-02461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Jaime L. Pacifico
- De La Salle University College of Medicine, De La Salle Medical Health Sciences Institute, Dasmarinas, Cavite, Philippines
| | | | - Jeroen Donkers
- Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Sylvia Heeneman
- Maastricht University Medical Centre, Maastricht, Netherlands
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Visser CLF, Wouters A, Croiset G, Kusurkar RA. Scaffolding Clinical Reasoning of Health Care Students: A Qualitative Exploration of Clinicians' Perceptions on an Interprofessional Obstetric Ward. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520907915. [PMID: 32133416 PMCID: PMC7040925 DOI: 10.1177/2382120520907915] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE Interprofessional education (IPE) on a ward supports students to generate interprofessional patient care plans as a means to learn about the roles, responsibilities, and clinical reasoning of other professions. We investigated how clinicians guide the clinical reasoning of students from their own and other professions and whether clinicians from nursing, midwifery, and medicine could scaffold students from all professions, that is, by providing just-in-time and tailored support. METHODS Nine supervising clinicians from medicine, nursing, and midwifery were interviewed and a repeat interview held 3 to 15 weeks later; one nurse supervisor was interviewed only once. Using conventional content analysis, themes were identified inductively. Next, we applied an existing scaffolding framework to conceptualise how clinicians supported the clinical reasoning in an IPE setting. RESULTS Themes were clinicians' interventions and intentions, results of interventions and of IPE, characteristics of students and clinicians, interactions between clinicians and students, and logistics. Clinicians applied various interventions and expressed several intentions to guide the learning of students from all professions. Clinicians stimulated students' clinical reasoning by structuring meetings, asking students to explain their thoughts to each other and through giving group assignments. Thus, clinicians used peer-assisted learning for the students. By collaborating with other supervising clinicians regarding the form and amount of guidance to give to the students, clinicians applied peer-assisted learning for themselves as well. CONCLUSION Clinicians can learn to scaffold the clinical reasoning of students from different professions, when they are provided with training, good examples, and structures. An existing scaffolding framework can serve as an overview of aims and interventions to provide just-in-time guidance to students from all professions. The scaffolding framework is useful for training clinicians and for depicting the pedagogical approach for IPE wards.
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Affiliation(s)
- Cora LF Visser
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amstel Academy, VU University Medical Center, Amsterdam, The Netherlands
| | - Anouk Wouters
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gerda Croiset
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Wilbur K, Driessen EW, Scheele F, Teunissen PW. Workplace-Based Assessment in Cross-Border Health Professional Education. TEACHING AND LEARNING IN MEDICINE 2020; 32:91-103. [PMID: 31339363 DOI: 10.1080/10401334.2019.1637742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Construct: The globalization of healthcare has been accentuated by the export of health professional curricula overseas. Yet intact translation of pedagogies and practices devised in one cultural setting may not be possible or necessarily appropriate for alternate environments. Purposeful examination of workplace learning is necessary to understand how the source or "home" program may need adapting in the distributed or "host" setting. Background: Strategies to optimize cross-border medical education partnerships have been largely focused on elements of campus-based learning. Determining how host clinical supervisors approach assessment in experiential settings within a different culture and uphold the standards of home programs is relevant given the influence of context on trainees' demonstrated competencies. In this mixed-methods study, we sought to explore assessor judgments of student workplace-based performance made by preceptors sharing a pharmacy curriculum in Canada and Qatar. Approach: Using modified Delphi consensus technique, we asked clinical supervisors in Canada (n = 18) and in Qatar (n = 14) to categorize trainee performance as described in 16 student vignettes. The proportion of ratings for three levels of expectation (exceeds, meets, or below) was calculated and within-country group consensus achieved if the level of agreement reached 80%. Between-country group comparisons were measured using a chi-square statistic. We then conducted follow-up semi-structured interviews to gain further perspectives and clarify assessor rationale. Transcripts were analyzed using thematic content analysis. Results: The threshold for between-country group differences in assessor impressions was met for only two of the 16 student vignettes. Compared to Canadian clinical supervisors, relatively more preceptors in Qatar judged one described student as meets rather than exceeds expectations and one as meets rather than falls below expectations. Analysis of follow-up interviews exploring how culture may inform variations in assessor judgments identified themes associated with the profession, organization, learner, and supervisor performance theories but not their particular geographic context. Clinical supervisors in both countries were largely aligned in expectations of student knowledge, skills, and behaviors demonstrated in patient care and multidisciplinary team interactions. Conclusions: Our study demonstrated that variation in student assessment was more frequent among clinical supervisors within the same national context than any differences identified between the two countries. In these program settings, national sociocultural norms did not predict global assessor impressions or competency-specific judgments; instead, professional and organizational cultures were more likely to inform student characterizations of performance in workplace-based settings. Further study situated within the specific experiential learning contexts of cross-border health professional curricula is assuredly warranted.
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Affiliation(s)
- Kerry Wilbur
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Erik W Driessen
- School of Health Professions Education (SHE), Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
| | - Fedde Scheele
- School of Health Professions Education (SHE), Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
- Athena Institute, VU School of Medical Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Pim W Teunissen
- School of Health Professions Education (SHE), Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics & Gynecology, VU University Medical Center, Amsterdam, The Netherlands
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Gawne S, Fish R, Machin L. Developing a Workplace-Based Learning Culture in the NHS: Aspirations and Challenges. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520947063. [PMID: 32821850 PMCID: PMC7412889 DOI: 10.1177/2382120520947063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/07/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND The delivery of patient care in the United Kingdom is under increasing financial pressure. The need to continuously improve service delivery while making financial savings is challenging. Alongside this, National Health Service (NHS) Trusts must provide a suitable educational environment that meets the needs of all learners while meeting performance standards and targets set by external regulating authorities. This research addresses the gap in literature concerning educational culture in the NHS. METHODS This case study examines the delivery of postgraduate medical education in the workplace. Semi-structured interviews were conducted with 6 lead educators in the Medical Division of a North West NHS Trust to glean their insights into what works and what needs to change. RESULTS A thematic analysis of the transcripts revealed a number of factors that facilitated and hindered educational opportunities for doctors in training, including the role of leadership, the demands of external regulatory authorities, and the pressures on frontline staff to deliver safe, personal, and effective care. CONCLUSION Opportunities for developing a collaborative approach between educational and clinical leaders and the individuals delivering education in the workplace to enhance the educational environment are discussed. Finally, an evaluatory toolkit based on the themes emerging from the data is proposed, as a resource for other health care organisations to help improve the delivery of workplace-based medical education.
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Affiliation(s)
| | - Rebecca Fish
- Lancaster Medical School, Lancaster University, UK
| | - Laura Machin
- Lancaster Medical School, Lancaster University, UK
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Ryan A, Hatala R, Brydges R, Molloy E. Learning With Patients, Students, and Peers: Continuing Professional Development in the Solo Practitioner Workplace. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:283-288. [PMID: 33284181 DOI: 10.1097/ceh.0000000000000307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Conceptualizations of workplace learning have moved from knowledge acquisition to learning as participation in the practices and cultures of the workplace environment. Along with this has come an appreciation of applicability of sociocultural learning theories, which frame learning as occurring within "communities of practice" or learning being "situated" within a workplace environment where collaboration and social interaction are fundamental to the learning process. These conceptualizations of workplace learning are ideally suited to health professions where learners are supervised in clinical work environments and then continue to work in team-based environments as graduates. However, what happens to workplace learning for novice practitioners who have limited periods of clinical supervision and then graduate into solo or small group practices (which may also be in rural or remote locations) and embark on long working careers without supervision? This paper argues workplace learning needs to be scaffolded and supported to reach its full potential in these environments. Drawing on workplace-based learning theory, we highlight the ubiquitous nature of learning in the workplace, the importance of active engagement, reflection, and individual meaning making. Through this reframing of traditional notions of continuing professional development, we emphasize the importance of patients, students, and other practitioners as partners in workplace learning for solo practitioners. We also focus on the role of educators, professional associations, and regulators in helping solo practitioners recognize, access, and maximize the learning opportunities inherent in relatively isolated practice environments.
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Affiliation(s)
- Anna Ryan
- Dr. Ryan: Associate Professor and Director of Assessment, Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia. Dr. Hatala: Professor, Department of Medicine, University of British Columbia, Vancouver, BC, Canada. Dr. Brydges: Director of Research and Scientist, Professor in Technology Enabled Education, Allan Waters Family Simulation Centre, Unity Health Toronto, Toronto, ON, Canada, and Associate Professor and Scientist, Department of Medicine and Wilson Centre, University of Toronto, Toronto, ON, Canada. Dr. Molloy: Professor and Director of Work Integrated Learning, Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Woolley T, Clithero-Eridon A, Elsanousi S, Othman AB. Does a socially-accountable curriculum transform health professional students into competent, work-ready graduates? A cross-sectional study of three medical schools across three countries. MEDICAL TEACHER 2019; 41:1427-1433. [PMID: 31407932 DOI: 10.1080/0142159x.2019.1646417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Socially-accountable health professional education (SAHPE) is committed to achieving health equity through training health-workers to meet local health needs and serve disadvantaged populations. This research assesses the biomedical and socially-accountable competencies and work-readiness of first year graduates from socially-accountable medical schools in Australia, the United States and Sudan.Method: A self-administered survey to hospital and community health facility staff closely associated with the training and/or supervision of first year medical graduates from three SAHPE medical schools.Main outcome measure: Likert scale ratings of key competencies of SAHPE graduates (as a group) employed as first-year doctors, compared to first year doctors from other medical schools in that country (as a group).Findings: Supervisors rated medical graduates from the 3 SAHPE schools highly for socially-accountable competencies ('communication skills', 'teamwork', 'professionalism', 'work-readiness', 'commitment to practise in rural communities', 'commitment to practise with underserved ethnic and cultural populations'), as well as 'overall performance' and 'overall clinical skills'.Interpretation: These findings suggest SAHPE medical graduates are well regarded by their immediate hospital supervisors, and SAHPE can produce a medical workforce as competent as from more traditional medical schools, but with greater commitment to health equity, working with underserved populations, and addressing local health needs.
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Affiliation(s)
- Torres Woolley
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Amy Clithero-Eridon
- Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Salwa Elsanousi
- Department of Family and Community Medicine, University of Gezira, Gezira, Sudan
| | - Abu-Bakr Othman
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Olmos-Vega FM, Dolmans DHJM, Guzmán-Quintero C, Echeverri-Rodriguez C, Teunnissen PW, Stalmeijer RE. Disentangling residents' engagement with communities of clinical practice in the workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:459-475. [PMID: 30659426 DOI: 10.1007/s10459-019-09874-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
Maximising the potential of the workplace as a learning environment entails understanding the complexity of its members' interactions. Although some articles have explored how residents engage with supervisors, nurses and pharmacists individually, there is little research on how residents enter into and engage with the broader community of clinical practice (CoCP). To this end, we designed a constructivist grounded theory study that took place at Universidad Javeriana in Bogotá, Colombia. We conducted semi-structured interviews with 13 residents from different training levels and disciplines during the first weeks of their new rotations. During the interviews, we used the Pictor technique as a visual aid to collect data. Using iterative data collection and analysis, constant comparison methods and theoretical sampling, we constructed the final results. When entering a CoCP, residents experienced recurring and intertwined processes including: exploring how their goals and interest are aligned with those of the CoCP; identifying the relevant CoCP members in the workplace environment; and understanding how these members could assist their successful engagement with the community's practices. Residents entered a CoCP with the intention of either having a central or a peripheral trajectory in it. The final resident participation and role resulted from negotiations between the resident and the CoCP members. Optimising workplace learning includes being mindful as to how each member of the healthcare team influence residents' engagement on practice, and on understanding the nuances of residents' participatory trajectories while interacting with them. Understanding such nuances could be key to align CoCPs' learning affordances and residents' goals and intentions.
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Affiliation(s)
- Francisco M Olmos-Vega
- Anaesthesiology Department, Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 40-62, Fourth Floor, Bogotá, Colombia.
- Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Diana H J M Dolmans
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Carlos Guzmán-Quintero
- Anthropology Department, Social Sciences Faculty, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Camila Echeverri-Rodriguez
- Anaesthesiology Department, Faculty of Medicine, Pontificia Universidad Javeriana, Carrera 7 40-62, Fourth Floor, Bogotá, Colombia
| | - Pim W Teunnissen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- VU University Medical Center, Amsterdam, The Netherlands
| | - Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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McKimm J, Mclean M, Gibbs T, Pawlowicz E. Sharing stories about medical education in difficult circumstances: Conceptualizing issues, strategies, and solutions. MEDICAL TEACHER 2019; 41:83-90. [PMID: 29490567 DOI: 10.1080/0142159x.2018.1442566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Global economic forces, political decisions, and natural disasters are only some of the factors that affect contemporary healthcare education. Given the centrality of health in all settings, the future of healthcare education depends on how we overcome these difficult circumstances. METHODS Through a series of collaborative activities involving healthcare educators from around the world and their attempts to overcome these difficulties, the authors have developed a conceptual model centered around the people involved, the impact of culture, and organizations and systems. RESULTS The model can help to frame discussions and develop strategies about how best we, as a community of health professionals and educators, collaborate and share wisdom, experiences and resources to assist colleagues who might be struggling to deliver education. What has clearly emerged from this work is the centrality of leadership and management in effectively challenging and addressing difficult circumstances. CONCLUSIONS Contemporary health professions' education leadership needs to be inclusive, mindful, compassionate and caring; echoing and role-modeling how we expect our students to be with patients and colleagues. This means being willing to confront unacceptable behaviors and speak out and challenge authority when needed. It also requires awareness and understanding of the complex systems in which healthcare education is provided.
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Affiliation(s)
- Judy McKimm
- a School of Medicine , Swansea University , Swansea , UK
| | - Michelle Mclean
- b Department of Medical Education, Faculty of Health Sciences & Medicine , Bond University , Gold Coast , QLD , Australia
| | | | - Ewa Pawlowicz
- d Department of Nephrology, Hypertension and Kidney Transplantation , Medical University of Lodz , Lodz , Poland
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Goldman J, Kuper A, Wong BM. How Theory Can Inform Our Understanding of Experiential Learning in Quality Improvement Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1784-1790. [PMID: 29901662 DOI: 10.1097/acm.0000000000002329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
It is widely accepted that quality improvement (QI) education should be experiential. Many training programs believe that making QI learning "hands-on" through project-based learning will translate into successful learning about QI. However, this pervasive and overly simplistic interpretation of experiential QI learning, and the general lack of empirical exploration of the factors that influence experiential learning processes, may limit the overall impact of project-based learning on educational outcomes.In this Perspective, the authors explore the opportunities afforded by a theoretically informed approach, to deepen understanding of the diverse factors that affect experiential QI learning processes in the clinical learning environment. The authors introduce the theoretical underpinnings of experiential learning more generally, and then draw on their experiences and data, obtained in organizing and studying QI education activities, to illuminate how sociocultural theories such as Billett's workplace learning theory, and sociomaterial perspectives such as actor-network theory, can provide valuable lenses for increasing our understanding of the varied individuals, objects, contexts, and their relationships that influence project-based experiential learning. The two theoretically informed approaches that the authors describe are amongst numerous others that can inform a QI education research agenda aimed at optimizing educational processes and outcomes. The authors conclude by highlighting how a theoretically informed QI education research agenda can advance the field of QI education; they then describe strategies for achieving this goal.
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Affiliation(s)
- Joanne Goldman
- J. Goldman is scientist, Centre for Quality Improvement and Patient Safety, and assistant professor, Department of Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada. A. Kuper is associate professor, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto Faculty of Medicine, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. B.M. Wong is associate professor, Department of Medicine, University of Toronto Faculty of Medicine, associate director, Centre for Quality Improvement and Patient Safety, University of Toronto Faculty of Medicine, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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von Below B, Rödjer S, Mattsson B, Hange D, Wahlqvist M. What factors motivate junior doctors to engage as clinical tutors? A qualitative study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2018; 9:151-157. [PMID: 29860243 PMCID: PMC6129157 DOI: 10.5116/ijme.5b07.d108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The study aimed to explore and identify factors motivating junior doctors to engage as long-term clinical tutors in undergraduate medical education. METHODS In this qualitative study, twenty-seven participants were recruited among junior doctors attending preparatory tutor courses at the Sahlgrenska Academy, University of Gothenburg, and the Primary Healthcare system, West Sweden. They were asked to respond to open-ended questions and write a short account of their needs as clinical tutors for medical students. A qualitative content analysis was performed. RESULTS A main theme emerged: "Let me develop my skills in a supportive workplace, provide feedback and merits, and I will continue tutoring". Participants described suitable personality as fundamental, and the need to develop professional skills, both as clinical tutors and physicians. Tutor education was an important source of knowledge and stimulation. A workplace environment, supporting learning and the tutor's role, was considered important, including having an adequate time frame. A clear and well-prepared assignment was regarded essential. Junior doctors requested feedback and merits in their work as long-term tutors. Clinical tutorship was considered an optional task. CONCLUSIONS In this exploratory study, motivating factors of junior doctors' engagement as future long-term tutors were identified. It is important to form a process where junior doctors can build up professional competence as clinical tutors and physicians. To ensure a sustainable tutorship in the future, we suggest that universities and healthcare authorities acknowledge and further study these motivating factors.
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Affiliation(s)
- Bernhard von Below
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Stig Rödjer
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Bengt Mattsson
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Mats Wahlqvist
- Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at University of Gothenburg, Sweden
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Bearman M, Tai J, Kent F, Edouard V, Nestel D, Molloy E. What should we teach the teachers? Identifying the learning priorities of clinical supervisors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:29-41. [PMID: 28315114 DOI: 10.1007/s10459-017-9772-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/09/2017] [Indexed: 06/06/2023]
Abstract
Clinicians who teach are essential for the health workforce but require faculty development to improve their educational skills. Curricula for faculty development programs are often based on expert frameworks without consideration of the learning priorities as defined by clinical supervisors themselves. We sought to inform these curricula by highlighting clinical supervisors own requirements through answering the research question: what do clinical supervisors identify as relative strengths and areas for improvement in their teaching practice? This mixed methods study employed a modified version of the Maastricht Clinical Teaching Questionnaire (mMCTQ) which included free-text reflections. Descriptive statistics were calculated and content analysis was conducted on textual comments. 481 (49%) of 978 clinical supervisors submitted their mMCTQs and associated reflections for the research study. Clinical supervisors self-identified relatively strong capability with interpersonal skills or attributes and indicated least capability with assisting learners to explore strengths, weaknesses and learning goals. The qualitative category 'establishing relationships' was the most reported strength with 224 responses. The qualitative category 'feedback' was the most reported area for improvement, with 151 responses. Key areas for curricular focus include: improving feedback practices; stimulating reflective and agentic learning; and managing the logistics of a clinical education environment. Clinical supervisors' self-identified needs provide a foundation for designing engaging and relevant faculty development programs.
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Affiliation(s)
- Margaret Bearman
- Centre for Research into Assessment and Digital Learning (CRADLE), Deakin University, Geelong, Australia.
| | - Joanna Tai
- Centre for Research into Assessment and Digital Learning (CRADLE), Deakin University, Geelong, Australia
| | - Fiona Kent
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- WISER Unit, Monash Health, Melbourne, Australia
| | - Vicki Edouard
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Debra Nestel
- Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Monash Institute of Health and Clinical Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Elizabeth Molloy
- Department of Medical Education, University of Melbourne, Melbourne, Australia
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Peters S, Clarebout G, van Nuland M, Aertgeerts B, Roex A. A Qualitative Exploration of Multiple Perspectives on Transfer of Learning Between Classroom and Clinical Workplace. TEACHING AND LEARNING IN MEDICINE 2018; 30:22-32. [PMID: 28753068 DOI: 10.1080/10401334.2017.1339605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Phenomenon: Transfer of learning between classroom and workplace appears to be difficult. Various conceptions about learning in either the classroom or the workplace exist among stakeholders, yet little is known about their conceptions of the transfer of learning between both settings. This study explored stakeholders' conceptions about transfer of learning between classroom-based learning and workplace practice. APPROACH Homogeneous focus groups with students, medical teachers, and workplace supervisors were conducted using a constructivist grounded theory approach. FINDINGS The 54 participants' conceptions mainly related to their beliefs about who was responsible for (a) preparing for transfer of learning, (b) being at the workplace and connecting back to classroom-based learning, and (c) reflecting on transfer of learning and continuing the process. A continuum was recognized between those who held medical teachers/workplace supervisors responsible and those who held students responsible. Insights: There appears to be a variety of conceptions about who is responsible for enabling the transfer process. These conceptions may influence learning and instructional activities. Hence, it may be necessary to make these beliefs explicit in order to better align stakeholders' conceptions. To this end, the conceptual framework created in this study may be a useful tool.
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Affiliation(s)
- Sanne Peters
- a Academic Center for General Practice , Department of Public Health and Primary Care , KU Leuven , Belgium
| | - Geraldine Clarebout
- b School of Health Professions Education , Maastricht University , the Netherlands
| | - Marc van Nuland
- a Academic Center for General Practice , Department of Public Health and Primary Care , KU Leuven , Belgium
| | - Bert Aertgeerts
- a Academic Center for General Practice , Department of Public Health and Primary Care , KU Leuven , Belgium
| | - Ann Roex
- a Academic Center for General Practice , Department of Public Health and Primary Care , KU Leuven , Belgium
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Barrett J, Trumble SC, McColl G. Novice students navigating the clinical environment in an early medical clerkship. MEDICAL EDUCATION 2017. [PMID: 28620982 DOI: 10.1111/medu.13357] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
CONTEXT The black box that is student learning in clinical environments is an ongoing research project. Our previous research showed that despite the time that students are given to learn with, about and from patients, some lack confidence for those encounters and see few patients. The study reported here investigated individual and environmental factors affecting medical students' self-directed learning time in hospital. METHODS We studied second year students in the four-year postgraduate Melbourne Medical School programme as they undertook the first of their four 9-week hospital placements in medical wards. Each week approximately 10 hours of structured teaching is offered; the remaining time is spent in self-directed learning. Over six weeks, we observed 31 medical students and interviewed 17 of them. The interviews were subjected to content analysis procedures and the observation notes added contextual information to what was said in interviews. We considered the findings through the Experience-based Learning framework. RESULTS We found four main themes in the data: finding and contacting patients challenges all students and overwhelms some; the educational design of the placement is a flawed navigational device providing inadequate clarity and security; the physical and social terrain of a large tertiary hospital is replete with obstacles making it easy for some students to stumble and retreat; finally, any positive connection with peers, staff and patients is empowering. CONCLUSIONS This study throws light on to the uncertain path of the novice clinical learner illuminating both the intractable aspects of hospital environments and opportunities for pedagogical and affective supports that can compensate. The processes and conditions for self-directed learning time need attention in order to provide for a safe, efficient or successful clerkship experience for all students. Particular effort is needed to sensitively identify those individuals who struggle and suffer on the journey, and provide appropriate support.
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Affiliation(s)
- Jenny Barrett
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Steve C Trumble
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoff McColl
- Medical Education Unit, University of Melbourne, Melbourne, Victoria, Australia
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Sagasser MH, Kramer AWM, Fluit CRMG, van Weel C, van der Vleuten CPM. Self-entrustment: how trainees' self-regulated learning supports participation in the workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:931-949. [PMID: 27785628 PMCID: PMC5579156 DOI: 10.1007/s10459-016-9723-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 10/13/2016] [Indexed: 05/12/2023]
Abstract
Clinical workplaces offer postgraduate trainees a wealth of opportunities to learn from experience. To promote deliberate and meaningful learning self-regulated learning skills are foundational. We explored trainees' learning activities related to patient encounters to better understand what aspects of self-regulated learning contribute to trainees' development, and to explore supervisor's role herein. We conducted a qualitative non-participant observational study in seven general practices. During two days we observed trainee's patient encounters, daily debriefing sessions and educational meetings between trainee and supervisor and interviewed them separately afterwards. Data collection and analysis were iterative and inspired by a phenomenological approach. To organise data we used networks, time-ordered matrices and codebooks. Self-regulated learning supported trainees to increasingly perform independently. They engaged in self-regulated learning before, during and after encounters. Trainees' activities depended on the type of medical problem presented and on patient, trainee and supervisor characteristics. Trainees used their sense of confidence to decide if they could manage the encounter alone or if they should consult their supervisor. They deliberately used feedback on their performance and engaged in reflection. Supervisors appeared vital in trainees' learning by reassuring trainees, discussing experience, knowledge and professional issues, identifying possible unawareness of incompetence, assessing performance and securing patient safety. Self-confidence, reflection and feedback, and support from the supervisor are important aspects of self-regulated learning in practice. The results reflect how self-regulated learning and self-entrustment promote trainees' increased participation in the workplace. Securing organized moments of interaction with supervisors is beneficial to trainees' self-regulated learning.
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Affiliation(s)
- Margaretha H Sagasser
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Cornelia R M G Fluit
- Centre on Research in Learning and Education, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- Department of Health Servicese Research and Policy, Australian National University, Canberra, Australia
| | - Cees P M van der Vleuten
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Olmos-Vega FM, Dolmans DHJM, Vargas-Castro N, Stalmeijer RE. Dealing with the tension: how residents seek autonomy and participation in the workplace. MEDICAL EDUCATION 2017; 51:699-707. [PMID: 28436048 DOI: 10.1111/medu.13326] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/07/2016] [Accepted: 02/10/2017] [Indexed: 05/14/2023]
Abstract
CONTEXT The workplace can be a strenuous setting for residents: although it offers a wealth of learning opportunities, residents find themselves juggling their responsibilities. Even though supervisors regulate what is afforded to residents, the former find it difficult to strike the proper balance between residents' independence and support, which could create tensions. But what tensions do residents experience during clinical supervision and how do they cope with them to maximise their learning opportunities? Understanding how residents act on different affordances in the workplace is of paramount importance, as it influences their learning. METHOD Residents from different levels of training and disciplines participated in three focus groups (n = 19) and 10 semi-structured interviews (n = 10). The authors recruited these trainees using purposive and convenience sampling. Audio-recordings were transcribed verbatim and the ensuing scripts were analysed using a constructivist grounded theory methodology. RESULTS Residents reported that the autonomy and practice opportunities given by their supervisors were either excessive or too limited, and both were perceived as tensions. When in excess, trainees enlisted the help of their supervisor or peers, depending on how safe they recognised the learning environment to be. When practice opportunities were curtailed, trainees tried to negotiate more if they felt the learning environment was safe. When they did not, trainees became passive observers. Learning from each engagement was subject to the extent of intersubjectivity achieved between the actors involved. CONCLUSIONS Tensions arose when supervisors did not give trainees the desired degree of autonomy and opportunities to participate. Trainees responded in various ways to maximise their learning opportunities. For these different engagement-related responses to enhance workplace learning in specialty training, achieving intersubjectivity between trainee and supervisor seems foundational.
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Affiliation(s)
- Francisco M Olmos-Vega
- Department of Anaesthesiology, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Diana H J M Dolmans
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Nicolas Vargas-Castro
- Department of Anaesthesiology, Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Renée E Stalmeijer
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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O'Connor E, Moore M, Cullen W, Cantillon P. A qualitative study of undergraduate clerkships in the intensive care unit: It's a brand new world. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:173-181. [PMID: 28390032 PMCID: PMC5466567 DOI: 10.1007/s40037-017-0349-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION While ICU clerkships are commonplace in undergraduate medical education, little is known about how students learn there. This study aimed to explore students' perceptions of the ICU as a learning environment, the factors influencing their learning and any perceived differences between learning in the ICU and non-ICU settings. METHODS We used interpretivist methodology, a social cognitive theoretical framework and a qualitative descriptive strategy. Ten medical students and four graduate doctors participated in four semi-structured focus group discussions. Data were analyzed by six-step thematic data analysis. Peer debriefing, audit trail and a reflexive diary were used. RESULTS Social cognitive influences on learning were apparent in the discussions. Numerous differences emerged between ICU and non-ICU clinical clerkships, in particular an unfamiliarity with the environment and the complex illness, and difficulty preparing for the clerkship. A key emergent theme was the concept of three phases of student learning, termed pre-clerkship, early clerkship and learning throughout the clerkship. A social cognitive perspective identified changes in learner agency, self-regulatory activities and reciprocal determinism through these phases. The findings were used to construct a workplace model of undergraduate intensive care learning, providing a chronological perspective on the clerkship experience. CONCLUSIONS The ICU, a rich, social learning environment, is different in many respects to other hospital settings. Students navigate through three phases of an ICU clerkship, each with its own attendant emotional, educational and social challenges and with different dynamics between learner and environment. This chronological perspective may facilitate undergraduate educational design in the ICU.
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Affiliation(s)
- Enda O'Connor
- Department of Anaesthesia and Intensive Care Medicine, St. James's Hospital and Trinity College, Dublin, Ireland.
| | - Michael Moore
- Department of Anaesthesia and Intensive Care Medicine, St. James's Hospital, Dublin, Ireland
| | - Walter Cullen
- Department of Urban Primary Care, University College Dublin, Dublin, Ireland
| | - Peter Cantillon
- Department of Primary Care, National University of Ireland, Galway, Ireland
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Chen HC, Wamsley MA, Azzam A, Julian K, Irby DM, O'Sullivan PS. The Health Professions Education Pathway: Preparing Students, Residents, and Fellows to Become Future Educators. TEACHING AND LEARNING IN MEDICINE 2017; 29:216-227. [PMID: 27813688 PMCID: PMC5546872 DOI: 10.1080/10401334.2016.1230500] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PROBLEM Training the next generation of health professionals requires leaders, innovators, and scholars in education. Although many medical schools and residencies offer education electives or tracks focused on developing teaching skills, these programs often omit educational innovation, scholarship, and leadership and are narrowly targeted to one level of learner. INTERVENTION The University of California San Francisco created the Health Professions Education Pathway for medical students, residents, and fellows as well as learners from other health professional schools. The Pathway applies the theoretical framework of communities of practice in its curricular design to promote learner identity formation as future health professions educators. It employs the strategies of engagement, imagination, and alignment for identity formation. CONTEXT Through course requirements, learners engage and work with members of the educator community of practice to develop the knowledge and skills required to participate in the community. Pathway instructors are faculty members who model a breadth of educator careers to help learners imagine personal trajectories. Last, learners complete mentored education projects, adopting scholarly methods and ethics to align with the broader educator community of practice. OUTCOME From 2009 to 2014, 117 learners participated in the Pathway. Program evaluations, graduate surveys, and web-based searches revealed positive impacts on learner career development. Learners gained knowledge and skills for continued engagement with the educator community of practice, confirmed their career aspirations (imagination), joined an educator-in-training community (engagement/imagination), and disseminated via scholarly meetings and peer-reviewed publications (alignment). LESSONS LEARNED Learners identified engagement with the learner community as the most powerful aspect of the Pathway; it provided peer support for imagining and navigating the development of their dual identities in the clinician and educator communities of practice. Also important for learner success was alignment of their projects with the goals of the local educator community of practice. Our community of practice approach to educator career development has shown promising early outcomes by nurturing learners' passion for teaching; expanding their interest in educational leadership, innovation, and scholarship; and focusing on their identity formation as future educators.
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Affiliation(s)
- H. Carrie Chen
- Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Maria A. Wamsley
- Division of General Internal Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Amin Azzam
- Department of Psychiatry, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Katherine Julian
- Division of General Internal Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - David M. Irby
- Department of Medicine and Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Patricia S. O'Sullivan
- Departments of Medicine and Surgery and the Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California, USA
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Palmgren PJ, Liljedahl M, Lindquist I, Laksov KB. A qualitative exploration of chiropractic and physiotherapy teachers' experiences and conceptualizations of the educational environment. THE JOURNAL OF CHIROPRACTIC EDUCATION 2017; 32:10-22. [PMID: 29257707 PMCID: PMC5834296 DOI: 10.7899/jce-17-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE There has been increasing scholarly interest in the role of environments in health care professional education, and the value of these has been widely acknowledged as an influential factor in educational quality. However, little is known about how teachers experience the environment, and there is a recognizable absence of a perspective from chiropractic and physiotherapy faculties. The aim of this study was to explore and contrast chiropractic and physiotherapy teachers' experiences and conceptualizations of the meaning of the educational environment. METHODS In this qualitative study, we performed semistructured interviews with 14 teachers, purposefully selected to obtain richness, variation, and breadth in the data. The data were analyzed using inductive qualitative content analysis. RESULTS The most noteworthy findings were, first, that chiropractic teachers experienced the meaning of the environment as motivating a vocational practice and modeling ideal, supporting and managing stressed students, and including students in the community of chiropractors. Physiotherapy teachers experienced the meaning of the environment as putting the pedagogical vision into practice, balancing students' expectations, and providing the prerequisites to grow within the profession. Second, both groups of teachers held common conceptualizations of the constituents of the environment as physical, organizational, relational, communicational, and pedagogical; however, they attached different connotations to these dimensions. CONCLUSION The findings conveyed a variance in the experience of the meaning of the educational environment that can be attributed to contextual and cultural differences.
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Hägg-Martinell A, Hult H, Henriksson P, Kiessling A. Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study. BMJ Open 2017; 7:e013046. [PMID: 28196948 PMCID: PMC5318643 DOI: 10.1136/bmjopen-2016-013046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- A Hägg-Martinell
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - H Hult
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - P Henriksson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - A Kiessling
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Delany C, Xafis V, Gillam L, Hughson JA, Hynson J, Wilkinson D. A good resource for parents, but will clinicians use it?: Evaluation of a resource for paediatric end-of-life decision making. BMC Palliat Care 2017; 16:12. [PMID: 28122549 PMCID: PMC5264290 DOI: 10.1186/s12904-016-0177-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Communication with parents about end-of-life care and decisions is a difficult and sensitive process. The objective of the present study was to ascertain clinicians’ views on the acceptability and usefulness of a handbook and web-based resource (Caring Decisions) that was designed as an aid for parents facing end-of-life decisions for their child. Methods Qualitative interviews were conducted with a range of health professionals who provide care to children facing life-limiting conditions. Results Data analysis confirmed the acceptability and usefulness of the resource. Two major themes were revealed: 1. Family empowerment, with sub-themes Giving words and clarity, Conversation starter, ‘I’m not alone in this’, and A resource to take away, highlighted how the resource filled a gap by supporting and enabling families in a multitude of ways; 2. Not just for families, with sub-themes A guide for staff, When to give the resource?, How to give the resource and Who should give the resource?, explored the significant finding that participants viewed the resource as a valuable tool for themselves, but its presence also brought into relief potential gaps in communication processes around end-of-life care. Conclusion The interview data indicated the positive reception and clear value and need for this type of resource. However, it is likely that successful resource uptake will be contingent on discussion and planning around dissemination and use within the health care team.
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Affiliation(s)
- Clare Delany
- Children's Bioethics Centre, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia. .,University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Vicki Xafis
- Sydney Children's Hospitals Network, Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW, 2145, Australia.,Centre for Values Ethics and the Law in Medicine, University of Sydney, Medical Foundation Building K25, Camperdown, NSW, 2006, Australia
| | - Lynn Gillam
- Children's Bioethics Centre, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | | | - Jenny Hynson
- Children's Bioethics Centre, Royal Children's Hospital Melbourne, 50 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Suite 8, Littlegate House, St Ebbes Street, Oxford, OX1 1PT, UK
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Birden H, Barker J, Wilson I. Effectiveness of a rural longitudinal integrated clerkship in preparing medical students for internship. MEDICAL TEACHER 2016; 38:946-956. [PMID: 26691824 DOI: 10.3109/0142159x.2015.1114594] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND We interviewed graduates from the first two cohorts of a postgraduate medical program that had a senior year longitudinal integrated clerkship (LIC) in a practice setting in rural New South Wales, Australia to determine how well their training prepared them to be junior doctors (3-4 years after graduation), and what aspects of that training they thought were particularly useful. METHODS In-depth interviews. RESULTS Fourteen junior doctors were interviewed. Participants reported feeling well prepared in ability to develop close relationships with clinical supervisors, good clinical and procedural skills, ability to work autonomously and work in teams, knowledge of health systems, ability to ensure self-care, and professionalism. Consensus view was that a rural placement was an excellent way to learn medicine for a variety of reasons including relationships with clinicians, less competition for access to patients, and opportunities to extend their clinical skills and act up to intern level. CONCLUSION The advantages we found in the training these junior doctors received which prepared them well for internship were integral both to the longitudinal, unstructured placement, and to the fact that it was carried out in a rural area. The two aspects of these placements appear to act synergistically, reinforcing the learning experience.
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Affiliation(s)
- Hudson Birden
- a James Cook University , Australia
- d University of Sydney , Australia
| | - Jane Barker
- b University of Western Sydney School of Medicine , Australia
| | - Ian Wilson
- c University of Wollongong Graduate School of Medicine , Australia
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Chen HC, ten Cate O, O'Sullivan P, Boscardin C, Eidson-Ton WS, Basaviah P, Woehrle T, Teherani A. Students' goal orientations, perceptions of early clinical experiences and learning outcomes. MEDICAL EDUCATION 2016; 50:203-13. [PMID: 26812999 DOI: 10.1111/medu.12885] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/16/2015] [Accepted: 08/10/2015] [Indexed: 05/15/2023]
Abstract
CONTEXT Workplace learning is optimised when learners engage in the activities of the workplace; learner engagement is influenced by workplace affordances and learner agency. Learner agency can be operationalised through achievement goal theory, which explains that students can have different goal orientations as they enter learning situations: mastery (learn and improve), performance approach (demonstrate competence) or performance-avoid (avoid demonstrating incompetence). Mastery-orientated, compared with performance-orientated, students approach curricular experiences as opportunities for developing rather than demonstrating competence. This study explored the relationships among students' achievement goal orientations, workplace affordances and learning outcomes in the context of early clinical experiences. METHODS Students who completed their preclerkship curricula at four medical schools answered a questionnaire about their personal goal orientation and the perceived goal structure and workplace affordances of their preceptorship experiences. All items used a 5-point scale (1 = strongly disagree/not at all true, 5 = strongly agree/very true). Students were evaluated by their preceptors and completed standardised-patient exams at the end of their pre-clerkship curricula. Analyses included descriptive statistics and mediation analysis. RESULTS Of 517 students, 296 (57.3%) responded and 253 (85.5%) had linked performance data. Student goal orientation means were: mastery, mean = 4.27 (SD = 0.65); performance-approach, 2.41 (0.76); performance-avoid, 2.84 (0.88). Student goal orientation and performance on preceptor evaluations (PEval) or standardised-patient exams (SPExam) were not significantly related. Perceptions of a mastery-structured curriculum and inviting workplace were associated with higher SPExam (β = 0.28, p = 0.02) and PEval (β = 0.51, p = 0.00) scores, respectively. Student mastery goal orientation was positively associated with perceptions of a mastery-structured curriculum (β = 0.59, p = 0.00) and positive workplace affordances (β = 0.25-0.29, p ≤ 0.01). CONCLUSIONS Students held a predominant mastery goal orientation towards their early clinical experiences. Mastery-orientated students perceived preceptorships as mastery-structured with positive workplace affordances, and those perceiving a mastery-structured or inviting preceptorship performed better. Clinical experiences should be structured to emphasise learning rather than demonstration of skills to promote learning outcomes.
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Affiliation(s)
- H Carrie Chen
- Department of Pediatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Olle ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Patricia O'Sullivan
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Christy Boscardin
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - W Suzanne Eidson-Ton
- Departments of Family and Community Medicine and Obstetrics and Gynecology, School of Medicine, University of California, Davis, California, USA
| | - Preetha Basaviah
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Theresa Woehrle
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Arianne Teherani
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
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Chen HC, Teherani A. Workplace affordances to increase learner engagement in the clinical workplace. MEDICAL EDUCATION 2015; 49:1184-6. [PMID: 26611182 DOI: 10.1111/medu.12888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Kramer AWM. Too much control diverts from the essence of learning and teaching. PERSPECTIVES ON MEDICAL EDUCATION 2015; 4:272-274. [PMID: 26358979 PMCID: PMC4602010 DOI: 10.1007/s40037-015-0216-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Palmgren PJ, Sundberg T, Laksov KB. Reassessing the educational environment among undergraduate students in a chiropractic training institution: A study over time. THE JOURNAL OF CHIROPRACTIC EDUCATION 2015; 29:110-26. [PMID: 26023892 PMCID: PMC4582609 DOI: 10.7899/jce-14-37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of the study was twofold: (1) to compare the perceived educational environment at 2 points in time and (2) to longitudinally examine potential changes in perceptions of the educational environment over time. METHODS The validated Dundee Ready Educational Environment Measure (DREEM), a 50-item, self-administered Likert-type inventory, was used in this prospective study. Employing convenience sampling, undergraduate chiropractic students were investigated at 2 points in time: 2009 (n = 124) and 2012 (n = 127). An analysis of 2 matching samples was performed on 27% (n = 34) of the respondents in 2009. RESULTS A total of 251 students (79%) completed the inventory, 83% (n = 124) in 2009 and 75% (n = 127) in 2012. The overall DREEM scores in both years were excellent: 156 (78%) and 153 (77%), respectively. The students' perceptions of teachers differed significantly between the 2 cohort years, decreasing from 77% to 73%. Three items received deprived scores: limited support for stressed students, authoritarian teachers, and an overemphasis on factual learning; the latter significantly decreased in 2012. In the longitudinal sample these items also displayed scores below the expected mean. CONCLUSION Students viewed the educational environment as excellent both in 2009 and 2012. The perceptions of teachers declined with time; however, this could be attributed to teachers' new roles. Certain aspects of the educational environment factored prominently during the comparative points in time, as well as longitudinally, and these ought to be further investigated and addressed to provide an enhanced educational environment.
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Palmgren PJ, Laksov KB. Exploring chiropractic students' experiences of the educational environment in healthcare professional training: a qualitative study. BMC MEDICAL EDUCATION 2015; 15:128. [PMID: 26242296 PMCID: PMC4526181 DOI: 10.1186/s12909-015-0417-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/24/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The educational environment has a significant impact on students' behavior, sense of well-being, and academic advancement. While various research methodologies have been used to explore the educational environment, there is a paucity of studies employing qualitative research methods. This study engages in an in-depth exploration of chiropractic students' experiences of the meaning of the educational environment. METHODS A qualitative approach was employed by interviewing 26 students in four focus group interviews at two different points in time. A conventional manifest and latent content analysis was chosen to investigate and interpret the experiences of the educational environment in an undergraduate chiropractic training institution in Sweden. RESULTS The analysis resulted in five overarching themes: Personal growth; Being part of a community; A place of meaningfulness; Trust in a regulated system; and Scaffolding relationships. Early in the training, the meaning of the educational environment was experienced as part of a vocational community and the scaffolding of intra-institutional relationships. In later stages, the environment was experienced in terms of personal growth - balancing academic pressures and progress within the professional community - thus laying the foundations for autonomy and motivation. During the clinical training, the environment was experienced as where learning happens, thus creating a place of meaningfulness. Throughout the training, the formal and clinical environments were experienced as isolating, with little bridging between the two. A regulated system - conveying an operative organization with clear communication regarding what to expect - was experienced as important for an apt educational environment. CONCLUSIONS We found that experiences of an educational environment are dynamic and change over time. When restructuring or evaluating curriculums, educational managers can consider the emerged themes as constituting facets relating to the educational environment, and thus possible learning conditions. Likewise, researchers can consider these aspects of the educational environment when: interpreting results from quantitative and qualitative inquiries, constructing and refining instruments, or conceptualizing and framing the educational environment phenomenon.
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Affiliation(s)
- Per J Palmgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, 171 77, Sweden.
| | - Klara Bolander Laksov
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, 171 77, Sweden.
- Department of Education, Stockholm University, Stockholm, Sweden.
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