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Kitto S, Danilovich N, Rowland P, Leslie K, Hendry P, Hodgson A, Fantaye A, Lochnan H. Teaching Observation as a Faculty Development Tool in Medical Education: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00090. [PMID: 37466351 DOI: 10.1097/ceh.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Health professions education often includes teaching observation to inform faculty development (FD) and indirectly improve student performance. Although these FD approaches are well received by faculty, they remain underused and/or underreported, with limited opportunities to receive feedback in workplace contexts. The goal of our study was to map the depth and breadth of education literature on the use of observation of teaching as a tool of professional development in medical education. METHODS Following the methodology by Arksey and O'Malley, we conducted a scoping review and searched four databases for articles published in English (final searches in April 2022). RESULTS Of 2080 articles identified, 45 met the inclusion criteria. All observation activities were associated with one of the following FD approaches: peer observation of teaching (23 articles, 51%), peer coaching (12, 27%), peer review (9, 20%), and the critical friends approach (1, 2%). Thirty-three articles (73%) concerned formative versions of the observation model that took place in clinical settings (21, 47%), and they tended to be a voluntary (27, 60%), one-off (18, 40%), in-person intervention (29, 65%), characterized by limited institutional support (13, 29%). Both barriers and challenges of teaching observation were identified. DISCUSSION This review identified several challenges and shortcomings associated with teaching observation, such as inadequate methodological quality of research articles, inconsistent terminology, and limited understanding of the factors that promote long-term sustainability within FD programs. Practical strategies to consider when designing an FD program that incorporates teaching observation are outlined.
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Affiliation(s)
- Simon Kitto
- Dr. Kitto: Director of Research, Office of Continuing Professional Development and Professor, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada, and Professor of Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore. Dr. Danilovich: Research Associate, Office of Continuing Professional Development, University of Ottawa, Ottawa, Ontario, Canada. Dr. Rowland: Scientist, Post MD and Wilson Centre, University of Toronto, Strategic Advisor, Centre for Interprofessional Education, University of Toronto, and Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada. Dr. Leslie: Professor of Paediatrics, University of Toronto, Staff Pediatrician, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Hendry: Vice-Dean of Continuing Professional Development and Professor of Surgery, Faculty of Medicine, University of Ottawa, and Cardiac Surgeon, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Ms. Hodgson: Health Sciences Librarian, University of Ottawa, Ottawa, Ontario, Canada. Mr. Fantaye: Research Associate, Office of Continuing Professional Development, University of Ottawa, Ottawa, Ontario, Canada. Dr. Lochnan: Assistant Dean, Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Head, Division of Endocrinology and Metabolism, Professor, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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Grant R, McMurtry A, Archibald D. Mapping Health Professions Education: Using Complexity Science to Make Sense of Learning Through Electronic Consultations. MEDICAL SCIENCE EDUCATOR 2023; 33:233-242. [PMID: 37008438 PMCID: PMC10060472 DOI: 10.1007/s40670-023-01730-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 06/19/2023]
Abstract
Phenomena studied within health professions education are often complex and multifaceted. This article describes a complexity science-informed theoretical framework that was developed for exploring how electronic consultations support learning among primary care providers, as well as within the larger organizations or systems in which they practice. This framework enables researchers to investigate learning occurring simultaneously at multiple levels (including individuals and social groups), without simplistically conflating levels or theories. The various levels of learning and associated theories are illustrated using examples from electronic consultations. This complexity science-inspired framework can be used for studying learning in complex, multilayered systems.
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Affiliation(s)
- Rachel Grant
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
| | - Angus McMurtry
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
| | - Douglas Archibald
- Faculty of Education, University of Ottawa, Ottawa, ON Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
- Bruyère Research Institute, Ottawa, ON Canada
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Livergant RJ, Ludlow NC, McBrien KA. Needs assessment for the creation of a community of practice in a community health navigator cohort. BMC Health Serv Res 2021; 21:657. [PMID: 34225704 PMCID: PMC8256652 DOI: 10.1186/s12913-021-06507-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Community Health Navigators (CHNs) are members of a patient's care team that aim to reduce barriers in accessing healthcare. CHNs have been described in various healthcare settings, including chronic disease management. The ENhancing COMmunity health through Patient navigation, Advocacy, and Social Support (ENCOMPASS) program of research employs CHNs, who are trained to improve access to care and community resources for patients with multiple chronic diseases. With complex and demanding roles, it is essential that CHNs communicate with each other to maintain knowledge exchange and best practices. A Community of Practice (CoP) is a model of situated learning that promotes communication, dedication, and collaboration that can facilitate this communication. The objective of this study was to engage with CHNs to determine how a CoP could be implemented to promote consistency in practices and knowledge for CHNs across primary care sites. METHODS A needs assessment for a CHN CoP was conducted using sequential steps of inquiry. A preliminary focused literature review (FLR) was done to examine the ways in which other healthcare CoPs have been implemented. Results from the FLR guided the creation of an exploratory survey and group interview with key informants to understand best approaches for CoP creation. Political, economic, social, and technological (PEST) and strengths, weaknesses, opportunities, and threats (SWOT) analyses synthesized results in a comprehensive manner for strategic recommendations. RESULTS The FLR identified different approaches and components of healthcare CoPs and guided analyses of mitigatable risk factors and leverageable assets for the intervention. The survey and group interview revealed an informal and effective CoP amongst current CHNs, with preferred methods including coffee meetings, group trainings, and seminars. A well-maintained web platform with features such as an encrypted discussion forum, community resource listing, calendar of events, and semi-annual CHN conferences were suggested methods for creating an inter-regional, formal CoP. CONCLUSION The study findings recognise the presence of an informal CoP within the studied CHN cohort. Implementation of a formal CoP should complement current CoP approaches and aid in facilitating expansion to other primary care centres utilizing digital communication methods, such as a comprehensive web platform and online forum.
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Affiliation(s)
- Rachel J Livergant
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Natalie C Ludlow
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Kerry A McBrien
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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McGrath C, Liljedahl M, Palmgren PJ. You say it, we say it, but how do we use it? Communities of practice: A critical analysis. MEDICAL EDUCATION 2020; 54:188-195. [PMID: 31852017 DOI: 10.1111/medu.14021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/21/2019] [Accepted: 10/10/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES As educational theories are increasingly used in medical education research there are concerns over how these theories are used, how well they are presented and what the authors intend. Communities of practice (CoP) is one example of an often-used theory and conceptual framework. This paper presents a critical analysis of how CoP theory is used in medical education research. METHODS A critical literature analysis was undertaken of articles published between 1998 and 2018 in eight internationally recognised medical education journals. From a total of 541 articles, 80 articles met the inclusion criteria and were analysed and mapped according to various patterns of use. RESULTS We discerned five categories of use, two misleading and cosmetic, off target and cosmeticising, and three functional, framing, lensing and transferring. A considerable number of articles either misrepresented the point of communities of practice or used it in a cosmetic fashion. The remainder used the theory to frame an ongoing study in relation to other work, as a lens through which to design the study and collect or analyse data, or as a way of discussing or demonstrating the transferability of the findings. CONCLUSIONS We conclude that almost half of the reviewed articles did not offer a functional and rigorous definition of what is meant by CoP; instead, they used it in a potentially misleading or cosmetic manner. This study therefore calls on editors, reviewers and authors alike to increase clarity and quality in the application of CoP theory in medical education.
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Affiliation(s)
- Cormac McGrath
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Education, Stockholm University, Stockholm, Sweden
| | - Matilda Liljedahl
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per J Palmgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Buckley H, Steinert Y, Regehr G, Nimmon L. When I say … community of practice. MEDICAL EDUCATION 2019; 53:763-765. [PMID: 30859612 DOI: 10.1111/medu.13823] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/10/2019] [Accepted: 01/17/2019] [Indexed: 05/13/2023]
Affiliation(s)
- Heather Buckley
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Education Scholarship (CHES), University of British Columbia, Vancouver, British Columbia, Canada
| | - Yvonne Steinert
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Centre for Medical Education, McGill University, Montreal, Quebec, Canada
| | - Glenn Regehr
- Centre for Health Education Scholarship (CHES), University of British Columbia, Vancouver, British Columbia, Canada
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Cleland J, Durning SJ. Education and service: how theories can help in understanding tensions. MEDICAL EDUCATION 2019; 53:42-55. [PMID: 30357894 DOI: 10.1111/medu.13738] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/09/2018] [Accepted: 06/18/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This paper reviews why tensions between service and education persist and highlights that this is an area of medical education research (MER) that, to date, lacks a robust body of theory-driven research. After carrying out a review of the literature on service-education tensions in medical education and training, we turn to consider how theory can help provide new insights into service-education tensions. METHODS We conducted a search of the literature on service-education tensions since 1998 to examine the use of theory in studies on this topic. RESULTS We identified 44 out of 603 relevant papers. Their focus fell into four broad categories: time residents spent on 'service' and 'education'; perceptions of the balance between service and education; considerations of how best to define service and education, and the impact of structural and systems changes on education/training. Of the papers reporting primary research, the dominant methodology was the bespoke survey. Rarely were the precise natures of tensions or how different factors interact to cause tensions examined in detail. DISCUSSION Through discussion and reflection, we then agreed on the applicability of four sociocultural theories for illuminating some examples of service-education tensions. We present four sociocultural theories: Holland's figured worlds, Kemmis et al.'s practice architectures, Lave and Wenger's situated learning and Engeström's cultural-historical activity theory (CHAT or AT). We describe each and then briefly illustrate how each theory can support new ways of thinking and potential directions for research focusing on education-service tensions. CONCLUSIONS The use of theory in research studies will not resolve service-education tensions. However, what theory can do is illuminate and magnify different aspects of service-education tensions, to generate new insight and knowledge that can then be used to inform future research and changes in practice.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Steven J Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Glicksman R, Ang M, Murray E, Simniceanu C, Lockhart E, Gilbert J, Gutierrez E, Warde P. Improving Quality of Radiation Therapy Care Across Ontario using a Community-of-Practice Approach. Pract Radiat Oncol 2018; 9:e242-e248. [PMID: 30447404 DOI: 10.1016/j.prro.2018.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/03/2018] [Accepted: 10/31/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE In 2003 and 2004, Cancer Care Ontario (CCO) divested its assets and staff to regional hospitals, leading to decreased contact between radiation therapy departments across Ontario's Regional Cancer Centres (RCCs). The Radiation Treatment Program (RTP) at CCO developed a communities-of-practice (CoPs) program to rebuild the provincial radiation therapy community to facilitate collaboration among centers, with the goals of decreasing variation in practice and improving the quality of patient care. RTP's CoPs are led and driven by volunteer frontline health care practitioners who identify and prioritize key quality issues and select corresponding projects to pursue. METHODS AND MATERIALS An evaluation of RTP's CoPs was conducted to assess whether they were successful in knowledge creation, knowledge transfer and exchange, and community building. The framework was developed based on the Centers for Disease Control and Prevention CoP evaluation framework and tools. Data were collected using prospectively administered member surveys (257 surveys), publications, and semistructured interviews (18 participants). RESULTS A total of 95% of participants reported that CoP projects were very relevant to their practice, and 50% reported changes in their practice stemming from CoP involvement. In addition, 90% of participants reported growth of their professional network as a result of CoPs. Overall, 93% of participants and 100% of interviewees reported that CoPs are a worthwhile initiative. The largest challenge of CoPs was the time commitment required to participate. CONCLUSIONS This approach of member-driven CoPs should be explored and modeled in other health care settings as a means to develop and share knowledge to reduce variation in care and improve the quality of radiation therapy care.
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Affiliation(s)
- Rachel Glicksman
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Treatment Program, Cancer Care Ontario, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Michelle Ang
- Radiation Treatment Program, Cancer Care Ontario, Ontario, Canada
| | - Elizabeth Murray
- Radiation Treatment Program, Cancer Care Ontario, Ontario, Canada
| | | | | | - Julie Gilbert
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Enhanced Program Evaluation Unit, Cancer Care Ontario, Ontario, Canada
| | - Eric Gutierrez
- Radiation Treatment Program, Cancer Care Ontario, Ontario, Canada
| | - Padraig Warde
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Radiation Treatment Program, Cancer Care Ontario, Ontario, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Johnston J, Bennett D, Kajamaa A. How to… get started with theory in education. CLINICAL TEACHER 2018; 15:294-297. [DOI: 10.1111/tct.12918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jenny Johnston
- Centre for Medical Education; Queen's University; Belfast UK
| | - Deirdre Bennett
- Medical Education Unit; University College Cork; Cork Ireland
| | - Anu Kajamaa
- Faculty of Educational Sciences; University of Helsinki; Helsinki Finland
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Cleland J, Roberts R, Kitto S, Strand P, Johnston P. Using paradox theory to understand responses to tensions between service and training in general surgery. MEDICAL EDUCATION 2018; 52:288-301. [PMID: 29105861 DOI: 10.1111/medu.13475] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/26/2017] [Accepted: 09/06/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT The tension between service and training in pressured health care environments can have a detrimental impact on training quality and job satisfaction. Yet the management literature proposes that competing demands are inherent in organisational settings: it is not the demands as such that lead to negative outcomes but how people and organisations react to opposing tensions. We explored how key stakeholders responded to competing service-training demands in a surgical setting that had recently gone through a highly-publicised organisational crisis. METHODS This was an explanatory case study of a general surgery unit. Public documents informed the research questions and the data were triangulated with semi-structured interviews (n = 14) with key stakeholders. Data coding and analysis were initially inductive but, after the themes emerged, we used a paradox lens to group themes into four contextual dimensions: performing, organising, belonging and learning. RESULTS Tensions were apparent in the data, with managers, surgeons and trainees or residents in conflict with each other because of different goals or priorities and divergent perspectives on the same issue of balancing service and training (performing). This adversely impacted on relationships across and within groups (belonging, learning) and led to individuals prioritising their own goals rather than working for the 'greater good' (performing, belonging). Yet although relationships and communication improved, the approach to getting a better balance maintained the 'compartmentalisation' of training (organising) rather than acknowledging that training and service cannot be separated. DISCUSSION Stakeholder responses to the tensions provided temporary relief but were unlikely to lead to real change if the tension between service and training was considered to be an interdependent and persistent paradox. Reframing the service-training paradox in this way may encourage adjusting responses to create effective working partnerships. Our findings add to the body of knowledge on this topic, and will resonate with all those engaged in surgical and other postgraduate training.
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Affiliation(s)
- Jennifer Cleland
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Ruby Roberts
- Centre for Healthcare Education Research and Innovation (CHERI), School of Medicine, Dentistry and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Simon Kitto
- Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON, Canada
| | - Pia Strand
- The Faculty of Medicine Centre for Teaching and Learning, Lund University, Lund, Sweden
| | - Peter Johnston
- NHS Education for Scotland, Northern Deanery, Aberdeen, UK
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