Finding your feet: student participation during initiation of international clinical placements : Student participation during initiation

Resident training in psychopathology and uncertainty in a clinical situation

The central theme of this article is the way in which psychiatry physicians-in-training deal with uncertainty in the discussion of clinical cases in Mexico. Methodologically, it is approached from the field of clinical ethnography and the narrative interpretation of plots in performative actions where there are sequences of communicative exchanges. In this way, it focuses on a detailed description of situations where clinical cases are reviewed to decipher, explain, and understand intersubjective meanings in the face of the emergence of uncertainty, its management, and the implications on decisions and actions. The study finds that limitations within the field of psychiatry lie in the nosographic construction of disease and its translation into the diagnostic hypotheses made by clinicians, where there are wide margins of ambiguity. The strategies implemented in the face of uncertainty are use of drugs, the collegiate review of the case, and utilization of intuition as a spontaneous, preconscious daily practice. The specific case described here provides a microscopic observation of the complex scenarios in which uncertainty occurs in educational and teaching processes, clearly revealing how patient care is articulated. The narratives and their interpretation are materials for training/curriculum and psychiatric clinical practice.

Challenges, coping and support during student placement abroad: A qualitative study

BACKGROUND

During placements abroad, healthcare students are confronted with different personal and professional challenges, related to participation in practice. This study investigates when and how students respond to such challenges, and which coping and support mechanisms students use to overcome these.

METHODS

Twenty-five international students shared their experiences about physiotherapy placement in The Netherlands. Using a critical incident technique, we asked participants to recall events where participation was affected by an unforeseen situation, in or outside the clinic. Further, we explored students' strategies of seeking support within their social network to overcome individual challenges. Two researchers applied thematic analysis to the interview data, following an iterative approach. Team discussions supported focused direction of data collection and analysis, before conceptualizing results.

RESULTS

Participants described a wide range of challenges. The scope and impact level of challenges varied widely, including intercultural differences, language barriers and inappropriate behaviour in the workplace, students' personal context and wellbeing. Mechanisms employed by students to overcome these challenges depended on the type of event (personal or professional), making purposeful use of their available network.

CONCLUSION

Students involve clinical staff, peers, family and friends during placement abroad, to make deliberate use of their support network to overcome challenges in participation, whereas the academic network remains distant. Findings may help reflect on the roles and responsibilities of academic staff and other professionals involved with placements abroad. Healthcare programmes should ensure support before, during and after placement is within students' reach.

'Making room for student autonomy' - an ethnographic study of student participation in clinical work

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.

Initiation of student participation in practice: An audio diary study of international clinical placements

BACKGROUND

Differences in professional practice might hinder initiation of student participation during international placements, and thereby limit workplace learning. This study explores how healthcare students overcome differences in professional practice during initiation of international placements.

METHODS

Twelve first-year physiotherapy students recorded individual audio diaries during the first month of international clinical placement. Recordings were transcribed, anonymized, and analyzed following a template analysis approach. Team discussions focused on thematic interpretation of results.

RESULTS

Students described tackling differences in professional practice via ongoing negotiations of practice between them, local professionals, and peers. Three themes were identified as the focus of students' orientation and adjustment efforts: professional practice, educational context, and individual approaches to learning. Healthcare students' initiation during international placements involved a cyclical process of orientation and adjustment, supported by active participation, professional dialogue, and self-regulated learning strategies.

CONCLUSIONS

Initiation of student participation during international placements can be supported by establishing a continuous dialogue between student and healthcare professionals. This dialogue helps align mutual expectations regarding scope of practice, and increase understanding of professional and educational practices. Better understanding, in turn, creates trust and favors meaningful students' contribution to practice and patient care.

A qualitative analysis of vertical leadership development amongst NHS health-care workers in low to middle income country settings

PURPOSE

The improving global health (IGH) programme is a leadership development programme that aims to develop leadership skills and behaviours alongside quality improvement methodology in National Health Service (NHS) employees in a global health setting. Through collaboration, experiential learning and mentorship, the programme aims to produce both vertical and horizontal leadership development in its participants. This paper aims to describe the programme and its impact, in terms of leadership development, in a sample of participants.

DESIGN/METHODOLOGY/APPROACH

Open coding and thematic analysis of leadership development summaries (LDS) completed by 39 returned IGH participants were conducted. LDS are written on completion of the overseas placement; participants reflect on their personal leadership development against the nine dimensions of the NHS Healthcare Leadership Model (2013).

FINDINGS

These IGH programme participants have reported a change in the way they think, behave and see the world. A development in sense of self and experience in developing team members are the two most commonly reported themes. Adaptability, communication, overcoming boundaries, collaborative working, "big picture" thinking and strategic thinking were also identified.

RESEARCH LIMITATIONS/IMPLICATIONS

The study is limited by the relatively low number of completed LDS. More work is needed to understand the long-term effect of this type of leadership development on the NHS. Other leadership development programmes should consider focussing on vertical and horizontal leadership development.

ORIGINALITY/VALUE

This more granular understanding of the leadership skills and behaviours developed and how it is the programme's design that creates it, has not previously been described.