Learning in the clinical environment

The situational analysis of teaching-learning in clinical education in Iran: a postmodern grounded theory study

BACKGROUND

Clinical teaching-learning is a context-bound phenomenon. One of the problems related to field of medical education research is the lack of sufficient attention to context-appropriate methodologies. The purpose of this qualitative inquiry is to explain and represent teaching-learning in the clinical education of general medicine in Iran using the three types of maps situational, social worlds/arenas, positional, in combination with discourse analysis.

METHODS

In this study, the authors used the situational analysis approach as a postmodern version of grounded theory. The data collection was undertaken in three stages. In the first stage, a mini literature review was conducted to highlight a possible gap in applying situational analysis in medical education research and the development of this methodology. In the second stage, the latest and most up-to-date documents of the Ministry of Health and Medical Education (MOHME) of Iran, the general medicine curriculum, and related documents were analyzed. Finally, the remote semi-structured interviews (web-based and telephone) were undertaken in the third stage. Participants in this stage included expert clinical teachers, medical education specialists, and students. In this study, the notes and transcripts were analyzed for the emergence and categorization of sub-themes and themes, represented in three maps.

RESULTS

Thirty-one participants were involved in the web-based interviews, while seven participants took part in the telephone interview. Based on this research, the teaching-learning situation in clinical education on general medicine in Iran was represented in three maps; situational, social worlds/arenas, and positional. In addition, the results showed, clinical education of general medicine in Iran in six positions (curriculum; culture, behavior and attitude; management and leadership; environment, space and time; financial; and technology) has serious problems and challenges. Finally, based on the horizontal axis of the positional map, recommendations were provided to develop and support effective clinical teaching.

CONCLUSIONS

The clinical learning environment is a complex and multi-layered social environment in which should be considered these numerous social layers, arenas, social worlds, and discourses while developing curricula and teaching.

Finding ways to support radiographers as teachers

INTRODUCTION

Teaching and supervision of medical imaging students are part of the role of many radiographers, yet they are frequently unsupported in the development of their role as a teacher. This study explores radiographers' experiences and level of confidence in teaching and establishes the areas of support they require to be more effective in their clinical teaching role.

METHODS

Sixty radiographers from across Australia completed an anonymous questionnaire, and nine radiographers participated in focus groups. Thematic analysis was conducted on the qualitative data, whilst quantitative data were analysed using one-way ANOVA and reported as descriptive statistics.

RESULTS

The findings demonstrate that radiographers were mostly confident in the domains of familiarising students to the practice environment, supervising students and assisting students to integrate into the practice environment, but were less confident in facilitating students' learning. Radiographers have identified the teaching skills and attributes they currently possess and the areas in which they need further development.

CONCLUSIONS

This study calls for support for radiographers in their teaching role and provides guidance for education providers wanting to design education to support radiographers' learning needs for teaching.

Perceived effectiveness of one-minute preceptor in microskills by residents in dental residency training at National Dental Centre Singapore

Background: The National Dental Centre Singapore (NDCS) has collaborated with the National University of Singapore’s Division of Graduate Dental Studies to provide supervised clinical training in the five dental specialties for residents since the early 1990s. Faculty were first introduced to the one-minute preceptor (OMP) in microskills through in-house workshops held from May to August 2014. Purpose: The aim of this study was to assess if a OMP faculty workshop impacts residents’ perceptions of clinical teaching in NDCS. Methods: First- and second-year residents were asked to rate their perceptions of the quantity and quality of clinical teaching, and the adequacy of the five OMP microskills performed by faculty before and one month after the OMP workshops. Data were analysed using descriptive statistics and non-parametric statistical tests. Results: A total of 37 NDCS clinical faculty participated in the OMP workshops and 34 residents participated in the pre- and post-workshop survey. The short-term impact of the OMP faculty workshop revealed minimal effect on residents’ perceptions of the clinical teaching in both quantity and quality. Conclusion: A one-time OMP workshop for faculty members does not substantially improve residents’ perceptions of the quality or quantity of clinical teaching. The results of this study indicate that the effort to improve clinical teaching by faculty must be a sustained effort. Future studies should investigate the barriers to faculty members’ performance of the OMP microskills.

A general survey on learners and faculty perspectives on educational activities held in the National Dental Centre, Singapore

Background:

The National Dental Centre Singapore (NDCS) has been educating learners since the late 1980s. However, in this time, no formal feedback about these educational activities has been garnered from education stakeholders (comprising learners and faculty). Furthermore, no formal faculty development efforts to improve the educational activities have been done.

Purpose:

The aim of the study was to collect data from learners about the NDCS’s educational activities and the faculty’s attitude towards teaching.

Methods:

A survey was administered to 239 education stakeholders from May to July 2015. The survey on learners focused on learners’ perceptions on the importance and frequency of the One-Minute Preceptor (OMP) five-step microskills model of clinical teaching, and the quality and quantity of teaching overall. For faculty, the survey focused on their attitudes around teaching.

Results:

A total of 92 responses were received from learners. Learners perceived the OMP elements to be important (mean Likert scores ranged from 4.13–4.44 out of 5). However, they reported infrequent use of this teaching model by the faculty (range 3.06–3.50 out of 5). While learners reported quality and content of teaching to be adequate, they felt the number of clinical hours for teaching could be increased. The faculty reported positive attitudes towards teaching.

Conclusion:

This study provided educators with valuable feedback on the NDCS’s educational activities, identifying strengths and weaknesses of the programmes that they can work towards improving.

Applying the one minute preceptor model to pediatric and adolescent gynecology education

There are multiple challenges to teaching in the clinical setting. The One Minute Preceptor is a learner-centered model for effective and efficient teaching in a clinical setting that can help to overcome these challenges. It consists of 5 microskills: get a commitment; probe for supporting evidence; teach general rules; reinforce what was right; correct mistakes. This article illustrates with case vignettes the use of these microskills for the busy Pediatric and Adolescent Gynecology clinician.

Clinical teaching based on principles of cognitive apprenticeship: views of experienced clinical teachers

PURPOSE

To explore (1) whether an instructional model based on principles of cognitive apprenticeship fits with the practice of experienced clinical teachers and (2) which factors influence clinical teaching during clerkships from an environmental, teacher, and student level as perceived by the clinical teachers themselves. The model was designed to apply directly to teaching behaviors of clinical teachers and consists of three phases, advocating teaching behaviors such as modeling, creating a safe learning environment, coaching, knowledge articulation, and exploration.

METHOD

A purposive sample of 17 experienced clinical teachers from five different disciplines and four different teaching hospitals took part in semistructured individual interviews. Two researchers independently performed a thematic analysis of the interview transcripts. Coding was discussed within the research team until consensus was reached.

RESULTS

All participants recognized the theoretical model as a structured picture of the practice of teaching activities during both regular and senior clerkships. According to participants, modeling and creating a safe learning environment were fundamental to the learning process of both regular and senior clerkship students. Division of teaching responsibilities, longer rotations, and proactive behavior of teachers and students ensured that teachers were able to apply all steps in the model.

CONCLUSIONS

The theoretical model can offer valuable guidance in structuring clinical teaching activities and offers suggestions for the design of effective clerkships.

Exploring the validity and reliability of a questionnaire for evaluating veterinary clinical teachers' supervisory skills during clinical rotations

BACKGROUND

Feedback to aid teachers in improving their teaching requires validated evaluation instruments. When implementing an evaluation instrument in a different context, it is important to collect validity evidence from multiple sources.

AIM

We examined the validity and reliability of the Maastricht Clinical Teaching Questionnaire (MCTQ) as an instrument to evaluate individual clinical teachers during short clinical rotations in veterinary education.

METHODS

We examined four sources of validity evidence: (1) Content was examined based on theory of effective learning. (2) Response process was explored in a pilot study. (3) Internal structure was assessed by confirmatory factor analysis using 1086 student evaluations and reliability was examined utilizing generalizability analysis. (4) Relations with other relevant variables were examined by comparing factor scores with other outcomes.

RESULTS

Content validity was supported by theory underlying the cognitive apprenticeship model on which the instrument is based. The pilot study resulted in an additional question about supervision time. A five-factor model showed a good fit with the data. Acceptable reliability was achievable with 10-12 questionnaires per teacher. Correlations between the factors and overall teacher judgement were strong.

CONCLUSIONS

The MCTQ appears to be a valid and reliable instrument to evaluate clinical teachers' performance during short rotations.

The Maastricht Clinical Teaching Questionnaire (MCTQ) as a valid and reliable instrument for the evaluation of clinical teachers

PURPOSE

Clinical teaching's importance in the medical curriculum has led to increased interest in its evaluation. Instruments for evaluating clinical teaching must be theory based, reliable, and valid. The Maastricht Clinical Teaching Questionnaire (MCTQ), based on the theoretical constructs of cognitive apprenticeship, elicits evaluations of individual clinical teachers' performance at the workplace. The authors investigated its construct validity and reliability, and they used the underlying factors to test a causal model representing effective clinical teaching.

METHOD

Between March 2007 and December 2008, the authors asked students who had completed clerkship rotations in different departments of two teaching hospitals to use the MCTQ to evaluate their clinical teachers. To establish construct validity, the authors performed a confirmatory factor analysis of the evaluation data, and they estimated reliability by calculating the generalizability coefficient and standard error measurement. Finally, to test a model of the factors, they fitted a structural linear model to the data.

RESULTS

Confirmatory factor analysis yielded a five-factor model which fit the data well. Generalizability studies indicated that 7 to 10 student ratings can produce reliable ratings of individual teachers. The hypothesized structural linear model underlined the central roles played by modeling and coaching (mediated by articulation).

CONCLUSIONS

The MCTQ is a valid and reliable evaluation instrument, thereby demonstrating the usefulness of the cognitive apprenticeship concept for clinical teaching during clerkships. Furthermore, a valuable model of clinical teaching emerged, highlighting modeling, coaching, and stimulating students' articulation and exploration as crucial to effective teaching at the clinical workplace.

Are the bigger hospitals better: DREEM on?

BACKGROUND

Clinical teaching in the undergraduate medical curriculum occurs at diverse sites. Analysis of the quality or effectiveness of such sites centres on student feedback. The Dundee Ready Education Environment Measure (DREEM) is a standardised instrument used internationally to analyse the educational environment.

AIM

Our objective was to analyse and compare the student experience at a range of hospital clinical sites in the year 3 undergraduate medical programme in the School of Medicine in University College Cork using the DREEM.

METHODS

All year 3 students were asked to complete the DREEM at the end of each hospital rotation.

RESULTS

All hospital sites performed well but smaller hospitals perform particularly well.

CONCLUSIONS

In the current climate, schools are compelled to make strategic decisions regarding the configuration of clinical teaching in a context where healthcare is also increasingly centralised. However, it is clear that smaller hospitals are preferred by students.