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Tam H, Scott I. Laying train tracks en route: How institutional education leaders navigate complexity during mandated curriculum change. MEDICAL EDUCATION 2024. [PMID: 38982726 DOI: 10.1111/medu.15464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/15/2024] [Accepted: 05/29/2024] [Indexed: 07/11/2024]
Abstract
INTRODUCTION Institutional education leaders serve key roles in leading major curricular change within residency education, yet little is known about how they accomplish these goals on the ground. Change management principles have predominantly been developed and described in the hierarchical context of management science and corporate settings. However, the non-hierarchical, complex and adaptive features of health professions education may render these traditional change management models inadequate. We explored how institutional educational leaders navigate the complex residency education system in implementing a major curricular change. METHODS Using constructivist grounded theory, we conducted and iteratively analysed semi-structured interviews with 11 institutional education leaders from across Canada who were responsible for leading the nationally mandated curricular change to competency-based residency education. Thematic analysis was performed iteratively using constant comparison. RESULTS Leaders managing the change process focused on two priorities: steering the direction of the change process as it evolved and maintaining the momentum amongst stakeholders to move forward steadily. Four common threats and opportunities impacted the focus on direction and momentum: multiplicity of contexts, innovation, resistance and distractions. In response, leaders utilised various tactics and harnessed diverse leadership styles to manage these challenges accordingly. CONCLUSIONS We identified a change framework that offers a more contextually nuanced understanding of curricular change in residency education that has not been described in the change management literature generated by the management sector. Institutional education leaders focused on maintaining the direction and momentum, while constantly assessing and adapting to evolving, uncertain and complex conditions. Our findings provide a simple and practical foundation to support leadership education in curricular change as well as researchers in developing further change theories in complex adaptive health professions education systems.
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Affiliation(s)
- Herman Tam
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Ian Scott
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
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Barry ES, Teunissen P, Varpio L. Followership in interprofessional healthcare teams: a state-of-the-art narrative review. BMJ LEADER 2024; 8:127-133. [PMID: 37696538 DOI: 10.1136/leader-2023-000773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE A state-of-the-art (SotA) literature review-a type of narrative review- was conducted to answer: What historical developments led to current conceptualisations of followership in interprofessional healthcare teams (IHTs)? DESIGN Working from a constructivist orientation, SotA literature reviews generate a chronological overview of how knowledge evolved and presents this summary in three parts: (1) this is where we are now, (2) this is how we got here and (3) this is where we should go next. Using the SotA six-stage methodology, a total of 48 articles focused on followership in IHTs were used in this study. RESULTS Articles about followership within IHTs first appeared in 1993. Until 2011, followership was framed as leader-centric; leaders used their position to influence followers to uphold their dictums. This perspective was challenged when scholars outside of healthcare emphasised the importance of team members for achieving goals, rejecting a myopic focus on physicians as leaders. Today, followership is an important focus of IHT research but two contradictory views are present: (1) followers are described as active team members in IHTs where shared leadership models prevail and (2) conceptually and practically, old ways of thinking about followership (ie, followers are passive team members) still occur. This incongruity has generated a variable set of qualities associated with good followership. CONCLUSIONS Leadership and followership are closely linked concepts. For leaders and followers in today's IHTs to flourish, the focus must be on followers being active members of the team instead of passive members. Since theories are increasingly encouraging distributed leadership, shared leadership and/or situational leadership, then we must understand the followership work that all team members need to harness. We need to be cognizant of team dynamics that work within different contexts and use leadership and followership conceptualisations that are congruent with those contexts.
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Affiliation(s)
- Erin S Barry
- Department of Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Pim Teunissen
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Lara Varpio
- Department of Pediatrics, Perelman School of Medicine at the University, Philadelphia, Pennsylvania, USA
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Fukami T. Patient engagement with psychological safety. DIALOGUES IN HEALTH 2023; 3:100153. [PMID: 38515810 PMCID: PMC10953965 DOI: 10.1016/j.dialog.2023.100153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/13/2023] [Accepted: 09/13/2023] [Indexed: 03/23/2024]
Abstract
Psychological safety is a multidimensional, dynamic phenomenon that concerns team members' perception of whether it is safe to take interpersonal risks at work. It is particularly important within health care teams who need to work interdependently to coordinate safe patient care within a highly complex, variable and high-stakes work environment. High levels of psychological safety have clear benefits for patient safety by improving the delivery of clinical care and promoting health care providers' job satisfaction and well-being. Feeling psychologically safe can enable team members to engage in speaking up behavior, such as asking questions, pointing out mistakes, or reporting errors. Several studies have explored psychological safety in health care teams and its impact on patient safety. These studies have highlighted the importance of psychological safety in health care organizations and provided strategies for promoting psychological safety. Psychological safety in health care involvement with patients can improve patient engagement.
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Affiliation(s)
- Tatsuya Fukami
- Patient Safety Division, Shimane University Hospital, 693-8501 Izumo, Japan
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Kemp S, Brewer M. Early stages of learning in interprofessional education: stepping towards collective competence for healthcare teams. BMC MEDICAL EDUCATION 2023; 23:694. [PMID: 37740200 PMCID: PMC10517498 DOI: 10.1186/s12909-023-04665-8] [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: 02/03/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Interprofessional education (IPE) is a core element of many health professional education curricula. To date the focus of much research has been on student perceptions of, and attitudes towards, the learning experience. Little is known about the impact of early IPE experience on how students understand and learn about effective interprofessional teamwork. METHODS This qualitative study involved first year university students enrolled in health professions degrees and investigated their descriptions of interprofessional teamwork through graphic elicitation and interviews. Participants were enrolled in a large-scale interprofessional unit (subject) in the university. RESULTS The data were analysed through the lens of a tool that classifies dimensions of interprofessional activity. The findings indicated the majority of students had what was classified as a Stage 1 (or 'nascent') understanding of integration between work practices and a Stage 2 (or 'emerging') understanding of the dimensions of interprofessional teamwork which were commitment, identity, goals, roles and responsibilities, and interdependence. CONCLUSIONS Based on the findings, the stages for a learning trajectory for interprofessional education are proposed and each stage is mapped to dimensions of interprofessional activity. A number of pedagogical strategies are suggested in order to move students through this two-stage model of learning and ensure their readiness for interprofessional teamwork as health professionals.
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Affiliation(s)
- Sandra Kemp
- Graduate School of Medicine, University of Wollongong, Wollongong, Australia.
| | - Margo Brewer
- Curtin School of Allied Health, Curtin University, Perth, Australia
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Bornman J, Louw B. Leadership Development Strategies in Interprofessional Healthcare Collaboration: A Rapid Review. J Healthc Leadersh 2023; 15:175-192. [PMID: 37641632 PMCID: PMC10460600 DOI: 10.2147/jhl.s405983] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/19/2023] [Indexed: 08/31/2023] Open
Abstract
Background Contemporary healthcare practitioners require leadership skills for a variety of professional roles related to improved patient/client outcomes, heightened personal and professional development, as well as strengthened interprofessional collaboration and teamwork. Objective/Aim The aim of this study is to systematically catalogue literature on leadership in healthcare practice and education to highlight the leadership characteristics and skills required by healthcare practitioners for collaborative interprofessional service delivery and the leadership development strategies found to be effective. Methods/Design A rapid review was conducted. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) diagram shows that the 11 databases, yielded 465 records. A total of 147 records were removed during the initial screening phase. The remaining 318 records were uploaded onto Rayyan, an online collaborative review platform. Following abstract level screening, a further 236 records were removed with 82 records meeting the eligibility criteria at full text level, of which 42 were included in the data extraction. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal. Results Results showed variability in methodologies used, representing various healthcare disciplines with a range in population size (n = 6 to n = 537). Almost half of the results reported on new programs, with interprofessional collaboration and teamwork being the most frequently mentioned strategies. The training content, strategies used as well as the length of training varied. There were five outcomes which showed positive change, namely skills, knowledge, confidence, attitudes, and satisfaction. Conclusion This rapid review provided an evidence-base, highlighted by qualitative, quantitative, and mixed methods research, which presents distinct opportunities for curriculum development by focusing on both content and the methods needed for leadership programs. Anchoring this evidence-base within a systematic search of the extant literature provides increased precision for curriculum development.
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Affiliation(s)
- Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Brenda Louw
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, Gauteng, South Africa
- Department Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, USA
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Gladman T, Grainger R. Cultural historical activity and the complexity of health professions education. MEDICAL EDUCATION 2022; 56:1058-1060. [PMID: 35953689 PMCID: PMC9804292 DOI: 10.1111/medu.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Commenting on Hu et al., Grainger and Gladman comment on how the purpose of student‐led community learning can change focus from the development of technical and professional skills to the aspirations and goals of the community in which students work.
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Affiliation(s)
- Tehmina Gladman
- Education UnitUniversity of Otago WellingtonWellingtonNew Zealand
| | - Rebecca Grainger
- Education UnitUniversity of Otago WellingtonWellingtonNew Zealand
- Te Whatu Ora Health New Zealand—Capital, Coast and Hutt ValleyWellingtonNew Zealand
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Paxino J, Molloy E, Denniston C, Woodward-Kron R. Dynamic and distributed exchanges: an interview study of interprofessional communication in rehabilitation. Disabil Rehabil 2022:1-11. [PMID: 35802465 DOI: 10.1080/09638288.2022.2096125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Interprofessional communication (IPC) in rehabilitation is important for patient care yet it has been shown to be variable and challenging. Existing research does not address the complexity of IPC in this setting. Understanding the influence of contextual factors on IPC may guide improvements to increase the effectiveness of communication within interprofessional teams. METHODS From July 2020 to February 2021 semi-structured interviews were conducted with 24 healthcare professionals across Australia and New Zealand. Cultural Historical Activity Theory provided a guiding theoretical and analytical framework for this qualitative study. RESULTS Participants described engaging in IPC through evolving interactions, piecing together information that underpinned patient care. Meetings occurred frequently, however communication extended well beyond formalised interactions, often requiring individuals to balance clinical workload with communication tasks. IPC reportedly relied on communication tools, however navigating information from multiple sources was demanding. CONCLUSIONS Our results indicate that IPC contributes significantly to the workload of healthcare professionals in rehabilitation. IPC was integral in the provision of cohesive patient care, however it proved time consuming, effortful and at times frustrating and potentially erroneous. Our findings promote the need for rigorous examination of communication practices to ensure they are meeting the needs of an increasingly interprofessional workforce. IMPLICATIONS FOR REHABILITATIONHealthcare professionals should recognise that time spent communicating within their team is a legitimate and important part of patient care.Rehabilitation teams should consider how they allocate resources for communication tasks.Teams should reconsider how they can use communication more effectively to save time by reducing repetition and errors.
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Affiliation(s)
- Julia Paxino
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Elizabeth Molloy
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Charlotte Denniston
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Robyn Woodward-Kron
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
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Consensus about GP interprofessional competencies: A nominal group study. BJGP Open 2022; 6:BJGPO.2021.0243. [PMID: 35338046 DOI: 10.3399/bjgpo.2021.0243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 12/22/2021] [Accepted: 02/22/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Since the requirements for collaboration in primary care increase, effective interprofessional teamwork between general practitioners (GPs) and other primary care professionals is crucial. The need for more training in interprofessional collaborative competencies is widely recognised. However, existing competency frameworks do not sufficiently specify interprofessional collaboration to guide interprofessional competency development. AIM Consensus among GPs and other primary care professionals on interprofessional competencies that GP and GP-trainees should learn. DESIGN & SETTING Qualitative consensus study among Dutch GPs and other primary care professionals, all with expertise in primary care interprofessional collaborative practice. METHOD Three nominal group sessions were held, each resulting in its own group consensus on GP interprofessional collaborative competencies. The researchers conducted a content analysis to merge and thematise the prioritised competencies into one list. Participants prioritised this list of competencies. A pre-set cut-off point was applied to determine the overall consensus on core GP interprofessional competencies. RESULTS Eighteen professionals from nine different disciplines participated. The content analysis resulted in 31 unique competencies of which fourteen competencies were prioritised in the final ranking into three main themes: 1. Professional identity development and role definition by the GP. (three competencies); 2. Developing and executing shared care plans for individual patients (6); 3. Setting up and maintaining interprofessional collaborative partnerships.(5) CONCLUSION: An interprofessional group of experts reached consensus on 14 competencies within 3 themes. This framework provides a steppingstone for GPs to focus on their development regarding interprofessional collaboration.
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Samuriwo R, Bullock A, Webb K, Monrouxe LV. 'Nurses whisper.' Identities in nurses' patient safety narratives of nurse-trainee doctors' interactions. MEDICAL EDUCATION 2021; 55:1394-1406. [PMID: 34060110 DOI: 10.1111/medu.14575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/20/2021] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
CONTEXT Nurses are integral to patient safety, but little is known about their narrative constructions of identity in relation to their dyadic interactions with trainee doctors about patient safety and competence during the trajectory of a medical career. AIM We sought to examine how identities are constructed by experienced nurses in their narratives of patient safety encounters with trainee doctors. METHODS Our qualitative study gathered narrative data through semi-structured interviews with nurses of different professional standing (n = 20). Purposive sampling was used to recruit the first eight participants, with the remainder recruited through theoretical sampling. Audio recordings were transcribed verbatim and analysed inductively through a social constructionist framework and deductively using a competence framework. RESULTS We classified seven identities that participants constructed in their narratives of dyadic interactions with trainee doctors in relation to patient safety: nurses as teacher, guardian of patient wellbeing, provider of emotional support, provider of general support, expert advisor, navigator and team player. These identities related to the two key roles of nurses as educators and as practitioners. As they narrated these dyadic interactions, participants constructed identities that positioned trainee doctors in character tropes, suggesting gaps in professional competence: nurses as provider of general support was commonly narrated in the context of perceived deficits of personal or functional capabilities and nurses as team player was mainly associated with concerns (or reassurances) around ethical capabilities. DISCUSSION AND CONCLUSION Our findings are consistent with, and extend the wider literature on the development of professional competence, interprofessional collaboration in health care, and the nature and organisation of nursing work. Nurses' work in ensuring patient safety and support trainee doctors' professional development merits greater formal recognition and legitimation.
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Affiliation(s)
- Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
- Wales Centre for Evidence Based Care, Cardiff University, Cardiff, UK
| | - Alison Bullock
- Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE), School of Social Sciences, Cardiff University, Cardiff, UK
| | - Katie Webb
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK
| | - Lynn V Monrouxe
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. MEDICAL EDUCATION 2021; 55:894-902. [PMID: 33651450 PMCID: PMC8359828 DOI: 10.1111/medu.14520] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 05/26/2023]
Abstract
CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
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Affiliation(s)
- Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Center for Health Professions EducationDepartment of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
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Varpio L, Bader-Larsen K, Hamwey M, Durning S, Meyer H, Cruthirds D, Artino A. Delivering patient care during large-scale emergency situations: Lessons from military care providers. PLoS One 2021; 16:e0248286. [PMID: 33788854 PMCID: PMC8011761 DOI: 10.1371/journal.pone.0248286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background Today, physicians are at the front lines of a pandemic response. Military physicians are uniquely trained to excel in such large-scale emergency situations. Civilian physicians can harness military know-how, but it will require research into military healthcare responses—specifically, we need to learn lessons from military interprofessional healthcare teams (MIHTs). Methods This research answers two questions: What are the characteristics of successful MIHTs? Why are those characteristics important to MIHT success in large-scale emergency situations? Using a Grounded Theory approach, 30 interviews were conducted soliciting perspectives from the broadest range of healthcare professionals who had experiences working in and leading MIHTs. Purposive sampling was used to recruit participants broadly across: contexts where MIHTs work; military branches; ranks; genders; and healthcare professions. Data were iteratively collected and analyzed. Results 30 participants were interviewed (18 male (60%); 21 officers (70%); 9 enlisted (30%)) who held various healthcare occupations (medic/tech/corpsman (9); nurse (7); physician (7); dentist (2); occupational therapist (2); chaplain (1); physician’s assistant (1); and psychiatrist (1)). Six characteristics of successful MIHTs that are directly applicable to large-scale emergency situations were identified thatthat clustered into two themes: own your purposes and responsibilities (through mission focus and ethical bearing) and get it done, safely (via situational awareness, adaptability, and leadership with followership). Conclusions This study provides insights, informed by decades of military service and training, to help civilian physicians succeed in large-scale emergency situations. These experiences from the war front can support today’s pandemic responses on the home front.
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Affiliation(s)
- Lara Varpio
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Karlen Bader-Larsen
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Meghan Hamwey
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Steven Durning
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Holly Meyer
- The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Danette Cruthirds
- Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Anthony Artino
- Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
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Morris C, Reid AM, Ledger A, Teodorczuk A. Expansive learning in medical education: Putting Change Laboratory to work. MEDICAL TEACHER 2021; 43:38-43. [PMID: 32723217 DOI: 10.1080/0142159x.2020.1796948] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This paper explores the purposeful use of conceptual and methodological tools provided by Cultural Historical Activity Theory (CHAT) to transform learning cultures and practices within and across diverse clinical learning environments. We describe how Change Laboratory methodology helped clinicians and others who support student, intern, and resident education to make changes collaboratively. A case study in undergraduate medical education shows how this created new forms of medical student placement and a postgraduate study shows how it addressed supervisors' undermining behaviour towards Obstetrics and Gynaecology residents. This empirical work illustrates ways of modifying the classical Change Laboratory process to fit local contexts, resources, and needs. We conclude with lessons learned and future directions for practitioner-researchers who wish to broaden the range of methodological tools they use to transform clinical learning environments.
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Affiliation(s)
- Clare Morris
- Institute of Continuing Education, University of Cambridge, Cambridge, UK
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Dornan T, Kearney GP, Pyörälä E. Destabilising institutions to make healthcare more equitable: Clinicians, educators, and researchers co-producing change. MEDICAL TEACHER 2021; 43:4-6. [PMID: 32721179 DOI: 10.1080/0142159x.2020.1795102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Gráinne P Kearney
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Eeva Pyörälä
- Centre for University Teaching and Learning, University of Helsinki, Helsinki, Finland
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Reid H, Gormley GJ, Dornan T, Johnston JL. Harnessing insights from an activity system - OSCEs past and present expanding future assessments. MEDICAL TEACHER 2021; 43:44-49. [PMID: 32735153 DOI: 10.1080/0142159x.2020.1795100] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective Structured Clinical Examinations (OSCEs) are a dominant, yet problematic, assessment tool across health professions education (HPE). OSCEs' standardised approach aligns with regulatory accountability, allowing learners to exchange exam success for the right to practice. We offer a sociohistorical account of OSCEs' development to support an interpretation of present assessment practices. OSCEs create tensions. Preparing for OSCE success diverts students away from the complexity of authentic clinical environments. Students will not qualify and will, therefore, be of no use to patients without getting marks providing evidence of competence. Performing in a formulaic and often non patient-centred way is the price to pay for a qualification. Acknowledging the stultifying effect of standardising human behaviour for OSCEs opens up possibilities to release latent energy for change in medical education. In this imagined future, the overall object of education is refocused on patient care.
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Affiliation(s)
- Helen Reid
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Gerard J Gormley
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- Department of Education Development and Research, Maastricht University, Maastricht, The Netherlands
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Gillespie H, McCrystal E, Reid H, Conn R, Kennedy N, Dornan T. The pen is mightier than the sword. Reinstating patient care as the object of prescribing education. MEDICAL TEACHER 2021; 43:50-57. [PMID: 32721185 DOI: 10.1080/0142159x.2020.1795103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Prescribing (writing medication orders) is one of residents' commonest tasks. Superficially, all they have to do is complete a form. Below this apparent simplicity, though, lies the complex task of framing patients' needs and navigating relationships with them and other clinicians. Mistakes, which compromise patient safety, commonly result. There is no evidence that competence-based education is preventing harm. We found a profound contradiction between medical students becoming competent, as defined by passing competence assessments, and becoming capable of safely caring for patients. We reinstated patients as the object of learning by allowing students to 'pre-prescribe' (complete, but not authorise prescriptions). This turned a disabling tension into a driver of curriculum improvement. Students 'knotworked' within interprofessional teams to the benefit of patients as well as themselves. Refocusing undergraduate medical education on patient care showed promise as a way of improving patient safety.
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Affiliation(s)
- Hannah Gillespie
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Eleanor McCrystal
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Helen Reid
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Richard Conn
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Neil Kennedy
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
- Department of Educational Development and Research, Maastricht University, Maastricht, Netherlands
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