1
|
Hallé MC, Bussières A, Asseraf-Pasin L, Storr C, Mak S, Root K, Owens H, Amari F, Thomas A. Stakeholders' priorities in the development of evidence-based practice competencies in rehabilitation students: a nominal group technique study. Disabil Rehabil 2024; 46:3196-3205. [PMID: 37489946 DOI: 10.1080/09638288.2023.2239138] [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: 11/10/2022] [Accepted: 07/15/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Clinically integrated teaching (CIT) is an effective approach for promoting evidence-based practice (EBP) competencies among medical students. Challenges towards the implementation of CIT in rehabilitation curricula include educators' different conceptualizations of EBP, the perceived complexity of EBP and the boundaries between the academic and the clinical setting. This study aimed to identify tailored strategies to implement in rehabilitation programs and their affiliated clinical sites to support the development of EBP competencies among students in occupational therapy (OT), physical therapy (PT) and speech-language pathology (S-LP). MATERIALS AND METHODS Nominal group technique (NGT) with stakeholders from three rehabilitation programs in Canada, offering the professional master's in OT and PT (n = 35 participants) and in S-LP (n = 8). RESULTS The top two strategies identified in the OT/PT NGT were: 1) Developing a flexible definition of EBP that recognizes its complexity; 2) Providing clinicians with more access to the teaching content by pairing faculty with preceptors. The top two strategies identified in the S-LP NGT were: 1) Providing students with opportunities for decision-making with experienced clinicians; 2) Increasing interactions between faculty and preceptors using formal group meetings. CONCLUSION Findings laid foundations for future integrated knowledge translation projects to collaboratively implement, and test identified strategies.
Collapse
Affiliation(s)
- Marie-Christine Hallé
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Département d'orthophonie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Liliane Asseraf-Pasin
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Caroline Storr
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Susanne Mak
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Kelly Root
- School of Communication Sciences and Disorders, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Heather Owens
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Fatima Amari
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| |
Collapse
|
2
|
Tolsgaard MG, Feragen A, Grierson L. Leveraging Education Science for AI-Clinician Collaboration in the Patient Care Ecosystem. ANNALS OF SURGERY OPEN 2024; 5:e442. [PMID: 38911634 PMCID: PMC11192000 DOI: 10.1097/as9.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 04/21/2024] [Indexed: 06/25/2024] Open
Affiliation(s)
- Martin Grønnebæk Tolsgaard
- From the Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Aasa Feragen
- DTU Compute, Technical University of Denmark, Lyngby, Denmark
| | - Lawrence Grierson
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
Gamborg ML, Mylopoulos M, Mehlsen M, Paltved C, Musaeus P. Exploring adaptive expertise in residency: the (missed) opportunity of uncertainty. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:389-424. [PMID: 37393377 PMCID: PMC11078830 DOI: 10.1007/s10459-023-10241-y] [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: 07/08/2021] [Accepted: 05/07/2023] [Indexed: 07/03/2023]
Abstract
Preparing novice physicians for an unknown clinical future in healthcare is challenging. This is especially true for emergency departments (EDs) where the framework of adaptive expertise has gained traction. When medical graduates start residency in the ED, they must be supported in becoming adaptive experts. However, little is known about how residents can be supported in developing this adaptive expertise. This was a cognitive ethnographic study conducted at two Danish EDs. The data comprised 80 h of observations of 27 residents treating 32 geriatric patients. The purpose of this cognitive ethnographic study was to describe contextual factors that mediate how residents engage in adaptive practices when treating geriatric patients in the ED. Results showed that all residents fluidly engaged in both adaptive and routine practices, but they were challenged when engaging in adaptive practices in the face of uncertainty. Uncertainty was often observed when residents' workflows were disrupted. Furthermore, results highlighted how residents construed professional identity and how this affected their ability to shift between routine and adaptive practices. Residents reported that they thought that they were expected to perform on par with their more experienced physician colleagues. This negatively impacted their ability to tolerate uncertainty and hindered the performance of adaptive practices. Thus, aligning clinical uncertainty with the premises of clinical work, is imperative for residents to develop adaptive expertise.
Collapse
Affiliation(s)
- Maria Louise Gamborg
- Centre for Educational Development (CED), Aarhus University, Trøjborgvej 82-82, Dk-8000, Aarhus C, Denmark.
- MidtSim, Department of Clinical Medicine, Aarhus University, Hedeager 5, Dk-8200, Aarhus N, Denmark.
| | - Maria Mylopoulos
- The Wilson Centre, Faculty of Medicine, University of Toronto, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
| | - Mimi Mehlsen
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Bartholins Allé 11, Dk-8000, Aarhus C, Denmark
| | - Charlotte Paltved
- MidtSim, Department of Clinical Medicine, Aarhus University, Hedeager 5, Dk-8200, Aarhus N, Denmark
| | - Peter Musaeus
- Centre for Educational Development (CED), Aarhus University, Trøjborgvej 82-82, Dk-8000, Aarhus C, Denmark
| |
Collapse
|
4
|
Hess BJ, Cupido N, Ross S, Kvern B. Becoming adaptive experts in an era of rapid advances in generative artificial intelligence. MEDICAL TEACHER 2024; 46:300-303. [PMID: 38092006 DOI: 10.1080/0142159x.2023.2289844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/28/2023] [Indexed: 02/24/2024]
Affiliation(s)
- Brian J Hess
- College of Family Physicians of Canada, Department of Certification and Assessment, Mississauga, Ontario, Canada
| | - Nathan Cupido
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, and the Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shelley Ross
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Canada
| | - Brent Kvern
- College of Family Physicians of Canada, Department of Certification and Assessment, Mississauga, Ontario, Canada
| |
Collapse
|
5
|
Darici D, Flägel K, Sternecker K, Missler M. Transfer of learning in histology: Insights from a longitudinal study. ANATOMICAL SCIENCES EDUCATION 2024; 17:274-286. [PMID: 38158384 DOI: 10.1002/ase.2363] [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: 02/18/2023] [Revised: 10/30/2023] [Accepted: 11/19/2023] [Indexed: 01/03/2024]
Abstract
All anatomical educators hope that students apply past training to both similar and new tasks. This two-group longitudinal study investigated the development of such transfer of learning in a histology course. After 0, 10, and 20 sessions of the 10-week-long course, medical students completed theoretical tasks, examined histological slides trained in the course (retention task), and unfamiliar histological slides (transfer task). The results showed that students in the histology group gradually outperformed the control group in all tasks, especially in the second half of the course, η2 = 0.268 (p < 0.001). The best predictor of final transfer performance was students' retention performance after 10 sessions, β = 0.32 (p = 0.028), and theoretical knowledge after 20 sessions, β = 0.46 (p = 0.003). Results of eye tracking methodology further revealed that the histology group engaged in greater "visual activity" when solving transfer tasks, as indicated by an increase in the total fixation count, η2 = 0.103 (p = 0.014). This longitudinal study provides evidence that medical students can use what they learn in histology courses to solve unfamiliar problems but cautions that positive transfer effects develop relatively late in the course. Thus, course time and the complex relationship between theory, retention, and transfer holds critical implications for anatomical curricula seeking to foster the transfer of learning.
Collapse
Affiliation(s)
- Dogus Darici
- Institute of Anatomy and Molecular Neurobiology, University of Münster, Münster, Germany
| | - Kristina Flägel
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Katharina Sternecker
- Chair of Neuroanatomy, Institute of Anatomy, Faculty of Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus Missler
- Institute of Anatomy and Molecular Neurobiology, University of Münster, Münster, Germany
| |
Collapse
|
6
|
Maxwell S, Fuchs-Young R, Wells GB, Kapler G, Green S, Pepper C, Gastel B, Huston DP. Short-Term Training with Basic Science Research Literature Advances Medical Students' Skills for Adaptive Expertise. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241227328. [PMID: 38304279 PMCID: PMC10832445 DOI: 10.1177/23821205241227328] [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: 02/27/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
Physicians must adapt their learning and expertise to the rapid evolution of healthcare. To train for the innovation-efficient demands of adaptive expertise, medical students need to acquire the skill of adaptive self-regulated learning, which includes accessing, interpreting, and synthesizing emerging basic and translational research to support patient care. In response, we developed the course Medical Student Grand Rounds (MSGR). It engages all pre-clerkship students at our institution with self-regulated learning from translational basic research literature. In this report, we describe MSGR's methodology and important outcomes. Students found, interpreted, critically assessed, and presented basic research literature about self-selected clinically relevant topics. In less than one semester and mentored by basic science researchers, they completed eight milestones: (a) search research literature databases; (b) choose a clinical topic using searching skills; (c) outline the topic's background; (d) outline a presentation based on the topic's mechanistic research literature; (e) attend translational research-oriented grand rounds by faculty; (f) learn to prepare oral presentations; (g) write an abstract; and (h) present at Grand Rounds Day, emphasizing their topic's research literature. Graded milestones and end-of-course self-assessments indicated students became proficient in interpreting research articles, preparing and delivering presentations, understanding links among basic and translational research and clinical applications, and pursuing self-regulated learning. Qualitative analysis of self-assessment surveys found most students thought they progressed toward the learning objectives: find scientific information about a research topic (56% positive responses), interpret and critically assess scientific information (64%), and prepare and deliver a scientific presentation (50%). Milestones improve time management and provide a scaffolded method for presenting focused research topics. MSGR equips students with critical thinking skills for lifelong, adaptive, self-regulated learning-a foundation for adaptive expertise. The master adaptive learner cycle of planning, learning, assessing, and adjusting is a conceptual framework for understanding students' MSGR learning experiences.
Collapse
Affiliation(s)
- Steve Maxwell
- Department of Cell Biology and Genetics, Texas A&M University, Bryan, Texas, USA
| | - Robin Fuchs-Young
- Department of Cell Biology and Genetics, Texas A&M University, Bryan, Texas, USA
| | - Gregg B. Wells
- Department of Cell Biology and Genetics, Texas A&M University, Bryan, Texas, USA
| | - Geoffrey Kapler
- Department of Cell Biology and Genetics, Texas A&M University, Bryan, Texas, USA
| | - Sheila Green
- Medical Sciences Library, Texas A&M University, Bryan, Texas, USA
| | - Catherine Pepper
- Medical Sciences Library, Texas A&M University, Bryan, Texas, USA
| | - Barbara Gastel
- Department of Veterinary Integrative Biosciences, Texas A&M University, Bryan, Texas, USA
- Department of Humanities in Medicine, Texas A&M University, Bryan, Texas, USA
| | - David P. Huston
- Department of Microbial Pathogenesis and Immunology, Texas A&M University, Bryan, Texas, USA
- Clinical Science and Translational Research Program, Texas A&M University School of Medicine, Bryan, Texas, USA
| |
Collapse
|
7
|
McGaghie WC, Barsuk JH, Wayne DB, Issenberg SB. Powerful medical education improves health care quality and return on investment. MEDICAL TEACHER 2024; 46:46-58. [PMID: 37930940 DOI: 10.1080/0142159x.2023.2276038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
INTRODUCTION Powerful medical education (PME) involves the use of new technologies informed by the science of expertise that are embedded in laboratories and organizations that value evidence-based education and support innovation. This contrasts with traditional medical education that relies on a dated apprenticeship model that yields uneven results. PME involves an amalgam of features, conditions and assumptions, and contextual variables that comprise an approach to developing clinical competence grounded in education impact metrics including efficiency and cost-effectiveness. METHODS This article is a narrative review based on SANRA criteria and informed by realist review principles. The review addresses the PME model with an emphasis on mastery learning and deliberate practice principles drawn from the new science of expertise. Pub Med, Scopus, and Web of Science search terms include medical education, the science of expertise, mastery learning, translational outcomes, cost effectiveness, and return on investment. Literature coverage is comprehensive with selective citations. RESULTS PME is described as an integrated set of twelve features embedded in a group of seven conditions and assumptions and four context variables. PME is illustrated via case examples that demonstrate improved ventilator patient management learning outcomes compared to traditional clinical education and mastery learning of breaking bad news communication skills. Evidence also shows that PME of physicians and other health care providers can have translational, downstream effects on patient care practices, patient outcomes, and return on investment. Several translational health care quality improvements that derive from PME include reduced infections; better communication among physicians, patients, and families; exceptional birth outcomes; more effective patient education; and return on investment. CONCLUSIONS The article concludes with challenges to hospitals, health systems, and medical education organizations that are responsible for producing physicians who are expected to deliver safe, effective, and cost-conscious health care.
Collapse
Affiliation(s)
- William C McGaghie
- Departments of Medical Education and Preventive Medicine and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeffrey H Barsuk
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diane B Wayne
- Departments of Medicine and Medical Education and Northwestern Simulation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - S Barry Issenberg
- Departments of Medicine and Medical Education and the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
8
|
Stoffels M, Koster AS, van der Burgt SME, de Bruin ABH, Daelmans HEM, Peerdeman SM, Kusurkar RA. Basic psychological needs satisfaction as a mediator between clinical learning climate, self-regulated learning and perceived learning in the nursing education context. MEDICAL TEACHER 2023; 45:1364-1372. [PMID: 37339482 DOI: 10.1080/0142159x.2023.2225729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE Self-regulated learning (SRL) can enhance students' learning process. Students need support to effectively regulate their learning. However, the effect of learning climate on SRL behavior, its ultimate effect on learning and the underlying mechanisms have not yet been established. We explored these relationships using self-determination theory. MATERIALS AND METHODS Nursing students (N = 244) filled in questionnaires about SRL behavior, perceived learning, perceived pedagogical atmosphere and Basic Psychological Needs (BPN) satisfaction after their clinical placement. Structural equation modelling was used to test a model in which perceived pedagogical atmosphere affects SRL behavior and subsequent perceived learning through BPN satisfaction. RESULTS The tested model had an adequate fit (RMSEA = 0.080, SRMR = 0.051; CFI = 0.972; TLI = 0.950). A positively perceived pedagogical atmosphere contributed to SRL behavior, which was fully explained by BPN satisfaction. SRL partially mediated the contribution of pedagogical atmosphere/BPN to perceived learning. CONCLUSIONS A learning climate that satisfies students' BPN contributes to their SRL behavior. SRL behavior plays a positive but modest role in the relationship between climate and perceived learning. Without a culture that is supportive of learning, implementation of tools to apply SRL behavior may not be effective. Study limitations include reliance on self-report scales and the inclusion of a single discipline.
Collapse
Affiliation(s)
- Malou Stoffels
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, VUmc Amstel Academy, Institute for Education and Training, Amsterdam, The Netherlands
- Faculty of Psychology and Education, LEARN! Research Institute for Learning and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andries S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Stephanie M E van der Burgt
- Teaching and Learning Centre Faculty of Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anique B H de Bruin
- Department of Educational Development & Research and School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Hester E M Daelmans
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Skills Training, Faculty of Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia M Peerdeman
- Teaching and Learning Centre Faculty of Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Neurosurgery, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Research in Education, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Faculty of Psychology and Education, LEARN! Research Institute for Learning and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Agrawal S, Law S, Levy M, Williams L, Mylopoulos M. Using Case-Based Learning in Residency to Support the Development of Adaptive Expertise in Working with People Living with Severe Mental Illness. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:535-539. [PMID: 35698021 PMCID: PMC9191753 DOI: 10.1007/s40596-022-01668-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Sacha Agrawal
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Samuel Law
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Matthew Levy
- St. Michael's Hospital, Toronto, Ontario, Canada
| | - Laura Williams
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | |
Collapse
|
10
|
Diaz BA, Rieker J, Ng S. Teaching critical reflection in health professions education with transformative-vygotskian praxis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1191-1204. [PMID: 36890283 DOI: 10.1007/s10459-023-10209-y] [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: 11/17/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
Reflective practice is a complex concept to adequately describe, communicate about and, ultimately, teach. Unrelieved tensions about the concept persist within the health professions education (HPE) literature owing to reflection's diverse theoretical history. Tensions extend from the most basic, e.g., what is reflection and what are its contents, to the complex, e.g., how is reflection performed and whether it should be evaluated. Nonetheless, reflection is generally seen as vital to HPE, because it imparts crucial strategies and awareness to learners in their professional practices. In this article, we explore both conceptual and pedagogical dimensions of teaching for reflection. We address the concept of reflection, its application to practice, and how to remain faithful to transformative, critical pedagogy when teaching for it. We present (a) an analysis of two theories of education in HPE: Transformative Learning and Vygotskian Cultural Historical Theory. We (b) outline a pedagogical approach that applies Piotr Gal'perin's SCOBA: schema for the complete orienting basis of an action. We then employ (a) and (b) to provide affordances for developing materials for educational interventions across HPE contexts.
Collapse
Affiliation(s)
- Brett A Diaz
- Centre for Faculty Development, Li Ka Shing International Healthcare, Education Centre, St. Michael's Hospital, 209 Victoria Street, 4th floor, Toronto, ON, Canada.
- The Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada.
| | - Jacob Rieker
- Department of Applied Linguistics, The Pennsylvania State University, University Park, USA
| | - Stella Ng
- The Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for Advancing Collaborative Healthcare & Education at University Health Network, Toronto Western Hospital, Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
11
|
Clarke SO, Ilgen JS, Regehr G. Fostering Adaptive Expertise Through Simulation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:994-1001. [PMID: 37094295 DOI: 10.1097/acm.0000000000005257] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Technology-enhanced simulation has been used to tackle myriad challenges within health professions education. Recently, work has typically adopted a mastery learning orientation that emphasizes trainees' sequential mastery of increasingly complex material. Doing so has privileged a focus on performance and task completion, as captured by trainees' observable behaviors and actions. Designing simulation in these ways has provided important advances to education, clinical care, and patient safety, yet also placed constraints around how simulation-based activities were enacted and learning outcomes were measured. In tracing the contemporary manifestations of simulation in health professions education, this article highlights several unintended consequences of this performance orientation and draws from principles of adaptive expertise to suggest new directions. Instructional approaches grounded in adaptive expertise in other contexts suggest that uncertainty, struggle, invention, and even failure help learners to develop deeper conceptual understanding and learn innovative approaches to novel problems. Adaptive expertise provides a new lens for simulation designers to think intentionally around how idiosyncrasy, individuality, and inventiveness could be enacted as central design principles, providing learners with opportunities to practice and receive feedback around the kinds of complex problems they are likely to encounter in practice. Fostering the growth of adaptive expertise through simulation will require a fundamental reimagining of the design of simulation scenarios, embracing the power of uncertainty and ill-defined problem spaces, and focusing on the structure and pedagogical stance of debriefing. Such an approach may reveal untapped potential within health care simulation.
Collapse
Affiliation(s)
- Samuel O Clarke
- S.O. Clarke is associate professor, Department of Emergency Medicine, University of California, Davis, Sacramento, California; ORCID: https://orcid.org/my-orcid?orcid=0000-0003-3762-1727
| | - Jonathan S Ilgen
- J.S. Ilgen is professor, Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington; ORCID: https://orcid.org/0000-0003-4590-6570
| | - Glenn Regehr
- G. Regehr is professor, Department of Surgery, and senior scientist, Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: https://orcid.org/0000-0002-3144-331X
| |
Collapse
|
12
|
Verheijden M, Giroldi E, van den Eertwegh V, Luijkx M, van der Weijden T, de Bruin A, Timmerman A. Identifying characteristics of a skilled communicator in the clinical encounter. MEDICAL EDUCATION 2023; 57:418-429. [PMID: 36223270 DOI: 10.1111/medu.14953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/21/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In medical communication research, there has been a shift from 'communication skills' towards 'skilled communication', the latter implying the development of flexibility and creativity to tailor communication to authentic clinical situations. However, a lack of consensus currently exists what skilled communication entails. This study therefore aims to identify characteristics of a skilled communicator, hereby contributing to theory building in communication research and informing medical training. METHOD In 2020, six nominal group technique (NGT) sessions were conducted in the context of the general practitioner (GP) training programme engaging 34 stakeholders (i.e. GPs, GP residents, faculty members and researchers) based on their experience and expertise in doctor-patient communication. Participants in each NGT session rank-ordered a 'Top 7' of characteristics of a skilled communicator. The output of the NGT sessions was analysed using mixed methods, including descriptive statistics and thematic content analysis during an iterative process. RESULTS Rankings of the six sessions consisted of 191 items in total, which were organised into 41 clusters. Thematic content analysis of the identified 41 clusters revealed nine themes describing characteristics of a skilled communicator: (A) being sensitive and adapting to the patient; (B) being proficient in applying interpersonal communication; (C) self-awareness, learning ability and reflective capacity; (D) being genuinely interested; (E) being proficient in applying patient-centred communication; (F) goal-oriented communication; (G) being authentic; (H) active listening; and (I) collaborating with the patient. CONCLUSIONS We conceptualise a skilled communication approach based on the identified characteristics in the present study to support learning in medical training. In a conceptual model, two parallel processes are key in developing adaptive expertise in communication: (1) being sensitive and adapting communication to the patient and (2) monitoring communication performance in terms of self-awareness and reflective capacity. The identified characteristics and the conceptual model provide a base to develop a learner-centred programme, facilitating repeated practice and reflection. Further research should investigate how learners can be optimally supported in becoming skilled communicators during workplace learning.
Collapse
Affiliation(s)
- Michelle Verheijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Valerie van den Eertwegh
- Skillslab, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marscha Luijkx
- Department of Family Medicine, School for Public Health and Primary Care, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Anique de Bruin
- Department of Educational Development and Research, School of Health Professions Educations (SHE), Maastricht University, Maastricht, The Netherlands
| | - Angelique Timmerman
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
13
|
Betinol E, Murphy S, Regehr G. Exploring the development of adaptive expertise through the lens of threshold concepts. MEDICAL EDUCATION 2023; 57:142-150. [PMID: 35918846 DOI: 10.1111/medu.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION While expert clinical practice requires a flexible approach to problem solving, evidence shows that medical clerks tend to focus on knowledge acquisition as the key to expertise. It is not until residency training that learners shift their understanding of expertise towards developing adaptive approaches to clinical problems. This raises the possibility that adaptive expertise is a threshold concept and that authentic clinical experiences involving complex problem solving are required to create the liminal state that enables transformation to an adaptive expertise mindset. With this possibility in mind, the current study examined the conceptualisations of expertise held by recently graduated physical therapists using the framework of threshold concepts as a sensitising lens. METHODS An exploratory qualitative study in the Constructivist Grounded Theory tradition was conducted, utilising 14 one-on-one semi-structured interviews with recently graduated physical therapists. RESULTS Most participants were in a transitional state regarding their conceptualisation of expertise, sometimes focusing on the acquisition of knowledge and routinisation of practice as their hallmark of expertise and at other times acknowledging the need for developing more dynamic and adaptive problem-solving approaches to patient care. These mixed responses were expressed not only in their framing of patient management but also in their reasons for valuing colleagues and in their approach to continuing professional development. Notably, many participants suggested that the interview itself was a key impetus to their reflecting on these issues. CONCLUSION Our findings suggest that participants were only beginning to transition into an adaptive expertise mindset upon entering practice, reinforcing the possibility that authentic practice may be an important impetus for recognising the limits of routine expertise. However, spontaneous comments from participants suggest that this transition might be better supported though active guided reflection in addition to meaningful clinical engagement with patients and colleagues.
Collapse
Affiliation(s)
- Edwin Betinol
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sue Murphy
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenn Regehr
- Department of Surgery and Centre for Health Education Scholarship, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
14
|
Jones H, Hammond L. The journey not the destination: Liminality and lifelong learning. MEDICAL EDUCATION 2023; 57:115-117. [PMID: 36259258 PMCID: PMC10092856 DOI: 10.1111/medu.14956] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
If we are to treat adaptive expertise as a threshold concept, the authors argue we must consider it a journey rather than a destination, requiring learners to respond to novel situations in innovative ways.
Collapse
Affiliation(s)
- Helen Jones
- Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Lucy Hammond
- Warwick Medical SchoolUniversity of WarwickCoventryUK
| |
Collapse
|
15
|
Gamborg ML, Mehlsen M, Paltved C, Vetter SS, Musaeus P. Clinical decision-making and adaptive expertise in residency: a think-aloud study. BMC MEDICAL EDUCATION 2023; 23:22. [PMID: 36635669 PMCID: PMC9835279 DOI: 10.1186/s12909-022-03990-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Clinical decision-making (CDM) is the ability to make clinical choices based on the knowledge and information available to the physician. It often refers to individual cognitive processes that becomes more dependent with the acquisition of experience and knowledge. Previous research has used dual-process theory to explain the cognitive processes involved in how physicians acquire experiences that help them develop CDM. However, less is known about how CDM is shaped by the physicians' situated cognition in the clinical environment. This is especially challenging for novice physicians, as they need to be adaptive to compensate for the lack of experience. The adaptive expert framework has been used to explain how novice physicians learn, but it has not yet been explored, how adaptive expertise is linked to clinical decision-making amongst novice physicians.This study aimed to analyse how residents utilize and develop adaptive expert cognition in a natural setting. By describing cognitive processes through verbalization of thought processes, we sought to explore their CDM strategies considering the adaptive expert framework.We used concurrent and retrospective think-aloud interviews in a natural setting of an emergency department (ED) at a university hospital, to query residents about their reasoning during a patient encounter. We analysed data using protocol analysis to map cognitive strategies from these verbalizations. Subsequently in a narrative analysis, we compared these strategies with the literature on adaptive expertise.Fourteen interviews were audio recorded over the course for 17 h of observation. We coded 78 informational concepts and 46 cognitive processes. The narrative analysis demonstrated how epistemic distance was prevalent in the initial CDM process and self-regulating processes occurred during hypothesis testing. However, residents who too quickly moved on to hypothesis testing tended to have to redirect their hypothesis more often, and thus be more laborious in their CDM. Uncertainty affected physicians' CDM when they did not reconcile their professional role with being allowed to be uncertain. This allowance is an important feature of orientation to new knowledge as it facilitates the evaluation of what the physician does not know.For the resident to learn to act as an adaptive decision-maker, she relied on contextual support. The professional role was crucial in decisional competency. This supports current literature, which argues that role clarification helps decisional competency. This study adds that promoting professional development by tolerating uncertainty may improve adaptive decisional competency.
Collapse
Affiliation(s)
- Maria Louise Gamborg
- Centre for Educational Development, Aarhus University, Aarhus C, Denmark.
- Coporate HR MidtSim & Department of Clinical Medicine, Faculty of Health, Aarhus University, Central Denmark Region, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark.
| | - Mimi Mehlsen
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Bartholins Allé 11, 8000, Aarhus C, Denmark
| | - Charlotte Paltved
- Coporate HR MidtSim & Department of Clinical Medicine, Faculty of Health, Aarhus University, Central Denmark Region, Palle Juul-Jensens Boulevard 82, DK-8200, Aarhus N, Denmark
| | - Sigrid Strunge Vetter
- Department of Psychology, Faculty of Business and Social Sciences, Aarhus University, Bartholins Allé 11, 8000, Aarhus C, Denmark
| | - Peter Musaeus
- Centre for Educational Development, Aarhus University, Aarhus C, Denmark
| |
Collapse
|
16
|
Cupido N, Ross S, Lawrence K, Bethune C, Fowler N, Hess B, van der Goes T, Schultz K. Making sense of adaptive expertise for frontline clinical educators: a scoping review of definitions and strategies. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1213-1243. [PMID: 36302908 DOI: 10.1007/s10459-022-10176-w] [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: 05/01/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Adaptive expertise has been promoted as an emerging model of expertise in health professions education in response to the inherent complexities of patient care; however, as the concept increasingly influences the structure of professional training and practice, it creates the potential for misunderstandings of the definition and implications of adaptive expertise. To foster a common understanding of the concept, we conducted a scoping review to explore how adaptive expertise has been discussed within health professions education literature. Five databases-MedLine, PubMed, ERIC, CINAHL, and PsycINFO-were searched using the exact term "adaptive expertise", producing 212 unique articles. Fifty-eight articles met inclusion criteria. In the included articles, authors discussed the conceptual implications of adaptive expertise for health professions education, strategies for training for adaptive expertise, and research findings aimed at supporting the development of adaptive expertise or utilizing adaptive expertise as a theoretical framework. The goal of this scoping review is to establish a resource for frontline educators tasked with fostering the development of adaptive expertise in learners through education initiatives. A common understanding of adaptive expertise is essential to ensuring effective implementation in training programs.
Collapse
Affiliation(s)
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada.
| | | | - Cheri Bethune
- Northern Ontario School of Medicine, Sudbury, Canada
| | - Nancy Fowler
- College of Family Physicians of Canada, Mississauga, Canada
| | - Brian Hess
- College of Family Physicians of Canada, Mississauga, Canada
| | | | | |
Collapse
|
17
|
Pelgrim E, Hissink E, Bus L, van der Schaaf M, Nieuwenhuis L, van Tartwijk J, Kuijer-Siebelink W. Professionals' adaptive expertise and adaptive performance in educational and workplace settings: an overview of reviews. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1245-1263. [PMID: 36508136 PMCID: PMC9859848 DOI: 10.1007/s10459-022-10190-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Professionals will increasingly be confronted with new insights and changes. This raises questions as to what kind of expertise professionals need, and how development of this expertise can be influenced within the contexts of both education and work. The terms adaptive expertise and adaptive performance are well-known concepts in the domains of education and Human Resource Development respectively. The literature, however, lacks a conceptual overview. Our research seeks to provide an overview on how adaptive expertise and adaptive performance are conceptualized. In addition we looked for what individual, task and organizational characteristics relate to adaptive expertise. We mined information drawn from existing reviews in an overview of reviews. Nine reviews met the inclusion criteria. Adaptive performance is best referred to as the visible expression of an adaptive expert and this is triggered by 'change'. The scope of this 'change' lies somewhere between change that is 'new for the learner' and change that is 'new for everyone in the whole world'. The extent to and way in which a learner or professional is able to deal with this change depends on the maturity of the learner or professional. We found numerous individual, task and environmental characteristics related to adaptive expertise and adaptive performance. The nature and relation of these characteristics, and their specificity in relation to adaptive expertise and adaptive performance are visualized in a figure, but also provide several suggestions for future research.
Collapse
Affiliation(s)
- Els Pelgrim
- Learning and Innovation Centre, Avans University of Applied Sciences, Breda, The Netherlands
| | - Elske Hissink
- Department of Research on Learning and Education, Radboud University Medical Center, Radboudumc Health Academy, Philips van Leydenlaan 25, 6525 EX NIJMEGEN, Nijmegen, The Netherlands.
| | - Lotte Bus
- School of Education, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Marieke van der Schaaf
- Utrecht Center for Research and Development of Health Professions Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Loek Nieuwenhuis
- School of Education, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Jan van Tartwijk
- Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wietske Kuijer-Siebelink
- Department of Research on Learning and Education, Radboud University Medical Center, Radboudumc Health Academy, Philips van Leydenlaan 25, 6525 EX NIJMEGEN, Nijmegen, The Netherlands
- School of Education, HAN University of Applied Sciences, Nijmegen, The Netherlands
| |
Collapse
|
18
|
Pusic MV, Hall E, Billings H, Branzetti J, Hopson LR, Regan L, Gisondi MA, Cutrer WB. Educating for adaptive expertise: case examples along the medical education continuum. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1383-1400. [PMID: 36414880 DOI: 10.1007/s10459-022-10165-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Adaptive expertise represents the combination of both efficient problem-solving for clinical encounters with known solutions, as well as the ability to learn and innovate when faced with a novel challenge. Fostering adaptive expertise requires careful approaches to instructional design to emphasize deeper, more effortful learning. These teaching strategies are time-intensive, effortful, and challenging to implement in health professions education curricula. The authors are educators whose missions encompass the medical education continuum, from undergraduate through to organizational learning. Each has grappled with how to promote adaptive expertise development in their context. They describe themes drawn from educational experiences at these various learner levels to illustrate strategies that may be used to cultivate adaptive expertise.At Vanderbilt University School of Medicine, a restructuring of the medical school curriculum provided multiple opportunities to use specific curricular strategies to foster adaptive expertise development. The advantage for students in terms of future learning had to be rationalized against assessments that are more short-term in nature. In a consortium of emergency medicine residency programs, a diversity of instructional approaches was deployed to foster adaptive expertise within complex clinical learning environments. Here the value of adaptive expertise approaches must be balanced with the efficiency imperative in clinical care. At Mayo Clinic, an existing continuous professional development program was used to orient the entire organization towards an adaptive expertise mindset, with each individual making a contribution to the shift.The different contexts illustrate both the flexibility of the adaptive expertise conceptualization and the need to customize the educational approach to the developmental stage of the learner. In particular, an important benefit of teaching to adaptive expertise is the opportunity to influence individual professional identity formation to ensure that clinicians of the future value deeper, more effortful learning strategies throughout their careers.
Collapse
Affiliation(s)
- Martin V Pusic
- Division of Pediatric Emergency Medicine, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, CH3306, USA.
| | - Elissa Hall
- Learning and Technology Innovation, Education Science, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Heather Billings
- Academy of Educational Excellence, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Laura R Hopson
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Linda Regan
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gisondi
- The Precision Education and Assessment Research Lab, Department of Emergency Medicine, Stanford School of Medicine, Palo Alto, CA, USA
| | - William B Cutrer
- Undergraduate Medical Education, Vanderbilt University School of Medicine, Nashville, TN, USA
| |
Collapse
|
19
|
Kua J, Teo W, Lim WS. Learning experiences of adaptive experts: a reflexive thematic analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1345-1359. [PMID: 36626011 PMCID: PMC9859887 DOI: 10.1007/s10459-022-10166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/15/2022] [Indexed: 06/17/2023]
Abstract
Whilst adaptive experts have well-researched beliefs and attitudes towards learning, what is unclear are the interactions that occur within the learning environment that constitute their learning experiences. The practice of geriatric medicine emphasises the interdisciplinary care of complex frail older adults. Our study sets out to understand the learning experiences of adaptive experts in geriatric medicine by examining how interactions at the intra-personal, inter-personal and organisational levels contributed to the development of adaptive expertise. We conducted an exploratory qualitative study through semi-structured interviews of 16 geriatricians experts from a tertiary hospital in Singapore. Data were analyzed via reflexive thematic analysis. The core essence of the learning experiences was described as a journey of 'knowing when we do not know', which was characterised by three themes: (i) Anchoring ethos of person-centric care where the experts drew upon their values to develop a holistic view of the patient beyond the medical domain, (ii) Enabling stance of being curious where their curiosity and openness to learning was nurtured through the practice of reflection, and with the benefit of time as a commodity and for development of expertise, and (iii) Scaffolding organisational culture of inquiry where an environment that is supportive of learning is built on the culture of psychological safety and the culture of mentoring. Taken together, our study highlighted the importance of interactions at the intra-personal, inter-personal and organisational levels in the learning experiences of adaptive experts.
Collapse
Affiliation(s)
- Joanne Kua
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Winnie Teo
- Group Education, National Healthcare Group, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| |
Collapse
|
20
|
Gamborg ML, Jensen RD, Musaeus P, Mylopoulos M. Balancing closure and discovery: adaptive expertise in the workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1317-1330. [PMID: 36418756 DOI: 10.1007/s10459-022-10177-9] [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: 05/14/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Residents must develop knowledge, skills, and attitudes to handle a rapidly developing clinical environment. To address this need, adaptive expertise has been suggested as an important framework for health professions education. However, research has yet to explore the relationship between workplace learning and adaptive expertise. This study sought to investigate how clinical supervision might support the development of adaptive expertise. The present study used a focused ethnography in two emergency departments. We observed 75 supervising situations with the 27 residents resulting in 116 pages of field notes. The majority of supervision was provided by senior physicians, but also included other healthcare professionals. We found that supervision could serve two purposes: closure and discovery. Supervision aimed at discovery included practices that reflected instructional approaches said to promote adaptive expertise, such as productive struggle. Supervision aimed at closure-included practices with instructional approaches deemed important for efficient and safe patient care, such as verifying information. Our results suggest that supervision is a shared practice and responsibility. We argue that setting and aligning expectations before engaging in supervision is important. Furthermore, results demonstrated that supervision was a dynamic process, shifting between both orientations, and that supervision aimed at discovery could be an an appropriate mode of supervision, even in the most demanding clinical situations.
Collapse
Affiliation(s)
- Maria Louise Gamborg
- Centre for Educational Development (CED), Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C., Denmark.
- MidtSim, Central Denmark Region, Aarhus, Denmark.
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N., Denmark.
| | - Rune Dall Jensen
- MidtSim, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N., Denmark
| | - Peter Musaeus
- Centre for Educational Development (CED), Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C., Denmark
| | - Maria Mylopoulos
- The Wilson Centre, Faculty of Medicine, University of Toronto, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
| |
Collapse
|
21
|
Archer RM. Expert Veterinarians Should Be Trained Expertly: Fostering the Development of Adaptive Expertise in Veterinary Students through Faculty Development for Veterinary Educators. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 50:e20220018. [PMID: 36036570 DOI: 10.3138/jvme-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The field of health professions education is rapidly evolving, and with it the field of veterinary education. This discussion piece amalgamates literature across health professions education to provide a picture of what a veterinary clinician-educator is, why there is a need for veterinary clinician-educators when developing learners with adaptive expertise, and how faculty development can support the growth of clinicians into clinician-educators. It is intended to outline the best practices for fostering the development of adaptive expertise in veterinary students through faculty development for veterinary educators.
Collapse
|
22
|
Branzetti J, Gisondi MA, Hopson LR, Regan L. Adaptive expertise: The optimal outcome of emergency medicine training. AEM EDUCATION AND TRAINING 2022; 6:e10731. [PMID: 35368500 PMCID: PMC8908303 DOI: 10.1002/aet2.10731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/08/2022] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | - Michael A. Gisondi
- Department of Emergency MedicinePrecision Education and Assessment Research LabStanford University School of MedicineStanfordCaliforniaUSA
| | - Laura R. Hopson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| |
Collapse
|
23
|
Lee KJ. Adaptive expertise, career adaptability, and career success of R&D personnel. TECHNOLOGY ANALYSIS & STRATEGIC MANAGEMENT 2022. [DOI: 10.1080/09537325.2022.2053517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kyoung-Joo, Lee
- College of Social Science, Gachon University, Seongnam-City, Gyeonggi-do, Republic of Korea
| |
Collapse
|
24
|
Regan L, Hopson LR, Gisondi MA, Branzetti J. Creating a better learning environment: a qualitative study uncovering the experiences of Master Adaptive Learners in residency. BMC MEDICAL EDUCATION 2022; 22:141. [PMID: 35241060 PMCID: PMC8895544 DOI: 10.1186/s12909-022-03200-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Adaptive expertise is an important physician skill, and the Master Adaptive Learner (MAL) conceptual model describes learner skills and behaviors integral to the acquisition of adaptive expertise. The learning environment is postulated to significantly impact how MALs learn, but it is unclear how these successful learners experience and interact with it. This study sought to understand the authentic experience of MALs within the learning environment and translate those experiences into practical recommendations to improve the learning environment for all trainees. METHODS Following a constructivist paradigm, we conducted a thematic analysis of transcripts from focus groups composed of MALs to identify commonalities in experiences and practices of successful postgraduate trainees in the learning environment. Saturation was achieved after seven focus groups, consisting of thirty-eight participants representing fourteen specialties from four institutions. Researchers coded transcripts using constant comparison analysis, which served as the foundation for our thematic analysis. RESULTS We identified eight themes and situated them within a 4-component model of the learning environment. Four themes were identified within the personal component: (1) patients drive learning; (2) learning has no endpoint; (3) management of emotions is crucial for learning; (4) successful learning requires a structured approach. Two themes were identified in the social component: (5) positive social relationships are leveraged to maximize learning; (6) teaching facilitates personal learning. Two themes were identified in the organizational component: (7) transitions challenge learners to adapt; (8) the learning environment dictates goal setting strategy. No major themes were identified in the physical/virtual component, although participants frequently used technology when learning. CONCLUSIONS Master Adaptive Learners experience similar facilitators of, and barriers to, success in the learning environment. Overall, our data show that acquisition of many successful strategies and skills that support learning are relegated to the hidden curriculum of residency training. Educators could support a more effective learning environment for all trainees by: (1) highlighting patients as the focal point of learning, (2) building a professional 'learner' identity, (3) teaching learning skills, and (4) creating opportunities for collaborative learning.
Collapse
Affiliation(s)
- Linda Regan
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21093, USA.
| | - Laura R Hopson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeremy Branzetti
- Department of Emergency Medicine, New York University School of Medicine, New York City, NY, USA
| |
Collapse
|
25
|
Steinert Y, Irby DM, Dolmans D. Reframing faculty development practice and research through the lens of adaptive expertise. MEDICAL TEACHER 2021; 43:865-867. [PMID: 34078230 DOI: 10.1080/0142159x.2021.1931081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine & Health Sciences, McGill University, Montreal, Canada
| | - David M Irby
- Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Diana Dolmans
- Department of Educational Development and Research, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
| |
Collapse
|