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Taylor AWR, Anderson ES, Gay S. 'It's a gamble': A phenomenological exploration of medical students' learning experiences as newcomers to clinical communities of practice. CLINICAL TEACHER 2024; 21:e13708. [PMID: 38058032 DOI: 10.1111/tct.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Medical students become members of the clinical team through participation in their activities, as described by Lave and Wenger's situated learning theory. While there is research into how medical students cognitively engage in clinical learning, there is limited work on clinical experiences using a social theoretical lens such as situated learning theory. METHOD This study explored third year medical students' lived experience as newcomers to clinical teams using a qualitative phenomenological approach. Medical students completed in-depth, semi-structured interviews in 2021. Interpretive phenomenological analysis (IPA) using Lave and Wenger's theory of situated learning was applied to understand students' experiences. RESULTS Seven students discussed their variable placement experiences. Learning related to three elements: conditions for participation, modes of participation and products of participation. When certain conditions were met relating to student, clinician and activity, students learned. This drove identity and relationship formation. The findings related and led to a self-perpetuating cycle with potential to advance student learning. When the conditions for participation were not met, the cycle stopped, leading to student disengagement. CONCLUSION Passivity in students is a result of modifiable factors in the workplace. To encourage proactivity, clinicians must enable students to move from observation to participation as their competence increases. Participation should be supervised, challenging and should contribute to patient care. Time pressures can make this difficult; one solution is to nominate a clinician to direct students and account for this in their workload or to employ a clinical fellow to assist with student training.
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Affiliation(s)
| | | | - Simon Gay
- University of Leicester School of Medicine, Leicester, UK
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Kirtchuk L, Markless S. Communities of practice: A theoretical framework for undergraduate longitudinal placements. CLINICAL TEACHER 2024; 21:e13692. [PMID: 37957816 DOI: 10.1111/tct.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND There has been a global shift towards longitudinal placements in undergraduate medicine, which are believed to play an important role in supporting medical student learning and professional identity formation. A better understanding of how learning occurs on such placements is needed, and community of practice (CoP), a social learning theory, has been proposed to form their pedagogical foundations. However, empirical research exploring learning through CoPs on longitudinal placements is limited. METHODS Case study methodology triangulating data from interviews, written reflections and routine evaluations was undertaken to explore how second-year students on an undergraduate longitudinal General Practice placement participated within CoPs and the factors enabling this participation. FINDINGS Routine evaluation data were available for 57% (n239) of students and in-depth interviews were carried out with five students and three tutors across eight placements. Themes identified through inductive thematic analysis were (i) participation within CoPs, (ii) enablers of legitimate peripheral participation and (iii) socialising agents. Student legitimate peripheral participation was greatly facilitated by making contributions to patient care, a welcoming clinical environment, access to the informal spaces and repertoires of the practice and effective brokerage of educational activities by tutors. DISCUSSION CoP is a theory that allows us to make tangible the somewhat abstract when deepening our understanding of how students learn on longitudinal placements. The extent to which students become legitimate peripheral participants varies, and this theoretical framework allows us to consider the factors that can enable such participation, with implications for how educators design curricula and placement infrastructure.
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Affiliation(s)
- Liza Kirtchuk
- King's Undergraduate Medical Education in the Community, Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sharon Markless
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
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Green E, Quilliam C, Sheepway L, Hays CA, Moore L, Rasiah RL, Bailie J, Howard C, Hyde S, Inyang I, Matthews K, Ferns J, Brown LJ, Jones S, Collett M. Identifying features of quality in rural placements for health students: scoping review. BMJ Open 2022; 12:e057074. [PMID: 35396299 PMCID: PMC8995951 DOI: 10.1136/bmjopen-2021-057074] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore and synthesise the evidence relating to features of quality in rural health student placements. DESIGN Scoping review. DATA SOURCES MEDLINE, CINAHL, Embase, ProQuest, Informit, Scopus, ERIC and several grey literature data sources (1 January 2005 to 13 October 2020). STUDY SELECTION The review included peer-reviewed and grey literature from Organisation for Economic Co-operation and Development listed countries that focused on quality of health student placements in regional, rural and remote areas. DATA EXTRACTION Data were extracted regarding the methodological and design characteristics of each data source, and the features suggested to contribute to student placement quality under five categories based on a work-integrated learning framework. RESULTS Of 2866 resulting papers, 101 were included for data charting and content analysis. The literature was dominated by medicine and nursing student placement research. No literature explicitly defined quality in rural health student placements, although proxy indicators for quality such as satisfaction, positive experiences, overall effectiveness and perceived value were identified. Content analysis resulted in four overarching domains pertaining to features of rural health student placement quality: (1) learning and teaching in a rural context, (2) rural student placement characteristics, (3) key relationships and (4) required infrastructure. CONCLUSION The findings suggest that quality in rural health student placements hinges on contextually specific features. Further research is required to explore these findings and ways in which these features can be measured during rural health student placements.
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Affiliation(s)
- Elyce Green
- Three Rivers University Department of Rural Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Claire Quilliam
- Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Lyndal Sheepway
- La Trobe Rural Health School, La Trobe University, Wodonga, Victoria, Australia
| | - Catherine A Hays
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - Leigh Moore
- Rural and Remote Health, Flinders University, Darwin, Northern Territory, Australia
| | - Rohan L Rasiah
- Western Australian Centre for Rural Health, The University of Western Australia, Karratha, Western Australia, Australia
| | - Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Lismore, New South Wales, Australia
| | - Christine Howard
- Three Rivers University Department of Rural Health, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Sarah Hyde
- Joint Program in Medicine School of Rural Medicine, Charles Sturt University, Orange, New South Wales, Australia
| | - Imo Inyang
- Centre for Rural Health, University of Tasmania, Launceston, Tasmania, Australia
| | - Kylie Matthews
- Majarlin Kimberley Centre for Remote Health, The University of Notre Dame, Broome, Western Australia, Australia
| | - Jane Ferns
- Department of Rural Health, The University of Newcastle, Taree, New South Wales, Australia
| | - Leanne J Brown
- Department of Rural Health, The University of Newcastle, Taree, New South Wales, Australia
| | - Sara Jones
- Department of Rural Health, University of South Australia, Whyalla, South Australia, Australia
| | - Marjorie Collett
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, Western Australia, Australia
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Richards E, Elliott L, Jackson B, Panesar A. Longitudinal integrated clerkship evaluations in UK medical schools: a narrative literature review. EDUCATION FOR PRIMARY CARE 2022; 33:148-155. [PMID: 35105274 DOI: 10.1080/14739879.2021.2021809] [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: 10/19/2022]
Abstract
PURPOSE Longitudinal Integrated Clerkships (LICs) are a recognised model of curriculum design used internationally as an alternative to traditional block rotations in medical schools that have been shown to offer a multitude of educational benefits. As a relatively new development in the United Kingdom (UK), it is not yet clear whether these benefits will translate into a UK healthcare context. This article provides an early review of evaluations of UK LIC programmes. METHODS A narrative literature review of LIC programme evaluations in UK medical schools. RESULTS UK students and faculty found value in the LIC programmes with reported benefits including continuity of relationships, increased responsibility and purpose for students, a patient-centred approach and development of professional skills. However, students and GP tutors expressed initial anxieties adapting to the newness of the programme design and preparedness for exams. CONCLUSIONS UK LIC programmes appear to be offering benefits for UK medical students and faculty members including personal and professional development in line with international literature. However, the current data is limited with significant gaps that need addressing for the impacts to be fully realised.
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Affiliation(s)
| | - L Elliott
- School of Primary Care, Yorkshire and Humber, UK
| | - B Jackson
- University of Sheffield, Sheffield, UK
| | - A Panesar
- University of Sheffield, Sheffield, UK
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Identification and evaluation of medication-related issues relating to patient’s own drugs by pharmacy students while on placement in a tertiary hospital. Int J Clin Pharm 2022; 44:575-579. [DOI: 10.1007/s11096-021-01370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/14/2021] [Indexed: 11/05/2022]
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Gupta S, Howden S. Insights into post-longitudinal integrated clerkship experience: medical students' perceptions of transition and learning. EDUCATION FOR PRIMARY CARE 2021; 32:211-218. [PMID: 33576322 DOI: 10.1080/14739879.2020.1865204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gupta S, Howden S. Medical students' perceptions of 'community' in a longitudinal integrated clerkship. EDUCATION FOR PRIMARY CARE 2020; 32:157-165. [PMID: 33342354 DOI: 10.1080/14739879.2020.1850211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Shalini Gupta
- School of Medicine, University of Dundee, Dundee, UK
| | - Stella Howden
- School of Medicine, University of Dundee, Dundee, UK
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Bartlett M, Couper I, Poncelet A, Worley P. The do's, don'ts and don't knows of establishing a sustainable longitudinal integrated clerkship. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:5-19. [PMID: 31953655 PMCID: PMC7012799 DOI: 10.1007/s40037-019-00558-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program. METHOD All four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do's, Don'ts and Don't Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline. RESULTS The final set of 18 Do's, Don'ts and Don't Knows is presented with an appraisal of the evidence for each one. CONCLUSION Implementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don't Knows, in particular the question of how cost-effectiveness is best measured.
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Affiliation(s)
- Maggie Bartlett
- Education in General Practice, Dundee University School of Medicine, Dundee, UK.
| | - Ian Couper
- Faculty of Medicine and Health Sciences, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ann Poncelet
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Paul Worley
- Department of Health, GPO Box 9848, 2601, Canberra, Australian Capital Territory, Australia
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Hays RB, McKinley RK, Sen Gupta TK. Twelve tips for expanding undergraduate clinical teaching capacity. MEDICAL TEACHER 2019; 41:271-274. [PMID: 29400107 DOI: 10.1080/0142159x.2018.1429587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Undergraduate medical education has expanded substantially in recent years, through both establishing new programs and increasing student numbers in existing programs. This expansion has placed pressure on the capacity for training students in clinical placements, raising concerns about the risk of dilution of experience, and reducing work readiness. The concerns have been greatest in more traditional environments, where clinical placements in large academic medical centers are often the "gold standard". However, there are ways of exposing medical students to patient interactions and clinical supervisors in many other contexts. In this paper, we share our experiences and observations of expanding clinical placements for both existing and new medical programs in several international locations. While this is not necessarily an easy task, a wide range of opportunities can be accessed by asking the right questions of the right people, often with only relatively modest changes in resource allocation.
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Affiliation(s)
- Richard B Hays
- a Remote and Rural Health , James Cook University , Townsville , Australia
| | | | - Tarun K Sen Gupta
- c Medical Education , James Cook University , Townsville , Australia
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Eggleton K, Fortier R, Fishman T, Hawken SJ, Goodyear-Smith F. Legitimate participation of medical students in community attachments. EDUCATION FOR PRIMARY CARE 2019; 30:35-40. [DOI: 10.1080/14739879.2018.1563503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kyle Eggleton
- Department of General Practice, The University of Auckland, Auckland, New Zealand
| | - Richard Fortier
- Department of General Practice, The University of Auckland, Auckland, New Zealand
| | - Tana Fishman
- Department of General Practice, The University of Auckland, Auckland, New Zealand
| | - Susan J. Hawken
- Department of General Practice, The University of Auckland, Auckland, New Zealand
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Bartlett M, Dowell J, Graham F, Knight K, Law S, Lockwood P, Muir F, Robson J, Watson E. Dundee’s Longitudinal Integrated Clerkship: drivers, implementation and early evaluation. EDUCATION FOR PRIMARY CARE 2019; 30:72-79. [DOI: 10.1080/14739879.2018.1564889] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Jon Dowell
- University of Dundee School of Medicine, Dundee, UK
| | | | - Kara Knight
- University of Dundee School of Medicine, Dundee, UK
| | - Susan Law
- University of Dundee School of Medicine, Dundee, UK
| | | | - Fiona Muir
- University of Dundee School of Medicine, Dundee, UK
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Somporn P, Ash J, Walters L. Stakeholder views of rural community-based medical education: a narrative review of the international literature. MEDICAL EDUCATION 2018; 52:791-802. [PMID: 29603320 DOI: 10.1111/medu.13580] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/02/2018] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
CONTEXT Rural community-based medical education (RCBME), in which medical student learning activities take place within a rural community, requires students, clinical teachers, patients, community members and representatives of health and government sectors to actively contribute to the educational process. Therefore, academics seeking to develop RCBME need to understand the rural context, and the views and needs of local stakeholders. OBJECTIVES The aim of this review is to examine stakeholder experiences of RCBME programmes internationally. METHODS This narrative literature review of original research articles published after 1970 utilises Worley's symbiosis model of medical education as an analysis framework. This model proposes that students experience RCBME through their intersection with multiple clinical, social and institutional relationships. This model seeks to provide a framework for considering the intersecting relationships in which RCBME programmes are situated. RESULTS Thirty RCBME programmes are described in 52 articles, representing a wide range of rural clinical placements. One-year longitudinal integrated clerkships for penultimate-year students in Anglosphere countries were most common. Such RCBME enables students to engage in work-integrated learning in a feasible manner that is acceptable to many rural clinicians and patients. Academic results are not compromised, and a few papers demonstrate quality improvement for rural health services engaged in RCBME. These programmes have delivered some rural medical workforce outcomes to communities and governments. Medical students also provide social capital to rural communities. However, these programmes have significant financial cost and risk student social and educational isolation. CONCLUSIONS Rural community-based medical education programmes are seen as academically acceptable and can facilitate symbiotic relationships among students, rural clinicians, patients and community stakeholders. These relationships can influence students' clinical competency and professional identity, increase graduates' interest in rural careers, and potentially improve rural health service stability. Formal prospective stakeholder consultations should be published in the literature.
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Affiliation(s)
- Praphun Somporn
- Hatyai Medical Education Centre, Hatyai Hospital, Hat Yai, Songkhla, Thailand
| | - Julie Ash
- Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, South Australia, Australia
| | - Lucie Walters
- Flinders Rural Health South Australia, Flinders University, Mount Gambier, South Australia, Australia
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Worley P. Why do we persist with teaching students in antagonistic unrepresentative learning environments? EDUCATION FOR PRIMARY CARE 2018; 29:11-12. [DOI: 10.1080/14739879.2017.1416494] [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)
- Paul Worley
- Department of Health, National Rural Health Commissioner, Canberra, Australia
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