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Dornan T, Armour D, McCrory R, Kelly M, Speyer F, Gormley G, Maxwell P. Striking fear into students' hearts: Unforeseen consequences of prescribing education. MEDICAL TEACHER 2024; 46:1337-1347. [PMID: 38301608 DOI: 10.1080/0142159x.2024.2308061] [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: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Undergraduate medical education (UGME) has to prepare students to do safety-critical work (notably, to prescribe) immediately after qualifying. Despite hospitals depending on them, medical graduates consistently report feeling unprepared to prescribe and they sometimes harm patients. Research clarifying how to prepare students better could improve healthcare safety. Our aim was to explore how students experienced preparing for one of their commonest prescribing tasks: intravenous fluid therapy (IVFT). METHODS Complexity assumptions guided the research, which used a qualitative methodology oriented towards hermeneutic phenomenology. The study design was an uncontrolled and unplanned complex intervention: judicial review of the iatrogenic death of five children due to hyponatraemia in our region had resulted in the recommendation that students' education in 'the implementation of important clinical guidelines' relevant to fluid and electrolyte balance should be intensified. An opportunity sample of 40 final-year medical students drew and gave audio-recorded commentaries on rich pictures. We completed two template analyses: one of participants' transcribed commentaries on the pictures and one using a novel heuristic to analyse the pictures themselves. We then reconciled the two analyses into a single template. RESULTS There were four themes: affects, teaching and learning, contradictions, and the curriculum as a journey. To explore interconnections between themes, we chose the picture best exemplifying each of the four themes and interpreted the curriculum journey depicted in each of them. These interpretations were grounded in each participant's picture, verbal account of the picture, and the aggregate findings of the template analysis. Participants' experiences were influenced by the situated complexity of IVFT. Layered on top of that, contradictions, overlaps, and gaps within the curriculum introduced extraneous complexity. Confusion and apprehension resulted. CONCLUSIONS After spending five years preparing to prescribe IVFT, participants felt unprepared to do so. We conclude that intensive teaching had not achieved its avowed goal of improving students' preparedness for safe practice. Merton's seminal work on the 'unanticipated consequences of purposive social action' suggests that intensive teaching may even have contributed to their unpreparedness.
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Affiliation(s)
- Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Dakota Armour
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Richard McCrory
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Martina Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Frederick Speyer
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Gerard Gormley
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Peter Maxwell
- Centre for Medical Education, Queen's University Belfast, Northern Ireland, United Kingdom
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Yamamoto I, Obara H, Verstegen D. How do mandatory emergency medicine rotations contribute to the junior residents' professional identity formation: a qualitative study. BMC MEDICAL EDUCATION 2024; 24:1054. [PMID: 39334029 PMCID: PMC11429119 DOI: 10.1186/s12909-024-06051-4] [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: 06/19/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND This study aims to investigate the impact of short-term mandatory emergency medicine rotations on professional identity formation of Japanese junior residents. Using situated learning theory as a theoretical framework, we explore how this rotation, which is part of a two-year Junior residency in the transition period from students to qualified physicians. METHODS We conducted a qualitative study conducting semi-structured face-to-face interviews with Year 1 postgraduate residents in the 2020-2021 classes of the junior residency program in Okinawa Chubu Hospital, Japan (n = 10). The data obtained from the interviews were analysed using inductive thematic analysis to identify the themes regarding professional identity formation. RESULTS Four main themes regarding professional identity formation emerged from the data analysis: patient care, teamwork, role models, and peers. Junior residents said they had the opportunity to participate in the emergency department community and experience training in authentic clinical contexts. Clinical exposure influenced the professional identity formation of the junior residents. Nurses and peers played a crucial role in this. Junior residents see the training in the emergency department as the beginning of their careers. CONCLUSION Short-term mandatory rotations enabled junior residents to integrate into the emergency department community, demonstrating autonomy and responsibility. These experiences fostered their professional identity by helping their socialisation within the community of practice.
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Affiliation(s)
- Ichita Yamamoto
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Chiba, Japan.
| | - Haruo Obara
- Department of General Internal Medicine, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
| | - Daniëlle Verstegen
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Marsch S, Yanagida T, Steinberg E. Workplace learning: the bidirectional relationship between stress and self-regulated learning in undergraduates. BMC MEDICAL EDUCATION 2024; 24:1038. [PMID: 39334175 PMCID: PMC11429500 DOI: 10.1186/s12909-024-06021-w] [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: 02/27/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024]
Abstract
The present study focused on the relationships between various aspects of self-regulated learning (SRL) and stress among undergraduate health science students in workplace settings. Although both constructs are associated with academic achievement (Ahmady Set al., in J Educ Health Promotion 10:32, 2021, Cho KK et al., in BMC Med Educ 17:112, 2017), it is still unclear how they influence each other. Employing a longitudinal diary design, the aim of the present study was to examine whether perceived stress in the previous week impacts SRL-aspects in the current week and, conversely, whether SRL-aspects in the previous week impacts stress in the current week. Subjects were 192 undergraduate health sciences students in their workplace placements. SRL-aspects and stress were assessed using scales and previously tested single-item measures. The 21 SRL-aspects used in this study included cognition (learning strategies), motivation, emotion, perception of the learning environment, and regulation of these areas on a metalevel (monitoring and control). Data collected over 15 weeks were analyzed using multilevel vector autoregressive models, with the data nested within weeks and one model dedicated to each SRL-aspect and its relationship with stress. Among the 21 path estimates assessing the impact of prior stress on individual SRL-aspects, 10 were statistically significant. For individual SRL-aspects impacting stress, 7 out of 21 paths were statistically significant (p < .05). Notably, no model showed statistical significance of effects in both directions. Except for two results, cross-lagged relationships were negative, indicating that better SRL-aspects from the previous week resulted in reduced stress in the current week and vice versa. The effects for the cross-lagged paths from SRL-aspects to stress were predominantly of medium size, whereas the influence of stress on individual SRL-aspects was predominantly small. The present study highlights a potentially causal and mostly negative relationship between stress and various aspects of SRL, but also that the individual relationships require differentiated consideration. The results can be used to develop targeted interventions in the practical part of the training of health science students to reduce stress and improve specific aspects of SRL. Furthermore, these findings underscore assumptions regarding connections between anxiety and increased stress, negative relationships between stress and motivation, and the importance of effective time management strategies for stress reduction.
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Affiliation(s)
- Stephan Marsch
- Vice-rectorate for Study Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine Vienna, Vienna, Austria.
| | - Takuya Yanagida
- Vice-rectorate for Study Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Evelyn Steinberg
- Vice-rectorate for Study Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
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Steinberg E, Marsch S, Yanagida T, Dörrenbächer-Ulrich L, Pfeiffer C, Bührle P, Schwarz L, Auer U, Kleinsorgen C, Perels F. Development and validation of the Workplace Learning Inventory in Health Sciences Education: a multimethod study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1075-1129. [PMID: 37938501 PMCID: PMC11369049 DOI: 10.1007/s10459-023-10295-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: 04/13/2023] [Accepted: 10/08/2023] [Indexed: 11/09/2023]
Abstract
Health sciences students face many challenges in regard to clinical practical learning. A better understanding of student learning is required to address student needs in this crucial phase. The theory of self-regulated learning provides a comprehensive view of learning and could serve as a basis for further research. There are instruments to assess self-regulated learning in preclinical academic learning. However, there are no such instruments for workplace learning. The aim of the present study is to provide a comprehensive inventory from which researchers can select those scales that are relevant to their research questions in the investigation of workplace learning. Hence, the aim is to develop and validate a set of scales to assess undergraduates' workplace learning in health sciences education in four areas (cognition, motivation, emotion, and context) on two levels (the learning process level and the metalevel). Study 1 is a qualitative multimethod study to identify indicators and develop items. It integrates the perspectives of students, teachers, and researchers and includes six steps: literature review, interviews, synthesis, item development, expert review, and cognitive pretesting. This study yields a set of scales for each area on both levels. Study 2 is a quantitative study to assess the psychometric properties. The results show acceptable values in terms of unidimensionality, reliability and validity for each of the 31 scales. The newly developed Workplace Learning Inventory is comprehensive; the scales are relevant to workplace learning and short enough that their administration is feasible in the workplace setting. The rigorous process of questionnaire development contributes to the validity of scales. By providing the Workplace Learning Inventory, we hope to encourage research on workplace learning in health sciences education from an educational psychology perspective.
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Affiliation(s)
- Evelyn Steinberg
- Vice-Rectorate for Study Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine Vienna, Vienna, Austria.
| | - Stephan Marsch
- Vice-Rectorate for Study Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Takuya Yanagida
- Vice-Rectorate for Study Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | | | - Christopher Pfeiffer
- Vice-Rectorate for Study Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Petra Bührle
- Vice-Rectorate for Study Affairs and Clinical Veterinary Medicine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Lukas Schwarz
- Clinic for Swine, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Ulrike Auer
- University Hospital for Small Animals, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Christin Kleinsorgen
- Centre for E-Learning, Didactics and Educational Research, University of Veterinary Medicine, Hannover, Germany
| | - Franziska Perels
- Department of Educational Science, Saarland University, Saarbrücken, Germany
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Kim K, Hornor E, Zarrabi AJ. The Museum as a Shared Space: Developing Contextual and Cross-Disciplinary Approaches to Arts-Based Education. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:761-769. [PMID: 39157535 PMCID: PMC11330253 DOI: 10.2147/amep.s464634] [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: 03/22/2024] [Accepted: 06/17/2024] [Indexed: 08/20/2024]
Abstract
Introduction Despite the growing evidence favoring use of context-based interdisciplinary pedagogies in medical education, museum learning remains underutilized as a low-cost, replicable tool for introducing such constructs. We describe a novel approach to museum-based education building off the existing pedagogy of Visual Thinking Strategies that heightens the role of context. Methods Outside the Frame, an optional elective at Emory University School of Medicine, was piloted in two iterations for a total of 7 second-year medical students who voluntarily enrolled in the course for the fall 2022 and 2023 semesters. Participating students were transitioning from the preclinical classroom environment to clinical clerkships, a period associated with feelings of personal and professional instability that may particularly benefit from critical reflection. The course included didactic components, hands-on crafting activities, presentations, and discussion groups. Student feedback was collected through anonymous pre- and post-course surveys, as well as written narrative reflections. Results All post-course responses ranked their experience of the course as being "valuable" or "very valuable". Narrative reflections were overall positive and highlighted the role of context and cross-disciplinary input in shaping metacognitive awareness and cultivating comfort with uncertainty. Discussion This pilot innovation demonstrates that a methodical framework to arts-based learning can elevate the role of context in a standardized museum education curriculum. Future visual arts and medicine courses may incorporate this framework to chart more active collaborations with museum educators and humanities faculty, as well as engage a broader range of communities and professional disciplines beyond medicine.
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Affiliation(s)
- Kain Kim
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ali-John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
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Weyant-Cheeseman ME, Abrams MP, Toselli N, Castiglioni A. Understanding learners' experiences across three major transitions in undergraduate medical education. BMC MEDICAL EDUCATION 2024; 24:748. [PMID: 38992668 PMCID: PMC11241916 DOI: 10.1186/s12909-024-05422-1] [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: 08/10/2023] [Accepted: 04/12/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Medical students in the United States undergo three significant transitions as they progress from pre-clinical to clinical rotations, to acting interns, and ultimately to first-year resident. However, there is limited understanding of whether the factors and strategies that impact these transitions remain consistent or are unique to each individual transition. METHODS Qualitative data was collected from three Nominal Group Technique (NGT) sessions held separately for third-year students (M3), fourth-year students (M4), and first-year residents (PGY-1). The participants were asked to share their perceptions on their most recent medical school transition. These responses were independently coded into thematic categories. RESULTS The NGT session with M3 students (n = 9) identified 67 transition factors and 64 coping strategies. The M4 (n = 8) session identified 33 transition factors and 72 strategies to manage their transition. The PGY-1 (n = 5) session identified 28 factors and 25 strategies. The coping strategies for each session were categorized into seven themes and the transition factors were assigned to ten thematic categories. CONCLUSION Just as each transition is unique, so too are the number and variety of factors and strategies to manage each transition. Despite these differences, the themes of "Professional socialization" and "Prioritization, efficiency, and delegation" emerged as impactful in all three transitions.
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Affiliation(s)
- Morgan E Weyant-Cheeseman
- Department of Pediatric Emergency Medicine, University of Texas Southwestern, 1935 Medical District Dr, 75235, Dallas, TX, USA.
| | - Matthew P Abrams
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Nicholas Toselli
- Department of Emergency Medicine, Orlando Health, Orlando, FL, USA
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Stojanović A, Fris DAH, Solms L, van Hooft EAJ, De Hoog M, de Pagter APJ. Lifelong development in medicine: a thematic analysis of coaching goals throughout medical careers. BMJ Open 2024; 14:e081139. [PMID: 38772887 PMCID: PMC11110559 DOI: 10.1136/bmjopen-2023-081139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/21/2024] [Indexed: 05/23/2024] Open
Abstract
OBJECTIVES Healthcare grapples with staff shortages and rising burnout rates for medical students, residents and specialists. To prioritise both their well-being and the delivery of high-quality patient care, it becomes imperative to deepen our understanding of physicians' developmental aims and needs. Our first aim is, therefore, to gain comprehensive insights into the specific developmental aims physicians prioritise by examining the coaching goals they set at the beginning of coaching. Since physicians face distinct roles as they advance in their careers, our second aim is to highlight similarities and differences in developmental aims and needs among individuals at various medical career stages. DESIGN We conducted a qualitative analysis of 2571 coaching goals. We performed an inductive thematic analysis to code one-half of coaching goals and a codebook thematic analysis for the other half. Our interpretation of the findings was grounded in a critical realist approach. SETTING Sixteen hospitals in the Netherlands. PARTICIPANTS A total of 341 medical clerkship students, 336 medical residents, 122 early-career specialists, 82 mid-career specialists and 57 late-career specialists provided their coaching goals at the start of coaching. RESULTS The findings revealed that coachees commonly set goals about their career and future, current job and tasks, interpersonal work relations, self-insight and development, health and well-being, nonwork aspects and the coaching process. Furthermore, the findings illustrate how the diversity of coaching goals increases as physicians advance in their careers. CONCLUSIONS Our findings underscore the significance of recognising distinct challenges at various career stages and the necessity for tailoring holistic support for physicians. This insight holds great relevance for healthcare organisations, enabling them to better align system interventions with physicians' needs and enhance support. Moreover, our classification of coaching goals serves as a valuable foundation for future research, facilitating a deeper exploration of how these goals influence coaching outcomes.
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Affiliation(s)
- Ana Stojanović
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Daan A H Fris
- Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lara Solms
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Edwin A J van Hooft
- Department of Work and Organizational Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Matthijs De Hoog
- Department of Neonatal & Pediatric Intensive Care/Division of Pediatric Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anne P J de Pagter
- Department of Quality and Patient Safety, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Quality and Patient Safety, Leiden University Medical Center, Leiden, The Netherlands
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Adnan N, Azhar F, Azim SR. Exploring perceptions of pre-clerkship students about workplace learning in the clinical learning environment at Gulf Medical University, UAE. BMC MEDICAL EDUCATION 2024; 24:528. [PMID: 38741110 DOI: 10.1186/s12909-024-05312-6] [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: 12/14/2022] [Accepted: 03/14/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Medical students view clinical workplace placements as an inspiring and motivating learning environment where active student participation is pivotal to development of students' identity. The progress from pre-clerkship to clerkship education harbors many challenges which consist of experiential learning, adjusting to the clinical environment, and understanding roles & responsibilities. Workplace learning is underpinned by various adult learning theories including social theories,constructivism, supported participation and legitimate peripheral participation. Workplace learning course was recently initiated for pre-clerkship students at a medical university in UAE, which will enable their smooth entry into the clerkship phase of the curriculum. OBJECTIVES The research aims to explore students' perceptions of various domains of their clinical learning environment (CLE), highlight the challenges they face, and extract valuable feedback to improve their environment. METHODS This study was conducted qualitatively by using focus groups method in order to explore students' perceptions of the clinical learning environment. Two focus group discussions were conducted (n = 8 +/-10) to determine the common challenges of workplace learning and its potential solutions. Data were analyzed using thematic analysis. The approach used to carry out this study was phenomenology, as it helps to understand the learning and behavior of these students who are undergoing this pre-clerkship training in order to transition smoothly to the clerkship phase. RESULT The focus groups helped to deeply explore the perceptions of students about their clinical learning environment. It helped to reveal the challenges encountered by the students including the significance of proper orientation of staff and students, language barrier, availability of learning opportunities, and supervision quality. The focus groups provided worthwhile suggestions to improve the learning opportunities in the clinical learning environment which include orientation of the staff and students what to expect, improved supervision, mentoring and providing learning opportunities to encourage participation. CONCLUSION This study attempted to identify the pre-clerkship students' perception of their clinical learning environment and the challenges they face over there. Possible suggestions by the students included a formal orientation for the staff and students to be carried out at the beginning. Efforts should be made by clerkship directors to provide students with learning opportunities by increasing patient exposure, encouraging participation, and providing high-quality supervision.
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Affiliation(s)
- Nooreen Adnan
- Dow University of Health Sciences, Karachi, Pakistan
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Muyselaar-Jellema JZ, Querido SJ. Twelve tips for having more meaningful conversations with medical students on specialty career choice. MEDICAL TEACHER 2024; 46:617-620. [PMID: 37967563 DOI: 10.1080/0142159x.2023.2280114] [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: 11/17/2023]
Abstract
Making a career choice is a multifaceted process and support for medical students on career choice is pivotal. Not all medical schools have programs or guidelines to support having meaningful conversations with medical students. However, medical students have questions and are seeking answers. This article presents twelve tips for having meaningful conversations with medical students for educators, mentors and internship tutors. The twelve tips have been grouped into three categories: the conversation, the reflection and the actions students can take in the process of their specialty career choice.
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Affiliation(s)
- Janneke Z Muyselaar-Jellema
- Public Health Educator and Coordinator of the Public Health Clerkship, Leiden University Medical Center, the Netherlands
| | - Sophie J Querido
- Director of the Central Board for Specialty Training in Elderly Care Medicine in the Netherlands (SOON), Utrecht, the Netherlands
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Tern H, Edqvist M, Rubertsson C, Ekelin M. Midwives' experiences of professional learning when practicing collegial midwifery assistance during the active second stage of labour: data from the oneplus trial. BMC Pregnancy Childbirth 2024; 24:287. [PMID: 38637732 PMCID: PMC11027315 DOI: 10.1186/s12884-024-06499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Learning is a lifelong process and the workplace is an essential arena for professional learning. Workplace learning is particularly relevant for midwives as essential knowledge and skills are gained through clinical work. A clinical practice known as 'Collegial Midwifery Assistance' (CMA), which involves two midwives being present during the active second stage of labour, was found to reduce severe perineal trauma by 30% in the Oneplus trial. Research regarding learning associated with CMA, however, is lacking. The aim was to investigate learning experiences of primary and second midwives with varying levels of work experience when practicing CMA, and to further explore possible factors that influence their learning. METHODS The study uses an observational design to analyse data from the Oneplus trial. Descriptive statistics and proportions were calculated with 95% confidence intervals. Stratified univariable and multivariable logistic regression analysis were performed. RESULTS A total of 1430 births performed with CMA were included in the study. Less experienced primary midwives reported professional learning to a higher degree (< 2 years, 76%) than the more experienced (> 20 years, 22%). A similar but less pronounced pattern was seen for the second midwives. Duration of the intervention ≥ 15 min improved learning across groups, especially for the least experienced primary midwives. The colleague's level of experience was found to be of importance for primary midwives with less than five years' work experience, whereas for second midwives it was also important in their mid to late career. Reciprocal feedback had more impact on learning for the primary midwife than the second midwife. CONCLUSIONS The study provides evidence that CMA has the potential to contribute with professional learning both for primary and second midwives, for all levels of work experience. We found that factors such as the colleague's work experience, the duration of CMA and reciprocal feedback influenced learning, but the importance of these factors were different for the primary and second midwife and varied depending on the level of work experience. The findings may have implications for future implementation of CMA and can be used to guide the practice.
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Affiliation(s)
- Helena Tern
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 117, Lund, SE-221 00, Sweden.
| | - Malin Edqvist
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Christine Rubertsson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 117, Lund, SE-221 00, Sweden
- Department of Obstetrics and Gynecology, Skåne University Hospital, Jan Waldenströms gata 47, Malmö, SE-214 28, Sweden
| | - Maria Ekelin
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 117, Lund, SE-221 00, Sweden
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Alwatban L, Alageel MS, Alshehri LA, Alfehaid NS, Albahlal RA, Almazrou NH, Almubarak R. The Stigma of Burnout Impeding Formal Help: A Qualitative Study Exploring Residents' Experiences During Training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:333-342. [PMID: 38646001 PMCID: PMC11032676 DOI: 10.2147/amep.s453564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/02/2024] [Indexed: 04/23/2024]
Abstract
Purpose Burnout is an occupational stress syndrome that gives rise to emotional exhaustion (EE) depersonalization (DP) and reduced personal accomplishment (PA). Increasing rates of burnout among health care professionals has been reported globally. Saudi Arabia appears to be among the highest in prevalence with reports of higher than 70%. Medical residents in training are the highest group at risk. The literature has repeatedly linked burnout among residents with poor academic performance on training exams, impaired quality of life, career choice regret and intentions to abandon medicine. In this study, we explore the factors that contribute to resident burnout, their experiences with burnout and how they choose to mitigate it. Methods A qualitative design was used to conduct this study in the city of Riyadh, Saudi Arabia. A total of 14 residents from surgical and non-surgical programs were interviewed through in-depth interviews. Interpretive thematic analysis was used in coding and generated coding templates. Categories were repetitively reviewed and revised, expanding to include new data as it emerged and collapsing to remove redundant codes. Categories were organized into the final themes and sub-themes. Results All participants demonstrated a shared thread of shame in reaching the level of burnout. Three main interlinked themes were identified: Burnout stigma cycle, amalgamated causes of burnout and self-coping with burnout. One of the concerning findings in our study is the participants' pursuit of self-coping strategies and the avoidance of formal help, creating a cycle of suffering in silence. Conclusion The literature has repeatedly reported high levels of burnout among residents in training. This study has added another dimension to those findings through the exploration of residents actual accounts and appears to link burnout with suboptimal training and working conditions. We have highlighted the pivotal role stigma and shame play in completely preventing residents from seeking professional help.
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Affiliation(s)
- Lemmese Alwatban
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- University Family Medicine Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mai S Alageel
- Department of Family Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Lina A Alshehri
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Shannon E, Cantillon P. Preparedness for the transition to medical registrar from senior house officer-What's the problem? CLINICAL TEACHER 2024; 21:e13712. [PMID: 38111222 DOI: 10.1111/tct.13712] [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: 10/30/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Transitions in clinical training are a hallmark in medical trainee's careers. The transition from senior house officer (SHO) to the role of medical registrar is often viewed as one of the most challenging, but to date, there is little research exploring why the transition is proving problematic for so many learners. The aim of this study was to explore the experiences of trainees preparing to make this transition. METHODS Using an interpretative phenomenological analysis (IPA) approach, this qualitative study employed semi-structured interviews to explore the lived experiences of transition in a purposive sample of trainees on the cusp of transition from SHO to registrar or who were in their first year of being a medical registrar. Interviews were recorded, transcribed verbatim and analysed using an IPA approach. RESULTS Six trainees participated in this study, four of whom were currently in SHO positions, with the remaining two in their first year of medical registrar. Two main themes emerged from data-perception of the medical registrar and barriers in transition. The role of the medical registrar was perceived to represent a strong leadership role, with barriers created due to increasing expectations, lack of support and uncertainties regarding the job. CONCLUSION The role of the medical registrar is a challenging one, representing periods of uncertainty, increased expectations and reduced supports. Within this, there is potential to further support SHOs in transitioning to the role of medical registrar.
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Affiliation(s)
- Eileen Shannon
- Department of Gastroenterology, University Hospital Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - Peter Cantillon
- School of Medicine, University of Galway, Galway, Ireland
- Discipline of General Practice, University of Galway, Galway, Ireland
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Frank JR, Karpinski J, Sherbino J, Snell LS, Atkinson A, Oswald A, Hall AK, Cooke L, Dojeiji S, Richardson D, Cheung WJ, Cavalcanti RB, Dalseg TR, Thoma B, Flynn L, Gofton W, Dudek N, Bhanji F, Wong BMF, Razack S, Anderson R, Dubois D, Boucher A, Gomes MM, Taber S, Gorman LJ, Fulford J, Naik V, Harris KA, St. Croix R, van Melle E. Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:201-223. [PMID: 38525203 PMCID: PMC10959143 DOI: 10.5334/pme.1096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 02/16/2024] [Indexed: 03/26/2024]
Abstract
Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.
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Affiliation(s)
- Jason R. Frank
- Centre for Innovation in Medical Education and Professor, Department of Emergency Medicine, Faculty of Medicine, University of Ottawa, ON, Canada
| | - Jolanta Karpinski
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Competency Based Medical Education, University of Ottawa, Ottawa, ON, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | | | - Linda S. Snell
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Medicine and Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Adelle Atkinson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Competency Based Medical Education, University of Alberta, Edmonton, AB, Canada
| | - Andrew K. Hall
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lara Cooke
- Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan Dojeiji
- Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada
| | - Denyse Richardson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, ON, Canada
| | - Warren J. Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rodrigo B. Cavalcanti
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- HoPingKong Centre, University Health Network, Toronto, ON, Canada
| | - Timothy R. Dalseg
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Brent Thoma
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Leslie Flynn
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Departments of Psychiatry and Family Medicine, and Co-Director Master of Health Sciences Education, Queen’s University, Kingston, ON, Canada
| | - Wade Gofton
- Department of Surgery (Division of Orthopedic Surgery), The Ottawa Hospital and University of Ottawa, Ottawa, ON, Canada
| | - Nancy Dudek
- Department of Medicine (Division of Physical Medicine & Rehabilitation) and The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Farhan Bhanji
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Brian M.-F. Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Canada
| | - Saleem Razack
- Centre for Health Education Scholarship, University of British Columbia and BC Children’s Hospital, Vancouver, BC, Canada
| | - Robert Anderson
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Northern Ontario School of Medicine University, Sudbury, ON, Canada
| | - Daniel Dubois
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrée Boucher
- Department of Medicine (Division of Endocrinology), Universitéde Montréal, Montréal, QC, Canada
| | - Marcio M. Gomes
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Taber
- Office of Standards and Assessment, Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Lisa J. Gorman
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
| | - Jane Fulford
- Canadian Internet Registration Authority, Canada
| | - Viren Naik
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Medical Council of Canada, Ottawa, ON, Canada
| | - Kenneth A. Harris
- Royal College of Physicians and Surgeons of Canada, Canada
- Emeritus, Western University, Canada
| | - Rhonda St. Croix
- Learning and Connecting at the Royal College of Physicians and Surgeons of Canada, Canada
| | - Elaine van Melle
- Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada
- Department of Family Medicine, Queen’s University, Kingston, ON, Canada
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Gilbert KG. Learning journeys - student learning development in the first years of a medical degree: an analysis of student conversations. FRONTIERS IN SOCIOLOGY 2023; 8:1244039. [PMID: 38111907 PMCID: PMC10725972 DOI: 10.3389/fsoc.2023.1244039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/07/2023] [Indexed: 12/20/2023]
Abstract
Introduction Students starting medical school generally come from a learning background that expects them to learn content, which is reproduced to pass an exam. As a part of their learning development, they must adapt and become self-motivated learners who can determine the underlying principles or concepts and use these to problem solve in the uncertainty of real-life clinical practice. Whilst much has been written about designing curricula to promote learning development, there is no one-size fits all approach to facilitating this type of learning, thus an analysis of what helps and hinders learning development is indicated. Methods Student pairs in Y2 and Y3 of an undergraduate Bachelor of Medicine, Bachelor of Surgery (BMBS) programme of a South-West UK medical school, were asked to audio record a conversation about their learning through a facilitated problem-based learning approach during the BMBS course so far. They were provided with a brief to aid them in their discussion in the style of the outside broadcast method of BBC Radio 4s listening project. Using this method, the conversation was unfacilitated and allowed to take its natural course. Conversations were transcribed and coded to determine emerging themes with respect to the developing understanding of the students about what and how they were learning. Results Four student pairs volunteered for the project one from Y2 and three from Y3. Five key themes were identified including: from 'learning it all, to structured learning'; 'developing understanding and the spiral curriculum'; 'working alone versus working with others'; 'integrated learning and understanding context' and 'assessment and resources.' Narrative analysis within these themes suggested that over the course of the first two to three years of study, participants developed a better understanding of how best to learn, although there were differences in both time and order that participants reached a point where learning felt more natural to them. Discussion Analysis of the data suggested that students develop independently towards being self-motivated lifelong learners. There were several key aspects of curriculum design that could be used to facilitate this development, which could easily be incorporated into developing or creating problem- / enquiry-based curricula.
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Affiliation(s)
- Kerry G. Gilbert
- School of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, University of Exeter, St Luke’s Campus, Exeter, United Kingdom
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15
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Marthyman A, Nimmon L. Exploring how immigrant international medical graduates successfully manage complex sociocultural challenges. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:40-50. [PMID: 38226312 PMCID: PMC10787855 DOI: 10.36834/cmej.76244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background While immigrant international medical graduates (I-IMGs) contribute significantly to the physician workforce in North America, researchers have highlighted the myriad of ways sociocultural challenges can negatively impact their success. Conceptual understanding that unpacks the complex processes of how I-IMGs effectively manage sociocultural challenges is relatively sparse. In addressing this critical knowledge gap, this study explored how I-IMGs successfully manage sociocultural differences as postgraduate residents. Methods We interviewed eleven I-IMGs from diverse backgrounds who are in training or recently trained in a distributed multi-site postgraduate medical training program in Canada. We used the lens of sociocultural learning theory to gain insights into the processes of how I-IMGs describe successful management of sociocultural challenges. Results The overarching storyline of participants emphasized that their experiences were humbling as they grappled with inner struggles, emotions, and vulnerabilities while embracing the ambiguity of not knowing what was expected of them. The following dominant themes from their narratives encapsulate the salient processes for how I-IMGs conceptualize and successfully manage sociocultural challenges: 1) successfully navigating transitions; 2) resisting or altering elements of prior sociocultural norms while embracing the new; 3) living and being in community and having supportive social networks; 4) risk taking to self-advocate and actively seek help. Conclusion Understanding the strengths and positive strategies for how I-IMGs interface with complex sociocultural challenges has application for medical training institutions. Our insights suggest the need for practical, effective, and continuous assistance within I-IMG training programs to better support future trainees dealing with sociocultural challenges.
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Affiliation(s)
- Azaria Marthyman
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
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Routh J, Paramasivam SJ, Cockcroft P, Wood S, Remnant J, Westermann C, Reid A, Pawson P, Warman S, Nadarajah VD, Jeevaratnam K. Clinical supervisors' and students' perspectives on preparedness for veterinary workplace clinical training: An international study. Vet Rec 2023; 193:e3504. [PMID: 37955283 DOI: 10.1002/vetr.3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The alignment of student and workplace supervisors' perspectives on student preparedness for veterinary workplace clinical training (WCT) is unknown, yet misalignment could negatively impact workplace learning. The aim of this study was to quantify the relative importance of WCT preparedness characteristics according to students and supervisors and to identify differences. METHODS A survey was completed by 657 veterinary students and 244 clinical supervisors from 25 veterinary schools, from which rankings of the preparedness characteristics were derived. Significant rank differences were assessed using confidence intervals and permutation tests. RESULTS 'Honesty, integrity and dependability' was the most important characteristic according to both groups. The three characteristics with the largest rank differences were: students' awareness of their own and others' mental wellbeing and the importance of self-care; being willing to try new practical skills with support (students ranked both of these higher); and having a clinical reasoning framework for common problems (supervisors ranked higher). LIMITATIONS Using pooled data from many schools means that the results are not necessarily representative of the perspectives at any one institution. CONCLUSION There are both similarities and differences in the perspectives of students and supervisors regarding which characteristics are more important for WCT. This provides insights that can be used by educators, curriculum developers and admissions tutors to improve student preparedness for workplace learning.
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Affiliation(s)
- Jennifer Routh
- School of Veterinary Medicine, University of Surrey, Guildford, UK
| | | | - Peter Cockcroft
- School of Veterinary Medicine, University of Surrey, Guildford, UK
| | - Sarah Wood
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - John Remnant
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, UK
| | - Cornélie Westermann
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Alison Reid
- School of Veterinary Science, University of Liverpool, Liverpool, UK
| | - Patricia Pawson
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Sheena Warman
- Bristol Veterinary School, University of Bristol, Bristol, UK
| | - Vishna Devi Nadarajah
- Division of Human Biology, School of Medicine and IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia
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Sarhan MM, Alwadi MAM. A qualitative study of dental internships in Saudi Arabia: moving beyond perceptions to the reality of the practices of dental interns. BMC MEDICAL EDUCATION 2023; 23:826. [PMID: 37924041 PMCID: PMC10623790 DOI: 10.1186/s12909-023-04802-3] [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: 08/02/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dental internships are a vital way for recent graduates of undergraduate dentistry courses to bridge the gap between study and clinical practice. Interns' perceptions of dental internships have been explored in certain studies but the reality of the dental internship and dental interns' practical performance has not been examined. Therefore, this study aims to explore the reality of the dental internship as a transitional stage after completion of an undergraduate course in dentistry. METHODS This qualitative research recruited 23 dental interns from Saudi Arabia's Riyadh Province. To explore the reality of dental internships, the research relied on a performative knowledge approach to examine interns' practices and performance. Diaries and semi-structured interviews conducted virtually were used to gather data across three months. The data was then subject to thematic analysis that applied an inductive strategy. The data analysis's credibility and trustworthiness were verified using triangulation techniques, an audit trail and member-checking. RESULTS Five key themes concerning dental interns' practices were identified in this research: exploration, addressing knowledge gaps, responsibilities, decision-making and social connections. The most significant findings reveal that dental internships go beyond clinical work to include certain personal and social aspects that dental interns undertake during their internships. CONCLUSION The findings of this research indicate that more real-world, practical knowledge should be integrated into the curricula of undergraduate dentistry programmes. In sum, this work highlights the need for holistic dental education that encompasses not only the clinical development of interns and students but also other elements such as their personal and social growth. Moreover, this research reveals that a performative knowledge approach can help researchers to identify significant findings regarding the practical experiences of dental interns. This study has implications for dentistry and any other medical speciality education programme that involves an internship.
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Affiliation(s)
- Mohammed Mahmoud Sarhan
- Department of Preventive Dental Sciences, College of Dentistry, Taibah University, 42353, Al- Madinah Al- Munawwarah, Saudi Arabia
| | - Maram Ali M Alwadi
- Department of Dental Health, College of Applied Medical Sciences, King Saud University, P.O. BOX 145111, 4545, Riyadh, Saudi Arabia.
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Walinga CW, Barnhoorn PC, Essers GTJM, Schaepkens SPC, Kramer AWM. 'You are not alone.' An exploratory study on open-topic, guided collaborative reflection sessions during the General Practice placement. BMC MEDICAL EDUCATION 2023; 23:769. [PMID: 37845655 PMCID: PMC10577966 DOI: 10.1186/s12909-023-04756-6] [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: 05/26/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND To support professional development of medical students faced with challenges of the clinical phase, collaborative reflection sessions (CRSs) are used to share and reflect on workplace experiences. Facilitation of CRSs seems essential to optimise learning and to provide important skills for lifelong learning as a professional. However, little is known about which workplace experiences students share in CRSs without advance guidance on specific topics, and how reflecting on these experiences contributes to students' professional development. Therefore, we explored which workplace experiences students shared, what they learned from reflection on these experiences, and how they perceived the value of CRSs. METHODS We conducted an exploratory study among medical students (N = 99) during their General Practice placement. Students were invited to openly share workplace experiences, without pre-imposed instruction. A thematic analysis was performed on shared experiences and student learning gains. Students' perceptions of CRSs were analysed using descriptive statistics. RESULTS All 99 students volunteered to fill out the questionnaire. We found four themes relating to students' shared experiences: interactions with patients, complex patient care, diagnostic or therapeutic considerations, and dealing with collegial issues. Regarding students' learning gains, we found 6 themes: learning from others or learning from sharing with others, learning about learning, communication skills, self-regulation, determination of position within the healthcare team, and importance of good documentation. Students indicated that they learned from reflection on their own and peer's workplace experiences. Students valued the CRSs as a safe environment in which to share workplace experiences and helpful for their professional development. CONCLUSIONS In the challenging General Practice placement, open-topic, guided CRSs provide a helpful and valued learning environment relevant to professional development and offer opportunities for vicarious learning among peers. CRSs may also be a valuable tool to incorporate into other placements.
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Affiliation(s)
- Chris W Walinga
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands.
| | - Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands
| | | | - Sven P C Schaepkens
- Department of General Practice, Erasmus University Medical Centre, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden, 2300 RC, The Netherlands
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Collini A, Alstead E, Knight A, Page M. "You may think that the consultants are great, and they know everything, but they don't": exploring how new emergency medicine consultants experience uncertainty. Emerg Med J 2023; 40:624-629. [PMID: 37236780 DOI: 10.1136/emermed-2022-213013] [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: 11/30/2022] [Accepted: 05/13/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Uncertainty is particularly obvious in emergency medicine (EM) due to the characteristics of the patient cohort, time constraints, and busy environment. Periods of transition are thought to add to uncertainty. Managing uncertainty is recognised as a key ability for medical practice, but is often not addressed explicitly. This study explored how new consultants in EM experience uncertainty, with the aim of making explicit what is often hidden and potentially informing support for doctors to manage the uncertainty they face. METHODS This was a qualitative study using interpretive phenomenological analysis (IPA). Five consultants working in the UK within one year of achieving a certificate of completion of training were interviewed online during 2021, these were transcribed and analysed using IPA. RESULTS Three superordinate themes were identified: 'transition and performance as a source of uncertainty', 'uncertainty and decision-making in the context of the emergency department' and 'sharing uncertainty and asking for help'. The transition created uncertainty related to their professional identity that was compounded by a lack of useful feedback. There was tension between perceived expectations of certainty and the recognition of uncertainty in practice. EM doctors were seen as experts in managing uncertainty, with responses to uncertainty including gathering information, sharing uncertainty and seeking help. Expressing uncertainty was viewed as necessary for good patient care but could be risky to credibility, with psychological safety and role modelling behaviour making it easier for the participants to express uncertainty. CONCLUSION This study highlights the need for new consultants to have psychologically safe, reflective spaces to think through uncertainties with others. This appears to reduce uncertainty, and also act as a source of feedback. The study adds to the existing calls to address uncertainty more explicitly in training, and challenge the expectations of certainty that exist within medicine.
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Affiliation(s)
- Anna Collini
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Elspeth Alstead
- Institute for Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Alec Knight
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Michael Page
- Institute for Health Sciences Education, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Corazza L, Shirkhani S, Berberat PO, Wijnen-Meijer M. Structured interviews on self-regulated learning strategies of medical students in the final year of medical school. BMC MEDICAL EDUCATION 2023; 23:604. [PMID: 37620862 PMCID: PMC10464390 DOI: 10.1186/s12909-023-04607-4] [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: 02/06/2023] [Accepted: 08/23/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND In the final year of medical school, the educational focus is on experiences in the clinical environment. This is where students acquire most of their practical knowledge for their future career and need to optimise their Self-Regulated Learning (SRL) strategies. Hence, the current study aims to explore which SRL strategies medical students use during their clerkships in different learning settings. METHODS Structured interviews were conducted between May 2019 and December 2020 with 43 medical students during their final year in Munich, Germany. The students were surveyed about their SRL strategies. The transcribed data were thematically analysed using the measurements Strategy Use (SU) and Strategy Frequency (SF). RESULTS Interview data were organized into 11 SRL strategy categories. The most used SRL strategy in general was "seeking information in the internet in form of a text" (SU: 1; SF: 2.605), with an e-learning tool; followed by "seeking social assistance from doctors" (SU: 0.977; SF: 1.884), and "seeking information in books" (SU: 0.884; SF: 1.419). There were differences in the usage of SRL in different learning contexts between female and male students. For example, 95.3% of students are "seeking social assistance from doctors" when having difficulties on the ward, but only 55.8% when they need help with written tasks (e.g. medical letter). The results show a difference in SRL usage when preparing for oral-practical (79.1% books) and written (97.7% e-learning tool) exam. However, it also appears that some students do not have SRL strategies for certain situations, mostly due to a lack of time. CONCLUSION Medical students in the clinical phase are adapting their SRL strategy to the learning situation. To better support students´ SRL, it is necessary to ensure availability for their preferred resources: e-learning tool and experienced physicians as supervisors. Future research should focus on strategies to handle the limited time during clerkships.
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Affiliation(s)
- Laura Corazza
- Technical University of Munich (TUM), School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sepide Shirkhani
- Technical University of Munich (TUM), School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Pascal O Berberat
- Technical University of Munich (TUM), School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Marjo Wijnen-Meijer
- Technical University of Munich (TUM), School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany.
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Joseph B, Tseng ES, Zielinski MD, Ramirez CL, Lynde J, Galey KM, Bhogadi SK, El-Qawaqzeh K, Hosseinpour H. Feeling like an imposter: are surgeons holding themselves back? Trauma Surg Acute Care Open 2023; 8:e001021. [PMID: 37575613 PMCID: PMC10414117 DOI: 10.1136/tsaco-2022-001021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/16/2023] [Indexed: 08/15/2023] Open
Abstract
Imposter syndrome is a psychological phenomenon where people doubt their achievements and have a persistent internalized fear of being exposed as a fraud, even when there is little evidence to support these thought processes. It typically occurs among high performers who are unable to internalize and accept their success. This phenomenon is not recognized as an official mental health diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; however, mental health professionals recognize it as a form of intellectual self-doubt. It has been reported that imposter syndrome is predominant in the high-stakes and evaluative culture of medicine, where healthcare workers are frequently agonized by feelings of worthlessness and incompetence. Imposter syndrome can lead to a variety of negative effects. These can include difficulty concentrating, decreased confidence, burnout, anxiety, stress, depression, and feelings of inadequacy. This article will discuss the prevalence of imposter syndrome among surgeons, its associated contributing factors, the effects it can have, and potential strategies for managing it. The recommended strategies to address imposter syndrome are based on the authors' opinions.
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Affiliation(s)
- Bellal Joseph
- Surgery, University of Arizona, Tucson, Arizona, USA
| | - Esther S Tseng
- Division of Trauma, Critical Care, Burns, and Emergency General Surgery, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Martin D Zielinski
- Division of Trauma and Acute Care Surgery, Department of Surgery, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Christine L Ramirez
- Department of Surgery, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Jennifer Lynde
- Division of Trauma, Acute Care Surgery and Surgical Critical Care, Department of Surgery, University of California Davis Health System, Sacramento, California, USA
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Ganesan I, Cham B, Teunissen PW, Busari JO. Stakes of Assessments in Residency: Influence on Previous and Current Self-Regulated Learning and Co-Regulated Learning in Early Career Specialists. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:237-246. [PMID: 37334108 PMCID: PMC10275342 DOI: 10.5334/pme.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Abstract
Introduction Assessments drive learning but the influence of the stakes of the assessments on self-regulated (SRL) during and after residency are unknown. As early career specialists (ECS) must continue learning independently, the answer to this is important as it may inform future assessments with the potential to promote life-long learning after graduation. Methods We utilized constructivist grounded theory to explore the perspectives of eighteen ECS on the influence of stakes of assessments within residency on their SRL during training and in current practice. We conducted semi-structured interviews. Results We initially set out to examine the influence of the stakes of assessments on SRL during residency and after graduation. However, it was apparent that learners increasingly engaged with others in co-regulated learning (CRL) as the perceived stakes of the assessments increased. The individual learner's SRL was embedded in CRL in preparation for the various assessments in residency. For low-stakes assessments, the learner engaged in less CRL, taking less cues from others. As stakes increased, the learner engaged in more CRL with peers with similar intellectual level and supervisors to prepare for these assessments. SRL and CRL influenced by assessments in residency had a knock-on effect in clinical practice as ECS in: 1) developing clinical reasoning, 2) improving doctor-patient communication and negotiation skills, and 3) self-reflections and seeking feedback to deal with expectations of self or others. Discussion Our study supported that the stakes of assessments within residency reinforced SRL and CRL during residency with a continued effect on learning as ECS.
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Affiliation(s)
- Indra Ganesan
- Department of Pediatrics, Kandang Kerbau Women’s and Children’s Hospital, Singapore
| | - Breana Cham
- Department of Genetics, Kandang Kerbau Women’s and Children’s Hospital, Singapore
| | - Pim W. Teunissen
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University and Department of Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jamiu O. Busari
- Department of Educational Development & Research, Faculty of Health, Medicine & Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Department of Pediatrics and HOH Academy, Horacio Oduber Hospital, Dr. Horacio E. Oduber Boulevard #1, Oranjestad, Aruba
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Bremer AE, Ruczynski LIA, Bot P, Fluit CRMG, van de Pol MHJ. A Qualitative Study on How Entrustable Professional Activities Support Medical Students in Their Transitions across Clerkships. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:187-197. [PMID: 37274808 PMCID: PMC10237239 DOI: 10.5334/pme.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/20/2023] [Indexed: 06/07/2023]
Abstract
Introduction Medical students regularly transition between clerkships. These transitions can lead to discontinuity in their development because of the need to adapt to a new environment. The use of entrustable professional activities (EPAs) might facilitate less disruptive transitions across clerkships, as they could provide support at the start of a clerkship. This study aims to shed light on how an EPA-based curriculum contributes to medical students' learning processes during transitions. Methods The authors used a constructivist rapid ethnographic design. They conducted observations and interviews with 11 medical students in their Pediatrics clerkship; six of them were in clerkships not utilizing EPAs, and five were using EPAs. Data collection was followed by template analysis such that all data were coded with a template that was continually updated until the authors all agreed upon a definitive template. Results Four themes proved important when considering the impact of EPAs during transitions between clerkships: transitions as a learning opportunity, building relationships in context, taking leadership in the landscape of practice and feedback-seeking behavior. Discussion EPAs smooth clerkship transitions, as they establish continuity in the student's development and facilitate navigating discontinuity in transitions. Students build skills and confidence in order to grow and work with increasing independence within the clerkships. Transitions offer important learning opportunities for students, which can be fully exploited by using EPA guidance.
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Affiliation(s)
- Anne E. Bremer
- Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Larissa I. A. Ruczynski
- Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petra Bot
- Radboud Amalia’s Children Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cornelia R. M. G. Fluit
- Department of Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
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Young Y, Leedham-Green K, Jensen-Martin J. Improving transitions between clinical placements. CLINICAL TEACHER 2023:e13580. [PMID: 37146063 DOI: 10.1111/tct.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/05/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Students regularly transition between clinical learning environments as they rotate through their clinical placements. These transitions are stressful for learners, as they must navigate unfamiliar policies, people and physical spaces. It is important to reduce cognitive overload at the start of each placement through appropriate inductions. Our governance processes found there was significant variation between induction processes at our affiliated teaching-hospital sites: our aim was to optimise and standardise these. APPROACH We opted for induction websites for each of our affiliated hospital sites, as these could be dynamically updated and quality assured. Our websites were informed by a conceptual framework of the clinical learning environment and the theory of sociomateriality. We co-produced them with students and other stakeholders through iterative evaluation and improvement cycles. EVALUATION To elicit end-user analysis, we conducted three focus groups with 19 students. We used the technology acceptance model to inform our topic guide and coding categories. Students reported that the websites were useful, easy to use, and fulfilled a significant unmet need. IMPLICATIONS Induction websites can be optimised through the involvement of a range of stakeholders and the application of theory. They can be pushed to students before each new placement and used to scaffold in-person inductions. Further research is needed to explore the wider impacts of improved site inductions on participation and engagement with clinical learning opportunities and on student satisfaction and experience.
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Affiliation(s)
- Yasmine Young
- Imperial College School of Medicine, Imperial College London, London, UK
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25
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Mills LM, O'Sullivan PS, Ten Cate O, Boscardin C. Investigating feedback orientation in medical learners. MEDICAL TEACHER 2023; 45:492-498. [PMID: 36306388 DOI: 10.1080/0142159x.2022.2138741] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/PURPOSE Feedback processes in health professions education (HPE) are not always successful. While recommendations to improve feedback provision dominate the literature, studying specific learner attributes that impact feedback uptake may also improve feedback processes. Feedback orientation is a concept from management science involving four dimensions of learner attributes and attitudes that impact their feedback uptake: utility, accountability, social awareness, and feedback self-efficacy. Feedback orientation may represent a valuable concept in HPE. We aimed to understand medical learners' feedback orientation at different stages in their development. METHODS We used the Feedback Orientation Scale, a 20-item survey instrument, for a cross-sectional analysis of feedback orientation in medical students and Internal Medicine residents at one large academic center. We performed descriptive statistics and analysis of variance for data analysis. RESULTS We found the same factors (dimensions) to feedback orientation in our population as in management science. Overall feedback orientation scores were high and were largely consistent across trainee levels. Utility was the domain that was highest across learners, whereas feedback self-efficacy was lowest. CONCLUSIONS Feedback orientation represents a useful concept to explore medical learners' attitudes toward feedback's role in their development. The four domains can help guide further nuanced feedback research and application.[Box: see text].
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Affiliation(s)
- Lynnea M Mills
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Olle Ten Cate
- University Medical Center Utrecht, Utrecht, the Netherlands
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26
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Vaa Stelling BE, Andersen CA, Suarez DA, Nordhues HC, Hafferty FW, Beckman TJ, Sawatsky AP. Fitting In While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-Career Faculty Physicians. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:514-520. [PMID: 36512808 DOI: 10.1097/acm.0000000000005049] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Professional identity formation (PIF) is a dynamic process by which an individual internalizes the core values and beliefs of a specific profession. Within medical education, PIF begins in medical school and continues throughout training and practice. Transitions affect PIF, with a critical transition occurring between medical training and unsupervised practice. This study aims to characterize PIF during the transition from resident to early-career faculty physician and explores the relationship between PIF and burnout during this transition. METHOD The authors conducted a qualitative study using constructivist grounded theory. They conducted semistructured interviews with early-career faculty physicians (defined as practicing for ≤ 5 years) from the Department of Medicine, Mayo Clinic. Deidentified interview transcripts were processed through open and axial coding. The authors organized themes and identified relationships between themes that were refined through discussion and constant comparison with newly collected data. During data analysis, the authors identified self-determination theory, with the concepts of autonomy, competence, and relatedness, as a framework to support the organization and analysis of the data. RESULTS Eleven early-career faculty physicians participated in the interviews. Their PIF was characterized by the dual desires to fit in and stand out. Striving for these desires was characterized by imposter syndrome, driving physicians to question their decision making and overall competence. Participants associated imposter syndrome and academic pressures with burnout. Autonomy support by the institution to pursue opportunities important for career development helped mitigate burnout and support PIF. CONCLUSIONS Early-career faculty physicians face identity challenges when transitioning from training to unsupervised practice, including striving to fit in and stand out. They link this tension to imposter syndrome, which they associated with burnout. Institutional awareness and support, including addressing structural and cultural contributors to imposter syndrome, are paramount as new faculty explore their identities and navigate new challenges.
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Affiliation(s)
- Brianna E Vaa Stelling
- B.E. Vaa Stelling is assistant professor of medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carl A Andersen
- C.A. Andersen is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Diego A Suarez
- D.A. Suarez is instructor of medicine, Division of Community Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hannah C Nordhues
- H.C. Nordhues is assistant professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-5610-0663
| | - Frederic W Hafferty
- F.W. Hafferty is professor of medical education, Division of General Internal Medicine, Program in Professionalism and Values, and College of Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-5604-7268
| | - Thomas J Beckman
- T.J. Beckman is professor of medicine and medical education, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Adam P Sawatsky
- A.P. Sawatsky is associate professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-4050-7984
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Onlock M, Nasser L, Riddell T, Snelgrove N, Pardhan K. Fear, health impacts, and life delays: residents' certification exam year experience. CAN J EMERG MED 2023:10.1007/s43678-023-00485-3. [PMID: 36967408 PMCID: PMC10040228 DOI: 10.1007/s43678-023-00485-3] [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: 01/23/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Residency training is associated with risks of burnout and impaired well-being. This may be due to multiple factors, including navigating various transitions. Chief among these is the transition to independent practice which, in Canada, involves a certification exam administered by the Royal College of Physicians and Surgeons of Canada or the College of Family Physicians of Canada. This qualitative study explored the experience of residents in their examination year, including residents impacted by pandemic-related examination postponment, to understand how these experiences may impact residents' well-being. METHODS Qualitative description methodology was used for this study. Participants were residents and physicians in independent practice from McMaster University and the University of Toronto. In depth, semi-structured, one-on-one interviews were conducted by one of the investigators. Each was transcribed, reviewed, and coded by two members of the investigating team. RESULTS Five themes were identified. Examinations were perceived to be a significant stressor, and the extent of preparation involved was viewed as a threat to one's physical and mental well-being. Participants identified a culture of fear surrounding the exam, as well as a perception that exam preparation requires significant sacrifice which can exacerbate the impacts of the exam year. Personal and professional supports were identified as important protective factors. CONCLUSION This study has identified unique challenges in the examination year, and its impact on the well-being of residents immediately before they enter independent practice. Residents also experienced significant learning and a sense of accomplishment through their preparation for the examination. The COVID-19 pandemic had a unique impact on one cohort of residents. This should prompt medical education institutions to examine the support provided to residents, the culture surrounding certification examinations, and mitigation strategies for future examination disruptions.
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Affiliation(s)
- Michelle Onlock
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laila Nasser
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tara Riddell
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | | | - Kaif Pardhan
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
- University of Toronto and McMaster University, Toronto, ON, Canada.
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Coakley N, O'Leary P, Bennett D. Endured and prevailed: a phenomenological study of doctors' first year of clinical practice. BMC MEDICAL EDUCATION 2023; 23:109. [PMID: 36782187 PMCID: PMC9923928 DOI: 10.1186/s12909-023-04059-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT The challenging nature of the transition from medical student to doctor is highlighted by the associated negative consequences to new doctors' mental health and wellbeing. Enhanced understanding of the lived experience of recent medical graduates as they move through the stages of transition over the first year of practice can inform interventions to ease the difficulties encountered. METHODS Using interpretative phenomenological analysis (IPA), a novel approach to this topic, we explored the lived experience of transition from student to doctor over the first year of practice after graduation. Twelve new graduates were purposively recruited. We conducted semi-structured interviews at the end of their first year of practice with respect to their experience over the first year. RESULTS The experience of transition was characterised by overlapping temporal stages. Participants' initial adjustment period was characterised by shock, coping and stabilisation. A phase of development followed, with growth in confidence and a focus on self-care. Adversity was experienced in the form of interprofessional tensions, overwork, isolation and mistreatment. Finally, a period of reflection and rationalisation marked the end of the first year. DISCUSSION Following initial anxiety regarding competence and performance, participants' experience of transition was predominantly influenced by cultural, relational and contextual aspects of clinical practice. Solutions to ease this challenging time include stage-specific transitional interventions, curricular change at both undergraduate and postgraduate levels and a re-evaluation of the clinical learning environment to mitigate the difficulties endured.
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Affiliation(s)
- Niamh Coakley
- Department of Medicine, University College Cork, National University of Ireland, Cork, Ireland.
| | - Paula O'Leary
- School of Medicine, University College Cork, National University of Ireland, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, National University of Ireland, Cork, Ireland
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29
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Kniha K, Bock A, Peters F, Heitzer M, Hölzle F, Raith S, Modabber A, Möhlhenrich SC. Guided discovery learning: A follow-up study of try-it-yourself surgery and subsequent video-assisted teaching for oral surgical skills training. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2023; 27:29-35. [PMID: 35051298 DOI: 10.1111/eje.12772] [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: 08/03/2021] [Revised: 12/22/2021] [Accepted: 01/15/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The purpose of this follow-up study was to assess the effects of discovery learning and subsequent standardised teaching on students' advanced dental surgical skills. MATERIALS AND METHODS A total of 29 dental students who had no theoretical education on the Rehrmann flap were included in the skills training programme. Without prior teaching, the students were initially asked to perform a discovery surgery with a subsequent multiple-choice test (MCT) on the first day. This was followed by a video-assisted teaching lecture. On the same day and after 122 days, the surgery and MCT were repeated. Aside from the practical and theoretical assessment forms, the training was evaluated by the students themselves. RESULTS Regarding the evaluation of surgery (EOS), significant improvements were measured between the first surgery and the second and third surgeries (p > .001). In addition, the theoretical test scores showed significant improvements after the first test when compared with the second (p = .004) and third tests (p < .001). For both assessments, no significant difference was found between the second and third attempts. The MCT and EOS in the second and third attempts strongly correlated (r = .77 and r = .71 respectively). CONCLUSION The dental students in this study successfully learned a complex oral surgical procedure, the Rehrmann flap technique, for closing oro-antral communications. The participants indicated their high satisfaction with the teaching approach. After 122 days of follow-up, their practical and theoretical test scores remained high and presented no significant difference, which suggests that the newly learnt individual skills were retained.
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Affiliation(s)
- Kristian Kniha
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
- Private Clinic for Oral and Maxillofacial Surgery, Kniha, Schlegel, and Colleagues, Munich, Germany
| | - Anna Bock
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Florian Peters
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Marius Heitzer
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Stefan Raith
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Ali Modabber
- Department of Oral and Cranio-Maxillofacial Surgery, University Hospital RWTH Aachen, Aachen, Germany
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Moffett J, Cassidy D, Collins N, Illing J, de Carvalho Filho MA, Bok H. Exploring Medical Students' Learning Around Uncertainty Management Using a Digital Educational Escape Room: A Design-based Research Approach. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:86-98. [PMID: 36969324 PMCID: PMC10038110 DOI: 10.5334/pme.844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/07/2023] [Indexed: 05/05/2023]
Abstract
Introduction Medical professionals meet many transitions during their careers, and must learn to adjust rapidly to unfamiliar workplaces and teams. This study investigated the use of a digital educational escape room (DEER) in facilitating medical students' learning around managing uncertainty in transitioning from classroom to clinical placement. Methods We used design-based research to explore the design, build, and test of a DEER, as well as gain insight into how these novel learning environments work, using Community of Inquiry (CoI) as a guiding conceptual framework. This study represented a mixed methods pilot test of a prototype DEER. Twenty-two medical students agreed to participate, and data were collected through qualitative (i.e., focus groups, game-play observations) and quantitative (i.e., questionnaires) methods. Results Eighty-two per cent of participants agreed or strongly agreed that the DEER supported their learning around uncertainty. Participants offered diverse examples of how the game had facilitated new insights on, and approaches to, uncertainty. With respect to the learning environment, multiple indicators and examples of the three domains of CoI - cognitive, teaching and social presence - were observed. Discussion Our findings suggested that DEERs offer a valuable online learning environment for students to engage with complex and emotion-provoking challenges, such as those experienced at transitions. The study also suggested that CoI can be applied to the design, implementation, and evaluation of DEER learning environments, and we have proposed a set of design principles that may offer guidance here.
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Affiliation(s)
- Jenny Moffett
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Dara Cassidy
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Naoise Collins
- Department of Visual and Human-Centred Computing, Dundalk Institute of Technology, Dublin Rd, Marshes Upper, Dundalk, Ireland
| | - Jan Illing
- HPEC Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin, Ireland
| | - Marco Antonio de Carvalho Filho
- Wenckebach Institute, Health Profession Education Research, Faculty of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Bok
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Stoffels M, van der Burgt SME, Bronkhorst LH, Daelmans HEM, Peerdeman SM, Kusurkar RA. Learning in and across communities of practice: health professions education students' learning from boundary crossing. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1423-1441. [PMID: 35819568 PMCID: PMC9274184 DOI: 10.1007/s10459-022-10135-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/11/2022] [Indexed: 06/15/2023]
Abstract
Learning to adapt to new contexts is crucial in health professions education (HPE). Boundaries between and within contexts challenge continuity in students' learning processes. Little is known about how HPE students can make these "boundary experiences" productive for learning. We investigated how and what nursing students learn from boundary experiences while they are simultaneously growing into a community of practice (CoP). Using a boundary-crossing lens, experiences of discontinuity were identified in pre-placement and post-placement interviews and diary fragments with 14 nursing students during their placement in an academic hospital. We found that students experience discontinuity as a result of different approaches to nursing care and to learning, both between (academic and clinical) settings and within a setting. When students feel safe enough, they can convert boundary experiences into meaningful learning situations, such as critical discussions with staff. Successfully overcoming boundary experiences improves students' understanding of healthcare and professional development and helps them to develop a personal approach to learning. Students critically address boundary experiences when they are motivated to learn and when they perceive a violation of ethical standards but not when they are concerned that it will affect their assessment. Objects designed to bridge theory and practice can generate additional barriers. This study adds to the HPE literature by demonstrating the learning potential of boundaries and to the broader literature by showing how responses to boundary experiences are intertwined with the process of growing into a CoP. The findings can be used to design future boundary objects.
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Affiliation(s)
- Malou Stoffels
- Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 118, 1081 HZ, 1007 MB, Amsterdam, The Netherlands.
- Amsterdam UMC, VUmc Amstel Academy, Institute for Education and Training, Amsterdam, The Netherlands.
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Stephanie M E van der Burgt
- Teaching & Learning Centre (TLC) FdG, University of Amsterdam, Amsterdam Umc Location Amc, Amsterdam, The Netherlands
| | - Larike H Bronkhorst
- Department of Education, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
| | - Hester E M Daelmans
- Research in Education, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 118, 1081 HZ, 1007 MB, Amsterdam, The Netherlands
- Faculty of Medicine, Department of Skills Training, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia M Peerdeman
- Teaching & Learning Centre (TLC) FdG, University of Amsterdam, Amsterdam Umc Location Amc, 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, De Boelelaan 118, 1081 HZ, 1007 MB, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Klitgaard TL, Gjessing S, Skipper M, Nøhr SB. Becoming a doctor-The potential of a change laboratory intervention. MEDICAL TEACHER 2022; 44:1376-1384. [PMID: 35862640 DOI: 10.1080/0142159x.2022.2098099] [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: 06/15/2023]
Abstract
In a previous ethnographic field study, we found that newly graduated doctors (NGDs) found their first months of practice challenging and overwhelming. By including an organisational perspective (Cultural Historical Activity Theory), we were able to identify contextual factors within the hospital organisation, which influence the NGDs' challenges. This raised the question: What can be done about it? To address this, we designed a Change Laboratory intervention (CL), consisting of six sessions, involving NGDs, junior doctors, and consultants across eight departments (on average, 18 doctors participated in each session). Through the CL, the participants were able to get a mutual understanding across departments and develop two initiatives to support the NGDs: An NGD introduction day with a 'need-to-know' focus, where the NGDs meet their future collaborators, and are introduced to important work procedures, and are given the opportunity to establish a peer network. This is followed up by a monthly NGD forum with a 'nice-to-know' focus, where new topics are introduced, allowing time for reflections, and supporting the further strengthening of a peer community. The CL approach promoted agency among participants and the results show how CL offers a unique opportunity for stakeholders to challenge and rethink their work practices within the hospital organisation.
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Affiliation(s)
- Tine Lass Klitgaard
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sofie Gjessing
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Mads Skipper
- Postgraduate Medical Educational Region North, Viborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susanne Backman Nøhr
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Robledo-Gil T, Ryznar E, Chisolm MS, Balhara KS. Identity and uncertainty: art-mediated medical student reflections in a time of transition. MEDICAL EDUCATION ONLINE 2022; 27:2120946. [PMID: 36066076 PMCID: PMC9467532 DOI: 10.1080/10872981.2022.2120946] [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: 06/21/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 05/19/2023]
Abstract
Medical education comprises intense periods of transition, which can significantly impact student well-being, as well as personal and professional development. In 2020, medical students navigating transitions from pre-clinical to clinical roles were also experiencing the historic forces of the COVID-19 pandemic and ongoing societal reckoning with systemic injustice and racism, likely heightening the usual challenges associated with these transitions. Reflection has been suggested as a tool for facilitating such transitions, and arts-mediated approaches hold promise in inspiring authentic reflection, yet they are rarely used to prompt medical student reflection. This article describes common themes in medical students' reflections on a specific period of transition during a unique moment in history, via qualitative analysis of their narrative responses to visual arts-mediated reflective prompts. The authors used a visual arts-based activity to explore medical students' hopes and concerns as they transitioned to clinical clerkships between the 2019-2020 and 2020-2021 academic years at one academic institution. Qualitative analysis using an exploratory constructivist approach revealed that students' reflections often focused on identity within three main themes: the personal self, the professional self, and the social self. Within these categories, subthemes included uncertainty and concerns focusing on medical training and knowledge, the sense of hope and value inherent to their social connections, critiques of the culture of medical education, and reflections on complicity and responsibility in racial injustice. This article not only provides a cross-sectional snapshot of the experiences of medical students during a historic moment, but also provides themes to guide discussions on training transitions and describes a low-cost, adaptable approach to facilitating deep exploration and reflection on tumultuous moments in training.
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Affiliation(s)
- Talia Robledo-Gil
- General Internal Medicine, Johns Hopkins University School of Medicine, MD, Baltimore, USA
- CONTACT Talia Robledo-Gil General Internist in Washington, 600 N Wolfe St, Meyer 8134, Baltimore, MD 21287, USA
| | - Elizabeth Ryznar
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Margaret S. Chisolm
- Psychiatry and Behavioral Sciences, and Professor of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kamna S. Balhara
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gottschalk M, Albert C, Werwick K, Spura A, Braun-Dullaeus RC, Stieger P. Students' perception and learning experience in the first medical clerkship. BMC MEDICAL EDUCATION 2022; 22:694. [PMID: 36167525 PMCID: PMC9513910 DOI: 10.1186/s12909-022-03754-4] [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: 02/01/2022] [Accepted: 09/07/2022] [Indexed: 06/08/2023]
Abstract
BACKGROUND The German clerkship ("Famulatur") is the first phase in medical education, in which students learn from a physician's perspective. According to the German Licensing Regulations for Physicians, students shall "familiarise" with providing care. However, specific learning objectives for the clerkship are not defined, although the acquisition of different competencies is implicitly demanded. Therefore, an additional understanding of the clerkship students' learning experience is needed. The goal of this study is to explore the student's learning perspective and experiences in the clerkship. METHODS Twelve guideline-based interviews were conducted with third year medical students. All participants completed their first clerkship. A qualitative content analysis was performed. The inductively identified categories were transferred into a quantitative questionnaire using a 5-point Likert-scale to explore their relevance in a validation cohort. The questionnaire was completed by 222 clinical students of the Otto-von-Guericke-Universität Magdeburg. RESULTS The qualitative analysis led to 26 individual items assigned to 4 main categories that describe the clerkship experience: 1) "coping with insecurities", 2) "the clerkship as a social arrangement", 3) "the clerkship as a learning opportunity" and 4) "the clerkship as a teaching opportunity". In the quantitative validation cohort, category one yielded a well-balanced result (median 3 = "neither agree nor disagree"; IQR 2-4), items addressed in categories 2-4 were generally supported by the students, predominantly selecting "strongly agree" or "agree" (Median 2; IQR 1-2 for each category). Students rated the role of the clinical team as especially important for their learning success and feared exclusion or negative reactions. CONCLUSIONS The medical clerkship provides an institutional, professional, and social framework, in which students are learning. Insecurities arose from curricular inconsistencies, a high dependency on the clinical team as well as the absence of specific learning objectives. Therefore, a better curricular integration regarding the semester structure and the learning objectives of the German clerkship is needed.
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Affiliation(s)
- Marc Gottschalk
- University Medicine Magdeburg, Center for Internal Medicine, University Clinic for Cardiology and Angiology, Leipziger Str. 44, D-, 39120 Magdeburg, Germany
| | - Christian Albert
- University Medicine Magdeburg, Center for Internal Medicine, University Clinic for Cardiology and Angiology, Leipziger Str. 44, D-, 39120 Magdeburg, Germany
- Diaverum Renal Services, MVZ, Potsdam, Germany
| | - Katrin Werwick
- Student Affairs, Medical Faculty, Magdeburg University, Magdeburg, Germany
| | - Anke Spura
- Federal Centre for Health Education, Cologne, Germany
| | - Ruediger C. Braun-Dullaeus
- University Medicine Magdeburg, Center for Internal Medicine, University Clinic for Cardiology and Angiology, Leipziger Str. 44, D-, 39120 Magdeburg, Germany
| | - Philipp Stieger
- University Medicine Magdeburg, Center for Internal Medicine, University Clinic for Cardiology and Angiology, Leipziger Str. 44, D-, 39120 Magdeburg, Germany
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Klitgaard TL, Stentoft D, Johansson N, Grønkjær M, Nøhr SB. Collaborators as a key to survival: an ethnographic study on newly graduated doctors' collaboration with colleagues. BMC MEDICAL EDUCATION 2022; 22:604. [PMID: 35927633 PMCID: PMC9354268 DOI: 10.1186/s12909-022-03655-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 07/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Newly graduated doctors find their first months of practice challenging and overwhelming. As the newly graduated doctors need help to survive this period, collaborators such as peers, senior doctors, registered nurses and other junior doctors are crucial. However, little is known about what characterise these collaborations, and how much is at stake when newly graduated doctors are striving to establish and maintain them. This study aims to describe and explore the collaborations in depth from the newly graduated doctors' point of view. METHODS We conducted 135 h of participant observations among newly graduated doctors (n = 11), where the doctors were observed throughout their working hours at various times of the day and the week. Furthermore, six semi-structured interviews (four group interviews and two individual) were carried out. The data was analysed thematically. RESULTS Newly graduated doctors consulted different collaborators (peers, senior doctors, registered nurses, and other junior doctors) dependent on the challenge at hand, and they used different strategies to get help and secure good relationships with their collaborators: 1) displaying competence; 2) appearing humble; and 3) playing the game. Their use of different strategies shows how they are committed to engage in these collaborations, and how much is at stake. CONCLUSIONS Newly graduated doctors rely on building relationships with different collaborators in order to survive their first months of practice. We argue that the collaboration with peer NGDs and registered nurses has not received the attention it deserves when working with the transition from medical school. We highlight how it is important to focus on these and other collaborators and discuss different work-agendas, mutual expectations, and interdependence. This could be addressed in the introduction period and be one way to ensure a better learning environment and a respectful interprofessional culture.
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Affiliation(s)
- Tine Lass Klitgaard
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Diana Stentoft
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Nicolaj Johansson
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette Grønkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Susanne Backman Nøhr
- Department of Postgraduate Medical Education, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Huang K, Mak D, Hafferty FW, Eva KW. The Advice Given During Near-Peer Interactions Before and After Curriculum Change. TEACHING AND LEARNING IN MEDICINE 2022; 34:351-359. [PMID: 34524067 DOI: 10.1080/10401334.2021.1957685] [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: 01/06/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
PhenomenonNear-peer interactions (NPIs) provide formal and informal mentorship that can allow medical students to share strategies for successful training. Such capacity to convey valuable advice, however, may depend on the similitude of experiences. Given that many factors can disrupt homogeneity, including curriculum renewal, we must better understand whether junior trainees feel disadvantaged when they do not have more senior peers with similar experiences. This study was, therefore, conducted to examine the focus of, and engagement with, advice available through NPIs during curriculum renewal. Approach: We used a generic exploratory qualitative research approach. Twenty MD undergraduate students, seven from the Class of 2019 (the first cohort post-curriculum change), and thirteen from the Class of 2020 (the first cohort with access to more senior students in the new curriculum), participated in semi-structured interviews. Anonymized transcriptions were analyzed with open, axial, and selective coding to generate themes until saturation was attained. Findings: Participants from the Class of 2019 reported having particularly few reasons to seek advice; because curriculum renewal disrupted their near peers' capacity to provide critical insights, students exerted little effort to learn from them. That said, this vacuum was not generally cause for concern. Deeper probing illustrated why: advice given during NPIs in both classes more commonly focused on nonacademic (e.g., work-life balance issues) than academic advice; academic advice, when sought or offered, tended not to be aimed at improving understanding of curriculum dependent content; and, while students in both classes welcomed advice, both were wary of accepting it at face value, precluding a sense of dependence on senior peers. Insights: Students' skepticism about the overall utility of academic advice raises a number of important issues for medical education and training. Positively, it shielded students from feeling loss when advice from similarly trained students was not available, reducing concerns about disadvantage that could arise during periods of curriculum revision. On the other hand, knowing that what students perceive and what educators claim to be important aspects of training can be at odds and knowing that self-assessment is flawed makes it surprising and unsettling, respectively, that participants so readily treated the lessons learned by those who came before them as irrelevant.
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Affiliation(s)
- Kelly Huang
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Mak
- Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Frederic W Hafferty
- Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin W Eva
- Education Research and Scholarship, University of British Columbia, Vancouver, British Columbia, Canada
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Noerholk LM, Bader‐Larsen KS, Morcke AM, Vamadevan A, Andreasen LA, Svendsen JH, Jørsboe H, Tolsgaard MG. Business as (un)usual: A qualitative study of clerkship experiences during a health crisis. MEDICAL EDUCATION 2022; 56:805-814. [PMID: 35199378 PMCID: PMC9543617 DOI: 10.1111/medu.14787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/07/2022] [Accepted: 02/18/2022] [Indexed: 06/01/2023]
Abstract
INTRODUCTION During a health crisis, hospitals must prioritise activities and resources, which can compromise clerkship-based learning. We explored how health crises affect clinical clerkships using the COVID-19 pandemic as an example. METHODS In a constructivist qualitative study, we conducted 22 semi-structured interviews with key stakeholders (i.e. medical students and doctors) from two teaching hospitals and 10 different departments. We used thematic analysis to investigate our data and used stakeholder theory as a sensitising concept. RESULTS We identified three themes: (1) emotional triggers and reactions; (2) negotiation of legitimacy; and (3) building resilience. Our results suggest that the health crisis accentuated already existing problems in clerkships, such as students' feelings of low legitimacy, constant negotiation of roles, inconsistencies navigating rules and regulations and low levels of active participation. Medical students and doctors adapted to the new organisational demands by developing increased resilience. Students responded by reaching out for guidance and acceptance to remain relevant in the clinical clerkships. Doctors developed a behaviour of closing in and focused on managing themselves and their patients. This created tension between these two stakeholder groups. CONCLUSION A health crisis can critically disrupt the hierarchical structure within the clinical clerkships and exacerbate existing conflicts between stakeholder groups. When medical students are not perceived as legitimate stakeholders in clinical clerkships during a health crisis, their attendance is perceived as unnecessary or even a nuisance. Despite increased student proactiveness and resilience, their roles inevitably shift from being doctors-to-be to students-to-be-managed.
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Affiliation(s)
- Laerke Marijke Noerholk
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Karlen S. Bader‐Larsen
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | | | - Anishan Vamadevan
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Lisbeth Anita Andreasen
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of CardiologyCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
| | - Hanne Jørsboe
- Nykøbing Falster Sygehus, Region ZealandNykøbing FalsterDenmark
| | - Martin G. Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES)Copenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Centre for Fetal Medicine, Juliane Marie CentreCopenhagen University Hospital ‐ RigshospitaletCopenhagenDenmark
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Rees CE, Ottrey E, Kemp C, Brock TP, Leech M, Lyons K, Monrouxe LV, Morphet J, Palermo C. Understanding Health Care Graduates' Conceptualizations of Transitions: A Longitudinal Qualitative Research Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1049-1056. [PMID: 34879008 DOI: 10.1097/acm.0000000000004554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Although transitions have been defined in various ways in the higher education literature (e.g., inculcation, development, becoming), little research exists exploring health care learners' conceptualizations of transitions across their transition from final year to new graduate. How they understand transitions is important because such conceptualizations will shape how they navigate their transitions and vice versa. METHOD The authors conducted a 3-month longitudinal qualitative research study with 35 health care learners from 4 disciplines (medicine, dietetics, nursing, and pharmacy) across their final year to new graduate transition to explore how they conceptualized transitions. Data collection occurred between July 2019 and April 2020 at Monash University in Victoria, Australia. The authors employed framework analysis to interrogate the interview and longitudinal audio diary data cross-sectionally and longitudinally. RESULTS The authors found 10 different conceptualizations of transitions broadly categorized as time bound and linear (one-off events, systems, linear, adaptation, linked to identities), ongoing and complex (ongoing processes, multifaceted, complex), or related to transition shock (labor, linked to emotions). The adaptation conceptualization increased in dominance over time, the linear conceptualization was more apparent in the interviews (time points 1 and 3), and the multifaceted and emotion-linked conceptualizations were more dominant in the longitudinal audio diaries (time point 2). CONCLUSIONS This novel study illustrates conceptualizations of transitions as broadly consistent with existing higher education literature but extends this research considerably by identifying differences in conceptualizations across time. The authors encourage health care learners, educators, and policy makers to develop expanded and more sophisticated understandings of transitions to ensure that health care learners can better navigate often challenging graduate transitions. Further research should explore stakeholders' transition conceptualizations over lengthier durations beyond the new graduate transition.
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Affiliation(s)
- Charlotte E Rees
- C.E. Rees is head of school, School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia, and adjunct professor, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0003-4828-1422
| | - Ella Ottrey
- E. Ottrey is postdoctoral fellow, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-2979-548X
| | - Caitlin Kemp
- C. Kemp is research assistant, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-4056-2230
| | - Tina P Brock
- T.P. Brock is professor of pharmacy education and practice, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7455-4063
| | - Michelle Leech
- M. Leech is deputy dean and head of medical course, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Kayley Lyons
- K. Lyons is Ware fellow for pharmacy education and leadership, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; ORCID: https://orcid.org/0000-0003-2224-1107
| | - Lynn V Monrouxe
- L.V. Monrouxe is professor for work integrated learning and academic lead of health professions education research, Faculty of Medicine and Health, The University of Sydney, Camperdown, Sydney, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-4895-1812
| | - Julia Morphet
- J. Morphet is associate professor, Monash Nursing and Midwifery, and affiliate, Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0001-7056-6526
| | - Claire Palermo
- C. Palermo is director, Monash Centre for Scholarship in Health Education, and head of education and education research, Department of Nutrition, Dietetics and Food, Monash University, Clayton, Victoria, Australia; ORCID: https://orcid.org/0000-0002-9423-5067
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Atherley A, Hu WCY, Dolmans D, Teunissen PW, Hegazi I. Medical Students' Socialization Tactics When Entering a New Clinical Clerkship: A Mixed Methods Study of Proactivity. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:884-893. [PMID: 35171118 PMCID: PMC9126257 DOI: 10.1097/acm.0000000000004627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Socialization into clinical clerkships is difficult in part due to ambiguity around students' new roles and expected behaviors. Being proactive reduces ambiguity and is essential to socialization. Proactive behavior can be taught and goes beyond having a proactive personality. Among students entering new undergraduate clinical clerkships, this study aimed to investigate (1) reported proactive behaviors and their association with social integration and (2) enabling and inhibiting factors for proactive behavior. METHOD This study was conducted at the 5-year MBBS program at Western Sydney University during academic year 2019-2020. Using a convergent mixed methods approach, survey and interview data from third-, fourth-, and fifth-year students were collected. Surveys explored 5 proactive behaviors: feedback seeking, information seeking, task negotiation, positive framing, and relationship building. Interviews elicited descriptions of how students described their proactivity and what influenced students to be proactive when entering a new clerkship. Data were integrated using the following the thread and mixed methods matrix techniques. RESULTS Students exhibited all 5 proactive behaviors. Survey data showed positive framing and task negotiation had the highest and lowest scores, respectively. Only positive framing correlated significantly with social integration scores (r = 0.27; P < .01), but this contrasted to interviews, in which students described how other proactive behaviors also led to social integration. Proactive behavior scores decreased across academic years. Integrated data showed 3 linked antecedents to whether students exhibited proactive behavior: feeling capable of being proactive, individual intention to be proactive, and the immediate environment and system-level factors. CONCLUSIONS Students who framed the experience positively were more likely to report increased social integration. Initiating task negotiation was challenging for most students. The authors propose a conceptual model for proactivity and social integration to support socialization and learning during clinical transitions for future research and interventional design.
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Affiliation(s)
- Anique Atherley
- A. Atherley was a dual PhD candidate, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia, and the School of Health Professions Education, Maastricht University, Maastricht, the Netherlands, at the time of writing. She is now assistant professor, Academy for Teaching and Learning, Ross University School of Medicine, Bridgetown, Barbados; ORCID: https://orcid.org/0000-0002-6350-7285
| | - Wendy C.-Y. Hu
- W.C.-Y. Hu is professor of medical education and associate dean of learning and innovation, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia; ORCID: http://orcid.org/0000-0002-1711-3808
| | - Diana Dolmans
- D. Dolmans is professor of innovative learning arrangements and educational scientist, School of Health Professions Education and the Department of Educational Development & Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-4802-1156
| | - Pim W. Teunissen
- P.W. Teunissen is professor of workplace learning in health care, School of Health Professions Education, and gynecologist, Department of Obstetrics & Gynecology, Maastricht University and Maastricht University Medical Center, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-0930-0048
| | - Iman Hegazi
- I. Hegazi is director of medical education and the undergraduate academic program, School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia; ORCID: https://orcid.org/0000-0002-5428-6564
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ten Cate O, Favier RP. Approaching Training-Practice Gaps After the Transition: A Practice Proposal for Supervision After Training. Front Med (Lausanne) 2022; 9:881274. [PMID: 35602504 PMCID: PMC9120653 DOI: 10.3389/fmed.2022.881274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/07/2022] [Indexed: 11/13/2022] Open
Abstract
Transitions within medical, veterinarian, and other health professional training, from classroom to workplace, between undergraduate, postgraduate, fellowship phases, and to unsupervised clinical practice, are often stressful. Endeavors to alleviate inadequate connections between phases have typically focused on preparation of learners for a next phase. Yet, while some of these efforts show results, they cannot obliviate transitional gaps. If reformulated as ‘not completely ready to assume the expected responsibilities in the next phase’, transitions may reflect intrinsic problems in a training trajectory. Indeed, the nature of classroom teaching and even skills training for example, will never fully reflect the true context of clinical training. In various stages of clinical training, the supervision provided to trainees, particularly medical residents, has increased over the past decades. This addresses calls for enhanced patient safety, but may inadequately prepare trainees for unsupervised practice. Transitions often evolve around the question how much support or supervision incoming trainees or junior professionals require. We propose to consider receiving incoming trainees and new employees in clinical workplaces with a conversation about required supervision for discrete tasks, or entrustable professional activities (EPAs). EPAs lend themselves for the question: “At what level of supervision will you be able to carry out this task?”. This question can be answered by both the trainee or junior employee and the supervisor or employer and can lead to agreement about specified supervision for a defined period of time. We expect that this “supported autonomy tool” could alleviate stress and enhance continued development after transitions.
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Affiliation(s)
- Olle ten Cate
- Utrecht University Medical Center, Utrecht University, Utrecht, Netherlands
- *Correspondence: Olle ten Cate
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Roten C, Baumgartner C, Mosimann S, Martin Y, Donzé J, Nohl F, Kraehenmann S, Monti M, Perrig M, Berendonk C. Challenges in the transition from resident to attending physician in general internal medicine: a multicenter qualitative study. BMC MEDICAL EDUCATION 2022; 22:336. [PMID: 35501754 PMCID: PMC9063076 DOI: 10.1186/s12909-022-03400-z] [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: 11/08/2021] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The attending physician in general internal medicine (GIM) guarantees comprehensive care for persons with complex and/or multiple diseases. Attendings from other medical specialties often report that transitioning from resident to attending is burdensome and stressful. We set out to identify the specific challenges of newly appointed attendings in GIM and identify measures that help residents better prepare to meet these challenges. METHODS We explored the perceptions of 35 residents, attendings, and department heads in GIM through focus group discussions and semi-structured interviews. We took a thematic approach to qualitatively analyze this data. RESULTS Our analysis revealed four key challenges: 1) Embracing a holistic, patient centered perspective in a multidisciplinary environment; 2) Decision making under conditions of uncertainty; 3) Balancing the need for patient safety with the need to foster a learning environment for residents; and 4) Taking on a leader's role and orchestrating an interprofessional team of health care professionals. Newly appointed attendings required extensive practical experience to adapt to their new roles. Most attendings did not receive regular, structured, professional coaching during their transition, but those who did found it very helpful. CONCLUSIONS Newly appointed attending physician in GIM face a number of critical challenges that are in part specific to the field of GIM. Further studies should investigate whether the availability of a mentor as well as conscious assignment of a series of increasingly complex tasks during residency by clinical supervisors will facilitate the transition from resident to attending.
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Affiliation(s)
- Christine Roten
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefanie Mosimann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Faculty of Health, Medicine & Life Sciences, Maastricht University, 6229 ER, Maastricht, The Netherlands
| | - Yonas Martin
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacques Donzé
- Division of Medicine, Hôpital Neuchâtelois, Neuchâtel, Switzerland
| | - Felix Nohl
- Department of General Internal Medicine, Regionalspital Emmental, Burgdorf, Switzerland
| | - Simone Kraehenmann
- Division of General Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Matteo Monti
- Department of Internal Medicine and Medical Education Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Martin Perrig
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Ross S, Pirraglia C, Aquilina AM, Zulla R. Effective competency-based medical education requires learning environments that promote a mastery goal orientation: A narrative review. MEDICAL TEACHER 2022; 44:527-534. [PMID: 34807798 DOI: 10.1080/0142159x.2021.2004307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Competency-based medical education (CBME) emphasizes the need for learners to be central to their own learning and to take an active role in learning. This approach has a dual aim: to encourage learners to actively engage in their own learning, and to push learners to develop learning strategies that will prepare them for lifelong learning. This review paper proposes a theoretical bridge between CBME and lifelong learning and puts forth the argument that in order for CBME programs to produce the physicians truly needed in our society now and in the future, learning environments must be intentionally designed to foster mastery goal orientations and to support the development of adaptive self-regulated learning skills and behaviours. MATERIALS AND METHODS This narrative literature review incorporated results of searches conducted by a subject librarian in PsycInfo and MedLine. Articles were also identified through reference lists of identified papers to capture older key citations. Analysis of the literature used a constructivist epistemological approach to develop an integrative description of the interaction of achievement goal orientation, self-regulated learning, learning environment, and lifelong learning. RESULTS Findings from achievement goal theory research support the assumption that adoption of a mastery goal orientation facilitates the use of adaptive learning behaviours, such as those described in self-regulated learning theory. Adaptive self-regulated learning strategies, in turn, facilitate effective lifelong learning. The authors offer evidence for how learning environments influence goal orientations and self-regulated learning, and propose that CBME programs intentionally plan for such learning environments. Finally, the authors offer specific suggestions and examples for how learning environments can be designed or adjusted to support adoption of a mastery goal orientation and use of self-regulated learning behaviours and strategies to help support development of adaptive lifelong learners.
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Affiliation(s)
- Shelley Ross
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | | | | | - Rosslynn Zulla
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
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Gordon L, Scanlan GM, Tooman TR, Walker KA, Cairns P, Ferguson J, Aitken G, Cecil J, Cunningham KB, Smith KG, Johnston PW, Laidlaw A, Pope LM, Wakeling J. Heard, valued, supported? Doctors' wellbeing during transitions triggered by COVID-19. MEDICAL EDUCATION 2022; 56:516-526. [PMID: 34796541 PMCID: PMC8662221 DOI: 10.1111/medu.14698] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Supporting doctors' wellbeing is crucial for medical education to help minimise negative long-term impacts on medical workforce retention and ultimately patient care. There is limited study of how doctors' transitions experiences impact wellbeing, particularly socially and culturally. Multiple Multidimensional Transitions (MMT) theory views transitions as dynamic, incorporating multiple contexts and multiple domains. Using MMT as our lens, we report a qualitative analysis of how transitions experienced by doctors during the pandemic impacted on social and cultural aspects of wellbeing. METHODS Longitudinal narrative inquiry was employed, using interviews and audio-diaries. Data were collected over 6 months in three phases: (i) interviews with doctors from across the career spectrum (n = 98); (ii) longitudinal audio-diaries for 2-4 months (n = 71); (iii) second interviews (n = 83). Data were analysed abductively, narrowing focus to factors important to social and cultural wellbeing. RESULTS Doctors described experiencing multiple interacting transitions triggered by the pandemic in multiple contexts (workplace, role, homelife and education). Patterns identifiable across the dataset allowed us to explore social and cultural wellbeing crosscutting beyond individual experience. Three critical factors contributed to social and cultural wellbeing both positively and negatively: being heard (e.g., by colleagues asking how they are); being valued (e.g., removal of rest spaces by organisations showing lack of value); and being supported (e.g., through regular briefing by education bodies). CONCLUSIONS This study is the first to longitudinally explore the multiple-multidimensional transitions experienced by doctors during the COVID-19 pandemic. Our data analysis helped us move beyond existing perceptions around wellbeing and articulate multiple factors that contribute to social and cultural wellbeing. It is vital that medical educators consider the learning from these experiences to help pinpoint what aspects of support might be beneficial to trainee doctors and their trainers. This study forms the basis for developing evidenced-based interventions that ensure doctors are heard, valued and supported.
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Affiliation(s)
- Lisi Gordon
- Centre for Medical EducationUniversity of DundeeDundeeUK
| | | | - Tricia R. Tooman
- Centre for Medical EducationUniversity of DundeeDundeeUK
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | - Kim A. Walker
- Centre for Healthcare Education Research and InnovationUniversity of AberdeenAberdeenUK
| | | | | | | | - Joanne Cecil
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | | | - Kathrine Gibson Smith
- Centre for Healthcare Education Research and InnovationUniversity of AberdeenAberdeenUK
| | - Peter W. Johnston
- Centre for Healthcare Education Research and InnovationUniversity of AberdeenAberdeenUK
- Medical DirectorateNHS Education for ScotlandScotlandUK
| | - Anita Laidlaw
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | | | - Judy Wakeling
- Medical DirectorateNHS Education for ScotlandScotlandUK
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Chakraverty D, Cavazos JE, Jeffe DB. Exploring reasons for MD-PhD trainees' experiences of impostor phenomenon. BMC MEDICAL EDUCATION 2022; 22:333. [PMID: 35490228 PMCID: PMC9055705 DOI: 10.1186/s12909-022-03396-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 03/30/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND Acceptance into U.S. MD-PhD dual-degree programs is highly competitive, and the lengthy training program requires transitioning between multiple phases (pre-clinical-, PhD-research-, and clinical-training phases), which can be stressful. Challenges faced during MD-PhD training could exacerbate self-doubt and anxiety. Impostor phenomenon is the experience of feeling like a fraud, with some high-achieving, competent individuals attributing their successes to luck or other factors rather than their own ability and hard work. To our knowledge, impostor phenomenon among MD-PhD trainees has not been described. This study examined impostor phenomenon experiences during MD-PhD training and reasons trainees attributed to these feelings. METHODS Individuals in science and medicine fields participated in an online survey that included the 20-item Clance Impostor Phenomenon Scale (CIPS); higher scores (range 20-100) indicate more frequent impostor phenomenon. Some respondents who reported experiencing impostor phenomenon also voluntarily completed a semi-structured interview, sharing experiences during training that contributed to feelings of impostor phenomenon. Interview transcripts were coded and analysed using the constant comparative method and analytic induction to identify themes. RESULTS Of 959 survey respondents (students and professionals in science and medicine), 13 MD-PhD students and residents completed the survey, nine of whom (five male, four female; four white, five other race-ethnicity) also completed an interview. These participants experienced moderate-to-intense scores on the CIPS (range: 46-96). Four themes emerged from the interview narratives that described participants' experiences of IP: professional identity formation, fear of evaluation, minority status, and, program-transition experiences. All reported struggling to develop a physician-scientist identity and lacking a sense of belonging in medicine or research. CONCLUSIONS Impostor experiences that MD-PhD participants attributed to bias and micro-aggressions in social interactions with peers, faculty, and patients challenged their professional identity formation as physician-scientists. It is important to further examine how MD-PhD-program structures, cultures, and social interactions can lead to feelings of alienation and experiences of impostor phenomenon, particularly for students from diverse and underrepresented populations in medicine.
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Affiliation(s)
- Devasmita Chakraverty
- Ravi J. Matthai Centre for Educational Innovation, India Institute of Management Ahmedabad, KLMDC# 36, Old Campus, Ahmedabad, Gujarat, 380 015, India.
| | - Jose E Cavazos
- South Texas Medical Scientist Training Program, University of Texas Health San Antonio, San Antonio, TX, 78229, USA
| | - Donna B Jeffe
- Washington University School of Medicine, St. Louis, MO, 63110, USA
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Galema G, Duvivier R, Pols J, Jaarsma D, Wietasch G. Learning the ropes: strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study. BMC MEDICAL EDUCATION 2022; 22:247. [PMID: 35382804 PMCID: PMC8981951 DOI: 10.1186/s12909-022-03315-9] [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: 09/30/2021] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Many residents experience their transitions, such as from medical student to resident, as demanding and stressful. The challenges they face are twofold: coping with changes in tasks or responsibilities and performing (new) social roles. This process of 'learning the ropes' is known as Organizational Socialization (OS). Although there is substantial literature on transitions from the perspective of residents, the voices of program directors (PDs) who facilitate and guide residents through the organizational socialization process have not yet been explored. PDs' perspectives are important, since PDs are formally responsible for Postgraduate Medical Education (PGME) and contribute, directly or indirectly, to residents' socialization process. Using the lens of OS, we explored what strategies PDs use to facilitate organizational socialization of newcomer residents. METHODS We conducted semi-structured interviews with 17 PDs of different specialties. We used a theory-informing inductive data analysis study design, comprising an inductive thematic analysis, a deductive interpretation of the results through the lens of OS and, subsequently, an inductive analysis to identify overarching insights. RESULTS We identified six strategies PDs used to facilitate organizational socialization of newcomer residents and uncovered two overarching insights. First, PDs varied in the extent to which they planned their guidance. Some PDs planned socialization as an explicit learning objective and assigned residents' tasks and responsibilities accordingly, making it an intended program outcome. However, socialization was also facilitated by social interactions in the workplace, making it an unintended program outcome. Second, PDs varied in the extent to which they adapted their strategies to the newcomer residents. Some PDs used individualized strategies tailored to individual residents' needs and skills, particularly in cases of poor performance, by broaching and discussing the issue or adjusting tasks and responsibilities. However, PDs also used workplace strategies requiring residents to adjust to the workplace without much intervention, which was often viewed as an implicit expectation. CONCLUSIONS PDs' used both intentional and unintentional strategies to facilitate socialization in residents, which may imply that socialization can occur irrespective of the PD's strategy. PDs' strategies varied from an individual-centered to a workplace-centered approach to socialization. Further research is needed to gain a deeper understanding of residents' perceptions of PD's efforts to facilitate their socialization process during transitions.
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Affiliation(s)
- Gerbrich Galema
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, the Netherlands.
| | - Robbert Duvivier
- University of Groningen, University Medical Center Groningen, Center for Education Development and Research in health professions (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), Groningen, the Netherlands
- Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Jan Pols
- University of Groningen, University Medical Center Groningen, Center for Education Development and Research in health professions (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), Groningen, the Netherlands
| | - Debbie Jaarsma
- University of Groningen, University Medical Center Groningen, Center for Education Development and Research in health professions (CEDAR), Lifelong Learning, Education and Assessment Research Network (LEARN), Groningen, the Netherlands
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Götz Wietasch
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Groningen, the Netherlands
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Bransen D, Driessen EW, Sluijsmans DMA, Govaerts MJB. How medical students co-regulate their learning in clinical clerkships: a social network study. BMC MEDICAL EDUCATION 2022; 22:193. [PMID: 35313887 PMCID: PMC8939067 DOI: 10.1186/s12909-022-03259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Self-regulated learning is a key competence to engage in lifelong learning. Research increasingly acknowledges that medical students in clerkships need others to regulate their learning. The concept of "co-regulated learning" captures this act of regulating one's learning by interacting with others. To effectively cultivate such skills in students, we need to increase our understanding of co-regulated learning. This study aimed to identify the purposes for which students in different phases of clinical training engage others in their networks to regulate their learning. METHODS In this social network study, we administered a questionnaire to 403 medical students during clinical clerkships (65.5% response rate). The questionnaire probed into the composition of students' co-regulatory networks and the purpose for which they engaged others in specified self-regulated learning activities. We calculated the proportion of students that engaged others in their networks for each regulatory activity. Additionally, we conducted ANOVAs to examine whether first-, second-, and third-year students differed in how they used their networks to support self-regulation. RESULTS Students used others within their co-regulatory networks to support a range of self-regulated learning activities. Whom students engaged, and the purpose of engagement, seemed to shift as students progressed through clinical training. Over time, the proportion of students engaging workplace supervisors to discuss learning goals, learning strategies, self-reflections and self-evaluations increased, whereas the proportion of students engaging peers to discuss learning strategies and how to work on learning goals in the workplace decreased. Of all purposes for which students engaged others measured, discussing self-reflections and self-evaluations were consistently among the ones most frequently mentioned. CONCLUSIONS Results reinforce the notion that medical students' regulation of learning is grounded in social interactions within co-regulatory networks students construct during clerkships. Findings elucidate the extent to which students enact self-regulatory learning within their co-regulatory networks and how their co-regulatory learning behaviors develop over time. Explicating the relevance of interactions within co-regulatory networks might help students and supervisors to purposefully engage in meaningful co-regulatory interactions. Additionally, co-regulatory interactions may assist students in regulating their learning in clinical workplaces as well as in honing their self-regulated learning skills.
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Affiliation(s)
- Derk Bransen
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
| | - Erik W Driessen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, the Netherlands
| | | | - Marjan J B Govaerts
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, the Netherlands
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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.
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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
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Tran M, Wearne S, Tapley A, Fielding A, Davey A, van Driel M, Holliday E, Ball J, FitzGerald K, Spike N, Magin P. Transitions in general practice training: quantifying epidemiological variation in trainees' experiences and clinical behaviours. BMC MEDICAL EDUCATION 2022; 22:124. [PMID: 35197039 PMCID: PMC8867826 DOI: 10.1186/s12909-022-03178-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND General Practice training in Australia is delivered through the apprenticeship model. General Practice supervisors support trainees transitioning from hospital-based work towards competent independent community-based practice. The timing and manner in which support should be provided is still not well understood. This study aimed to establish the variation in clinical and educational experiences and behaviours, and location, of general practice trainees' consultations by stage of their vocational training. It was hypothesised that change is greater in earlier stages of training. METHODS A cross-sectional analysis of data (2010-2018) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours. Multinomial logistic regression assessed the association of demographic, educational, and clinical factors in different stages of training. The outcome factor was the training term. RESULTS Two thousand four hundred sixteen registrars contributed data for 321,414 patient consultations. For several important variables (seeing patients with chronic disease; new patients; seeking in-consultation information or assistance; ordering pathology and imaging; and working in a small or regional practice), odds ratios were considerably greater for comparisons of Term 1 and 3, relative to comparisons of Term 2 and 3. CONCLUSION Differences experienced in demographic, clinical and educational factors are significantly more pronounced earlier in registrars' training. This finding has educational and training implications with respect to resource allocation, trainee supervision and curriculum design. Sociocultural learning theory enables an understanding of the impact of transitions on, and how to support, general practice trainees and supervisors.
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Affiliation(s)
- Michael Tran
- School of Medicine, Western Sydney University, Narellan Road & Gilchrist Drive, Campbelltown, NSW 2560 Australia
| | - Susan Wearne
- Academic Unit of General Practice, Australian National University, The Canberra Hospital, Yamba Drive Garran, Canberra, ACT 2605 Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Brisbane, QLD 4029 Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kristen FitzGerald
- School of Medicine, University of Tasmania, 17 Liverpool Street, TAS 7000 Hobart, Australia
- General Practice Training Tasmania (GPPT), Regional Training Organisation (RTO), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Neil Spike
- Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street Carlton, Victoria, 3053 Australia
- Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation (RTO), 15 Cato Street, Hawthorn, VIC 3122 Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Northways Road, Churchill, VIC 3842 Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
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Scott NL, Mahran S, Patel R, Culshaw M. Perceptions of transition into clinical placement. CLINICAL TEACHER 2022; 19:129-135. [DOI: 10.1111/tct.13465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 12/24/2021] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nicola Lawson Scott
- Undergraduate Medical Education Department Nottingham University Hospitals Nottingham UK
| | - Samer Mahran
- Undergraduate Medical Education Department Nottingham University Hospitals Nottingham UK
| | - Rakesh Patel
- Medical education department University of Nottingham Nottingham UK
| | - Martin Culshaw
- Undergraduate Medical Education Department Nottingham University Hospitals Nottingham UK
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Malau-Aduli BS, Lee A, Alele F, Adu M, Drovandi A, Jones K. Preclinical to clinical transition experiences of dental students at an Australian Regional University. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022; 26:182-196. [PMID: 33825285 DOI: 10.1111/eje.12687] [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] [Revised: 01/28/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Clinical experience is a crucial component of dental education as it prepares students for real-world practice. Our study aimed to investigate the transition from preclinical to clinical training experiences of dental students at a regional Australian dental school. MATERIALS AND METHODS A mixed-methods study was conducted using a survey and focus groups. Participants were dental students who recently transitioned into clinical training. Survey data were analysed quantitatively using descriptive statistics, whilst the qualitative data were thematically analysed using the conceptual framework of organisational socialisation theory (OST). RESULTS Forty-eight of the 69 students in the cohort completed the survey and 10 participated in the focus groups. The quantitative findings revealed that the transition was perceived to be abrupt and associated with a heavy workload. However, orientation sessions and engaging in chairside teaching made transitioning into clinical studies easier. The qualitative findings revealed that the transition process occurred in three phases. In phase 1, participants navigated the educational and social challenges using developmental characteristics such as resilience and positivity. Lessons learnt in phase 1 were used to make necessary learning adjustments in phase 2 and this subsequently enhanced developmental growth in the final phase, which helped ease the transition. CONCLUSION This study confirms that transitioning into clinical training can be complex. However, the educational and socialisation challenges associated with the transition can provide stimulating developmental learning opportunities that advance students' adjustments to the clinical environment with positive, empowering and motivational outcomes that facilitate a smooth transition.
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Affiliation(s)
- Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Andrew Lee
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Faith Alele
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Mary Adu
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - Karina Jones
- College of Medicine and Dentistry, James Cook University, Queensland, Australia
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