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Rahimi M, Haghani F, Kohan S, Shirani M. A model for improving the learning environment in high-stress and emotion-bound clinical settings. MEDICAL TEACHER 2024; 46:1099-1107. [PMID: 38122811 DOI: 10.1080/0142159x.2023.2292977] [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: 10/05/2022] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In clinical settings, it is necessary to create a clinical learning environment that provides the ground for the learners to acquire competencies especially in high-stress and emotion-bound clinical settings. METHODS In the present study, a model for improving the learning environment in high-stress and emotion-bound clinical settings was designed by conducting a multi-method study in the form of three sub-studies. RESULTS This model was designed with 3 pivotal concepts; organizing learning opportunities around safe care, fair participation in learning opportunities and creating a positive emotional climate and 6 peripheral concepts; designing physical space and appropriate equipment for education and care, preparing learners to attend the clinical setting, preparing learners to participate in learning opportunities, balancing the learner role and the care provided by the learners, the presence of a competent educator and providing education to all learners, and acquiring the ability to manage emotions by learners, faculty and staff. CONCLUSIONS The implementation of the model obtained from this study provides the basis for solving the challenges of clinical learning environments, especially in high-stress and emotion-bound clinical settings, and improves clinical education and the realization of educational and care outcomes.
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Affiliation(s)
- Masoumeh Rahimi
- Education Development Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
- Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Haghani
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Kohan
- Faculty of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Shirani
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Lin YL, Chen HL, Chen YY, Cheng SY, Chen WL, Chiu YC, Chiu YL. The effects of job characteristics on physicians' orientation toward lifelong learning. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1151-1169. [PMID: 36705767 PMCID: PMC9881521 DOI: 10.1007/s10459-022-10202-x] [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: 11/05/2021] [Accepted: 12/29/2022] [Indexed: 06/18/2023]
Abstract
With the rapidly growing body of medical knowledge, physicians must engage in lifelong learning. Physicians' orientation toward lifelong learning is of crucial importance. This study aimed to explore the effects of job characteristics on physicians' lifelong learning. A multicenter study collecting data from physicians from three medical centers in Taiwan was performed. A total of 321 physicians were surveyed with the Chinese version of the Job Content Questionnaire (C-JCQ) and the revised Jefferson Scale of Physician Lifelong Learning (JeffSPLL) to assess their job characteristics (i.e., job demands, job control, social support) and orientation toward lifelong learning. Exploratory factor analysis was employed to validate both questionnaires. Hierarchical regression was utilized to explore the relationship of job characteristics and predictors with physicians' lifelong learning. The results revealed that job demands (β = 0.10), job control (β = 0.19), social support from supervisors (β = 0.16), the interaction of job demands × job control (β = - 0.11) and the interaction of job demands × social support from colleagues (β = 0.13) were significantly (p < .05, p < .001) related to lifelong learning. Moreover, physicians in the active group (high demand, high control) possessed a stronger orientation toward lifelong learning (mean = 3.57) than those in the low-strain group (mean = 3.42), high-strain group (mean = 3.39) and passive group (mean = 3.20). In conclusion, examining physicians' job demands, job control and social support helps us to understand their orientation toward lifelong learning and may provide insight to improve educational strategies.
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Affiliation(s)
- Ying-Li Lin
- Department of Family Medicine, Changhua Christian Hospital, Changhua City, Taiwan
| | - Huey-Ling Chen
- Department and Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, No. 1 Jen Ai Road, Section 1, Taipei, 100, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Yuan Chen
- Department and Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, No. 1 Jen Ai Road, Section 1, Taipei, 100, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Shao-Yi Cheng
- Department of Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Li Chen
- National Taiwan University Hospital, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chun Chiu
- Department and Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, No. 1 Jen Ai Road, Section 1, Taipei, 100, Taiwan
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Yen-Lin Chiu
- Department and Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, No. 1 Jen Ai Road, Section 1, Taipei, 100, Taiwan.
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Teheux L, Wollaars H, Draaisma JMT, Coolen EHAJ, Kuijer-Siebelink W, van der Velden JAEM. Learning for doctor-to-doctor collaboration: a qualitative study exploring the experiences of residents and supervisors with intraprofessional workplace learning in complex tertiary care. BMC MEDICAL EDUCATION 2023; 23:478. [PMID: 37370026 DOI: 10.1186/s12909-023-04363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND To deliver high-quality care for individuals with complex medical conditions, residents need to be trained across the boundaries of their specialties. This study aimed to explore learning activities and influencing factors in intraprofessional workplace learning by residents in complex tertiary care. METHODS This qualitative study was conducted in a tertiary care children's hospital. In September - December 2017, fourteen individual and two focus group interviews were conducted with a purposive sample of residents and supervisors of various specialties. Transcribed interviews were thematically analyzed to describe learning activities and influencing factors that play a role in intraprofessional workplace learning in complex tertiary care settings during residency training. RESULTS Respondents described numerous activities that they considered opportunities for intraprofessional learning, both directly and not directly related to patient care. However, deliberate attention to intraprofessional learning often seemed to be lacking in clinical practice. Influencing factors on a system (macro), organization (meso) and personal and interpersonal level (micro) level were identified. Factors on the macro and meso level mainly determined whether intraprofessional learning opportunities arose, while micro level factors mainly influenced whether opportunities were seized. CONCLUSIONS There are ample opportunities for intraprofessional workplace learning in complex tertiary care for residents. Residents may benefit more from intraprofessional learning opportunities if these are made more intentional and deliberate. Influencing factors at the macro, meso and micro level provide targets for interventions aimed at enhancing intraprofessional workplace learning in postgraduate medical training.
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Affiliation(s)
- Lara Teheux
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.
| | - Hanna Wollaars
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Ester H A J Coolen
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Wietske Kuijer-Siebelink
- Department of Research on Learning and Education, Radboud University Medical Center, Radboudumc Health Academy, Nijmegen, The Netherlands
- School of Education, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Koufidis C, Manninen K, Nieminen J, Wohlin M, Silén C. Representation, interaction and interpretation. Making sense of the context in clinical reasoning. MEDICAL EDUCATION 2022; 56:98-109. [PMID: 33932248 DOI: 10.1111/medu.14545] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/06/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND All thinking occurs in some sort of context, rendering the relation between context and clinical reasoning a matter of significant interest. Context, however, has a notoriously vague and contested meaning. A profound disagreement exists between different research traditions studying clinical reasoning in how context is understood. However, empirical evidence examining the impact (or not) of context on clinical reasoning cannot be interpreted without reference to the meaning ascribed to context. Such meaning is invariably determined by assumptions concerning the nature of knowledge and knowing. The epistemology of clinical reasoning determines in essence how context is conceptualised. AIMS Our intention is to provide a sound epistemological framework of clinical reasoning that puts context into perspective and demonstrates how context is understood and researched in relation to clinical reasoning. DISCUSSION We identify three main epistemological dimensions of clinical reasoning research, each of them corresponding to fundamental patterns of knowing: the representational dimension views clinical reasoning as an act of categorisation, the interactional dimension as a cognitive state emergent from the interactions in a system, while the interpretative dimension as an act of intersubjectivity and socialisation. We discuss the main theories of clinical reasoning under each dimension and consider how the implicit epistemological assumptions of these theories determine the way context is conceptualised. These different conceptualisations of context carry important implications for the phenomenon of context specificity and for learning of clinical reasoning. CONCLUSION The study of context may be viewed as the study of the epistemology of clinical reasoning. Making sense of 'what is going on with this patient' necessitates reading the context in which the encounter is unfolding and deliberating a path of response justified in that specific context. Mastery of the context in this respect becomes a core activity of medical practice.
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Affiliation(s)
- Charilaos Koufidis
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden
| | - Katri Manninen
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Juha Nieminen
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Wohlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Charlotte Silén
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Ilgen JS, de Bruin ABH, Teunissen PW, Sherbino J, Regehr G. Supported Independence: The Role of Supervision to Help Trainees Manage Uncertainty. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S81-S86. [PMID: 34348381 DOI: 10.1097/acm.0000000000004308] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Safe and effective supervised practice requires a negotiated partnership between trainees and their supervisors. Substantial work has explored how supervisors make judgments about trainees' readiness to safely engage in critical professional activities, yet less is known about how trainees leverage the support of supervisors when they perceive themselves to be at the limits of their abilities. The purpose of this study is to explore how trainees use supervisory support to navigate experiences of clinical uncertainty. METHOD Using a constructivist grounded theory approach, the authors explored how novice emergency medicine trainees conceptualized the role of their supervisors during experiences of clinical uncertainty. They employed a critical incident technique to elicit stories from participants immediately following clinical shifts between July and September 2020, and asked participants to describe their experiences of uncertainty within the context of supervised practice. Using constant comparison, 2 investigators coded line-by-line and organized these stories into focused codes. The relationships between these codes were discussed by the research team, and this enabled them to theorize about the relationships between the emergent themes. RESULTS Participants reported a strong desire for supported independence, where predictable and accessible supervisory structures enabled them to work semiautonomously through challenging clinical situations. They described a process of borrowing their supervisors' comfort during moments of uncertainty and mechanisms to strategically broadcast their evolving understanding of a situation to implicitly invoke (the right level of) support from their supervisors. They also highlighted challenges they faced when they felt insufficiently supported. CONCLUSIONS By borrowing comfort from-or deliberately projecting their thinking to-supervisors, trainees aimed to strike the appropriate balance between independence for the purposes of learning and support to ensure safety. Understanding these strategic efforts could help educators to better support trainees in their growth toward self-regulation.
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Affiliation(s)
- Jonathan S Ilgen
- J.S. Ilgen is associate professor, Department of Emergency Medicine, University of Washington, Seattle, Washington, and a PhD candidate, School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands; ORCID: http://orcid.org/0000-0003-4590-6570
| | - Anique B H de Bruin
- A.B.H. de Bruin is professor, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; ORCID: http://orcid.org/0000-0001-5178-0287
| | - Pim W Teunissen
- P.W. Teunissen is professor, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands, and maternal fetal medicine specialist, Department of Obstetrics & Gynecology, Maastricht University Medical Center, Maastricht, The Netherlands; ORCID: http://orcid.org/0000-0002-0930-0048
| | - Jonathan Sherbino
- J. Sherbino is professor, Division of Emergency Medicine, Department of Medicine, and assistant dean, McMaster Education Research, Innovation and Theory (MERIT) program, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada; ORCID: http://orcid.org/0000-0003-0344-8057
| | - Glenn Regehr
- G. Regehr is professor, Department of Surgery and Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada. ORCID: http://orcid.org/0000-0002-3144-331X
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Teheux L, Coolen EHAJ, Draaisma JMT, de Visser M, Scherpbier-de Haan ND, Kuijer-Siebelink W, van der Velden JAEM. Intraprofessional workplace learning in postgraduate medical education: a scoping review. BMC MEDICAL EDUCATION 2021; 21:479. [PMID: 34493263 PMCID: PMC8424991 DOI: 10.1186/s12909-021-02910-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/22/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Residents need to be trained across the boundaries of their own specialty to prepare them for collaborative practice. Intraprofessional learning (i.e. between individuals of different disciplines within the same profession) has received little attention in the postgraduate medical education literature, in contrast to the extensive literature on interprofessional learning between individuals of different professions. To address this gap, we performed a scoping review to investigate what and how residents learn from workplace-related intraprofessional activities, and what factors influence learning. METHODS The PRISMA guidelines were used to conduct a scoping review of empirical studies on intraprofessional workplace learning in postgraduate medical education published between 1 January 2000 to 16 April 2020 in Pubmed, Embase, PsycINFO, ERIC and Web of Science. This study applied 'best fit' framework-based synthesis to map the existing evidence, using the presage-process-product (3P) model developed by Tynjälä (2013). RESULTS Four thousand three hundred thirty records were screened, and 37 articles were included. This review identified influencing (presage) factors that derived from the sociocultural environment, learner and learning context. Studies described that complexity of care can both facilitate and hinder learning. Furthermore, intraprofessional learning is threatened by professional stereotyping and negative perceptions, and awareness of learning opportunities and explicit reflection are critical in intraprofessional workplace learning. Studies described a range of informal and formal intraprofessional activities (process) under the headings of collaboration in clinical practice, rotations or placements, formal educational sessions and simulated workplace training. In general, learners responded well and their attitudes and perceptions improved, learners reported increased knowledge and skills and positive behavioural changes (product). Learning outcomes were reported in the domains of patient-centred care, collaborative attitudes and respect, mutual knowledge and understanding, collaborative decision making, communication, leadership, teamwork and reflexivity. CONCLUSIONS This review gives insight into the high learning potential of intraprofessional activities. Many of the included studies relied on self-reported perceptions of change, therefore, future research should focus on generating more robust evidence including objectively examined outcome measures. This review offers a comprehensive overview of the factors that influence intraprofessional workplace learning in postgraduate medical education. Finally, we provide recommendations for enhancing intraprofessional learning in clinical practice.
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Affiliation(s)
- Lara Teheux
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Ester H A J Coolen
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke de Visser
- Department of Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nynke D Scherpbier-de Haan
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wietske Kuijer-Siebelink
- Department of Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Janiëlle A E M van der Velden
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Rahimi M, Haghani F, Kohan S, Shirani M. Medical interns; the neglected learners of the maternity ward learning environment. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:287. [PMID: 34667787 PMCID: PMC8459875 DOI: 10.4103/jehp.jehp_1425_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/24/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Clinical training during internship is an important part of medical education. The maternity ward is a clinical environment in which medical students pass their obstetrics and gynecology internship to obtain competencies in this field. The present study was conducted to explain medical interns' manner of learning in the maternity ward. MATERIAL AND METHODS The present study was conducted using a qualitative approach with the inductive content analysis method. This study observed the maternity wards of teaching hospitals affiliated to medical sciences universities of Isfahan and Shahrekord. Data were collected through observation and semi-structured individual interviews. RESULTS Two main categories and seven subcategories emerged from the analysis of the data. Inadequate participation in learning opportunities included the following three subcategories: the incongruousness of the learning opportunities with the educational goals, inadequate readiness for participation in learning opportunities, and the overlap between learning opportunities and diminished autonomous practice. Inadequate formal and structured education included the following four subcategories: inadequate learning support and direction, subordinate roles and aimless presence, the pale educational role played by the attendants and senior residents, and learning through the support of midwifery educators. CONCLUSION Participation in and access to learning opportunities in the maternity ward are very difficult for interns. Interns, therefore, need to attend the maternity ward by a structured program and in the company of training supervisors or competent educators to obtain the required competencies in pregnancy and childbirth.
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Affiliation(s)
- Masoumeh Rahimi
- Education Development Center, Shahrekord University of Medical Sciences, Shahrekord, Iran, Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Haghani
- Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Kohan
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Shirani
- Department of Urology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Skipper M, Nøhr SB, Engeström Y. The change laboratory in medical education: Two examples of tackling contradictory challenges. MEDICAL EDUCATION 2021; 55:93-100. [PMID: 32722852 DOI: 10.1111/medu.14298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Medical education and workplace learning is bound to develop through tensions between providing high quality patient care and providing training of the future specialist healthcare workforce. This paper on the Change Laboratory and the theoretical framework supporting it, shows examples on how to explore inherent and contradictory tensions in medical education and healthcare and use them as a driving force for change. We argue that the traditional tools and theories for change and fixing tensions are inadequate and therefore suggest an alternative strategy found in Cultural-Historical Activity Theory (CHAT) and the Change Laboratory method. METHODS The Change Laboratory intervention method builds on the theoretical framework of CHAT and specifically the theory of expansive learning. The Change Laboratory intervention method uses well-defined steps for participants in collaboration with researchers/facilitators to co-construct and develop new ways of going about their work practice. RESULTS Drawing on our own research on implementing the Change Laboratory intervention method we present two case examples of interventions in respectively a Finnish surgical unit and a Danish paediatric outpatient clinic. CONCLUSIONS The Change Laboratory intervention offers ways to systematically leverage tensions in medical education and thus could be effective in developing and designing organisational and professional change. It is not a quick fix solution as participators must be motivated and engaged in uncovering inherent contradictions in their activity systems (workplace) and get familiar with the concepts and theory underlying the intervention and its procedures. Profound knowledge and transformative agency emerges when participants and facilitators/researchers are given the time and opportunity to analyse both historical practice, current data on practice, and organisational issues collaboratively in order to envision and redesign their practice and learning environment.
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Affiliation(s)
- Mads Skipper
- Ringgold Standard Institution, Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- Postgraduate Medical Education Region North, Viborg, Denmark
| | - Susanne Backman Nøhr
- Ringgold Standard Institution, Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- Department for Postgraduate Education, Ringgold Standard Institution, Aalborg University Hospital, Aalborg, Denmark
| | - Yrjö Engeström
- Faculty of Educational Sciences, Ringgold Standard Institution, CRADLE, University of Helsinki, Helsinki, Finland
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Sturman N, Fitzmaurice L, Lee C, Sheldrake M, Ingham G. Good help: a model for providing in-consultation supervision of general practice trainees. EDUCATION FOR PRIMARY CARE 2020; 32:104-108. [PMID: 33371787 DOI: 10.1080/14739879.2020.1864779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Timely clinical supervision of trainee consultations plays a key role in ensuring the safety of patients under the care of general practice trainees, and in trainee learning and professional development. Trainee requests for assistance during their consultations present supervisors with a number of challenges, however, and a number of factors act as barriers to, or reduce the utility of, this in-consultation assistance from the trainee's perspective. Face-to-face supervision in the presence of the patient presents particular challenges and opportunities. It is important to address barriers to trainee help-seeking and improve both trainee and supervisor skills in promoting safe, effective and efficient in-consultation supervision. We introduce a model (β-LACTAM) to assist supervisors in planning and delivering their face-to-face in-consultation supervision. The recent evidence which informed the development of this model is outlined, and some preliminary findings from a pilot of β-LACTAM in Australian general practice training are presented.
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Affiliation(s)
- Nancy Sturman
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Liz Fitzmaurice
- General Practice Training Queensland (GPTQ), Springwood, Australia
| | - Cathy Lee
- General Practice Training Queensland (GPTQ), Springwood, Australia
| | | | - Gerard Ingham
- Murray City Country Coast GP Training (MCCC), Melbourne, Australia
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van der Goot WE, Cristancho SM, de Carvalho Filho MA, Jaarsma ADC, Helmich E. Trainee-environment interactions that stimulate motivation: A rich pictures study. MEDICAL EDUCATION 2020; 54:242-253. [PMID: 31885121 PMCID: PMC7065236 DOI: 10.1111/medu.14019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/19/2019] [Accepted: 10/02/2019] [Indexed: 05/15/2023]
Abstract
CONTEXT Staying motivated when working and learning in complex workplaces can be challenging. When complex environments exceed trainees' aptitude, this may reduce feelings of competence, which can hamper motivation. Motivation theories explain how intrapersonal and interpersonal aspects influence motivation. Clinical environments include additional aspects that may not fit into these theories. We used a systems approach to explore how the clinical environment influences trainees' motivation and how they are intertwined. METHODS We employed the rich pictures drawing method as a visual tool to capture the complexities of the clinical environment. A total of 15 trainees drew a rich picture representing a motivating situation in the workplace and were interviewed afterwards. Data collection and analysis were performed iteratively, following a constructivist grounded theory approach, using open, focused and selective coding strategies as well as memo writing. Both drawings and the interviews were used to reach our results. RESULTS Trainees drew situations pertaining to tasks they enjoyed doing and that mattered for their learning or patient care. Four dimensions of the environment were identified that supported trainees' motivation. First, social interactions, including interpersonal relationships, supported motivation through close collaboration between health care professionals and trainees. Second, organisational features, including processes and procedures, supported motivation when learning opportunities were provided or trainees were able to influence their work schedule. Third, technical possibilities, including tools and artefacts, supported motivation when tools were used to provide trainees with feedback or trainees used specific instruments in their training. Finally, physical space supported motivation when the actual setting improved the atmosphere or trainees were able to modify the environment to help them focus. CONCLUSIONS Different clinical environment dimensions can support motivation and be modified to create optimal motivating situations. To understand motivational dynamics and support trainees to navigate through postgraduate medical education, we need to take all clinical environment dimensions into account.
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Affiliation(s)
- Wieke E. van der Goot
- Martini AcademieMartini HospitalGroningenthe Netherlands
- Center for Education Development and Research in health professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Sayra M. Cristancho
- Schulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioCanada
| | - Marco Antonio de Carvalho Filho
- Center for Education Development and Research in health professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
- Department of Emergency MedicineSchool of Medical SciencesUniversity of CampinasCampinasBrazil
| | - A. Debbie C. Jaarsma
- Center for Education Development and Research in health professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
| | - Esther Helmich
- Center for Education Development and Research in health professions (CEDAR)Lifelong Learning, Education and Assessment Research Network (LEARN)University of GroningenUniversity Medical Center GroningenGroningenthe Netherlands
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Peláez Zuberbuhler MJ, Salanova M, Martínez IM. Coaching-Based Leadership Intervention Program: A Controlled Trial Study. Front Psychol 2020; 10:3066. [PMID: 32116873 PMCID: PMC7011779 DOI: 10.3389/fpsyg.2019.03066] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/26/2019] [Indexed: 12/01/2022] Open
Abstract
In spite of the potential benefits that coaching-based leadership interventions can bring to organizations, basic questions remain about their impact on developing coaching skills and increasing psychological capital (PsyCap), work engagement and in- and extra-role performance. In a controlled trial study, 41 executives and middle managers (25 in the experimental group and 16 in the waiting-list control group) from an automotive sector company in Spain received pre-assessment feedback, a coaching-based leadership group workshop, and three individual executive coaching sessions over a period of 3 months. The intervention program used a strengths-based approach and the RE-GROW model, and it was conducted by executive coaching psychologists external to the organization. Participants (N = 41) and their supervisors (N = 41) and employees (N = 180) took part in a pre-post-follow up 360-degree assessment during the research period. Quantitative data were analyzed using Analyses of Variance (ANOVA) with a 2 × 2 design, paired-samples t-tests, and univariate analyses between groups. Results indicated that the intervention program was successful in increasing the participants' coaching-based leadership skills, PsyCap, work engagement, and in- and extra-role performance. Qualitative measures were also applied, and results from individual responses provided additional support for the study hypotheses. Regarding practical implications, the results suggest that the Coaching-based Leadership Intervention Program can be valuable as an applied positive intervention to help leaders develop coaching skills and enhance well-being and optimal functioning in organizations.
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The clinical learning environment of a maternity ward: A qualitative study. Women Birth 2019; 32:e523-e529. [DOI: 10.1016/j.wombi.2019.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/04/2019] [Accepted: 01/06/2019] [Indexed: 12/30/2022]
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Gaunt A, Markham DH, Pawlikowska TRB. Exploring the Role of Self-Motives in Postgraduate Trainees' Feedback-Seeking Behavior in the Clinical Workplace: A Multicenter Study of Workplace-Based Assessments From the United Kingdom. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1576-1583. [PMID: 29979211 DOI: 10.1097/acm.0000000000002348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To explore trainees' feedback-seeking behavior in the postgraduate surgical workplace using a self-motives framework. Self-motives include self-assessment "to obtain accurate information about the self," self-improvement "to improve one's traits, abilities, and skills," self-enhancement "to enhance the favorability of self views," and self-verification "to maintain consistency between one's central self-view and new self-relevant information." METHOD This project constituted a further framework analysis of previously obtained qualitative focus group data that originally explored trainees' perceptions and use of workplace-based assessment (WBA). Data were collected from multiple centers in the United Kingdom from 2012 to 2013. Content was analyzed to identify references in the data that reflected the above self-motives and in relation to contextual themes identified from within the data. RESULTS Trainees' motivations for seeking feedback broadly fit within a self-motives framework. Trainees' feedback seeking using WBA related to self-enhancement and self-verification, whereas outside WBA trainees reported self-improvement and self-assessment motives. Where trainees perceived WBA represented an opportunity to learn, they described a self-improvement motive toward seeking feedback, whereas when WBA represented an assessment of learning, trainees described tensions between self-enhancement and self-improvement motives. CONCLUSIONS Surgical trainees' motivations for seeking feedback can be explained using a conceptual self-motives framework. Trainees need to be motivated to seek accurate informational feedback so they can improve their performance within the clinical workplace. To achieve this, trainees need training; current assessment systems must change to allow trainees to seek such feedback without fear and concern about this information being used as an assessment of learning.
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Affiliation(s)
- Anne Gaunt
- A. Gaunt was a PhD student, Warwick Medical School, University of Warwick, Coventry, United Kingdom, and registrar in general surgery, University Hospital North Midlands, Stoke on Trent, United Kingdom, at the time of this work. She is currently a registrar in general surgery, New Cross Hospital, Wolverhampton, United Kingdom. D.H. Markham is consultant general surgeon, South Warwickshire Foundation Trust, Warwick, United Kingdom. T. Pawlikowska is general practitioner, medical educationalist, and director, Health Professions Education Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
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Locke R, Bell J, Scallan S, Ozguler B, Caesar S. The experience and professional development of medical appraisers. EDUCATION FOR PRIMARY CARE 2018; 29:351-356. [PMID: 30246615 DOI: 10.1080/14739879.2018.1514987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article explores the experiences of General Practitioner (GP) appraisers working in a unfamiliar setting (Jersey) with appraisees new to the process. Findings were interpreted using the learning theory, 'situated cognition', to shed light on the experience of appraisers working with new appraisees more generally and contribute to new understandings of workplace learning. Rich qualitative data derived from transcripts of nine in-depth interviews with GP appraisers were analysed thematically in a rigorous and iterative manner process. GP appraisers working in an unfamiliar environment shared a common sense of culture shock and discomfort. Initially, they needed to work much harder than usual to establish rapport and credibility, but by the second round of appraisals, appraisers were reminded of the power of appraisal. The innovative application of 'situated cognition' helps to explain why appraisers felt like 'novices' in Jersey and how they were required to reconstruct their professional knowledge. This is the first time appraiser development has been considered in this way and appraisers can be helped to develop professionally if they are offered a mix of appraisal-related activities in new places and with new people. Such implications for educational support apply internationally where doctors are involved in a process of peer review as part of on-going professional development.
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Affiliation(s)
- Rachel Locke
- a Research and Knowledge Exchange Centre , University of Winchester , Winchester , United Kingdom of Great Britain and Northern Ireland
| | - Jane Bell
- a Research and Knowledge Exchange Centre , University of Winchester , Winchester , United Kingdom of Great Britain and Northern Ireland
| | - Samantha Scallan
- a Research and Knowledge Exchange Centre , University of Winchester , Winchester , United Kingdom of Great Britain and Northern Ireland
| | - Bee Ozguler
- a Research and Knowledge Exchange Centre , University of Winchester , Winchester , United Kingdom of Great Britain and Northern Ireland
| | - Susi Caesar
- b Health Education England, working across Wessex , Winchester , United Kingdom of Great Britain and Northern Ireland
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Wiese A, Kilty C, Bennett D. Supervised workplace learning in postgraduate training: a realist synthesis. MEDICAL EDUCATION 2018; 52. [PMCID: PMC6175369 DOI: 10.1111/medu.13655] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Context This paper presents a realist synthesis of the literature that began with the objective of developing a theory of workplace learning specific to postgraduate medical education (PME). As the review progressed, we focused on informal learning between trainee and senior doctor or supervisor, asking what mechanisms occur between trainee and senior doctor that lead to the outcomes of PME, and what contexts shape the operation of these mechanisms and the outcomes they produce? Methods We followed the procedures outlined in the RAMESES Publication Standards for Realist Synthesis. We searched the English‐language literature published between 1995 and 2017 for empirical papers related to informal workplace learning between supervisor and trainee, excluding formal interventions such as workplace‐based assessment. We made a pragmatic decision to exclude general practice training to keep the review within manageable limits. Results We reviewed 5197 papers and selected 90. Synthesis revealed three workplace learning processes occurring between supervisors and trainees, each underpinned by a pair of mechanisms: supervised participation in practice (entrustment and support seeking); mutual observation of practice (monitoring and modelling), and dialogue during practice (meaning making and feedback). These mechanisms result in outcomes of PME, including safe participation in practice, learning skills, attitudes and behaviours and professional identity development. Contexts shaping the outcomes of these mechanisms were identified at individual, interpersonal, local and systems levels. Conclusions Our realist theory of workplace learning between supervisors and trainees is informed by theory and empirical research. It highlights the two‐way nature of supervision, the importance of trainees’ agency in their own learning and the deleterious effect of fragmented working patterns on supervisor–trainee learning mechanisms. Further empirical research is required to test and refine this theory. In the meantime, it provides a useful framework for the design of supportive learning environments and for the preparation of supervisors and trainees for their roles in workplace learning. The authors describe a realist theory of learning between supervisor and postgraduate trainee in the workplace, emphasising the role of individual, interpersonal, local and systems contexts in shaping key mechanisms and their outcomes.
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Affiliation(s)
- Anel Wiese
- Medical Education UnitUniversity College CorkCorkIreland
| | - Caroline Kilty
- Medical Education UnitUniversity College CorkCorkIreland
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Shahsavari H, Zare Z, Parsa-Yekta Z, Griffiths P, Vaismoradi M. Learning Situations in Nursing Education: A Concept Analysis. Res Theory Nurs Pract 2018. [DOI: 10.1891/1541-6577.32.1.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and purpose:The nursing student requires opportunities to learn within authentic contexts so as to enable safe and competent practice. One strategy to facilitate such learning is the creation of learning situations. A lack of studies on the learning situation in nursing and other health care fields has resulted in insufficient knowledge of the characteristics of the learning situation, its antecedents, and consequences. Nurse educators need to have comprehensive and practical knowledge of the definition and characteristics of the learning situation so as to enable their students to achieve enhanced learning outcomes. The aim of this study was to clarify the concept of the learning situation as it relates to the education of nurses and improve understanding of its characteristics, antecedents, and consequences.Methods:The Bonis method of concept analysis, as derived from the Rodgers’ evolutionary method, provided the framework for analysis. Data collection and analysis were undertaken in two phases: “interdisciplinary” and “intra-disciplinary.” The data source was a search of the literature, encompassing nursing and allied health care professions, published from 1975 to 2016.Results:No agreement on the conceptual phenomenon was discovered in the international literature. The concept of a learning situation was used generally in two ways and thus classified into the themes of: “formal/informal learning situation” and “biologic/nonbiologic learning situation.” Antecedents to the creation of a learning situation included personal and environmental factors. The characteristics of a learning situation were described in terms of being complex, dynamic, and offering potential and effective learning opportunities. Consequences of the learning situation included enhancement of the students’ learning, professionalization, and socialization into the professional role.Implication for Practice:The nurse educator, when considering the application of the concept of a learning situation in their educational planning, must acknowledge that the application of this concept will include the student’s clinical learning experiences. More studies are required to determine factors influencing the creation of a successful learning situation from the perspectives of nurse educators and nursing students, clinical nurses and patients.
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Berkhout JJ, Helmich E, Teunissen PW, van der Vleuten CPM, Jaarsma ADC. Context matters when striving to promote active and lifelong learning in medical education. MEDICAL EDUCATION 2018; 52:34-44. [PMID: 28984375 DOI: 10.1111/medu.13463] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/05/2017] [Accepted: 08/14/2017] [Indexed: 05/11/2023]
Abstract
UNLABELLED WHERE DO WE STAND NOW?: In the 30 years that have passed since The Edinburgh Declaration on Medical Education, we have made tremendous progress in research on fostering 'self-directed and independent study' as propagated in this declaration, of which one prime example is research carried out on problem-based learning. However, a large portion of medical education happens outside of classrooms, in authentic clinical contexts. Therefore, this article discusses recent developments in research regarding fostering active learning in clinical contexts. SELF-REGULATED, LIFELONG LEARNING IN MEDICAL EDUCATION Clinical contexts are much more complex and flexible than classrooms, and therefore require a modified approach when fostering active learning. Recent efforts have been increasingly focused on understanding the more complex subject of supporting active learning in clinical contexts. One way of doing this is by using theory regarding self-regulated learning (SRL), as well as situated learning, workplace affordances, self-determination theory and achievement goal theory. Combining these different perspectives provides a holistic view of active learning in clinical contexts. ENTRY TO PRACTICE, VOCATIONAL TRAINING AND CONTINUING PROFESSIONAL DEVELOPMENT: Research on SRL in clinical contexts has mostly focused on the undergraduate setting, showing that active learning in clinical contexts requires not only proficiency in metacognition and SRL, but also in reactive, opportunistic learning. These studies have also made us aware of the large influence one's social environment has on SRL, the importance of professional relationships for learners, and the role of identity development in learning in clinical contexts. Additionally, research regarding postgraduate lifelong learning also highlights the importance of learners interacting about learning in clinical contexts, as well as the difficulties that clinical contexts may pose for lifelong learning. However, stimulating self-regulated learning in undergraduate medical education may also make postgraduate lifelong learning easier for learners in clinical contexts.
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Affiliation(s)
- Joris J Berkhout
- Center for Evidence-Based Education, Academic Medical Center (AMC-UvA), University of Amsterdam, Amsterdam, The Netherlands
| | - Esther Helmich
- Center for Research and Innovation in Medical Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pim W Teunissen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, VU University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - A Debbie C Jaarsma
- Center for Research and Innovation in Medical Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Mausz J, Tavares W. Learning in professionally 'distant' contexts: opportunities and challenges. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:581-600. [PMID: 27295218 DOI: 10.1007/s10459-016-9693-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 06/07/2016] [Indexed: 06/06/2023]
Abstract
The changing nature of healthcare education and delivery is such that clinicians will increasingly find themselves practicing in contexts that are physically and/or conceptually different from the settings in which they were trained, a practice that conflicts on some level with socio-cultural theories of learning that emphasize learning in context. Our objective was therefore to explore learning in 'professionally distant' contexts. Using paramedic education, where portions of training occur in hospital settings despite preparing students for out-of-hospital work, fifty-three informants (11 current students, 13 recent graduates, 16 paramedic program faculty and 13 program coordinators/directors) took part in five semi-structured focus groups. Participants reflected on the value and role of hospital placements in paramedic student development. All sessions were audio recorded, transcribed verbatim and analyzed using inductive thematic analysis. In this context six educational advantages and two challenges were identified when using professionally distant learning environments. Learning could still be associated with features such as (a) engagement through "authenticity", (b) technical skill development, (c) interpersonal skill development, (d) psychological resilience, (e) healthcare system knowledge and (f) scaffolding. Variability in learning and misalignment with learning goals were identified as potential threats. Learning environments that are professionally distant from eventual practice settings may prove meaningful by providing learners with foundational and preparatory learning experiences for competencies that may be transferrable. This suggests that where learning occurs may be less important than how the experience contributes to the learner's development and the meaning or value he/she derives from it.
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Affiliation(s)
- Justin Mausz
- School of Community and Health Studies, Centennial College, P.O. Box 731, Station A, Toronto, ON, M1K 5E9, Canada.
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Peel Regional Paramedic Services, Regional Municipality of Peel, Brampton, ON, Canada.
| | - Walter Tavares
- School of Community and Health Studies, Centennial College, P.O. Box 731, Station A, Toronto, ON, M1K 5E9, Canada
- Division of Emergency Medicine, Faculty of Medicine, McMaster University, Hamilton, ON, Canada
- York Region Emergency Medical Services, Sharon, ON, Canada
- Ornge Transport Medicine, Mississauga, ON, Canada
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Skipper M, Nøhr SB, Jacobsen TK, Musaeus P. Organisation of workplace learning: a case study of paediatric residents' and consultants' beliefs and practices. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:677-694. [PMID: 26696031 DOI: 10.1007/s10459-015-9661-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 12/13/2015] [Indexed: 06/05/2023]
Abstract
Several studies have examined how doctors learn in the workplace, but research is needed linking workplace learning with the organisation of doctors' daily work. This study examined residents' and consultants' attitudes and beliefs regarding workplace learning and contextual and organisational factors influencing the organisation and planning of medical specialist training. An explorative case study in three paediatric departments in Denmark including 9 days of field observations and focus group interviews with 9 consultants responsible for medical education and 16 residents. The study aimed to identify factors in work organisation facilitating and hindering residents' learning. Data were coded through an iterative process guided by thematic analysis. Findings illustrate three main themes: (1) Learning beliefs about patient care and apprenticeship learning as inseparable in medical practice. Beliefs about training and patient care expressed in terms of training versus production caused a potential conflict. (2) Learning context. Continuity over time in tasks and care for patients is important, but continuity is challenged by the organisation of daily work routines. (3) Organisational culture and regulations were found to be encouraging as well inhibiting to a successful organisation of the work in regards to learning. Our findings stress the importance of consultants' and residents' beliefs about workplace learning as these agents handle the potential conflict between patient care and training of health professionals. The structuring of daily work tasks is a key factor in workplace learning as is an understanding of underlying relations and organisational culture in the clinical departments.
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Affiliation(s)
- Mads Skipper
- Department for Postgraduate Education, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark.
| | - Susanne Backman Nøhr
- Department for Postgraduate Education, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
| | - Tine Klitgaard Jacobsen
- Department for Postgraduate Education, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark
| | - Peter Musaeus
- Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
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Cleland J, Walker KG, Gale M, Nicol LG. Simulation-based education: understanding the socio-cultural complexity of a surgical training 'boot camp'. MEDICAL EDUCATION 2016; 50:829-841. [PMID: 27402043 DOI: 10.1111/medu.13064] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 10/07/2015] [Accepted: 01/20/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The focus of simulation-based education (SBE) research has been limited to outcome and effectiveness studies. The effect of social and cultural influences on SBE is unclear and empirical work is lacking. Our objective in this study was to explore and understand the complexity of context and social factors at a surgical boot camp (BC). METHODS A rapid ethnographic study, employing the theoretical lenses of complexity and activity theory and Bourdieu's concept of 'capital', to better understand the socio-cultural influences acting upon, and during, two surgical BCs, and their implications for SBE. Over two 4-day BCs held in Scotland, UK, an observer and two preceptors conducted 81 hours of observations, 14 field interviews and 11 formal interviews with faculty members (n = 10, including the lead faculty member, session leaders and junior faculty members) and participants (n = 19 core surgical trainees and early-stage residents). RESULTS Data collection and inductive analysis for emergent themes proceeded iteratively. This paper focuses on three analytical themes. First, the complexity of the surgical training system and wider health care education context, and how this influenced the development of the BC. Second, participants' views of the BC as a vehicle not just for learning skills but for gaining 'insider information' on how best to progress in surgical training. Finally, the explicit aim of faculty members to use the Scottish Surgical Bootcamp to welcome trainees and residents into the world of surgery, and how this occurred. CONCLUSIONS To the best of our knowledge, this is the first empirical study of a surgical BC that takes a socio-cultural approach to exploring and understanding context, complexities, uncertainties and learning associated with one example of SBE. Our findings suggest that a BC is as much about social and cultural processes as it is about individual, cognitive and acquisitive learning. Acknowledging this explicitly will help those planning similar enterprises and open up a new perspective on SBE research.
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Affiliation(s)
- Jennifer Cleland
- Institute of Education for Medical and Dental Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- Highland Surgical Research Unit, Raigmore Hospital and the Centre for Health Science, NHS Highland and University of Stirling, Inverness, UK
| | - Michael Gale
- Highland Medical Education Centre, The Centre for Health Science, NHS Highland and University of Aberdeen, Inverness, UK
| | - Laura G Nicol
- Highland Surgical Research Unit, Raigmore Hospital and the Centre for Health Science, NHS Highland and University of Stirling, Inverness, UK
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Bates J, Ellaway RH. Mapping the dark matter of context: a conceptual scoping review. MEDICAL EDUCATION 2016; 50:807-16. [PMID: 27402041 DOI: 10.1111/medu.13034] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 12/07/2015] [Accepted: 01/20/2016] [Indexed: 05/08/2023]
Abstract
CONTEXT Like dark matter, the contexts for medical education are largely invisible to those within them, although context can have profound influences on teaching, learning and practice. For something that is so intrinsic to the field of medical education, the concept of context remains troubling to scholars and those running medical education programmes. This paper reports on a critical and conceptual review of the concept of context within the medical education literature and beyond. METHODS A review was undertaken drawing on two sources: concepts of context in the medical education literature, and concepts of context across multiple academic disciplines. This body of material was iteratively, discursively and inductively synthesised. RESULTS Few of the articles from the medical education literature described or defined context directly, tending instead to focus on describing specific elements of context, such as clinical disciplines, physical settings and political pressures, that could or did influence learning outcomes. The results were framed in terms of what context 'is', how context works (in terms of context-mechanism-outcome), and how context can be represented using patterns. The authors propose a definition of context in medical education, along with the means to model, contrast and compare different contexts based on recurring patterns. CONCLUSIONS Context matters in medical education and it can, despite many challenges, be considered systematically and objectively. The findings from this study both represent a catalyst and challenge medical education researchers to look at context afresh.
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Affiliation(s)
- Joanna Bates
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Novick RJ, Lingard L, Cristancho SM. The call, the save, and the threat: understanding expert help-seeking behavior during nonroutine operative scenarios. JOURNAL OF SURGICAL EDUCATION 2015; 72:302-9. [PMID: 25451719 PMCID: PMC5578753 DOI: 10.1016/j.jsurg.2014.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/17/2014] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Asking for help in the operating room occurs within a surgical culture that has traditionally valued independence, decisiveness, and confidence. A tension exists between these deeply ingrained character traits and the new culture of team-based practice that emphasizes maximizing patient safety. The objective of this study is to explore surgeon-to-surgeon help-seeking behaviors during complex and unanticipated operative scenarios. STUDY DESIGN Semistructured interviews were conducted with a purposeful sample of 14 consultant surgeons from multiple specialties. We used constructivist grounded theory to explore help-seeking experiences. Analysis occurred alongside and informed data collection. Themes were identified iteratively using constant comparisons. SETTING The setting included 3 separate hospital sites in a Canadian academic health sciences center. PARTICIPANTS A total of 14 consultant surgeons from 3 separate departments and 7 divisions were included. RESULTS We developed the "Call-Save-Threat" framework to conceptualize the help-seeking phenomenon. Respondents highlighted both explicit and tacit reasons for calling for help; the former included technical assistance and help with decision making, and the latter included the need for moral support, "saving face," and "political cover." "The Save" included the provision of enhanced technical expertise, a broader intraoperative perspective, emotional support, and a learning experience. "The Threat" included potential downsides to calling, which may result in near-term or delayed negative consequences. These included giving up autonomy as primary surgeon, threats to a surgeon's image as a competent practitioner, and a failure to progress with respect to independent judgment and surgical abilities. CONCLUSIONS Our "Call-Save-Threat" framework suggests that surgeons recurrently negotiate when and how to seek help in the interests of patient safety, while attending to the traditional cultural values of autonomy and decisive action. This has important implications for surgical postgraduate education and also throughout a surgeon's career trajectory.
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Affiliation(s)
- Richard J Novick
- Department of Surgery, Schulich School of Medicine and the Centre for Education Research and Innovation, Western University, London, Ontario, Canada; Department of Medicine, Schulich School of Medicine and the Centre for Education Research and Innovation, Western University, London, Ontario, Canada.
| | - Lorelei Lingard
- Department of Medicine, Schulich School of Medicine and the Centre for Education Research and Innovation, Western University, London, Ontario, Canada
| | - Sayra M Cristancho
- Department of Surgery, Schulich School of Medicine and the Centre for Education Research and Innovation, Western University, London, Ontario, Canada
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Robinson D, Chin D, Kong A. Debunking myths and enhancing medical student learning within the emergency department. Emerg Med Australas 2015; 27:72-4. [PMID: 25586745 DOI: 10.1111/1742-6723.12354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Danielle Robinson
- Austin Clinical School, The University of Melbourne, Austin Health, Melbourne, Victoria, Australia
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Cristancho SM, Bidinosti SJ, Lingard LA, Novick RJ, Ott MC, Forbes TL. What's behind the scenes? Exploring the unspoken dimensions of complex and challenging surgical situations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:1540-7. [PMID: 25250744 PMCID: PMC5578758 DOI: 10.1097/acm.0000000000000478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE Physicians regularly encounter challenging and/or complex situations in their practices; in training settings, they must help learners understand such challenges. Context becomes a fundamental construct when seeking to understand what makes a situation challenging and how physicians respond to it; however, the question of how physicians perceive context remains largely unexplored. If the goal is to teach trainees to deal with challenging situations, the medical education community requires an understanding of what "challenging" means for those in charge of training. METHOD The authors relied on visual methods for this research. In 2013, they collected 40 snapshots (i.e., data sets) from a purposeful sample of five faculty surgeons through a combination of interviews, observations, and drawing sessions. The analytical process involved three phases: analysis of each drawing, a compare-and-contrast analysis of multiple drawings, and a team analysis conducted in collaboration with three participating surgeons. RESULTS Findings demonstrate that experts perceive the challenge of surgical situations to extend beyond their procedural dimensions to include unspoken, nonprocedural dimensions-specifically, team dynamics, trust, emotions, and external pressures. CONCLUSIONS Findings show that analysis of surgeons' drawings is an effective means of gaining insight into surgeons' perceptions. The findings refine the common belief that procedural complexity is what makes a surgery challenging for expert surgeons. Focusing exclusively on the procedure during training may put trainees at risk of missing the "big picture." Understanding the multidimensionality of medical challenges and having a language to discuss these both verbally and visually will facilitate teaching around challenging situations.
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Affiliation(s)
- Sayra M Cristancho
- Dr. Cristancho is assistant professor, Department of Surgery, and scientist, Centre for Education Research & Innovation, Western University, London, Ontario, Canada. Ms. Bidinosti is research associate, Centre for Education Research & Innovation, Western University, London, Ontario, Canada. Dr. Lingard is professor, Department of Medicine, and director and scientist, Centre for Education Research & Innovation, Western University, London, Ontario, Canada. Dr. Novick is professor, Department of Surgery, Division of Cardiac Surgery, Western University, London, Ontario, Canada. Dr. Ott is associate professor, Department of Surgery, Division of General Surgery, Western University, London, Ontario, Canada. Dr. Forbes is professor and division chair/chief, Department of Surgery, Division of Vascular Surgery, Western University, London, Ontario, Canada
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25
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Pimmer C, Brysiewicz P, Linxen S, Walters F, Chipps J, Gröhbiel U. Informal mobile learning in nurse education and practice in remote areas--a case study from rural South Africa. NURSE EDUCATION TODAY 2014; 34:1398-1404. [PMID: 24745478 DOI: 10.1016/j.nedt.2014.03.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/16/2014] [Accepted: 03/25/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND With the proliferation of portable digital technology, mobile learning is becoming increasingly popular in nursing education and practice. Most of the research in this field has been concentrated on small-scale projects in high income countries. Very little is known about the ways in which nurses and midwives use mobile technology in remote and resource poor areas in informal learning contexts in low and middle income countries. OBJECTIVES To address this gap, this study investigates whether nurses use mobile phones as effective educational tools in marginalized and remote areas, and if so, how and why. SETTING AND METHODS In rural South Africa, 16 nurses who attended an advanced midwifery education program, facilitators and clinical managers were interviewed about their use of digital mobile technology for learning. Techniques of qualitative content analysis were used to examine the data. RESULTS Several rich "organically-grown", learning practices were identified: mobile phone usage facilitated (1) authentic problem solving; (2) reflective practice; (3) emotional support and belongingness; (4) the realization of unpredictable teaching situations; and (5) life-long learning. CONCLUSIONS It is concluded that mobile phones, and the convergence of mobile phones and social media, in particular, change learning environments. In addition, these tools are suitable to connect learners and learning distributed in marginalized areas. Finally, a few suggestions are made about how these insights from informal settings can inform the development of more systematic mobile learning formats.
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Affiliation(s)
- Christoph Pimmer
- learning.lab/Institute for Information Systems, University of Applied Sciences and Arts Northwestern Switzerland, Peter Merian-Strasse 86, 4002 Basel, Switzerland. http://www.fhnw.ch
| | - Petra Brysiewicz
- School of Nursing and Public Health, College of Health Sciences, Desmond Clarence Building, University of KwaZulu-Natal (UKZN), Durban 4000, KwaZulu-Natal, South Africa.
| | - Sebastian Linxen
- learning.lab/Institute for Information Systems, University of Applied Sciences and Arts Northwestern Switzerland, Peter Merian-Strasse 86, 4002 Basel, Switzerland. http://www.fhnw.ch
| | - Fiona Walters
- School of Nursing and Public Health, College of Health Sciences, Desmond Clarence Building, University of KwaZulu-Natal (UKZN), Durban 4000, KwaZulu-Natal, South Africa.
| | - Jennifer Chipps
- School of Nursing and Public Health, College of Health Sciences, Desmond Clarence Building, University of KwaZulu-Natal (UKZN), Durban 4000, KwaZulu-Natal, South Africa.
| | - Urs Gröhbiel
- learning.lab/Institute for Information Systems, University of Applied Sciences and Arts Northwestern Switzerland, Peter Merian-Strasse 86, 4002 Basel, Switzerland. http://www.fhnw.ch
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Kirsh SR, Ho PM, Aron DC. Providing specialty consultant expertise to primary care: an expanding spectrum of modalities. Mayo Clin Proc 2014; 89:1416-26. [PMID: 24889514 DOI: 10.1016/j.mayocp.2014.04.016] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 01/18/2023]
Abstract
In most models of health care delivery, the bulk of services are provided in primary care and there is frequent request for the input of specialty consultants. A critical issue for current and future health care systems is the effective and efficient delivery of specialist expertise for clinicians and patients. Input on a patient's care from specialty consultants usually requires a face-to-face visit between the patient and the consultant. New and complementary models of knowledge sharing have emerged. We describe a framework assessment of a spectrum of knowledge-sharing methods in the context of a patient-centered medical home. This framework is based on our experience in the Veterans Health Administration and a purposive review of the literature. These newer modes of specialty consultation include electronic consultation, secure text messaging, telemedicine of various types, and population preemptive consults. In addition to describing these modes of consultation, our framework points to several important areas in which further research is needed to optimize effectiveness.
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Affiliation(s)
- Susan R Kirsh
- Office of Specialty Care, Veterans Health Administration, Washington, DC; Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - P Michael Ho
- Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Eastern Colorado Health Care System Medical Center, Aurora, CO; Department of Medicine, School of Medicine, University of Colorado Denver, Aurora, CO
| | - David C Aron
- Office of Specialty Care/VA HSR&D QUERI Evaluation Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH; Department of Organizational Behavior, Weatherhead School of Management, Cleveland, OH.
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van den Eertwegh V, van Dalen J, van Dulmen S, van der Vleuten C, Scherpbier A. Residents' perceived barriers to communication skills learning: comparing two medical working contexts in postgraduate training. PATIENT EDUCATION AND COUNSELING 2014; 95:91-7. [PMID: 24468200 DOI: 10.1016/j.pec.2014.01.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 12/23/2013] [Accepted: 01/04/2014] [Indexed: 05/13/2023]
Abstract
OBJECTIVE Contextual factors are known to influence the acquisition and application of communication skills in clinical settings. Little is known about residents' perceptions of these factors. This article aims to explore residents' perceptions of contextual factors affecting the acquisition and application of communication skills in the medical workplace. METHOD We conducted an exploratory study comprising seven focus groups with residents in two different specialities: general practice (n=23) and surgery (n=18). RESULTS Residents perceive the use of summative assessment checklists that reduce communication skills to behavioural components as impeding the learning of their communication skills. Residents perceive encouragement to deliberately practise in an environment in which the value of communication skills is recognised and support is institutionalised with appropriate feedback from role models as the most important enhancing factors in communication skills learning. CONCLUSION To gradually realise a clinical working environment in which the above results are incorporated, we propose to use transformative learning theory to guide further studies. PRACTICAL IMPLICATIONS Provided it is used continuously, an approach that combines self-directed learning with observation and discussion of resident-patient consultations seems an effective method for transformative learning of communication skills.
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Affiliation(s)
| | - Jan van Dalen
- Skillslab, Maastricht University, Maastricht, The Netherlands
| | - Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands; Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Buskerud University College, Drammen, Norway
| | - Cees van der Vleuten
- Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands; University of Copenhagen, Copenhagen, Denmark; King Saudi University, Riyadh, Saudi Arabia; Radboud University, Nijmegen, The Netherlands
| | - Albert Scherpbier
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Pimmer C, Mateescu M, Zahn C, Genewein U. Smartphones as multimodal communication devices to facilitate clinical knowledge processes: randomized controlled trial. J Med Internet Res 2013; 15:e263. [PMID: 24284080 PMCID: PMC3868983 DOI: 10.2196/jmir.2758] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/17/2013] [Accepted: 10/07/2013] [Indexed: 12/04/2022] Open
Abstract
Background Despite the widespread use and advancements of mobile technology that facilitate rich communication modes, there is little evidence demonstrating the value of smartphones for effective interclinician communication and knowledge processes. Objective The objective of this study was to determine the effects of different synchronous smartphone-based modes of communication, such as (1) speech only, (2) speech and images, and (3) speech, images, and image annotation (guided noticing) on the recall and transfer of visually and verbally represented medical knowledge. Methods The experiment was conducted from November 2011 to May 2012 at the University Hospital Basel (Switzerland) with 42 medical students in a master’s program. All participants analyzed a standardized case (a patient with a subcapital fracture of the fifth metacarpal bone) based on a radiological image, photographs of the hand, and textual descriptions, and were asked to consult a remote surgical specialist via a smartphone. Participants were randomly assigned to 3 experimental conditions/groups. In group 1, the specialist provided verbal explanations (speech only). In group 2, the specialist provided verbal explanations and displayed the radiological image and the photographs to the participants (speech and images). In group 3, the specialist provided verbal explanations, displayed the radiological image and the photographs, and annotated the radiological image by drawing structures/angle elements (speech, images, and image annotation). To assess knowledge recall, participants were asked to write brief summaries of the case (verbally represented knowledge) after the consultation and to re-analyze the diagnostic images (visually represented knowledge). To assess knowledge transfer, participants analyzed a similar case without specialist support. Results Data analysis by ANOVA found that participants in groups 2 and 3 (images used) evaluated the support provided by the specialist as significantly more positive than group 1, the speech-only group (group 1: mean 4.08, SD 0.90; group 2: mean 4.73, SD 0.59; group 3: mean 4.93, SD 0.25; F2,39=6.76, P=.003; partial η2=0.26, 1–β=.90). However, significant positive effects on the recall and transfer of visually represented medical knowledge were only observed when the smartphone-based communication involved the combination of speech, images, and image annotation (group 3). There were no significant positive effects on the recall and transfer of visually represented knowledge between group 1 (speech only) and group 2 (speech and images). No significant differences were observed between the groups regarding verbally represented medical knowledge. Conclusions The results show (1) the value of annotation functions for digital and mobile technology for interclinician communication and medical informatics, and (2) the use of guided noticing (the integration of speech, images, and image annotation) leads to significantly improved knowledge gains for visually represented knowledge. This is particularly valuable in situations involving complex visual subject matters, typical in clinical practice.
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Affiliation(s)
- Christoph Pimmer
- Institute for Information Systems, School of Business, University of Applied Sciences and Arts Northwestern Switzerland FHNW, Basel, Switzerland.
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Gordon M. When shifting context: the role of context dynamics in educating and understanding handover. MEDICAL EDUCATION 2013; 47:438-440. [PMID: 23574055 DOI: 10.1111/medu.12156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Morris Gordon
- Department of Paediatrics, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire FY3 8NR, UK.
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