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Mazzoli Smith L, Villar F, Wendel S. Narrative-based learning for person-centred healthcare: the Caring Stories learning framework. MEDICAL HUMANITIES 2023; 49:583-592. [PMID: 37208190 PMCID: PMC10803961 DOI: 10.1136/medhum-2022-012530] [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] [Accepted: 03/21/2023] [Indexed: 05/21/2023]
Abstract
This paper describes the learning framework for an innovative narrative-based training platform for healthcare professionals based on older patients' narratives. The aim of Caring Stories is to place patients' desires and needs at the heart of healthcare and by doing so to promote person-centred care (PCC). It is argued that this narrative-based approach to training in healthcare education will provide professionals from different fields with competencies to better understand how to interpret the lifeworlds of older people, as well as facilitate better communication and navigation through increasingly complex care trajectories. The spiral learning framework supports narrative-based training to be accessible to a broad range of healthcare practitioners. We suggest this is a theoretically sophisticated methodology for training diverse healthcare professionals in PCC, alongside core tenets of narrative medicine, with applicability beyond the patient group it was designed for. The learning framework takes into account professionals' mindsets and draws on the epistemic tenets of pragmatism to support interprofessional education. Being informed by narrative pedagogy, narrative inquiry, and expansive learning and transformative learning theories, ensures that a robust pedagogical foundation underpins the learning framework. The paper sets out the conceptual ideas about narrative that we argue should be more widely understood in the broad body of work that draws on patient narratives in healthcare education, alongside the learning theories that best support this framing of narrative. We suggest that this conceptual framework has value with respect to helping to disseminate the ways in which narrative is most usefully conceptualised in healthcare education when we seek to foster routes to bring practitioners closer to the lifeworlds of their patients. This conceptual framework is therefore generic with respect to being a synthesis of the critical orientations to narrative that are important in healthcare education, then adaptable to different contexts with different patient narratives.
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Affiliation(s)
| | - Feliciano Villar
- Department of Cognition, Development and Educational Psychology, University of Barcelona, Barcelona, Catalunya, Spain
| | - Sonja Wendel
- Erasmus School of Economics, Erasmus Universiteit Rotterdam, Rotterdam, Zuid-Holland, Netherlands
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Kaushik JS, Ramachandran P, Kukreja S, Gupta P, Singh T. Delivering Electives the Clerkship Way: Consolidating the Student Doctor Method of Training. Indian Pediatr 2022. [DOI: 10.1007/s13312-022-2600-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Brown MEL, Ard C, Adams J, O'Regan A, Finn GM. Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1385-1392. [PMID: 35507462 DOI: 10.1097/acm.0000000000004732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Longitudinal integrated clerkships (LICs) have been implemented worldwide to increase authentic student participation in patient care over time. Studies have shown benefits of the model include the ability of LICs to attract future practitioners to underserved areas, student engagement in advocacy, and development of an "ethic of caring." Less is known, however, about how LICs impart their benefits, although LICs may strengthen professional identity. As such, this study aimed to explore medical student professional identity construction through time within LICs internationally. METHOD This was a longitudinal qualitative study from 2019 to 2020, involving 33 students across 4 medical schools in the United Kingdom, Ireland, and the United States. The authors explored participating students' identity construction during LICs. Data collection involved 3 stages: individual, semistructured interviews at entry (n = 33) and exit of the LIC (n = 29), and audio diaries throughout. Data were analyzed inductively using a reflexive thematic approach. RESULTS Three themes were identified. Longitudinal relationships with patients and preceptors encouraged patient care ownership and responsibility; LIC students identified as patient advocates; and longitudinal relationships shaped students' social consciences. Themes were underpinned by continuity of relationships between students and patients, and students and tutors. CONCLUSIONS Though continuity is lauded as the cornerstone of LICs, these findings suggest that this is too broad a way of understanding the benefits of LICs. Instead, continuity should be seen as facilitating the development of important relationships within diverse communities of practice, which leads medical students to construct professional identities as responsible, compassionate advocates for underserved populations. This was the case across the institutions, nations, and LIC types in this study. By highlighting the ways in which LICs influence identity, these findings offer important insight relating to the future development and delivery of LICs.
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Affiliation(s)
- Megan E L Brown
- M.E.L. Brown is a teaching fellow in medical education research, Medical Education Innovation and Research Centre, Imperial College London, London. At the time of this research, she was a PhD candidate in medical education, Health Professions Education Unit, Hull York Medical School, York, United Kingdom; ORCID: http://orcid.org/0000-0002-9334-0922
| | - Catherine Ard
- C. Ard is an internal medicine resident, University of Colorado, Aurora, Colorado
| | - Jennifer Adams
- J. Adams is professor of medicine and assistant dean, medical education and clinical clerkships, University of Colorado School of Medicine, Aurora, Colorado, and internal medicine specialist, Denver Health and Hospital Authority, Denver, Colorado; ORCID: https://orcid.org/0000-0002-5433-8600
| | - Andrew O'Regan
- A. O'Regan is a general practitioner and senior lecturer in general practice, University of Limerick School of Medicine, Limerick, Ireland; ORCID: https://orcid.org/0000-0001-8470-2736
| | - Gabrielle M Finn
- G.M. Finn is professor of medical education and vice dean of teaching and learning, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom; ORCID: http://orcid.org/0000-0002-0419-694X
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Richards E, Elliott L, Jackson B, Panesar A. Longitudinal integrated clerkship evaluations in UK medical schools: a narrative literature review. EDUCATION FOR PRIMARY CARE 2022; 33:148-155. [PMID: 35105274 DOI: 10.1080/14739879.2021.2021809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Longitudinal Integrated Clerkships (LICs) are a recognised model of curriculum design used internationally as an alternative to traditional block rotations in medical schools that have been shown to offer a multitude of educational benefits. As a relatively new development in the United Kingdom (UK), it is not yet clear whether these benefits will translate into a UK healthcare context. This article provides an early review of evaluations of UK LIC programmes. METHODS A narrative literature review of LIC programme evaluations in UK medical schools. RESULTS UK students and faculty found value in the LIC programmes with reported benefits including continuity of relationships, increased responsibility and purpose for students, a patient-centred approach and development of professional skills. However, students and GP tutors expressed initial anxieties adapting to the newness of the programme design and preparedness for exams. CONCLUSIONS UK LIC programmes appear to be offering benefits for UK medical students and faculty members including personal and professional development in line with international literature. However, the current data is limited with significant gaps that need addressing for the impacts to be fully realised.
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Affiliation(s)
| | - L Elliott
- School of Primary Care, Yorkshire and Humber, UK
| | - B Jackson
- University of Sheffield, Sheffield, UK
| | - A Panesar
- University of Sheffield, Sheffield, UK
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Gupta S, Howden S. Medical students' experiences of a longitudinal integrated clerkship: a threshold concepts analysis. EDUCATION FOR PRIMARY CARE 2021; 32:336-343. [PMID: 34415822 DOI: 10.1080/14739879.2021.1939796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Longitudinal Integrated Clerkships (LIC) are known to provide several pedagogical advantages including transformational educational experiences. The study explored the learning experience of undergraduate medical students who undertook a rural LIC in a Scottish primary care setting. This paper presents an analysis of the transformative role of LIC placements using the Threshold Concept (TC) theory. This qualitative study gathered students' perceptions of their LIC experience longitudinally through written and audio diaries over a period of 1-2 months. The issues narrated in diaries were followed-up in individual semi-structured interviews. Transcripts were thematically analysed to identify key characteristics of TCs using a criterion-based approach. Data from 12 audio and nine written diaries, and five interviews led to identification of three inter-connected themes associated with the LIC year: professional identity formation, becoming an agentic learner and comfort with uncertainty. These appeared transformative in nature and resembled threshold concepts in their character and effect. An active and legitimate role in the healthcare team, longitudinality and transdisciplinary learning during LIC placements were contributary towards navigating these thresholds. The LIC exposure provided transformative learning experiences, and a stable environment that facilitated acquisition of specific TCs in the medical students' journey towards becoming a doctor. LIC affordances fostered a transformed view of self, which was more confident in dealing with uncertainty, comfortable in the emerging professional identity, and described having enhanced agentic capabilities.
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Affiliation(s)
- Shalini Gupta
- School of Medicine, University of Dundee, Dundee, Scotland
| | - Stella Howden
- School of Medicine, University of Dundee, Dundee, Scotland
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Padley J, Boyd S, Jones A, Walters L. Transitioning from university to postgraduate medical training: A narrative review of work readiness of medical graduates. Health Sci Rep 2021; 4:e270. [PMID: 33855193 PMCID: PMC8025846 DOI: 10.1002/hsr2.270] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 03/04/2021] [Indexed: 01/01/2023] Open
Abstract
CONTEXT Work readiness is often described in terms of the clinical competence medical graduates bring to day 1 of internship. Despite being increasingly viewed as a key graduate outcome, work readiness has remained poorly defined. OBJECTIVE This narrative review draws on the international literature to explore how different research methods provide differing insight into what constitutes work readiness of medical graduates. From this, we explored contributory factors and developed a conceptual framework to better understand work readiness. METHODS Databases were searched using the terms including "ready," "readiness," "preparedness," "medical graduates," "intern," and "junior doctor." Information was summarized using a textual description template that included information on study setting, participants, methodologies, limitations, and key result areas (including measures/themes and study conclusions). Consensus discussions between authors led to the naming and understanding of the key themes. RESULTS Seventy studies were included in the review. Study participants included final-year medical students (n = 20), junior doctors early in internship (n = 24), and junior doctors late in internship or postgraduate year 2 and above (n = 23). Most studies explored work readiness through the retrospective self-report of the students and/or junior doctor participants. Quantitative research methods elaborated on key skills-based competencies, whereas qualitative research methods provided insight into key contextual and individual characteristics that contributed to preparedness. CONCLUSIONS Different research methods provided insight into competencies, as well as individual and contextual aspects, associated with preparedness for practice. The transition from university to clinical practice is significant and requires personal capability and confidence, as well as a supportive training context. Enabling students to engage authentically in clinical environments enhanced preparedness by promoting understanding of role and responsibility. Individual resilience is important, but contextual factors, including provision of adequate support and feedback, can enhance or subtract from feeling prepared. We propose a novel conceptual framework for better understanding work readiness.
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Affiliation(s)
- James Padley
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Sarah Boyd
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Alison Jones
- College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Lucie Walters
- Discipline of Rural and Remote Health, College of Medicine & Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
- Adelaide Rural Clinical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
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Van Schalkwyk SC, Hafler J, Brewer TF, Maley MA, Margolis C, McNamee L, Meyer I, Peluso MJ, Schmutz AM, Spak JM, Davies D. Transformative learning as pedagogy for the health professions: a scoping review. MEDICAL EDUCATION 2019; 53:547-558. [PMID: 30761602 DOI: 10.1111/medu.13804] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/16/2018] [Accepted: 12/13/2018] [Indexed: 05/13/2023]
Abstract
CONTEXT Transformative learning (TL) has been described as learning that challenges established perspectives, leading to new ways of being in the world. As a learning theory it has resonated with educators globally, including those in the health professions. Described as a complex metatheory, TL has evolved over time, eliciting divergent interpretations of the construct. This scoping review provides a comprehensive synthesis of how TL is currently represented in the health professions education literature, including how it influences curricular activities, to inform its future application in the field. METHODS Arksey and O'Malley's six-step framework was adopted to review the period from 2006 to May 2018. A total of 10 bibliographic databases were searched, generating 1532 potential studies. After several rounds of review, first of abstracts and then of full texts, 99 studies were mapped by two independent reviewers onto the internally developed data extraction sheet. Descriptive information about included studies was aggregated. Discursive data were subjected to content analysis. RESULTS A mix of conceptual and empirical research papers, which used a range of qualitative methodologies, were included. Studies from the USA, the UK and Australia were most prevalent. Insights relating to how opportunities for TL were created, how it manifests and influences behaviour, as well as how it is experienced, demonstrated much congruency. Conceptions of TL were seen to be clustered around the work of key theorists. CONCLUSIONS The training of health professionals often takes place in unfamiliar settings where students are encouraged to be active participants in providing care. This increases the opportunity for exposure to learning experiences that are potentially transformative, allowing for a pedagogy of uncertainty that acknowledges the complexity of the world we live in and questions what we believe we know about it. TL provides educators in the health professions with a theoretical lens through which they can view such student learning.
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Affiliation(s)
- Susan C Van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janet Hafler
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Timothy F Brewer
- Departments of Medicine and Epidemiology, David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Moira A Maley
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Carmi Margolis
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Lakshini McNamee
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ilse Meyer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael J Peluso
- Division of Infectious Diseases, University of California-San Francisco Medical Center, San Francisco, California, USA
| | - Ana Ms Schmutz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Judy M Spak
- Cushing/Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Davies
- Warwick Medical School, University of Warwick, Coventry, UK
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Michelson CD, Dzara K, Ramani S, Vinci R, Schumacher D. Keystone: Exploring Pediatric Residents' Experiences in a Longitudinal Integrated Block. TEACHING AND LEARNING IN MEDICINE 2019; 31:99-108. [PMID: 30303403 DOI: 10.1080/10401334.2018.1478732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PROBLEM Residency training in many specialties has traditionally been divided into short, discrete, single-specialty rotations. Although providing the learner with in-depth exposure to a specific discipline, educators have challenged this rotational model, citing problems with patient and team continuity and maladaptive coping. Longitudinal integrated clerkships, adopted by many medical schools, offer an alternative model and have demonstrated improved outcomes for students related to patient-centeredness, advocacy, and integration with teams. Despite this, longitudinal integrated training in residency is rare. INTERVENTION We developed a novel 3-month longitudinal integrated block for residents, called Keystone. The block combined 3 previously discrete, shorter rotations in developmental-behavioral pediatrics, advocacy, and emergency medicine into a longer and integrated experience. Within each week, the block utilized half-day sessions in the resident's primary care clinic, a new continuity Developmental Behavioral Pediatrics clinic where the resident worked with the same faculty preceptor and interprofessional team each week, shifts in the emergency department, and half-day sessions dedicated to clinic- and community-based advocacy activities. CONTEXT The context was a single, large pediatric urban residency program based at 2 university-affiliated hospitals, an academic freestanding children's hospital, and academic safety net hospital. OUTCOME Using a phenomenologic framework, we conducted interviews and a focus group discussion to explore residents' attitudes about the block; their perceptions regarding the block's impact on relationships with preceptors, peers, or patients; and the block's impact on learning and practice. Fourteen residents participated, 10 in interviews and 4 in the focus group discussion. Six themes emerged from thematic analysis: (a) the longitudinal nature of Keystone influenced professional relationships and as a result entrustment, (b) the longitudinal integrated design shaped engagement and learning, (c) flexibility promoted work-life balance and self-directed learning, (d) learners experienced time and space for professional identity development, (e) Keystone provided a unique opportunity to reclaim patient-centeredness, and (f) learners experienced important advantages and challenges related to the schedule. LESSONS LEARNED The longitudinal integrated nature of Keystone provided a novel structure for addressing important yet challenging educational goals in residency, including enhancing relationships, facilitating entrustment and engagement, encouraging patient-centeredness, and emphasizing the importance of self-directed learning.
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Affiliation(s)
- Catherine D Michelson
- a Department of Pediatrics , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Kristina Dzara
- b Department of Pediatrics , Massachusetts General Hospital for Children , Boston , Massachusetts , USA
| | - Subha Ramani
- c Department of Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston , Massachusetts , USA
| | - Robert Vinci
- a Department of Pediatrics , Boston University School of Medicine , Boston , Massachusetts , USA
| | - Daniel Schumacher
- d Division of Emergency Medicine , Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
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Brown MEL, Anderson K, Finn GM. A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519849409. [PMID: 31206031 PMCID: PMC6537286 DOI: 10.1177/2382120519849409] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 05/31/2023]
Abstract
Hailed by supporters as the answer to many challenges facing medical schools and the wider health care system, longitudinal integrated clerkships (LICs) offer a practical and sustainable alternative to more traditional block rotational models. Given this, their popularity as a curricular measure is increasing, although such clerkships remain relatively novel within the United Kingdom. This narrative literature review of international work provides a comprehensive introduction to developing and implementing LICs within medical education. This review generates a practical guide for medical educators with a focus on the development and implementation of LICs within the United Kingdom, on which there is little work. Using illustrated examples and with reference to contemporary literature, it outlines the rationale for considering an LIC within a curriculum, the different types of LIC, barriers and enabling factors to LIC implementation and considers the contemporary application of LIC models within the United Kingdom. The practical guide details key questions educators must consider when developing and implementing an LIC, particularly within the landscape of UK medical education.
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Affiliation(s)
- Megan EL Brown
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
| | - Kevin Anderson
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
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Worley P, Couper I, Strasser R, Graves L, Cummings BA, Woodman R, Stagg P, Hirsh D. A typology of longitudinal integrated clerkships. MEDICAL EDUCATION 2016; 50:922-32. [PMID: 27562892 DOI: 10.1111/medu.13084] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/14/2015] [Accepted: 03/14/2016] [Indexed: 05/13/2023]
Abstract
CONTEXT Longitudinal integrated clerkships (LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time-limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution-specific studies. OBJECTIVES This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. METHODS Data on all LIC and LIC-like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student-years of LIC-like curricula. RESULTS Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC-like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. CONCLUSIONS Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context.
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Affiliation(s)
- Paul Worley
- Prideaux Centre for Research in Health Professions Education, School of Medicine, Flinders University, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ian Couper
- Ukwanda Centre for Rural Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Lisa Graves
- Department of Family and Community Medicine, School of Medicine, Western Michigan University, Kalamazoo, Michigan, USA
| | - Beth-Ann Cummings
- Centre for Medical Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatics, Flinders University, Adelaide, South Australia, Australia
| | - Pamela Stagg
- Centre for Remote Health, School of Medicine, Flinders University, Darwin, Australia
| | - David Hirsh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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von Pressentin KB, Waggie F, Conradie H. Towards tailored teaching: using participatory action research to enhance the learning experience of Longitudinal Integrated Clerkship students in a South African rural district hospital. BMC MEDICAL EDUCATION 2016; 16:82. [PMID: 26957124 PMCID: PMC4782508 DOI: 10.1186/s12909-016-0607-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 03/01/2016] [Indexed: 05/12/2023]
Abstract
BACKGROUND The introduction of Stellenbosch University's Longitudinal Integrated Clerkship (LIC) model as part of the undergraduate medical curriculum offers a unique and exciting training model to develop generalist doctors for the changing South African health landscape. At one of these LIC sites, the need for an improvement of the local learning experience became evident. This paper explores how to identify and implement a tailored teaching and learning intervention to improve workplace-based learning for LIC students. METHODS A participatory action research approach was used in a co-operative inquiry group (ten participants), consisting of the students, clinician educators and researchers, who met over a period of 5 months. Through a cyclical process of action and reflection this group identified a teaching intervention. RESULTS The results demonstrate the gaps and challenges identified when implementing a LIC model of medical education. A structured learning programme for the final 6 weeks of the students' placement at the district hospital was designed by the co-operative inquiry group as an agreed intervention. The post-intervention group reflection highlighted a need to create a structured programme in the spirit of local collaboration and learning across disciplines. The results also enhance our understanding of both students and clinician educators' perceptions of this new model of workplace-based training. CONCLUSIONS This paper provides practical strategies to enhance teaching and learning in a new educational context. These strategies illuminate three paradigm shifts: (1) from the traditional medical education approach towards a transformative learning approach advocated for the 21(st) century health professional; (2) from the teaching hospital context to the district hospital context; and (3) from block-based teaching towards a longitudinal integrated learning model. A programme based on balancing structured and tailored learning activities is recommended in order to address the local learning needs of students in the LIC model. We recommend that action learning sets should be developed at these LIC sites, where the relevant aspects of work-place based learning are negotiated.
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Affiliation(s)
- Klaus B von Pressentin
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - Firdouza Waggie
- Interdisciplinary Teaching and Learning Unit, Faculty of Community and Health Sciences, University of the Western Cape, Private Bag X17, Bellville, 7535, South Africa.
| | - Hoffie Conradie
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
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Greenhill J, Fielke KR, Richards JN, Walker LJ, Walters LK. Towards an understanding of medical student resilience in longitudinal integrated clerkships. BMC MEDICAL EDUCATION 2015; 15:137. [PMID: 26292832 PMCID: PMC4546182 DOI: 10.1186/s12909-015-0404-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/06/2015] [Indexed: 05/11/2023]
Abstract
BACKGROUND Resilience is required to succeed academically, overcome challenges during clinical training and cope positively with stress in future professional life. With medical students at high risk of mental illness, socially accountable medical schools are seeking to foster student resilience. This exploratory study proposes a conceptual framework for student resilience in longitudinal integrated clerkships (LICs). METHODS This qualitative study sought to understand student resilience during the first year of clinical training in a rural LIC where there were consistent anecdotal reports of high student resilience. In-depth interviews were conducted with a purposive sample of 19 medical students, professional staff and clinician teachers. An interpretive approach was used to analyse the data with emerging concepts compared to define evolving theoretical constructs, and develop a conceptual framework. RESULTS LIC students experienced adversity during the first clinical year of the medical course due to challenges encountered in the learning environment. This distress was moderated by: a secure, supportive learning environment; their profound learning journey; and utilisation of organisational structures to stay on course. CONCLUSION This triad of inter-related themes forms a conceptual model that challenges simplistic notions that medical courses should focus solely on providing tangible and emotional supports for students. How LIC programs may contribute to student wellbeing is discussed through the lenses of agentic, reflective and transformative learning.
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Affiliation(s)
- Jennene Greenhill
- Flinders University Rural Clinical School, South Australia, PO Box 852, Renmark, 5341, South Australia.
| | - Ken R Fielke
- Flinders University Rural Clinical School, South Australia, PO Box 852, Renmark, 5341, South Australia.
| | - Janet N Richards
- Flinders University Rural Clinical School, South Australia, PO Box 852, Renmark, 5341, South Australia.
| | - Leesa J Walker
- Flinders University Rural Clinical School, South Australia, PO Box 852, Renmark, 5341, South Australia.
| | - Lucie K Walters
- Flinders University Rural Clinical School, South Australia, PO Box 852, Renmark, 5341, South Australia.
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Strand P, Edgren G, Borna P, Lindgren S, Wichmann-Hansen G, Stalmeijer RE. Conceptions of how a learning or teaching curriculum, workplace culture and agency of individuals shape medical student learning and supervisory practices in the clinical workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:531-57. [PMID: 25160816 DOI: 10.1007/s10459-014-9546-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 08/14/2014] [Indexed: 05/10/2023]
Abstract
The role of workplace supervisors in the clinical education of medical students is currently under debate. However, few studies have addressed how supervisors conceptualize workplace learning and how conceptions relate to current sociocultural workplace learning theory. We explored physician conceptions of: (a) medical student learning in the clinical workplace and (b) how they contribute to student learning. The methodology included a combination of a qualitative, inductive (conventional) and deductive (directed) content analysis approach. The study triangulated two types of interview data from 4 focus group interviews and 34 individual interviews. A total of 55 physicians participated. Three overarching themes emerged from the data: learning as membership, learning as partnership and learning as ownership. The themes described how physician conceptions of learning and supervision were guided by the notions of learning-as-participation and learning-as-acquisition. The clinical workplace was either conceptualized as a context in which student learning is based on a learning curriculum, continuity of participation and partnerships with supervisors, or as a temporary source of knowledge within a teaching curriculum. The process of learning was shaped through the reciprocity between different factors in the workplace context and the agency of students and supervising physicians. A systems-thinking approach merged with the "co-participation" conceptual framework advocated by Billet proved to be useful for analyzing variations in conceptions. The findings suggest that mapping workplace supervisor conceptions of learning can be a valuable starting point for medical schools and educational developers working with changes in clinical educational and faculty development practices.
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Affiliation(s)
- Pia Strand
- Faculty of Medicine, Lund University, P.O. Box 157, 221 00, Lund, Sweden,
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Vaughan B, MacFarlane C, Florentine P. Clinical education in the osteopathy program at Victoria University. INT J OSTEOPATH MED 2014. [DOI: 10.1016/j.ijosm.2013.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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