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Vestergaard SK, Risor T. "I felt like a little kind of jolt of energy in my chest": embodiment in learning in continuing professional development for general practitioners. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10332-4. [PMID: 38683301 DOI: 10.1007/s10459-024-10332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
Learning in medical education encompasses a broad spectrum of learning theories, and an embodiment perspective has recently begun to emerge in continuing professional development (CPD) for health professionals. However, empirical research into the experience of embodiment in learning in CPD is sparse, particularly in the practice of general medicine. In this study, we aimed to explore general practitioners' (GPs') learning experiences during CPD from an embodiment perspective, studying the appearance of elements of embodiment-the body, actions, emotions, cognition, and interactions with the surroundings and others-to build an explanatory structure of embodiment in learning. We drew on the concepts of embodied affectivity and mutual incorporation to frame our understanding of embodiment. Four Danish and three Canadian GPs were interviewed to gain insight into specific learning experiences; the interviews and the analysis were inspired by micro-phenomenology, augmented with a complex adaptive systems approach. We constructed an explanatory structure of learning with two entrance points (disharmony and mundanity), an eight-component learning phase, and an ending phase with two exit points (harmony and continuing imbalance). All components of the learning phase-community, pride, validation, rehearsal, do-ability, mind-space, ambiance, and preparing for the future-shared features of embodied affectivity and mutual incorporation and interacted in multi-directional and non-linear ways. We discuss integrating the embodiment perspective into existing learning theories and argue that CPD for GPs would benefit from doing so.
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Affiliation(s)
- Stense Kromann Vestergaard
- Section of Education, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, Herlev, Copenhagen, 2730, Denmark.
- Section of General Practice, Department of Public Health, University of Copenhagen, København, Denmark.
| | - Torsten Risor
- Section of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Törnqvist T, Lindh Falk A, Jensen CB, Iversen A, Tingström P. Are the stars aligned? Healthcare students' conditions for negotiating tasks and competencies during interprofessional clinical placement. BMC MEDICAL EDUCATION 2023; 23:648. [PMID: 37684583 PMCID: PMC10492383 DOI: 10.1186/s12909-023-04636-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Healthcare students must learn to collaborate across professional boundaries so they can make use of each other's knowledge and competencies in a way that benefits the patient. One aspect of interprofessional collaboration implies negotiating what needs to be done and by whom. Research, focused on the conditions under which students perform this negotiation when they are working together during interprofessional clinical placement, needs to be further developed. The study therefore aimed to explore students' negotiation of tasks and competencies when students are working together as an interprofessional team during clinical placement. METHODS The study was designed as a focused ethnographic observational study. Two Nordic sites where final-year healthcare students perform clinical interprofessional education were included. Data consists of fieldnotes, together with informal conversations, group, and focus group interviews. In total, 160 h of participating observations and 3 h of interviews are included in the study. The analysis was informed by the theory on communities of practice. RESULTS Students relate to intersecting communities of practice when they negotiate what they should do to help a patient and who should do it. When the different communities of practice align, they support students in coming to an agreement. However, these communities of practice sometimes pulled the students in different directions, and negotiations were sometimes interrupted or stranded. On those occasions, observations show how the interprofessional learning practice conflicted with either clinical practice or one of the student's profession-specific practices. Conditions that had an impact on whether or not communities of practice aligned when students negotiated these situations proved to be 'having time to negotiate or not', as well as 'feeling safe or not'. CONCLUSIONS Final-year healthcare students can negotiate who in the team has the competence suited for a specific task. However, they must adapt their negotiations to different communities of practice being enacted at the same time. Educators need to be attentive to this and make an effort to ensure that students benefit from these intersecting communities of practice, both when they align and when they are in conflict.
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Affiliation(s)
- Tove Törnqvist
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Annika Lindh Falk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Catrine Buck Jensen
- Centre for Faculty Development, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Anita Iversen
- Centre for Faculty Development, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Pia Tingström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Bradbury-Jones C, Herber OR, Miller R, Taylor J. Improving the visibility and description of theory in qualitative research: The QUANTUM typology. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531299 PMCID: PMC9753101 DOI: 10.1016/j.ssmqr.2021.100030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 06/17/2023]
Abstract
The relationship between theory and qualitative research has been much debated. In 2014, based on an analysis of qualitative studies, we published a five-point typology on the levels of visibility expounded in such studies. The typology captured a range of theoretical visibility - from seemingly absent to consistently applied. In 2020, we undertook a project to critique and revise the typology, guided by the ADAPT-ITT framework. ADAPT-ITT was developed originally to inform the adaptation of evidence-based interventions to new geographic regions, cultural contexts or populations related to HIV. It has subsequently evolved as a helpful framework in a number of health and social fields. The ADAPT-ITT framework provides a systematic, stepwise process that allows existing interventions to be adapted, rather than creating new interventions unnecessarily. The use of ADAPT-ITT to guide the adaptation of a methodological framework (as opposed to a health intervention) is novel and we used it flexibly, as reported in this article. Core to this process was the engagement of 14 international qualitative research experts, drawn mainly from health and social science disciplines. The outcome was a revised typology, presented in this article. We offer this as a reflexive aide for the conduct and reporting of qualitative research.
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Affiliation(s)
| | - Oliver Rudolf Herber
- Witten/Herdecke University, School of Nursing Science, Alfred-Herrhausen-Str. 50, 58455 Witten, Germany
- Heinrich Heine University Dusseldorf, Institute of General Practice, Moorenstr. 5, 40225 Dusseldorf, Germany
| | - Rosemarie Miller
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, B15 2TT, UK
| | - Julie Taylor
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, B15 2TT, UK
- Birmingham Women's and Children's NHS Foundation Trust, UK
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Malau-Aduli BS, Jones K, Smith AM, Sen Gupta T, Hays RB. Understanding medical students' transformative experiences of early preclinical international rural placement over a 20-year period. BMC MEDICAL EDUCATION 2022; 22:652. [PMID: 36042497 PMCID: PMC9427436 DOI: 10.1186/s12909-022-03707-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Rural placements are an important component of rural medical education programs seeking to develop rural practice pathways for medical students. These placements are usually domestic, but James Cook University in Australia developed an international rural placement program in the first half of the medical course that was funded through bursaries. This study explores how the international rural placement helped to shape the lives (personal development and learning) of the participants, using Transformational Learning Theory as a framework for identifying and describing the transformational elements, process and impact of the program. METHODS Sixty-five students received a bursary for an international rural placement between 2001-2019. All were contacted by email and invited to participate in a short survey and a follow-up interview. Fifteen participants agreed and twelve were able to participate in individual semi-structured interviews which were recorded, transcribed and analysed using inductive thematic analysis. RESULTS Participants reported that the bursary provided a "once in a lifetime opportunity" to "experience eye-opening and culturally rich difference". Nonetheless, some elements of the placement experience presented disorientating dilemmas that triggered deep reflections and shifts in perceptions. The bursary recipients realised that "being open-minded" allowed them "enjoy good company". They were also able to assume "outsider view which allowed reassessment of their own country" and the "isolation experiences gingered desire to right health wrongs". The triggers and mental shifts had significant impact on the bursary recipients and fostered the development of "inspirational new horizons" based on an appreciation of the "value of rural practice" and "role-modelling for life-long learning." These findings are consistent with Transformational Learning Theory. CONCLUSION Participants in this study reported meaningful and strongly positive impacts from the experiences gained during an international rural clinical placement early in their course. They described transformative experiences which appear to contribute strongly to personal development. This finding supports maintaining opportunities for international experiences during rurally-oriented medical programs as these may impact longer term career choice.
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Affiliation(s)
- Bunmi S Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia.
| | - Karina Jones
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Amy M Smith
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Richard B Hays
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Lavoie P, Lapierre A, Maheu-Cadotte MA, Rodriguez D, Lavallée A, Mailhot T. Improving the recognition and management of hemorrhage: A scoping review of nursing and midwifery education. NURSE EDUCATION TODAY 2022; 113:105361. [PMID: 35429750 DOI: 10.1016/j.nedt.2022.105361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Hemorrhage is a frequent complication that nurses and midwives must recognize and manage to avoid life-threatening consequences for patients. There is currently no synthesis of evidence on educational interventions in nursing and midwifery regarding hemorrhage, thus limiting the definition of best practices. OBJECTIVE To map the literature on nursing and midwifery education regarding the recognition and management of hemorrhage. DESIGN Scoping review based on the Joanna Briggs Institute guidelines. DATA SOURCES Quantitative studies evaluating the effect of educational interventions with students, nurses, or midwives published in English or French, with no time limit. REVIEW METHODS Study selection, data extraction, and quality assessment were conducted by two independent reviewers. We characterized educational interventions based on the Guideline for Reporting Evidence-Based Practice Educational Interventions and Teaching. We categorized learning outcomes using the New World Kirkpatrick Model. Methodological quality appraisal was performed with tools from the Joanna Briggs Institute. Findings were synthesized using descriptive statistics and graphical methods RESULT: Most of the 38 studies used a single-group design (n = 26, 68%) and were conducted with professionals (n = 28, 74%) in hospital settings (n = 20, 53%). Most were of low (n = 14; 37%) or moderate (n = 18, 47%) methodological quality. Most interventions focused on postpartum hemorrhage (n = 34, 89%) and combined two or more teaching strategies (n = 25, 66%), often pairing an informational segment (e.g., lecture, readings) with a practical session (e.g., workshop, simulation). Learning outcomes related to the management (n = 27; 71%) and recognition of hemorrhage (n = 19, 50%), as well as results for patients and organizations (n = 9, 24%). CONCLUSION Considerable heterogeneity in interventions and learning outcomes precluded conducting a systematic review of effectiveness. High-quality, controlled studies are needed, particularly in surgery and trauma. Reflection on the contribution of nurses and midwives to the detection, monitoring, and management of hemorrhage could enrich the content and expected outcomes of hemorrhage education.
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Affiliation(s)
- Patrick Lavoie
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada.
| | - Alexandra Lapierre
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada
| | - Marc-André Maheu-Cadotte
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada
| | - Dora Rodriguez
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada
| | - Andréane Lavallée
- Department of Pediatrics, Columbia University Medical Center, 51 Audubon Ave, Suite 100, New York, NY 10032, United States
| | - Tanya Mailhot
- Faculty of Nursing, Université de Montréal, 2375 Chemin De la Côte-Sainte-Catherine, Montreal, Quebec H3C 3J7, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, Quebec H1T 1C8, Canada
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Schaepkens SPC, Veen M, de la Croix A. Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:537-551. [PMID: 34767115 PMCID: PMC9117338 DOI: 10.1007/s10459-021-10082-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/31/2021] [Indexed: 05/21/2023]
Abstract
Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical findings has not resulted in definite evidence on how to foster reflection. The concept is as slippery as soap. This leaves the research field with the question, 'how can research approach the conceptual indeterminacy of reflection to produce knowledge?'. The authors conducted a critical narrative umbrella review of research on reflection in medical education. Forty-seven review studies on reflection research from 2000 onwards were reviewed. The authors used the foundational literature on reflection from Dewey and Schön as an analytical lens to identify and critically juxtapose common approaches in reflection research that tackle the conceptual complexity. Research on reflection must deal with the paradox that every conceptualization of reflection is either too sharp or too broad because it is entrenched in practice. The key to conceptualizing reflection lies in its use and purpose, which can be provided by in situ research of reflective practices.
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Affiliation(s)
- Sven P C Schaepkens
- Department of General Practice, Erasmus University Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
| | - M Veen
- Department of General Practice, Erasmus University Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - A de la Croix
- Faculty of Medicine, Vrije Universiteit Amsterdam, Postbus 7057, 1007 MB, Amsterdam, The Netherlands
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Goldman J, Smeraglio A, Lo L, Kuper A, Wong BM. Theory in quality improvement and patient safety education: A scoping review. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:319-326. [PMID: 34609733 PMCID: PMC8633332 DOI: 10.1007/s40037-021-00686-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Theory plays an important role in education programming and research. However, its use in quality improvement and patient safety education has yet to be fully characterized. The authors undertook a scoping review to examine the use of theory in quality improvement and patient safety education. METHODS Eligible articles used theory to inform the design or study of a quality improvement or patient safety curriculum. The authors followed scoping review methodology and searched articles referenced in 20 systematic reviews of quality improvement and patient safety education, or articles citing one of these reviews, and hand searched eligible article references. Data analysis involved descriptive and interpretive summaries of theories used and the perspectives the theories offered. RESULTS Eligibility criteria were met by 28 articles, and 102 articles made superficial mention of theory. Eligible articles varied in professional group, learning stage and journal type. Theories fell into two broad categories: learning theories (n = 20) and social science theories (n = 11). Theory was used in the design (n = 12) or study (n = 17) of quality improvement and patient safety education. The range of theories shows the opportunity afforded by using more than one type of theory. DISCUSSION Theory can guide decisions regarding quality improvement and patient safety education practices or play a role in selecting a methodology or lens through which to study educational processes and outcomes. Educators and researchers should make deliberate choices around the use of theory that relates to aspects of an educational program that they seek to illuminate.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- The Wilson Centre, Toronto, Ontario, Canada.
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Andrea Smeraglio
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
- Division of Hospital & Specialty Medicine, Portland Veterans Administration Medical Center, Portland, OR, USA
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Kuper
- The Wilson Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Brian M Wong
- Centre for Quality Improvement and Patient Safety, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Bearman M, Mahoney P, Tai J, Castanelli D, Watling C. Invoking culture in medical education research: A critical review and metaphor analysis. MEDICAL EDUCATION 2021; 55:903-911. [PMID: 33539558 DOI: 10.1111/medu.14464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/14/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION 'Culture' is a word frequently invoked within medical education literature to explain challenges faced by learners in practice. While social settings and practices are widely acknowledged as critical influences on medical education, there is vast variability in how the term 'culture' is employed. This may lead to confusion, resulting in assumptions and oversights. OBJECTIVE This critical literature review aims to characterise how the term 'culture' is explicitly and implicitly conceptualised in medical education research. METHODS Four leading English language journals in the medical education field were searched in a twelve-month period for research papers or reviews that mentioned culture in title or abstract in a substantive way. A content analysis was undertaken of extracted definitions. In addition, metaphor analysis was used to identify conceptual metaphors, which were subsequently clustered thematically. RESULTS Our search yielded 26 papers, 8 of which contained definitions, mostly from the organisational literature. We interpreted nine conceptual metaphors related to how the term culture was employed (terroir, divider, dominant force, toxic force, obstacle, microclimate, object, brand and holdall) in four categories (unchanging, powerful, can adapt around, can be used). DISCUSSION This critical review reveals that medical education as a field: 1) draws most explicitly from the organisational literature; 2) invokes culture in multiple means but in ways that privilege either acontextual human agency or all-powerful social forces; and 3) regards culture as a negative or neutral force but rarely a positive one. There is a notable absence around conceptualisations of 'culture' that allow educator, student and administrator agency but at the same time acknowledge the deep forces that various social settings and practices exert. Other literatures investigating learning cultures and cultural reflexivity focus on this nexus and may provide possible means to advance considerations of culture within medical education research.
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Affiliation(s)
- Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Vic., Australia
| | - Paige Mahoney
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Vic., Australia
| | - Joanna Tai
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Vic., Australia
| | - Damian Castanelli
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Vic., Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic., Australia
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Melbourne, Vic., Australia
| | - Christopher Watling
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Maggio LA, Larsen K, Thomas A, Costello JA, Artino AR. Scoping reviews in medical education: A scoping review. MEDICAL EDUCATION 2021; 55:689-700. [PMID: 33300124 PMCID: PMC8247025 DOI: 10.1111/medu.14431] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 12/04/2020] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Over the last two decades, the number of scoping reviews in core medical education journals has increased by 4200%. Despite this growth, research on scoping reviews provides limited information about their nature, including how they are conducted or why medical educators undertake this knowledge synthesis type. This gap makes it difficult to know where the field stands and may hamper attempts to improve the conduct, reporting and utility of scoping reviews. Thus, this review characterises the nature of medical education scoping reviews to identify areas for improvement and highlight future research opportunities. METHOD The authors searched PubMed for scoping reviews published between 1/1999 and 4/2020 in 14 medical education journals. The authors extracted and summarised key bibliometric data, the rationales given for conducting a scoping review, the research questions and key reporting elements as described in the PRISMA-ScR. Rationales and research questions were mapped to Arksey and O'Malley's reasons for conducting a scoping review. RESULTS One hundred and one scoping reviews were included. On average, 10.1 scoping reviews (SD = 13.1, median = 4) were published annually with the most reviews published in 2019 (n = 42). Authors described multiple reasons for undertaking scoping reviews; the most prevalent being to summarise and disseminate research findings (n = 77). In 11 reviews, the rationales for the scoping review and the research questions aligned. No review addressed all elements of the PRISMA-ScR, with few authors publishing a protocol (n = 2) or including stakeholders (n = 20). Authors identified shortcomings of scoping reviews, including lack of critical appraisal. CONCLUSIONS Scoping reviews are increasingly conducted in medical education and published by most core journals. Scoping reviews aim to map the depth and breadth of emerging topics; as such, they have the potential to play a critical role in the practice, policy and research of medical education. However, these results suggest improvements are needed for this role to be fully realised.
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Affiliation(s)
- Lauren A. Maggio
- Department of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Kelsey Larsen
- Department of Politics, Security, and International AffairsUniversity of Central FloridaOrlandoFLUSA
| | - Aliki Thomas
- School of Physical and Occupational TherapyInstitute of Health Sciences EducationFaculty of MedicineMcGill UniversityMontrealQCCanada
| | | | - Anthony R. Artino
- Department of Health, Human Function, and Rehabilitation SciencesThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
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Torres-Calixto MG. Trends and challenges of medical education. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n3.84330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The aim of this article is to reflect on the contextual factors that influence medical education, in order to provide some recommendations about the challenges that physicians face.
A literature review was conducted to write this reflection paper, and it was found that the education of health professionals has undergone significant changes that are based on the development of biomedical sciences, technology, and pedagogy, and are influenced by the needs of the general population, the requirements of the health systems of each country, and scientific progress.
These changes have given rise to challenges inherent to the special characteristics of each country and related to the quantity, quality, and relevance of the training of physicians. In this regard, it has been suggested that, in the face of such changes, it is necessary to design curricula that integrate all aspects of health care, consider the supply and demand of medical services, emphasize professionalism, take into account the pedagogical training of health sciences teachers, comply with quality standards, assist students in selecting undergraduate programs adequately (in this case Medicine), and ensure relevant clinical practice scenarios.
It should also be noted that medical education has not adapted adequately to the aforementioned changes in many countries and, therefore, the development of teaching and learning strategies has lagged behind and physicians in such countries do not have the capacity to provide the health care required by the general population in a proper manner.
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Grierson L, Vanstone M. The rich potential for education research in family medicine and general practice. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:753-763. [PMID: 32986222 DOI: 10.1007/s10459-020-09994-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Medical education is a rapidly growing field of research, incorporating diverse disciplinary perspectives to assist physician trainees in developing the complex skills needed for practice. Education science is happening in many medical specialties; however, Family Medicine or General Practice settings have not seen a proportional share of theory-driven education research. The limited nature of education research in Family Medicine is surprising, given that there are several aspects of general practice that make it a particularly unique and interesting context to study issues of general importance to medical education, and there is a particular need for education research to further the discipline of Family Medicine. It is important that the community of medical education researchers in Family Medicine have a strong understanding and perspective on the breadth and potential impact of their work, and what this means for the training that occurs within and for the discipline. This Reflection aims to inform strategic thinking, collaboration, and innovation in medical education research as it pertains to Family Medicine. It does so by discussing four hallmarks of Family Medicine practice and outlining their independent and interactive potential for medical education research.
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Affiliation(s)
- Lawrence Grierson
- Department of Family Medicine, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, USA.
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, USA.
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, USA
- McMaster FHS Program for Education Research, Innovation, and Theory (MERIT), McMaster University, Hamilton, USA
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Delany C, Kameniar B, Lysk J, Vaughan B. "Starting from a higher place": linking Habermas to teaching and learning clinical reasoning in the emergency medicine context. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:809-824. [PMID: 32006129 DOI: 10.1007/s10459-020-09958-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/14/2020] [Indexed: 06/10/2023]
Abstract
Teaching clinical reasoning in emergency medicine requires educators to foster diagnostic accuracy and judicious decision-making amidst chaotic ambient factors including clinician fatigue, high cognitive load, and diverse patient expectations. The current study applies the early work of Jurgen Habermas and his knowledge-constitutive interests as a lens to explore an educational approach where physician-educators were asked to make their expert reasoning visible to emergency medicine trainees, to more deliberately make visible and accessible the context-specific thinking that emergency physicians routinely use. An action research methodology was used. The 'making thinking visible' teaching approach was introduced to five emergency medicine educators working in large public hospital emergency departments. Participants were asked to trial this teaching method and document its impact on student learning over two reporting cycles. Based on written reports of trialing the teaching approach, participants identified a need to change from: (1) introducing thinking structures to cultivating enquiry; and, (2) providing explanations based on cognitive thinking routines towards encouraging the learner to see the relevance of the clinical context. Educators described how they developed a more diagnostic and reflexive approach to learners, recognized the need to cultivate independent thinking, and valued the opportunity to reflect on their usual teaching. Teaching clinical reasoning using the 'making thinking visible' approach prompted educators to decrease the emphasis on providing technical information to assisting learners to understand the purposes and meanings behind clinical reasoning in emergency medicine. The knowledge-constitutive interests work of Jurgen Habermas was found to provide a robust framework supporting this emancipatory teaching approach.
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Affiliation(s)
- Clare Delany
- Department of Medical Education, University of Melbourne, Grattan Street,, Melbourne, Parkville, VIC, 3010, Australia.
| | - Barbara Kameniar
- Melbourne Graduate School of Education, University of Melbourne, Melbourne, Australia
- Faculty of Education, University of Tasmania, Hobart, Australia
| | - Jayne Lysk
- Department of Medical Education, University of Melbourne, Grattan Street,, Melbourne, Parkville, VIC, 3010, Australia
| | - Brett Vaughan
- Department of Medical Education, University of Melbourne, Grattan Street,, Melbourne, Parkville, VIC, 3010, Australia
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Gordon L, Teunissen PW, Jindal-Snape D, Bates J, Rees CE, Westerman M, Sinha R, van Dijk A. An international study of trainee-trained transitions: Introducing the transition-to-trained-doctor (T3D) model. MEDICAL TEACHER 2020; 42:679-688. [PMID: 32150488 DOI: 10.1080/0142159x.2020.1733508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Throughout their careers, doctors and other healthcare professionals experience numerous transitions. When supporting transitions, opportunities for development and learning should be maximized, while stressors having negative impacts on well-being should be minimized. Building on our international data, this study aimed to develop a conceptual model of the trainee-trained transition (i.e. the significant transitions experienced by doctors as they complete postgraduate training moving from trainee/resident status to medical specialist roles).Methods: Employing Multiple and Multidimensional Transitions (MMT) theory and current conceptualizations of clinical context, this study undertook secondary analysis of 55 interviews with doctors from three countries (Netherlands, Cananda and the UK) undergoing trainee-trained transitions.Results: Through this analysis, the Transition-To-Trained-Doctor (T3D) conceptual model has been developed. This model takes into consideration the multiple contexts and multiple domains in which transitions take place.Discussion: This model is significant in that it has several uses and is applicable across countries: to remind doctors, managers and medical educators of the complexity of transitions; to frame and facilitate supportive conversations; and as a basis to teach about transitions.
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Affiliation(s)
- Lisi Gordon
- Centre for Medical Education, University of Dundee, Dundee, UK
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia
| | - Pim W Teunissen
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | | | - Joanna Bates
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, Canada
| | - Charlotte E Rees
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Australia
- College of Science, Health, Engineering & Education, Murdoch University, Murdoch, Australia
| | - Michiel Westerman
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, the Netherlands
| | - Roona Sinha
- University of Saskatchewan, Saskatoon, Canada
| | - Anne van Dijk
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
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O'Brien BC, Battista A. Situated learning theory in health professions education research: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:483-509. [PMID: 31230163 DOI: 10.1007/s10459-019-09900-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/20/2019] [Indexed: 05/18/2023]
Abstract
At a time when cognitive and behavioral theories dominated the landscape of learning theories, Lave and Wenger's situated learning theory (SLT) opened new territory by illuminating social and cultural learning processes. Many researchers and educators in the health professions embraced this theory, but few have considered how SLT has been used and what has been learned or improved through its use in health professions education (HPE). In this scoping review, the authors examine these questions and consider opportunities for future work with SLT in HPE. The authors followed Levac's modified scoping review framework. They conducted a search of CINAHL, ERIC, PubMed, Scopus, and Web of Science for articles referencing SLT or related concepts in HPE between 2006 and 2016. Two reviewers screened all titles and abstracts, then screened full text for inclusion based on substantive treatment of SLT. Two authors extracted, analyzed and synthesized data from the final set of 193 articles. The authors identified two patterns of theory use. One sought an understanding of social learning processes in a specific context. The other aimed to design and/or evaluate interventions associated with communities of practice. These patterns are similar to other literatures (e.g., general education, healthcare, and organizational development) and, according to Lave and Wenger, may reflect confusion about the purpose, stance, and terminology of SLT. The authors discuss their findings in relation to primary source literature and consider opportunities for HPE researchers to employ and contribute to SLT going forward.
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Affiliation(s)
- Bridget C O'Brien
- Department of Medicine, Center for Faculty Educators, University of California, San Francisco, 533 Parnassus Avenue, Suite U-80, Box 0710, San Francisco, CA, 94143, USA.
| | - Alexis Battista
- Graduate Programs in Health Professions Education, Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD, 20814-4712, USA
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15
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Ingham G, Plastow K, Kippen R, White N. Closer supervision in Australian general practice training: planning major system change. Aust J Prim Health 2020; 26:184-190. [PMID: 32050081 DOI: 10.1071/py19156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/23/2019] [Indexed: 11/23/2022]
Abstract
Major system change involving closer supervision of trainee GP registrars in Australia is warranted. Change management guidelines recommend involving stakeholders in developing change. The views of those involved in general practice training about current and potential supervisory practice were explored. Semi-structured interviews were conducted with a lead medical educator from nine Australian regions. Focus groups were conducted with GP supervisors and GP registrars. Transcripts from the interviews and focus groups were analysed using conventional content analysis, with themes emerging inductively from the data. The findings were that over 1-3 months, a registrar could progress from their supervisor observing all consultations through to the registrar only calling when they identify the need for help. There is strong support from registrars for this change to closer supervision, but less support from supervisors and educators. Barriers to the proposed change include high clinical demand competing with teaching capacity, inadequate payment for closer supervision and supervisors lacking skills or motivation to have a more active role in registrar supervision. If funding and logistic barriers to change are addressed, a change to a closer level of supervision is possible. A pilot study to further refine the change is indicated.
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Affiliation(s)
- Gerard Ingham
- Murray City Country Coast GP Training, Level 2, 369 Royal Parade, Parkville, Vic. 3052, Australia; and Corresponding author.
| | - Kayty Plastow
- Murray City Country Coast GP Training, Level 2, 369 Royal Parade, Parkville, Vic. 3052, Australia
| | - Rebecca Kippen
- Rural Health, Monash University, 26 Mercy Street, Bendigo, Vic. 3550, Australia
| | - Nicky White
- Murray City Country Coast GP Training, Level 2, 369 Royal Parade, Parkville, Vic. 3052, Australia
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Brown J, Nestel D. Theories and myths in medical education: What is valued and who is served? MEDICAL EDUCATION 2020; 54:4-6. [PMID: 31849097 DOI: 10.1111/medu.14003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- James Brown
- Monash Institute of Health and Clinical Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Eastern Victoria GP Training, Churchill, Victoria, Australia
| | - Debra Nestel
- Monash Institute of Health and Clinical Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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17
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Paes P. Practical wisdom, a dormant character in medical education? MEDICAL EDUCATION 2019; 53:428-429. [PMID: 30932203 DOI: 10.1111/medu.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Paul Paes
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
- Palliative Care, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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