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McLeod K, Woodward-Kron R, Rashid P, Archer J, Nestel D. "I'm on an island": A qualitative study of underperforming surgical trainee perspectives on remediation. Am J Surg 2024; 234:11-16. [PMID: 38350749 DOI: 10.1016/j.amjsurg.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/14/2023] [Accepted: 01/28/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND There is a significant gap in the literature regarding trainees' perceptions of remediation. This study aims to explore surgical trainees' experiences and perspectives of remediation. METHODS This qualitative study used semi-structured interviews with 11 doctors who have experienced formal remediation as a surgical trainee. Reflexive thematic analysis was used for data analysis. RESULTS In this study, trainees perceived remediation as a harrowing and isolating experience, with long-lasting emotions. There was a perceived lack of clarity regarding explanations of underperformance and subjective goals. Remediation was viewed as a 'performance' and tick-box exercise with superficial plans, with challenging trainee/supervisor dynamics. CONCLUSIONS These findings about trainees' perspectives on remediation show a need for trainees to be better emotionally supported during remediation and that remediation plans must be improved to address deficits. Integrating the perspectives and experiences of surgical trainees who have undergone remediation should help improve remediation outcomes and patient care.
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Affiliation(s)
- Kathryn McLeod
- Department of Urological Surgery, Barwon Health, University Hospital, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia; Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia.
| | - Robyn Woodward-Kron
- Department of Medical Education, The University of Melbourne, Melbourne, Australia
| | - Prem Rashid
- Department of Urology, Port Macquarie Base Hospital, Rural Clinical School, The University of New South Wales, Port Macquarie, Australia
| | - Julian Archer
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia
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2
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Brand G, Peters S, Dart J. Verbatim theatre as a creative approach to health professions education research translation. MEDICAL EDUCATION 2024. [PMID: 38922957 DOI: 10.1111/medu.15449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/02/2024] [Accepted: 05/11/2024] [Indexed: 06/28/2024]
Abstract
CONTEXT Traditionally, the impact and outcomes from health professions education research (HPER) have focused on academic outputs, whereas in the humanities, research translation is conceptualised more broadly and creatively, including research-based performances like verbatim theatre. Translating HPER findings through the emotive and embodied nature of a verbatim theatre performance provides a unique opportunity to translate research data and create alternative learning spaces for rich and valuable insights that aligns with transformative pedagogy. APPROACH In this paper, we describe the background of verbatim theatre, a form of performance, which draws on a research participants' testimony and lived experience and how we used this creative approach to translate HPER findings. We discuss the experiential process of bringing an interdisciplinary team together, health professions academics and an academic playwright to craft a verbatim theatre script that provided space to honour the breadth, depth and diversity of participant voices from a large (n = 100) qualitative research study exploring professionalism and sociocultural factors in health professions education (HPE). Furthermore, we discuss the powerful potential of drawing on research-based performance to create alternative, safe and non-threatening learning spaces to resonate with and experience HPER in new and transformative ways. Finally, we offer reflexive insights on the key opportunities and challenges we encountered in translating HPER into a verbatim theatre performance. CONCLUSIONS Verbatim theatre presents an innovative and creative way to communicate and translate HPER. This paper offers research and pedagogical insights in translating research into verbatim theatre to support transformative pedagogy and practice in HPE. In conclusion, we encourage other health professions researchers to consider this dynamic and creative approach to transforming HPE.
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Affiliation(s)
- Gabrielle Brand
- Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
| | - Sarah Peters
- College of Humanities, Arts and Social Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Janeane Dart
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Victoria, Australia
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3
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Rothpletz-Puglia P, Smith J, Pavuk C, Leotta J, Pike K, Presley CJ, Krok-Schoen JL, Braun A, Cohen MK, Rogers GT, Chui KKH, Zhang FF, Spees CK. A theoretical explanation for how a nutrition counseling and medically tailored meal delivery program benefitted participants living with lung cancer. Support Care Cancer 2024; 32:428. [PMID: 38869623 PMCID: PMC11176247 DOI: 10.1007/s00520-024-08616-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/29/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The purpose of this study was to assess participants' perceptions and experiences while participating in a Food is Medicine medically tailored meal plus intensive nutrition counseling intervention to create a theoretical explanation about how the intervention worked. METHODS This interpretive qualitative study included the use of semi-structured interviews with active participants in a randomized controlled trial aimed at understanding how a medically tailored meal plus nutrition counseling intervention worked for vulnerable individuals with lung cancer treated at four cancer centers across the USA. During the 8-month long study, participants in the intervention arm were asked to be interviewed, which were recorded, transcribed verbatim, and analyzed using conventional content analysis with principles of grounded theory. RESULTS Twenty individuals participated. Data analysis resulted in a theoretical explanation of the intervention's mechanism of action. The explanatory process includes three linked and propositional categories leading to patient resilience: engaging in treatment, adjusting to diagnosis, and active coping. The medically tailored meals plus nutrition counseling engaged participants throughout treatment, which helped participants adjust to their diagnosis, leading to active coping through intentional self-care, behavior change, and improved quality of life. CONCLUSIONS These findings provide evidence that a Food is Medicine intervention may buffer some of the adversity related to the diagnosis of lung cancer and create a pathway for participants to experience post-traumatic growth, develop resilience, and change behaviors to actively cope with lung cancer. Medically tailored meals plus intensive nutrition counseling informed by motivational interviewing supported individuals' adjustment to their diagnosis and resulted in perceived positive behavior change.
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Affiliation(s)
- Pamela Rothpletz-Puglia
- Rutgers, The State University of New Jersey, School of Health Professions, New Brunswick, NJ, USA
| | - Jade Smith
- School of Health and Rehabilitation Sciences, Division of Medical Dietetics, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Chloe Pavuk
- School of Health and Rehabilitation Sciences, Division of Medical Dietetics, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Jana Leotta
- School of Health and Rehabilitation Sciences, Division of Medical Dietetics, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Kimberli Pike
- Rutgers, The State University of New Jersey, School of Health Professions, New Brunswick, NJ, USA
| | - Carolyn J Presley
- The James Comprehensive Cancer Center, Columbus, OH, USA
- Division of Medical Oncology, Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jessica L Krok-Schoen
- The James Comprehensive Cancer Center, Columbus, OH, USA
- School of Health and Rehabilitation Sciences, Division of Health Sciences, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Ashlea Braun
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Tulsa, OK, USA
| | - Mary Kathryn Cohen
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Gail T Rogers
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Kenneth Kwan Ho Chui
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Fang Fang Zhang
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Colleen K Spees
- School of Health and Rehabilitation Sciences, Division of Medical Dietetics, The Ohio State University, College of Medicine, Columbus, OH, USA.
- The James Comprehensive Cancer Center, Columbus, OH, USA.
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Cavaleiro I, de Carvalho Filho MA. Harnessing student feedback to transform teachers: Role of emotions and relationships. MEDICAL EDUCATION 2024; 58:750-760. [PMID: 37984443 DOI: 10.1111/medu.15264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/21/2023] [Accepted: 10/14/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Feedback is crucial to promote learning and improve performance. However, we lack a nuanced understanding of how medical teachers reflect on and internalise (or not) student feedback (SF). This study aims to fill this gap by exploring how teachers make sense of SF to improve their performance and nurture their personal and professional development. METHODS In this cross-sectional qualitative study based on a constructivist paradigm, 14 medical teachers individually drew a Rich Picture (RP) of a feedback experience in which they received informal or formal feedback from students, resulting in a personal or professional change. After the drawing, we interviewed the participants to deepen our understanding of teachers' experiences. We analysed the drawings and interview transcripts using an iterative process of thematic analysis. RESULTS SF that culminated in personal or professional change is a highly emotional experience for teachers, often with long-lasting consequences. It may threaten or reassure their self-concept and professional identity, generating feedback avoidance or feedback-seeking behaviour. SF is particularly powerful in transforming teaching practices when teachers feel connected to students through an honest and constructive relationship. Remarkably, some teachers intentionally build relationships with certain (selected) students to get 'qualified' feedback. SF acceptance also increases when teachers are open to receiving feedback and there is an institutional culture that values feedback. Finally, medical teachers believe that formal (planned) feedback is relevant to improve the curriculum, while informal (spontaneous) feedback is important for promoting teachers' personal and professional development. DISCUSSION SF has the potential to become a transformative learning experience for teachers. The student-teacher relationship and teachers' emotional reactions affect the way teachers make sense of and internalise SF and enact behavioural change. Understanding the complexity surrounding SF is vital for supporting teachers in seizing opportunities for growth and in nurturing a meaningful relationship with the act of teaching.
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Affiliation(s)
- Inês Cavaleiro
- School of Medicine, University of Minho, Braga, Portugal
| | - Marco Antonio de Carvalho Filho
- Wenckebach Institute (WIOO) - Lifelong Learning, Education, and Assessment Research Network (LEARN), University Medical Center Groningen, Groningen, The Netherlands
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Rooholamini A, Salajegheh M. Health profession education hackathons: a scoping review of current trends and best practices. BMC MEDICAL EDUCATION 2024; 24:554. [PMID: 38773526 PMCID: PMC11110329 DOI: 10.1186/s12909-024-05519-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/06/2024] [Indexed: 05/24/2024]
Abstract
BACKGROUND While the concept of hacking in education has gained traction in recent years, there is still much uncertainty surrounding this approach. As such, this scoping review seeks to provide a detailed overview of the existing literature on hacking in health profession education and to explore what we know (and do not know) about this emerging trend. METHODS This was a scoping review study using specific keywords conducted on 8 databases (PubMed, Embase, Scopus, Web of Science, ERIC, PsycINFO, Education Source, CINAHL) with no time limitation. To find additional relevant studies, we conducted a forward and backward searching strategy by checking the reference lists and citations of the included articles. Studies reporting the concept and application of hacking in education and those articles published in English were included. Titles, abstracts, and full texts were screened and the data were extracted by 2 authors. RESULTS Twenty-two articles were included. The findings are organized into two main categories, including (a) a Description of the interventions and expected outcomes and (b) Aspects of hacking in health profession education. CONCLUSION Hacking in health profession education refers to a positive application that has not been explored before as discovering creative and innovative solutions to enhance teaching and learning. This includes implementing new instructional methods, fostering collaboration, and critical thinking to utilize unconventional approaches.
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Affiliation(s)
- Azadeh Rooholamini
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahla Salajegheh
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran.
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Dubé TV, Cumyn A, Fourati M, Chamberland M, Hatcher S, Landry M. Pathways, journeys and experiences: Integrating curricular activities related to social accountability within an undergraduate medical curriculum. MEDICAL EDUCATION 2024; 58:556-565. [PMID: 37885341 DOI: 10.1111/medu.15260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/12/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program. METHODS We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data. RESULTS The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation. CONCLUSIONS We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA.
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Affiliation(s)
- Tim V Dubé
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Annabelle Cumyn
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mariem Fourati
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Martine Chamberland
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Sharon Hatcher
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Michel Landry
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Université de Moncton, Moncton, New Brunswick, Canada
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Phillips EC, Tallentire V. Routine versus prompted clinical debriefing: aligning aims, mechanisms and implementation. BMJ Qual Saf 2024; 33:280-283. [PMID: 38307848 DOI: 10.1136/bmjqs-2023-016836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Affiliation(s)
- Emma Claire Phillips
- NHS Lothian, Edinburgh, UK
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
| | - Victoria Tallentire
- NHS Lothian, Edinburgh, UK
- Scottish Centre for Simulation and Clinical Human Factors, Larbert, UK
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Müller J, Meyer R, Bantjes J, Archer E, Couper I. Handle with Care: Transformative Learning as Pedagogy in an Under-Resourced Health Care Context. TEACHING AND LEARNING IN MEDICINE 2024:1-10. [PMID: 38634761 DOI: 10.1080/10401334.2024.2332885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/15/2024] [Indexed: 04/19/2024]
Abstract
Issue: A significant component of health professions education is focussed on students' exposure to the social determinants of health and the challenges that patients within the health care system face. An appropriate way to provide such exposure is through distributed clinical training. This usually entails students training in smaller groups along the continuum of care, away from tertiary academic hospitals. This also means students are away from their existing academic and social support systems. It is evident that knowledge and clinical skills alone are not sufficient to prepare students, they also need to be taught to critically reflect on how their own values and attitudes traverse their knowledge and skills to influence their practice as healthcare professionals. This process of critical reflection should aim to provide a transformative learning experience for students and requires active facilitation. In under-resourced health care contexts where clinicians responsible for student training are facing high patient load, lack of resources, inequitable health care services and high levels of burn-out, the facilitation of student learning may be compromised. Evidence: Clinical learning opportunities that are considered transformative, frequently challenge students' sense of self and sense of belonging. This experience can have detrimental effects if the processes of transformative learning pedagogy are not adequately facilitated. The provision of support staff, lecturers and clinical facilitators on the distributed training platform is challenged by the remote nature of some of the sites and the cost of recruiting and capacitating additional on-site staff. The potential for what has been termed "transformative trauma" and the subsequent halted transformative learning experience, has ethical implications in terms of student wellness and the educational responsibility institutions carry. Implications: The authors suggest considerations in facilitating an ethical transformative learning process. These include making the transformative learning pedagogy explicit to students and clinical facilitators and using the 'brave spaces' framework to help students with individuation and provide them with the tools to understand how emotion influences behavior. Strategies to improve relationship development and communities of support, as well as ideas for faculty development are offered.
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Affiliation(s)
- Jana Müller
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rhoda Meyer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jason Bantjes
- Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Elize Archer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Elster MJ, Parsons AS, Collins S, Gusic ME, Hauer KE. 'We're like Spider-Man; with great power comes great responsibility': Coaches' experiences supporting struggling medical students. MEDICAL TEACHER 2024:1-9. [PMID: 38588710 DOI: 10.1080/0142159x.2024.2337250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Medical students can experience a range of academic and non-academic struggles. Coaching is a valuable strategy to support learners, but coaches describe working with struggling learners as taxing. Transformative learning theory (TLT) provides insights into how educators grow from challenging experiences to build resilience. This study explores how coaches evolve as educators through supporting struggling students. METHODS This qualitative study grounded in an interpretivist paradigm used interviews of longitudinal medical student coaches at two academic institutions. Interviews, using TLT as a sensitizing concept, explored coaches' experience coaching struggling learners. We performed thematic analysis. RESULTS We interviewed 15 coaches. Coaches described supporting students through multi-faceted struggles which often surprised the coach. Three themes characterized coaches' experiences: personal responsibility, emotional response, and personal learning. Coaches shouldered high personal responsibility for learners' success. For some, this burden felt emotional, raised parental instincts and questions about maintaining boundaries with learners. Coaches evolved their coaching approach, challenged biases, and built skills. Coaches learned to better appreciate the learner point of view and employ resources to support students. DISCUSSION Through navigating learner struggles, educators can gain self-efficacy, learn to understand learners' perspectives, and evolve their coaching approach to lessen their personal emotional burden through time.
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Affiliation(s)
- Martha J Elster
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Andrew S Parsons
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Sally Collins
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | | | - Karen E Hauer
- University of California San Francisco School of Medicine, San Francisco, California, USA
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Thomas JK, Arnold MA, Woodend KR, Riccioni MJ, Rissmiller BJ. Establishing excellence: Implementation of an onboarding and continuing education curriculum for pediatric intensive care unit nurse practitioners and physician associates. J Am Assoc Nurse Pract 2024; 36:233-240. [PMID: 38011632 DOI: 10.1097/jxx.0000000000000965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 11/29/2023]
Abstract
ABSTRACT This study describes a novel curriculum for onboarding and clinical education for nurse practitioners and physician associates (NPs and PAs) in the pediatric intensive care unit setting. The objective was to provide details on the initial orientation and continuing education program to ensure the attainment of knowledge and skills needed to care for critically ill patients safely and effectively. A needs assessment was completed, and a knowledge gap identified in five themes: (1) in-depth knowledge on common critical care diagnoses; (2) understanding of pathophysiology; (3) disease management processes; (4) critical thinking; and (5) procedure competency. Using Kern 6-step curriculum and the Kirkpatrick evaluation model, we designed a program for orientation and continuing education for critical care NPs and PAs. Transformative learning theory provided the framework for the program because the cyclical steps of disorienting dilemma, critical reflection, discourse, and action were used repeatedly to transform a new graduate to a competent critical care provider and then into an expert who is able to, in turn, teach others. A total of 31 NPs and 5 PAs completed the 12-week orientation phase. Participants reported that the orientation phase was valuable to their educational advancement and increased critical care knowledge. All participants showed improvement in knowledge, skills, and ability to provide competent patient care.
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Affiliation(s)
- Jenilea K Thomas
- Division of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
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Middleton R, Lewer K, Antoniou C, Pratt H, Bowdler S, Jans C, Rolls K. Understanding the processes, practices and influences of calibration on feedback literacy in higher education marking: A qualitative study. NURSE EDUCATION TODAY 2024; 135:106106. [PMID: 38335909 DOI: 10.1016/j.nedt.2024.106106] [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: 10/11/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND In the University setting, striving for consistency and reliability of assessment evaluation is essential to reducing the impact of marking variations. Marking processes such as consensus calibration have the potential to reduce issues which arise from the influence of markers professional knowledge and experience, as well as fixed and acquired marking habits. Furthermore, the influence of marker feedback which supports learning development is associated with the feedback literacy of both the teacher and the student. A gap is currently present in the literature as these practices are not discussed together. OBJECTIVES To explore how nursing academics perceive and understand calibration practices and associated feedback literacy. DESIGN Theoretical underpinnings in participatory and person-centred research methodology supported the critical ontological perspective of this study where the intent of the research was to explore the reality that exists within the context where the research was conducted. SETTING A single School of Nursing in an Australian University with six campuses spanning metropolitan, regional and rural sites. PARTICIPANTS Nursing academics and casual tutors with various levels of experience in assessment marking and feedback. METHODS Semi-structured group interviews that were analysed using reflexive thematic analysis. RESULTS Four overarching themes were identified; rubrics, calibration, feedback and justice. CONCLUSION Calibration improves staff cohesion, fosters better practices and consistency, and permits nuanced interpretation of assessments while maintaining uniformity. Enhanced feedback literacy that integrates principles of equity, justice, and learner-centeredness is required. Fundamentally calibration guides educators toward holistic approaches that foster consistency, equity, and thorough feedback practices.
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Affiliation(s)
| | - Kelly Lewer
- School of Nursing, Faculty of Science, Medicine & Health, Australia.
| | | | - Helen Pratt
- School of Nursing, Faculty of Science, Medicine & Health, Australia.
| | - Suzanne Bowdler
- School of Nursing, Faculty of Science, Medicine & Health, Australia.
| | - Carley Jans
- School of Nursing, Faculty of Science, Medicine & Health, Australia.
| | - Kaye Rolls
- School of Nursing, Faculty of Science, Medicine & Health, Australia.
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12
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Sherwood G. Transforming education: Developing a practice-ready workforce. Int J Nurs Sci 2024; 11:159-161. [PMID: 38707683 PMCID: PMC11064571 DOI: 10.1016/j.ijnss.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 05/07/2024] Open
Affiliation(s)
- Gwen Sherwood
- University of North Carolina at Chapel Hill, School of Nursing, 2900 Arthurs Lane, Lenoir, NC, 28645, USA
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van Schalkwyk S, Blitz J. Curriculum renewal towards critically conscious graduates: Implications for faculty development. MEDICAL EDUCATION 2024; 58:299-307. [PMID: 37699795 DOI: 10.1111/medu.15216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/24/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Globally, faculty development initiatives in support of health professions (HP) educators continue to extend their remit. This work becomes more critical as HP curriculum renewal activities are influenced by needing to move beyond a biomedical focus attending to issues such as social accountability, social justice and health equity. This raises questions about how best to support our HP educators who may need to change their teaching practice as they embrace these more complex, social constructs. METHODS The research question for this qualitative study was: What implications are there for faculty development that can support HP educators as they are expected to incorporate the principles of critical consciousness and social accountability into their teaching as part of a curriculum renewal process? Data from 11 focus group discussions and 11 subsequent individual interviews with HP educators from two undergraduate programmes were thematically analysed after which further analysis focussed on the implications of these findings for faculty development. Transformative learning theory and models about change provided a sensitising framework. RESULTS Our findings pointed to an expanded role for HP educators and consequently also for those responsible for faculty development. Three main ideas were highlighted: Curriculum renewal catalyses a renewed need for faculty development, the nature of faculty development that can enable change and new foci for faculty development. CONCLUSIONS Faculty development can make a significant contribution to enabling change, including in the context of curriculum renewal that often extends the roles and responsibilities of HP educators. When renewal seeks to shift fundamental curriculum principles, providing support to embrace this expanded remit results in an equally expanded remit for faculty developers-one that calls for initiatives that enable critical, dialogic encounters that might foster critical consciousness, leading to change in HP education. This challenges us, as faculty developers, to turn the mirror on ourselves to consider the nature of such expanded support.
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Affiliation(s)
- Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Paloniemi E, Hagnäs M, Mikkola I, Timonen M, Vatjus R. Reflective capacity and context of reflections: qualitative study of second-year medical students' learning diaries related to a general practice course. BMC MEDICAL EDUCATION 2024; 24:222. [PMID: 38429724 PMCID: PMC10908101 DOI: 10.1186/s12909-024-05199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Reflective capacity is a prerequisite for transformative learning. It is regarded as an essential skill in professional competence in the field of medicine. Our aim was to investigate the reflective capacity and the objects of action (themes) which revealed reflective writing of medical students during a general practice/family medicine course. METHODS Second-year medical students were requested to write learning diaries during a compulsory course in general practice/family medicine consisting of the principles of the physician-patient relationship. The course included a group session supervised by a clinical lecturer and a 3-day training period in a local health centre. We conducted data-driven content analysis of the learning diaries. In the learning diaries, student observations were most commonly directed to events during the training period and to group sessions. Occasionally, observation was directed at inner experience. RESULTS The following themes were related to reflective writing: feelings towards the end of life, demanding situations in practice, physician's attitude to patient, student's inner experiences, and physician's well-being. The entries indicated different types of reflective capacity. Three subgroups were identified: 'simple reporting,' 'reflective writing,' and 'advanced reflective writing.' CONCLUSION Professional growth requires the development of reflective capacity, as it is essential for successful patient care and better clinical outcomes. To develop and enhance the reflective capacity of medical students during their education, the curriculum should provide frequent opportunities for students to assess and reflect upon their various learning experiences.
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Affiliation(s)
- Elina Paloniemi
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland
| | - Maria Hagnäs
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland
| | - Ilona Mikkola
- Research Unit of Population Health, University of Oulu, Oulu, Finland.
- Rovaniemi Health Center, The Wellbeing Services County of Lapland, Rovaniemi, Finland.
| | - Markku Timonen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Ritva Vatjus
- Research Unit of Population Health, University of Oulu, Oulu, Finland
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15
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Bürkin BM, Czabanowska K, Babich S, Casamitjana N, Vicente-Crespo M, De Souza LE, Ehrenberg JP, Hoffmann A, Kamath R, Matthiä A, Okumu F, Rutebemberwa E, Waser M, Kuenzli N, Bohlius J. Competencies for Transformational Leadership in Public Health-An International Delphi Consensus Study. Int J Public Health 2024; 69:1606267. [PMID: 38481704 PMCID: PMC10935731 DOI: 10.3389/ijph.2024.1606267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/19/2024] [Indexed: 03/17/2024] Open
Abstract
Objectives: This Delphi study intended to develop competencies for transformational leadership in public health, including behavioral descriptions (descriptors) tailored to individuals and their contexts. Methods: The study involved five rounds, including online "e-Delphi" consultations and real-time online workshops with experts from diverse sectors. Relevant competencies were identified through a literature review, and experts rated, ranked, rephrased, and proposed descriptors. The study followed the Guidance on Conducting and REporting DElphi Studies (CREDES) and the COmpeteNcy FramEwoRk Development in Health Professions (CONFERD-HP) reporting guidelines. Results: Our framework comprises ten competencies for transformational public health leadership (each with its descriptors) within four categories, and also describes a four-stage model for developing relevant competencies tailored to different contexts. Conclusion: Educators responsible for curriculum design, particularly those aiming to align curricula with local goals, making leadership education context-specific and -sensitive, may benefit from the proposed framework. Additionally, it can help strengthen links between education and workforce sectors, address competency gaps, and potentially reduce the out-migration of graduates in the health professions.
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Affiliation(s)
- Barbara Maria Bürkin
- Department Education and Training, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Katarzyna Czabanowska
- Department of International Health, Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Health Policy Management, Institute of Public Health, Medical College, Jagiellonian University, Krakow, Poland
| | - Suzanne Babich
- Department of International Health, Institute of Care and Public Health Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, Indiana University at Indianapolis, Indianapolis, United States
| | - Núria Casamitjana
- ISGlobal, Hospital Clinic—Universitat de Barcelona, Barcelona, Spain
| | - Marta Vicente-Crespo
- Research and Related Capacity Strengthening Division, African Population and Health Research Center, Nairobi, Kenya
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - John P. Ehrenberg
- Arboretum Frutales Mayas Non-Governmental Organization Cholul, Mérida, Colima, Mexico
| | - Axel Hoffmann
- Department Education and Training, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Rajesh Kamath
- Department of Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Anja Matthiä
- Department Education and Training, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Fredros Okumu
- Department of Environmental Health and Ecological Sciences, Ifakara Health Institute, Ifakara, Tanzania
| | - Elizeus Rutebemberwa
- African Field Epidemiology Network (AFENET), Kampala, Uganda
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Marco Waser
- Department Education and Training, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Nino Kuenzli
- Department Education and Training, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Julia Bohlius
- Department Education and Training, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Rothpletz-Puglia P, Smith J, Pavuk C, Leotta J, Pike K, Presley CJ, Krok-Schoen J, Braun A, Cohen MK, Rogers GT, Kwan HKC, Zhang FF, Spees C. How a Medically Tailored Meal Intervention with Intensive Nutrition Counseling Created Active Coping with Behavior Change for Vulnerable Patients with Lung Cancer. RESEARCH SQUARE 2024:rs.3.rs-3915333. [PMID: 38352464 PMCID: PMC10862975 DOI: 10.21203/rs.3.rs-3915333/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Purpose The purpose of this study was to assess participants' perceptions and experiences while participating in a Food is Medicine medically tailored meal plus nutrition counseling intervention to create a theoretical explanation about how the intervention worked. Methods This interpretive qualitative study included the use of semi-structured interviews with active intervention participants. Purposeful sampling included vulnerable (uninsured, rural zip code residency, racial/ethnic minority, 65 years old, and/or low-income) individuals with lung cancer treated at four cancer centers across the United States. Interviews were recorded, transcribed verbatim, and analyzed using conventional content analysis with principles of grounded theory. Results Twenty individuals participated. Data analysis resulted in a theoretical explanation of the intervention's mechanism of action. The explanatory process includes 3 linked and propositional categories leading to patient resilience: engaging in treatment, adjusting to diagnosis, and active coping. The medically tailored meals plus intensive nutrition counseling engaged participants throughout treatment, which helped participants adjust to their diagnosis, leading to active coping through intentional self-care, behavior change, and improved quality of life. Conclusions These findings provide evidence that a food is medicine intervention may buffer some of the adversity related to the diagnosis of lung cancer and create a pathway for participants to experience post-traumatic growth, develop resilience, and change behaviors to actively cope with lung cancer. Medically tailored meals plus intensive nutrition counseling informed by motivational interviewing supported individuals' adjustment to their diagnosis and resulted in perceived positive behavior change.
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17
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Nolan HA, Roberts L. Trigger warnings as tools for learning-theorising an evolving cultural concept. MEDICAL EDUCATION 2024; 58:185-195. [PMID: 37528527 DOI: 10.1111/medu.15172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/20/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND While definitions of trigger warnings vary, it is generally accepted that they caution about potential reactions arising from exposure to distressing material. Controversy surrounds use of warnings in education, with concerns noted regarding impacts on academic freedom, "coddling", thereby undermining resilience, reinforcement of traumatised identity and enablement of avoidance. Proponents of warnings position them as accommodations for those affected by trauma, enhancing inclusion, and suggest warnings empower choice and enable informed engagement in learning. A recent meta-analysis of warnings' efficacy demonstrated no effect on affective responses or comprehension. Findings regarding avoidance suggested warnings may increase engagement with material. Synthesis of heterogeneous results relating to context of warning application necessitates cautious interpretation of findings. Furthermore, controlled experimental designs do not reflect complex ecologies of social learning environments. METHODS Evidence relating to warnings in healthcare professions education remains limited. We undertake a narrative review and synthesis of evidence regarding the role and functions of trigger warnings from a range of disciplines, to inform healthcare education practice. We apply this evidence in considering how warnings may act within a range of theoretical frameworks for healthcare professionals educations including andragogy, self-directed learning and, ultimately, transformative learning. Tensions between exposure to emotionally stimulating learning episodes and the necessity of emotion for learning while simultaneously attending to learners' needs and fulfilling educators' responsibilities are explored. We probe gaps and contentions in existing theoretical frameworks for learning, and consider implications of recognised limitations with reference to warnings. We summarise by proposing a conceptual model for the role of warnings that considers wider salient factors for fostering effective learning. DISCUSSION AND CONCLUSIONS Difficulties associated with deriving contextually-relevant evidence and conclusions relating to warnings as an evolving cultural concept are highlighted. We propose warnings as tools to enable critical reflection and emotional literacy, to curate effective learning environments and support humanistic healthcare professional identity formation, within wider trauma-informed pedagogies and educator practice.
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18
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Hill Weller L, Rubinsky AD, Shade SB, Liu F, Cheng I, Lopez G, Robertson A, Smith J, Dang K, Leiva C, Rubin S, Martinez SM, Bibbins-Domingo K, Morris MD. Lessons learned from implementing a diversity, equity, and inclusion curriculum for health research professionals at a large academic research institution. J Clin Transl Sci 2024; 8:e22. [PMID: 38384906 PMCID: PMC10879992 DOI: 10.1017/cts.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 02/23/2024] Open
Abstract
Objective Despite advances in incorporating diversity and structural competency into medical education curriculum, there is limited curriculum for public health research professionals. We developed and implemented a four-part diversity, equity, and inclusion (DEI) training series tailored for academic health research professionals to increase foundational knowledge of core diversity concepts and improve skills. Methods We analyzed close- and open-ended attendee survey data to evaluate within- and between-session changes in DEI knowledge and perceived skills. Results Over the four sessions, workshop attendance ranged from 45 to 82 attendees from our 250-person academic department and represented a mix of staff (64%), faculty (25%), and trainees (11%). Most identified as female (74%), 28% as a member of an underrepresented racial and ethnic minority (URM) group, and 17% as LGBTQI. During all four sessions, attendees increased their level of DEI knowledge, and within sessions two through four, attendees' perception of DEI skills increased. We observed increased situational DEI awareness as higher proportions of attendees noted disparities in mentoring and opportunities for advancement/promotion. An increase in a perceived lack of DEI in the workplace as a problem was observed; but only statistically significant among URM attendees. Discussion Developing applied curricula yielded measurable improvements in knowledge and skills for a diverse health research department of faculty, staff, and students. Nesting this training within a more extensive program of departmental activities to improve climate and address systematic exclusion likely contributed to the series' success. Additional research is underway to understand the series' longer-term impact on applying skills for behavior change.
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Affiliation(s)
- LaMisha Hill Weller
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA
- Office of Diversity and Outreach, University of California, San Francisco, CA, USA
| | - Anna D. Rubinsky
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Starley B. Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Felix Liu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Georgina Lopez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Asha Robertson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Jennifer Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kristina Dang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Christian Leiva
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Susan Rubin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Suzanna M. Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Meghan D. Morris
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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McDonald J, Hu W, Heeneman S. Struggles and Joys: A Mixed Methods Study of the Artefacts and Reflections in Medical Student Portfolios. PERSPECTIVES ON MEDICAL EDUCATION 2024; 3:1-11. [PMID: 38188594 PMCID: PMC10768569 DOI: 10.5334/pme.1029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
Introduction Portfolios scaffold reflection on experience so students can plan their learning. To elicit reflection, the learning experiences documented in portfolios must be meaningful. To understand what experiences first- and second-year medical students find meaningful, we studied the patterns in the artefacts chosen for portfolios and their associated written reflections. Methods This explanatory mixed methods study of a longitudinal dataset of 835 artefacts from 37 medical student' portfolios, identified patterns in artefact types over time. Mixed model logistic regression analysis identified time, student and curriculum factors associated with inclusion of the most common types of artefacts. Thematic analysis of participants' reflections about their artefacts provided insight into their choices. Interpretation of the integrated findings was informed by Transformative Learning (TL) theory. Results Artefact choices changed over time, influenced by curriculum changes and personal factors. In first year, the most common types of artefacts were Problem Based Learning mechanism diagrams and group photos representing classwork; in second year written assignments and 'selfies' representing social and clinical activities. Themes in the written reflections were Landmarks and Progress, Struggles and Strategies, Connection and Collaboration, and Joyful Memories for Balance. Coursework artefacts and photographic self-portraits represented all levels of transformative learning from across the curriculum. Conclusions Medical students chose artefacts to represent challenging and/or landmark experiences, balanced by experiences that were joyful or fostered peer connection. Novelty influenced choice. To maximise learning students should draw from all experiences, to promote supported reflection with an advisor. Tasks should be timed to coincide with the introduction of new challenges.
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Affiliation(s)
- Jenny McDonald
- Translational Health Research Institute, School of Medicine, Western Sydney University, South Penrith, Australia
- School of Health Profession Education, Maastricht University, the Netherlands
| | - Wendy Hu
- Translational Health Research Institute, School of Medicine, Western Sydney University, South Penrith, Australia
| | - Sylvia Heeneman
- School of Health Profession Education, Maastricht University, the Netherlands
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20
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Ruhweza Katahoire A, Allison J, Vicente-Crespo M, Fonn S. Transformed through the CARTA experience: changes reported by CARTA fellows about their PhD journey. Glob Health Action 2023; 16:2272392. [PMID: 37942510 PMCID: PMC10653687 DOI: 10.1080/16549716.2023.2272392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/13/2023] [Indexed: 11/10/2023] Open
Abstract
Transformative learning occurs when a person, group, or larger social unit encounters ideas that are at odds with their prevailing perspective. This discrepant perspective can lead to an examination of previously held beliefs, values, and assumptions. The Consortium for Advanced Research Training in Africa (CARTA) has since 2011 been training and supporting faculty from different African universities, to become more reflective and productive researchers, research leaders, educators, and change agents who will drive institutional changes in their institutions. As part of a mid-term evaluation of CARTA, an open-ended question was posed to the CARTA fellows asking them to describe any changes they had experienced in their professional lives as a result of the CARTA Programme. The 135 responses were inductively coded and analysed using qualitative thematic analysis. These themes were subsequently mapped onto Hoggan's typology of transformative learning outcomes. CARTA fellows reported shifts in their sense of self; worldviews; beliefs about the definition of knowledge, how it is constructed and evaluated; and changes in behaviour/practices and capacities. This paper argues that the changes described by the CARTA fellows reflect transformative learning that is embedded in CARTA's Theory of Change. The reported transformation was enabled by a curriculum intentionally designed to facilitate critical reflection, further exploration, and questioning, both formally and informally during the fellows' PhD journey with the support of CARTA facilitators. Documenting and disseminating these lessons provide a guide for future practice, and educators wishing to revitalise their PhD training may find it useful to review the CARTA PhD curriculum.
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Affiliation(s)
| | - Jill Allison
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada
| | - Marta Vicente-Crespo
- African Population and Health Research Center, Nairobi, Kenya
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Sharon Fonn
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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21
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Ray S, Mudokwenyu-Rawdon C, Bonduelle M, Iliff G, Maposhere C, Mataure P, Jacobs C, Van Schalkwyk SC. Hearing the voices of midwives through reflective writing journals: Qualitative research on an educational intervention for Respectful Maternity Care in Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002008. [PMID: 38134000 PMCID: PMC10745140 DOI: 10.1371/journal.pgph.0002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/19/2023] [Indexed: 12/24/2023]
Abstract
Women attending public and private sector health facilities in Africa have reported abuse and neglect during childbirth, which carries a risk of poor health outcomes. We explored from the midwives' perspective the influence of an educational intervention in changing the attitudes, behaviour and practices of a group of midwives in Zimbabwe, using transformative learning theory as the conceptual framework. The twelve-week educational intervention motivating for Respectful Maternity Care consisted of a two-day workshop and five follow-up sessions every two weeks. Thematic analysis was conducted on eighteen reflective journals written by the midwives with member-checking during follow-up discussions and a further one-day participative workshop a year later. The midwives reported being more women-centred, with involvement of birth companions and use of different labour positions, stronger professional pride and agency, collaborative decision-making and less hierarchical relationships which persisted over the year. Their journal narratives included examples of treating birthing women with more compassion. Some categories aligned with the phases of transformative learning theory (self-examination of prior experience, building of competence and self-confidence into new roles and relationships). Others related to improving communications and effective teamwork, providing role-models of good behaviour, use of scientific knowledge to inform practice and demonstrating competence in management of complex cases. This study shows that innovative educational initiatives have the potential to change the way midwives work together, even in challenging physical environments, leading to a shared vision for the quality of service they want to provide, to improve health outcomes and to develop life-long learning skills.
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Affiliation(s)
- Sunanda Ray
- Department of Community Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Myriam Bonduelle
- Swansea Bay University Health Board, Swansea, Wales, United Kingdom
| | - Ginny Iliff
- Private obstetric practice, Harare, Zimbabwe
| | | | - Priscilla Mataure
- Department of Family and Health Sciences, Women’s University in Africa, Harare, Zimbabwe
| | - Cecilia Jacobs
- Faculty of Medicine and Health Sciences, Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
| | - Susan C. Van Schalkwyk
- Faculty of Medicine and Health Sciences, Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
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van Zyl M, Archer E. Shifting perspectives: Unveiling the transformative potential of home visits to persons living with disability in rural settings for medical students. MEDICAL TEACHER 2023:1-7. [PMID: 38104586 DOI: 10.1080/0142159x.2023.2292981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE This study aims to examine the transformative learning experiences of medical students participating in home visits to persons living with disabilities in rural areas of South Africa, in order to explore the potential of such experiences to shape their beliefs about their professional development and clinical practice. METHODS Qualitative data was collected from the students through written reflections and semi-structured interviews. The data were analyzed thematically using a phenomenological approach guided by Mezirow's theory of transformative learning. RESULTS The findings reveal a three-stage process of transformative learning for the students. Firstly, students held predominantly negative views towards the learning activity, prior to the home visits. Secondly the role of critical reflection facilitated a change in students' perspectives. Finally, there was a change in perspective towards a predominantly positive valuing of the activity to their learning and approach to clinical practice. DISCUSSION This study highlights the significance of incorporating home visits and structured critical reflection into undergraduate medical curricula. It underscores the need for further research in this area and contributes to the understanding of transformative learning in healthcare education. The findings emphasize the potential of community-based activities to shape inclusive practices and foster holistic patient care.
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Affiliation(s)
- Maria van Zyl
- Centre for Health Professions Education, Stellenbosch University, Western Cape, South Africa
- Division for Disability and Rehabilitation Studies, Stellenbosch University, Western Cape, South Africa
| | - Elize Archer
- Centre for Health Professions Education, Stellenbosch University, Western Cape, South Africa
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Vipler BS, Sawatsky AP. When I say… transformative learning. MEDICAL EDUCATION 2023; 57:1184-1186. [PMID: 37584372 DOI: 10.1111/medu.15189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/07/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023]
Abstract
Transformation = change. Learning = change. So what do @VipsMDMEd & @APSawatskyMD mean when they say #TransformativeLearning?
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Affiliation(s)
- Benjamin S Vipler
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Er AT, Sng LH. Overcoming ageism: Ensuring quality geriatric care during radiology examinations. J Med Imaging Radiat Sci 2023; 54:S32-S37. [PMID: 37741709 DOI: 10.1016/j.jmir.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/19/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Amanda Tw Er
- Department of Radiology, Changi General Hospital, Singapore; Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, VIC 3800, Australia.
| | - Li Hoon Sng
- Department of Radiology, Sengkang General Hospital, Singapore; Health and Social Sciences, Singapore Institute of Technology (SIT), Singapore
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Carlsson Y, Bergman S, Nilsdotter A, Liljedahl M. The medical internship as a meaningful transition: A phenomenographic study. MEDICAL EDUCATION 2023; 57:1230-1238. [PMID: 37283081 DOI: 10.1111/medu.15146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The transition from student to doctor is often depicted as a struggle in the literature, and previous research has focused on interventions to minimise difficulties in transitioning from undergraduate to postgraduate training. In considering this transition as a potential transformative experience, we intend to produce new insights into how junior doctors experience the transition to clinical work. The aim of this study was to explore medical interns' conceptualisations of the transition from student to doctor through studying the Swedish medical internship, which serves as a bridge between undergraduate and postgraduate studies. The research question was formulated as follows: How do medical interns perceive the meaning of the medical internship? METHODS The data were collected through in-depth interviews with 12 senior medical interns in western Sweden. The transcribed interviews were analysed using a phenomenographic approach, which resulted in four qualitatively varying ways of perceiving the meaning of the internship, organised hierarchically in a phenomenographic outcome space. RESULTS The interns perceived the meaning of the internship as an opportunity to work and learn in an authentic setting (internship as in-service training) and in a protected environment (internship as a space). The internship guaranteed a minimum level of competence (internship as a quality marker) and allowed the interns to gain new insights into themselves and their world (internship as an eye-opener). DISCUSSION Being allowed to be learners in a protected space seemed pivotal for the interns to develop into competent, confident and independent practitioners. The medical internship studied here could be viewed as a meaningful transition into new ways of experiencing, allowing for an increased understanding of oneself and the world. This study adds to the scientific literature on what constitutes a transformative transition.
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Affiliation(s)
- Yvonne Carlsson
- General Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Bergman
- General Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Nilsdotter
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Matilda Liljedahl
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Hill Weller L, Tang J, Chen R, Boscardin C, Ehie O. Tools for Addressing Microaggressions: An Interactive Workshop for Perioperative Trainees. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11360. [PMID: 38034501 PMCID: PMC10682127 DOI: 10.15766/mep_2374-8265.11360] [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: 04/02/2023] [Accepted: 08/24/2023] [Indexed: 12/02/2023]
Abstract
Introduction Graduate trainees from diverse backgrounds may experience discrimination, mistreatment, and microaggressions. While the ability to identify and respond to microaggressions is a much-needed skill for all emerging trainees, limited training workshops exist for residents, especially within perioperative medicine. To embody the principles of diversity, equity, inclusion, and anti-racism (DEIA), we aimed to empower trainees in the perioperative environment with several strategies for addressing microaggressions to bridge this training gap. Methods Based on critical race theory, transformative learning, minority stress theory, and the structural theory of gender and power, this workshop was developed with the primary aim of educating trainees on microaggressions, amplifying the role of allyship, and providing tools to respond to microaggressions as an ally. We used a mixed methods approach to examine participants' pre/post self-evaluations of microaggression intervention tools and the overall effectiveness of the workshop. Results The postsurvey captured the experiences of 54 trainees, including 37 of 44 (84%) first-year clinical anesthesia residents and 14 of 24 (58%) surgery residents. The facilitator and course feedback was remarkably positive. Paired t test analyses on participants' pre- and postsurvey responses demonstrated a statistically significant increase in knowledge of microaggressions. This workshop also significantly increased learners' self-reported tools for responding to microaggressions. Discussion Overall, these promising findings suggest that the strategies presented in this workshop could be applied across other graduate medical education programs. Institutions may wish to customize workshop elements, such as the case scenarios, and the workshop can also be incorporated within a DEIA curriculum.
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Affiliation(s)
- LaMisha Hill Weller
- Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, School of Medicine
| | - Janette Tang
- Fourth-Year Medical Student, University of California, San Francisco, School of Medicine
| | - Rebecca Chen
- Fourth-Year Medical Student, University of California, San Francisco, School of Medicine
| | - Christy Boscardin
- Professor, Departments of Medicine and Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine
| | - Odinakachukwu Ehie
- Associate Clinical Professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine
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Smyth Zahra F, Pearson J, Piper K. The ' Clinical Humanities & Wellbeing programme'- sustainable healthcare education for an era of uncertainty. Int Rev Psychiatry 2023; 35:636-644. [PMID: 38461386 DOI: 10.1080/09540261.2023.2262026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 03/11/2024]
Abstract
This article presents a case study where integration of arts and humanities into a clinical programme is being implemented at scale, as core mandatory learning for all students within a UK dental, undergraduate context. The cross-disciplinary programme described, that integrates the Humanities with Clinical Sciences, is a longitudinal professional identity formation curriculum for sustainable oral healthcare which aligns with the UK dental regulator's proposals for a 'safe practitioner' framework for new graduates. The Clinical Humanities & Wellbeing modules embrace the emotional and attitudinal aspects of learning and educate clinical students for the practical wisdom (phronesis) required to deliver 21st century oral healthcare in an era of uncertainty. The overarching aim of the curriculum and its accompanying assessment is to promote critical reflection, student insight and development of integrity, reflexivity, and responsibility. Enabling the subjectification of professional identity formation in this cross-disciplinary way aims to develop students as 'safe practitioners', with increased professional autonomy, responsible for their own actions, and who are better equipped for the uncertainties and phronesis of clinical practice. At present, the programme is being evaluated, employing illuminative evaluation methodology and we present some tentative initial findings. The authors believe that this unique approach and signature pedagogy is, with careful curation, transferrable to other health professions' contexts.
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Affiliation(s)
- Flora Smyth Zahra
- Centre for Dental Education, Faculty of Dentistry Oral & Craniofacial Sciences, King's College London, London
| | | | - Kim Piper
- Centre for Dental Education, Faculty of Dentistry Oral & Craniofacial Sciences, King's College London, London
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Perez S, Schwartz A, Hauer KE, Karani R, Hirshfield LE, McNamara M, Henry D, Lupton KL, Woods M, Teherani A. Developing Evidence for Equitable Assessment Characteristics Based on Clinical Learner Preferences Using Discrete Choice Experiments. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S108-S115. [PMID: 37983403 DOI: 10.1097/acm.0000000000005360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Medical education is only beginning to explore the factors that contribute to equitable assessment in clinical settings. Increasing knowledge about equitable assessment ensures a quality medical education experience that produces an excellent, diverse physician workforce equipped to address the health care disparities facing patients and communities. Through the lens of the Anti-Deficit Achievement framework, the authors aimed to obtain evidence for a model for equitable assessment in clinical training. METHOD A discrete choice experiment approach was used which included an instrument with 6 attributes each at 2 levels to reveal learner preferences for the inclusion of each attribute in equitable assessment. Self-identified underrepresented in medicine (UIM) and not underrepresented in medicine (non-UIM) (N = 306) fourth-year medical students and senior residents in medicine, pediatrics, and surgery at 9 institutions across the United States completed the instrument. A mixed-effects logit model was used to determine attributes learners valued most. RESULTS Participants valued the inclusion of all assessment attributes provided except for peer comparison. The most valued attribute of an equitable assessment was how learner identity, background, and trajectory were appreciated by clinical supervisors. The next most valued attributes were assessment of growth, supervisor bias training, narrative assessments, and assessment of learner's patient care, with participants willing to trade off any of the attributes to get several others. There were no significant differences in value placed on assessment attributes between UIM and non-UIM learners. Residents valued clinical supervisors valuing learner identity, background, and trajectory and clinical supervisor bias training more so than medical students. CONCLUSIONS This study offers support for the components of an antideficit-focused model for equity in assessment and informs efforts to promote UIM learner success and guide equity, diversity, and inclusion initiatives in medical education.
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Affiliation(s)
- Sandra Perez
- S. Perez is a resident, Department of Pathology, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Alan Schwartz
- A. Schwartz is the Michael Reese Endowed Professor of Medical Education, Department of Medical Education, and research professor, Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, and director, Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network (APPD LEARN), McLean, Virginia; ORCID: http://orcid.org/0000-0003-3809-6637
| | - Karen E Hauer
- K.E. Hauer is professor, Department of Medicine, and associate dean for competency assessment and professional standards, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0002-8812-4045
| | - Reena Karani
- R. Karani is professor, Departments of Medicine, Medical Education, and Geriatrics and Palliative Medicine, and director, Institute for Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laura E Hirshfield
- L.E. Hirshfield is the Dr. Georges Bordage Medical Education Faculty Scholar, associate professor, PhD program codirector, and associate director of graduate studies, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-0894-2994
| | - Margaret McNamara
- M. McNamara is professor, Department of Pediatrics, and pediatric residency program director, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Duncan Henry
- D. Henry is associate professor, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Katherine L Lupton
- K.L. Lupton is professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Majka Woods
- M. Woods holds the Dibrell Family Professorship in the Art of Medicine, and is assistant professor, Department of Surgery, and vice dean for academic affairs, John Sealy School of Medicine at the University of Texas Medical Branch, Galveston, Texas
| | - Arianne Teherani
- A. Teherani is professor, Department of Medicine, education scientist, Center for Faculty Educators, director of program evaluation and education continuous quality improvement, and founding codirector, University of California Center for Climate Health and Equity, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2936-9832
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Berglund L, von Knorring J, McGrath A. When theory meets reality- a mismatch in communication: a qualitative study of clinical transition from communication skills training to the surgical ward. BMC MEDICAL EDUCATION 2023; 23:728. [PMID: 37794444 PMCID: PMC10552412 DOI: 10.1186/s12909-023-04633-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Communication skills training in patient centered communication is an integral part of the medical undergraduate education and has been shown to improve various components of communication. While the effects of different educational interventions have been investigated, little is known about the transfer from theoretical settings to clinical practice in the context of communication skills courses not integrated in the clinical curriculum. Most studies focus on single factors affecting transfer without considering the comprehensive perspective of the students themselves. The aim of this study is to explore how the students experience the transition to clinical practice and what they perceive as challenges in using patient centered communication. METHODS Fifteen 4th year medical students were interviewed 3 weeks after the transition from an advanced communication skills course to surgical internship using semi-structured interviews. Qualitative content analysis was used to analyze the interviews. RESULTS The analysis resulted in a theme 'When theory meets reality- a mismatch in communication'. It was comprised of four categories that encompassed the transfer process, from theoretical education, practical communication training and surgical internship to students' wishes and perceived needs. CONCLUSIONS We concluded that preparing the students through theoretical and practical training should reflect the reality they will face when entering clinical practice. When educating medical students as a group, their proclivity for perfectionism, high performance environment and achievement-related stress should be taken into consideration. The role of tutors being role models, offering guidance, giving feedback and providing support plays a major part in facilitating transfer of communication skills. To enable transfer to a larger extent, the environment needs to promote patient centeredness and students need more opportunities to practice communication with their patients.
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Affiliation(s)
- Leif Berglund
- Department of Clinical Sciences, Umeå- University, Umeå, Sweden
| | | | - Aleksandra McGrath
- Department of Clinical Sciences, Umeå- University, Umeå, Sweden.
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.
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Hansen A, Engel-Hills P, Jacobs C, Blitz J, Cooke R, Hess-April L, Leisegang K, Naidoo N, Volschenk M, van Schalkwyk S. Understandings and practices: Towards socially responsive curricula for the health professions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1131-1149. [PMID: 36732399 PMCID: PMC9894667 DOI: 10.1007/s10459-023-10207-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/03/2023] [Indexed: 05/21/2023]
Abstract
Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.
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Affiliation(s)
- Anthea Hansen
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Penelope Engel-Hills
- Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Cecilia Jacobs
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Cooke
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Hess-April
- Department of Occupational Therapy, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Niri Naidoo
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mariette Volschenk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Diaz BA, Rieker J, Ng S. Teaching critical reflection in health professions education with transformative-vygotskian praxis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1191-1204. [PMID: 36890283 DOI: 10.1007/s10459-023-10209-y] [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: 11/17/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
Reflective practice is a complex concept to adequately describe, communicate about and, ultimately, teach. Unrelieved tensions about the concept persist within the health professions education (HPE) literature owing to reflection's diverse theoretical history. Tensions extend from the most basic, e.g., what is reflection and what are its contents, to the complex, e.g., how is reflection performed and whether it should be evaluated. Nonetheless, reflection is generally seen as vital to HPE, because it imparts crucial strategies and awareness to learners in their professional practices. In this article, we explore both conceptual and pedagogical dimensions of teaching for reflection. We address the concept of reflection, its application to practice, and how to remain faithful to transformative, critical pedagogy when teaching for it. We present (a) an analysis of two theories of education in HPE: Transformative Learning and Vygotskian Cultural Historical Theory. We (b) outline a pedagogical approach that applies Piotr Gal'perin's SCOBA: schema for the complete orienting basis of an action. We then employ (a) and (b) to provide affordances for developing materials for educational interventions across HPE contexts.
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Affiliation(s)
- Brett A Diaz
- Centre for Faculty Development, Li Ka Shing International Healthcare, Education Centre, St. Michael's Hospital, 209 Victoria Street, 4th floor, Toronto, ON, Canada.
- The Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada.
| | - Jacob Rieker
- Department of Applied Linguistics, The Pennsylvania State University, University Park, USA
| | - Stella Ng
- The Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for Advancing Collaborative Healthcare & Education at University Health Network, Toronto Western Hospital, Toronto, ON, Canada
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
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Sumpter D, Thurman W, Wright M, Johnson K, Duplechain D, Abbyad C. ART Praxis: Evidence-Based Strategies for Antiracist Teaching in Nursing. Nurs Educ Perspect 2023; 44:273-278. [PMID: 37594418 DOI: 10.1097/01.nep.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
AIM This integrative review seeks to provide effective teaching and learning strategies for teaching about racism and advancing health equity. BACKGROUND Most faculty preparation remains devoid of an exploration of racism and the skills to critique how historical events and socialization create and reinforce the biases that influence how we teach and provide care. It is difficult to teach what we do not know. METHOD Using Whittmore and Knafl's approach, we conducted an integrative review of multidisciplinary literature from 2009 to 2021 to uncover best practices for teaching about racism. Seven databases yielded 55 relevant articles from 18 disciplines. RESULTS Four themes emerged illuminating effective strategies for teaching and learning about systemic racism: encounter education, reflection, discussion, and activism. CONCLUSION Findings of this review align with Mezirow's transformative learning theory and highlight the importance of not just "doing" antiracist activities in a course but "becoming" an antiracist educator.
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Affiliation(s)
- Danica Sumpter
- About the Authors The authors are faculty at the University of Texas at Austin School of Nursing, Austin, Texas. Danica Sumpter, PhD, RN, CNE, is a clinical associate professor. Whitney Thurman, PhD, RN, is an assistant professor. Michelle Wright, PhD, RN, FAAN, is an assistant professor. Karen Johnson, PhD, RN, FSAHM, FAAN, is an associate professor. Danielle Duplechain, MSN, RN, is a graduate research assistant. Chris Abbyad, PhD, RN, WHNP, is a clinical associate professor. This research was support by a Josiah Macy Jr. Award to Dr. Sumpter. For more information, contact Dr. Sumpter at
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Hutcheson NR, Carter B, Cowden J, Turner B. Implicit Racial Bias Attitudes and Mitigation in Neonatal Nurse Practitioners: A Quality Improvement Project. Neonatal Netw 2023; 42:192-201. [PMID: 37491036 DOI: 10.1891/nn-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE to assess the impact of education using the implicit bias recognition and management (IBRM) teaching approach. DESIGN longitudinal quasi-experimental design. Surveys at baseline, immediate postimplementation, and 4-week postimplementation using the modified version of the Attitudes Toward Implicit Bias Instrument (ATIBI). The 4-week survey included items about implicit bias recognition and mitigation strategies. SAMPLE thirty-six neonatal nurse practitioners assigned to the NICU in a Midwest urban children's hospital. RESULTS one-way repeated-measures analysis of variance was used, and the score range was 16-96. The results showed a statistically significant model, F (1.49, 707.97) = 34.46, p <.001, partial η2 = 0.496. Pairwise comparisons showed improvement from pre (M = 73.08, SD = 9.36) to immediate postimplementation (M = 80.06, SD = 8.19), p <.001. Scores were sustained at 4-week postimplementation (M = 79.28, SD = 10.39), p = .744. CONCLUSIONS The IBRM teaching approach improved scores from baseline on a modified ATIBI that remained improved 4 weeks after the education.
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Gonzalez CM, Onumah CM, Walker SA, Karp E, Schwartz R, Lypson ML. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:541-587. [PMID: 36534295 DOI: 10.1007/s10459-022-10168-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
One criticism of published curricula addressing implicit bias is that few achieve skill development in implicit bias recognition and management (IBRM). To inform the development of skills-based curricula addressing IBRM, we conducted a scoping review of the literature inquiring, "What interventions exist focused on IBRM in professions related to social determinants of health: education, law, social work, and the health professions inclusive of nursing, allied health professions, and medicine?"Authors searched eight databases for articles published from 2000 to 2020. Included studies: (1) described interventions related to implicit bias; and (2) addressed knowledge, attitude and/or skills as outcomes. Excluded were interventions solely focused on reducing/neutralizing implicit bias. Article review for inclusion and data charting occurred independently and in duplicate. Investigators compared characteristics across studies; data charting focused on educational and assessment strategies. Fifty-one full-text articles for data charting and synthesis, with more than 6568 learners, were selected. Educational strategies included provocative/engagement triggers, the Implicit Association Test, reflection and discussion, and various active learning strategies. Most assessments were self-report, with fewer objective measures. Eighteen funded studies utilized federal, foundation, institutional, and private sources. This review adds to the literature by providing tangible examples of curricula to complement existing frameworks, and identifying opportunities for further research in innovative skills-based instruction, learner assessment, and development and validation of outcome metrics. Continued research addressing IBRM would enable learners to develop and practice skills to recognize and manage their implicit biases during clinical encounters, thereby advancing the goal of improved, equitable patient outcomes.
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Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
| | - Chavon M Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sydney A Walker
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elisa Karp
- Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA
| | | | - Monica L Lypson
- Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Bürkin BM, Venticich PM, Adongo PB, De Almeida-Filho N, Magaña L, Middleton J, Souza LE, Czabanowska K. Revolutionizing the Public Health Workforce—A Policy Brief in Retrospect of the World Congress on Public Health Rome 2020. Public Health Rev 2023; 44:1604807. [PMID: 37077509 PMCID: PMC10106605 DOI: 10.3389/phrs.2023.1604807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/02/2023] [Indexed: 04/05/2023] Open
Abstract
Background: The COVID-19 pandemic dramatically illustrates the consequences of inadequate prioritization of the Public Health Workforce (PHW). This Policy Brief introduces a Call for Action following the plenary session entitled “Revolutionising the Public Health Workforce (PHW) as Agents of Change” as part of the 2020 World Congress on Public Health.Policy Options and Recommendations: In order to revolutionize the PHW, five long-term key approaches are proposed: 1. Transforming public health competencies through transdisciplinary education and inter-professional training; 2. Revolutionizing educational systems by shifting the public health paradigm; 3. Linking public health education and work opportunities; 4. Overcoming the paradoxical shortage and overproduction of graduates and 5. Developing adaptable, multisectoral agents of change.Conclusion: Public health education of the future requires a paradigm shift towards a holistic understanding of public health, characterized by transdisciplinary education, inter-professional training and a closer integration of academia, health services, and communities.
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Affiliation(s)
- Barbara Maria Bürkin
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- *Correspondence: Barbara Maria Bürkin,
| | - Pete Milos Venticich
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Philip Baba Adongo
- Department of Social and Behavioural Science, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Laura Magaña
- Association of Schools and Programs of Public Health (ASPPH), Washington, DC, United States
| | - John Middleton
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Luis Eugenio Souza
- Federal University of Southern Bahia, Salvador, Brazil
- World Federation of Public Health Associations (WFPHA), Geneva, Switzerland
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Health Policy Management, Institute of Public Health, Medical College, Jagiellonian University, Krakow, Poland
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Nawagi F, Raman A. The importance of in-country African instructors in International experiential training programs; a qualitative case study from the university of Minnesota. BMC MEDICAL EDUCATION 2023; 23:145. [PMID: 36869302 PMCID: PMC9985212 DOI: 10.1186/s12909-023-04129-z] [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: 05/10/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND For effective delivery of international experiential training programs, many universities in the global north, have created partnerships with universities in the global south especially in Africa to enhance their capacity and diversity of learning for their students. However, there is hardly any literature that exhibits the importance of African instructors in international experiential learning programs. This study aimed at establishing the importance of African instructors in international experiential learning programs. METHODS This was a qualitative case study that examined the importance of instructors and experts from Africa in influencing student learning processes and outcomes in the GCC 3003/5003 - Seeking Solutions to Global Health Issues. Semi-structured interviews with (2) students, (2) University of Minnesota lead faculty for the course, and (3) in-country instructors/experts from countries in East Africa and the Horn of Africa were conducted. Data was analyzed thematically. RESULTS Four themes were identified: (1) Filling gaps in knowledge, (2) Orchestrating partnerships for practical exposure, (3) Improving the quality of training, and (4) orchestrating professional personal growth for students. The African in-country course instructors/experts contributed to student learning by providing a true picture reflection of happenings on the ground. CONCLUSION The importance of in-country African instructors' can be viewed as that aimed at validating students' ideas to apply to the local settings, streamlining students' focus, providing a platform for multi-stakeholder engagement to a particular topic, coupled with bringing an in-country context experience in the classroom.
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Affiliation(s)
- Faith Nawagi
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
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Nawagi F, Iacone A, Seeling J, Mukherjee S. Developing an African medical and health professions student regional elective exchange program: approaches and lessons learned. MEDEDPUBLISH 2023. [DOI: 10.12688/mep.19095.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
Background: Given the significant gap in International Medical Elective (IME) opportunities for African health professions students, the Educational Commission for Foreign Medical Graduates and the Foundation for Advancement of International Medical Education and Research (ECFMG|FAIMER) launched an African regional elective exchange program through the Global Educational Exchange in Medicine and the Health Professions (GEMx) in 2016. This paper provides an overview of the development of the GEMx program, the pillars of implementation, and lessons learned. Methods: The authors conducted a longitudinal qualitative study utilizing in-depth interviews with institutional leaders, program leaders, and faculty, participant observation through symposia, strategic planning meetings, staff meetings, and document review of the annual progress reports, strategic plans, and newsletter articles, abstracts, and concept notes. Common categories were identified and incorporated into a matrix to create themes. Data were analyzed using the manifest content approach guided by a literature review. Results: The key pillars for implementation of the GEMx Africa regional elective exchange program included: the commitment from African training institutional networks and their member institutions that enabled electives to be offered, the GEMx Charter (multilateral agreement) that enabled reciprocity and diversity of elective opportunities, GEMx web-based application system that enabled the centralization of the application process and real-time feedback on acceptance, GEMx Africa Regional Coordination Center in Kampala, Uganda that lead the development and implementation in Africa, and ECFMG mini-grants that helped defray elective costs. Conclusions: Through the development of multilateral partnerships across the continent, the GEMx regional elective exchange program contributed towards bridging a long-existing gap of inadequate opportunities for African health professions students to enhance their global exposure and strengthen their knowledge and skills. .
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Evans W, Lisiecka D, Farrell D. Exploring the impact educational interventions have on nursing and medical students' attitudes and empathy levels towards people with disability. A systematic review. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2023:17446295231155781. [PMID: 36798039 DOI: 10.1177/17446295231155781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This systematic review aimed to explore the impact educational interventions have on undergraduate nursing and medical students' attitudes and empathy levels towards people with disability. There are over one billion people with some form of disability currently. A growing body of research reveals that nurses and doctors display negative attitudes including decreased empathy towards people with disability. A systematic review using narrative synthesis of chosen randomized controlled trials was employed. A comprehensive search was completed in June 2021 on six databases (CINAHL, Medline, Science Direct, Health Research Premium - PROQUEST, Scopus. Cochrane Library). The search strategy yielded 21,616 studies and only three randomised controlled trials fulfilled the eligibility criteria. These trials included 125 participants (n = 50 medical students and n = 75 nursing students) and evaluated the effectiveness of a disabled health course, disability education module with bedside teaching and wheelchair workshop intervention. Findings from one study revealed that a disabled health course using affective learning method based on a transformative learning theory significantly improves attitudes to disability amongst nursing students however there was no statistically significant difference in empathy levels. More high-quality randomised controlled trials with greater theoretical and methodological complexity are needed to identify more effective educational approaches that enhance attitude and empathy levels of these key stakeholders.
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Affiliation(s)
- William Evans
- 8813Department of Nursing and Healthcare Sciences, School of Health and Social Sciences, Munster Technology University Tralee, Ireland
| | | | - Dawn Farrell
- 8813Munster Technology University Kerry, Tralee, Ireland
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Greville H, House W, Tarrant S, Thompson SC. Addressing Complex Social Problems Using the Lens of Family Violence: Valuable Learning from the First Year of an Interdisciplinary Community of Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3501. [PMID: 36834195 PMCID: PMC9967701 DOI: 10.3390/ijerph20043501] [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: 01/13/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
It is imperative that universities continue to explore innovations that support staff and student learning and pursue their mission to promote social responsibility and community service. Communities of Practice have been used to facilitate innovation and regenerate teaching and learning in tertiary contexts, including interdisciplinary collaborations around complex problems. This study describes the challenges and achievements of the first year of an interdisciplinary Community of Practice which aimed to create innovative approaches to teaching and learning about family and domestic violence, a complex social issue, inherently gendered, which receives little attention across the University discipline areas, despite the centrality of this issue in much of the future work of University graduates within a range of professional areas. We interviewed engaged members to explore the value gained from their first year of involvement in the Community of Practice. This initiative brought members substantial value while recognising the need for long-term engagement and commitment from the senior University leadership to embed innovation. A key lesson was that developing an innovative curriculum to address critical and ongoing social and public health issues requires much more senior leadership, responsibilities shared across faculty, and commitment of dedicated resources and staff time. The findings provide valuable learning for other Communities of Practice attempting to engage with complex problems and create innovative interdisciplinary approaches to teaching, learning, and research.
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Affiliation(s)
- Heath Greville
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
| | - William House
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
| | - Stella Tarrant
- Law School, University of Western Australia, Perth, WA 6009, Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6530, Australia
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Ulfsdottir H, Johnson K, Rubertsson C, Ekelin M, Edqvist M. A complex and demanding situation - Midwifery preceptors and midwifery students' experiences of teaching and learning prevention of severe perineal trauma. Women Birth 2023; 36:e118-e124. [PMID: 35568665 DOI: 10.1016/j.wombi.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/06/2022] [Accepted: 05/06/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described. AIM To describe midwifery preceptors and midwifery students' experiences' of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma. METHODS A qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis. RESULTS "A complex and demanding situation with mutual need for feedback, reflection and safety" was the overall theme describing the conditions. Three sub-themes were identified. "Adapting to a unique situation" refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. "Hindering and limiting circumstances" describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. "A trustful and communicative relationship" describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part. CONCLUSION An increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors' confidence in teaching.
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Affiliation(s)
- H Ulfsdottir
- Department of Women's Health and Health professions Karolinska University Hospital, Stockholm, Sweden
| | - K Johnson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - C Rubertsson
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - M Ekelin
- Department of Health Sciences, Faculty of Medicine, Lund University, Sweden
| | - M Edqvist
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Ventres WB. Deeper Teaching: from Theory and Practice to Learner-Centered Medical Education. J Gen Intern Med 2023; 38:213-215. [PMID: 36163532 PMCID: PMC9849626 DOI: 10.1007/s11606-022-07815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/14/2022] [Indexed: 01/22/2023]
Affiliation(s)
- William B Ventres
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Dalton LM, Hills AP, Jayasinghe S, Strong K, Hyland P, Byrne NM. The Allied Health Expansion Program: Rethinking how to prepare a workforce to enable improved public health outcomes. Front Public Health 2023; 11:1119726. [PMID: 36875373 PMCID: PMC9982750 DOI: 10.3389/fpubh.2023.1119726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Improvements in global public health require universal health care supported by a health workforce with competencies appropriate for local population needs-the right capabilities, in the right place, and at the right time. Health inequities persist in Tasmania, and Australia more broadly, most notably for those people living in rural and remote areas. The article describes the curriculum design thinking approach being used to codesign and develop a connected system of education and training to target intergenerational change in the allied health (AH) workforce capacity in Tasmania, and beyond. A curriculum design thinking process is engaging AH participant groups (faculty, AH professionals, and leaders across health, education, aged and disability sectors) in a series of focus groups and workshops. The design process deals with four questions: What is? What if? What wows? and What works? It also involves Discover, Define, Develop and Deliver phases that continue to inform the development of the new suite of AH education programs. The British Design Council's Double Diamond model is used to organize and interpret stakeholder input. During the initial design thinking discover phase, stakeholders identified four overarching problems: rurality, workforce challenges, graduate skill set shortfalls, and clinical placements and supervision. These problems are described in terms of relevance to the contextual learning environment in which AH education innovation is occurring. The develop phase of design thinking continues to involve working collaboratively with stakeholders to codesign potential solutions. Solutions to date include AH advocacy, a transformative visionary curriculum, and an interprofessional community-based education model. In Tasmania, innovative educational innovations are catalyzing attention and investment in the effective preparation of AH professionals for practice to deliver improved public health outcomes. A suite of AH education that is deeply networked and engaged with Tasmanian communities is being developed to drive transformational public health outcomes. These programs are playing an important role in strengthening the supply of allied health professionals with the right capabilities for metropolitan, regional, rural, and remote Tasmania. They are situated in a broader AH education and training strategy that supports the ongoing development of the AH workforce to better meet the therapy needs of people in Tasmanian communities.
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Affiliation(s)
- Lisa M Dalton
- College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Andrew P Hills
- College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Sisitha Jayasinghe
- College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | - Kendra Strong
- Department of Health, Tasmanian Government, Hobart, TAS, Australia
| | - Paula Hyland
- Tasmanian Health Services, Department of Health, Hobart, TAS, Australia
| | - Nuala M Byrne
- College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
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Matchett CL, Nordhues HC, Bashir MU, Merry SP, Sawatsky AP. Residents' Reflections on Cost-Conscious Care after International Health Electives: A Single-Center Qualitative Study. J Gen Intern Med 2023; 38:42-48. [PMID: 35411536 PMCID: PMC9849602 DOI: 10.1007/s11606-022-07556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/30/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Estimates suggest 30% of health care expenditures are wasteful. This has led to increased educational interventions in graduate medical education (GME) training aimed to prepare residents for high value, cost-conscious practice. International health electives (IHE) are widely available in GME training and may be provide trainees a unique perspective on principles related to high value, cost-conscious care (HVCCC). OBJECTIVE The purpose of this study was to explore how trainee reflections on IHE experiences offer insight into HVCCC. DESIGN The authors conducted an applied thematic analysis of narrative reflective reports of GME trainees' IHE experiences to characterize their perceptions of HVCCC. PARTICIPANTS The Mayo International Health Program (MIHP) supports residents and fellows from all specialties across all Mayo Clinic sites. We included 546 MIHP participants from 2001 to 2020. APPROACH The authors collected post-elective narrative reports from all MIHP participants. Reflections were coded and themes were organized into model for transformative learning during IHEs, focusing on HVCCC. KEY RESULTS GME trainees across 24 different medical specialties participated in IHEs in 73 different countries. Three components of transformative learning were identified: disorienting dilemma, critical reflection, and commitment to behavior change. Within the component of critical reflection, three topics related to HVCCC were identified: cost transparency, resource stewardship, and reduced fear of litigation. Transformation was demonstrated through reflection on future behavioral change, including cost-aware practice, stepwise approach to health care, and greater reliance on clinical skills. CONCLUSIONS IHEs provide rich experiences for transformative learning and reflection on HVCCC. These experiences may help shape trainees' ideology of and commitment to HVCCC practices.
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Affiliation(s)
- Caroline L Matchett
- Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Hannah C Nordhues
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Usmaan Bashir
- Division of General Medicine, Geriatrics and Palliative Care, University of Virginia Health, Charlottesville, VA, USA
| | - Stephen P Merry
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Adam P Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Nash-Patel T, Morrow E, Paliokosta P, Dundas J, O'Donoghue B, Anderson E. Co-design and delivery of a relational learning programme for nursing students and young people with severe and complex learning disabilities. NURSE EDUCATION TODAY 2022; 119:105548. [PMID: 36116386 DOI: 10.1016/j.nedt.2022.105548] [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: 01/05/2022] [Revised: 08/12/2022] [Accepted: 09/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND National Health Service (NHS) staff in the UK are required to undergo training about learning disabilities at the appropriate level for their role. However, this requirement does not apply to nurses in training and student nurses report fear and anxiety about caring for people with intellectual learning disabilities (ILDs). Young people with intellectual disabilities report feeling scared of nurses and parents feel staff do not listen to them or involve them in care. OBJECTIVES (i) For a university and special school for young people with server and complex ILDs to work in partnership to co-design a programme for nursing students, young people, their teachers, and parents. (ii) To deliver the programme online as part of the university's existing nursing courses. DESIGN The partnership between the university and the special school focused on co-design of an interactive programme, parent involvement, safeguarding, and the design of accessible learning resources to support young people with severe and complex ILDs' engagement. The programme was informed by relational inquiry, service user and transformative pedagogies, and parents and teacher's knowledge and views about the young people. Delivery of the programme was designed to fit into existing nursing courses and enable students on placement and young people at home or in hospital to participate. A rights-based ethnographic evaluation was designed to support participant feedback and programme development. SETTING The Heritage2Health Virtual Arts and Drama Programme was piloted with nursing students at one UK university and young people with severe and complex ILDs from one special school, their parents and teachers. PARTICIPANTS 15 nursing students (BSc Year 2 = 10, Year 3 = 3, MSc = 2) and 7 young people with severe and complex learning disabilities (age 11-14 yrs). Other participants were parents/guardians of young people (7), arts/drama facilitators (2), academic lecturers (2), special needs teachers (2), registered nurse (1). METHODS An 8-week dynamic programme of arts and drama. Sessions included 30-min start-up/presencing, 45-min storytelling/drama with young people and parents, 30-min reflection/close. Sessions were facilitated by 2 arts and drama specialists. The story of 'Ubuntu the Lion with the Long, Long, Mane' (by TNP) was used to explore difference and ways of being. The evaluation methods were participant observation, semi-structured interviews (2-6 weeks post) and thematic analysis. RESULTS Participation in the programme was a challenging, creative, and reflective experience that was transformative for all. Nurses and young people's fears and anxieties about each other were revealed and addressed by participating in arts and drama activities together. Nursing students learnt how to adopt a relational orientation to young people and their parents and teachers. CONCLUSIONS A co-designed programme for nursing students and young people with severe and complex ILDs can benefit student knowledge and skills and reduce fears and anxieties between nurses and young people with ILDs. With adequate planning and resources, the programme could be adopted by multidisciplinary partnerships between other universities and special schools.
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Affiliation(s)
- Theresa Nash-Patel
- Kingston University & St George's University of London, Heritage2Health, United Kingdom.
| | | | - Paty Paliokosta
- Inclusive Education and Special Educational Needs, Inclusion and Social Justice Special Interest Group, Kingston University & St George's University of London, United Kingdom.
| | - Jane Dundas
- Kingston University & St George's University of London, Heritage2Health, United Kingdom.
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Kua J, Teo W, Lim WS. Learning experiences of adaptive experts: a reflexive thematic analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1345-1359. [PMID: 36626011 PMCID: PMC9859887 DOI: 10.1007/s10459-022-10166-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/15/2022] [Indexed: 06/17/2023]
Abstract
Whilst adaptive experts have well-researched beliefs and attitudes towards learning, what is unclear are the interactions that occur within the learning environment that constitute their learning experiences. The practice of geriatric medicine emphasises the interdisciplinary care of complex frail older adults. Our study sets out to understand the learning experiences of adaptive experts in geriatric medicine by examining how interactions at the intra-personal, inter-personal and organisational levels contributed to the development of adaptive expertise. We conducted an exploratory qualitative study through semi-structured interviews of 16 geriatricians experts from a tertiary hospital in Singapore. Data were analyzed via reflexive thematic analysis. The core essence of the learning experiences was described as a journey of 'knowing when we do not know', which was characterised by three themes: (i) Anchoring ethos of person-centric care where the experts drew upon their values to develop a holistic view of the patient beyond the medical domain, (ii) Enabling stance of being curious where their curiosity and openness to learning was nurtured through the practice of reflection, and with the benefit of time as a commodity and for development of expertise, and (iii) Scaffolding organisational culture of inquiry where an environment that is supportive of learning is built on the culture of psychological safety and the culture of mentoring. Taken together, our study highlighted the importance of interactions at the intra-personal, inter-personal and organisational levels in the learning experiences of adaptive experts.
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Affiliation(s)
- Joanne Kua
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Winnie Teo
- Group Education, National Healthcare Group, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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Ryan CL, Cant R, McAllister MM, Vanderburg R, Batty C. Transformative learning theory applications in health professional and nursing education: An umbrella review. NURSE EDUCATION TODAY 2022; 119:105604. [PMID: 36265209 DOI: 10.1016/j.nedt.2022.105604] [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: 05/09/2022] [Revised: 09/07/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES This review intended to synthesise existing evidence on the application of transformative learning theory in nursing education. DESIGN An umbrella review, or review of reviews. DATA SOURCES Six databases were systematically searched: CINAHL, Cochrane Reviews, Ebscohost, OVID, ProQuest Central, and PubMed. The structured framework of PCC: Population/Concept/Context was employed to identify relevant literature, published in English between 2012 and March 1st, 2022. REVIEW METHODS Elements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided this review. A modified version of the Johanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Synthesis was applied to determine final inclusions. RESULTS Sixteen (16) reviews were included. Most reviews were scoping reviews. Nursing featured in 10 of the 16, medicine in half (8/16) and various allied health disciplines were reported in seven reviews. Studies reported on differing scholarly approaches to transformative learning theory. Curricula design and evaluation, developing leadership skills and a professional identity were common applications. Critical reflection and learning experiences that challenge students' and professionals' existing ideologies also featured. Few reviews reported on studies of models and tools for educators to guide them in applying the theory in lesson design and teaching practice. CONCLUSION Applying transformative learning theory in curriculum design, program evaluation and healthcare professional education can be beneficial. There were reported successes and some critiques. Researchers should design more rigorous studies to evaluate the theory in practice and to develop and test frameworks that guide educators in teaching with transformative learning theory.
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Affiliation(s)
- Colleen L Ryan
- Nursing, Midwifery and Social Sciences/Higher Education, CQUniversity Australia, 160 Ann St, Brisbane, QLD 4001, Australia.
| | - Robyn Cant
- Health Innovation and Transformation Centre, Federation University Australia, Clyde Road, Berwick, Victoria 3806, Australia.
| | - Margaret M McAllister
- Nursing, Midwifery and Social Sciences/Higher Education, CQUniversity Australia, Building A.1, 90 Goodchap St, Noosaville, Qld 4566, Australia.
| | - Robert Vanderburg
- School of Education and the Arts, CQUniversity Australia, Building 5/G.30, University Drive, Bundaberg, QLD 4670, Australia.
| | - Craig Batty
- UniSA Creative, University of South Australia, City West Campus (Kaurna Building - K3-23), GPO Box 2471, Adelaide, SA 5001, Australia.
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Kelly M, Lynch J, Mainstone P, Green A, Sturman N. 'Things we are expected to just do and deal with': Using the medical humanities to encourage reflection on vulnerability and nurture clinical skills, collegiality, compassion, and self-care. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:300-304. [PMID: 35960444 PMCID: PMC9582175 DOI: 10.1007/s40037-022-00724-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
The Vulnerability in Medicine (ViM) program was developed to provide protected time and psychologically safe spaces for third-year medical students to consider challenges in the doctor-patient relationship and the clinical workplace. A suite of discussion-prompts presented in a small-group learning environment provides a springboard for students to reflect on their development as clinicians, understand the personhood of their patients, explore the therapeutic relationship, and consider emotional responses and personal, cultural, and social assumptions that impact on care. The program supports students to recognise vulnerability in themselves, the patient, their tutors, and the wider clinical team, as they face the challenge of aligning the clinician they want to become with ideals of professionalism and the imperfect clinical workplace. This 6‑week program focuses on the vulnerability of patients, students, and doctors in a weekly tutorial interposed with clinical placements primarily in geriatric, rehabilitation, or palliative medicine. The tutorials draw from the medical humanities and use experiential, reflective, and narrative learning techniques. They are facilitated by generalist clinicians who model their own vulnerability, humanity, and reflective practice by sharing tutorial tasks equally with students. Students report feeling supported, and appreciate the opportunity to discuss ethical, psychosocial, and emotional aspects of medicine whilst reflecting on what medical practice means to them. Tutors experience a deeper appreciation of student journeys and their own vocations as clinicians and teachers. The sharing of vulnerability exposes the humanity of patients, students, and clinicians, and sustains our whole-person approach to the care of patients, students, and ourselves.
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Affiliation(s)
- Michaela Kelly
- General Practice Clinical Unit, The University of Queensland, Brisbane, Australia.
| | - Johanna Lynch
- General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Penny Mainstone
- General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Alison Green
- General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Nancy Sturman
- General Practice Clinical Unit, The University of Queensland, Brisbane, Australia
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Lingard L, Colquhoun H. The story behind the synthesis: writing an effective introduction to your scoping review. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:289-294. [PMID: 35960445 PMCID: PMC9582165 DOI: 10.1007/s40037-022-00719-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Lorelei Lingard
- Centre for Education Research & Innovation, and Department of Medicine, Schulich School of Medicine & Dentistry and Faculty of Education, Western University, London, Canada.
| | - Heather Colquhoun
- Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
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Vipler B, Snyder B, McCall-Hosenfeld J, Haidet P, Peyrot M, Stuckey H. Transformative learning of medical trainees during the COVID-19 pandemic: A mixed methods study. PLoS One 2022; 17:e0274683. [PMID: 36112640 PMCID: PMC9481004 DOI: 10.1371/journal.pone.0274683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had a transformative effect on individuals across the world, including those in healthcare. Transformative learning is an educational theory in which an individual’s worldview is fundamentally altered through conscious reflection (Cognitive Rational), insights (Extrarational), or social reform (Social Critique). We utilized transformative learning theory to characterize the experiences of medical trainees during the pandemic. Methods We used the Transformative Learning Survey in September and October 2020 to evaluate the processes and outcomes of transformative learning in health professions students and housestaff at an academic medical center during the pandemic. We analyzed survey scores for three process domains and four outcome subdomains. We inductively coded the survey’s two open-ended questions and performed qualitative and mixed-methods analyses. Results The most prominent TL outcome was Self-Awareness, Acting Differently was intermediate, and Openness and Worldview Shifts were lowest. Cognitive Rational and Social Critique processes were more prominent than Extrarational processes. Students were more likely than housestaff to undergo transformative learning through the Social Critique process (p = 0.025), in particular the sub-processes of Social Action (p = 0.023) and Ideology Critique (p = 0.010). Qualitative analysis via the aggregation of codes identified four responses to the pandemic: negative change, positive change, existential change, or no change. Negative changes (67.7%) were most common, with students reporting more of these changes than housestaff (74.8% vs 53.6%; p < 0.01). Only 8.4% of reported changes could be defined as transformative Conclusions Through the theoretical lens of transformative learning, our study provides insight into the lives of learners during the pandemic. Our finding that medical students were more likely to use Social Critique processes has multiple parallels in the literature. If leaders in academic medicine desire to create enlightened change agents through transformative learning, such education must continue throughout graduate medical education and beyond.
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Affiliation(s)
- Benjamin Vipler
- Division of Hospital Medicine, University of Colorado Hospital, Aurora, CO, United States of America
- Division of General Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, United States of America
- * E-mail:
| | - Bethany Snyder
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, PA, United States of America
| | - Jennifer McCall-Hosenfeld
- Division of General Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
| | - Paul Haidet
- Division of General Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America
- Department of Humanities, Penn State College of Medicine, Hershey, PA, United States of America
| | - Mark Peyrot
- Department of Sociology, Loyola University Maryland, Baltimore, MD, United States of America
| | - Heather Stuckey
- Division of General Internal Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, PA, United States of America
- Qualitative and Mixed Methods Core, Penn State College of Medicine, Hershey, PA, United States of America
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Pimentel J, López P, Cockcroft A, Andersson N. The most significant change for Colombian medical trainees going transformative learning on cultural safety: qualitative results from a randomised controlled trial. BMC MEDICAL EDUCATION 2022; 22:670. [PMID: 36088369 PMCID: PMC9463722 DOI: 10.1186/s12909-022-03711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cultural safety training is not yet standard in Colombian medical education. If incorporated, it could address currently adversarial interactions between health professionals and the 40% of people who use traditional medicine practices. In 2019, a randomised controlled trial tested the impact of cultural safety training for medical students using participatory serious game design. The quantitative evaluation showed improved cultural safety intentions of Colombian medical trainees. We report here a qualitative evaluation of the most significant change perceived by trial participants. METHODS This qualitative descriptive study used the most significant change technique. We invited the trial participants engaged in clinical settings to describe stories of change in their supervised clinical practice that they attributed to the intervention. Using a deductive thematic analysis based on a modified theory of planned behaviour, two independent reviewers coded the stories and, by consensus, created themes and sub-themes. RESULTS From 27 stories of change, we identified seven themes and 15 subthemes: (a) Conscious knowledge: benefits of cultural safety training, consequences of culturally unsafe behaviour, cultural diversity and cultural practices; (b) Attitudes: respect and appreciation for cultural diversity, openness, and self-awareness; (c) Subjective norms: positive perception of cultural practices and less ethnocentrism; (d) Intention to Change; (e) Agency to accept cultural diversity and to prevent culturally unsafe actions; (f) Discussion; and (g) Action: better communication and relationship with patients and peers, improved outcomes for patients, physicians, and society, investigation about cultural health practices, and efforts to integrate modern medicine and cultural health practices. CONCLUSION The narratives illustrated the transformative impact of cultural safety training on a results chain from conscious knowledge through to action. Our results encourage medical educators to report other cultural safety training experiences, ideally using patient-related outcomes or direct observation of medical trainees in clinical practice. TRIAL REGISTRATION Registered on ISRCTN registry on 18/07/2019. REGISTRATION NUMBER ISRCTN14261595.
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Affiliation(s)
- Juan Pimentel
- CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges 3rd Floor, Suite 300, Montreal, QC H3S 1Z1 Canada
- Facultad de Medicina, Universidad de La Sabana, Campus Universitario puente del común, CP 250001 Chía, Colombia
| | - Paola López
- Facultad de Medicina, Universidad de La Sabana, Campus Universitario puente del común, CP 250001 Chía, Colombia
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges 3rd Floor, Suite 300, Montreal, QC H3S 1Z1 Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Calle Pino S/N Colonia El Roble, 39640 Acapulco, Guerrero Mexico
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges 3rd Floor, Suite 300, Montreal, QC H3S 1Z1 Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Calle Pino S/N Colonia El Roble, 39640 Acapulco, Guerrero Mexico
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