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O'Toole M, Doyle A, Collins N, Sullivan C, Mulhall C, Condron C, Doherty E, Eppich W. 'They mirror what they see': A constructivist grounded theory study of simulation culture in four professional domains in Ireland. MEDICAL TEACHER 2024:1-8. [PMID: 38340311 DOI: 10.1080/0142159x.2024.2311863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE In simulation-based education (SBE), educators integrate their professional experiences to prepare learners for real world practice and may embed unproductive stereotypical biases. Although learning culture influences educational practices, the interactions between professional culture and SBE remain less clear. This study explores how professional learning culture informs simulation practices in healthcare, law, teacher training and paramedicine. METHODS Using constructivist grounded theory, we interviewed 19 educators about their experiences in designing and delivering simulation-based communication training. Data collection and analysis occurred iteratively via constant comparison, memo-writing and reflexive analytical discussions to identify themes and explore their relationships. RESULTS Varied conceptualizations and enactments of SBE contributed to distinct professional learning cultures. We identified a unique 'simulation culture' in each profession, which reflected a hyper-real representation of professional practice shaped by three interrelated elements: purpose and rationale for SBE, professional values and beliefs, and educational customs and techniques. Dynamic simulation cultures created tensions that may help or hinder learning for later interprofessional practice. CONCLUSION The concept of simulation culture enhances our understanding of SBE. Simulation educators must be mindful of their uni-professional learning culture and its impacts. Sharing knowledge about simulation practices across professional boundaries may enhance interprofessional education and learners' professional practice.
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Affiliation(s)
- Michelle O'Toole
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrea Doyle
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Naoise Collins
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Visual and Human Computing, Dundalk Institute of Technology, Dundalk, Ireland
| | - Clare Sullivan
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Mulhall
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eva Doherty
- Department of Surgical Affairs, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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DeCloux K, Hoy G, Grum C, Kwakye G, Schiller J, Heidelbaugh J, Holman E, Monrad SU. Assessing Correlations Between Competency Ratings and Assessment-Specific Global Rating Scores Across Seven Core Clinical Clerkships at the University of Michigan Medical School. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S198-S199. [PMID: 37983444 DOI: 10.1097/acm.0000000000005342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Korynne DeCloux
- Author affiliations: K. DeCloux, Yale School of Medicine; G. Hoy, C. Grum, G. Kwakye, J. Schiller, J. Heidelbaugh, E. Holman, S.U. Monrad, University of Michigan Medical School
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Bearman M, Ajjawi R, Castanelli D, Denniston C, Molloy E, Ward N, Watling C. Meaning making about performance: A comparison of two specialty feedback cultures. MEDICAL EDUCATION 2023; 57:1010-1019. [PMID: 37142553 DOI: 10.1111/medu.15118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Specialty trainees often struggle to understand how well they are performing, and feedback is commonly seen as a solution to this problem. However, medical education tends to approach feedback as acontextual rather than located in a specialty-specific cultural world. This study therefore compares how specialty trainees in surgery and intensive care medicine (ICM) make meaning about the quality of their performance and the role of feedback conversations in this process. METHODS We conducted a qualitative interview study in the constructivist grounded theory tradition. We interviewed 17 trainees from across Australia in 2020, eight from ICM and nine from surgery, and iterated between data collection and analytic discussions. We employed open, focused, axial and theoretical coding. FINDINGS There were significant divergences between specialties. Surgical trainees had more opportunity to work directly with supervisors, and there was a strong link between patient outcome and quality of care, with a focus on performance information about operative skills. ICM was a highly uncertain practice environment, where patient outcome could not be relied upon as a source of performance information; valued performance information was diffuse and included tacit emotional support. These different 'specialty feedback cultures' strongly influenced how trainees orchestrated opportunities for feedback, made meaning of their performance in their day-to-day patient care tasks and 'patched together' experiences and inputs into an evolving sense of overall progress. DISCUSSION We identified two types of meaning-making about performance: first, trainees' understanding of an immediate performance in a patient-care task and, second, a 'patched together' sense of overall progress from incomplete performance information. This study suggests approaches to feedback should attend to both, but also take account of the cultural worlds of specialty practice, with their attendant complexities. In particular, feedback conversations could better acknowledge the variable quality of performance information and specialty specific levels of uncertainty.
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Affiliation(s)
- Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
| | - Damian Castanelli
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Anaesthesia and Perioperative Medicine, Monash Health, Clayton, Victoria, Australia
| | - Charlotte Denniston
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Elizabeth Molloy
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Natalie Ward
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Australia
| | - Chris Watling
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Ajjawi R, Bearman M, Molloy E, Noble C. The role of feedback in supporting trainees who underperform in clinical environments. Front Med (Lausanne) 2023; 10:1121602. [PMID: 37181376 PMCID: PMC10167016 DOI: 10.3389/fmed.2023.1121602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/03/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction Underperformance in clinical environments can be costly and emotional for all stakeholders. Feedback is an important pedagogical strategy for working with underperformance - both formal and informal strategies can make a difference. Feedback is a typical feature of remediation programs, and yet there is little consensus on how feedback should unfold in the context of underperformance. Methods This narrative review synthesises literature at the intersections of feedback and underperformance in clinical environments where service, learning and safety need to be considered. We do so with a critical eye towards generating insights for working with underperformance in the clinical environment. Synthesis and discussion There are compounding and multi-level factors that contribute to underperformance and subsequent failure. This complexity overwrites simplistic notions of 'earned' failure through individual traits and deficit. Working with such complexity requires feedback that goes beyond educator input or 'telling'. When we shift beyond feedback as input to process, we recognise that these processes are fundamentally relational, where trust and safety are necessary for trainees to share their weaknesses and doubts. Emotions are always present and they signal action. Feedback literacy might help us consider how to engage trainees with feedback so that they take an active (autonomous) role in developing their evaluative judgements. Finally, feedback cultures can be influential and take effort to shift if at all. A key mechanism running through all these considerations of feedback is enabling internal motivation, and creating conditions for trainees to feel relatedness, competence and autonomy. Broadening our perceptions of feedback, beyond telling, might help create environments for learning to flourish.
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Affiliation(s)
- Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, VIC, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, VIC, Australia
| | - Elizabeth Molloy
- Department of Medical Education, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Christy Noble
- Academy for Medical Education, Medical School, The University of Queensland, Herston, QLD, Australia
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Zhao X, Zheng Y, Zhao X. Global bibliometric analysis of conceptual metaphor research over the recent two decades. Front Psychol 2023; 14:1042121. [PMID: 36844282 PMCID: PMC9951592 DOI: 10.3389/fpsyg.2023.1042121] [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: 09/12/2022] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Abstract
Conceptual Metaphor has been a prevalent theme in the linguistic field for the recent twenty years. Numerous scholars worldwide have shown interest in it and published many academic papers from various stances on this topic. However, so far, there have been few rigorous scientific mapping investigations. With the help of bibliometric analysis tool, we selected 1,257 articles on Conceptual Metaphors published from 2002 to 2022, as collected in the Web of Sciences Core Collection database, from unique cognitive perspectives. The global annual scientific output of Conceptual Metaphor, including the cited articles, sources, keywords, and research trends, will be examined in this study. The most notable findings of this study are the following. First, there has been an upward trend in Conceptual Metaphor research over the last two decades. Second, the five most prominent research groups on Conceptual Metaphors are in Spain, the United States of America, China, Great Britain, and Russia. Third, future research on Conceptual Metaphors may focus on corpus linguistics, neurolinguistics, psychology, and critical discourse analysis. The interdisciplinary study may enhance the growth of Conceptual Metaphors.
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Affiliation(s)
- Xia Zhao
- School of Foreign Languages, Jiangsu University of Science and Technology, Zhenjiang, China,*Correspondence: Xia Zhao,
| | - Yi Zheng
- School of Foreign Languages, Jiangsu University of Science and Technology, Zhenjiang, China
| | - Xincheng Zhao
- Center for Applied English Studies, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Jamieson J, Gibson S, Hay M, Palermo C. Teacher, Gatekeeper, or Team Member: supervisor positioning in programmatic assessment. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10193-9. [PMID: 36469231 DOI: 10.1007/s10459-022-10193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Competency-based assessment is undergoing an evolution with the popularisation of programmatic assessment. Fundamental to programmatic assessment are the attributes and buy-in of the people participating in the system. Our previous research revealed unspoken, yet influential, cultural and relationship dynamics that interact with programmatic assessment to influence success. Pulling at this thread, we conducted secondary analysis of focus groups and interviews (n = 44 supervisors) using the critical lens of Positioning Theory to explore how workplace supervisors experienced and perceived their positioning within programmatic assessment. We found that supervisors positioned themselves in two of three ways. First, supervisors universally positioned themselves as a Teacher, describing an inherent duty to educate students. Enactment of this position was dichotomous, with some supervisors ascribing a passive and disempowered position onto students while others empowered students by cultivating an egalitarian teaching relationship. Second, two mutually exclusive positions were described-either Gatekeeper or Team Member. Supervisors positioning themselves as Gatekeepers had a duty to protect the community and were vigilant to the detection of inadequate student performance. Programmatic assessment challenged this positioning by reorientating supervisor rights and duties which diminished their perceived authority and led to frustration and resistance. In contrast, Team Members enacted a right to make a valuable contribution to programmatic assessment and felt liberated from the burden of assessment, enabling them to assent power shifts towards students and the university. Identifying supervisor positions revealed how programmatic assessment challenged traditional structures and ideologies, impeding success, and provides insights into supporting supervisors in programmatic assessment.
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Affiliation(s)
- Janica Jamieson
- Monash University, Melbourne, Australia.
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
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Shah AP, Walker KA, Hawick L, Walker KG, Cleland J. Scratching beneath the surface: How organisational culture influences curricular reform. MEDICAL EDUCATION 2022. [PMID: 36458943 DOI: 10.1111/medu.14994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Curricular reform is often proposed as the means to improve medical education and training. However, reform itself may not lead to noticeable change, possibly because the influence of organisational culture on change is given insufficient attention. We used a national reform of early-years surgical training as a natural opportunity to examine the interplay between organisational culture and change in surgical education. Our specific research question was: in what ways did organisational culture influence the implementation of Improving Surgical Training (IST)? METHODS This is a qualitative study underpinned by social constructivism. Interviews were conducted with core surgical trainees (n = 46) and their supervising consultants (n = 25) across Scotland in 2020-2021. Data coding and analysis were initially inductive. The themes indicated the importance of many cultural factors as barriers or enablers to IST implementation. We therefore carried out a deductive, secondary data analysis using Johnson's (1988) cultural web model to identify and examine the different elements of organisational culture and their impact on IST. RESULTS The cultural web enabled a detailed understanding of how organisational culture influenced IST implementation as per Johnson's six elements-Rituals and Routines (e.g. departmental rotas), Stories (e.g. historical training norms and culture), Symbols (e.g. feedback mechanisms, visibility and value placed on education), Power Structures (e.g. who has the power in local contexts), Organisational Structures (e.g. relationships and accountability) and the Control System (e.g. consultant job plans and service targets)-and how these interact. However, it did not shed light on the influence of exogenous events on change. CONCLUSION Our data reveal cultural reasons why this curricular reform met with varying degrees of success across different hospital sites, reinforcing that curricular reform is not simply about putting recommendations into practice. Many different aspects of context must be considered when planning and evaluating change in medical education and training.
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Affiliation(s)
- Adarsh P Shah
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kim A Walker
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Lorraine Hawick
- Centre for Healthcare Education Research and Innovation (CHERI), University of Aberdeen, Aberdeen, UK
| | - Kenneth G Walker
- NHS Education for Scotland, Centre for Health Science, Inverness, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore
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Johnson MW, Gheihman G, Thomas H, Schiff G, Olson APJ, Begin AS. The impact of clinical uncertainty in the graduate medical education (GME) learning environment: A mixed-methods study. MEDICAL TEACHER 2022; 44:1100-1108. [PMID: 35666840 DOI: 10.1080/0142159x.2022.2058383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Uncertainty is ubiquitous in medicine. Studies link intolerance of uncertainty to burnout, ineffective communication, cognitive bias, and inappropriate resource use. Little is known about how uncertainty manifests in the clinical learning environment. We aimed to explore the perceptions and experiences of uncertainty among residents and attendings. METHODS We conducted a mixed-methods study including a survey, semi-structured interviews, and ethnographic observations during rounds with residents and attendings at an academic medical center. The survey included three validated instruments: Physicians' Reaction to Uncertainty Scale; Maslach Burnout Inventory 2-item; and Educational Climate Inventory. RESULTS 35/60 (58%) of eligible residents and 14/21 (67%) attendings completed the survey. Residents reported higher anxiety due to uncertainty than attendings, higher concern about bad outcomes, and greater reluctance to disclose uncertainty to patients. Residents reported increased symptoms of burnout (p < .05). Perceiving the learning environment as more competitive correlated with reluctance to disclose uncertainty (r = -0.44; p < .01). Qualitative themes included: recognizing and facing uncertainty, and consequences for the learning environment. Observations revealed senior clinicians have greater comfort acknowledging uncertainty. CONCLUSIONS Medical curricula should be developed to promote recognition and acknowledgement of uncertainty. Greater acknowledgement of uncertainty, specifically by attendings and senior residents, may positively impact the clinical learning environment.
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Affiliation(s)
- Mark W Johnson
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Galina Gheihman
- Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Horatio Thomas
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Gordon Schiff
- Division of General Internal Medicine, Center for Patient Safety Research and Practice, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School Center for Primary Care, Hospitals and Health Care, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Andrew P J Olson
- Development and Scholarship, Medical Education Outcomes Center, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Arabella Simpkin Begin
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Center for Educational Innovation and Scholarship, Massachusetts General Hospital, Boston, MA, USA
- Internal Medicine Residency at Massachusetts General Hospital, Boston, MA, USA
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Roberts C, Khanna P, Bleasel J, Lane S, Burgess A, Charles K, Howard R, O'Mara D, Haq I, Rutzou T. Student perspectives on programmatic assessment in a large medical programme: A critical realist analysis. MEDICAL EDUCATION 2022; 56:901-914. [PMID: 35393668 PMCID: PMC9542097 DOI: 10.1111/medu.14807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Fundamental challenges exist in researching complex changes of assessment practice from traditional objective-focused 'assessments of learning' towards programmatic 'assessment for learning'. The latter emphasise both the subjective and social in collective judgements of student progress. Our context was a purposively designed programmatic assessment system implemented in the first year of a new graduate entry curriculum. We applied critical realist perspectives to unpack the underlying causes (mechanisms) that explained student experiences of programmatic assessment, to optimise assessment practice for future iterations. METHODS Data came from 14 in-depth focus groups (N = 112/261 students). We applied a critical realist lens drawn from Bhasker's three domains of reality (the actual, empirical and real) and Archer's concept of structure and agency to understand the student experience of programmatic assessment. Analysis involved induction (pattern identification), abduction (theoretical interpretation) and retroduction (causal explanation). RESULTS As a complex educational and social change, the assessment structures and culture systems within programmatic assessment provided conditions (constraints and enablements) and conditioning (acceptance or rejection of new 'non-traditional' assessment processes) for the actions of agents (students) to exercise their learning choices. The emergent underlying mechanism that most influenced students' experience of programmatic assessment was one of balancing the complex relationships between learner agency, assessment structures and the cultural system. CONCLUSIONS Our study adds to debates on programmatic assessment by emphasising how the achievement of balance between learner agency, structure and culture suggests strategies to underpin sustained changes (elaboration) in assessment practice. These include; faculty and student learning development to promote collective reflexivity and agency, optimising assessment structures by enhancing integration of theory with practice, and changing learning culture by both enhancing existing and developing new social structures between faculty and the student body to gain acceptance and trust related to the new norms, beliefs and behaviours in assessing for and of learning.
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Affiliation(s)
- Chris Roberts
- Faculty of Medicine and Health, Sydney Medical School, Education OfficeThe University of SydneySydneyNew South Wales
| | - Priya Khanna
- Faculty of Medicine and Health, Sydney Medical School, Education OfficeThe University of SydneySydneyNew South Wales
| | - Jane Bleasel
- Faculty of Medicine and Health, Sydney Medical School, Education OfficeThe University of SydneySydneyNew South Wales
| | - Stuart Lane
- Faculty of Medicine and Health, Sydney Medical School, Education OfficeThe University of SydneySydneyNew South Wales
| | - Annette Burgess
- Faculty of Medicine and Health, Sydney Medical School, Education OfficeThe University of SydneySydneyNew South Wales
| | - Kellie Charles
- Faculty of Medicine and Health, Sydney Medical School, Education OfficeThe University of SydneySydneyNew South Wales
- Faculty of Medicine and Health, Sydney Pharmacy School, Discipline of PharmacologyThe University of SydneySydneyNew South WalesAustralia
| | - Rosa Howard
- Faculty of Medicine and Health, Sydney Medical School, Education OfficeThe University of SydneySydneyNew South Wales
| | - Deborah O'Mara
- Faculty of Medicine and Health, Sydney Medical School, Education OfficeThe University of SydneySydneyNew South Wales
| | - Inam Haq
- Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Timothy Rutzou
- School of MedicineThe University of Notre DameChippendaleNew South WalesAustralia
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Heisen C, Wychera C, Park H, Lee YM. Tight and loose culture in medical education. KOREAN JOURNAL OF MEDICAL EDUCATION 2022; 34:239-241. [PMID: 36070994 PMCID: PMC9452372 DOI: 10.3946/kjme.2022.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Christine Heisen
- Ludwig-Maximilian University, Faculty of Medicine, Munich,
Germany
| | - Chiara Wychera
- Ludwig-Maximilian University, Faculty of Medicine, Munich,
Germany
| | - Hyunmi Park
- Department of Medical Education, Korea University College of Medicine, Seoul,
Korea
| | - Young-Mee Lee
- Department of Medical Education, Korea University College of Medicine, Seoul,
Korea
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Gordon L, Scanlan GM, Tooman TR, Walker KA, Cairns P, Ferguson J, Aitken G, Cecil J, Cunningham KB, Smith KG, Johnston PW, Laidlaw A, Pope LM, Wakeling J. Heard, valued, supported? Doctors' wellbeing during transitions triggered by COVID-19. MEDICAL EDUCATION 2022; 56:516-526. [PMID: 34796541 PMCID: PMC8662221 DOI: 10.1111/medu.14698] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Supporting doctors' wellbeing is crucial for medical education to help minimise negative long-term impacts on medical workforce retention and ultimately patient care. There is limited study of how doctors' transitions experiences impact wellbeing, particularly socially and culturally. Multiple Multidimensional Transitions (MMT) theory views transitions as dynamic, incorporating multiple contexts and multiple domains. Using MMT as our lens, we report a qualitative analysis of how transitions experienced by doctors during the pandemic impacted on social and cultural aspects of wellbeing. METHODS Longitudinal narrative inquiry was employed, using interviews and audio-diaries. Data were collected over 6 months in three phases: (i) interviews with doctors from across the career spectrum (n = 98); (ii) longitudinal audio-diaries for 2-4 months (n = 71); (iii) second interviews (n = 83). Data were analysed abductively, narrowing focus to factors important to social and cultural wellbeing. RESULTS Doctors described experiencing multiple interacting transitions triggered by the pandemic in multiple contexts (workplace, role, homelife and education). Patterns identifiable across the dataset allowed us to explore social and cultural wellbeing crosscutting beyond individual experience. Three critical factors contributed to social and cultural wellbeing both positively and negatively: being heard (e.g., by colleagues asking how they are); being valued (e.g., removal of rest spaces by organisations showing lack of value); and being supported (e.g., through regular briefing by education bodies). CONCLUSIONS This study is the first to longitudinally explore the multiple-multidimensional transitions experienced by doctors during the COVID-19 pandemic. Our data analysis helped us move beyond existing perceptions around wellbeing and articulate multiple factors that contribute to social and cultural wellbeing. It is vital that medical educators consider the learning from these experiences to help pinpoint what aspects of support might be beneficial to trainee doctors and their trainers. This study forms the basis for developing evidenced-based interventions that ensure doctors are heard, valued and supported.
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Affiliation(s)
- Lisi Gordon
- Centre for Medical EducationUniversity of DundeeDundeeUK
| | | | - Tricia R. Tooman
- Centre for Medical EducationUniversity of DundeeDundeeUK
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | - Kim A. Walker
- Centre for Healthcare Education Research and InnovationUniversity of AberdeenAberdeenUK
| | | | | | | | - Joanne Cecil
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | | | - Kathrine Gibson Smith
- Centre for Healthcare Education Research and InnovationUniversity of AberdeenAberdeenUK
| | - Peter W. Johnston
- Centre for Healthcare Education Research and InnovationUniversity of AberdeenAberdeenUK
- Medical DirectorateNHS Education for ScotlandScotlandUK
| | - Anita Laidlaw
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | | | - Judy Wakeling
- Medical DirectorateNHS Education for ScotlandScotlandUK
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Castanelli DJ, Weller JM, Molloy E, Bearman M. How Trainees Come to Trust Supervisors in Workplace-Based Assessment: A Grounded Theory Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:704-710. [PMID: 34732657 PMCID: PMC9028297 DOI: 10.1097/acm.0000000000004501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE In competency-based medical education, workplace-based assessment provides trainees with an opportunity for guidance and supervisors the opportunity to judge the trainees' clinical practice. Learning from assessment is enhanced when trainees reveal their thinking and are open to critique, which requires trust in the assessor. If supervisors knew more about how trainees come to trust them in workplace-based assessment, they could better engender trainee trust and improve trainees' learning experience. METHOD From August 2018 to September 2019, semistructured interviews were conducted with 17 postgraduate anesthesia trainees across Australia and New Zealand. The transcripts were analyzed using constructivist grounded theory methods sensitized by a sociocultural view of learning informed by Wenger's communities of practice theory. RESULTS Participants described a continuum from a necessary initial trust to an experience-informed dynamic trust. Trainees assumed initial trust in supervisors based on accreditation, reputation, and a perceived obligation of trustworthiness inherent in the supervisor's role. With experience and time, trainees' trust evolved based on supervisor actions. Deeper levels of trainee trust arose in response to perceived supervisor investment and allowed trainees to devote more emotional and cognitive resources to patient care and learning rather than impression management. Across the continuum from initial trust to experience-informed trust, trainees made rapid trust judgments that were not preceded by conscious deliberation; instead, they represented a learned "feel for the game." CONCLUSIONS While other factors are involved, our results indicate that the trainee behavior observed in workplace-based assessment is a product of supervisor invitation. Supervisor trustworthiness and investment in trainee development invite trainees to work and present in authentic ways in workplace-based assessment. This authentic engagement, where learners "show themselves" to supervisors and take risks, creates assessment for learning.
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Affiliation(s)
- Damian J. Castanelli
- D.J. Castanelli is senior lecturer, School of Clinical Sciences at Monash Health, Monash University, consultant anesthetist, Department of Anaesthesia and Perioperative Medicine, Monash Health, Clayton, Victoria, Australia, and PhD candidate, Centre for Research in Assessment and Digital Learning, Deakin University, Geelong, Victoria, Australia; ORCID: https://orcid.org/0000-0002-5377-809X
| | - Jennifer M. Weller
- J.M. Weller is professor and head, Centre for Medical and Health Sciences Education, University of Auckland, and specialist anesthetist, Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand; ORCID: https://orcid.org/0000-0003-3029-1390
| | - Elizabeth Molloy
- E. Molloy is professor of work-integrated learning, Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia; ORCID: https://orcid.org/0000-0001-9457-9348
| | - Margaret Bearman
- M. Bearman is research professor, Centre for Research in Assessment and Digital Learning, Deakin University, Geelong, Victoria, Australia; ORCID: https://orcid.org/0000-0002-6862-9871
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Beck J, Falco CN, O'Hara KL, Bassett HK, Randall CL, Cruz S, Hanson JL, Dean W, Senturia K. The Norms and Corporatization of Medicine Influence Physician Moral Distress in the United States. TEACHING AND LEARNING IN MEDICINE 2022:1-11. [PMID: 35466844 DOI: 10.1080/10401334.2022.2056740] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
PhenomenonMoral distress, which occurs when someone's moral integrity is seriously compromised because they feel unable to act in accordance with their core values and obligations, is an increasingly important concern for physicians. Due in part to limited understanding of the root causes of moral distress, little is known about which approaches are most beneficial for mitigating physicians' distress. Our objective was to describe system-level factors in United States (U.S.) healthcare that contribute to moral distress among pediatric hospitalist attendings and pediatric residents.ApproachIn this qualitative study, we conducted one-on-one semi-structured interviews with pediatric hospitalist attendings and pediatric residents from 4 university-affiliated, freestanding children's hospitals in the U.S. between August 2019 and February 2020. Data were coded with an iteratively developed codebook, categorized into themes, and then synthesized.FindingsWe interviewed 22 hospitalists and 18 residents. Participants described in detail how the culture of medicine created a context that cultivated moral distress. Norms of medical education and the practice of medicine created conflicts between residents' strong sense of professional responsibility to serve the best interests of their patients and the expectations of a hierarchical system of decision-making. The corporatization of the U.S. healthcare system created administrative and financial pressures that conflicted with the moral responsibility felt by both residents and hospitalists to provide the care that their patients and families needed.InsightsThese findings highlight the critical role of systemic sources of moral distress. These findings suggest that system-level interventions must supplement existing interventions that target individual health care providers. Preventing and managing moral distress will require a broad approach that addresses systemic drivers, such as the corporatization of medicine, which are entrenched in the culture of medicine.
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Affiliation(s)
- Jimmy Beck
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Carla N Falco
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Kimberly L O'Hara
- Department of Pediatrics, University of Colorado School of Medicine, CO, USA
| | - Hannah K Bassett
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Cameron L Randall
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Stephanie Cruz
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Janice L Hanson
- Department of Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Wendy Dean
- Moral Injury of Healthcare LLC, Carlisle, PA, USA
| | - Kirsten Senturia
- Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA
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Sheehan D, Wilkinson TJ. Widening how we see the impact of culture on learning, practice and identity development in clinical environments. MEDICAL EDUCATION 2022; 56:110-116. [PMID: 34433232 DOI: 10.1111/medu.14630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
As part of this State of the Science series on Self, Society and Situation, we focus on how we might see the situation of the workplace as a learning environment in the future. Research to date into how health professionals learn while working in clinical workplace environments has mostly focused on the supervisor-trainee relationship or on the interaction between the affordances of a workplace and the receptiveness of trainees. However, the wider environment has not received as much focus-though frequently mentioned, it is seldom investigated. We suggest there is a need to embrace the wider institution factors, recognise and acknowledge an organisation's values and culture as they impact on clinical learning in order to work with these, not around them or ignore them, to make what may be tacit visible through reflection and observation and to embrace a range of perspectives on culture.
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Affiliation(s)
- Dale Sheehan
- Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Tim J Wilkinson
- Education Unit, University of Otago, Christchurch, Ringgold standard institution, Christchurch, New Zealand
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Samuriwo R. Values, culture, narrative and medical education: The case for a renewed focus. MEDICAL EDUCATION 2021; 55:888-889. [PMID: 34003497 DOI: 10.1111/medu.14569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Ray Samuriwo
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
- Wales Centre for Evidence Based Care, Cardiff University, Cardiff, UK
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