Experiential Learning of Interdisciplinary Care Skills in Surgery Assessed From Student Reflections

INTRODUCTION

Interdisciplinary healthcare collaboration improves patient outcomes, increases workplace satisfaction, and reduces costs. Our medical school utilizes an experiential learning tool for teaching interprofessionalism known as the Longitudinal Patient Project (LPP). Medical students are directed to identify a surgical patient to establish continuity with by observing them throughout preoperative, intraoperative, and postoperative periods, and follow-up with the patient after their procedure. Students then write reflections on their LPP experience. This study examines the LPP as an interprofessionalism teaching tool using qualitative analysis of student reflections.

METHODS

NVivo 12 was used to code reflections. One researcher coded reflections for subject, depth, temporality, and confidence. Depth was assessed using Mezirow's Critical Reflection Theory, with students receiving titles of "content," "process," or "premise" reflectors based on the deepest level of reflection exhibited. Confidence was assessed by labeling reflective statements as "concrete" or "verbal." Data were coded by a second researcher for validation. Consensus was reached, the remainder of the dataset was updated to reflect codebook changes, and trends were assessed.

RESULTS

Inter-rater agreement was 83%. All students achieved "content" level reflection. Ninety-seven percent of students reached "process" reflection. Ninety-three percent of students reached "premise" reflection. Students provided more concrete indicators of knowledge gained from the LPP than from prior experiences. Subjects included communication, team dynamics, patient impact, and student experience. Increased depth and breadth of reflection on communication and team dynamics were observed from the LPP.

CONCLUSIONS

The LPP illustrates the importance of interdisciplinary care in surgery. Future iterations should emphasize the impact on patients and their families.

Transformative learning theory applications in health professional and nursing education: An umbrella review

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.

Development of Critical Reflection Competency Scale for Clinical Nurses

Critical reflection develops nurses' critical thinking and clinical reasoning competency. It is necessary to develop a validated scale to measure critical reflection competency considering the clinical situation and nursing context. Therefore, this study analyzed the concept of critical reflection, developed a scale to measure critical reflection competency, and verified its validity and reliability. The concept of critical reflection and components of the scale were confirmed through literature review and results of previous studies on content analysis. A total of 64 preliminary items were derived on a 5-point Likert scale. The adequacy of vocabulary and expression was checked, and a content validity test was conducted. An I-CVI value of 0.88-1.00 was computed. Construct validity was conducted through an exploratory factor analysis, and data collected from 296 clinical nurses were analyzed. Five factors and nineteen items were derived, and the explanatory power was found to be 53.02%. Cronbach's α of the scale was 0.853. Future studies need to develop a critical reflection education program and utilize this concept as an educational strategy. We propose a study to verify the effect of applying an educational program using the critical reflection competency scale developed in this study.

Place and transformative learning in climate change focused community science

Community science involves the co-creation of scientific pursuits, learning, and outcomes and is presented as a transformative practice for community engagement and environmental governance. Emphasizing critical reflection, this study adopts Mezirow’s conception of transformative learning to theorize the transformative capacity of community science. Findings from interviews with participants in a community science program reveal critical reflection, although instances acknowledging attitudes and beliefs without challenging personal assumptions were more common. Program elements most likely to prompt participants to identify beliefs, values, and assumptions include data collection and interaction in team dynamics, whereas data collection in a novel environment was most likely to prompt participants to challenge their beliefs, values, and assumptions. A review of 71 climate change focused programs further demonstrates the extent that program designs support transformative learning. Key features of the community science landscape like the broad inclusion of stated learning objectives offer a constructive starting point for deepening transformative capacity, while the dominance of contributory program designs stands as a likely roadblock. Overall, this study contributes by applying a developed field to theorize transformation in relation to community science and by highlighting where facilitators should focus program design efforts to better promote transformation toward environmental sustainability.

The process of reflection: A principle-based concept analysis

The purpose of this paper is to evaluate the concept reflection as a process using a principle-based method of analysis that acknowledges the philosophical premises of formal cognitive operations (experiencing, understanding, judging, and deciding) espoused by Bernard Lonergan. The aim is to understand how we think and process cognitively in reflection while developing consciousness in knowing. Using Lonergan's formal cognitive operations adds a philosophical perspective and structure to the concept. Fostering the enactment of reflection is a complex process, but it is vital for nursing science and disciplinary advancement.