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Thoonen BPA, Scherpbier-de Haan ND, Fluit CRMG, Stalmeijer RE. How Do Trainees Use EPAs to Regulate Their Learning in the Clinical Environment? A Grounded Theory Study. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:431-441. [PMID: 39247555 PMCID: PMC11378707 DOI: 10.5334/pme.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/19/2024] [Indexed: 09/10/2024]
Abstract
Introduction Entrustable Professional Activities (EPAs) can potentially support self-regulated learning in the clinical environment. However, critics of EPAs express doubts as they see potential harms, like checkbox behaviour. This study explores how GP-trainees use EPAs in the clinical environment through the lens of self-regulated learning theory and addresses the question of whether EPAs help or hinder trainees' learning in a clinical environment. Methods Using constructivist grounded theory methodology, a purposive and theoretical sample of GP-trainees across different years of training were interviewed. Two PICTOR interviews were added to refine and confirm constructed theory. Data collection and analysis followed principles of constant comparative analysis. Results and Discussion Trainees experience both hindering and helping influences of EPAs and self-regulate their learning by balancing these influences throughout GP-placements. Three consecutive stages were constructed each with different use of EPAs: adaptation, taking control, and checking the boxes. EPAs were most helpful in the 'taking control' stage. EPAs hindered self-regulated learning most during the final stage of training as trainees had other learning goals and experienced assessment of EPAs as bureaucratic and demotivating. Regularly discussing EPAs with supervisors helped to focus on specific learning goals, create opportunities for learning, and generate task-oriented feedback. Conclusion EPAs can both help and hinder self-regulated learning. How trainees balance both influences changes over time. Therefore, placements need to be at least long enough to enable trainees to gain and maintain control of learning. Supervisors and teachers should assist trainees in balancing the hindering and helping influences of EPAs.
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Affiliation(s)
- Bart P A Thoonen
- Development of Education in Primary Care at the Department of Primary and Community Care, Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Nynke D Scherpbier-de Haan
- Department of Primary and Long-term Care, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Ekelund K, Tolsgaard MG, Jacobsen RVB, Østergaard D, Bader-Larsen K. Learning strategies for the advanced trainee in specialist training. MEDICAL TEACHER 2024; 46:948-955. [PMID: 38145618 DOI: 10.1080/0142159x.2023.2289845] [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: 05/22/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND A significant factor of clinicians' learning is based on their ability to effectively transfer acquired knowledge, skills, and attitudes from specialty-specific clinical courses to their working environment. MATERIAL AND METHOD We conducted semi-structured interviews with 20 anaesthesiologist trainees (i.e. residents) in four group and five individual interviews using SRL principles as sensitizing concepts. Data were collected and analyzed iteratively using thematic analysis. RESULTS Advanced trainees are highly motivated to explore what they have learned in specialty-specific courses, but they often face several barriers in implementing their learning in the workplace environment. Four themes emerged from the interview data: 'Be ready to learn', "Take the 'take-home-messages' home', "Be ready to create your own opportunities', and "Face it, it's not entirely up to you'. Understanding the challenges regarding transferring knowledge from courses to the working environment is an important lesson for assisting trainees set their learning goals, monitor their progress, and re-evaluate their SRL processes. CONCLUSION Even for advanced trainees, successfully transferring knowledge from specialty-specific courses often requires adequate commitment and support. Medical supervisors and other relevant stakeholders must be aware of their shared responsibility for creating individual environments that support opportunities for trainees to self-regulate their learning.
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Affiliation(s)
- Kim Ekelund
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
- The University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesiology, Juliane Marie Centre, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Martin Grønnebæk Tolsgaard
- The University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Rikke Vita Borre Jacobsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
- The University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
- The University of Copenhagen, Copenhagen, Denmark
| | - Karlen Bader-Larsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
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Erumeda NJ, Jenkins LS, George AZ. Workplace-based learning opportunities in a South African family medicine training programme. Afr J Prim Health Care Fam Med 2023; 15:e1-e13. [PMID: 37916718 PMCID: PMC10623584 DOI: 10.4102/phcfm.v15i1.4073] [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: 03/08/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. Different types of WBL opportunities have been described in high-income countries, but the opportunities in the district health systems of sub-Saharan Africa have not been characterised. AIM This study explored family physicians' (FPs) and registrars' perceptions of WBL opportunities in a decentralised postgraduate family medicine registrar training programme. SETTING The study was conducted at five decentralised training sites across two provinces affiliated with the University of the Witwatersrand in South Africa. METHODS This instrumental case study involved semi-structured qualitative interviews with 11 FPs and 11 registrars purposively sampled across the training sites. The verbatim transcripts were thematically analysed using Braun and Clark's six-step approach. RESULTS Workplace-based learning opportunities were grouped into four themes: Learning from interpersonal interactions, learning from district activities, self-directed learning and contextual influences on learning opportunities. Registrars learnt from patients, peers, FPs and other professionals. Feedback, self-reflection, portfolio use, involvement in various district events, such as student and staff teaching, and continuous medical education augmented learning. Contextual influences originated from health facilities, resource availability, district management and university support, excessive workload and a need for standardised district learning opportunities. CONCLUSION Registrars are exposed to several types of WBL opportunities in district health systems. Effective engagement with available opportunities and addressing contextual challenges could enhance registrar learning.Contribution: Maximising learning opportunities to promote registrars' acquisition of required skills and competencies to efficiently address community needs in a middle-income country such as South Africa.
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Affiliation(s)
- Neetha J Erumeda
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Gauteng Department of Health, Ekurhuleni District Health Services, Germiston.
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Ting JJQ, Phua GLG, Hong DZ, Lam BKY, Lim AJS, Chong EJX, Pisupati A, Tan R, Yeo JYH, Koh YZ, Quek CWN, Lim JY, Tay KT, Ong YT, Chiam M, Zhou JX, Mason S, Wijaya L, Krishna LKR. Evidence-guided approach to portfolio-guided teaching and assessing communications, ethics and professionalism for medical students and physicians: a systematic scoping review. BMJ Open 2023; 13:e067048. [PMID: 36977542 PMCID: PMC10069516 DOI: 10.1136/bmjopen-2022-067048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVES Guiding the development of longitudinal competencies in communication, ethics and professionalism underlines the role of portfolios to capture and evaluate the multiple multisource appraisals and direct personalised support to clinicians. However, a common approach to these combined portfolios continues to elude medical practice. A systematic scoping review is proposed to map portfolio use in training and assessments of ethics, communication and professionalism competencies particularly in its inculcation of new values, beliefs and principles changes attitudes, thinking and practice while nurturing professional identity formation. It is posited that effective structuring of portfolios can promote self-directed learning, personalised assessment and appropriate support of professional identity formation. DESIGN Krishna's Systematic Evidence-Based Approach (SEBA) is employed to guide this systematic scoping review of portfolio use in communication, ethics and professionalism training and assessment. DATA SOURCES PubMed, Embase, PsycINFO, ERIC, Scopus and Google Scholar databases. ELIGIBILITY CRITERIA Articles published between 1 January 2000 and 31 December 2020 were included. DATA EXTRACTION AND SYNTHESIS The included articles are concurrently content and thematically analysed using the split approach. Overlapping categories and themes identified are combined using the jigsaw perspective. The themes/categories are compared with the summaries of the included articles in the funnelling process to ensure their accuracy. The domains identified form the framework for the discussion. RESULTS 12 300 abstracts were reviewed, 946 full-text articles were evaluated and 82 articles were analysed, and the four domains identified were indications, content, design, and strengths and limitations. CONCLUSIONS This review reveals that when using a consistent framework, accepted endpoints and outcome measures, longitudinal multisource, multimodal assessment data fashions professional and personal development and enhances identity construction. Future studies into effective assessment tools and support mechanisms are required if portfolio use is to be maximised.
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Affiliation(s)
- Jacquelin Jia Qi Ting
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Daniel Zhihao Hong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Bertrand Kai Yang Lam
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Annabelle Jia Sing Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Eleanor Jia Xin Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Rei Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jocelyn Yi Huang Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yi Zhe Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jia Yin Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Kuang Teck Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Jamie Xuelian Zhou
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Department of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
- Duke-NUS Medical School, Singapore
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Goldowsky A, Rencic J. Self-regulated learning and the future of diagnostic reasoning education. Diagnosis (Berl) 2023; 10:24-30. [PMID: 36476651 DOI: 10.1515/dx-2022-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
Diagnostic reasoning is a foundational ability of health professionals. The goal of enhancing clinical reasoning education is improved diagnostic accuracy and reduced diagnostic error. In order to do so, health professions educators need not only help learners improve their clinical reasoning, but teach them how to develop expert performance. An evidence-based learning strategy that is strongly associated with expert performance is self-regulated learning (SRL). SRL is the modulation of "self-generated thoughts, feelings, and actions that are planned and cyclically adapted to the attainment of personal goals". At this time, there is little data on the use of SRL to improve diagnostic reasoning. However, there appear to be numerous opportunities to utilize SRL in novel ways to improve diagnostic reasoning given what is already known about this competency. Examples that are discussed include the role SRL can play in simulation, clinical experiences, assessment, and novel technologies such as virtual reality, artificial intelligence, and machine learning. SRL is central to the philosophy that health professionals are life-long learners, as it teaches learners "how to learn". SRL has the potential to help achieve the goal of improved diagnostic accuracy and reduced diagnostic error.
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Affiliation(s)
- Alexander Goldowsky
- Division of Gastroenterology and Hepatology, Boston University School of Medicine, Boston, MA, USA
| | - Joseph Rencic
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
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De Vocht K, Verheyen K, Michels NR. Learning objectives of Belgian general practitioner trainees regarding their hospital training: A qualitative study. Eur J Gen Pract 2022; 28:173-181. [PMID: 35833734 PMCID: PMC9291655 DOI: 10.1080/13814788.2022.2081319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In Europe, hospital training is integrated in the postgraduate curriculum of General Practitioners (GPs) according to the European Directives. However, little is known about the specific learning objectives of GP trainees during this training. Objectives This exploratory study investigated GP trainees’ expected learning objectives for their hospital training and the factors influencing the learning process. Methods Semi-structured interviews were conducted in three focus groups consisting of first-year GP trainees before their hospital training. Data were coded thematically and analysed in NVivo. Results A total of 22 Belgian GP trainees (55% females, average age of 26.2 years) were interviewed. Three major themes emerged: learning objectives, factors influencing learning and organisational aspects. GP trainees mainly wanted to improve their knowledge of common conditions by conducting consultations and follow certain patients’ hospitalisation trajectory. Emergency medicine or internal medicine was the preferred specialty. Other GP trainees wanted to learn more about some specific conditions. Conversely, an overloaded work schedule was dreaded to hinder effective learning. Regular meetings and supervision from their hospital trainer were deemed crucial to strengthen GP trainees’ learning trajectory. Conclusion GP trainees wanted to learn more about both common conditions and some specific conditions. Their previous year in a GP setting strengthened their confidence and facilitated purposeful learning. Relieving GP trainees from administrative tasks when working as supplementary doctors could strike a better balance between the continuity of the clinical department and their personal learning objectives.
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Affiliation(s)
- Kimberley De Vocht
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Katleen Verheyen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nele R Michels
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Schwill S, Krug K, Poppleton A, Reith D, Senft JD, Szecsenyi J, Stengel S. How can competencies in minor surgery in general practice be increased? Assessing the effect of a compact intervention in postgraduate training: a mixed-methods study. BMJ Open 2022; 12:e060991. [PMID: 35902194 PMCID: PMC9341175 DOI: 10.1136/bmjopen-2022-060991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 07/20/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to assess general practice (GP) trainees' self-perception of surgical competencies and to explore longitudinal effects of a compact intervention. DESIGN We performed a mixed-methods study including a before and after comparison in the intervention group (IG), a comparison of attendees and non-attendees (control group (CG)) and a qualitative evaluation of the intervention. Competencies were self-assessed through surveys. Semi-structured interviews were performed after 9 months. SETTING In 2019, a 2-day voluntary seminar focussing on minor surgery/injuries was offered on 13 occasions by educators from KWBW Verbundweiterbildungplus (Competence Centre for Postgraduate Medical Education Baden-Württemberg). PARTICIPANTS All enrolled GP trainees were offered participation. GP trainees who did not attend a seminar (non-attendees) were recruited for CG after the 13th intervention. INTERVENTION Attendees took part in an interactive, GP-oriented short course incorporating 270 min of focused minor surgery/injuries training (compact intervention) on the second day of the 2-day seminar. RESULTS 326 GP trainees (IG: n=257; CG: n=69) participated in the study. 17 attendees were interviewed. CG had more often experienced a surgical rotation (p=0.03) and reported higher interest in performing minor surgery in future practice (p=0.03). GP trainees self-rated their all-round competency in minor surgery as average (IG: 3.0±1.0, CG: 3.2±0.9, IG:CG p=0.06). After the intervention, attendees felt that surgical skills should be a core component of GP vocational training (p=0.05). After 9 months, attendees remembered a variety of content and valued the interactive, case-oriented, peer-to-peer approach in a mixed learning group. Some attendees reported they had started to overcome competency gaps in minor surgery. CONCLUSIONS A compact intervention in minor surgery provides an 'intense' stimulus which could foster positive attitudes towards minor surgery and promote longitudinal personal development of related competencies in GP trainees, including those with little interest in surgery. Such measures appear crucial to support individual progress of GP trainees to provide comprehensive primary care.
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Affiliation(s)
- Simon Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Dorothee Reith
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Jonas D Senft
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Stengel
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Consensus about GP interprofessional competencies: A nominal group study. BJGP Open 2022; 6:BJGPO.2021.0243. [PMID: 35338046 DOI: 10.3399/bjgpo.2021.0243] [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: 12/22/2021] [Revised: 12/22/2021] [Accepted: 02/22/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Since the requirements for collaboration in primary care increase, effective interprofessional teamwork between general practitioners (GPs) and other primary care professionals is crucial. The need for more training in interprofessional collaborative competencies is widely recognised. However, existing competency frameworks do not sufficiently specify interprofessional collaboration to guide interprofessional competency development. AIM Consensus among GPs and other primary care professionals on interprofessional competencies that GP and GP-trainees should learn. DESIGN & SETTING Qualitative consensus study among Dutch GPs and other primary care professionals, all with expertise in primary care interprofessional collaborative practice. METHOD Three nominal group sessions were held, each resulting in its own group consensus on GP interprofessional collaborative competencies. The researchers conducted a content analysis to merge and thematise the prioritised competencies into one list. Participants prioritised this list of competencies. A pre-set cut-off point was applied to determine the overall consensus on core GP interprofessional competencies. RESULTS Eighteen professionals from nine different disciplines participated. The content analysis resulted in 31 unique competencies of which fourteen competencies were prioritised in the final ranking into three main themes: 1. Professional identity development and role definition by the GP. (three competencies); 2. Developing and executing shared care plans for individual patients (6); 3. Setting up and maintaining interprofessional collaborative partnerships.(5) CONCLUSION: An interprofessional group of experts reached consensus on 14 competencies within 3 themes. This framework provides a steppingstone for GPs to focus on their development regarding interprofessional collaboration.
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Regan L, Hopson LR, Gisondi MA, Branzetti J. Creating a better learning environment: a qualitative study uncovering the experiences of Master Adaptive Learners in residency. BMC MEDICAL EDUCATION 2022; 22:141. [PMID: 35241060 PMCID: PMC8895544 DOI: 10.1186/s12909-022-03200-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Adaptive expertise is an important physician skill, and the Master Adaptive Learner (MAL) conceptual model describes learner skills and behaviors integral to the acquisition of adaptive expertise. The learning environment is postulated to significantly impact how MALs learn, but it is unclear how these successful learners experience and interact with it. This study sought to understand the authentic experience of MALs within the learning environment and translate those experiences into practical recommendations to improve the learning environment for all trainees. METHODS Following a constructivist paradigm, we conducted a thematic analysis of transcripts from focus groups composed of MALs to identify commonalities in experiences and practices of successful postgraduate trainees in the learning environment. Saturation was achieved after seven focus groups, consisting of thirty-eight participants representing fourteen specialties from four institutions. Researchers coded transcripts using constant comparison analysis, which served as the foundation for our thematic analysis. RESULTS We identified eight themes and situated them within a 4-component model of the learning environment. Four themes were identified within the personal component: (1) patients drive learning; (2) learning has no endpoint; (3) management of emotions is crucial for learning; (4) successful learning requires a structured approach. Two themes were identified in the social component: (5) positive social relationships are leveraged to maximize learning; (6) teaching facilitates personal learning. Two themes were identified in the organizational component: (7) transitions challenge learners to adapt; (8) the learning environment dictates goal setting strategy. No major themes were identified in the physical/virtual component, although participants frequently used technology when learning. CONCLUSIONS Master Adaptive Learners experience similar facilitators of, and barriers to, success in the learning environment. Overall, our data show that acquisition of many successful strategies and skills that support learning are relegated to the hidden curriculum of residency training. Educators could support a more effective learning environment for all trainees by: (1) highlighting patients as the focal point of learning, (2) building a professional 'learner' identity, (3) teaching learning skills, and (4) creating opportunities for collaborative learning.
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Affiliation(s)
- Linda Regan
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 6-100, Baltimore, MD, 21093, USA.
| | - Laura R Hopson
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael A Gisondi
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jeremy Branzetti
- Department of Emergency Medicine, New York University School of Medicine, New York City, NY, USA
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10
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Bearman M, Dracup M, Garth B, Johnson C, Wearne E. Learning to recognise what good practice looks like: how general practice trainees develop evaluative judgement. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:215-228. [PMID: 34859317 DOI: 10.1007/s10459-021-10086-3] [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] [Received: 04/30/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
The nature of healthcare means doctors must continually calibrate the quality of their work within constantly changing standards of practice. As trainees move into working as fully qualified professionals, they can struggle to know how well they are practising in the absence of formal oversight. They therefore need to build their evaluative judgement: their capability to interpret cues and messages from the clinical environment, allowing them to judge quality of practice. This paper explores how Australian general practice (GP) trainees develop their evaluative judgement. We interviewed 16 GPs, who had recently completed certification requirements, asking them how they managed complex learning challenges across their training trajectory. A thematic analysis was sensitised by conceptualisations of evaluative judgement and feedback for future practice. Findings are reported via three themes: sources of performance relevant information; sense-making about progress within complex learning challenges; and changing practice as evaluative judgement develops. Trainees actively sought to understand what quality practice looked like within complex and ambiguous circumstances but often found it difficult to calibrate their performance. While reflective practice was key to developing evaluative judgment, feedback conversations could provide significant opportunities for trainees and supervisors to co-construct meaning. A 'feedback community' was available for frequent instances where supervisors were absent or not regarded as entirely credible, although feedback conversations in themselves did not necessarily assist trainees to develop evaluative judgement. There is room for a more active role for supervisors in assisting trainees to consider how to independently make sense of learning cues.
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Affiliation(s)
- Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Tower 2, Level 12, 727 Collins St, Docklands Melbourne, 3008, Australia.
| | - Mary Dracup
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Tower 2, Level 12, 727 Collins St, Docklands Melbourne, 3008, Australia
| | - Belinda Garth
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Caroline Johnson
- Eastern Victoria General Practice Training, Melbourne/Churchill, Australia
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Elisabeth Wearne
- Eastern Victoria General Practice Training, Melbourne/Churchill, Australia
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11
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Tran M, Wearne S, Tapley A, Fielding A, Davey A, van Driel M, Holliday E, Ball J, FitzGerald K, Spike N, Magin P. Transitions in general practice training: quantifying epidemiological variation in trainees' experiences and clinical behaviours. BMC MEDICAL EDUCATION 2022; 22:124. [PMID: 35197039 PMCID: PMC8867826 DOI: 10.1186/s12909-022-03178-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND General Practice training in Australia is delivered through the apprenticeship model. General Practice supervisors support trainees transitioning from hospital-based work towards competent independent community-based practice. The timing and manner in which support should be provided is still not well understood. This study aimed to establish the variation in clinical and educational experiences and behaviours, and location, of general practice trainees' consultations by stage of their vocational training. It was hypothesised that change is greater in earlier stages of training. METHODS A cross-sectional analysis of data (2010-2018) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours. Multinomial logistic regression assessed the association of demographic, educational, and clinical factors in different stages of training. The outcome factor was the training term. RESULTS Two thousand four hundred sixteen registrars contributed data for 321,414 patient consultations. For several important variables (seeing patients with chronic disease; new patients; seeking in-consultation information or assistance; ordering pathology and imaging; and working in a small or regional practice), odds ratios were considerably greater for comparisons of Term 1 and 3, relative to comparisons of Term 2 and 3. CONCLUSION Differences experienced in demographic, clinical and educational factors are significantly more pronounced earlier in registrars' training. This finding has educational and training implications with respect to resource allocation, trainee supervision and curriculum design. Sociocultural learning theory enables an understanding of the impact of transitions on, and how to support, general practice trainees and supervisors.
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Affiliation(s)
- Michael Tran
- School of Medicine, Western Sydney University, Narellan Road & Gilchrist Drive, Campbelltown, NSW 2560 Australia
| | - Susan Wearne
- Academic Unit of General Practice, Australian National University, The Canberra Hospital, Yamba Drive Garran, Canberra, ACT 2605 Australia
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Alison Fielding
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Brisbane, QLD 4029 Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kristen FitzGerald
- School of Medicine, University of Tasmania, 17 Liverpool Street, TAS 7000 Hobart, Australia
- General Practice Training Tasmania (GPPT), Regional Training Organisation (RTO), Level 3, RACT House, 179 Murray Street, Hobart, TAS 7000 Australia
| | - Neil Spike
- Department of General Practice and Primary Health Care, University of Melbourne, 200 Berkeley Street Carlton, Victoria, 3053 Australia
- Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation (RTO), 15 Cato Street, Hawthorn, VIC 3122 Australia
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Northways Road, Churchill, VIC 3842 Australia
| | - Parker Magin
- School of Medicine and Public Health, University of Newcastle, University Drive, NSW 2308 Callaghan, Newcastle, Australia
- GP Synergy, Regional Training Organisation (RTO), NSW & ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304 Australia
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12
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Ballouk R, Mansour V, Dalziel B, Hegazi I. The development and validation of a questionnaire to explore medical students' learning in a blended learning environment. BMC MEDICAL EDUCATION 2022; 22:4. [PMID: 34980084 PMCID: PMC8722320 DOI: 10.1186/s12909-021-03045-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/17/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND A blended learning environment is multifaceted and widely used in medical education. However, there is no validated instrument for exploring students' learning in a blended learning environment in medical programs. This study aimed to develop and validate an instrument for exploring how medical students learn in an undergraduate medical program that employs a blended learning approach. METHOD Using Artino's seven step approach, we developed a questionnaire to investigate how medical students learn in a blended learning environment. For pilot testing, 120 students completed this 19-item questionnaire. These 19-items were evaluated for construct and convergent validity across an expert medical education panel. Further item testing was analysed with principal component analysis (PCA) with varimax rotation for item reduction and factor estimation. Hence, validity was thoroughly addressed to ensure the questionnaire was representative of the key focus questions. Cronbach's Alpha was used for item reliability testing, and Spearman's Rho was used for the correlation between the questionnaire items and the extensively used MSLQ. Hence, validity and reliability were systematically addressed. RESULTS Exploratory Factor analysis identified four factors F1 and F3: Resources: Accessibility & Guidance (14-items), F2: Learning behaviours: Social and Contextual (5-items), and F4: Motivational factors: Intrinsic and Extrinsic Motivation (4-items). Internal consistency and reliability tests were satisfactory (Cronbach's Alpha ranged from 0.764 to 0.770). CONCLUSIONS The resulting Blended Learning Questionnaire (BLQ) was determined to be a reliable instrument to explore undergraduate medical students' learning in a blended learning environment.
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Affiliation(s)
- Rouba Ballouk
- School of Medicine, University of Western Sydney, Sydney, Australia
| | - Victoria Mansour
- School of Medicine, University of Western Sydney, Sydney, Australia
| | - Bronwen Dalziel
- School of Medicine, University of Western Sydney, Sydney, Australia
| | - Iman Hegazi
- School of Medicine, University of Western Sydney, Sydney, Australia
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13
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Welink LS, van Charldorp TC, Di Colandrea L, Bartelink ML, Pype P, Damoiseaux RA, de Groot E. Bidirectional learning opportunities: How GP-supervisors and trainees exchange knowledge. MEDICAL EDUCATION 2021; 55:1407-1418. [PMID: 34176147 PMCID: PMC9291942 DOI: 10.1111/medu.14590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Workplace-based learning conversations can be a good opportunity for supervisors and trainees to learn from each other. When both professionals discuss their specific knowledge openly with each other, learning conversations may be a useful educational tool, for instance for learning how to apply evidence-based medicine (EBM) in the workplace. We do, however, need a better understanding of how the exchange of knowledge provides opportunities for such bidirectional learning. The aim of this study was therefore to analyse how trainees and supervisors currently handle bidirectional learning opportunities by describing in detail how supervisors respond to knowledge expressed by trainees during a learning conversation. METHOD We video-recorded learning conversations between supervisors and trainees in general practice (GP). Within these learning conversations, EBM discussions on medical topics were selected and transcribed. We then identified, analysed using Conversation Analysis (CA) and categorised each expression of knowledge by the trainee and the supervisor's subsequent response. RESULTS We found that when a trainee expresses knowledge during the learning conversation, supervisors either (a) refute the expressed knowledge, (b) immediately suggest an alternative or (c) pose (additional) questions. These responses have consequences for the learning opportunities of both trainee and supervisor: it is only when supervisors pose further questions that trainees are encouraged to elaborate on their knowledge, leading to a bidirectional learning opportunity. DISCUSSION Improving EBM learning opportunities for both supervisors and trainees requires more than simply instructing trainees to express knowledge-based-for instance-on recent evidence more often. Inflexible institutional roles related to historical claims of supervisors' epistemic authority hamper bidirectional learning. Posing open questions during learning conversations enhances the flexibility of institutional roles while also creating bidirectional learning opportunities.
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Affiliation(s)
- Lisanne S. Welink
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUniversiteitsweg, UtrechtThe Netherlands
| | | | - Laura Di Colandrea
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUniversiteitsweg, UtrechtThe Netherlands
| | - Marie‐Louise L. Bartelink
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUniversiteitsweg, UtrechtThe Netherlands
| | - Peter Pype
- Department of Public Health and Primary CareGhent UniversityGhentBelgium
| | - Roger A.M.J. Damoiseaux
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUniversiteitsweg, UtrechtThe Netherlands
| | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrecht UniversityUniversiteitsweg, UtrechtThe Netherlands
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14
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Jackson D, Davison I, Brady J. Institutional influences on the supervision of GP trainees: a documentary analysis. EDUCATION FOR PRIMARY CARE 2021; 33:13-31. [PMID: 34486946 DOI: 10.1080/14739879.2021.1888661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: The supervisory relationship is a key source of support for postgraduate GP trainees in the United Kingdom. This article focuses on the institutional influences on GP supervision through an analysis of training documentation.Methods: Training documents were identified through a search of key sources of institutional influence: General Medical Council, Royal College of General Practitioners, Health Education West Midlands and a local university's supervisor-training material. Searches were run from September 2016 until February 2019, and 60 documents identified. Content analysis was undertaken, and documents were considered based on audience, context, language and purpose.Results: Institutional expectations regarding the functions of trainees and supervisors were identified, and supervisory relationships appeared entangled within the broader contexts of the training practice, wider profession and political events. Collation of evidence, quality assurance and patient safety were prominent messages within the documents. The institutional hierarchy was accentuated through these messages, and through processes for trainees to raise concerns. Moving down this hierarchy, messages from within the profession changed in emphasis and content.Conclusion: With patient safety paramount, and high-quality training and supervision expected, the hierarchical system outlined by the documents is perhaps unsurprising. However, unintended messages may result: collation of evidence may be prized above quality and trainees may feel unable to raise legitimate concerns. Furthermore, conflicting messages from different institutions illustrate the tensions and complexities of GP supervision. For trainees and supervisors, these inconsistencies could lead to different perspectives and expectations as they interact within the supervisory relationship.
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Affiliation(s)
- Dawn Jackson
- College of Medical and Dental Sciences, Medical School, University of Birmingham, Birmingham, UK
| | - Ian Davison
- School of Education, University of Birmingham, Birmingham, UK
| | - Josephine Brady
- Education Department, Mary Immaculate College, Limerick, Ireland
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15
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Rietmeijer CBT, Blankenstein AH, Huisman D, van der Horst HE, Kramer AWM, de Vries H, Scheele F, Teunissen PW. What happens under the flag of direct observation, and how that matters: A qualitative study in general practice residency. MEDICAL TEACHER 2021; 43:937-944. [PMID: 33765396 DOI: 10.1080/0142159x.2021.1898572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION In competency-based medical education, direct observation (DO) of residents' skills is scarce, notwithstanding its undisputed importance for credible feedback and assessment. A growing body of research is investigating this discrepancy. Strikingly, in this research, DO as a concrete educational activity tends to remain vague. In this study, we concretised DO of technical skills in postgraduate longitudinal training relationships. METHODS Informed by constructivist grounded theory, we performed a focus group study among general practice residents. We asked residents about their experiences with different manifestations of DO of technical skills. A framework describing different DO patterns with their varied impact on learning and the training relationship was constructed and refined until theoretical sufficiency was reached. RESULTS The dominant DO pattern was ad hoc, one-way DO. Importantly, in this pattern, various unpredictable, and sometimes unwanted, scenarios could occur. Residents hesitated to discuss unwanted scenarios with their supervisors, sometimes instead refraining from future requests for DO or even for help. Planned bi-directional DO sessions, though seldom practiced, contributed much to collaborative learning in a psychologically safe training relationship. DISCUSSION AND CONCLUSION Patterns matter in DO. Residents and supervisors should be made aware of this and educated in maintaining an open dialogue on how to use DO for the benefit of learning and the training relationship.
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Affiliation(s)
- Chris B T Rietmeijer
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Annette H Blankenstein
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Daniëlle Huisman
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University, Leiden, The Netherlands
| | - Henk de Vries
- Department of General Practice, Location VUmc, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Fedde Scheele
- School of Medical Sciences, Amsterdam University Medical Center, Location VUmc, Athena Institute for Transdisciplinary Research, VU University, Amsterdam, The Netherlands
| | - Pim W Teunissen
- School of Health Professions Education, Maastricht University, Universiteitssingel 60, Maastricht, The Netherlands
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16
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Hall J, Oswald A, Hauer KE, Hall AK, Englander R, Cheung WJ. Twelve tips for learners to succeed in a CBME program. MEDICAL TEACHER 2021; 43:745-750. [PMID: 34020580 DOI: 10.1080/0142159x.2021.1925233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The international movement to competency-based medical education (CBME) marks a major transition in medical education that requires a shift in educators' and learners' approach to clinical experiences, the way assessment data are collected and integrated, and in learners' mindsets. Learners entering a CBME curriculum must actively drive their learning experiences and education goals. For some, this expectation may be a significant change from their previous approach to learning in medicine. This paper highlights 12 tips to help learners succeed within a CBME model.
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Affiliation(s)
- Jena Hall
- Queen's University, Kingston, Canada
| | - Anna Oswald
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- University of Alberta, Edmonton, Canada
| | | | - Andrew K Hall
- Queen's University, Kingston, Canada
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
| | | | - Warren J Cheung
- Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
- University of Ottawa, Ottawa, Canada
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17
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Schwill S, Krug K, Valentini J, Rentschler A, Nikendei C, Szecsenyi J, Bugaj TJ. How to strengthen basic competencies in self-care - a pre-post interventional study with postgraduate trainees in family medicine in Germany. Postgrad Med 2021; 133:572-580. [PMID: 33843446 DOI: 10.1080/00325481.2021.1916298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Self-care includes taking care of our psychosocial health. Many experts agree that self-care should be included in training for Family Medicine (FM) residents, though it is unclear to what extent and by what means. Objective: The aim of this study was to evaluate competencies of FM residents in self-care and changes in knowledge, skills and attitudes after an educational compact intervention.Methods: The authors performed a pre-post comparison on residents who were registered in the FM residency program KWBW VerbundweiterbildungPLUS© (n = 401). FM residents were offered participation in a self-care training (270 minutes featuring a broad spectrum of input and practical experience). The intervention group (IG) completed a questionnaire directly before the seminar (T1) and 10 weeks afterwards (T2). Non-attendees (=control group; CG) were asked to fill out a basic questionnaire once. Basic questionnaires for IG and CG covered previous experiences and skills while the follow-up questionnaire at T2 also focused on change of competencies and attitudes. All questionnaires contained free-text questions to capture qualitative impressions.Results: 287 FM residents (IG: n = 212; CG: n = 75) participated in the study. Generally, 86.4% of FM residents had worried that their profession might endanger their personal health (T1: n = 180, CG: n = 68). At T2, 59.5% of IG (n = 66/111) declared that they would not worry about their personal health anymore (T1:T2, p < .01). IG learned to facilitate time for recreation (T1:T2, p = .04) and to use relaxation techniques (T1:T2, p = .01). Gain in competence was described in awareness of stress, self-reward, activation of personal resources, and time management. A total of 85.6% of IG reflected their attitudes towards psychosocial health of physicians in general (n = 95/111) and 22.5% of IG changed the views on their own health (n = 25/111) in terms of improved risk-awareness, increased intention for self-care and change of behavior.Conclusion: A compact intervention in self-care strengthens competencies, increases awareness, and helps FM residents identify their psychosocial health risks. Further research is necessary to specify the effectiveness of similar compact interventions in self-care and their long-term results.
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Affiliation(s)
- S Schwill
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - K Krug
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - J Valentini
- Institute of General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - A Rentschler
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - C Nikendei
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
| | - J Szecsenyi
- Department of General Practice and Health Services Research, University of Heidelberg, Heidelberg, Germany
| | - T J Bugaj
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany
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18
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Pinilla S, Kyrou A, Klöppel S, Strik W, Nissen C, Huwendiek S. Workplace-based assessments of entrustable professional activities in a psychiatry core clerkship: an observational study. BMC MEDICAL EDUCATION 2021; 21:223. [PMID: 33882926 PMCID: PMC8059233 DOI: 10.1186/s12909-021-02637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/27/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) in competency-based, undergraduate medical education (UME) have led to new formative workplace-based assessments (WBA) using entrustment-supervision scales in clerkships. We conducted an observational, prospective cohort study to explore the usefulness of a WBA designed to assess core EPAs in a psychiatry clerkship. METHODS We analyzed changes in self-entrustment ratings of students and the supervisors' ratings per EPA. Timing and frequencies of learner-initiated WBAs based on a prospective entrustment-supervision scale and resultant narrative feedback were analyzed quantitatively and qualitatively. Predictors for indirect supervision levels were explored via regression analysis, and narrative feedback was coded using thematic content analysis. Students evaluated the WBA after each clerkship rotation. RESULTS EPA 1 ("Take a patient's history"), EPA 2 ("Assess physical & mental status") and EPA 8 ("Document & present a clinical encounter") were most frequently used for learner-initiated WBAs throughout the clerkship rotations in a sample of 83 students. Clinical residents signed off on the majority of the WBAs (71%). EPAs 1, 2, and 8 showed the largest increases in self-entrustment and received most of the indirect supervision level ratings. We found a moderate, positive correlation between self-entrusted supervision levels at the end of the clerkship and the number of documented entrustment-supervision ratings per EPA (p < 0.0001). The number of entrustment ratings explained 6.5% of the variance in the supervisors' ratings for EPA 1. Narrative feedback was documented for 79% (n = 214) of the WBAs. Most narratives addressed the Medical Expert role (77%, n = 208) and used reinforcement (59%, n = 161) as a feedback strategy. Students perceived the feedback as beneficial. CONCLUSIONS Using formative WBAs with an entrustment-supervision scale and prompts for written feedback facilitated targeted, high-quality feedback and effectively supported students' development toward self-entrusted, indirect supervision levels.
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Affiliation(s)
- Severin Pinilla
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland.
| | - Alexandra Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Klöppel
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Werner Strik
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
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Sturman N, Fitzmaurice L, Lee C, Sheldrake M, Ingham G. Flags for seeking help: making supervisor expectations of general practice trainee help-seeking explicit. EDUCATION FOR PRIMARY CARE 2021; 32:109-117. [PMID: 33583342 DOI: 10.1080/14739879.2020.1864780] [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: 09/27/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
Timely supervisor input into patient care plays a key role in ensuring the safety of patients under the care of general practice trainees. Current models of clinical supervision for trainees in both hospital and general practice training have, however, been criticised for placing too much onus on the trainee to request assistance, despite the many known barriers for trainees to do so. An important barrier to general practice trainee help-seeking is trainee uncertainty about when and how their clinical supervisor expects them to seek this assistance. We introduce a tool, 'Flags for Seeking Help', which was modified from an existing checklist, to assist supervisors to tailor their input to the care of their trainee's patients. The tool aims to make supervisor expectations of trainees explicit, including when trainees should request assistance during consultations (rather than defer this until more convenient opportunities) and when this assistance should be face-to-face (rather than by phone or messaging systems). Our aim is to reduce the barriers for trainees to request in-consultation and face-to-face supervision, in particular, when it is indicated. We outline the evidence which informed the development of the tool, and present some preliminary findings from a pilot in Australian general practice training.
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Affiliation(s)
- Nancy Sturman
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Liz Fitzmaurice
- General Practice Training Queensland (GPTQ), Queensland, Australia
| | - Cathy Lee
- General Practice Training Queensland (GPTQ), Queensland, Australia
| | | | - Gerard Ingham
- Murray City Country Coast GP Training (MCCC), Melbourne, Australia
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20
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Sturman N, Fitzmaurice L, Lee C, Sheldrake M, Ingham G. Good help: a model for providing in-consultation supervision of general practice trainees. EDUCATION FOR PRIMARY CARE 2020; 32:104-108. [PMID: 33371787 DOI: 10.1080/14739879.2020.1864779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Timely clinical supervision of trainee consultations plays a key role in ensuring the safety of patients under the care of general practice trainees, and in trainee learning and professional development. Trainee requests for assistance during their consultations present supervisors with a number of challenges, however, and a number of factors act as barriers to, or reduce the utility of, this in-consultation assistance from the trainee's perspective. Face-to-face supervision in the presence of the patient presents particular challenges and opportunities. It is important to address barriers to trainee help-seeking and improve both trainee and supervisor skills in promoting safe, effective and efficient in-consultation supervision. We introduce a model (β-LACTAM) to assist supervisors in planning and delivering their face-to-face in-consultation supervision. The recent evidence which informed the development of this model is outlined, and some preliminary findings from a pilot of β-LACTAM in Australian general practice training are presented.
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Affiliation(s)
- Nancy Sturman
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Liz Fitzmaurice
- General Practice Training Queensland (GPTQ), Springwood, Australia
| | - Cathy Lee
- General Practice Training Queensland (GPTQ), Springwood, Australia
| | | | - Gerard Ingham
- Murray City Country Coast GP Training (MCCC), Melbourne, Australia
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21
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van der Gulden R, Heeneman S, Kramer AWM, Laan RFJM, Scherpbier-de Haan ND, Thoonen BPA. How is self-regulated learning documented in e-portfolios of trainees? A content analysis. BMC MEDICAL EDUCATION 2020; 20:205. [PMID: 32591021 PMCID: PMC7318487 DOI: 10.1186/s12909-020-02114-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/18/2020] [Indexed: 05/28/2023]
Abstract
BACKGROUND It is assumed that portfolios contribute to self-regulated learning (SRL). Presence of these SRL processes within the documentation kept in portfolios is presupposed in common educational practices, such as the assessment of reflective entries. However, questions can be asked considering the presence of SRL within portfolios. The aim of this study was to gain insight into the documentation of SRL processes within the electronic (e)-portfolio content of medical trainees. SRL consists of numerous processes, for this study the focus was on self-assessment via reflection and feedback, goal-setting and planning, and monitoring, as these are the processes that health professions education research mentions to be supported by portfolios. METHODS A database containing 1022 anonymous e-portfolios from General Practitioner trainees was used to provide descriptive statistics of the various available e-portfolio forms. This was followed by a quantitative content analysis of 90 e-portfolios, for which, a codebook was constructed to rate the documentation of the included SRL processes. RESULTS The numbers of forms in the e-portfolios varied to a great extent. Content analysis showed a limited documentation of reflective entries, and available entries mainly described events and experiences without explanations and context. Feedback was generally limited to comments on what went well and lacked specificity, context and suggestions for future action. Learning goals and plans were short of specificity, but did contain challenging topics and different goals were compatible with each other. 75% of the e-portfolios showed (limited) signs of monitoring. CONCLUSIONS The e-portfolio content showed limited documentation of SRL processes. As documentation of SRL requires time and asks for a high level of introspection and writing skills, one cannot expect documentation of SRL processes to appear in e-portfolio content without efforts.
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Affiliation(s)
- R van der Gulden
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
| | - S Heeneman
- Department of Pathology, School of Health Professions Education, School of Cardiovascular Research Institute Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - A W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - R F J M Laan
- Radboud Institute for Health Sciences, Department of Radboudumc Health Academy, Radboud university medical center, Nijmegen, The Netherlands
| | - N D Scherpbier-de Haan
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - B P A Thoonen
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
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22
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Willison J, Zhu X, Xie B, Yu X, Chen J, Zhang D, Shashoug I, Sabir F. Graduates' affective transfer of research skills and evidence based practice from university to employment in clinics. BMC MEDICAL EDUCATION 2020; 20:89. [PMID: 32223748 PMCID: PMC7104532 DOI: 10.1186/s12909-020-1988-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND This research sought to determine the impact of explicit program-based development of skills associated with research and Evidence Based Practice (EBP) on the attitudes and sustained behaviours of graduates subsequently employed in clinics. Systematic reviews have shown that university teaching of EBP and research skills rarely result in transfer of commensurate attitudes and sustained behaviours of students to their subsequent studies or to employment. Studies have therefore called for detailed exploration of what may enable this transfer of knowledge and skills to attitudes and behaviours. In keeping with these calls, this paper presents a fine-grained qualitative study of graduates' research skills and EBP in clinics with particular reference to pertinent attitudes, values and behaviours sustained, or further developed, one year after program completion. METHODS The study revolved around employed graduates of a Bachelor of Oral Health (BOH) program, which used the Research Skill Development (RSD) framework to structure the explicit, coherent and cyclic development of the skills associated with research in multiple semesters of the degree. One year after their completion of the BOH program, semi-structured interviews were conducted with nine employed graduates, three from each of three consecutive cohorts, to gain their professional perspectives on their research skills and EBP developed at university and then used in clinics. While the pre-determined interview questions focused on employed graduates' knowledge and skills, the attitudes and values around research skills and EBP emerged spontaneously. RESULTS Graduates that were interviewed relayed in detail their attitudes and values associated with research skills and EBP when asked about their work in clinics, even though the affective elements were not specifically elicited. In the employment context, the positive affective aspects of the skills associated with research and EBP that graduates discussed were pronounced, and this contrasted with working graduates retrospective view of university research skills and EBP. CONCLUSIONS The richness of affective interaction with patients was a factor that enabled the interviewed graduates to transfer university knowledge and skills into attitudes and behaviours associated with EBP. We recommend similar fine-grained qualitative research to further develop constructs that enable quantification of the interplay of cognitive and affective facets in researching and EBP.
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Affiliation(s)
| | - Xiaoxin Zhu
- Guangzhou Jiangnan Foreign Language School, Guangzhou, China
| | - Baolin Xie
- University of Adelaide, Adelaide, Australia
| | | | - Jie Chen
- Changsha Country Garden Venice Bilingual School, Changsha, China
| | - Deng Zhang
- University of Adelaide, Adelaide, Australia
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Sturman N, Jorm C, Parker M. With a grain of salt? Supervisor credibility and other factors influencing trainee decisions to seek in-consultation assistance: a focus group study of Australian general practice trainees. BMC FAMILY PRACTICE 2020; 21:28. [PMID: 32033540 PMCID: PMC7007682 DOI: 10.1186/s12875-020-1084-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/10/2020] [Indexed: 11/22/2022]
Abstract
Background ‘Ad hoc’ help-seeking by trainees from their supervisors during trainee consultations is important for patient safety, and trainee professional development. We explored trainee objectives and activities in seeking supervisor assistance, and trainee perceptions of the outcomes of this help-seeking (including the utility of supervisor responses). Methods Focus groups with Australian general practice trainees were undertaken. All data was audio-recorded and transcribed, coded using in-vivo and descriptive codes, and analysed by the constant comparison of provisional interpretations and themes with the data. Findings are reported under the over-arching categories of help-seeking objectives, activities and outcomes. Results Early in their general practice placements trainees needed information about practice facilities, and the “complex maze” of local patient resources and referral preferences: some clinical presentations were also unfamiliar, and many trainees were unaccustomed to making patient management decisions. Subsequent help-seeking was often characterised informally as “having a chat” or “getting a second opinion” so as not to “miss anything” when trainees were “not 100% sure”. Trainees emphasised the importance of being (and demonstrating that they were) clinically safe. Workflow constraints, and supervisory and doctor-patient relationships, had a powerful influence on trainee help-seeking activities. An etiquette for providing help in front of patients was described. Trainees assessed the credibility of supervisors based on their approach to risk and their clinical expertise in the relevant area. Several trainees reported reservations about their supervisor’s advice on occasions. Conclusion A trainee’s subsequent help-seeking is strongly influenced by how their supervisor responds when their help is sought. Trainees prefer to seek help from credible supervisors who respond promptly and maintain trainee ‘face’ in front of patients. Trainees learn through help-seeking to make their own clinical decisions but may remain uncertain about professional and societal expectations, and curious about how other general practitioners practise. Trainees value opportunities throughout their training to observe expert general practice.
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Affiliation(s)
- Nancy Sturman
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
| | - Christine Jorm
- New South Wales Regional Health Partners, Newcastle, Australia
| | - Malcolm Parker
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
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de Bever S, van Rhijn SC, van Dijk N, Kramer A, Visser MRM. Professionals' perspectives on factors affecting GP trainees' patient mix: results from an interview and focus group study among professionals working in Dutch general practice. BMJ Open 2019; 9:e032182. [PMID: 31843835 PMCID: PMC6924856 DOI: 10.1136/bmjopen-2019-032182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Seeing and treating patients in daily practice forms the basis of general practitioner (GP) training. However, the types of patients seen by GP trainees do not always match trainees' educational needs. Knowledge about factors that shape the mix of patient types is limited, especially with regard to the role of the professionals who work in the GP practice. AIM We investigated factors affecting the mix of patients seen by GP trainees from the perspective of professionals. DESIGN AND SETTING This qualitative study involved GP trainees, GP supervisors, medical receptionists and nurse practitioners affiliated with a GP Specialty Training Institute in the Netherlands. METHODS Twelve focus groups and seven interviews with 73 participants were held. Data collection and analysis were iterative, using thematic analysis with a constant comparison methodology. RESULTS The characteristics of patients' health problems and the bond between the doctor and patient are important determinants of GP trainees' patient mix. Because trainees have not yet developed bonds with patients, they are less likely to see patients with complex health problems. However, trainees can deliberately influence their patient mix by paying purposeful attention to bonding with patients and by gaining professional trust through focused engagement with their colleagues. CONCLUSION Trainees' patient mix is affected by various factors. Trainees and team members can take steps to ensure that this mix matches trainees' educational needs, but their success depends on the interaction between trainees' behaviour, the attitudes of team members and the context. The findings show how the mix of patients seen by trainees can be influenced to become more trainee centred and learning oriented.
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Affiliation(s)
- Sarah de Bever
- Department of General Practice/ GP Specialty Training Program, Amsterdam UMC, University of Amsterdam, Amsterdam School of Public Health, Amsterdam, The Netherlands
| | - Suzanne C van Rhijn
- Department of General Practice/ GP Specialty Training Program, Amsterdam UMC, University of Amsterdam, Amsterdam School of Public Health, Amsterdam, The Netherlands
| | - Nynke van Dijk
- Department of General Practice/ GP Specialty Training Program, Amsterdam UMC, University of Amsterdam, Amsterdam School of Public Health, Amsterdam, The Netherlands
| | - Anneke Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mechteld R M Visser
- Department of General Practice/ GP Specialty Training Program, Amsterdam UMC, University of Amsterdam, Amsterdam School of Public Health, Amsterdam, The Netherlands
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Jackson D, Davison I, Adams R, Edordu A, Picton A. A systematic review of supervisory relationships in general practitioner training. MEDICAL EDUCATION 2019; 53:874-885. [PMID: 31074063 DOI: 10.1111/medu.13897] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/22/2019] [Accepted: 03/20/2019] [Indexed: 05/14/2023]
Abstract
OBJECTIVES The educational alliance is argued to be at the heart of supervision in medical education. This review aims to map the research field and develop a conceptualisation of the nature of such educational alliances within postgraduate supervision for general practitioners. METHODS An integrative review of the international literature on supervision from 2011 to 2018 was undertaken, and papers assessed for relevance and quality. Data analysis incorporated framework analysis techniques. Bordin's working alliance-based model of supervision was used as a springboard for synthesis, as well as allowing for the emergence of new ideas, theories and concepts from the literature. RESULTS A total of 49 full texts were included for analysis. There was evidence of the importance of trust, agreement and bond in accordance with Bordin's model. The results also highlighted the importance of greater clarity on supervisory goals, and the tasks to support these goals, to effectively address competing priorities and roles within supervision. Non-hierarchical relationships were advocated, although supervisors must remain impartial in their assessment and monitoring roles. The influence of the wider practice community and situated learning through legitimate peripheral participation are documented. A model of General practice (GP) supervision is proposed that integrates the findings. CONCLUSIONS GP supervision requires a greater emphasis than is suggested by the working alliance model, both on the clarity of expectations and the appreciation of the multiple roles and competing priorities of both trainee and supervisor. Furthermore, as GP supervision develops within the rising workload of contemporary general practice, the role of the wider community of practice may become more prominent. We have adapted the working alliance model for postgraduate General practice (GP) supervision, emphasising the explicit sharing of expectations relating to goals, tasks and roles to facilitate negotiation and agreement.
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Affiliation(s)
- Dawn Jackson
- Medical School, University of Birmingham, Birmingham, UK
| | - Ian Davison
- School of Education, University of Birmingham, Birmingham, UK
| | - Rachel Adams
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Adaeze Edordu
- Primary Care and Health Sciences, University of Keele, Keele, UK
| | - Aled Picton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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van Houten‐Schat MA, Berkhout JJ, van Dijk N, Endedijk MD, Jaarsma ADC, Diemers AD. Self-regulated learning in the clinical context: a systematic review. MEDICAL EDUCATION 2018; 52:1008-1015. [PMID: 29943415 PMCID: PMC6175376 DOI: 10.1111/medu.13615] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 01/29/2018] [Accepted: 04/05/2018] [Indexed: 05/09/2023]
Abstract
OBJECTIVES Research has suggested beneficial effects of self-regulated learning (SRL) for medical students' and residents' workplace-based learning. Ideally, learners go through a cyclic process of setting learning goals, choosing learning strategies and assessing progress towards goals. A clear overview of medical students' and residents' successful key strategies, influential factors and effective interventions to stimulate SRL in the workplace is missing. This systematic review aims to provide an overview of and a theoretical base for effective SRL strategies of medical students and residents for their learning in the clinical context. METHODS This systematic review was conducted according to the guidelines of the Association for Medical Education in Europe. We systematically searched PubMed, EMBASE, Web of Science, PsycINFO, ERIC and the Cochrane Library from January 1992 to July 2016. Qualitative and quantitative studies were included. Two reviewers independently performed the review process and assessed the methodological quality of included studies. A total of 3341 publications were initially identified and 18 were included in the review. RESULTS We found diversity in the use of SRL strategies by medical students and residents, which is linked to individual (goal setting), contextual (time pressure, patient care and supervision) and social (supervisors and peers) factors. Three types of intervention were identified (coaching, learning plans and supportive tools). However, all interventions focused on goal setting and monitoring and none on supporting self-evaluation. CONCLUSIONS Self-regulated learning in the clinical environment is a complex process that results from an interaction between person and context. Future research should focus on unravelling the process of SRL in the clinical context and specifically on how medical students and residents assess their progress towards goals.
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Affiliation(s)
- Maaike A van Houten‐Schat
- Department of General Practice and Elderly Care MedicineUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands
- Centre for Research and Innovation in Medical EducationUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands
| | - Joris J Berkhout
- Centre for Evidence‐Based EducationAcademic Medical CentreUniversity of AmsterdamAmsterdamthe Netherlands
| | - Nynke van Dijk
- Department of General PracticeAcademic Medical CentreUniversity of AmsterdamAmsterdamthe Netherlands
| | - Maaike D Endedijk
- Department of Educational SciencesFaculty of Behavioural, Management and Social SciencesUniversity of TwenteEnschedethe Netherlands
| | - A Debbie C Jaarsma
- Centre for Research and Innovation in Medical EducationUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands
| | - Agnes D Diemers
- Department of General Practice and Elderly Care MedicineUniversity Medical Centre GroningenUniversity of GroningenGroningenthe Netherlands
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Rietmeijer CBT, Huisman D, Blankenstein AH, de Vries H, Scheele F, Kramer AWM, Teunissen PW. Patterns of direct observation and their impact during residency: general practice supervisors' views. MEDICAL EDUCATION 2018; 52:981-991. [PMID: 30043397 PMCID: PMC6120450 DOI: 10.1111/medu.13631] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/06/2018] [Accepted: 04/27/2018] [Indexed: 05/17/2023]
Abstract
CONTEXT Direct observation (DO) of residents' performance, despite the importance that is ascribed to it, does not readily fit in with the practice of postgraduate medical education (PGME); it is infrequent and the quality of observation may be poor in spite of ongoing efforts towards improvement. In recent literature, DO is mostly portrayed as a means to gather information on the performance of residents for purposes of feedback and assessment. The role of DO in PGME is likely to be more complex and poorly understood in the era of outcome-based education. By exploring the possible complexity of DO in workplace learning, our research aims to contribute to a better use of DO in the practice of PGME. METHODS Constructivist grounded theory informed our data collection and analysis. Data collection involved focus group sessions with supervisors in Dutch general practice who were invited to discuss the manifestations, meanings and effects of DO of technical skills. Theoretical sufficiency was achieved after four focus groups, with a total of 28 participants being included. RESULTS We found four patterns of DO of technical skills: initial planned DO sessions; resident-initiated ad hoc DO; supervisor-initiated ad hoc DO, and continued planned DO sessions. Different patterns of DO related to varying meanings, such as checking or trusting, and effects, such as learning a new skill or experiencing emotional discomfort, all of them concerning the training relationship, patient safety or residents' learning. CONCLUSIONS Direct observation, to supervisors, means much more than gathering information for purposes of feedback and assessment. Planned DO sessions are an important routine during the initiation phase of a training relationship. Continued planned bidirectional DO sessions, although infrequently practised, potentially combine most benefits with least side-effects of DO. Ad hoc DO, although much relied upon, is often hampered by internal tensions in supervisors, residents or both.
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Affiliation(s)
- Chris B T Rietmeijer
- Department of General Practice and Elderly Care MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Daniëlle Huisman
- Department of General Practice and Elderly Care MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Annette H Blankenstein
- Department of General Practice and Elderly Care MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Henk de Vries
- Department of General Practice and Elderly Care MedicineVU University Medical CentreAmsterdamThe Netherlands
| | - Fedde Scheele
- School of Medical SciencesVU University Medical CentreAmsterdamThe Netherlands
- Athena Institute for Transdisciplinary ResearchVU UniversityAmsterdamThe Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary CareLeiden University Medical CentreLeidenThe Netherlands
| | - Pim W Teunissen
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
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28
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Partanen R. Don't miss the boat: maximise ad hoc teaching with general practice trainees. MEDICAL EDUCATION 2018; 52:143-145. [PMID: 29356082 DOI: 10.1111/medu.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Kogan JR, Hatala R, Hauer KE, Holmboe E. Guidelines: The do's, don'ts and don't knows of direct observation of clinical skills in medical education. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:286-305. [PMID: 28956293 PMCID: PMC5630537 DOI: 10.1007/s40037-017-0376-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Direct observation of clinical skills is a key assessment strategy in competency-based medical education. The guidelines presented in this paper synthesize the literature on direct observation of clinical skills. The goal is to provide a practical list of Do's, Don'ts and Don't Knows about direct observation for supervisors who teach learners in the clinical setting and for educational leaders who are responsible for clinical training programs. METHODS We built consensus through an iterative approach in which each author, based on their medical education and research knowledge and expertise, independently developed a list of Do's, Don'ts, and Don't Knows about direct observation of clinical skills. Lists were compiled, discussed and revised. We then sought and compiled evidence to support each guideline and determine the strength of each guideline. RESULTS A final set of 33 Do's, Don'ts and Don't Knows is presented along with a summary of evidence for each guideline. Guidelines focus on two groups: individual supervisors and the educational leaders responsible for clinical training programs. Guidelines address recommendations for how to focus direct observation, select an assessment tool, promote high quality assessments, conduct rater training, and create a learning culture conducive to direct observation. CONCLUSIONS High frequency, high quality direct observation of clinical skills can be challenging. These guidelines offer important evidence-based Do's and Don'ts that can help improve the frequency and quality of direct observation. Improving direct observation requires focus not just on individual supervisors and their learners, but also on the organizations and cultures in which they work and train. Additional research to address the Don't Knows can help educators realize the full potential of direct observation in competency-based education.
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Affiliation(s)
- Jennifer R Kogan
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Rose Hatala
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen E Hauer
- University of California San Francisco, San Francisco, CA, USA
| | - Eric Holmboe
- Accreditation Council of Graduate Medical Education, Chicago, IL, USA
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Sagasser MH, Kramer AWM, Fluit CRMG, van Weel C, van der Vleuten CPM. Self-entrustment: how trainees' self-regulated learning supports participation in the workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:931-949. [PMID: 27785628 PMCID: PMC5579156 DOI: 10.1007/s10459-016-9723-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 10/13/2016] [Indexed: 05/12/2023]
Abstract
Clinical workplaces offer postgraduate trainees a wealth of opportunities to learn from experience. To promote deliberate and meaningful learning self-regulated learning skills are foundational. We explored trainees' learning activities related to patient encounters to better understand what aspects of self-regulated learning contribute to trainees' development, and to explore supervisor's role herein. We conducted a qualitative non-participant observational study in seven general practices. During two days we observed trainee's patient encounters, daily debriefing sessions and educational meetings between trainee and supervisor and interviewed them separately afterwards. Data collection and analysis were iterative and inspired by a phenomenological approach. To organise data we used networks, time-ordered matrices and codebooks. Self-regulated learning supported trainees to increasingly perform independently. They engaged in self-regulated learning before, during and after encounters. Trainees' activities depended on the type of medical problem presented and on patient, trainee and supervisor characteristics. Trainees used their sense of confidence to decide if they could manage the encounter alone or if they should consult their supervisor. They deliberately used feedback on their performance and engaged in reflection. Supervisors appeared vital in trainees' learning by reassuring trainees, discussing experience, knowledge and professional issues, identifying possible unawareness of incompetence, assessing performance and securing patient safety. Self-confidence, reflection and feedback, and support from the supervisor are important aspects of self-regulated learning in practice. The results reflect how self-regulated learning and self-entrustment promote trainees' increased participation in the workplace. Securing organized moments of interaction with supervisors is beneficial to trainees' self-regulated learning.
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Affiliation(s)
- Margaretha H Sagasser
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands.
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Cornelia R M G Fluit
- Centre on Research in Learning and Education, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- Department of Health Servicese Research and Policy, Australian National University, Canberra, Australia
| | - Cees P M van der Vleuten
- Department of Primary and Community Care, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Magin P, Tapley A, Davey A, Morgan S, Holliday E, Ball J, Wearne S, Henderson K, Catzikiris N, Mulquiney K, Spike N, Kerr R, van Driel M. General practitioner trainees' in-consultation generation of clinical questions for later answering: prevalence and associations. Fam Pract 2017; 34:599-605. [PMID: 28369454 DOI: 10.1093/fampra/cmx021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As well as generating patient-specific questions, patient consultations are a rich source of questions relating to clinicians' need to acquire or maintain wider clinical knowledge. This is especially so for GP trainees. OBJECTIVES To establish the prevalence and associations of GP trainees' generation of 'learning goals' (LGs: questions generated during clinical consultations for intended post-consultation answering). Also, to characterize the type of learning goals generated. METHODS A cross-sectional analysis (2010-15) of an ongoing cohort study of Australian GP trainees' consultations. Once each 6-month training term, trainees record detailed data of 60 consecutive consultations. The primary outcome was generation of an LG. Analysis was at the level of individual problem/diagnosis managed. The secondary outcome was the problems/diagnoses to which the LGs related. RESULTS One thousand one hundred and twenty-four trainees contributed data for 154746 consultations including 222307 problems/diagnoses. LGs were generated for 16.6% [95% confidence intervals (CI) = 16.4-16.7] of problems/diagnoses, in 22.1% (95% CI = 21.9-22.3%) of consultations. Associations of LGs included patient factors: younger age and having seen the trainee previously; trainee factors: earlier training stage, being overseas-trained and the trainee's training organization; consultation factors: longer duration, addressing a chronic disease, referring the patient, organizing follow-up, organizing investigations and accessing in-consultation information. LGs were commonly generated for skin (12.9% of all learning goals), musculoskeletal (12.7%) and respiratory (8.7%) problems. LGs were generated for 31.8% of male genital, 27.0% of neurological and 23.3% of eye problems. CONCLUSION Australian GP trainees frequently generate questions in-consultation to be pursued post-consultation. Prevalence, 'complexity' and familiarity of clinical topic area influenced LG generation.
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Affiliation(s)
- Parker Magin
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia.,Research and Evaluation Unit, GP Synergy, Mayfield, New South Wales, Australia
| | - Amanda Tapley
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia.,Research and Evaluation Unit, GP Synergy, Mayfield, New South Wales, Australia
| | - Andrew Davey
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia.,Research and Evaluation Unit, GP Synergy, Mayfield, New South Wales, Australia
| | - Simon Morgan
- Elermore Vale General Practice, Elermore Vale, New South Wales, Australia
| | - Elizabeth Holliday
- Clinical Research Design IT and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design IT and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Susan Wearne
- Academic Unit of General Practice, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Health Workforce Division, Department of Health, Canberra, Australian Capital Territory, Australia
| | - Kim Henderson
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia.,Research and Evaluation Unit, GP Synergy, Mayfield, New South Wales, Australia
| | - Nigel Catzikiris
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia.,Research and Evaluation Unit, GP Synergy, Mayfield, New South Wales, Australia
| | - Katie Mulquiney
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia.,Research and Evaluation Unit, GP Synergy, Mayfield, New South Wales, Australia
| | - Neil Spike
- Eastern Victoria GP Training, Hawthorn, Victoria, Australia.,Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
| | - Rohan Kerr
- General Practice Training Tasmania, Hobart, Tasmania, Australia
| | - Mieke van Driel
- Discipline of General Practice, The University of Queensland, Brisbane, Queensland, Australia
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Sagasser MH, Fluit CRMG, van Weel C, van der Vleuten CPM, Kramer AWM. How Entrustment Is Informed by Holistic Judgments Across Time in a Family Medicine Residency Program: An Ethnographic Nonparticipant Observational Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:792-799. [PMID: 28557945 DOI: 10.1097/acm.0000000000001464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
PURPOSE Entrustment has mainly been conceptualized as delegating discrete professional tasks. Because residents provide most of their patient care independently, not all resident performance is visible to supervisors; the entrustment process involves more than granting discrete tasks. This study explored how supervisors made entrustment decisions based on residents' performance in a long-term family medicine training program. METHOD A qualitative nonparticipant observational study was conducted in 2014-2015 at competency-based family medicine residency programs in the Netherlands. Seven supervisor-resident pairs participated. During two days, one researcher observed first-year residents' patient encounters, debriefing sessions, and supervisor-resident educational meetings and interviewed them separately afterwards. Data were collected and analyzed using iterative, phenomenological inductive research methodology. RESULTS The entrustment process developed over three phases. Supervisors based their initial entrustment on prior knowledge about the resident. In the ensuing two weeks, entrustment decisions regarding independent patient care were derived from residents' observed general competencies necessary for a range of health problems (clinical reasoning, decision making, relating to patients); medical knowledge and skills; and supervisors' intuition. Supervisors provided supervision during and after encounters. Once residents performed independently, supervisors kept reevaluating their decisions, informed by residents' overall growth in competencies rather than by adhering to a predefined set of tasks. CONCLUSIONS Supervisors in family medicine residency training took a holistic approach to trust, based on general competencies, knowledge, skills, and intuition. Entrustment started before training and developed over time. Building trust is a mutual process between supervisor and resident, requiring a good working relationship.
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Affiliation(s)
- Margaretha H Sagasser
- M.H. Sagasser was educationalist and researcher, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands, at the time of the study. The author is now educationalist and researcher, Huisartsopleiding Nederland, Utrecht, the Netherlands. C.R.M.G. Fluit is head, Center on Research in Learning and Education, Radboud University Medical Center Health Academy, Nijmegen, the Netherlands. C. van Weel is professor emeritus of general practice, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands, and honorary professor of primary health care research, Department of Health Services Research and Policy, Australian National University, Canberra, ACT, Australia. C.P.M. van der Vleuten is professor of education and director, School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, the Netherlands. A.W.M. Kramer is general practitioner, professor of general practice, and head, Family Medicine Residency Program, Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
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Berkhout JJ, Teunissen PW, Helmich E, van Exel J, van der Vleuten CPM, Jaarsma DADC. Patterns in clinical students' self-regulated learning behavior: a Q-methodology study. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2017; 22:105-121. [PMID: 27235123 PMCID: PMC5306423 DOI: 10.1007/s10459-016-9687-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 05/14/2016] [Indexed: 05/24/2023]
Abstract
Students feel insufficiently supported in clinical environments to engage in active learning and achieve a high level of self-regulation. As a result clinical learning is highly demanding for students. Because of large differences between students, supervisors may not know how to support them in their learning process. We explored patterns in undergraduate students' self-regulated learning behavior in the clinical environment, to improve tailored supervision, using Q-methodology. Q-methodology uses features of both qualitative and quantitative methods for the systematic investigation of subjective issues by having participants sort statements along a continuum to represent their opinion. We enrolled 74 students between December 2014 and April 2015 and had them characterize their learning behavior by sorting 52 statements about self-regulated learning behavior and explaining their response. The statements used for the sorting were extracted from a previous study. The data was analyzed using by-person factor analysis to identify clusters of individuals with similar sorts of the statements. The resulting factors and qualitative data were used to interpret and describe the patterns that emerged. Five resulting patterns were identified in students' self-regulated learning behavior in the clinical environment, which we labelled: Engaged, Critically opportunistic, Uncertain, Restrained and Effortful. The five patterns varied mostly regarding goals, metacognition, communication, effort, and dependence on external regulation for learning. These discrete patterns in students' self-regulated learning behavior in the clinical environment are part of a complex interaction between student and learning context. The results suggest that developing self-regulated learning behavior might best be supported regarding individual students' needs.
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Affiliation(s)
- Joris J Berkhout
- Center for Evidence-Based Education, Academic Medical Center (AMC-UvA), University of Amsterdam, Amsterdam, The Netherlands.
| | - Pim W Teunissen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics and Gynecology, VU University Medical Center, VU University Amsterdam, Amsterdam, The Netherlands
| | - Esther Helmich
- Center for Evidence-Based Education, Academic Medical Center (AMC-UvA), University of Amsterdam, Amsterdam, The Netherlands
| | - Job van Exel
- Institute of Health Policy and Management (BMG), Erasmus University, Rotterdam, The Netherlands
| | - Cees P M van der Vleuten
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Debbie A D C Jaarsma
- Center for Research and Innovation in Medical Education, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Cottrell E, Yardley S. Lived experiences of multimorbidity: An interpretative meta-synthesis of patients', general practitioners' and trainees' perceptions. Chronic Illn 2015; 11:279-303. [PMID: 25770097 DOI: 10.1177/1742395315574764] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Multimorbidity is an increasing challenge. Better understanding of lived experiences of patients, general practitioners and trainees, may advance patient care and medical education. This interpretative meta-synthesis sought to (i) understand lived experiences of patients, general practitioners and trainees regarding multimorbidity, (ii) identify how similarities and differences in experiences should shape future solutions. METHODS Empirical studies containing qualitative data and pertaining to lived experiences from our recent realist synthesis (PROSPERO 2013:CRD42013003862) were included. Following quality assessment, data were extracted from key studies to build an integrated analytic framework. Data from remaining studies were utilised to expand and refine the framework through thematic analysis of concepts within and between perspectives. RESULTS Twenty-one papers were included in the meta-synthesis. Analysis of 70 concepts produced five themes: (1) goals of care and decision making, (2) complexity, (3) meeting expectations, (4) logistics and (5) interpersonal dynamics. The complexities of multimorbidity lead to shared feelings of vulnerability, uncertainty and enforced compromises. Barriers to optimal care-education included system constraints, inadequate continuity and role uncertainty. DISCUSSION There was little evidence of shared discussion of these challenges. Addressing these issues and more explicit exploration of the experiences of each group during interactions may improve delivery and satisfaction in care and education.
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Kramer AWM. Too much control diverts from the essence of learning and teaching. PERSPECTIVES ON MEDICAL EDUCATION 2015; 4:272-274. [PMID: 26358979 PMCID: PMC4602010 DOI: 10.1007/s40037-015-0216-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Sagasser MH, Kramer AWM, van Weel C, van der Vleuten CPM. GP supervisors' experience in supporting self-regulated learning: a balancing act. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:727-44. [PMID: 25314934 DOI: 10.1007/s10459-014-9561-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 10/03/2014] [Indexed: 05/11/2023]
Abstract
Self-regulated learning is essential for professional development and lifelong learning. As self-regulated learning has many inaccuracies, the need to support self-regulated learning has been recommended. Supervisors can provide such support. In a prior study trainees reported on the variation in received supervisor support. This study aims at exploring supervisors' perspectives. The aim is to explore how supervisors experience self-regulated learning of postgraduate general practitioners (GP) trainees and their role in this, and what helps and hinders them in supervising. In a qualitative study using a phenomenological approach, we interviewed 20 supervisors of first- and third-year postgraduate GP trainees. Supervisors recognised trainee activity in self-regulated learning and adapted their coaching style to trainee needs, occasionally causing conflicting emotions. Supervisors' beliefs regarding their role, trainees' role and the usefulness of educational interventions influenced their support. Supervisors experienced a relation between patient safety, self-regulated learning and trainee capability to learn. Supervisor training was helpful to exchange experience and obtain advice. Supervisors found colleagues helpful in sharing supervision tasks or in calibrating judgments of trainees. Busy practice occasionally hindered the supervisory process. In conclusion, supervisors adapt their coaching to trainees' self-regulated learning, sometimes causing conflicting emotions. Patient safety and entrustment are key aspects of the supervisory process. Supervisors' beliefs about their role and trainees' role influence their support. Supervisor training is important to increase awareness of these beliefs and the influence on their behaviour, and to improve the use of educational instruments. The results align with findings from other (medical) education, thereby illustrating its relevance.
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Affiliation(s)
- Margaretha H Sagasser
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, ELG 117, Postbus 9101, 6500 HB, Nijmegen, The Netherlands,
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Wearne SM, Teunissen PW, Dornan T, Skinner T. Physical isolation with virtual support: Registrars' learning via remote supervision. MEDICAL TEACHER 2015; 37:670-676. [PMID: 25156104 DOI: 10.3109/0142159x.2014.947941] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE Changing the current geographical maldistribution of the medical workforce is important for global health. Research regarding programs that train doctors for work with disadvantaged, rural populations is needed. This paper explores one approach of remote supervision of registrars in isolated rural practice. Researching how learning occurs without on-site supervision may also reveal other key elements of postgraduate education. METHODS Thematic analysis of in-depth interviews exploring 11 respondents' experiences of learning via remote supervision. RESULTS Remote supervision created distinctive learning environments. Respondents' attributes interacted with external supports to influence whether and how their learning was promoted or impeded. Registrars with clinical and/or life experience, who were insightful and motivated to direct their learning, turned the challenges of isolated practice into opportunities that accelerated their professional development. DISCUSSION Remote supervision was not necessarily problematic but instead provided rich learning for doctors training in and for the context where they were needed. Registrars learnt through clinical responsibility for defined populations and longitudinal, supportive supervisory relationships. Responsibility and continuity may be as important as supervisory proximity for experienced registrars.
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Affiliation(s)
| | - Pim W Teunissen
- b Maastricht University , The Netherlands
- c VU University Medical Center , The Netherlands
| | - Tim Dornan
- b Maastricht University , The Netherlands
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Yardley S, Cottrell E, Rees E, Protheroe J. Modelling successful primary care for multimorbidity: a realist synthesis of successes and failures in concurrent learning and healthcare delivery. BMC FAMILY PRACTICE 2015; 16:23. [PMID: 25886592 PMCID: PMC4343192 DOI: 10.1186/s12875-015-0234-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/29/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND People are increasingly living for longer with multimorbidity. Medical education and healthcare delivery must be re-orientated to meet the societal and individual patient needs that multimorbidity confers. The impact of multimorbidity on the educational needs of doctors is little understood. There has been little critique of how learning alongside healthcare provision is negotiated by patients, general practitioners and trainee doctors. This study asked 'what is known about how and why concurrent healthcare delivery and professional experiential learning interact to generate outcomes, valued by patients, general practitioners and trainees, for patients with multimorbidity in primary care?' METHODS This realist synthesis is reported using RAMESES standards. Relationship-centred negotiation of needs-based learning and care was the primary outcome of interest. Healthcare, social science and educational literature were sought as evidence. Data extraction focused on context, mechanism and outcome configurations within studies and on data which might assist understanding and explain; i) these configurations; ii) the relationships between them and; iii) their role and place in evolving programme theories arising from data synthesis. Mind-mapping software and team meetings were used to aid interpretative analysis. RESULTS The final synthesis included 141 papers of which 34 contained models for workplace-based experiential learning and/or patient care. Models of experiential learning for practitioners and for patient engagement were congruent, frequently referencing theories of transformation and socio-cultural processes as mechanisms for improving clinical care. Key issues included the perceived impossibility of reconciling personalised concepts of success with measurability of clinical markers or adherence to guidelines, and the need for greater recognition of social dynamics between patients, GPs and trainees including the complexities of shared responsibilities. A model for considering the implications of concurrency for learning and healthcare delivery in the context of multimorbidity in primary care is proposed and supporting evidence is presented. CONCLUSIONS This study is novel in considering empirical evidence from patients, GPs and trainees engaged in concurrent learning and healthcare delivery. The findings should inform future interventions designed to produce a medical workforce equipped to provide multimorbidity care. TRIAL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42013003862.
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Affiliation(s)
- Sarah Yardley
- Primary Care and Health Sciences, Keele University, Keele, Staffs, ST5 5BG, UK.
| | - Elizabeth Cottrell
- Primary Care and Health Sciences, Keele University, Keele, Staffs, ST5 5BG, UK.
| | - Eliot Rees
- Primary Care and Health Sciences, Keele University, Keele, Staffs, ST5 5BG, UK.
| | - Joanne Protheroe
- Primary Care and Health Sciences, Keele University, Keele, Staffs, ST5 5BG, UK.
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Embo MPC, Driessen E, Valcke M, Van Der Vleuten CPM. Scaffolding reflective learning in clinical practice: a comparison of two types of reflective activities. MEDICAL TEACHER 2014; 36:602-607. [PMID: 24787531 DOI: 10.3109/0142159x.2014.899686] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND The development of reflective learning skills is a continuous process that needs scaffolding. It can be described as a continuum, with the focus of reflection differing in granularity from recent, concrete activities to global competency development. AIM To explore learners' perceptions regarding the effects of two reflective writing activities designed to stimulate reflection at different degrees of granularity during clinical training. METHODS Totally 142 respondents (students and recent graduates) completed a questionnaire. Quantitative and qualitative data were triangulated. RESULTS Immediate reflection-on-action was perceived to be more valuable than delayed reflection-on-competency-development because it facilitated day-to-day improvement. Delayed reflection was perceived to facilitate overall self-assessment, self-confidence and continuous improvement, but this perception was mainly found among graduates. Detailed reflection immediately after a challenging learning experience and broad reflection on progress appeared to serve different learning goals and consequently require different arrangements regarding feedback and timing. CONCLUSIONS Granularity of focus has consequences for scaffolding reflective learning, with immediate reflection on concrete events and reflection on long-term progress requiring different approaches. Learners appeared to prefer immediate reflection-on-action.
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Affiliation(s)
- M P C Embo
- University College Arteveldehogeschool Ghent , Belgium
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