1
|
Abbonizio J, Palermo C, Brand G, Buus N, Fossey E, Dart J. Co-designing formal health professions curriculum in partnership with students: A scoping review. MEDICAL TEACHER 2024:1-12. [PMID: 38621357 DOI: 10.1080/0142159x.2024.2339403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/02/2024] [Indexed: 04/17/2024]
Abstract
There is growing evidence of the value of co-design and partnering with students in the design, development, and delivery of health professions education (HPE). However, the way in which students participate in co-designing HPE remains largely unexplored and there is little guidance on how to embed and strengthen partnerships with students. Using scoping review methodology, we identified and aggregated research reporting studies in which students were active partners in co-designing formal curricula in HPE. After searching five databases and screening 12,656 articles against inclusion criteria, 21 studies were identified. We found that most of the research was based in medical programs (n = 15) across Western contexts. Studies were mostly descriptive case reports (n = 10), with only three studies utilising participatory/action research designs. The co-designed outputs were mostly classroom-based learning on challenging HPE topics, for example, ethics, health inequities, racial and sexual bias, global health, and Indigenous health. Detailed descriptions of student-faculty partnerships and underpinning approaches were lacking overall. To optimise co-design methods, HPE and research require deeper engagement with critical research and pedagogical approaches and more robust evaluations of the processes, outputs and outcomes of co-design. In pedagogical practices, this necessitates challenging institutional structures, teaching and learning cultures and relational elements, such as through creating formal roles and opportunities for students as active co-design partners and fostering more equitable student-faculty positioning in HPE.
Collapse
Affiliation(s)
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Gabrielle Brand
- Department of Nursing & Midwifery, Monash University, Frankston, Victoria, Australia
| | - Niels Buus
- Department of Nursing & Midwifery, Monash University, Frankston, Victoria, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Janeane Dart
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
2
|
Chen X, Gong MF, Wu S, He J. "LEARN", a novel teaching method for Chinese clinical clerkship: A cross-sectional study. Front Surg 2023; 10:1113267. [PMID: 36860941 PMCID: PMC9968847 DOI: 10.3389/fsurg.2023.1113267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Background Despite the clerkship being crucial in the training of a future doctor, no widely accepted education model has been proposed. This study devised a new model for clinical clerkship rotations, titled "LEARN" for Lecture, English-video, Advisor, Real-case and Notion, and evaluated whether the LEARN model is appropriate for medical education in China. Methods A cross-sectional study was performed among 101 fourth-year students from the Xiangya School of Medicine during an Orthopaedic Surgery clerkship rotation in the Third Xiangya Hospital. They were divided into seven groups and took clerkship based on the LEARN model. A questionnaire was collected at the conclusion to measure learning outcomes. Results The LEARN model was highly accepted with the acceptance of five sessions being 95.92% (94/98), 93.88% (92/98), 96.98% (97/98), 100% (98/98) and 96.94% (95/98). The outcomes of two genders were comparable, whereas a difference was observed in the test score among groups (group 3 scored 93.93 ± 5.20, higher than others). Quantitative analysis showed that positive correlations existed in participation in the Notion (Notion means students' case discussion) section with leadership (r = 0.84, 95% CI: 0.72-0.94, p < 0.001), participation in the Real-case section with leadership (r = 0.66, 95% CI: 0.50-0.80, p < 0.001), participation in the Real-case section with mastery of inquiring skills (r = 0.57, 95% CI: 0.40-0.71, p < 0.001) and participation in the Notion section with mastery of physical examination skills (r = 0.56, 95% CI: 0.40-0.69, p < 0.001). Further qualitative analysis demonstrated that high-level participation in the English-video section indicated better outcomes in mastery of inquiring (p < 0.01), physical examination (p < 0.001), film reading (p < 0.01) and clinical reasoning (p < 0.01) skills. Conclusion Our results support the LEARN model is a promising method for medical clerkship in China. Further research involving more participants and more meticulous design is planned to test its efficacy. For refinement, educators may try to promote students' participation in the English-video session.
Collapse
Affiliation(s)
- Xiangyu Chen
- Department of Orthopaedic Surgery, Central South University Third Xiangya Hospital, Changsha, China,Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Matthew F. Gong
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Song Wu
- Department of Orthopaedic Surgery, Central South University Third Xiangya Hospital, Changsha, China
| | - Jinshen He
- Department of Orthopaedic Surgery, Central South University Third Xiangya Hospital, Changsha, China,Correspondence: Jinshen He
| |
Collapse
|
3
|
Gupta S, Howden S. Medical students' experiences of a longitudinal integrated clerkship: a threshold concepts analysis. EDUCATION FOR PRIMARY CARE 2021; 32:336-343. [PMID: 34415822 DOI: 10.1080/14739879.2021.1939796] [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: 10/20/2022]
Abstract
Longitudinal Integrated Clerkships (LIC) are known to provide several pedagogical advantages including transformational educational experiences. The study explored the learning experience of undergraduate medical students who undertook a rural LIC in a Scottish primary care setting. This paper presents an analysis of the transformative role of LIC placements using the Threshold Concept (TC) theory. This qualitative study gathered students' perceptions of their LIC experience longitudinally through written and audio diaries over a period of 1-2 months. The issues narrated in diaries were followed-up in individual semi-structured interviews. Transcripts were thematically analysed to identify key characteristics of TCs using a criterion-based approach. Data from 12 audio and nine written diaries, and five interviews led to identification of three inter-connected themes associated with the LIC year: professional identity formation, becoming an agentic learner and comfort with uncertainty. These appeared transformative in nature and resembled threshold concepts in their character and effect. An active and legitimate role in the healthcare team, longitudinality and transdisciplinary learning during LIC placements were contributary towards navigating these thresholds. The LIC exposure provided transformative learning experiences, and a stable environment that facilitated acquisition of specific TCs in the medical students' journey towards becoming a doctor. LIC affordances fostered a transformed view of self, which was more confident in dealing with uncertainty, comfortable in the emerging professional identity, and described having enhanced agentic capabilities.
Collapse
Affiliation(s)
- Shalini Gupta
- School of Medicine, University of Dundee, Dundee, Scotland
| | - Stella Howden
- School of Medicine, University of Dundee, Dundee, Scotland
| |
Collapse
|
4
|
Hense H, Harst L, Küster D, Walther F, Schmitt J. Implementing longitudinal integrated curricula: Systematic review of barriers and facilitators. MEDICAL EDUCATION 2021; 55:558-573. [PMID: 33099784 DOI: 10.1111/medu.14401] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/07/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE The increase of longitudinal integrated curricula in medical schools worldwide represents the shift towards an outcome-oriented education. This novel model allows comprehensive student-patient interactions over time and integrates the educational content across disciplines. According to quantitative research, students, patients, doctors and communities benefit from this educational model in terms of participant satisfaction, learning outcomes and clinician recruitment. However, quantitative research does not provide detailed information on programme implementation processes. Therefore, this review aims to summarise facilitators and barriers of programme implementation reported in qualitative and mixed methods studies. METHOD The authors reviewed the literature about facilitators and barriers for the implementation of longitudinal integrated curricula in undergraduate medical education programmes. The systematic search was conducted in MEDLINE, Embase and PsycINFO on 2 December 2019. The authors used the CASP checklist for qualitative research for the critical appraisal and summarised the results across studies using thematic content analysis. RESULTS The authors screened 1682 reports. Twenty studies examining 17 different curricula met the inclusion criteria. Most curricula were implemented in the United States (n = 6/17), Australia (n = 5/17) or Canada (n = 4/17). Programme implementation is facilitated and hampered by its educational components (eg continuity of supervision, safe learning environments), organisational structures (eg community involvement) and participating students' and staff' motivation and personality. The critical appraisal revealed that several studies lacked transparent documentation and adequate reflection on the researcher-participant relationship (n = 20/20), data collection instruments (n = 12/20) and recruitment strategy (n = 4/20). CONCLUSIONS The authors derived practical recommendations for the implementation of undergraduate, patient-centred, integrated medical curricula. Programme managers need to define and communicate common objectives with all participants. They should clarify the implementation of the objectives in all processes in a transparent and structured manner. Considering reporting guidelines, future studies in this field should document more transparently the methods used to gain qualitative insights and the researchers' personal involvement.
Collapse
Affiliation(s)
- Helene Hense
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Lorenz Harst
- Research Association Public Health, Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Denise Küster
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Felix Walther
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, University Hospital and Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany
| |
Collapse
|
5
|
Gupta S, Howden S. Insights into post-longitudinal integrated clerkship experience: medical students' perceptions of transition and learning. EDUCATION FOR PRIMARY CARE 2021; 32:211-218. [PMID: 33576322 DOI: 10.1080/14739879.2020.1865204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
6
|
Bartlett M, Couper I, Poncelet A, Worley P. The do's, don'ts and don't knows of establishing a sustainable longitudinal integrated clerkship. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:5-19. [PMID: 31953655 PMCID: PMC7012799 DOI: 10.1007/s40037-019-00558-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The longitudinal integrated clerkship is a model of clinical medical education that is increasingly employed by medical schools around the world. These guidelines are a result of a narrative review of the literature which considered the question of how to maximize the sustainability of a new longitudinal integrated clerkship program. METHOD All four authors have practical experience of establishing longitudinal integrated clerkship programs. Each author individually constructed their Do's, Don'ts and Don't Knows and the literature that underpinned them. The lists were compiled and revised in discussion and a final set of guidelines was agreed. A statement of the strength of the evidence is included for each guideline. RESULTS The final set of 18 Do's, Don'ts and Don't Knows is presented with an appraisal of the evidence for each one. CONCLUSION Implementing a longitudinal integrated clerkship is a complex process requiring the involvement of a wide group of stakeholders in both hospitals and communities. The complexity of the change management processes requires careful and sustained attention, with a particular focus on the outcomes of the programs for students and the communities in which they learn. Effective and consistent leadership and adequate resourcing are important. There is a need to select teaching sites carefully, involve students and faculty in allocation of students to sites and support students and faculty though the implementation phase and beyond. Work is needed to address the Don't Knows, in particular the question of how cost-effectiveness is best measured.
Collapse
Affiliation(s)
- Maggie Bartlett
- Education in General Practice, Dundee University School of Medicine, Dundee, UK.
| | - Ian Couper
- Faculty of Medicine and Health Sciences, Ukwanda Centre for Rural Health, Stellenbosch University, Stellenbosch, South Africa
| | - Ann Poncelet
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Paul Worley
- Department of Health, GPO Box 9848, 2601, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
7
|
Van Schalkwyk SC, Hafler J, Brewer TF, Maley MA, Margolis C, McNamee L, Meyer I, Peluso MJ, Schmutz AM, Spak JM, Davies D. Transformative learning as pedagogy for the health professions: a scoping review. MEDICAL EDUCATION 2019; 53:547-558. [PMID: 30761602 DOI: 10.1111/medu.13804] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/16/2018] [Accepted: 12/13/2018] [Indexed: 05/13/2023]
Abstract
CONTEXT Transformative learning (TL) has been described as learning that challenges established perspectives, leading to new ways of being in the world. As a learning theory it has resonated with educators globally, including those in the health professions. Described as a complex metatheory, TL has evolved over time, eliciting divergent interpretations of the construct. This scoping review provides a comprehensive synthesis of how TL is currently represented in the health professions education literature, including how it influences curricular activities, to inform its future application in the field. METHODS Arksey and O'Malley's six-step framework was adopted to review the period from 2006 to May 2018. A total of 10 bibliographic databases were searched, generating 1532 potential studies. After several rounds of review, first of abstracts and then of full texts, 99 studies were mapped by two independent reviewers onto the internally developed data extraction sheet. Descriptive information about included studies was aggregated. Discursive data were subjected to content analysis. RESULTS A mix of conceptual and empirical research papers, which used a range of qualitative methodologies, were included. Studies from the USA, the UK and Australia were most prevalent. Insights relating to how opportunities for TL were created, how it manifests and influences behaviour, as well as how it is experienced, demonstrated much congruency. Conceptions of TL were seen to be clustered around the work of key theorists. CONCLUSIONS The training of health professionals often takes place in unfamiliar settings where students are encouraged to be active participants in providing care. This increases the opportunity for exposure to learning experiences that are potentially transformative, allowing for a pedagogy of uncertainty that acknowledges the complexity of the world we live in and questions what we believe we know about it. TL provides educators in the health professions with a theoretical lens through which they can view such student learning.
Collapse
Affiliation(s)
- Susan C Van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janet Hafler
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Timothy F Brewer
- Departments of Medicine and Epidemiology, David Geffen School of Medicine and Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Moira A Maley
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Carmi Margolis
- Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel
| | - Lakshini McNamee
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ilse Meyer
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michael J Peluso
- Division of Infectious Diseases, University of California-San Francisco Medical Center, San Francisco, California, USA
| | - Ana Ms Schmutz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Judy M Spak
- Cushing/Whitney Medical Library, Yale School of Medicine, New Haven, Connecticut, USA
| | - David Davies
- Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
8
|
Brown MEL, Anderson K, Finn GM. A Narrative Literature Review Considering the Development and Implementation of Longitudinal Integrated Clerkships, Including a Practical Guide for Application. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519849409. [PMID: 31206031 PMCID: PMC6537286 DOI: 10.1177/2382120519849409] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/15/2019] [Indexed: 05/31/2023]
Abstract
Hailed by supporters as the answer to many challenges facing medical schools and the wider health care system, longitudinal integrated clerkships (LICs) offer a practical and sustainable alternative to more traditional block rotational models. Given this, their popularity as a curricular measure is increasing, although such clerkships remain relatively novel within the United Kingdom. This narrative literature review of international work provides a comprehensive introduction to developing and implementing LICs within medical education. This review generates a practical guide for medical educators with a focus on the development and implementation of LICs within the United Kingdom, on which there is little work. Using illustrated examples and with reference to contemporary literature, it outlines the rationale for considering an LIC within a curriculum, the different types of LIC, barriers and enabling factors to LIC implementation and considers the contemporary application of LIC models within the United Kingdom. The practical guide details key questions educators must consider when developing and implementing an LIC, particularly within the landscape of UK medical education.
Collapse
Affiliation(s)
- Megan EL Brown
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
| | - Kevin Anderson
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical
School, University of York, York, UK
| |
Collapse
|
9
|
De Villiers M, Conradie H, Van Schalkwyk S. Teaching Medical Students in a New Rural Longitudinal Clerkship: Opportunities and Constraints. Ann Glob Health 2018; 84:58-65. [PMID: 30873776 PMCID: PMC6748171 DOI: 10.29024/aogh.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Medical schools in Africa are responding to the call to increase numbers of medical graduates by up-scaling decentralized clinical training. One approach to decentralized clinical training is the longitudinal integrated clerkship (LIC), where students benefit from continuity of setting and supervision. The ability of family physician supervisors to take responsibility for the clinical training of medical students over a longer period than the usual, in addition to managing their extensive role on the district health platform, is central to the success of such training. Objective: This study investigated the teaching experiences of family physicians as clinical supervisors in a newly introduced LIC model in a rural sub-district in the Western Cape, South Africa. Method: Nine semi-structured interviews were conducted with six family physicians as part of the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) five-year longitudinal study. Code lists were developed inductively using Atlas.ti v7, they were compared, integrated, and categories were identified. Emerging common themes were developed. Findings: Three overarching themes emerged from the data, each containing subthemes. The rural platform was seen to be an enabling learning space for the LIC students. The family physicians’ experienced their new teaching role in the LIC as empowering, but also challenging. Lack of time for teaching and the unstructured nature of the work emerged as constraints. Despite being uncertain about the new LIC model, the family physicians felt that it was easier to manage than anticipated. Conclusion: The centrality of the rural context framed the teaching experiences of the family physicians in the new LIC, forming the pivot around which constraints and opportunities for teaching arose. The African family physician is well positioned to make an important contribution to the upscaling of decentralized medical training, but would need to be supported by academic institutions and health service managers in their teaching role.
Collapse
Affiliation(s)
| | - Hoffie Conradie
- Faculty of Medicine and Health Sciences, Stellenbosch University, ZA
| | | |
Collapse
|
10
|
Besigye I, Mash R, Essuman A, Flinkenflögel M. Conference report: Undergraduate family medicine and primary care training in Sub-Saharan Africa: Reflections of the PRIMAFAMED network. Afr J Prim Health Care Fam Med 2017; 9:e1-e5. [PMID: 28155289 PMCID: PMC5291078 DOI: 10.4102/phcfm.v9i1.1351] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 10/11/2016] [Indexed: 11/23/2022] Open
Abstract
Internationally, there is a move towards strengthening primary healthcare systems and encouraging community-based and socially responsible education. The development of doctors with an interest in primary healthcare and family medicine in the African region should begin during undergraduate training. Over the last few years, attention has been given to the development of postgraduate training in family medicine in the African region, but little attention has been given to undergraduate training. This article reports on the 8th PRIMAFAMED (Primary Care and Family Medicine Education) network meeting held in Nairobi from 21 to 24 May 2016. At this meeting the delegates spent time presenting and discussing the current state of undergraduate training at 18 universities in the region and shared lessons on how to successfully implement undergraduate training. This article reports on the rationale for, information presented, process followed and conclusions reached at the conference.
Collapse
|