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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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Teheux L, Wollaars H, Draaisma JMT, Coolen EHAJ, Kuijer-Siebelink W, van der Velden JAEM. Learning for doctor-to-doctor collaboration: a qualitative study exploring the experiences of residents and supervisors with intraprofessional workplace learning in complex tertiary care. BMC MEDICAL EDUCATION 2023; 23:478. [PMID: 37370026 DOI: 10.1186/s12909-023-04363-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND To deliver high-quality care for individuals with complex medical conditions, residents need to be trained across the boundaries of their specialties. This study aimed to explore learning activities and influencing factors in intraprofessional workplace learning by residents in complex tertiary care. METHODS This qualitative study was conducted in a tertiary care children's hospital. In September - December 2017, fourteen individual and two focus group interviews were conducted with a purposive sample of residents and supervisors of various specialties. Transcribed interviews were thematically analyzed to describe learning activities and influencing factors that play a role in intraprofessional workplace learning in complex tertiary care settings during residency training. RESULTS Respondents described numerous activities that they considered opportunities for intraprofessional learning, both directly and not directly related to patient care. However, deliberate attention to intraprofessional learning often seemed to be lacking in clinical practice. Influencing factors on a system (macro), organization (meso) and personal and interpersonal level (micro) level were identified. Factors on the macro and meso level mainly determined whether intraprofessional learning opportunities arose, while micro level factors mainly influenced whether opportunities were seized. CONCLUSIONS There are ample opportunities for intraprofessional workplace learning in complex tertiary care for residents. Residents may benefit more from intraprofessional learning opportunities if these are made more intentional and deliberate. Influencing factors at the macro, meso and micro level provide targets for interventions aimed at enhancing intraprofessional workplace learning in postgraduate medical training.
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Affiliation(s)
- Lara Teheux
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands.
| | - Hanna Wollaars
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Ester H A J Coolen
- Department of Pediatrics, Radboud University Medical Center, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Wietske Kuijer-Siebelink
- Department of Research on Learning and Education, Radboud University Medical Center, Radboudumc Health Academy, Nijmegen, The Netherlands
- School of Education, HAN University of Applied Sciences, Nijmegen, the Netherlands
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Janssen M, Fluit CRMG, Lubbers RR, Cornelissen SA, de Graaf J, Scherpbier ND. Learning collaboration at the primary-secondary care interface: a dual-method study to define design principles for interventions in postgraduate training programmes. BMC MEDICAL EDUCATION 2023; 23:308. [PMID: 37138295 PMCID: PMC10158135 DOI: 10.1186/s12909-023-04254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Collaboration between primary and secondary care (PSCC) is important to provide patient-centered care. Postgraduate training programmes should provide training to learn PSCC. With a design based research (DBR) approach design principles can be formulated for designing effective interventions in specific contexts. The aim of this study is to determine design principles for interventions aimed to learn PSCC in postgraduate training programmes. METHODS DBR is characterised by multi-method studies. We started with a literature review on learning collaboration between healthcare professionals from different disciplines within the same profession (intraprofessional) to extract preliminary design principles. These were used to inform and feed group discussions among stakeholders: trainees, supervisors and educationalists in primary and secondary care. Discussions were audiotaped, transcribed and analysed using thematic analysis to formulate design principles. RESULTS Eight articles were included in the review. We identified four preliminary principles to consider in the design of interventions: participatory design, work process involvement, personalised education and role models. We conducted three group discussions with in total eighteen participants. We formulated three design principles specific for learning PSCC in postgraduate training programmes: (1) The importance of interaction, being able to engage in a learning dialogue. (2) Facilitate that the learning dialogue concerns collaboration. (3) Create a workplace that facilitates engagement in a learning dialogue. In the last design principle we distinguished five subcategories: intervention emphasises the urge for PSCC and is based on daily practice, the presence of role models, the work context creates time for learning PSCC, learning PSCC is formalised in curricula and the presence of a safe learning environment. CONCLUSION This article describes design principles for interventions in postgraduate training programmes with the aim to learn PSCC. Interaction is key in learning PSCC. This interaction should concern collaborative issues. Furthermore, it is essential to include the workplace in the intervention and make adjacent changes in the workplace when implementing interventions. The knowledge gathered in this study can be used to design interventions for learning PSCC. Evaluation of these interventions is needed to acquire more knowledge and adjust design principles when necessary.
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Affiliation(s)
- Marijn Janssen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands.
| | - Cornelia R M G Fluit
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel R Lubbers
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sylvia A Cornelissen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Department Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline de Graaf
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nynke D Scherpbier
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Bajwa NM, Sader J, Kim S, Park YS, Nendaz MR, Bochatay N. Development and validity evidence for the intraprofessional conflict exercise: An assessment tool to support collaboration. PLoS One 2023; 18:e0280564. [PMID: 36800365 PMCID: PMC9937497 DOI: 10.1371/journal.pone.0280564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/02/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Effective collaboration is the foundation for delivering safe, high quality patient care. Health sciences curricula often include interprofessional collaboration training but may neglect conflicts that occur within a profession (intraprofessional). We describe the development of and validity evidence for an assessment of intraprofessional conflict management. METHODS AND FINDINGS We designed a 22-item assessment, the Intraprofessional Conflict Exercise, to evaluate skills in managing intraprofessional conflicts based on a literature review of conflict management. Using Messick's validity framework, we collected evidence for content, response process, and internal structure during a simulated intraprofessional conflict from 2018 to 2019. We performed descriptive statistics, inter-rater reliability, Cronbach's alpha, generalizability theory, and factor analysis to gather validity evidence. Two trained faculty examiners rated 82 trainees resulting in 164 observations. Inter-rater reliability was fair, weighted kappa of 0.33 (SE = 0.03). Cronbach's alpha was 0.87. The generalizability study showed differentiation among trainees (19.7% person variance) and was highly reliable, G-coefficient 0.88, Phi-coefficient 0.88. The decision study predicted that using one rater would have high reliability, G-coefficient 0.80. Exploratory factor analysis demonstrated three factors: communication skills, recognition of limits, and demonstration of respect for others. Based on qualitative observations, we found all items to be applicable, highly relevant, and helpful in identifying how trainees managed intraprofessional conflict. CONCLUSIONS The Intraprofessional Conflict Exercise provides a useful and reliable way to evaluate intraprofessional conflict management skills. It provides meaningful and actionable feedback to trainees and may help health educators in preparing trainees to manage intraprofessional conflict.
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Affiliation(s)
- Nadia M. Bajwa
- Department of General Pediatrics at the Children’s Hospital, Geneva University Hospitals in Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julia Sader
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sara Kim
- Department of Surgery, School of Medicine, University of Washington, Seattle, Washington, United States of America
| | - Yoon Soo Park
- MGH Institute of Health Professions at Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Mathieu R. Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Naïke Bochatay
- Department of Pediatrics at the University of California, San Francisco, San Francisco, California, United States of America
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Baecher-Lind L, Fleming AC, Bhargava R, Cox SM, Everett EN, Forstein DA, Madani Sims S, Morgan HK, Morosky CM, Royce CS, Sonn TS, Sutton JM, Graziano SC. Enhancing interprofessional collaboration and interprofessional education in women's health. MEDICAL EDUCATION ONLINE 2022; 27:2107419. [PMID: 35924355 PMCID: PMC9359162 DOI: 10.1080/10872981.2022.2107419] [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: 11/21/2021] [Revised: 05/05/2022] [Accepted: 07/26/2022] [Indexed: 08/05/2023]
Abstract
This article is from the 'To The Point' series from the Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. The purpose of this review is to provide an understanding of the differing yet complementary nature of interprofessional collaboration and interprofessional education as well as their importance to the specialty of Obstetrics and Gynecology. We provide a historical perspective of how interprofessional collaboration and interprofessional education have become key aspects of clinical and educational programs, enhancing both patient care and learner development. Opportunities to incorporate interprofessional education within women's health educational programs across organizations are suggested. This is a resource for medical educators, learners, and practicing clinicians from any field of medicine or any health-care profession.
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Affiliation(s)
- Laura Baecher-Lind
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
| | - Angela C. Fleming
- Department of Obstetrics and Gynecology, Beaumont Hospital, Novi, MI, USA
| | - Rashmi Bhargava
- Department of Obstetrics and Gynecology, University of Saskatchewan College of Medicine, Regina, SK, Canada
| | - Susan M. Cox
- Department of Obstetrics and Gynecology, Dell Medical School, Austin, TX, USA
| | - Elise N. Everett
- Department of Obstetrics and Gynecology, Larner College of Medicine at the University of Vermont, Burlington, VT, Canada
| | - David A. Forstein
- Department of Obstetrics and Gynecology, Rocky Vista College of Osteopathic Medicine, Parker, CO, USA
| | - Shireen Madani Sims
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Helen K. Morgan
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christopher M. Morosky
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Celeste S. Royce
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Tammy S. Sonn
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Jill M. Sutton
- Department of Obstetrics and Gynecology, Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Scott C. Graziano
- Department of Obstetrics and Gynecology, Loyola University Medical Center, Hines, IL, 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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Looman N, de Graaf J, Thoonen B, van Asselt D, de Groot E, Kramer A, Scherpbier N, Fluit C. Designing the learning of intraprofessional collaboration among medical residents. MEDICAL EDUCATION 2022; 56:1017-1031. [PMID: 35791303 PMCID: PMC9543842 DOI: 10.1111/medu.14868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND To preserve quality and continuity of care, collaboration between primary-care and secondary-care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design-Principles guide the design and development of educational activities when theory-driven Design-Principles are tailored into context-sensitive Design-Principles. The aim of this study was to develop and substantiate a set of theory-driven and context-sensitive Design-Principles for intraPC learning during hospital placements. METHODS Based on our earlier research, we formulated nine theory-driven Design-Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design-Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design-Principles. RESULTS The theoretical Design-Principles were discussed and modified iteratively. Two new Design-Principles were added during focus group 1, and one more Design-Principle was added during focus group 2. The Design-Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design-Principles in the Culture cluster were prerequisites to facilitate intraPC learning. CONCLUSION This study led to the development of 12 theory-driven and context-sensitive Design-Principles that may guide the design of educational activities to support intraPC learning during hospital placements.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Bart Thoonen
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUMC UtrechtUtrechtThe Netherlands
| | - Anneke Kramer
- Department of Public health and Primary CareLeiden UMCLeidenThe Netherlands
| | - Nynke Scherpbier
- Department of General Practice and Elderly CareUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenThe Netherlands
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AlSarhan MA, Alaqeely RS, Ahmedani MS, AL Jasser RN, Alotaibi DH, Aloraini SS, Habib SR. Dental students' attitudes and perceptions about intraprofessional collaboration/education. J Taibah Univ Med Sci 2022; 18:287-294. [PMID: 36817224 PMCID: PMC9926108 DOI: 10.1016/j.jtumed.2022.09.003] [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] [Received: 06/07/2022] [Revised: 07/22/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022] Open
Abstract
Objectives To investigate dental students' attitudes and perceptions about intraprofessional collaboration/education (IPC/IPE) and shared learning, and to explore the impact of IPC/IPE on the personal and professional development of participating students. Methods A custom-designed questionnaire was used in this cross-sectional study. The questionnaire comprised 17 questions targeting to capture the student's perceptions about IPC/IPE using three factors: (1) dental students' preference/opinion about the IPC/IPE; (2) dental students' experience about the impact of IPC/IPE on learning outcomes and professional development; and (3) students' feedback about the significance of IPC/IPE in clinical/clinical simulation labs and workplace setting. The students rated each of the 17 statements on the 5-point Likert scale (range: 1 = strongly disagree to 5 = strongly agree). Results A total of 259 responses were analysed (response rate = 65%). All students were aware of IPC/IPE in the field of dentistry (mean score = 4.22). The students preferred collaborative/shared learning with their own classmates. There was a consensus among students about the positive impact of IPC/IPE on enhanced learning, enhancement of communication skills, and enrichment of professional relationships with supporting staff as well as with the patients. There was also improved analytical and psychomotor skills, understanding of complex problems in the clinic, and understanding of strengths and limitations leading to self-improvement and increased efficiency and productivity. Conclusion IPC/IPE had a compelling, powerful, and positive impact according to the experience of the participating dental students. It is recommended that a standardized curriculum be designed and guidelines set for IPC/IPE at dental institutions for effective interactions among students of all stages.
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Affiliation(s)
- Mohammed A. AlSarhan
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Razan S. Alaqeely
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Shoaib Ahmedani
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Reham N. AL Jasser
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Dalal H. Alotaibi
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Saleh S. Aloraini
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Syed R. Habib
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia,Corresponding address: Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
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Meeker D, Friedberg MW, Knight TK, Doctor JN, Zein D, Cayasso-McIntosh N, Goldstein NJ, Fox CR, Linder JA, Persell SD, Dea S, Giboney P, Yee HF. Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial. J Gen Intern Med 2022; 37:1400-1407. [PMID: 34505234 PMCID: PMC8428492 DOI: 10.1007/s11606-021-07002-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health system rapidly adapts to multiple new practices and communication tools, new mechanisms to measure and improve performance in this context are needed. OBJECTIVE To test whether feedback comparing physicians to top performing peers using co-specialists' ratings improves performance. DESIGN Cluster-randomized controlled trial PARTICIPANTS: Eighty facility-specialty clusters and 214 clinicians INTERVENTION: Providers in the feedback arms were sent messages that announced their membership in an elite group of "Top Performers" or provided actionable recommendations with feedback for providers that were "Not Top Performers." MAIN MEASURES The primary outcomes were changes in peer ratings in the following performance dimensions after feedback was received: (1) elicitation of information from primary care practitioners; (2) adherence to institutional clinical guidelines; (3) agreement with peer's medical decision-making; (4) educational value; (5) relationship building. KEY RESULTS Specialists showed significant improvements on 3 of the 5 consultation performance dimensions: medical decision-making (odds ratio 1.52, 95% confidence interval 1.08-2.14, p<.05), educational value (1.86, 1.17-2.96) and relationship building (1.63, 1.13-2.35) (both p<.01). CONCLUSIONS The pandemic has shed light on clinicians' commitment to professionalism and service as we rapidly adapt to changing paradigms. Interventions that appeal to professional norms can help improve the efficacy of new systems of practice. We show that specialists' performance can be measured and improved with feedback using aspirational norms. TRIAL REGISTRATION clinicaltrials.gov NCT03784950.
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Affiliation(s)
- Daniella Meeker
- Department of Population and Public Health Sciences, University of Southern California, 2250 Alcazar St, Los Angeles, CA, 90033, USA.
| | - Mark W Friedberg
- Brigham and Women's Hospital, Boston, MA, USA
- Blue Cross Blue Shield of Massachusetts, Boston, MA, USA
| | - Tara K Knight
- Sol Price School of Public Policy & Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Jason N Doctor
- Sol Price School of Public Policy & Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA, USA
| | - Dina Zein
- Department of Population and Public Health Sciences, University of Southern California, 2250 Alcazar St, Los Angeles, CA, 90033, USA
| | | | - Noah J Goldstein
- Anderson School of Management, University of California, Los Angeles, Los Angeles, USA
| | - Craig R Fox
- Anderson School of Management, University of California, Los Angeles, Los Angeles, USA
| | - Jeffrey A Linder
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephen D Persell
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stanley Dea
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Paul Giboney
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Hal F Yee
- Los Angeles County Department of Health Services, Los Angeles, CA, USA
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Truong AT, Winman T, Ekström-Bergström A. Studying intraprofessional and interprofessional learning processes initiated by an educational intervention applying a qualitative design with multimethod approach: a study protocol. BMJ Open 2022; 12:e058779. [PMID: 35437255 PMCID: PMC9016398 DOI: 10.1136/bmjopen-2021-058779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/24/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Interprofessional collaboration in education and practice has been highlighted as a premise for providing good care. Both the intraprofessional and interprofessional impacts have bearing on healthcare professionals' performance and learning. Likewise, from the perspective of work-integrated learning, intraprofessional and interprofessional learning play an enduring part in studies about the development of healthcare organisations and professional competence. Educational-intervention research has become significant, which may indicate challenges the healthcare, for example, the area of disabilities is confronting. Earlier studies on intraprofessional and interprofessional learning have often focused on the learning outcome, whereas the learning process remains unexplored. The learning process is complex and is normally influenced by several factors. Therefore, develop knowledge about the intraprofessional and interprofessional learning processes initiated by an educational-intervention and the factors influencing this process may contribute to educational-intervention research, which is also the aim of the forthcoming study. METHODS AND ANALYSIS An inductive qualitative study design with interpretivism as the epistemological stand will be applied. Professionals in healthcare services for people with intellectual disabilities in four residential settings in Sweden are included in the educational-intervention based on web-based training and structured group reflections. Intended data collections are videorecordings of group reflections and individual interviews. An ethnomethodological approach will be applied for studying the details of conversation and interaction in group reflections. The interviews will be analysed using qualitative content analysis to gain participants' viewpoints of the intervention. ETHICS AND DISSEMINATION Approval was obtained from the Swedish Ethical Review Authority, Dnr 35 517. In Addition, a supplemental application to the extended part of the intervention in the forthcoming study has been submitted and approval was received on 21 September 2021. Ethical principles following the Declaration of Helsinki will be strictly followed. TRIAL REGISTRATION NUMBER NCT03390868; Post-results.
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Affiliation(s)
- Anh Thuc Truong
- Department of Health Science, University West, Trollhattan, Sweden
| | - Thomas Winman
- Department of Economy and IT, University West, Trollhattan, Sweden
| | - Anette Ekström-Bergström
- Department of Health Science, University West, Trollhattan, Sweden
- Research Group Family Centerd Health (FamCeH), University of Skövde, Skovde, Sweden
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Looman N, van Woezik T, van Asselt D, Scherpbier‐de Haan N, Fluit C, de Graaf J. Exploring power dynamics and their impact on intraprofessional learning. MEDICAL EDUCATION 2022; 56:444-455. [PMID: 34841565 PMCID: PMC9300127 DOI: 10.1111/medu.14706] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND During postgraduate training, considerable efforts for intraprofessional education are in place to prepare primary care residents (PC residents) and medical specialty residents (MS residents) for intraprofessional collaboration (intraPC). Power dynamics are inherently present in such hierarchical medical contexts. This affects intraPC (learning). Yet little attention has been paid to factors that impact power dynamics. This study aims to explore power dynamics and their impact on intraPC learning between PC residents and MS residents during hospital placements. METHODS This study expands on previously published ethnographic research investigating opportunities and barriers for intraPC learning among residents in five Dutch hospitals. We analysed transcripts of observations and in-depth interviews using template analysis. A critical theory paradigm was employed. Discourse analysis additionally informed the data. RESULTS We defined five interrelated themes that describe characteristics of power dynamics in intraPC learning during hospital placements: beliefs; power distribution; interaction style; subjection; and fearless learning. Power dynamics operate both within and between the themes: power distribution between PC residents, MS residents and MS supervisors seemed to be an attribution affected by underlying beliefs about professional norms or about other professions; beliefs influenced the way PC residents, MS residents and MS supervisors interacted; power distribution based on inequity could lead to subjection of PC residents; power distribution based on equity could lead to fearless learning; and open interactions enabled fearless intraPC learning. CONCLUSIONS Power dynamics have an impact on intraPC learning among residents in hospitals. Constructive power dynamics occur when power distribution is based on equity, combined with sincere open interactions, actively inviting each other into discussions and enlisting the support of MS supervisors to foster fearless learning. This can be achieved by creating awareness of implicit beliefs and making them explicit, recognising interaction that encourages intraPC learning and creating policies that support fearless intraPC learning.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | - Tamara van Woezik
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Nynke Scherpbier‐de Haan
- Department of General Practice and Elderly CareUniversity Medical Centre GroningenThe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenThe Netherlands
| | - Jacqueline de Graaf
- Department of Internal MedicineRadboudumc Health AcademyNijmegenThe Netherlands
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Teheux L, Coolen EHAJ, Draaisma JMT, de Visser M, Scherpbier-de Haan ND, Kuijer-Siebelink W, van der Velden JAEM. Intraprofessional workplace learning in postgraduate medical education: a scoping review. BMC MEDICAL EDUCATION 2021; 21:479. [PMID: 34493263 PMCID: PMC8424991 DOI: 10.1186/s12909-021-02910-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/22/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND Residents need to be trained across the boundaries of their own specialty to prepare them for collaborative practice. Intraprofessional learning (i.e. between individuals of different disciplines within the same profession) has received little attention in the postgraduate medical education literature, in contrast to the extensive literature on interprofessional learning between individuals of different professions. To address this gap, we performed a scoping review to investigate what and how residents learn from workplace-related intraprofessional activities, and what factors influence learning. METHODS The PRISMA guidelines were used to conduct a scoping review of empirical studies on intraprofessional workplace learning in postgraduate medical education published between 1 January 2000 to 16 April 2020 in Pubmed, Embase, PsycINFO, ERIC and Web of Science. This study applied 'best fit' framework-based synthesis to map the existing evidence, using the presage-process-product (3P) model developed by Tynjälä (2013). RESULTS Four thousand three hundred thirty records were screened, and 37 articles were included. This review identified influencing (presage) factors that derived from the sociocultural environment, learner and learning context. Studies described that complexity of care can both facilitate and hinder learning. Furthermore, intraprofessional learning is threatened by professional stereotyping and negative perceptions, and awareness of learning opportunities and explicit reflection are critical in intraprofessional workplace learning. Studies described a range of informal and formal intraprofessional activities (process) under the headings of collaboration in clinical practice, rotations or placements, formal educational sessions and simulated workplace training. In general, learners responded well and their attitudes and perceptions improved, learners reported increased knowledge and skills and positive behavioural changes (product). Learning outcomes were reported in the domains of patient-centred care, collaborative attitudes and respect, mutual knowledge and understanding, collaborative decision making, communication, leadership, teamwork and reflexivity. CONCLUSIONS This review gives insight into the high learning potential of intraprofessional activities. Many of the included studies relied on self-reported perceptions of change, therefore, future research should focus on generating more robust evidence including objectively examined outcome measures. This review offers a comprehensive overview of the factors that influence intraprofessional workplace learning in postgraduate medical education. Finally, we provide recommendations for enhancing intraprofessional learning in clinical practice.
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Affiliation(s)
- Lara Teheux
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Ester H A J Coolen
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos M T Draaisma
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke de Visser
- Department of Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nynke D Scherpbier-de Haan
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wietske Kuijer-Siebelink
- Department of Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Janiëlle A E M van der Velden
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Meijer LJ, de Groot E, Honing-de Lange G, Kearney G, Schellevis FG, Damoiseaux RAMJ. Transcending boundaries for collaborative patient care. MEDICAL TEACHER 2021; 43:27-31. [PMID: 32767903 DOI: 10.1080/0142159x.2020.1796947] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Dutch general practitioners (GPs) and medical specialists (MSs) create collaborative patient care agreements (CPCAs) to improve intraprofessional collaboration. We set out to identify contradictions between the activity systems of primary and secondary care that could result in expansive learning and new ways of working collaboratively. We analysed nineteen semi-structured interviews using activity theory (AT) as a theoretical framework and using these two activity systems as the units of analysis. There were contradictions within and between the activity systems related, for example, to different understandings of 'care' in generalist and specialist settings. GPs and MSs were able to identify contradictions and learn expansively when they iteratively co-created CPCAs in groups. They found it much harder to tackle contradictions, however, when they disseminated these tools within their respective professional communities, leaving unresolved contradictions and missed opportunities for collaboration. This research shows the educational benefits of taking collective responsibility for improving collaborative patient care.
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Affiliation(s)
- Loes J Meijer
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Esther de Groot
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Gerdine Honing-de Lange
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - Grainne Kearney
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | - François G Schellevis
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roger A M J Damoiseaux
- Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
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14
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Looman N, Fluit C, van Wijngaarden M, de Groot E, Dielissen P, van Asselt D, de Graaf J, Scherpbier‐de Haan N. Chances for learning intraprofessional collaboration between residents in hospitals. MEDICAL EDUCATION 2020; 54:1109-1119. [PMID: 32564390 PMCID: PMC7754101 DOI: 10.1111/medu.14279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 05/13/2023]
Abstract
CONTEXT Intraprofessional collaboration (intraPC) between primary care (PC) doctors and medical specialists (MSs) is becoming increasingly important. Patient safety issues are often related to intraPC. In order to equip doctors well for their task of providing good quality and continuity of care, intraPC needs explicit attention, starting in postgraduate training. Worldwide, PC residents undertake a hospital placement during their postgraduate training, where they work in proximity with MS residents. This placement offers the opportunity to learn intraPC. It is yet unknown whether and how residents learn intraPC and what barriers to and opportunities for exist in learning intraPC during hospital placements. METHODS We performed an ethnographic non-participatory observational study in three emergency departments and three geriatric departments of five hospitals in the Netherlands. This was followed by 42 in-depth interviews with the observed residents and supervisors. The observations were used to feed the questions for the in-depth interviews. We analysed the interviews iteratively following the data collection using template analysis. RESULTS Hospital wards are rich in opportunities for learning intraPC. These opportunities, however, are seldom exploited for various reasons: intraPC receives limited attention when formulating placement goals, so purposeful learning of intraPC hardly takes place; residents lack awareness of the learning of intraPC; MS residents are not accustomed to searching for expertise from PC residents; PC residents adapt to the MS role and they contribute very little of their PC knowledge, and power dynamics in the hospital department negatively influence the learning of intraPC. Therefore, improvements in mindset, professional identity and power dynamics are crucial to facilitate and promote intraPC. CONCLUSIONS Intraprofessional collaboration is not learned spontaneously during hospital placements. To benefit from the abundant opportunities to learn intraPC, adjustments to the set-up of these placements are necessary. Learning intraPC is promoted when there is a collaborative culture, hierarchy is limited, and there is dedicated time for intraPC and support from the supervisor.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenthe Netherlands
| | - Marielle van Wijngaarden
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
- Department of Geriatric MedicineRadboudumcNijmegenthe Netherlands
| | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Patrick Dielissen
- Department of Primary and Community CareRadboudumcNijmegenthe Netherlands
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15
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Trauma Teams That Train as One Work as One: Invasive Procedure Training in Residency Education. J Surg Res 2020; 254:142-146. [PMID: 32445929 DOI: 10.1016/j.jss.2020.04.007] [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: 01/09/2020] [Revised: 03/13/2020] [Accepted: 04/11/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Invasive surgical procedures occur infrequently in an emergency department setting; however, procedural competence is expected from trauma residents. Emergent procedures are challenging to train in a formal manner because of the urgent nature when they present. To supplement education, new and creative teaching tools such as simulation and multidisciplinary training are being used. Our study organized a multidisciplinary simulated learning workshop with surgery and emergency medicine residents for invasive, emergent procedures. MATERIALS AND METHODS In total, 14 surgical and 36 emergency medicine residents at our institution participated in a simulated learning experience. Ten workshops were organized, with six to seven residents participating in each session. Using a human cadaveric model, all residents were taught by senior-level residents and attendings from both specialties on how to perform uncommonly or anatomically challenging emergent invasive procedures. A pre- and post-laboratory survey was completed by all the residents to assess confidence in performing each of the 13 procedures. RESULTS All residents (N = 50), who participated in the study, completed pre- and post-laboratory surveys. Comparison of the pre- and post-laboratory confidence levels indicated significant increases in confidence in performing all procedures. Residents stated that this multidisciplinary approach to education in a controlled setting was helpful and fostered a collaborative relationship between both specialties. CONCLUSIONS Although some surgical procedures remain uncommon in the emergency department, competency is nevertheless expected for appropriate patient care. Using a collaborative simulation-based cadaver laboratory to teach emergent procedures significantly improved residents' confidence while concurrently fostering professional relationships.
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Boeckxstaens P, Brown JB, Reichert SM, Smith CNC, Stewart M, Fortin M. Perspectives of specialists and family physicians in interprofessional teams in caring for patients with multimorbidity: a qualitative study. CMAJ Open 2020; 8:E251-E256. [PMID: 32253205 PMCID: PMC7144580 DOI: 10.9778/cmajo.20190222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value of bringing physicians together across the boundaries of health care settings. METHODS This was a descriptive qualitative, interview-based study. Physicians who had previously participated in the Telemedicine Interprofessional Model of Practice for Aging and Complex Treatments (Telemedicine IMPACT Plus [TIP] Program) were invited to participate and asked to describe their experience of being a member of the program. Interviews were conducted from March to May 2016. We conducted an iterative and interpretive process using both individual and team analysis to identify themes. RESULTS There were 15 participants, 9 specialists and 6 family physicians. Three themes emerged in the analysis: creating new perspectives on care for patients with multimorbidity by sharing knowledge, skills and attitudes; the shift from a consultant model to an interprofessional team model (allowing a window into the community, extending discussions beyond the medical model and focusing on the patient's health in context); and opportunities for learners, including learning about interprofessional collaboration and gaining exposure to a real-world model for caring for people with multimorbidity in outpatient settings. INTERPRETATION Family physicians and specialists participating in a TIP Program believed the program improved their knowledge and skills, while also serving as an effective care delivery strategy. The findings also support that learners require more exposure to nontraditional consultant models in order to care for patients with multimorbidity effectively.
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Affiliation(s)
- Pauline Boeckxstaens
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.
| | - Judith Belle Brown
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Sonja M Reichert
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Christopher N C Smith
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Moira Stewart
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Martin Fortin
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
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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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18
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Janssen M, Sagasser MH, Laro EAM, de Graaf J, Scherpbier-de Haan ND. Learning intraprofessional collaboration by participating in a consultation programme: what and how did primary and secondary care trainees learn? BMC MEDICAL EDUCATION 2017; 17:125. [PMID: 28724408 PMCID: PMC5517789 DOI: 10.1186/s12909-017-0961-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/10/2017] [Indexed: 05/09/2023]
Abstract
BACKGROUND A growing number of patients require overview and management in both primary and secondary care. This situation requires that primary and secondary care professionals have well developed collaborative skills. While knowledge about interprofessional collaboration and education is rising, little is known about intraprofessional collaboration and education between physicians of various disciplines. This study examines a newly developed consultation programme for trainees in general practice and internal medicine to acquire intraprofessional collaboration skills. METHODS Focus groups were conducted with trainees and their supervisors and mentors to explore what and how the trainees learned by participating in the consultation programme. RESULTS Trainees reported that they gained knowledge about and skills in collaboration and consultation they could not have gained otherwise. Furthermore, the programme gave the opportunity to gain other competencies relevant for becoming the medical expert trainees they are expected to be. Learning outcomes were comparable to those described in interprofessional education literature. Interaction, by meeting each other and by discussing cases with mentors or supervisors, appeared to be a key factor in the learning process. Meetings, discussing preconceptions and enthusiasm of the mentors and supervisors facilitated the learning. Technical problems and lack of information hampered the learning. These influencing factors are important for future development of intraprofessional learning programmes. CONCLUSIONS Participants in an innovative consultation programme for GP- and IM-trainees reported that they acquired consultation and collaboration skills they could not have gained otherwise. Interaction appeared to be an important factor in the learning process. The findings of this study can inform developers of intraprofessional education programmes between primary and secondary care trainees.
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Affiliation(s)
- Marijn Janssen
- Department of Internal Medicine, Radboud University Medical Centre, Post box 9101, 6500 HB Nijmegen, the Netherlands
| | - Margaretha H. Sagasser
- Department of Primary and Community care, Radboud University Medical Centre, Post box 9101, 6500 HB Nijmegen, Nijmegen, the Netherlands
- National postgraduate training programme in general practice, Post box 20072, 3502 LB, Utrecht, the Netherlands
| | - Elisabeth A. M. Laro
- Department of Primary and Community care, Radboud University Medical Centre, Post box 9101, 6500 HB Nijmegen, Nijmegen, the Netherlands
| | - Jacqueline de Graaf
- Department of Internal Medicine, Radboud University Medical Centre, Post box 9101, 6500 HB Nijmegen, the Netherlands
| | - Nynke D. Scherpbier-de Haan
- Department of Primary and Community care, Radboud University Medical Centre, Post box 9101, 6500 HB Nijmegen, Nijmegen, the Netherlands
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Tani K, Okura Y, Tabata R, Yuasa S, Kawaminami S, Nakanishi Y, Kawahito K, Inaba K, Inaba K, Kageji T, Tanaka H, Suzuki Y, Yamaguchi H. Characteristics of medical students who would like to be a generalist physician and contribute to remote area medicine. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 64:210-216. [DOI: 10.2152/jmi.64.210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kenji Tani
- Department of General Medicine, Institute of Biomedical Sciences, the University of Tokushima Graduate School
| | | | - Ryo Tabata
- Department of General Medicine, Institute of Biomedical Sciences, the University of Tokushima Graduate School
| | | | - Shingo Kawaminami
- Department of General Medicine, Institute of Biomedical Sciences, the University of Tokushima Graduate School
| | - Yoshinori Nakanishi
- Department of General Medicine, Institute of Biomedical Sciences, the University of Tokushima Graduate School
| | | | | | | | | | - Hiroki Tanaka
- Fifth year student, the University of Tokushima Faculty of Medicine
| | - Yoshihiro Suzuki
- Department of General Medicine, Institute of Biomedical Sciences, the University of Tokushima Graduate School
| | - Harutaka Yamaguchi
- Department of General Medicine, Institute of Biomedical Sciences, the University of Tokushima Graduate School
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