Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education

Peer Learning Has Double Effects in Clinical Research Education: A Qualitative Study

Background

Peer learning has been recognized for its effectiveness in health professional education. However, its effects on clinical research education are not clear and were explored qualitatively in this study.

Methods

The peer-learning method was implemented in a clinical research education seminar for early-career physicians at a children's and mothers' hospital in 2019. We conducted semistructured interviews with participants about peer-learning experience and qualitatively analyzed verbatim transcripts using Engeström's "activity theory" framework.

Results

From framework analysis, learning processes were extracted mainly in four domains, namely, (a) instrument and its usage: research design and its match with research question, (b) outcome: research result, (c) community: seminar, and (d) division of labor: roles of participants and staff.

Conclusions

In this report of a peer-learning trial in postgraduate clinical research education, the following two pathways of peer-learning effects were abstracted. The indirect pathway was the presentations by experienced participants providing concrete examples of research processes. The direct pathway was the questions from experienced participants to beginners about specific and concrete questions. There were also two points to consider in peer learning in clinical research education: gaps in premise knowledge and beginners' frustration about expected outcomes. We believe that these extracted pathways and points imply the significance and considerations for continuing the peer-learning trial in clinical research education. Future tasks are to promote clinical research education with a view to the learning effects, not only on individuals, but also on groups.

Using cultural historical activity theory to understand how post-graduate residents perform discharge planning at a medical center in Taiwan

BACKGROUND

Despite the importance of discharge planning in physicians' education, currently in most countries, no identical training is provided. Difficulties in promoting physician discharge planning education in Taiwan are still noted. This study aims to find the physicians' role of discharge planning training in educating post graduate year residents (PGY) in Taiwan.

MATERIALS AND METHODS

We took advantage of government and hospital policies that promote the discharge planning program to teach and implement it, beginning with PGY residents by incorporating it into their training program. We recruited 30 PGY residents who were attending their three-month general internal medicine training from 2018 to 2019. They were interviewed at the end of the program using cultural-historical activity theory (CHAT). Qualitative research methods were used to further understand how discharge planning and care was implemented.

RESULTS

Trainees initially believed that they did not have any role in discharge planning. Using the cycle of expansive learning, we found that the role of physicians in discharge planning was unclear. There were still some inconsistencies in the teaching and implementation of the discharge planning program for PGY residents that needed to be resolved, but this study also let participants learn through practice to improve their identification of discharge planning.

CONCLUSIONS

This study analyzed the impact of a discharge planning program for PGY physicians in Taiwan. It showed that the program affected physicians' practice and medical education, although some contradictions remain.

Cultural historical activity and the complexity of health professions education

Commenting on Hu et al., Grainger and Gladman comment on how the purpose of student‐led community learning can change focus from the development of technical and professional skills to the aspirations and goals of the community in which students work.