Exploring workplace-based learning in distributed healthcare settings: a qualitative study

BACKGROUND

Distributed healthcare settings such as district hospitals, primary care, and public health facilities are becoming the real-life settings for workplace-based learning required to educate the future healthcare workforce. Therefore, a major focus should be on designing and developing workplace-based learning in these learning environments. Healthcare professionals and educational policymakers play a significant role in these settings as role models in workplace-based learning, and as leaders in integrating learning into their work environments. It is relevant to explore their beliefs, attitudes, and behaviors towards workplace-based learning in their own settings, in order to provide context-relevant recommendations that can assist in shaping workplace-based learning environments.

METHODS

We used individual interviews to understand professionals' experiences with workplace-based learning in distributed healthcare settings. We - three clinicians, an educationalist, and a philosopher - thematically analyzed transcripts of 13 interviews with healthcare professionals and educational policymakers from different healthcare settings who were involved in the clinical phase of undergraduate medical education.

RESULTS

Clustering and categorizing of the data led to the construction of five overarching themes: Identification with and attitude towards medical education, Sense of ownership, Perceived time and space, Mutual preconceptions and relations, and Curriculum for a changing profession.

CONCLUSIONS

These themes accentuate aspects relevant to the development of workplace-based learning in distributed healthcare settings on the individual, team, or organizational level. We highlight the significance of individual professionals in the development of workplace-based learning and emphasize the need for recognition and support for those occupying the 'broker' role at the intersection of education and practice. For future research and educational practice, we recommend prioritizing initiatives that build on good-practices in workplace-based learning and involve dedicated individuals in distributed healthcare settings.

Modelling the sustainability of a primary school digital education curricular reform and professional development program

Sustaining changes in teachers' practices is a challenge that determines the success of curricular reforms, from which Digital Education (DE) is not exempt. As the literature on sustainability is considered "scarce" and "scattered", long-term studies modelling the factors impacting teachers' sustained uptake of DE pedagogical content are lacking. Thus, we investigate whether and how 287 in-service teachers sustained a primary school DE curricular reform over a year after they completed their two-year DE professional development program. We model the sustainability of the reform through Structural Equation Modelling, and identify critical sustainability-factors. The validated Sustainable Adoption of Digital Education (SADE) model confirms that sustainability in the fourth year of the reform depends on perceived usefulness of teaching the new content, ease of implementation, and access to sufficient support in schools. Such factors should thus be evaluated, accounted for in the implementation phase of the reform, and sustained over time. The findings confirm that the DE curricular reform model contributes to positive self-efficacy to teach DE, provides sufficient in-school support, and promotes increasing adoption over time. However, as teachers' practices have not yet stabilised, and teachers may still adopt more to cover the breadth of DE-concepts, it is important to remain attentive to remaining sustainability barriers: lack of time, effort required to teach DE with teachers preferring to delegate, and lack of student-learning evidence, the latter being a significant challenge to address in the literature. These barriers must therefore be jointly addressed by researchers and practitioners in the field in order to promote the sustainability of the reform.

Medical undergraduates' self-evaluation: before and after curriculum reform

BACKGROUND

In 2013, Taiwan launched a curriculum reform-the 7-year undergraduate medical education program was shortened to 6 years. This study explored the evaluation results from students regarding the curriculum reform and investigated graduates' perceptions regarding the curriculum organization of the two academic training programs affected by this curricular reform.

METHODS

A cross-sectional survey was conducted from May 14 to June 12, 2019. The 315 graduates from both the 7-year and 6-year curriculum programs in the same medical school in Taipei were invited to participate in this study. In total, 197 completed questionnaires were received, representing a response rate of 62.5%. The results of the principal component analysis confirmed the validity of the constructs employed in this self-administered questionnaire.

RESULTS

The t-test results yielded two main findings. First, the graduates from the 6-year program had significantly lower scores for preparedness for the upcoming postgraduate-year residency training than did their 7-year program counterparts. Additionally, the male graduates had significantly higher scores in terms of perceptions regarding curriculum organization and preparedness for postgraduate-year residency training than the female graduates. The results of stepwise regression also indicated that the sex difference was significantly correlated with graduates' readiness for their postgraduate-year residency training.

CONCLUSION

To avoid sex disparities in career development, a further investigation of female medical students' learning environment and conditions is necessary. In addition to the cross-sectional study of students' perceptions, further repeated measurements of the objective academic or clinical performance of graduates in clinical settings are desirable.

Comparison of OSCE performance between 6- and 7-year medical school curricula in Taiwan

BACKGROUND

The year 2013 marks a watershed in the history of medical education in Taiwan. Following Taiwan's Taskforce of Medical School Curriculum Reform recommendations, the medical school curriculum was reduced from 7 to 6 years. This study aimed to analyze the impact of medical school curriculum reform on medical students' performance in objective structured clinical examinations (OSCEs).

METHODS

We retrospectively analyzed the OSCE records at Taipei Veterans General Hospital (Taipei VGH), one of Taiwan's largest tertiary medical centers, between November 2016 and July 2020. The eligibility criteria were medical students receiving a full one-year clinical sub-internship training at Taipei VGH and in their last year of medical school. All medical students received a mock OSCE-1 at the beginning of their sub-internship, a mock OSCE-2 after six months of training, and a national OSCE at the end of their sub-internship. The parameters for performance in OSCEs included "percentage of scores above the qualification standard" and "percentage of qualified stations."

RESULTS

Between November 2016 and July 2020, 361 undergraduates underwent clinical sub-internship training at Taipei VGH. Among them, 218 were taught under the 7-year curriculum, and 143 were instructed under the 6-year curriculum. Based on baseline-adjusted ANCOVA results, medical students under the 7-year curriculum had a higher percentage of scores above the qualification standard than those under the 6-year curriculum at the mock OSCE-1 (7-year curriculum vs. 6-year curriculum: 33.8% [95% CI 32.0-35.7] vs. 28.2% [95% CI 25.9-30.4], p < 0.001), and mock OSCE-2 (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 87.4-91.4] vs. 84.0% [95% CI 81.5-86.4], p = 0.001). Moreover, medical students in the 7-year curriculum had a higher percentage of qualified stations in mock OSCE-1 (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 87.4-91.4] vs. 84.0% [95% CI 81.5-86.4], p = 0.001) and mock OSCE-2 (7-year curriculum vs. 6-year curriculum: 91.9% [95% CI 90.1-93.8] vs. 86.1% [95% CI 83.8-88.3], p = 0.001). After clinical sub-internship training, there were no differences in the percentage of scores above the qualification standard (7-year curriculum vs. 6-year curriculum: 33.5% [95% CI 32.2-34.9] vs. 34.6 [95% CI 32.9-36.3], p = 0.328) and percentage of qualified stations (7-year curriculum vs. 6-year curriculum: 89.4% [95% CI 88.1-90.7] vs. 90.2% [95% CI 88.6-91.8], p = 0.492).

CONCLUSIONS

At the beginning of the sub-internship, medical students under the 7-year curriculum had better OSCE performance than those under the 6-year curriculum. After the clinical sub-internship training in Taipei VGH, there was no difference in the national OSCE score between the 6- and 7-year curricula. Our study suggests that clinical sub-internship is crucial for the development of clinical skills and performance in the national OSCE.

Unintended Consequences? Assessing the Impact of Curricular Change on Medical Student Participation in a Student-Run Free Clinic

INTRODUCTION

In a prior qualitative study of the impact of a new (ACE) medical school curriculum, students and faculty reported decreased participation in the student-run free clinic (SRFC) attributed to more intensive scheduling and more frequent testing compared to the previous (Legacy) curriculum.

MATERIALS AND METHODS

To verify and understand this perception formed during curriculum reform, we conducted a mixed method study to measure student participation in the SRFC before and after curricular change and assessed student beliefs and motivations about SRFC participation using focus groups.

RESULTS

Overall SRFC participation did not decrease among students in the ACE cohort following curriculum change. Additionally, both Legacy and ACE groups showed lower participation during test weeks, but the decrease was not significantly different between the ACE and Legacy cohorts. Focus groups confirmed the pervasive misbelief that SRFC participation was indeed lower among ACE students and attributed to reduced student discretionary time plus increased preparation time for frequent testing. Focus groups also revealed several "values" about volunteering at the SRFC which should be endorsed and promoted by schools considering curricular change. Participants valued the SRFC for educational items that were most effectively taught in the SRFC, notably social determinants of health, interprofessional practice, and interviewing with medical interpreters. They also valued the SRFC for professional validation, opportunities to apply course content, practice clinical skills, form important professional relationships, and provide community service.

CONCLUSIONS

Our findings validate the value of SRFC experience as reported by students and demonstrate that, contrary to misbeliefs, participation was not negatively impacted by curricular reform.

The Fallacy of Teaching and the Illusion of Learning: Improving Articulation of Basic Science in the Medical School Curriculum

Despite calls from educators to re-engineer how faculty deliver medical student curricula with integrated basic science concepts, this content is still frequently disarticulated from other curricular components. We renewed our curriculum using evidence-based pedagogical and cognitive learning strategies to interleave basic science across the 4-year curriculum.

Comparing Curricular Reform in Medical Schools and the Ship of Theseus: Insights Regarding Philosophical and Ideological Characteristics

Most of the curricular reforms are either imprecise, lacking appropriate contextualization or keen in "lifting" the solution from one context and fixing it in some other context. The greatest obstacle for curricular reform is something intrinsic [philosophical and ideological] and related to the general disposition of educators to resist the change and love status quo. We would like to put forth that viewing reforms under these lenses is the ultimate requirement and when winds of reform begin to blow in curriculum, definitely it would become unstoppable and one reform would give birth to the necessity for other reform. This commentary intends to discuss the under emphasized intricacies related to curricular reform by comparing it with analogy of "The Ship of Theseus."

Curriculum reform: Why? What? How? and how will we know it works?

In a recent IJHPR article, Dankner et al. describe a reform in one longitudinal strand within Basic Medical Education i.e.“ public health and preventive medicine curriculum” using a Competency Based Medical Education approach. This reform raises several concerns: What should prompt a medical school to change a curriculum? How should such change be conducted? What kinds of paradigms may inform such a change? What constitutes a success in a curricular reform? And, how can curricular reform be evaluated within a reasonable time framework?

This commentary addresses these concerns and concludes that curricular reform should follow as much as possible the current wisdom of educational innovation and change strategy, follow a clear vision, mission, and selected educational paradigm, and pay attention to stakeholders, context, culture and politics. The design should allow for the emergence of unintended consequences. Implementation needs careful planning and monitoring and the evaluation should be multi-faceted. Finally, since all Israeli medical schools are now using the Competency Based Medical Education approach and aligning their curricula and testing accordingly, a fascinating collaborative opportunity exists to professionalize this process and hopefully make a positive impact.

How are competency frameworks perceived and taught? : An exploratory study in the context of pharmacy education

INTRODUCTION

Faculties of Pharmacy worldwide have to adapt their curriculum to accreditation criteria. The present study explored how the Association of Faculties of Pharmacy of Canada's (AFPC's) 2010 Educational Outcomes are perceived and taught at the Leslie Dan Faculty of Pharmacy (LDFP). These outcomes were adapted from the CanMeds Physician Competency Framework which describes both medical expert and non-expert roles.

METHODS

We wondered if pharmacy would struggle, as medicine has, to integrate these roles into curricula in meaningful ways, given the absence of previous studies from Pharmacy. We conducted an exploratory interview study with 10 core faculty members in charge of courses where non-expert roles were taught. Data were analysed using conventional content analysis.

RESULTS

Faculty members understood that the AFPC Outcomes are important for students, patients, and the profession of pharmacy, and some saw the roles as knowledge-based and teachable using content from academic disciplines. However, most saw them as skills taught informally or through clinical experience. They used the roles as a framing device to legitimize their course content and relied on informal role modelling to do most of the teaching. The few faculty members who taught content related to these roles had postgraduate education in a social science or humanities discipline.

DISCUSSION

Similar to studies of Faculties of Medicine, our study highlights the difficulty of translating a role-based, competency framework into concrete, integrated curricula for students. Competency development should be explicitly embedded into the curriculum and cannot be left to individual instructors.

Ophthalmology Teaching-Learning in Undergraduate Classes: Roadblocks and The Remedies

The curriculum needs to run apace with the changing morbidity pattern and social needs. Teaching methodology requires constant evolution. With a static curriculum and teaching methods undergraduate ophthalmology proves difficult for many students. This article briefly analyses the ophthalmology curriculum, highlights the problems of teaching and offers some solutions.