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Verhees MJM, Landstra AM, Engbers R, Koksma JJ, Laan RFJM. Exploring workplace-based learning in distributed healthcare settings: a qualitative study. BMC Med Educ 2024; 24:78. [PMID: 38254144 PMCID: PMC10804752 DOI: 10.1186/s12909-024-05053-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
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.
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Affiliation(s)
- Myrthe J M Verhees
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands.
| | - Anneke M Landstra
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands
- Rijnstate, Arnhem, the Netherlands
| | - Rik Engbers
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands
| | - Jur J Koksma
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands
| | - Roland F J M Laan
- Radboudumc Health Academy, Radboudumc, Gerard van Swietenlaan 2, Nijmegen, 6525 GB, the Netherlands
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Verhees MJM, Engbers R, Landstra AM, Bremer AE, van de Pol M, Laan RFJM, Assendelft WJJ. Workplace-based learning about health promotion in individual patient care: a scoping review. BMJ Open 2023; 13:e075657. [PMID: 37963689 PMCID: PMC10649380 DOI: 10.1136/bmjopen-2023-075657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVE To outline current knowledge regarding workplace-based learning about health promotion in individual patient care. DESIGN Scoping review. DATA SOURCES PubMed, ERIC, CINAHL and Web of Science from January 2000 to August 2023. ELIGIBILITY CRITERIA We included articles about learning (activities) for healthcare professionals (in training), about health promotion in individual patient care and in the context of workplace-based learning. DATA EXTRACTION AND SYNTHESIS The studies were evaluated using a charting template and were analysed thematically using a template based on Designable Elements of Learning Environments model. RESULTS From 7159 studies, we included 31 that described evaluations of workplace-based learning about health promotion, around a variety of health promotion topics, for different health professions. In the articles, health promotion was operationalised as knowledge, skills or attitudes related to specific lifestyle factors or more broadly, with concepts such as health literacy, advocacy and social determinants of health. We assembled an overview of spatial and instrumental, social, epistemic and temporal elements of learning environments in which health promotion is learnt. CONCLUSIONS The studies included in our analysis varied greatly in their approach to health promotion topics and the evaluation of learning outcomes. Our findings suggest the importance of providing opportunities for health profession learners to engage in authentic practice situations and address potential challenges they may experience translating related theory into practice. Additionally, our results highlight the need for conscious and articulated integration of health promotion in curricula and assessment structures. We recommend the exploration of opportunities for health profession students, professionals and patients to learn about health promotion together. Additionally, we see potential in using participatory research methods to study future health promotion learning. STUDY REGISTRATION Open Science Framework, https://doi.org/10.17605/OSF.IO/6QPTV.
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Affiliation(s)
| | - Rik Engbers
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
| | - Anneke M Landstra
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
- Paediatrics, Rijnstate, Arnhem, The Netherlands
| | - Anne E Bremer
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
| | - Marjolein van de Pol
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
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Coolen E, Engbers R, Draaisma J, Heinen M, Fluit C. The use of SBAR as a structured communication tool in the pediatric non-acute care setting: bridge or barrier for interprofessional collaboration? J Interprof Care 2020:1-10. [PMID: 33190546 DOI: 10.1080/13561820.2020.1816936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
SBAR (Situation, Background, Assessment and Recommendation) is a structured method developed for communicating critical information that requires immediate action. In 2016 the SBAR tool was introduced at the Amalia Children's Hospital in the Netherlands to improve communication between healthcare workers. Despite formal training and the introduction of aids to facilitate implementation, observed adherence to the tool was low. A qualitative study was undertaken to study the use of SBAR by pediatric residents and nurses in the non-acute clinical care setting of an academic children's hospital. Semi-structured focus group sessions were conducted and qualitatively analyzed using a constructed coding template to search for facilitators and barriers in the use of SBAR by different professionals. We found professionals' use of SBAR was influenced by departmental, cultural, and individual factors. Important themes for effective implementation and use of SBAR in an interprofessional setting, like situation dependency, learning climate and professional identity had not been addressed during the initial implementation. To facilitate SBAR's use it is important to identify professionals' needs to use the tool effectively, to take into account how tasks and responsibilities are perceived by different professions, and to stimulate interprofessional feedback and role modeling.
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Affiliation(s)
- Ester Coolen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Rik Engbers
- Radboud Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Maud Heinen
- IQ Health Care, Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Cornelia Fluit
- Radboud Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
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de Visser M, Laan RF, Engbers R, Cohen-Schotanus J, Fluit C. Selection as a learning experience: an exploratory study. Adv Med Educ Pract 2018; 9:345-355. [PMID: 29785147 PMCID: PMC5953412 DOI: 10.2147/amep.s164446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Research on selection for medical school does not explore selection as a learning experience, despite growing attention for the learning effects of assessment in general. Insight in the learning effects allows us to take advantage of selection as an inclusive part of medical students' learning process to become competent professionals. The aims of this study at Radboud University Medical Center, the Netherlands, were 1) to determine whether students have learning experiences in the selection process, and, if so, what experiences; and 2) to understand what students need in order to utilize the learning effects of the selection process at the start of the formal curriculum. MATERIALS AND METHODS We used focus groups to interview 30 students admitted in 2016 about their learning experiences in the selection process. Thematic analysis was used to explore the outcomes of the interviews and to define relevant themes. RESULTS In the selection process, students learned about the curriculum, themselves, their relation to others, and the profession they had been selected to enter, although this was not explicitly perceived as learning. Students needed a connection between selection and the curriculum as well as feedback to be able to really use their learning experiences for their further development. DISCUSSION Medical school selection qualifies as a learning experience, and students as well as medical schools can take advantage of this. We recommend a careful design of the selection procedure, integrating relevant selection learning experiences into the formal curriculum, providing feedback and explicitly approaching the selection and the formal curriculum as interconnected contributors to students' development.
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Affiliation(s)
- Marieke de Visser
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roland F Laan
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rik Engbers
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janke Cohen-Schotanus
- Center for Research and Innovation in Medical Education, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
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Engbers R, Fluit CRMG, Bolhuis S, de Visser M, Laan RFJM. Implementing medical teaching policy in university hospitals. Adv Health Sci Educ Theory Pract 2017; 22:985-1009. [PMID: 27853908 PMCID: PMC5579150 DOI: 10.1007/s10459-016-9737-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 11/07/2016] [Indexed: 05/13/2023]
Abstract
Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers' strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher's strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty's use of teaching policy incentives.
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Affiliation(s)
- Rik Engbers
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands.
| | - Cornelia R M G Fluit
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands
| | - Sanneke Bolhuis
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands
| | - Marieke de Visser
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands
| | - Roland F J M Laan
- Department for Research in Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (43), The Netherlands
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Engbers R, Fluit CRMG, Bolhuis S, Sluiter R, Stuyt PMJ, Laan RFJM. Relations between policy for medical teaching and basic need satisfaction in teaching. Adv Health Sci Educ Theory Pract 2015; 20:969-80. [PMID: 25503924 DOI: 10.1007/s10459-014-9575-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 12/06/2014] [Indexed: 05/24/2023]
Abstract
Policy initiatives that aim to elevate the position of medical teaching to that of medical research could influence the satisfaction of three basic psychological needs related to motivation for medical teaching. To explore relations between the satisfaction of three basic psychological needs towards medical teaching and two policy initiatives for medical teaching: (Junior) Principal Lecturer positions [(J)PL positions] and Subsidized Innovation and Research Projects in Medical Education (SIRPMEs). An online questionnaire was used to collect data about medical teaching in the setting of a university hospital. We adapted the Work-related Basic Need Satisfaction scale (Van den Broeck et al. in J Occup Organ Psychol, 83(4):981-1002, 2010), in order to measure feelings of autonomy, competence, and relatedness in teaching. We examined the relations between (J)PL positions and SIRPMEs and the satisfaction of three basic psychological needs. A total of 767 medical teachers participated. The initiatives appear to be related to different beneficial outcomes in terms of feelings of autonomy, competence, and relatedness in medical teaching. Either a (J)PL position is obtained by teachers who feel competent and related towards medical teaching, or obtaining a (J)PL position makes teachers feel more competent and related towards teaching, or these relations could be interacting. Also, either a SIRPME is obtained by teachers who feel competent and autonomous towards medical teaching, or obtaining a SIRPME makes teachers feel more competent and autonomous towards teaching, or these relations could be interacting. Additional research needs to scrutinize the causal or interacting relations further and to determine optimal conditions for these policy initiatives more specifically. Implications for future research are discussed.
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Affiliation(s)
- Rik Engbers
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Cornelia R M G Fluit
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sanneke Bolhuis
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Roderick Sluiter
- Department of Political Science, Nijmegen School of Management, Radboud University, Nijmegen, The Netherlands
| | - Paul M J Stuyt
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Roland F J M Laan
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Engbers R, de Caluwé LIA, Stuyt PMJ, Fluit CRMG, Bolhuis S. Towards organizational development for sustainable high-quality medical teaching. Perspect Med Educ 2013; 2:28-40. [PMID: 23670655 PMCID: PMC3576482 DOI: 10.1007/s40037-013-0043-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Literature shows that faculty development programmes are not organizationally embedded in academic hospitals. This leaves medical teaching a low and informal status. The purpose of this article is to explore how organizational literature can strengthen our understanding of embedding faculty development in organizational development, and to provide a useful example of organizational development with regards to medical teaching and faculty development. Constructing a framework for organizational development from the literature, based on expert brainstorming. This framework is applied to a case study. A framework for organizational development is described. Applied in a context of medical teaching, these organizational insights show the process (and progress) of embedding faculty development in organizational development. Organizational development is a necessary condition for assuring sustainable faculty development for high-quality medical teaching. Organizational policies can only work in an organization that is developing. Recommendations for further development and future research are discussed.
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Affiliation(s)
- Rik Engbers
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Nijmegen Medical Centre, 306 IWOO, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Léon I. A. de Caluwé
- Department of Management & Organization, Faculty of Economics and Business Administration, VU University Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Paul M. J. Stuyt
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Nijmegen Medical Centre, 306 IWOO, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Cornelia R. M. G. Fluit
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Nijmegen Medical Centre, 306 IWOO, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Sanneke Bolhuis
- Department for Evaluation, Quality and Development of Medical Education, Radboud University Nijmegen Medical Centre, 306 IWOO, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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Molenaar WM, Zanting A, van Beukelen P, de Grave W, Baane JA, Bustraan JA, Engbers R, Fick TE, Jacobs JCG, Vervoorn JM. A framework of teaching competencies across the medical education continuum. Med Teach 2009; 31:390-6. [PMID: 19811129 DOI: 10.1080/01421590902845881] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND The quality of teachers in higher education is subject of increasing attention, as exemplified by the development and implementation of guidelines for teacher qualifications at Universities in The Netherlands. AIM Because medical education takes a special position in higher education the Council of Deans of Medical Schools in The Netherlands installed a national task force to explore a method to weigh criteria for teacher qualifications of medical teachers. METHODS A framework was developed covering competencies of teachers throughout the medical education continuum and including medicine, dentistry and veterinary medicine. RESULTS The framework distinguishes 3 dimensions: (a) six domains of teaching (development - organization - execution - coaching - assessment - evaluation); (b) three levels in the organization at which teachers perform (micro, meso and macro level) and (c) competencies as integration of knowledge, skills and attitude and described as behaviour in specific context. The current framework is the result of several cycles of descriptions, feedback from the field and adaptations. It is meant as a guideline, leaving room for local detailing. CONCLUSION The framework provides a common language that may be used not only by teachers and teacher trainers, but also by quality assurance committees, human resource managers and institutional boards.
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Affiliation(s)
- W M Molenaar
- Center for Professional Development of Teachers, Institute of Medical Education, University Medical Center Groningen, Amsterdam, The Netherlands.
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