Learning to interact and interacting to learn: a substantive theory of clinical workplace learning for diverse cohorts

The influence of occupational therapy students' preferred language on academic and clinical performance in a Canadian university program

The Occupational Therapy Program at this Canadian university is a French program however, students must be bilingual to function in English or French clinical fieldwork settings. An understanding of the role of language in successful completion of program requirements was needed to effectively support students' education. The study objectives were to identify the role of linguistic factors in students' academic and clinical performance and to provide recommendations for strategies to address areas of learning difficulty. A multimethod approach used 4 data sources: (1) Multiple Mini Interview (MMI) informal language assessment scores, (2) grade point average (GPA), (3) fieldwork evaluation reports, and (4) an online survey of program graduates. The GPA on admission and MMI scores of 140 students predicted respectively only 20% and 2% of the variation in GPA on program completion. The areas of poorest performance in failed clinical fieldwork reports were in clinical reasoning and communication competencies. Among survey respondents (n = 47), 44.5% reported that a clinical placement in their second language with related charting (51.6%) and client communication (40.9%) were the most significant difficulties encountered in the program. Clients with mental health issues (45.4%) were the most challenging population to work with, attributed to communication barriers in the students' second language. Strategies are proposed to support occupational therapy students' academic and clinical language proficiency, including conversational training courses, problem-based learning activities in students' second language, focussed teaching on the clinical reasoning process and reflective skills, and language coaching to address early signs of difficulty in clinical fieldwork.

Professional socialisation and professional fit: Theoretical approaches to address student learning and teaching in speech-language pathology

Purpose: The sociocultural and historical context and membership of the speech-language pathology (SLP) profession underpins our norms of practice and our discourses. This context also informs and defines the ways that we practice today, including who we legitimise to enter our profession and why. In this paper, we used theory as a tool to critically explore how this socioculturally constituted knowledge and practice influences how students experience learning in SLP practice placements.Method: We used the theory of Legitimate Peripheral Participation (1991) as a conceptual framework to interpret qualitative data from two separate programs of research that had explored the phenomena of student learning in SLP practice placements.Result: The analysis cast light on how our understanding and expectations of SLP students' learning and competency development in placements is recursive and strongly legitimised in our profession. Students adjust to accommodate the professional knowledges, practices and expectations they encounter in their placements. This facilitates the perpetuation of practices proffered by the majority culture.Conclusion: The use of theory allowed us to explore the phenomena of student learning in placements in a new light, which unmasked new understandings of the longstanding challenge to increase diversity in the SLP community.

"Clinical Teachers: Teaching Tips for the Busy Veterinary Team": Reflections on the Development of a Multimodal Resource for Veterinarians and Veterinary Nurses/ Technologists New to Clinical Teaching

Clinical practice-based training/work-integrated learning is an applied, social, and high-impact element of the veterinary curriculum. Within this context, students are learning on the job with clinician-educators who are carrying out their professional duties at the same time as supporting learning. To equip clinician-educators with role awareness and general teaching skills, it is recommended that all have access to basic teacher training. However, delivering this training can be challenging to organize and potentially costly when busy, time-poor clinician-educators are distributed across many geographical locations. This Teaching Tip shares our insights about developing and delivering a set of novel clinical teacher resources for veterinarians and veterinary nurses/technologists new to clinical teaching. The resources, underpinned by the principles of participatory design, integrate contemporary clinical educational theories with practical strategies and are interwoven with video clips capturing staff and student perspectives on key topics. While initially focused on creating just an online resource, we ultimately produced an A6 ring-bound booklet version and face-to-face workshops. In this article, we unpack considerations involved in committing to such a project and designing and creating the resources. We hope that this information may be of use to others when developing similar resources.

The social construction of teacher and learner identities in medicine and surgery

INTRODUCTION

There are growing concerns about the quality and consistency of postgraduate clinical education. In response, faculty development for clinical teachers has improved formal aspects such as the assessment of performance, but informal work-based teaching and learning have proved intractable. This problem has exposed a lack of research into how clinical teaching and learning are shaped by their cultural contexts. This paper explores the relationship between teacher-learner identity, educational practice and the workplace educational cultures of two major specialties: internal medicine and surgery.

METHODS

This was a secondary analysis of a large dataset, comprising field notes, participant interviews, images and video-recordings gathered in an ethnographic study. The lead author embedded himself in four clinical teams (two surgical and two medical) in two different hospitals. The authors undertook a critical reanalysis of the observational dataset, using Dialogism and Figured Worlds theory to identify how teachers and postgraduate learners figured and authored their professional identities in the specialty-specific cultural worlds of surgery and internal medicine.

RESULTS

Surgery and internal medicine privileged different ways of being, knowing and talking in formal and informal settings, where trainees authored themselves as capable practitioners. The discourse of surgical education constructed proximal coaching relationships in which trainees placed themselves at reputational risk in a closely observed, embodied practice. Internal medicine constructed more distal educational relationships, in which trainees negotiated abstract representations of patients' presentations, which aligned to a greater or lesser degree with supervisors' representations.

CONCLUSIONS

Our research suggests that clinical education and the identity positions available to teachers and learners were strongly influenced by the cultural worlds of individual specialties. Attempts to change work-based learning should be founded on situated knowledge of specialty-specific clinical workplace cultures and should be done in collaboration with the people who work there, the clinicians.

Using Learning Theories to Develop a Veterinary Student Preparedness Toolkit for Workplace Clinical Training

Learning theories are abstract descriptions which help us make sense of educational practice. Multiple theories can inform our understanding of a single concept, in this case: veterinary workplace clinical training (WCT), which occurs just prior to students' graduation as competent veterinary surgeons. The competency movement has strongly influenced reforms in veterinary education and is considered important. In reflection of this, the term “preparedness” is operationalised here as a measure of the likelihood that the veterinary student is going to be a competent learner and participant during WCT. Preparedness itself is therefore important because it directly impacts performance. Workplace clinical training is explored through the lenses of cognitivist, social constructivist and socio-culturalist learning theories and used to inform student preparedness characteristics (“tools”) in terms of their behaviours, personal attributes, knowledge and skills, and awarenesses to optimise learning and participation. These form a new conceptual framework—the “Preparedness Toolkit.”

Widening how we see the impact of culture on learning, practice and identity development in clinical environments

As part of this State of the Science series on Self, Society and Situation, we focus on how we might see the situation of the workplace as a learning environment in the future. Research to date into how health professionals learn while working in clinical workplace environments has mostly focused on the supervisor-trainee relationship or on the interaction between the affordances of a workplace and the receptiveness of trainees. However, the wider environment has not received as much focus-though frequently mentioned, it is seldom investigated. We suggest there is a need to embrace the wider institution factors, recognise and acknowledge an organisation's values and culture as they impact on clinical learning in order to work with these, not around them or ignore them, to make what may be tacit visible through reflection and observation and to embrace a range of perspectives on culture.

Qualitative Research in Veterinary Medical Education: Part 2-Carrying Out Research Projects

This is the second of two articles that together comprise an orientation and introduction to qualitative research for veterinary medical educators who may be new to research, or for those whose research experience is based on the quantitative traditions of biomedicine. In the first article (Part 1-Principles of Qualitative Design), we explored the types of research interests and goals suited to qualitative inquiry and introduced the concepts of research paradigms and methodologies. In this second article, we move to the strategies and actions involved in conducting a qualitative study, including selection and sampling of research sites and participants, data collection and analysis. We introduce some guidelines for reporting qualitative research and explore the ways in which qualitative research is evaluated and the findings applied. Throughout, we provide illustrative examples from veterinary and human medical education and suggest useful resources for further reading. Taken together, the two articles build an understanding of qualitative research, outline how it may be conducted, and equip readers with an improved capacity to appraise its value.

Qualitative Research in Veterinary Medical Education: Part 1-Principles of Qualitative Design

Qualitative methodologies are relative newcomers to health sciences education research. While they may look very different to their quantitative counterparts in terms of size and scope, when well-applied they offer a fresh perspective and generate valuable research findings. Although qualitative research is being increasingly conducted in veterinary medical education, there are few contextualized resources to assist those who would like to develop their expertise in this area. In this article, we address this by introducing the principles of qualitative research design in a veterinary medical education context. Drawing from a range of contemporary resources, we explore the types of research goals and questions that are amenable to qualitative inquiry and discuss the process of formulating a worthwhile research question. We explain what research paradigms are and introduce readers to some of the methodological options available to them in qualitative research. Examples from veterinary medical education are used to illustrate key points. In a second companion article, we will focus on the decisions that need to be made regarding data sampling, collection, and analysis. We will also consider how qualitative research is evaluated, and discuss how qualitative findings are applied. Taken together, the two articles build an understanding of qualitative research, illuminate its potential to contribute to the scholarship of teaching and learning in veterinary medical education, and equip readers with an improved capacity to appraise its value.

Initiation of student participation in practice: An audio diary study of international clinical placements

BACKGROUND

Differences in professional practice might hinder initiation of student participation during international placements, and thereby limit workplace learning. This study explores how healthcare students overcome differences in professional practice during initiation of international placements.

METHODS

Twelve first-year physiotherapy students recorded individual audio diaries during the first month of international clinical placement. Recordings were transcribed, anonymized, and analyzed following a template analysis approach. Team discussions focused on thematic interpretation of results.

RESULTS

Students described tackling differences in professional practice via ongoing negotiations of practice between them, local professionals, and peers. Three themes were identified as the focus of students' orientation and adjustment efforts: professional practice, educational context, and individual approaches to learning. Healthcare students' initiation during international placements involved a cyclical process of orientation and adjustment, supported by active participation, professional dialogue, and self-regulated learning strategies.

CONCLUSIONS

Initiation of student participation during international placements can be supported by establishing a continuous dialogue between student and healthcare professionals. This dialogue helps align mutual expectations regarding scope of practice, and increase understanding of professional and educational practices. Better understanding, in turn, creates trust and favors meaningful students' contribution to practice and patient care.

Invoking culture in medical education research: A critical review and metaphor analysis

INTRODUCTION

'Culture' is a word frequently invoked within medical education literature to explain challenges faced by learners in practice. While social settings and practices are widely acknowledged as critical influences on medical education, there is vast variability in how the term 'culture' is employed. This may lead to confusion, resulting in assumptions and oversights.

OBJECTIVE

This critical literature review aims to characterise how the term 'culture' is explicitly and implicitly conceptualised in medical education research.

METHODS

Four leading English language journals in the medical education field were searched in a twelve-month period for research papers or reviews that mentioned culture in title or abstract in a substantive way. A content analysis was undertaken of extracted definitions. In addition, metaphor analysis was used to identify conceptual metaphors, which were subsequently clustered thematically.

RESULTS

Our search yielded 26 papers, 8 of which contained definitions, mostly from the organisational literature. We interpreted nine conceptual metaphors related to how the term culture was employed (terroir, divider, dominant force, toxic force, obstacle, microclimate, object, brand and holdall) in four categories (unchanging, powerful, can adapt around, can be used).

DISCUSSION

This critical review reveals that medical education as a field: 1) draws most explicitly from the organisational literature; 2) invokes culture in multiple means but in ways that privilege either acontextual human agency or all-powerful social forces; and 3) regards culture as a negative or neutral force but rarely a positive one. There is a notable absence around conceptualisations of 'culture' that allow educator, student and administrator agency but at the same time acknowledge the deep forces that various social settings and practices exert. Other literatures investigating learning cultures and cultural reflexivity focus on this nexus and may provide possible means to advance considerations of culture within medical education research.

Becoming the temporary surgeon: A grounded theory examination of anaesthetists performing emergency front of neck access in inter-disciplinary simulation-based training

The time-critical 'can't intubate, can't oxygenate' [CICO] emergency post-induction of anaesthesia is rare, but one which, should it occur, requires Anaesthetists to perform rapid emergency front of neck access [FONA] to the trachea, restoring oxygenation, and preventing death or brain hypoxia. The UK Difficult Airway Society [DAS] has directed all Anaesthetists to be trained with surgical cricothyroidotomy [SCT] as the primary emergency FONA method, sometimes referred to as 'Cric' as a shorthand. We present a longitudinal analysis using a classical approach to Grounded Theory methodology of ten Specialist Trainee Anaesthetists' data during a 6-month training programme delivered jointly by Anaesthetists and Surgeons. We identified with a critical realist ontology and an objectivist epistemology meaning data interpretation was driven by participants' narratives and accepted as true accounts of their experience. Our theory comprises three themes: 'Identity as an Anaesthetist'; 'The Role of a Temporary Surgeon'; and 'Training to Reconcile Identities', whereby training facilitated the psychological transition from a 'bloodless Doctor' (Anaesthetist) to becoming a 'temporary Surgeon'. The training programme enabled Specialist Trainees to move between the role of control and responsibility (Identity as an Anaesthetist), through self-described 'failure' and into a role of uncertainty about one's own confidence and competence (The Role of a Temporary Surgeon), and then return to the Anaesthetist's role once the airway had been established. Understanding the complexity of an intervention and providing a better insight into the training needs of Anaesthetic trainees, via a Grounded Theory approach, allows us to evaluate training programmes against the recognised technical and non-technical needs of those being trained.