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Thomas A, Kinston R, Yardley S, McKinley RK, Lefroy J. How do medical schools influence their students' career choices? A realist evaluation. MEDICAL EDUCATION ONLINE 2024; 29:2320459. [PMID: 38404035 PMCID: PMC10898266 DOI: 10.1080/10872981.2024.2320459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 02/14/2024] [Indexed: 02/27/2024]
Abstract
INTRODUCTION The career choices of medical graduates vary widely between medical schools in the UK and elsewhere and are generally not well matched with societal needs. Research has found that experiences in medical school including formal, informal and hidden curricula are important influences. We conducted a realist evaluation of how and why these various social conditions in medical school influence career thinking. METHODS We interviewed junior doctors at the point of applying for speciality training. We selected purposively for a range of career choices. Participants were asked to describe points during their medical training when they had considered career options and how their thinking had been influenced by their context. Interview transcripts were coded for context-mechanism-outcome (CMO) configurations to test initial theories of how career decisions are made. RESULTS A total of 26 junior doctors from 12 UK medical schools participated. We found 14 recurring CMO configurations in the data which explained influences on career choice occurring during medical school. DISCUSSION Our initial theories about career decision-making were refined as follows: It involves a process of testing for fit of potential careers. This process is asymmetric with multiple experiences needed before deciding a career fits ('easing in') but sometimes only a single negative experience needed for a choice to be ruled out. Developing a preference for a speciality aligns with Person-Environment-Fit decision theories. Ruling out a potential career can however be a less thought-through process than rationality-based decision theories would suggest. Testing for fit is facilitated by longer and more authentic undergraduate placements, allocation of and successful completion of tasks, being treated as part of the team and enthusiastic role models. Informal career guidance is more influential than formal. We suggest some implications for medical school programmes.
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Affiliation(s)
| | | | - Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Galema G, Schönrock-Adema J, Jaarsma DADC, Wietasch GJKG. Patterns of Medical Residents' Preferences for Organizational Socialization Strategies to Facilitate Their Transitions: A Q-study. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:169-181. [PMID: 38496363 PMCID: PMC10941690 DOI: 10.5334/pme.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024]
Abstract
Introduction To facilitate various transitions of medical residents, healthcare team members and departments may employ various organizational socialization strategies, including formal and informal onboarding methods. However, residents' preferences for these organizational socialization strategies to ease their transition can vary. This study identifies patterns (viewpoints) in these preferences. Methods Using Q-methodology, we asked a purposeful sample of early-career residents to rank a set of statements into a quasi-normal distributed grid. Statements were based on previous qualitative interviews and organizational socialization theory. Participants responded to the question, 'What are your preferences regarding strategies other health care professionals, departments, or hospitals should use to optimize your next transition?' Participants then explained their sorting choices in a post-sort questionnaire. We identified different viewpoints based on by-person (inverted) factor analysis and Varimax rotation. We interpreted the viewpoints using distinguishing and consensus statements, enriched by residents' comments. Results Fifty-one residents ranked 42 statements, among whom 36 residents displayed four distinct viewpoints: Dependent residents (n = 10) favored a task-oriented approach, clear guidance, and formal colleague relationships; Social Capitalizing residents (n = 9) preferred structure in the onboarding period and informal workplace social interactions; Autonomous residents (n = 12) prioritized a loosely structured onboarding period, independence, responsibility, and informal social interactions; and Development-oriented residents (n = 5) desired a balanced onboarding period that allowed independence, exploration, and development. Discussion This identification of four viewpoints highlights the inadequacy of one-size-fits-all approaches to resident transition. Healthcare professionals and departments should tailor their socialization strategies to residents' preferences for support, structure, and formal/informal social interaction.
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Affiliation(s)
- Gerbrich Galema
- University of Groningen and University Medical Center Groningen (UMCG), and member of the Lifelong Learning, Education and Assessment Research Network (LEARN), She is also a resident in anesthesiology at the department of anesthesiology, NL
| | - Johanna Schönrock-Adema
- Wenckebach Institute for Education and Training, University of Groningen and University Medical Center Groningen, and at the Prins Claus Conservatoire, Hanze University of Applied Sciences, Groningen, Furthermore, she is a LEARN member, NL
| | | | - Götz J. K. G. Wietasch
- University of Groningen and University Medical Center Groningen, Department of Anesthesiology, and a LEARN member, NL
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Kinston R, Gay S, McKinley RK, Sam S, Yardley S, Lefroy J. How well do UK assistantships equip medical students for graduate practice? Think EPAs. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:173-198. [PMID: 37347459 DOI: 10.1007/s10459-023-10249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
The goal of better medical student preparation for clinical practice drives curricular initiatives worldwide. Learning theory underpins Entrustable Professional Activities (EPAs) as a means of safe transition to independent practice. Regulators mandate senior assistantships to improve practice readiness. It is important to know whether meaningful EPAs occur in assistantships, and with what impact. Final year students at one UK medical school kept learning logs and audio-diaries for six one-week periods during a year-long assistantship. Further data were also obtained through interviewing participants when students and after three months as junior doctors. This was combined with data from new doctors from 17 other UK schools. Realist methods explored what worked for whom and why. 32 medical students and 70 junior doctors participated. All assistantship students reported engaging with EPAs but gaps in the types of EPAs undertaken exist, with level of entrustment and frequency of access depending on the context. Engagement is enhanced by integration into the team and shared understanding of what constitutes legitimate activities. Improving the shared understanding between student and supervisor of what constitutes important assistantship activity may result in an increase in the amount and/or quality of EPAs achieved.
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Affiliation(s)
- Ruth Kinston
- School of Medicine, Keele University, Clinical Education Centre, University Hospital of North Midlands, Newcastle Road, Staffordshire, ST4 6QG, UK.
| | - Simon Gay
- University of Leicester School of Medicine, Leicester, UK
- Keele University School of Medicine, Keele, UK
| | | | - Sreya Sam
- Keele University School of Medicine, Keele, UK
| | - Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central & North West London NHS Foundation Trust, London, UK
| | - Janet Lefroy
- School of Medicine and Faculty Lead for the Health Professionals Education Research Theme, Keele University, Keele, UK
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Childress A, Lou M. Illness Narratives in Popular Music: An Untapped Resource for Medical Education. THE JOURNAL OF MEDICAL HUMANITIES 2023; 44:533-552. [PMID: 37566168 DOI: 10.1007/s10912-023-09813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
Illness narratives convey a person's feelings, thoughts, beliefs, and descriptions of suffering and healing as a result of physical or mental breakdown. Recognized genres include fiction, nonfiction, poetry, plays, and films. Like poets and playwrights, musicians also use their life experiences as fodder for their art. However, illness narratives as expressed through popular music are an understudied and underutilized source of insights into the experience of suffering, healing, and coping with illness, disease, and death. Greater attention to the value of music within medical education is needed to improve students' perspective-taking and communication. Like reading a good book, songs that resonate with listeners speak to shared experiences or invite them into a universe of possibilities that they had not yet imagined. In this article, we show how uncovering these themes in popular music might be integrated into medical education, thus creating a space for reflection on the nature and meaning of illness and the fragility of the human condition. We describe three kinds of illness narratives that may be found in popular music (autobiographical, biographical, and metaphorical) and show how developing skills of close listening through exposure to these narrative forms can improve patient-physician communication and expand students' moral imaginations.
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Affiliation(s)
- Andrew Childress
- Humanities Expression and Arts Lab, Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA.
| | - Monica Lou
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Coakley N, Wiese A, O'Leary P, Bennett D. Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study. BMJ Open 2023; 13:e069101. [PMID: 37137555 PMCID: PMC10163558 DOI: 10.1136/bmjopen-2022-069101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
CONTEXT Factors contributing to the stressful transition from student to doctor include issues with preparedness for practice, adjusting to new status and responsibility, and variable support. Existing transitional interventions provide inconsistent participation, responsibility and legitimacy in the clinical environment. Enhanced support by near peers for new doctors may ease the transition. Irish medical graduates of 2020 commenced work early, creating an unprecedented period of overlap between new graduates and the cohort 1 year ahead. OBJECTIVE To explore the experience of commencing practice for these new doctors with this increased near-peer support. DESIGN We used interpretive phenomenological analysis as our methodological approach, informed by the cognitive apprenticeship model, to explore the experience of enhanced near-peer support at the transition to practice. Participants recorded audio diaries from their commencement of work, and a semistructured interview was conducted with each, after 3 months, concerning their experience of their overlap with the previous year's interns. SETTING University College Cork, one of six medical schools in Ireland. PARTICIPANTS Nine newly qualified medical doctors. MAIN OUTCOME MEASURES An exploration of their experience of transition to clinical practice, in the context of this enhanced near-peer support, will inform strategies to ease the transition from student to doctor. RESULTS Participants felt reassured by having a near-peer in the same role and safe to seek their support. This empowered them to gradually assume increasing responsibility and to challenge themselves to further their learning. Participants perceived that commencing work before the annual change-over of other grades of doctor-in-training enhanced their professional identities and improved patient safety. CONCLUSIONS Enhanced near-peer support for new doctors offers a potential solution to the stressful transition to practice. Participants were legitimate members of the community of practice, with the status and responsibility of first-year doctors. Furthermore, this study reinforces the benefit of asynchronous job change-over for doctors-in-training.
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Affiliation(s)
- Niamh Coakley
- Department of Medicine, University College Cork, Cork, Ireland
| | - Anel Wiese
- Medical Education Unit, University College Cork, Cork, Ireland
| | - Paula O'Leary
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, Cork, Ireland
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Homberg A, Narciß E, Thiesbonenkamp-Maag J, Schüttpelz-Brauns K. Experience-based learning during the final year - quantitative content analyses of students' self-reports. MEDICAL TEACHER 2023; 45:542-549. [PMID: 36370418 DOI: 10.1080/0142159x.2022.2144187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The final year offers students the opportunity to explore their future role as a physician in different environments. Learning success depends in large part on how students experience these assignments. The aim of this study is to analyze students' self-reported experiences to derive factors that promote experience-based learning in the transition phase during the final year of medical school in order to optimally prepare students for professional practice. METHOD Data were collected from 2013 to 2019 via written survey after each assignment in the final year. Students were asked to report their pleasant and unpleasant experiences in free-text fields. The text material was analyzed using quantitative content analysis. RESULTS The authors included 1762 questionnaires for analysis. They formed 12 main categories from the text material, equally covering pleasant and unpleasant experiences. Supervisors and teamwork played a central role in both questions, responsibility and working areas frequently led to positive experiences, and working conditions to negative ones. CONCLUSION This study confirms the great importance of supervision. Above all, successful collaboration serves as a door opener into a feeling of security which students need to take on responsibility. The authors adapted Dornan's model of experience-based learning to the transition phase to help medical schools establish tailored conditions for students' successful entry into professional practice.
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Affiliation(s)
- A Homberg
- Department of Medical Education Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - E Narciß
- Competence Center for final-year education, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - J Thiesbonenkamp-Maag
- Department of Medical Education Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - K Schüttpelz-Brauns
- Department of Medical Education Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Atherley A, Teunissen P, Hegazi I, Hu W, Dolmans D. Longitudinal exploration of students' identity formation during the transition from pre-clinical to clinical training using research poetry. MEDICAL EDUCATION 2022. [PMID: 36460437 DOI: 10.1111/medu.14998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Transitions are critical periods that can lead to growth and, or, distress. Transitions are a sociocultural process, yet most approaches to transitions in practice and research do not explore the social or developmental aspects of entering a new training phase. Wenger reminds us that identity development is crucial when newcomers navigate change. In this paper, we use Wenger's modes of identification: engagement, imagination and alignment to explore students' identity development (as a student and professional) during the transition from pre-clinical to clinical training. METHODS We enrolled nine 2nd-year medical students who generated 61 entries comprising audio diary (or typed) reflections over 9 months (starting 3 months before clinical clerkships began) and interviewed them twice. We used research poems (transcripts reframed as poetry) to help construct a meaningful, emotive elicitation of our longitudinal data and analysed data using sensitising concepts from Wenger's modes of identification. RESULTS Students described their transition as a journey filled with positive and negative emotions and uncertainty about their current and future careers. Students navigated the transition using three mechanisms: (1) becoming more engaged through taking charge, (2) shaping their image of self through engagement and finding role models and (3) learning to flexibly adapt to clerkship norms by managing expectations and adopting a journey mindset. CONCLUSIONS We successfully narrated students' identity formation during their transition to clinical training. We learned that students became more engaged over time by learning to take charge. They shaped their image of self by engaging in team activities and reflecting on role models. They learnt to adapt flexibly to clerkship norms by managing expectations and adopting a journey mindset. We suggest that institutions provide a safe opportunity for medical students to reflect, allowing students' transition periods to be lived, reflected on and supported.
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Affiliation(s)
- Anique Atherley
- Academy for Teaching and Learning, Ross University School of Medicine, Bridgetown, Barbados
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Pim Teunissen
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Iman Hegazi
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Diana Dolmans
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Mount GR, Kahlke R, Melton J, Varpio L. A Critical Review of Professional Identity Formation Interventions in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S96-S106. [PMID: 35947478 DOI: 10.1097/acm.0000000000004904] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Professional identity formation (PIF) can be defined as the integration of the knowledge, skills, values, and behaviors of a profession with one's preexisting identity and values. Several different, and sometimes conflicting, conceptualizations and theories about PIF populate the literature; applying these different theories in PIF curricula and pedagogic strategies can profoundly impact the PIF of future physicians. The authors conducted a critical review of the recent literature on PIF interventions in medical education to explore the conceptualizations of and theoretical approaches to PIF that underlie them. METHOD The authors searched articles on PIF educational interventions published in 5 major medical education journals between 2010 and March 2021. The articles' context and findings were extracted, analyzed, and summarized to identify conceptualizations and theoretical approaches to PIF. RESULTS The authors identified 43 studies examining medical education interventions aimed at influencing PIF. The majority of the studies (n = 31) focused on undergraduate medical education. Reflective writing and the use of narrative reflections were the dominant modes of student activity in PIF interventions, supporting the dominant individualist approach to PIF. Less commonly PIF was understood as a socialization process or as an active process with both individually and socially focused influences. CONCLUSIONS Relying on reflective writing as the intervention of choice to impact PIF feeds the dominant individualist perspective on PIF. An unintended consequence of this individualist orientation is that cultural problems embedded in the profession can become burdens for individual physicians to personally bear. Future education and research into PIF should account for theoretical preferences and the impact of these preferences.
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Affiliation(s)
- George R Mount
- G.R. Mount is associate professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-5265-2823
| | - Renate Kahlke
- R. Kahlke is a scientist, McMaster Education Research, Innovation & Theory Program, and assistant professor, Division of Education & Innovation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; ORCID: http://orcid.org/0000-0002-4473-5039
| | - John Melton
- J. Melton is assistant professor, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Lara Varpio
- L. Varpio is professor of medicine and associate director of research, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-1412-4341
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Brown MEL, Lim JH, Horsburgh J, Pistoll C, Thakerar V, Maini A, Johnson C, Beaton L, Mahoney C, Kumar S. Identity Development in Disorientating Times: the Experiences of Medical Students During COVID-19. MEDICAL SCIENCE EDUCATOR 2022; 32:995-1004. [PMID: 35936649 PMCID: PMC9340721 DOI: 10.1007/s40670-022-01592-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Professional identity development is a central aim of medical education, which has been disrupted during COVID-19. Yet, no research has qualitatively explored COVID-19's impact across institutions or countries on medical students' identities. Kegan proposes a cognitive model of identity development, where 'disorientating dilemmas' prompt student development. Given the potential of COVID-related disruption to generate disorientating dilemmas, the authors investigated the ways in which COVID-19 influenced students' identity development. METHODS The authors conducted an international qualitative study with second year medical students from Imperial College London, and third year students from Melbourne Medical School. Six focus groups occurred 2020-2021, with three to six students per group. Authors analysed data using reflexive thematic analysis, applying Kegan's model as a sensitising theoretical lens. RESULTS COVID-19 has resulted in a loss of clinical exposure, loss of professional relationships, and a shift in public perception of physicians. Loss of exposure to clinical practice removed the external validation from patients and seniors many students depended on for identity development. Students' experiences encouraged them to assume the responsibilities of the profession and the communities they served, in the face of conflicting demands and risk. Acknowledging and actioning this responsibility facilitated identity development as a socially responsible advocate. CONCLUSIONS Educators should consider adapting medical education to support students through Kegan's stages of development. Measures to foster relationships between students, patients, and staff are likely necessary. Formal curricula provisions, such as spaces for reflection and opportunities for social responsibility, may aid students in resolving the conflict many have recently experienced. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01592-z.
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Affiliation(s)
- Megan E. L. Brown
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Jun Hua Lim
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Chance Pistoll
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Viral Thakerar
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Arti Maini
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Caroline Johnson
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Laura Beaton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Claire Mahoney
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Sonia Kumar
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
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Kjær LB, Strand P, Christensen MK. 'Making room for student autonomy' - an ethnographic study of student participation in clinical work. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1067-1094. [PMID: 35896868 DOI: 10.1007/s10459-022-10131-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 05/29/2022] [Indexed: 06/15/2023]
Abstract
Participation in clinical work is important for medical students' professional development. However, students often report that they experience a passive observer role, and further research on contextual factors that influence student participation is needed. The theory of practice architectures contributes a new perspective to this challenge by elucidating how cultural-discursive, material-economic, and social-political arrangements enable and constrain student participation in clinical work. The aim of this study was to explore how practice architectures in clinical learning environments enable and constrain medical students' participation. The study was designed as an ethnographic field study in three student clinics: 106 h of observation. Analysis comprised ethnographic analysis followed by application of the theory of practice architectures. The ethnographic analysis resulted in six themes: setting the scene, when to call for help, my room - my patient, getting in a routine, I know something you don't, and my work is needed. Applying the theory of practice architectures showed that material-economic arrangements, such as control of the consultation room and essential artefacts, were crucial to student participation and position in the clinical workplace. Furthermore, co-production of a student mandate to independently perform certain parts of a consultation enabled a co-productive student position in the hierarchy of care-producers. The findings offer a conceptually generalisable model for the study of material and social dimensions of clinical learning environments. Although not all clinical learning environments may wish to or have the resources to implement a student clinic, the findings offer insights into general issues about the arrangements of student participation relevant to most clinical teaching contexts.
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Affiliation(s)
- Louise Binow Kjær
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C, Denmark.
| | - Pia Strand
- Faculty of Medicine, Centre for Teaching and Learning, Lund University, Margaretavägen 1B, 222 40, Lund, Sweden
| | - Mette Krogh Christensen
- Centre for Educational Development, Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C, Denmark
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Moore CJS, Blencowe NS, Hollén L, van Hamel C. Interim Foundation Year One (FiY1) and preparedness for foundation year 1: A national survey of UK foundation doctors. MEDICAL TEACHER 2022; 44:622-628. [PMID: 34936534 DOI: 10.1080/0142159x.2021.2015065] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Induction programmes aim to ease the transition from medical student to doctor. The interim foundation year 1 (FiY1) placement, introduced in the first COVID-19 wave, provided experience in advance of the Foundation Year 1 (FY1) start in August; providing more time and enhanced responsibilities than traditional induction programmes. This study examines the effects of the FiY1 placement on anxiety levels and preparedness for FY1. METHODS This was a descriptive cross-sectional study using data from four cohorts of FY1s who completed the online National FY1 induction survey from 2017 to 2020 (n = 4766). Questions evaluated self-reported preparedness and anxiety levels. Differences in preparedness and anxiety levels of FiY1 and non-FiY1 participants in 2020, and the 2017-2019 participants (non-FiY1 controls), were evaluated. RESULTS FiY1s in 2020 reported higher self-reported preparedness (79%) than non-FiY1s (54%) in 2020 (p = <0.001) and the control 2017-2019 cohort (63.8%) (p < 0.001). Fewer FiY1s experienced pathological anxiety (29.3% versus 40.8% for non-FiY1s; p = 0.001). CONCLUSION Time spent in an FiY1 role is associated with an increase in self-perceptions of preparedness and a reduction in anxiety. These data indicate that time spent in an FiY1 role may have utility in further improving the transition period from medical school to FY1.
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Affiliation(s)
- Connor J S Moore
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Natalie S Blencowe
- Division of Surgery, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Linda Hollén
- Centre for Academic Child Health, University of Bristol, Bristol, UK
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Grandinetti P, Gooney M, Scheibein F, Testa R, Ruggieri G, Tondo P, Corona A, Boi G, Floris L, Profeta VF, Wells JSG, De Berardis D. Stress and Maladaptive Coping of Italians Health Care Professionals during the First Wave of the Pandemic. Brain Sci 2021; 11:brainsci11121586. [PMID: 34942888 PMCID: PMC8699311 DOI: 10.3390/brainsci11121586] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 12/23/2022] Open
Abstract
Stress during the pandemic has had an impact on the mental health of healthcare professionals (HCPs). However, little is known about coping and “maladaptive” coping behaviours of this population. This study investigates “maladaptive” coping behaviours and their correlation with stress, anxiety and insomnia of Italian HCPs during the pandemic. It reports on a cross-sectional, descriptive and correlational study based on a survey of 1955 Italian HCPs. Overall participants reported increases in cigarette smoking, time spent online and video playing. Overall reported alcohol consumption decreased but increased in those reporting drinking more than once a week. Those reporting starting smoking during the pandemic were found to have higher SAS and PSS scores. Those reporting being online for 3 or more hours were found to have higher ISS scores. Doctors who reported playing video games were found to have higher PSS, ISS and SAS scores whilst nurses who reported playing video games were found to have higher ISS scores. Doctors who reported playing for longer than one hour had higher PSS scores. Online behaviours may be a coping behaviour of HCPs affected by the pandemic. However, this is an underexplored area for the wellbeing of HCPs. These deficits need to be addressed going forward.
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Affiliation(s)
- Paolo Grandinetti
- Department of Territorial Assistance, ASL Teramo, 64100 Teramo, Italy; (P.G.); (G.R.); (P.T.)
| | - Martina Gooney
- School of Health Sciences, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (M.G.); (F.S.); (J.S.G.W.)
| | - Florian Scheibein
- School of Health Sciences, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (M.G.); (F.S.); (J.S.G.W.)
| | - Roberta Testa
- Department of Mental Health, ASL Teramo, 64100 Teramo, Italy; (R.T.); (V.F.P.)
| | - Gaetano Ruggieri
- Department of Territorial Assistance, ASL Teramo, 64100 Teramo, Italy; (P.G.); (G.R.); (P.T.)
| | - Paolo Tondo
- Department of Territorial Assistance, ASL Teramo, 64100 Teramo, Italy; (P.G.); (G.R.); (P.T.)
| | - Anastasia Corona
- Department of Mental Health and Addiction, ATTS Sardegna-Zona Sud, 09100 Cagliari, Italy; (A.C.); (G.B.); (L.F.)
| | - Graziella Boi
- Department of Mental Health and Addiction, ATTS Sardegna-Zona Sud, 09100 Cagliari, Italy; (A.C.); (G.B.); (L.F.)
| | - Luca Floris
- Department of Mental Health and Addiction, ATTS Sardegna-Zona Sud, 09100 Cagliari, Italy; (A.C.); (G.B.); (L.F.)
| | - Valerio F. Profeta
- Department of Mental Health, ASL Teramo, 64100 Teramo, Italy; (R.T.); (V.F.P.)
| | - John S. G. Wells
- School of Health Sciences, Waterford Institute of Technology, X91 K0EK Waterford, Ireland; (M.G.); (F.S.); (J.S.G.W.)
| | - Domenico De Berardis
- Department of Territorial Assistance, ASL Teramo, 64100 Teramo, Italy; (P.G.); (G.R.); (P.T.)
- Correspondence:
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Brown MEL, Proudfoot A, Mayat NY, Finn GM. A phenomenological study of new doctors' transition to practice, utilising participant-voiced poetry. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1229-1253. [PMID: 33847851 PMCID: PMC8452574 DOI: 10.1007/s10459-021-10046-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/22/2021] [Indexed: 06/02/2023]
Abstract
Transition to practice can be a turbulent time for new doctors. It has been proposed transition is experienced non-linearly in physical, psychological, cultural and social domains. What is less well known, however, is whether transition within these domains can contribute to the experience of moral injury in new doctors. Further, the lived experience of doctors as they transition to practice is underexplored. Given this, we asked; how do newly qualified doctors experience transition from medical school to practice? One-to-one phenomenological interviews with 7 recently qualified UK doctors were undertaken. Findings were analysed using Ajjawi and Higgs' framework of hermeneutic analysis. Following identification of secondary concepts, participant-voiced research poems were crafted by the research team, re-displaying participant words chronologically to convey meaning and deepen analysis. 4 themes were identified: (1) The nature of transition to practice; (2) The influence of community; (3) The influence of personal beliefs and values; and (4) The impact of unrealistic undergraduate experience. Transition to practice was viewed mostly negatively, with interpersonal support difficult to access given the 4-month nature of rotations. Participants describe relying on strong personal beliefs and values, often rooted in an 'ethic of caring' to cope. Yet, in the fraught landscape of the NHS, an ethic of caring can also prove troublesome and predispose to moral injury as trainees work within a fragmented system misaligned with personal values. The disjointed nature of postgraduate training requires review, with focus on individual resilience redirected to tackle systemic health-service issues.
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Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, York, UK.
| | - Amy Proudfoot
- Health Professions Education Unit, Hull York Medical School, York, UK
| | - Nabilah Y Mayat
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, York, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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