Drawing on drawings: Moving beyond text in health professions education research

Research in action-developing and evaluating a student research placement experience

BACKGROUND

Evidence based practice is essential in the provision of high-quality contemporary nursing practice. Yet nursing students often lack an understanding of the research process because applied research experience is rarely facilitated in undergraduate nursing programmes. Students research knowledge is mostly gained via classroom based theoretical teaching; however, it is a challenging subject to teach and is often evaluated poorly by students who find the subject uninteresting and difficult to apply to their clinical practice.

AIM

The aim of the study was to explore the experiences of student nurses after undertaking a nurse led primary research study placement.

METHODS

The study explores the students' experiences of a research placement using a phenomenological approach with the data collection method of drawings and narration which were then subject to Interpretive Phenomenological Analysis as a data analysis method.

SETTINGS

This study was undertaken with 18 nursing students who were enrolled in a United Kingdom university, who had recently participated in a nurse-led research study exploring the use of sensors to detect atrial fibrillation in members of the public in a supermarket.

RESULTS

The following themes were developed by the researchers: Practice makes perfect, Enhancing communication, Research attitude, Making a difference, Increased confidence, Enhanced skills, Researcher collaborations, The views of others.

CONCLUSIONS

Students valued the research placement; the experience provided insight into the conduct of research in primary health and allowed students to learn about research in an experiential way which proved to be more effective than usual classroom methods. Students' communication skills were enhanced, through interacting with the public in a different way, who were keen to engage with them because of their student status.

Striking fear into students' hearts: Unforeseen consequences of prescribing education

PURPOSE

Undergraduate medical education (UGME) has to prepare students to do safety-critical work (notably, to prescribe) immediately after qualifying. Despite hospitals depending on them, medical graduates consistently report feeling unprepared to prescribe and they sometimes harm patients. Research clarifying how to prepare students better could improve healthcare safety. Our aim was to explore how students experienced preparing for one of their commonest prescribing tasks: intravenous fluid therapy (IVFT).

METHODS

Complexity assumptions guided the research, which used a qualitative methodology oriented towards hermeneutic phenomenology. The study design was an uncontrolled and unplanned complex intervention: judicial review of the iatrogenic death of five children due to hyponatraemia in our region had resulted in the recommendation that students' education in 'the implementation of important clinical guidelines' relevant to fluid and electrolyte balance should be intensified. An opportunity sample of 40 final-year medical students drew and gave audio-recorded commentaries on rich pictures. We completed two template analyses: one of participants' transcribed commentaries on the pictures and one using a novel heuristic to analyse the pictures themselves. We then reconciled the two analyses into a single template.

RESULTS

There were four themes: affects, teaching and learning, contradictions, and the curriculum as a journey. To explore interconnections between themes, we chose the picture best exemplifying each of the four themes and interpreted the curriculum journey depicted in each of them. These interpretations were grounded in each participant's picture, verbal account of the picture, and the aggregate findings of the template analysis. Participants' experiences were influenced by the situated complexity of IVFT. Layered on top of that, contradictions, overlaps, and gaps within the curriculum introduced extraneous complexity. Confusion and apprehension resulted.

CONCLUSIONS

After spending five years preparing to prescribe IVFT, participants felt unprepared to do so. We conclude that intensive teaching had not achieved its avowed goal of improving students' preparedness for safe practice. Merton's seminal work on the 'unanticipated consequences of purposive social action' suggests that intensive teaching may even have contributed to their unpreparedness.

Calibrating logics: How adolescents and young adults calibrate often-competing logics in their daily self-management of type 1 diabetes

Adolescents and young adults with type 1 diabetes must manage a demanding chronic condition in their daily lives, but adequate self-management remains a major challenge. In this article, we explore the logics invoked in shaping daily type 1 diabetes self-management among adolescents and young adults and propose an analytical view of self-management as a matter of 'calibrating logics'. Drawing on Annemarie Mol's concept of logic, our analysis of in-depth interviews with 21 adolescents and young adults with type 1 diabetes suggested that three main logics collectively shaped their self-management: biomedical, embodied and social. Biomedical logics appeared in the form of routinised insulin therapy, frequent blood glucose testing, and carbohydrate counting, all of which emphasise controlling blood glucose levels. Embodied logics emerged as refined practices such as 'thinking insulin units' and 'listening' to blood glucose fluctuations. Finally, social logics were at play when discreet or postponed self-management practices were used to adjust to social situations. While these logics may complement each other, study participants invoked how these logics often competed in daily life, generating tensions. We therefore propose viewing self-management as a matter of calibrating logics in which often-competing logics are at play. This can provide nuanced insights into the effort and challenges related to the daily self-management of type 1 diabetes for adolescents and young adults, in contrast to the prevailing dichotomy of adherence versus nonadherence to prescribed treatment regimens.

Becoming a physician for older patients: exploring the professional identity formation of medical students during a nursing home clerkship. A qualitative study

BACKGROUND

To prepare medical students for the growing population of older patients, an appropriate professional identity formation is desirable. The community of practice of medical school is primarily hospital-based and disease-oriented which will lead to the development of a physician who is mainly focused on cure. This focus alone however is not always appropriate for older persons' health care. The aim of this study is to explore the influence of participating in a nursing home community of practice on the professional identity formation of medical students.

METHODS

A qualitative study based on a constructivist research paradigm was conducted, using individual semi-structured, in-depth interviews and a visual narrative method (drawing) as a prompt. Thematic analysis was applied to structure and interpret the data. The study population consisted of fifth-year medical students participating in a six-week nursing home clerkship. Thirteen participants were purposefully sampled. The clerkship took place in nursing homes in the South-West of the Netherlands.

RESULTS

The medical students described the nursing home as the living environment of the patients. Actively participating in the patients' care and experiencing the daily life of the patients was meaningful for the physician the students want to become in five ways: (1) a physician with a complete picture; (2) a physician who is close; (3) a physician who is in dialogue; (4) a physician who is able to let go and (5) a physican who collaborates.

CONCLUSIONS

Caring for older patients in the nursing home influences the professional identity formation of medical students. Patient-centeredness, personal, holistic and tailored care, approachability and collaboration are important characteristics in becoming a physician for older persons' health care. The context of this care provides relevant learning experiences for this development and the becoming of a physician in general.

Early stages of learning in interprofessional education: stepping towards collective competence for healthcare teams

BACKGROUND

Interprofessional education (IPE) is a core element of many health professional education curricula. To date the focus of much research has been on student perceptions of, and attitudes towards, the learning experience. Little is known about the impact of early IPE experience on how students understand and learn about effective interprofessional teamwork.

METHODS

This qualitative study involved first year university students enrolled in health professions degrees and investigated their descriptions of interprofessional teamwork through graphic elicitation and interviews. Participants were enrolled in a large-scale interprofessional unit (subject) in the university.

RESULTS

The data were analysed through the lens of a tool that classifies dimensions of interprofessional activity. The findings indicated the majority of students had what was classified as a Stage 1 (or 'nascent') understanding of integration between work practices and a Stage 2 (or 'emerging') understanding of the dimensions of interprofessional teamwork which were commitment, identity, goals, roles and responsibilities, and interdependence.

CONCLUSIONS

Based on the findings, the stages for a learning trajectory for interprofessional education are proposed and each stage is mapped to dimensions of interprofessional activity. A number of pedagogical strategies are suggested in order to move students through this two-stage model of learning and ensure their readiness for interprofessional teamwork as health professionals.

Learning by… Knowledge and skills acquisition through work-based learning and research

Purpose

Issues around informal, non-formal and formal learning, intended and unintended learning and competencies and capabilities have been considered in work-based learning (WBL). However, demarcated modes of learning, or what can be called strategies or pedagogies of learning, associated with experience of work environments have yet to be examined. One mode of learning which has been highlighted in relation to work is reflective practice, and its centrality to learning at work has been established. But reflective practice as a core skill, and its relation to other approaches to learning and research in WBL, remains uncovered. The purpose of the present study therefore is to identify different modes of learning as they appear in the literature and to present a proto-theoretical “learning by …” model for WBL and research founded on learning by reflection.

Design/methodology/approach

Proto-theoretical modelling and qualitative descriptions of each mode of learning.

Findings

Work environments, and the higher degree WBL programmes which support them, should provide learning via every available mode of learning, thereby allowing students to find their own best orientation to learning and encourage it by any means.

Originality/value

The proto-theoretical model and 12 modes of learning applied to WBL are unique to this study. WBL provides participants of work with multiple opportunities and approaches to learn and similarly provides multiple modes through which learning can occur on the basis of knowledge and skills in reflective practice.

Qualitative ego networks in health professions education: Capturing the self in relation to others

INTRODUCTION

Our very sense of self emerges through interactions with others. As part of this State of the Science series on Self, Society, and Situation, we introduce a qualitative ego network research approach. This research approach offers insights into the self's (the ego's) interpretation of and relation to named others in the social network in question.

PURPOSE

Visual mapping of participants' social networks is gaining traction, yet this research approach has received no focused attention in the health professions education (HPE) literature. A qualitative ego network approach is a compelling research approach because it uniquely maps participants' perceptions of the complex social world they are embedded in. Although many methodologies can explore participants' social world, ego networks can enhance expression of tacit knowledge of one's social environment and encourage reflection. This approach, combined with other qualitative data, can also reveal hidden relational data that the researcher may not observe or consider. To demonstrate its value as a visual methodology, we will showcase two examples of qualitative ego network studies. We then balance the paper with some critical reflections of this research approach.

CONCLUSIONS

A qualitative ego network approach holds potential for deepening understanding of the self in relation to society and situation in future HPE research. We look forward to intentional, impactful and invigorated research using a qualitative ego network approach as we tackle unknowns about how self and society in specific HPE situations interact.

Drawing on experience: exploring the pedagogical possibilities of using rich pictures in health professions education

In both clinical and health professions education research, rich pictures, or participant-generated drawings of complex phenomena, are gaining recognition as a useful method for exploring multifaceted and emotional topics in medicine. For instance, two recent studies used rich pictures to augment semi-structured interviews exploring trainees', health care professionals' (HCPs), and parents' experiences of difficult conversations in the Neonatal Intensive Care Unit (NICU)-an environment in which communication is often challenging, anxiety-provoking, and emotionally distressing. In both studies, participants were invited to draw a picture depicting how they experienced a difficult conversation in this setting. As part of the interview process, participants were asked to both describe how they engaged with rich pictures, and to share their perceptions about the affordances and limitations of this research method. Here, their perspectives are reported and the possibilities of using rich pictures to inform pedagogical innovations in health professions education and research are considered.

Drawing in Veterinary Anatomy Education: What Do Students Use It For?

In contrast to medical education, information on the use of arts as a learning approach is scarce in veterinary anatomy. The aim of this prospective, questionnaire-based study was to survey students' use of drawing in various aspects of veterinary anatomy learning (self-study, examinations, preparation for, and reflection on cadaver dissection). The quantitative data showed that first-year students with artistic preferences used drawing significantly more often in most aspects of anatomy learning than students with no such preferences, apart from the reported use of drawing in examinations and for reflection after cadaver dissection. The lack of significant correlations of the reported use of drawing in examinations with any other study variable provided support for the author's observation that student-generated drawings are not as commonly used in examinations as previously. In contrast to the study hypothesis, previous university studies did not correlate significantly with any aspect of the use of drawing in anatomy learning. None of the reported uses of drawing addressed the benefits of drawing in learning the comparative anatomy of animal species, a characteristic distinguishing veterinary anatomy from human anatomy. Qualitative student feedback indicated that encouragement and teacher-produced images would increase the use of drawing as a learning approach even if the implementation of drawing into the curriculum is not feasible. Conclusions from this study were implemented through self-directed learning in anatomy courses that replaced the canceled cadaveric dissections during the COVID-19 outbreak and also through the ongoing drawing workshops to further advance the use of drawing in veterinary anatomy learning.

Pictures and a thousand words: the experiences of significant others whose loved ones have a severe brain injury who are being discharged home

Purpose:

To investigate the experiences of significant others when their loved one with a severe acquired brain injury (ABI) is being discharged from an ABI-specific rehabilitation unit.

Participants:

Significant others of loved ones with an ABI participated in interviews close to their loved ones being discharged from inpatient ABI rehabilitation.

Methods:

Semi-structured interviews were conducted, and thematic analysis applied. Additionally, the drawing method was also used which involved participants drawing what it was like for them as their loved one was going home. Image analysis was then combined with the interview data.

Results:

Eight significant others participated in interviews on discharge and completed a drawing describing their experience. Five themes were identified (Change, Mixed feelings, Support of family and friends, Journey and Staff interactions).

Conclusion:

The experience of having a loved one with a severe ABI in rehabilitation is an emotional event. Compassionate communication, consistency of information and thorough discharge planning practices were cornerstones to enhancing the experience of significant others, empowering them to undertake their new role.

Exploring mindfulness and artworks/drawings to predict dental students' performance

PURPOSE/OBJECTIVES

To explore and assess self-reported trait mindfulness and artwork/drawings as tools to predict students' performance.

METHODS

This longitudinal study explored whether year 2 dental students' artwork/drawings produced during the first week of a preclinical endodontics course and Mindfulness Attention Awareness Scale (MAAS) scores could be used as a predictor of performance (grades/rank) at the end of the course. A convergent design of mixed methods approaches was used to integrate the quantitative and qualitative datasets. Qualitative analysis consisted of a multilayered process of thematic analysis of artwork/drawings that was used to generate codes, categories, and themes-according to lower and higher students' grades. Quantitative analysis consisted of statistical correlation between mindfulness scores and final grades. Findings were independently analyzed and further merged to answer our research question.

RESULTS

The bivariate analysis found nonsignificant relationship between students' grades/rank and mindfulness scores: Pearson's correlation r = -0.097 (p = 0.578) and Spearman's correlation rho = 0.120 (p = 0.494). Codes, categories, and themes resulting from graphical data collected from the artwork/drawings strongly suggested that the higher students' grades group depicted solutions to deal with negative feelings/emotions and presented traits of confidence to reach goals. Artworks produced from students with lower grades left questions, such as in relation to competency in dentistry, unanswered, but at the same time, they seemed to perceive everything as emotion related. Upon merging the findings, we recognized more image components suggestive of positive feelings exuding from the artworks/drawings of higher grades group; but an increase in mindfulness was not associated with increase (or decrease) in final grade.

CONCLUSION

Feelings/emotions represented in the artwork/drawings produced in the beginning of the course predicted students' performance at the end of the course; however, self-reported trait mindfulness was not correlated with performance.

The "Make Surgical Pathology Easy" project: learning Pathology through tailored digital infographics - the case for renovation of an old teaching method

The term ‘infographics’ is a blend of the two words “information” and “graphics”. Infographics can be described as ‘information visualizations’, conceived as visual translation of data including text, numbers, graphs, charts, drawings and so on. Visual representations are a fundamental part of scientific communication. They match the need to organize different pieces of information in a coherent and synthetic structure and constitute one of the most effective methods scientists rely on to divulge their findings. In particular, infographics provide an overview of key points regarding specific topics in a form that promotes quick learning and knowledge retention. They can be presented in printed or digital formats, being the latter particularly suitable for a global-scale diffusion via social media or websites.

In recent years, many pathologists have started developing digital infographics as a strategy for providing free educational contents on Facebook, Twitter or websites. In the present review, we focus on the value of digital infographics to summarize various aspects of Surgical and General Pathology. They shed light on diagnostic criteria, differentials and predictive/prognostic markers for many diseases, being a useful learning tool both for residents and practicing pathologists. In this paper, the model of infographics ideation, processing and sharing to an online audience is described and the impact of infographics on knowledge processes in Pathology is investigated.

Use of mind maps in dental education: An activity performed in a preclinical endodontic course

PURPOSE/OBJECTIVES

(1) to assess the ability of dental students to use mind maps to express the relationships of endodontic theory and technique; (2) to explore features illustrated from the highest- and lowest-graded mind maps; and (3) to evaluate improvements in successive mind maps from the same student.

METHODS

A total of 31 second-year students were asked to configure a mind map on root canal cleaning-shaping and then 18 weeks later develop a second mind map on root canal obturation. Faculty visually analyzed the mind maps using a qualitative approach: a multilayered process of thematic analysis. Codes and themes were generated to investigate if students were able to express appropriate and evidence-based ideas on the topics (accuracy of relationships and depth of information presented). Two of the highest- and 2 of the lowest-graded mind maps for each activity were directly compared. Improvement by the same student from the first to second mind map was also evaluated based on trend/style and creativity.

RESULTS

The majority of the students accurately expressed the scientific basis for root canal cleaning-shaping and obturation. The highest-graded mind maps displayed the biomedical and humanistic conceptions of critical thinking. In comparing the second mind map to the first, nearly 50% of the students incorporated more detail and artistic expression in the second map.

CONCLUSIONS

using mind maps in dental education can benefit students with different learning styles and help the instructor to identify the level of conceptualization that the student had developed about a topic.

Autoethnography as a Strategy for Engaging in Reflexivity

Reflexivity is a key feature in qualitative research, essential for ensuring rigor. As a nurse practitioner with decades of experience with individuals who have chronic diseases, now embarking on a PhD, I am confronted with the question “how will my clinical experiences shape my research?” Since there are few guidelines to help researchers engage in reflexivity in a robust way, deeply buried aspects that may affect the research may be overlooked. The purpose of this paper is to consider the affordances of combining autoethnography (AE) with visual methods to facilitate richer reflexivity. Reflexive activities such as free writing of an autobiographical narrative, drawings of clinical vignettes, and interviews conducted by an experienced qualitative researcher were analyzed to probe and make visible perspectives that may impact knowledge production. Two key themes reflecting my values—fostering advocacy and favoring independence and autonomy were uncovered with this strategy.

Sailing Across the Atlantic: An Exploration of the Psychological Experience Using Arts-Based Research

The reported study pursues the bidimensional objective, namely, (1) to grasp the essence of the psychological experience of a transatlantic journey and (2) to observe the potential of arts-based research for the enhancement of the well-being of sailors. The sample consisted of three males and one female - Latvian citizens, aged 36-68 years, with higher education and different sailing experience. In the context of a case study grounded on arts-based research methods, the freehand drawings of self-portraits or something important during the day were obtained using individual diaries containing daily reports on the sailing experience. After the journey, individual drawings prompted interviews organized for each participant. The results were triangulated with data from the logbook. In their drawings, participants focused more on the environment rather than on self-representation, that is, telling the story about "here and now" in terms of specific time (journey), place (boat), and their relationship with nature, as well as dealing with problems during the trip. The psychological experience of transoceanic sailing matched the three general dimensions (dynamics, context, and content of experience) of the conceptual framework constructed for this study. The three dimensions of experience were equivalently represented in research data; however, only dynamics and context were fully delineated in all theoretical subcategories. As to the potential of arts-based research for the enhancement of sailors' well-being, the findings show both direct and indirect evidence concerning their psychological and existential well-being. Further research is still needed to confirm the findings on a broader scale and in other contexts.

An international study of trainee-trained transitions: Introducing the transition-to-trained-doctor (T3D) model

Background: Throughout their careers, doctors and other healthcare professionals experience numerous transitions. When supporting transitions, opportunities for development and learning should be maximized, while stressors having negative impacts on well-being should be minimized. Building on our international data, this study aimed to develop a conceptual model of the trainee-trained transition (i.e. the significant transitions experienced by doctors as they complete postgraduate training moving from trainee/resident status to medical specialist roles).Methods: Employing Multiple and Multidimensional Transitions (MMT) theory and current conceptualizations of clinical context, this study undertook secondary analysis of 55 interviews with doctors from three countries (Netherlands, Cananda and the UK) undergoing trainee-trained transitions.Results: Through this analysis, the Transition-To-Trained-Doctor (T3D) conceptual model has been developed. This model takes into consideration the multiple contexts and multiple domains in which transitions take place.Discussion: This model is significant in that it has several uses and is applicable across countries: to remind doctors, managers and medical educators of the complexity of transitions; to frame and facilitate supportive conversations; and as a basis to teach about transitions.

Re-visioning Academic Medicine Through a Constructionist Lens

Constructionism in academic medicine matters. It encourages educators and researchers to question taken-for-granted assumptions, paying close attention to socially and historically contingent meanings. In this Invited Commentary, the authors explain what constructionism is; examine its ontological, epistemological, and axiological underpinnings; and outline its common methodologies and methods. Although constructivism favors the individual, constructionism privileges the social as the controlling force behind the construction of meaning. Where micro-constructionism attends to the minutiae of language, macro-constructionism focuses on broader discourses reproduced through material and social practices and structures. While social constructionists might situate themselves at any point on the relativist-realist continuum, many constructionists focus on constructionism as epistemology (the nature of knowledge) rather than ontology (the nature of reality). From an epistemological standpoint, constructionism asserts that how we come to know the world is constructed through social interaction. Constructionism thus values language, dialogue, and context, in addition to internal coherence between epistemology, methodology, and methods. Constructionism similarly values the concepts of dependability, authenticity, credibility, confirmability, reflexivity, and transferability. It also embraces the researcher-researched relationship. Given the privileging of language, qualitative methodologies and methods are key in constructionism, with constructionist-type questions focusing on how people speak. Here, the authors encourage the reader to develop an understanding of constructionism to re-vision academic medicine through a constructionist lens.

Rich pictures: a companion method for qualitative research in medical education

CONTEXT

Within the social sciences, researchers increasingly build on visual methods to explore complex phenomena and understand how people experience and give meaning to this complexity. Amongst the variety of visual methods available, rich pictures are beginning to gain traction in health professions education (HPE) research.

APPROACH

A rich picture is a pictorial representation of a particular situation, including what happened, who was involved, how people felt, how people acted, how people behaved, and what external pressures they acted upon. Rich pictures expand our perspective; they may highlight connections, illuminate the big picture and reveal unexpected emotions. Although new methods bring excitement to the field, it is our responsibility to also be cautious and insightful about their limitations. Rich pictures are a method in evolution in HPE research, with many unknowns about what is possible and what is optimal.

PURPOSE

In the current paper, we aim to map out the background, describe the process and share some reflective insights of using rich pictures as a data collection method.