On Communities of Practice in Medical Education

Barriers and facilitators to the cultivation of communities of practice for faculty development in medical education: A scoping review

BACKGROUND

Communities of practice (CoPs) have been promoted as a strategy to foster the professional development of faculty. In recent years, there have been a rising number of publications in the field of medical education that report on the impact of CoPs in faculty development (FD), as well as the factors that influence their cultivation. The objective of this scoping review was to comprehensively map the reported barriers and facilitators to cultivating CoPs for FD in medical education.

METHODS

The authors searched five electronic databases on 15 January 2022, and in a final update search on 4 August 2024. The authors used the updated Consolidated Framework for Implementation Research as an a priori coding framework to guide coding. The authors applied a quasi-statistical content analysis to quantify and draw meaning from the factors that constrain and support CoP formation, implementation and sustainability.

RESULTS

The authors generated 359 codes for barriers and facilitators from 25 included empirical and non-empirical articles, of which 295 codes (82%) were relevant to forming and implementing a CoP, and 64 (18%) relevant to sustaining a CoP. The main barriers and facilitators were related to: the sufficiency of structural, cultural and resource support; the availability and fit of required stakeholders; relevance to member needs; planning; member attraction and engagement; and reflection and evaluation of the CoP.

CONCLUSIONS

This review highlights the key patterns and gaps in the emerging publications on CoP cultivation for FD in medical education, from their formation to their sustainability. There remain key unresolved problems and gaps in the evidence concerning how to create long-term participation successfully to sustain CoPs for FD in medical education. Although hybrid and virtual CoPs appear to be the way forward, there is still a need to account for individual member capabilities and needs, and the nature of the medical education context on CoP sustainability.

Good bedside teaching on secondary care placement: The student perspective

BACKGROUND

Students' experience of bedside teaching (BST) on clinical placement has significantly decreased, with a shift in teaching away from the bedside. The educational value of teaching on ward rounds (WRs) has also been debated.

OBJECTIVE

This research considered what constitutes good BST from the student perspective; guidance to support clinician teachers was produced.

METHODS

Semi-structured interviews were conducted with 10 second-year students and 10 fourth- and fifth-year students studying at Leeds Medical School. Data were analysed using thematic analysis.

FINDINGS

We identified four themes: (1) benefits of early clinical experience, (2) qualities of good clinical teachers, (3) shift in preference from structured to opportunistic learning and (4) increased valuing of the WR as a site of learning.

CONCLUSION

The structure of BST should be adapted to the learners' stage of training with a graduated approach, from a structured preparation for observation to authentic, observed participation with feedback. Students' early lack of clinical knowledge makes it difficult to meaningfully observe and partake in ward activities. During early clinical experience, good teaching is perceived as structured and supported by the clinician. As learners progress, they are better able to engage in opportunistic learning, which actively involves them in patient care. They also valued structured teaching and feedback. While patient contact should be supervised, a more participatory, observed and feedback-driven approach should be adopted in the later years. Teaching must address both knowledge and skills required to be a doctor; this is facilitated by an active role in patient care.

Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study

PURPOSE

Longitudinal integrated clerkships (LICs) have been implemented worldwide to increase authentic student participation in patient care over time. Studies have shown benefits of the model include the ability of LICs to attract future practitioners to underserved areas, student engagement in advocacy, and development of an "ethic of caring." Less is known, however, about how LICs impart their benefits, although LICs may strengthen professional identity. As such, this study aimed to explore medical student professional identity construction through time within LICs internationally.

METHOD

This was a longitudinal qualitative study from 2019 to 2020, involving 33 students across 4 medical schools in the United Kingdom, Ireland, and the United States. The authors explored participating students' identity construction during LICs. Data collection involved 3 stages: individual, semistructured interviews at entry (n = 33) and exit of the LIC (n = 29), and audio diaries throughout. Data were analyzed inductively using a reflexive thematic approach.

RESULTS

Three themes were identified. Longitudinal relationships with patients and preceptors encouraged patient care ownership and responsibility; LIC students identified as patient advocates; and longitudinal relationships shaped students' social consciences. Themes were underpinned by continuity of relationships between students and patients, and students and tutors.

CONCLUSIONS

Though continuity is lauded as the cornerstone of LICs, these findings suggest that this is too broad a way of understanding the benefits of LICs. Instead, continuity should be seen as facilitating the development of important relationships within diverse communities of practice, which leads medical students to construct professional identities as responsible, compassionate advocates for underserved populations. This was the case across the institutions, nations, and LIC types in this study. By highlighting the ways in which LICs influence identity, these findings offer important insight relating to the future development and delivery of LICs.

Value-Added Roles of Medical Students During the COVID-19 Pandemic: Assessment of Medical Students' Perceptions and Willingness in Sri Lanka

Purpose

Since the coronavirus disease 2019 (COVID-19) pandemic is an opportune time to introduce the value-added roles of medical students, this study assessed medical students’ perceptions and willingness to assist in COVID-19 health sector preparedness and response via value-added roles in Sri Lanka.

Methods

A cross-sectional online survey was conducted among all medical students studying in six batches of the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, in June 2020. A Google form in English with 10 statements about individual perceptions of medical students’ roles and their willingness to assist in the COVID-19 health sector response via value-added roles was used to collect data. The responses were recorded on a five-point Likert scale. The chi-squared test for independence was used to explore the associations between the academic year and the responses to each statement.

Results

Out of 856 (response rate 79.6%) study participants, the majority were females (n=601, 70.2%). The majority (n=804, 93.9%) reported that they have a responsibility to contribute to the country’s COVID-19 health sector response. There was a statistically significant association between medical students’ perceived level of clinical knowledge, having the clinical skills to assist in the COVID-19 health sector response and academic year (p<0.001). The commonly identified value-added roles were developing (n=770, 89.9%) and disseminating (n=744, 86.9%) health education messages, and field contact tracing activities (n=653, 76.3%). Other value-added roles were assisting the curative health sector in COVID-19 patient management (n=380, 44.4%) and other non-COVID-19 patient management (n=463, 54.1%).

Conclusion

Medical students are mostly willing to engage in preventive health sector value-added roles and, to a lesser extent, in curative health sector value-added roles during the COVID-19 outbreak. However, medical educators need to clearly define the value-added roles and provide adequate training and supervision for medical students across academic years to enable them to combine learning with making meaningful contributions to the health-care system during the COVID-19 pandemic.

You say it, we say it, but how do we use it? Communities of practice: A critical analysis

OBJECTIVES

As educational theories are increasingly used in medical education research there are concerns over how these theories are used, how well they are presented and what the authors intend. Communities of practice (CoP) is one example of an often-used theory and conceptual framework. This paper presents a critical analysis of how CoP theory is used in medical education research.

METHODS

A critical literature analysis was undertaken of articles published between 1998 and 2018 in eight internationally recognised medical education journals. From a total of 541 articles, 80 articles met the inclusion criteria and were analysed and mapped according to various patterns of use.

RESULTS

We discerned five categories of use, two misleading and cosmetic, off target and cosmeticising, and three functional, framing, lensing and transferring. A considerable number of articles either misrepresented the point of communities of practice or used it in a cosmetic fashion. The remainder used the theory to frame an ongoing study in relation to other work, as a lens through which to design the study and collect or analyse data, or as a way of discussing or demonstrating the transferability of the findings.

CONCLUSIONS

We conclude that almost half of the reviewed articles did not offer a functional and rigorous definition of what is meant by CoP; instead, they used it in a potentially misleading or cosmetic manner. This study therefore calls on editors, reviewers and authors alike to increase clarity and quality in the application of CoP theory in medical education.