Examining the Impact of Dialogic Learning on Critically Reflective Practice

The expository phase of debriefing in clinical simulation: a qualitative study

BACKGROUND

Clinical simulation fosters reflective, experiential learning in a safe environment, allowing participants to learn from mistakes without patient risk. Debriefing, essential for reflection, is typically facilitator driven. The MAES© methodology (Self-Learning Methodology in Simulated Environments) shifts the focus to students, guiding them through six sequential phases: group identity creation, topic selection, objective setting, competency establishment, scenario design, simulation, and debriefing. MAES© introduces an expository phase in debriefing, where students present theoretical and practical content. The facilitator assumes a significant, yet secondary role, fostering increased student-led learning opportunities and, at times, enabling even trained real patients to co-facilitate the debriefing.

OBJECTIVE

To explore participants' experiences and perceptions regarding the expository phase of debriefing within the MAES© methodology framework, with specific focus on the student-led debriefing component.

METHOD

A descriptive qualitative inductive approach with thematic content analysis was used. Open-ended questionnaires from 151 undergraduate final year and post-graduate nursing students, captured their experiences with the MAES© expository phase. Open-ended questionnaires allow participants to freely and anonymously express their perspectives and experiences. Responses were transcribed, independently coded, and analyzed using MaxQDA® v18. Data were coded and analyzed based on absolute and relative frequencies of emerging categories. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines.

RESULTS

The analysis revealed several key themes in student evaluations. Satisfaction with the methodology emerged strongly, with over one-third of participants expressing no desired changes. The reflective nature of the approach was prominently valued, along with its effectiveness for concept clarification and fostering collaborative learning. Participants particularly noted developmental outcomes in communication competencies and technical skills, while appreciating the motivational learning environment and evidence-based focus. The suggested improvements focused on three main aspects: increased session dynamism, a greater use of visual and interactive elements, and reduced dependence on slide-based presentations.

CONCLUSION

The study highlights the value of the expository phase in the MAES© methodology, emphasizing its effectiveness in clarifying concepts, fostering collaboration, and developing technical and communication skills. It also promotes student autonomy through active engagement. However, participants suggested improvements, such as greater dynamism, personalization, and varied presentation methods using videos, skill stations or patient's-oriented debriefing. Overall, the expository phase proves to be a valuable pedagogical tool with potential for broader application in simulation-based learning and other debriefing models.

CLINICAL TRIAL NUMBER

Not applicable.

Seeing Ourselves in Others: Understanding and Addressing Biases in Medical School Admissions Processes

Purpose

Medical school admissions is a vital area for advancing diversity, equity, and inclusion (DEI). Integrating bias recognition and management (BRM) within the context of admissions is critical in advancing DEI. However, there is a dearth of empirically informed literature on BRM in the admissions context. Therefore, this study sought to explore how individuals involved in admissions decisions process and integrate bias related feedback.

Methods

The authors conducted a qualitative exploratory study using constructivist grounded theory. 21 semi-structured interviews were conducted with various participants in the admissions process at a North American medical school who had participated in bias related training. Participants included medical school faculty, senior medical students, and community volunteers.

Results

Overall, participants expressed diverse perspectives on their personal biases and how these biases impact admissions decisions. Their reflections were shaped by their identities, values, and priorities, which varied based on whether they were faculty members, students, or community members. Participants also highlighted that their biases influenced their perceptions of the ideal admissions candidate, thus influencing their decision-making process. They emphasized the need for more opportunities to engage in dialogue with peers to openly share and discuss how to recognize and manage their biases.

Conclusion

Our study suggests that fostering critical reflection about identity tensions, building and sustaining a community of practice, and facilitating sustained dialogue may provide admissions committees with an evidence-informed, meaningful, and sustained approach to advancing DEI through bias recognition and management.

Critical reflection in team-based practice: A narrative review

INTRODUCTION

Research on critical reflection (a process of recognising and challenging assumptions that frame health care practice) has demonstrated strong potential for making health care more collaborative and equitable, yet its enactment within team-based health care remains underexplored. We conducted a narrative review to advance understanding of how critical reflection develops, occurs in and impacts team-based practice and care.

METHODS

We searched three databases (Medline, CINAHL and Scopus) for articles related to the concepts of critical reflection and/or critically reflective practice in the context of team-based health care and examined how teams engage with those theoretical concepts, to inform ideas for a new approach to support critically reflective practice.

FINDINGS

The search identified 974 citations of which nine articles showed elements of critical reflection in team-based practice. However, since only one of the nine included articles explicitly used the term 'critical reflection' in their research, critical reflection as a theoretical concept was found to be largely missing from the current team-based health care literature. Instead, aspects of critical reflection were evident in terms of challenging power hierarchies and questioning practice assumptions through dialogue, with a goal of collaborative practice. This sharing of knowledge and skills allowed teams to push boundaries and innovate together in practice. The included articles also emphasised the importance of creating a purposeful environment for open dialogue and practice change to occur.

CONCLUSION

To support equitable care through collaborative practices, we suggest dialogue as and for critical reflection should be explicitly developed and researched within team-based health care.

"What got you here, won't get you there": Students as leaders of the change we need

Lack of access, system inequities, and inefficiencies plague our current healthcare system. With a challenge this complex, no one intervention is sufficient; all will be necessary. The primary care system needs a strong health workforce prepared in bold new ways. Students represent an important voice, given their role as future leaders of health education and healthcare. For students to lead, educators must leverage education paradigms that position current students as leaders of transformation. Yet, in current health education systems, students are often seen as passive recipients of knowledge and skill. Transformative education seeks to foster critical reflection (an ongoing process of questioning unhelpful assumptions and power relations) and informed action in students to enable them to challenge and change norms and change practices, structures, and society. This article highlights the value of transformative education in cultivating thoughtful change agents and provides one tangible example of a new education/practice model that puts this paradigm into action.

A critical interpretive synthesis of interprofessional education interventions

Interprofessional practice can look quite different depending on a number of dynamics. Interprofessional education interventions may or may not orient toward this range of practice possibilities. This literature review explores: (1) how interprofessional education interventions relate to different kinds of interprofessional practice and (2) the range of interprofessional practices assumed by interprofessional education interventions. Four databases were searched for articles published between 2011-2021 describing pre-licensure level interprofessional education interventions, resulting in a dataset of 110 articles. Our analysis involved (1) descriptive summaries of the articles, and (2) content analysis of the rationale and description of the intervention. Of the articles, 93% (102/110) of interprofessional education interventions were designed and/or evaluated using the concept of interprofessional education competencies. "Teamwork" was the most relied upon competency. Most articles were not explicit about the different kinds of interprofessional practices that these competencies might be oriented toward. Our study substantiates earlier claims that interprofessional education literature tends to focus on competencies and orient toward undifferentiated understandings of "teamwork." This analysis is particularly important as interprofessional teams are engaging in increasingly complex, fluid, and distributed forms of interprofessional practice that may not be captured in an undifferentiated approach to "teamwork."

Improving patient-centered care for HIV and mental illness: exploring hospital and community integration through education

Current models of care delivery are failing patients with complexity, like those living with HIV, mental illness and other psychosocial challenges. These patients often require resource-intensive personalized care across hospital and community settings, but available supports can be fragmented and challenging to access and navigate. To improve this, the authors created a program to enhance integrated, trauma-informed care through an innovative educational role for a HIV community caseworker embedded in an academic HIV Psychiatry clinic, called the Mental Health Clinical Fellowship. Through qualitative interviews with 21 participants (patients, physicians, clinicians and Mental Health Clinical Fellows) from October 2020-March 2023, the authors explore how implementation of this program affects patient experiences and satisfaction with care. Patients described their care experiences as less stigmatizing, more accessible, holistic and coordinated. They often attributed this to the integration between fellow and psychiatrist, and specifically the accessible stance of community organizations embedded within a hospital, which helped build trust. Interchangeable and integrated support by caseworker and psychiatrist improved patient engagement in psychiatric management and patient satisfaction with their care. Cross-context and cross-disciplinary care provision that includes providers from community and hospital working directly together to deliver care can improve care for patients with significant complexity.

'First in family' experiences in a Canadian medical school: A critically reflexive study

BACKGROUND

Medical students from affluent and highly educated backgrounds remain overrepresented in Canadian medical schools despite widespread efforts to improve diversity. Little is known of the medical school experiences of students who are first in their family (FiF) to attend university. Drawing on Bourdieu and a critically reflexive lens, this study explored the experiences of FiF students in a Canadian medical school to better understand the ways in which the medical school environment can be exclusive and inequitable to underrepresented students.

METHODS

We interviewed 17 medical students who self-identified as being FiF to attend university. Utilising theoretical sampling, we also interviewed five students who identified as being from medical families to test our emerging theoretical framework. Participants were asked to discuss what 'first in family' meant to them, their journey into medical school and their experiences at medical school. Bourdieu's theories and concepts were used as sensitising concepts to explore the data.

RESULTS

FiF students discussed the implicit messages they received about who belongs in medical school, challenges in shifting from their pre-medical lives to a medical identity and competing with peers for residency programmes. They reflected on the advantages they perceived they had over their fellow students due to their less 'typical' social backgrounds.

CONCLUSION

While medical schools continue to make strides when it comes to increasing diversity, inclusivity and equity require increased attention. Our findings highlight the ongoing need for structural and cultural change at admissions and beyond-change that recognises the much-needed presence and perspectives that underrepresented medical students, including those who are FiF, bring to medical education and healthcare. Engaging in critical reflexivity represents a key way that medical schools can continue to address issues of equity, diversity and inclusion.

Teaching critical reflection in health professions education with transformative-vygotskian praxis

Reflective practice is a complex concept to adequately describe, communicate about and, ultimately, teach. Unrelieved tensions about the concept persist within the health professions education (HPE) literature owing to reflection's diverse theoretical history. Tensions extend from the most basic, e.g., what is reflection and what are its contents, to the complex, e.g., how is reflection performed and whether it should be evaluated. Nonetheless, reflection is generally seen as vital to HPE, because it imparts crucial strategies and awareness to learners in their professional practices. In this article, we explore both conceptual and pedagogical dimensions of teaching for reflection. We address the concept of reflection, its application to practice, and how to remain faithful to transformative, critical pedagogy when teaching for it. We present (a) an analysis of two theories of education in HPE: Transformative Learning and Vygotskian Cultural Historical Theory. We (b) outline a pedagogical approach that applies Piotr Gal'perin's SCOBA: schema for the complete orienting basis of an action. We then employ (a) and (b) to provide affordances for developing materials for educational interventions across HPE contexts.