Situating Learning in the Workplace – Having Another Look at Apprenticeships

Faculty Development for the People: Workplace-Based Solutions for Busy Clinicians

BACKGROUND

Across clinical learning environments (CLEs), learners often encounter supervising clinicians who do not self-identify as educators and, therefore, may not seek out faculty development to augment their teaching skills. To reach those faculty, we conducted a proof-of-concept project framed by Billet's theory on workplace learning, bringing tailored faculty development to the clinical workplace.

APPROACH

We recruited 22 faculty champions from 8 clinical departments at our institution, reflecting a broad and diverse range of CLEs. We created core materials for faculty development around feedback skills, which the faculty champions adapted to meet the needs of their individual CLEs. They took a variety of different approaches, including online modules, instructional posters in the OR and brief workshops offered during existing meetings.

EVALUATION

Between fall 2019 and summer 2022, this faculty development initiative reached a large number of faculty across departments, with the highest participation if activities were embedded in existing meetings. Based on available survey data, faculty satisfaction ratings with the offerings were high, and self-perceived competence increased. Despite successes, we also encountered challenges, including variable uptake dependent on departmental priorities, leadership buy-in and incentives offered.

IMPLICATIONS

This proof-of-concept project led to ongoing integration of workplace-based faculty development offerings at our institution, where a central 'hub' provides a broad array of activities and resources that can be adapted to different contexts ('spokes'). The lessons learned from this work can inform other institutions in the development and implementation of initiatives aimed at augmenting the reach of faculty development for busy clinicians.

How do mandatory emergency medicine rotations contribute to the junior residents' professional identity formation: a qualitative study

BACKGROUND

This study aims to investigate the impact of short-term mandatory emergency medicine rotations on professional identity formation of Japanese junior residents. Using situated learning theory as a theoretical framework, we explore how this rotation, which is part of a two-year Junior residency in the transition period from students to qualified physicians.

METHODS

We conducted a qualitative study conducting semi-structured face-to-face interviews with Year 1 postgraduate residents in the 2020-2021 classes of the junior residency program in Okinawa Chubu Hospital, Japan (n = 10). The data obtained from the interviews were analysed using inductive thematic analysis to identify the themes regarding professional identity formation.

RESULTS

Four main themes regarding professional identity formation emerged from the data analysis: patient care, teamwork, role models, and peers. Junior residents said they had the opportunity to participate in the emergency department community and experience training in authentic clinical contexts. Clinical exposure influenced the professional identity formation of the junior residents. Nurses and peers played a crucial role in this. Junior residents see the training in the emergency department as the beginning of their careers.

CONCLUSION

Short-term mandatory rotations enabled junior residents to integrate into the emergency department community, demonstrating autonomy and responsibility. These experiences fostered their professional identity by helping their socialisation within the community of practice.

"Nothing without connection"-Participant perspectives and experiences of mentorship in capacity building in Timor-Leste

The literature on mentorship approaches to capacity building in global health is limited. Likewise, there are few qualitative studies that describe mentorship in capacity building in global health from the perspective of the mentors and mentees. This qualitative study examined the perspectives and experiences of participants involved in a program of health capacity building in Timor-Leste that was based on a side-by-side, in-country mentorship approach. Semi-structured interviews were conducted with 23 participants (including Timorese and expatriate mentors, and local Timorese colleagues) from across a range of professional health disciplines, followed by a series of member checking workshops. Findings were reviewed using inductive thematic analysis. Participants were included in review and refinement of themes. Four major themes were identified: the importance of trust and connection within the mentoring relationship; the side-by-side nature of the relationship (akompaña); mentoring in the context of external environmental challenges; and the need for the mentoring relationship to be dynamic and evolving, and aligned to a shared vision and goals. The importance of accompaniment (akompaña) as a key element of the mentoring relationship requires further exploration and study. Many activities in global health capacity building remain focused on provision of training, supervision, and supportive supervision of competent task performance. Viewed through a decolonising lens, there is an imperative for global health actors to align with local priorities and goals, and work alongside individuals supporting them in their vision to become independent leaders of their professions. We propose that placing mentoring relationships at the centre of human resource capacity building programs encourages deep learning, and is more likely to lead to long term, meaningful and sustainable change.

Community, Coaching, and Action Research: Promoting Ambitious Teaching in Medical Education

Ambitious teaching is an instructional approach enacted through central tasks of teaching that involves a fundamental shift in mindset and practice. In this approach, the teacher facilitates student learning in the context of authentic, interactive experiences by eliciting student thinking and adapting instruction accordingly. We designed the Medical Educator-Excellence in Teaching (MEET) program to promote ambitious teaching in medical education. Here, we describe the structure of MEET, the framework that informed our work, and program evaluation data. We propose MEET as a model of educator development that promotes ambitious teaching through development of educator community, focused coaching, and inquiry into practice.

Medicine as a Community of Practice: Implications for Medical Education

The presence of a variety of independent learning theories makes it difficult for medical educators to construct a comprehensive theoretical framework for medical education, resulting in numerous and often unrelated curricular, instructional, and assessment practices. Linked with an understanding of identity formation, the concept of communities of practice could provide such a framework, emphasizing the social nature of learning. Individuals wish to join the community, moving from legitimate peripheral to full participation, acquiring the identity of community members and accepting the community's norms.Having communities of practice as the theoretical basis of medical education does not diminish the value of other learning theories. Communities of practice can serve as the foundational theory, and other theories can provide a theoretical basis for the multiple educational activities that take place within the community, thus helping create an integrated theoretical approach.Communities of practice can guide the development of interventions to make medical education more effective and can help both learners and educators better cope with medical education's complexity. An initial step is to acknowledge the potential of communities of practice as the foundational theory. Educational initiatives that could result from this approach include adding communities of practice to the cognitive base; actively engaging students in joining the community; creating a welcoming community; expanding the emphasis on explicitly addressing role modeling, mentoring, experiential learning, and reflection; providing faculty development to support the program; and recognizing the necessity to chart progress toward membership in the community.

How physicians teach in the clinical setting: The embedded roles of teaching and clinical care

BACKGROUND

Clinical teaching lies at the heart of medical education. However, few studies have explored the embedded nature of teaching and clinical care. The goal of this study was to examine the process of clinical teaching as it naturally, and spontaneously, unfolds in a broad range of authentic contexts with medical students and residents.

METHODS

This focused ethnographic study consisted of 160 hours of participant observation and field interviews with three internal medicine teams. Thematic analysis guided data organization and interpretation.

FINDINGS

Three overlapping themes emerged: the interconnectedness between clinical work and pedagogy; a multiplicity of teachers; and the influence of space and artifacts on teaching and learning. Clinical teaching, which was deeply embedded in clinical care, was influenced by the acuity of patient problems, learner needs, and the context in which teaching unfolded; it also occurred on a spectrum that included planned, opportunistic, formal, and informal teaching (and learning).

CONCLUSIONS

Study findings suggest that clinical teaching, which is marked by an intersection between service and teaching, can be viewed as an example of work-based teaching. They also yield suggestions for the enhancement of clinical teaching in inpatient settings, faculty development, and educational policies that recognize clinical teaching and learning.

Re-positioning faculty development as knowledge mobilization for health professions education

Faculty development as knowledge mobilization offers a particularly fruitful and novel avenue for exploring the research-practice interface in health professions education. We use this 'eye opener' to build off this assertion to envision faculty development as an enterprise that provides a formal, recognized space for the sharing of research and practical knowledge among health professions educators. Faculty development's knowledge mobilizing strategies and outcomes, which draw upon varied sources of knowledge, make it a potentially effective knowledge mobilization vehicle.First, we explain our choice of the term knowledge mobilization over translation, in an attempt to resist the false dichotomy of 'knowledge user' and 'knowledge creator'. Second, we leverage the documented strengths of faculty development against the documented critiques of knowledge mobilization in the hopes of avoiding some of the pitfalls that have befallen previous attempts at closing knowing-doing gaps.Through faculty development, faculty are indeed educated, in the traditional sense, to acquire new knowledge and skill, but they are also socialized to go on to form the systems and structures of their workplaces, as leaders and workers. Therefore, faculty development can not only mobilize knowledge, but also create knowledge mobilizers. Achieving this vision of faculty development as knowledge mobilization requires an acceptance of multiple sources of knowledge, including practice-based knowledge, and of multiple purposes for education and faculty development, including professional socialization.

Affirming professional identities through an apprenticeship: insights from a four-year longitudinal case study

PURPOSE

A four-year course, entitled Physician Apprenticeship, was introduced at McGill University's Faculty of Medicine in 2005. The primary objective of the course is to assist students in their transition from laymen to physicians. The goal of this study was to understand the apprenticeship learning process, particularly its contribution to professional identity formation.

METHOD

For data collection, the authors used a longitudinal case study design with mixed methods. They conducted the study over a four-year curricular cycle, from 2008-2009 to 2011-2012. The case consisted of three apprenticeship groups. Students (n = 24) and teachers (n = 3) represented two subgroups for data analysis.

RESULTS

Physician Apprenticeship activities promoted and sustained medical professionalization in the participants. Salient features of successful apprenticeship learning were access to authentic clinical experiences as well as the provision of a safe learning environment and guided critical reflection. The latter two ingredients appear to be mutually reinforcing and contributed to the creation of meaningful student-teacher relationships. Teachers exhibited several qualities that align with a parental role. Students became increasingly aware of having entered the kinship of physicians. Teachers experienced a renewal and validation of their commitment to the ideals of medicine.

CONCLUSIONS

Findings strongly suggest that a longitudinal apprenticeship in an undergraduate medical program can contribute to the formation and reaffirmation of professional identity. The case study design permitted the authors to create a provisional conceptual model explicating important features of the apprenticeship learning process.

Confident to seek help: the development of skill and judgement in nurse practitioners. A mixed methods study

BACKGROUND

Healthcare is undergoing a transformation in terms of traditional role and skill assignations of staff, with an attendant blurring of boundaries. Expert judgement is used in order to develop and assess learners as they prepare for these new roles.

OBJECTIVES

To determine factors related to the perceived usefulness of feedback, to find out how participants use expert judgement, to develop skill and to examine how the context of learning affects the development of judgement.

SETTING

Four NHS Health Board areas within Scotland.

PARTICIPANTS

95 nurse practitioners who had successfully completed a specified course of skills based education between September 2008 and August 2010. 10 participants agreed to follow up interview.

DESIGN

Survey and follow-up semi-structured interviews.

METHODS

Mixed methods. 20 item, internet based questionnaire (n = 85) and semi-structured interviews (n = 10), collected between September 2010 and February 2011.

RESULTS

Response rate was 55%-confidence level of 99%, this sample yields a confidence interval of 12.9%. The results demonstrate that the demonstration of skill and the perception of expertise of the supervisor are related to the perceived usefulness of feedback (p < 0.004). The participants use feedback as one strategy to develop skill and judgement, although the mining of the tacit knowledge of medical colleagues, reference to associated theory and peer support and learning strategies are also seen to be important. The development of judgement is restricted by the tightly controlled learning environment.

CONCLUSIONS

Identification of participants with the expertise of the supervisory group reveals a group who are highly aspirational and for whom the governance of learning leads the participants to be confident to seek help and not the confidence to identify learning needs. Learning is seen to be dominated by the context in which it is set and as the participants learn motor skills, they learn to fit in and manage a brittle working environment.