What is feedback in clinical education?

Longitudinal faculty development to improve interprofessional collaboration and practice: a multisite qualitative study at five US academic health centres

OBJECTIVES

Interprofessional (IP) collaboration and effective teamwork remain variable in healthcare organisations. IP bias, assumptions and conflicts limit the capacity of healthcare teams to leverage the expertise of their members to meet growing complexities of patient needs and optimise healthcare outcomes. We aimed to understand how a longitudinal faculty development programme, designed to optimise IP learning, influenced its participants in their IP roles.

DESIGN

In this qualitative study, using a constructivist grounded theory approach, we analysed participants' anonymous narrative responses to open-ended questions about specific knowledge, insights and skills acquired during our IP longitudinal faculty development programme and applications of this learning to teaching and practice.

SETTING

Five university-based academic health centres across the USA.

PARTICIPANTS

IP faculty/clinician leaders from at least three different professions completed small group-based faculty development programmes over 9 months (18 sessions). Site leaders selected participants from applicants forecast as future leaders of IP collaboration and education.

INTERVENTIONS

Completion of a longitudinal IP faculty development programme designed to enhance leadership, teamwork, self-knowledge and communication.

RESULTS

A total of 26 programme participants provided 52 narratives for analysis. Relationships and relational learning were the overarching themes. From the underlying themes, we developed a summary of relational competencies identified at each of three learning levels: (1) Intrapersonal (within oneself): reflective capacity/self-awareness, becoming aware of biases, empathy for self and mindfulness. (2) Interpersonal (interacting with others): listening, understanding others' perspectives, appreciation and respect for colleagues and empathy for others. (3) Systems level (interacting within organisation): resilience, conflict engagement, team dynamics and utilisation of colleagues as resources.

CONCLUSIONS

Our faculty development programme for IP faculty leaders at five US academic health centres achieved relational learning with attitudinal changes that can enhance collaboration with others. We observed meaningful changes in participants with decreased biases, increased self-reflection, empathy and understanding of others' perspectives and enhanced IP teamwork.

Team-Based Learning in the Clinical Setting: Perspectives of Doctor of Nursing Practice Students

Background

Team-based learning is a teaching modality that meets at the intersection of active learning, teamwork, and assimilation of complex course concepts to prepare students for lifelong learning. Yet little is known about how principles of team-based learning could be employed outside of the classroom.

Objective

To provide direction as to how principles of team-based learning could be applied to the “real-world” clinical setting.

Methods

The synthesis is the result of a class discussion among practicing DNP (Doctor of Nursing Practice) students (n = 16) at an urban university.

Results

Students perceived that the application of team-based learning in the clinical setting could reduce isolationism and improve interprofessional communication, job satisfaction, respect, quality of care, cost effectiveness, coordination of care, efficiency, and patient safety. Projects that might benefit from this approach include those that involve difficult or complex cases in which the correct answer is challenging or debatable. Nevertheless, logistical, financial, and complicated power dynamics were perceived as potential barriers

Conclusions

Team-based learning can be effectively applied to the clinical setting, although perceived barriers must be addressed.

Implications for Nursing

When applied to an appropriate clinical problem or clinical setting, team-based learning may have the potential to advance lifelong learning by following a structured, yet provider-centric approach.

The effects of Team-Based Learning on learning behaviors in the maternal-child nursing course

BACKGROUND

The Team-Based Learning (TBL) method has been used as a teaching strategy in many disciplines. It is instructor-led, learner-centered learning with functions similar to those of problem-based learning, but it is more cost-effective. However, little is known about the application of TBL to nursing education.

OBJECTIVES

The objectives of the study are to employ the TBL approach in a Maternal-Child Nursing course and to evaluate its effects on learning outcomes.

DESIGN

We present one-group pretest-posttest research design with the intervention of the TBL teaching strategy.

SETTINGS

The study was conducted in one of the nursing universities in Taiwan.

PARTICIPANTS

One-hundred-four students in 2011 and 103 students in 2012 in an RN-to-BSN program who enrolled in the Maternal-Child Nursing course participated in this study. These students had graduated from a five-year nursing diploma program before enrolling in the RN-BSN program.

METHODS

Data were collected before and after the implementation of the TBL, which included active learning, in-class activities, and application exercises. The Class Engagement Survey (CES), Value of Teams (VTs), Self-Directed Learning Instrument (SDLI), and exam scores were used to measure students' learning outcomes.

RESULTS

TBL significantly influenced the students' learning outcomes. Students who expressed that TBL increased their learning interests had a higher score on VT; and students who had high achievement from the current TBL course had higher scores on the CES, VT, and SDLI. The means of the group test scores and the final examination score were significantly higher than the individual scores from the in-class tests in both 2011, 2012, and the combination of 2011 and 2012.

CONCLUSION

The TBL design requires out-of-class preparation before all classes, which requires active and self-directed learning. TBL provides opportunities to foster learner-to-learner interactions, which lead to more active engagement and teamwork among learners. It also promotes the students' class engagement and teamwork values, and it increases academic performance. The TBL is suggested to have a greater effect on academically weaker students.

Convergence at the surface; divergence beneath: cross-agency working within a small-scale, schools-based project

In the UK school system social remits - requiring schools to work towards improved social as well as educational outcomes for children - have become significant over the last decade. This study focuses upon the inter-professional issues in the running of one small-scale intervention involving parents and their babies based in schools in an urban setting in the UK. The programme, run over the school year 2007/08, provided a professional framework in which parents from the local community surrounding a school brought their babies into classroom settings to talk about aspects of baby care and development. This professional framework included classroom teachers, one senior cross-school education manager, family health visitors and one senior children's health nurse. Despite agreement about the benefits of the programme there were also clear differences of priority. This paper describes the different perceptions that each of these two sets of professionals - from health and from education - had of the programme, and highlights some critical perspectives that tended to come more from health professionals. It also maps out potential solutions which draw upon recent literature that is similarly focused upon inter-professional and inter-agency service delivery. In so doing it offers valuable insights to professionals working in inter-agency collaborations in schools.

Pedagogical strategies used in clinical medical education: an observational study

BACKGROUND

Clinical teaching is a complex learning situation influenced by the learning content, the setting and the participants' actions and interactions. Few empirical studies have been conducted in order to explore how clinical supervision is carried out in authentic situations. In this study we explore how clinical teaching is carried out in a clinical environment with medical students.

METHODS

Following an ethnographic approach looking for meaning patterns, similarities and differences in how clinical teachers manage clinical teaching; non-participant observations and informal interviews were conducted during a four month period 2004-2005. The setting was at a teaching hospital in Sweden. The participants were clinical teachers and their 4th year medical students taking a course in surgery. The observations were guided by the aim of the study. Observational notes and notes from informal interviews were transcribed after each observation and all data material was analysed qualitatively.

RESULTS

Seven pedagogical strategies were found to be applied, namely: 1) Questions and answers, 2) Lecturing, 3) Piloting, 4) Prompting, 5) Supplementing, 6) Demonstrating, and 7) Intervening.

CONCLUSIONS

This study contributes to previous research in describing a repertoire of pedagogical strategies used in clinical education. The findings showed that three superordinate qualitatively different ways of teaching could be identified that fit Ramsden's model. Each of these pedagogical strategies encompass different focus in teaching; either a focus on the teacher's knowledge and behaviour or the student's behaviour and understanding. We suggest that an increased awareness of the strategies in use will increase clinical teachers' teaching skills and the consequences they will have on the students' ability to learn. The pedagogical strategies need to be considered and scrutinized in further research in order to verify their impact on students' learning.