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Romanova A, Touchie C, Ruller S, Kaka S, Moschella A, Zucker M, Cole V, Humphrey-Murto S. Learning Plan Use in Undergraduate Medical Education: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:1038-1045. [PMID: 38905130 DOI: 10.1097/acm.0000000000005781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
PURPOSE How to best support self-regulated learning (SRL) skills development and track trainees' progress along their competency-based medical education learning trajectory is unclear. Learning plans (LPs) may be the answer; however, information on their use in undergraduate medical education (UME) is limited. This study summarizes the literature regarding LP use in UME, explores the student's role in LP development and implementation, and identifies additional research areas. METHOD MEDLINE, Embase, PsycInfo, Education Source, and Web of Science databases were searched for articles published from database inception to March 6, 2024, and relevant reference lists were manually searched. The review included studies of undergraduate medical students, studies of LP use, and studies of the UME stage in any geographic setting. Data were analyzed using quantitative and qualitative content analyses. RESULTS The database search found 7,871 titles and abstracts with an additional 25 found from the manual search for a total of 7,896 articles, of which 39 met inclusion criteria. Many LPs lacked a guiding framework. LPs were associated with self-reported improved SRL skill development, learning structure, and learning outcomes. Barriers to their use for students and faculty were time to create and implement LPs, lack of training on LP development and implementation, and lack of engagement. Facilitators included SRL skill development, LP cocreation, and guidance by a trained mentor. Identified research gaps include objective outcome measures, longitudinal impact beyond UME, standardized framework for LP development and quality assessment, and training on SRL skills and LPs. CONCLUSIONS This review demonstrates variability of LP use in UME. LPs appear to have potential to support medical student education and facilitate translation of SRL skills into residency training. Successful use requires training and an experienced mentor. However, more research is required to determine whether benefits of LPs outweigh the resources required for their use.
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Alston J, Gandell D, Kangasjarvi E, Brydges R. Ready, Set, Goal: A Mixed Methods Study of a Goal-Setting Intervention on 2 Competency-Based Geriatric Medicine Rotations. J Grad Med Educ 2024; 16:453-460. [PMID: 39148878 PMCID: PMC11324169 DOI: 10.4300/jgme-d-24-00069.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/05/2024] [Accepted: 06/03/2024] [Indexed: 08/17/2024] Open
Abstract
Background More research is required to understand the effects of implementing structured goal-setting on trainee engagement in competency-based clinical learning environments. Objective To explore how residents experienced a rotation-specific goal-setting intervention on geriatric medicine rotations at 2 hospitals. Methods All rotating residents were expected to complete the intervention, consisting of a SMART-based (Specific, Measurable, Achievable, Relevant, and Time-Bound) goal-setting form and feedback sessions with teaching faculty. From November 2019 to June 2021, we recruited a convenience sample of rotating residents. Study participants completed pre- and postrotation 35-item Dutch Residency Educational Climate Test (D-RECT) questionnaires to compare scores from their rotation before the geriatric rotation and a postrotation semistructured interview, which we transcribed and analyzed using principles of constant comparison and reflexive thematic analysis. Results We interviewed 12 of 58 (20.7%) residents participating in the goal-setting intervention, 11 of whom completed both D-RECT questionnaires. Participants' D-RECT scores favored the geriatric medicine rotation versus the immediately preceding clinical rotation (M=4.29±0.37; M=3.84±0.44, P=.002). Analyses of interview transcripts yielded 3 themes on how participants perceived the intervention influenced their learning experience: (1) structured forms and processes mediate, inform, and constrain goal selection; (2) interactions with faculty, patients, and system factors influenced goal enactment; and (3) unstructured assessments led to uncertainty around goal achievement. Challenges included time restrictions and unpredictable clinical opportunities. Conclusions Goal-setting appeared to help many residents direct their learning efforts and engage in collaborative processes with teaching faculty. We identified challenges limiting residents' engagement with the goal-setting intervention, which may inform the practical implementation of goal-setting in other competency-based curricula.
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Affiliation(s)
- Jillian Alston
- Jillian Alston, MD, MScCH, FRCPC, is Assistant Professor, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, and Staff Physician, Division of Geriatric Medicine, Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Dov Gandell
- Dov Gandell, MDCM, FRCPC, is Assistant Professor, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, and Staff Physician, Division of Geriatric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Emilia Kangasjarvi
- Emilia Kangasjarvi, MSSc, is Research Coordinator, Applied Education Research Operatives, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada; and
| | - Ryan Brydges
- Ryan Brydges, PhD, has a Professorship in Technology-Enabled Education, St. Michael’s Hospital, Unity Health Toronto, and is Associate Professor, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Stoffels M, Broeksma LA, Barry M, van der Burgt SME, Daelmans HEM, Peerdeman SM, Kusurkar RA. Bridging School and Practice? Barriers to the Integration of 'Boundary Objects' for Learning and Assessment in Clinical Nursing Education. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:392-405. [PMID: 39006554 PMCID: PMC11243767 DOI: 10.5334/pme.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 06/21/2024] [Indexed: 07/16/2024]
Abstract
Introduction In clinical health professions education, portfolios, assignments and assessment standards are used to enhance learning. When these tools fulfill a bridging function between school and practice, they can be considered 'boundary objects'. In the clinical setting, these tools may be experienced as time-consuming and lacking value. This study aimed to investigate the barriers to the integration of boundary objects for learning and assessment from a Cultural-Historical Activity Theory (CHAT) perspective in clinical nursing education. Methods Nineteen interviews and five observations were conducted with team leads, clinical educators, supervisors, students, and teachers to obtain insight into intentions and use of boundary objects for learning and assessment. Boundary objects (assessment standards, assignments, feedback/reflection/patient care/development plan templates) were collected. The data collection and thematic analysis were guided by CHAT. Results Barriers to the integration of boundary objects included: a) conflicting requirements in clinical competency monitoring and assessment, b) different application of analytical skills, and c) incomplete integration of boundary objects for self-regulated learning into supervision practice. These barriers were amplified by the simultaneous use of boundary objects for learning and assessment. Underlying contradictions included different objectives between school and practice, and tensions between the distribution of labor in the clinical setting and school's rules. Discussion School and practice have both convergent and divergent priorities around students' clinical learning. Boundary objects can promote continuity in learning and increase students' understanding of clinical practice. However, effective integration requires for flexible rules that allow for collaborative learning around patient care.
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Affiliation(s)
- Malou Stoffels
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Amsterdam UMC, VUmc Amstel Academy, Institute for Education and Training, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands
| | - Louti A Broeksma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
| | - Margot Barry
- RadboudUmc Health Academy, Nijmegen, The Netherlands
| | - Stephanie M E van der Burgt
- Amsterdam UMC location University of Amsterdam, Teaching and Learning Center (TLC), Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Hester E M Daelmans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Department of skills training, The Netherlands
| | - Saskia M Peerdeman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- Research institute: Amsterdam Public Health (APH), program Quality of Care, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Faculty of Medicine, Research in Education, Amsterdam, The Netherlands
- LEARN! research institute for learning and education, Faculty of Psychology and Education, VU University Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
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Ekelund K, Tolsgaard MG, Jacobsen RVB, Østergaard D, Bader-Larsen K. Learning strategies for the advanced trainee in specialist training. MEDICAL TEACHER 2024; 46:948-955. [PMID: 38145618 DOI: 10.1080/0142159x.2023.2289845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND A significant factor of clinicians' learning is based on their ability to effectively transfer acquired knowledge, skills, and attitudes from specialty-specific clinical courses to their working environment. MATERIAL AND METHOD We conducted semi-structured interviews with 20 anaesthesiologist trainees (i.e. residents) in four group and five individual interviews using SRL principles as sensitizing concepts. Data were collected and analyzed iteratively using thematic analysis. RESULTS Advanced trainees are highly motivated to explore what they have learned in specialty-specific courses, but they often face several barriers in implementing their learning in the workplace environment. Four themes emerged from the interview data: 'Be ready to learn', "Take the 'take-home-messages' home', "Be ready to create your own opportunities', and "Face it, it's not entirely up to you'. Understanding the challenges regarding transferring knowledge from courses to the working environment is an important lesson for assisting trainees set their learning goals, monitor their progress, and re-evaluate their SRL processes. CONCLUSION Even for advanced trainees, successfully transferring knowledge from specialty-specific courses often requires adequate commitment and support. Medical supervisors and other relevant stakeholders must be aware of their shared responsibility for creating individual environments that support opportunities for trainees to self-regulate their learning.
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Affiliation(s)
- Kim Ekelund
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
- The University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesiology, Juliane Marie Centre, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Martin Grønnebæk Tolsgaard
- The University of Copenhagen, Copenhagen, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Juliane Marie Centre, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Rikke Vita Borre Jacobsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
- The University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesiology, Centre of Head and Orthopaedics, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Herlev Hospital, University Hospital of Copenhagen, Herlev, Denmark
- The University of Copenhagen, Copenhagen, Denmark
| | - Karlen Bader-Larsen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
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Kajamaa A, Lahtinen P, Mattick K, Bethune R. Repairing disrupted care processes as sources of stability, learning and change in a Finnish hospital: An activity-theoretical study. MEDICAL EDUCATION 2024. [PMID: 38711330 DOI: 10.1111/medu.15407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION In high-income countries, it is estimated that one in every 10 patients is harmed while receiving hospital care; 50% of these are preventable. The aim of this study was to deepen our understanding of disruptions of care processes and how the repairing of disruptions can be sources of stability, learning and change in complex health care settings. METHODS The organisational interactions associated with disruptions in the standard care processes of 15 surgical patients were followed in a public sector hospital in Finland. The patients and medical professionals were interviewed in situ during the observation of the care processes. An activity-theoretically informed methodological framework was used to identify and analyse disruptions and the associated repair efforts and repair solutions. RESULTS Disruptions were frequent and found in all 15 care processes. These related to (1) the patient's worsening physiological state, (2) the equipment used in surgical care, (3) the information flow, (4) delays in the care process and (5) the unclear division of labour within the team. The actors carried out three types of repair efforts (technical, cognitive-emotional and extended collaborative) to overcome the disrupted processes, which usually led to repair solutions that restored stability. DISCUSSION The different repair efforts required different kinds of collaboration and learning. Extended collaborative repair was most demanding, providing challenges and opportunities for practice change and expansive learning.
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Affiliation(s)
- Anu Kajamaa
- Learning and Learning Processes Research Unit, Department of Education and Psychology, University of Oulu, Oulu, Finland
| | - Päivikki Lahtinen
- Division of Research and Innovation, University of Agder, Kristiansand, Norway
- Center for Research on Activity, Development and Learning (CRADLE), University of Helsinki, Helsinki, Finland
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, Medical School, St Luke's Campus, Exeter, UK
| | - Rob Bethune
- Academic Department of Colo-rectal surgery, Royal Devon University Helathcare NHS Foundation Trust, Exeter, UK
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Wong WYA, Thistlethwaite J, Moni K, Roberts C. Using cultural historical activity theory to reflect on the sociocultural complexities in OSCE examiners' judgements. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:27-46. [PMID: 35943605 PMCID: PMC9992227 DOI: 10.1007/s10459-022-10139-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Examiners' judgements play a critical role in competency-based assessments such as objective structured clinical examinations (OSCEs). The standardised nature of OSCEs and their alignment with regulatory accountability assure their wide use as high-stakes assessment in medical education. Research into examiner behaviours has predominantly explored the desirable psychometric characteristics of OSCEs, or investigated examiners' judgements from a cognitive rather than a sociocultural perspective. This study applies cultural historical activity theory (CHAT) to address this gap in exploring examiners' judgements in a high-stakes OSCE. Based on the idea that OSCE examiners' judgements are socially constructed and mediated by their clinical roles, the objective was to explore the sociocultural factors that influenced examiners' judgements of student competence and use the findings to inform examiner training to enhance assessment practice. Seventeen semi-structured interviews were conducted with examiners who assessed medical student competence in progressing to the next stage of training in a large-scale OSCE at one Australian university. The initial thematic analysis provided a basis for applying CHAT iteratively to explore the sociocultural factors and, specifically, the contradictions created by interactions between different elements such as examiners and rules, thus highlighting the factors influencing examiners' judgements. The findings indicated four key factors that influenced examiners' judgements: examiners' contrasting beliefs about the purpose of the OSCE; their varying perceptions of the marking criteria; divergent expectations of student competence; and idiosyncratic judgement practices. These factors were interrelated with the activity systems of the medical school's assessment practices and the examiners' clinical work contexts. Contradictions were identified through the guiding principles of multi-voicedness and historicity. The exploration of the sociocultural factors that may influence the consistency of examiners' judgements was facilitated by applying CHAT as an analytical framework. Reflecting upon these factors at organisational and system levels generated insights for creating fit-for-purpose examiner training to enhance assessment practice.
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Affiliation(s)
- Wai Yee Amy Wong
- School of Education and Faculty of Medicine, The University of Queensland, Brisbane, QLD, 4072, Australia.
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, BT9 7BL, UK.
| | - Jill Thistlethwaite
- Faculty of Health, The University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Karen Moni
- School of Education, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Chris Roberts
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2006, Australia
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Phinney LB, Fluet A, O'Brien BC, Seligman L, Hauer KE. Beyond Checking Boxes: Exploring Tensions With Use of a Workplace-Based Assessment Tool for Formative Assessment in Clerkships. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1511-1520. [PMID: 35703235 DOI: 10.1097/acm.0000000000004774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE To understand the role of a workplace-based assessment (WBA) tool in facilitating feedback for medical students, this study explored changes and tensions in a clerkship feedback activity system through the lens of cultural historical activity theory (CHAT) over 2 years of tool implementation. METHOD This qualitative study uses CHAT to explore WBA use in core clerkships by identifying feedback activity system elements (e.g., community, tools, rules, objects) and tensions among these elements. University of California, San Francisco core clerkship students were invited to participate in semistructured interviews eliciting experience with a WBA tool intended to enhance direct observation and feedback in year 1 (2019) and year 2 (2020) of implementation. In year 1, the WBA tool required supervisor completion in the school's evaluation system on a computer. In year 2, both students and supervisors had WBA completion abilities and could access the form via a smartphone separate from the school's evaluation system. RESULTS Thirty-five students participated in interviews. The authors identified tensions that shifted with time and tool iterations. Year 1 students described tensions related to cumbersome tool design, fear of burdening supervisors, confusion over WBA purpose, WBA as checking boxes, and WBA usefulness depending on clerkship context and culture. Students perceived dissatisfaction with the year 1 tool version among peers and supervisors. The year 2 mobile-based tool and student completion capabilities helped to reduce many of the tensions noted in year 1. Students expressed wider WBA acceptance among peers and supervisors in year 2 and reported understanding WBA to be for low-stakes feedback, thereby supporting formative assessment for learning. CONCLUSIONS Using CHAT to explore changes in a feedback activity system with WBA tool iterations revealed elements important to WBA implementation, including designing technology for tool efficiency and affording students autonomy to document feedback with WBAs.
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Affiliation(s)
- Lauren B Phinney
- L.B. Phinney is a first-year internal medicine resident, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Angelina Fluet
- A. Fluet is a fourth-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Bridget C O'Brien
- B.C. O'Brien is professor of medicine and education scientist, Department of Medicine and Center for Faculty Educators, University of California, San Francisco School of Medicine, San Francisco, California
| | - Lee Seligman
- L. Seligman is a second-year internal medicine resident, Department of Medicine, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Law M, Veinot P, Mylopoulos M, Bryden P, Brydges R. Applying activity theory to undergraduate medical curriculum reform: Lessons in contradictions from multiple stakeholders' perspectives. MEDICAL TEACHER 2022; 44:800-811. [PMID: 35199616 DOI: 10.1080/0142159x.2022.2041190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Medical school curricula require regular updating. We adopted an activity theory lens to conduct a holistic, multiple stakeholder-informed analysis of curricular reform, aiming to understand how the social relations between groups contribute to unanticipated tensions and outcomes. METHODS A research assistant conducted semi-structured interviews with purposively sampled (N = 19) administrative staff, faculty course leads, faculty tutors, curriculum developers, change leaders and student leaders. The team applied a framework analysis to guide within and between stakeholder comparisons. RESULTS Participants reported unique (N = 21) and cross-cutting (N = 17) contradictions underscoring emerging drivers of current and potential change. Unique contradictions raised by 1-2 groups represented seeds of change that had the potential to spread across all groups. By contrast, two general types of cross-cutting contradictions arose when one group had a dominant, confirming voice or two or more groups had contrasting perspectives. CONCLUSIONS While finding contradictions was expected, our analysis profiled their nature and some of the specific tensions they raised across and within stakeholder groups. The activity theory lens provided an accessible way to unravel curricular reform into manageable units of analysis. Systematically identifying contradictions arising from curricular reform will help stakeholders collaborate with a shared purpose toward positive, sustained change.
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Affiliation(s)
- Marcus Law
- Department of Family and Community Medicine, and MD program, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula Veinot
- Independent Research Consultant, Halifax, Nova Scotia, Canada
| | - Maria Mylopoulos
- Temerty Faculty of Medicine and Wilson Centre, University of Toronto, Toronto, Ontario, Canada
| | - Pier Bryden
- Department of Psychiatry, and Clinical Affairs and Professional Values, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan Brydges
- Technology-Enabled Education, St. Michael's Hospital, Unity Health Toronto, and Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Munangatire T, McInerney P. A phenomenographic study exploring the conceptions of stakeholders on their teaching and learning roles in nursing education. BMC MEDICAL EDUCATION 2022; 22:404. [PMID: 35619092 PMCID: PMC9134698 DOI: 10.1186/s12909-022-03392-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Nursing education involves a number of stakeholders in the teaching and learning process, and these are student nurses, lecturers, clinical instructors and nurses. The role that each of these parties play in the teaching and learning process is dependent on each other and is key to the development of competence among student nurses. However, there is scanty literature on the discourse of how these stakeholders conceptualise their roles to maximise student learning. The objective of this study was to explore the conceptions of stakeholders on their teaching and learning roles in nursing education. METHODS Thirty-eight semi-structured interviews and three focus group discussions were conducted with nursing students, lecturers, clinical educators at a Namibian nursing college and nurses at teaching hospitals. Phenomenographic data analysis approach was applied. RESULTS Four conceptions were constructed that described the level of involvement of the different parties in teaching and learning. These were initiating, supporting, becoming part of and owning the teaching and learning role. Three dimensions of variation marked the differences among the conceptions: responsibility and accountability, priorities and level of collaboration. CONCLUSIONS The parties involved in the teaching and learning in nursing education have qualitatively different understating of their roles and those of others. There is a pattern transcending from being at the periphery of teaching and learning to taking ownership of teaching and learning. And a movement from limited responsibility and collaboration to that of being responsible, accountable and high level of collaboration in the teaching and learning of nursing students. The conceptions in this study add more ways of enhancing collaboration between theoretical and clinical sites in nursing education, by ensuring that those involved are aware of their role and that of others and work collaboratively at the micro-level.
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Affiliation(s)
| | - Patricia McInerney
- Faculty of Health Sciences, Centre for Health Sciences Education, University of Witwatersrand, Johannesburg, South Africa
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Routh J, Paramasivam SJ, Cockcroft P, Nadarajah VD, Jeevaratnam K. Using Learning Theories to Develop a Veterinary Student Preparedness Toolkit for Workplace Clinical Training. Front Vet Sci 2022; 9:833034. [PMID: 35464375 PMCID: PMC9021599 DOI: 10.3389/fvets.2022.833034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/14/2022] [Indexed: 11/24/2022] Open
Abstract
Learning theories are abstract descriptions which help us make sense of educational practice. Multiple theories can inform our understanding of a single concept, in this case: veterinary workplace clinical training (WCT), which occurs just prior to students' graduation as competent veterinary surgeons. The competency movement has strongly influenced reforms in veterinary education and is considered important. In reflection of this, the term “preparedness” is operationalised here as a measure of the likelihood that the veterinary student is going to be a competent learner and participant during WCT. Preparedness itself is therefore important because it directly impacts performance. Workplace clinical training is explored through the lenses of cognitivist, social constructivist and socio-culturalist learning theories and used to inform student preparedness characteristics (“tools”) in terms of their behaviours, personal attributes, knowledge and skills, and awarenesses to optimise learning and participation. These form a new conceptual framework—the “Preparedness Toolkit.”
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Affiliation(s)
- Jennifer Routh
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- *Correspondence: Jennifer Routh
| | | | - Peter Cockcroft
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
| | - Vishna Devi Nadarajah
- Division of Human Biology, School of Medicine and IMU Centre for Education, International Medical University, Kuala Lumpur, Malaysia
| | - Kamalan Jeevaratnam
- School of Veterinary Medicine, University of Surrey, Guildford, United Kingdom
- Kamalan Jeevaratnam
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Bullock JL, Seligman L, Lai CJ, O'Sullivan PS, Hauer KE. Moving toward Mastery: Changes in Student Perceptions of Clerkship Assessment with Pass/Fail Grading and Enhanced Feedback. TEACHING AND LEARNING IN MEDICINE 2022; 34:198-208. [PMID: 34014793 DOI: 10.1080/10401334.2021.1922285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/08/2021] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
ProblemClerkship grades contribute to a summative assessment culture in clerkships and can therefore interfere with students' learning. For example, by focusing on summative, tiered clerkship grades, students often discount accompanying feedback that could inform future learning. This case report seeks to explore whether an assessment system intervention which eliminated tiered grades and enhanced feedback was associated with changes in student perceptions of clerkship assessment and perceptions of the clinical learning environment. Intervention: In January 2019, our institution eliminated tiered clerkship grading (honors/pass/fail) for medical students during the core clerkship year and implemented pass/fail clerkship grading along with required twice weekly, work-based assessments for formative feedback. Context: In this single institution, cross-sectional survey study, we collected data from fourth-year medical students one year after an assessment system intervention. The intervention entailed changing from honors/pass/fail to pass/fail grading in all eight core clerkships and implementing an electronic system to record twice-weekly real-time formative work-based assessments. The survey queried student perceptions on the fairness and accuracy of grading and the clinical learning environment-including whether clerkships were mastery- or performance-oriented. We compared responses from students one year after the assessment intervention to those from the class one year before the intervention. Comparisons were made using unpaired, two-tailed t-tests or chi-squared tests as appropriate with Cohen's d for effect size estimation for score differences. Content analysis was used to analyze responses from two open-ended questions about feedback and grading. Impact: Survey response rates were similar before and after intervention (76% (127/168) vs. 72% (118/163), respectively) with no between-group differences in demographics. The after-intervention group showed statistically significant increases in the following factors: "grades are transparent and fair" (Cohen's d = 0.80), "students receive useful feedback" (d = 0.51), and "resident evaluation procedures are fair" (d = 0.40). After-intervention respondents perceived the clerkship learning environment to be more mastery-oriented (d = 0.52), less performance approach-oriented (d = 0.63), and less performance avoid-oriented (d = 0.49). There were no statistical differences in the factors "attending evaluation procedures are fair," "evaluations are accurate," "evaluations are biased," or "perception of stereotype threat." Open-ended questions revealed student recommendations to improve clerkship summary narratives, burden of work-based assessment, and in-person feedback. Lessons Learned: After an assessment system change to pass/fail grading with work-based assessments, we observed moderate to large improvements in student perceptions of clerkship grading and the mastery orientation of the learning environment. Our intervention did not improve perceptions around bias in assessment in clerkships. Other medical schools may consider similar interventions to begin to address student concerns with clerkship assessment and promote a more adaptive learning environment.
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Affiliation(s)
- Justin L Bullock
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Lee Seligman
- Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Cindy J Lai
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Patricia S O'Sullivan
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
- Department of Surgery, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Karen E Hauer
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
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Yardley S, Francis SA, Dean Franklin B, Ogden M, Kajamaa A, Mattick K. Getting palliative medications right across the contexts of homes, hospitals and hospices: protocol to synthesise scoping review and ethnographic methods in an activity theory analysis. BMJ Open 2022; 12:e061754. [PMID: 35301215 PMCID: PMC8932278 DOI: 10.1136/bmjopen-2022-061754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Prescribing and medication use in palliative care is a multistep process. It requires systems coordination and is enacted through activities of patients, informal carers and professionals. This study compares practice to idealised descriptions of what should happen; identifying when, how and why process disturbances impact on quality and safety. Our objectives are to:Document an intended model (phase 1, scoping review).Refine the model with study of practice (phase 2, ethnography).Use the model to pinpoint 'hot' (viewed as problematic by participants) and 'cold' spots (observed as problematic by researchers) within or when patients move across three contexts-hospice, hospital and community (home).Create learning recommendations for quality and safety targeted at underlying themes and contributing factors. METHODS AND ANALYSIS The review will scope Ovid Medline, CINAHL and Embase, Google Scholar and Images-no date limits, English language only. The Population (palliative), Concept (medication use), Context (home, hospice, hospital) framework defines inclusion/exclusion criteria. Data will be extracted to create a model illustrating how processes ideally occur, incorporating multiple steps of typical episodes of prescribing and medication use for symptom control. Direct observations, informal conversations around acts of prescribing and medication use, and semistructured interviews will be conducted with a purposive sample of patients, carers and professionals. Drawing on activity theory, we will synthesise analysis of both phases. The analysis will identify when, how and why activities affect patient safety and experience. Generating a rich multivoiced understanding of the process will help identify meaningful targets for improvement. ETHICS AND DISSEMINATION Ethical approval granted by the Camden & Kings Cross NHS Regional Ethics Committee (21/LO/0459). A patient and public involvement (PPI) coinvestigator, a multiprofessional steering group and a PPI engagement group are working with the research team. Dissemination of findings is planned through peer-reviewed publications and a stakeholder (policymakers, commissioners, clinicians, researchers, public) report/dissemination event.
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Affiliation(s)
- Sarah Yardley
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Central & North West London NHS Foundation Trust, London, London
| | - Sally-Anne Francis
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Bryony Dean Franklin
- University College London School of Pharmacy, London, UK
- Pharmacy Department, Imperial College Healthcare NHS Trust, London, UK
| | - Margaret Ogden
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Anu Kajamaa
- Faculty of Education, University of Oulu, Oulu, Finland
| | - Karen Mattick
- College of Medicine & Health, University of Exeter, Exeter, UK
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Witkop CT, Maggio LA, Harvey EJ, Torre DM. Complexity in shared decision making: a qualitative analysis of clinical encounters and patient/physician interviews. MEDEDPUBLISH 2022. [DOI: 10.12688/mep.19043.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Shared decision making is a complex clinical activity, for which the most effective educational interventions are unclear. Cultural Historical Activity Theory (CHAT) can be utilized as a framework to help medical educators understand and teach shared decision making. The objective of this qualitative study was to utilize CHAT to explore, through analysis of clinical encounters and interviews, patient and provider perspectives of a medical decision-making process that included use of a decision aid mobile application (app). Methods: Female patients from age 17 to 45, who sought care at a contraceptive clinic between April and June 2019, and physicians providing care in the clinic, were recruited for this study. Patients utilized the decision aid app prior to the visit. The clinical encounter and semi-structured interviews with each patient and physician were recorded. Template analysis was used to analyze the transcripts with themes including elements of activity systems within CHAT, tensions within and between activity systems, and agency. Results: In total, 21 patients and eight providers participated in the study. Evidence of CHAT elements were identified for each patient-physician dyad. In analyzing occurrences of codes across transcripts, recurring contradictions and themes emerged, such as how the app is utilized as a mediating tool and the importance of patient and physician communities. Conclusions: Through analysis of clinical encounters and focused interviews, patient and provider perspectives provided a unique understanding of the complex process of decision-making. These findings can assist educators in developing more effective teaching strategies that may lead to enhanced patient agency, effective relational agency, and successful shared decision making.
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Bransen D, Govaerts MJB, Sluijsmans DMA, Donkers J, Van den Bossche PGC, Driessen EW. Relationships between medical students' co-regulatory network characteristics and self-regulated learning: a social network study. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:28-35. [PMID: 33929685 PMCID: PMC8733107 DOI: 10.1007/s40037-021-00664-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/22/2021] [Accepted: 04/07/2021] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Recent conceptualizations of self-regulated learning acknowledge the importance of co-regulation, i.e., students' interactions with others in their networks to support self-regulation. Using a social network approach, the aim of this study is to explore relationships between characteristics of medical students' co-regulatory networks, perceived learning opportunities, and self-regulated learning. METHODS The authors surveyed 403 undergraduate medical students during their clinical clerkships (response rate 65.5%). Using multiple regression analysis, structural equation modelling techniques, and analysis of variance, the authors explored relationships between co-regulatory network characteristics (network size, network diversity, and interaction frequency), students' perceptions of learning opportunities in the workplace setting, and self-reported self-regulated learning. RESULTS Across all clerkships, data showed positive relationships between tie strength and self-regulated learning (β = 0.095, p < 0.05) and between network size and tie strength (β = 0.530, p < 0.001), and a negative relationship between network diversity and tie strength (β = -0.474, p < 0.001). Students' perceptions of learning opportunities showed positive relationships with both self-regulated learning (β = 0.295, p < 0.001) and co-regulatory network size (β = 0.134, p < 0.01). Characteristics of clerkship contexts influenced both co-regulatory network characteristics (size and tie strength) and relationships between network characteristics, self-regulated learning, and students' perceptions of learning opportunities. DISCUSSION The present study reinforces the importance of co-regulatory networks for medical students' self-regulated learning during clinical clerkships. Findings imply that supporting development of strong networks aimed at frequent co-regulatory interactions may enhance medical students' self-regulated learning in challenging clinical learning environments. Social network approaches offer promising ways of further understanding and conceptualising self- and co-regulated learning in clinical workplaces.
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Affiliation(s)
- Derk Bransen
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands.
| | - Marjan J B Govaerts
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | | | - Jeroen Donkers
- School of Health Professions Education (SHE), Maastricht University, Maastricht, The Netherlands
| | - Piet G C Van den Bossche
- Department of Training and Education, Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
- Department of Educational Research and Development, School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - Erik W Driessen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
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Witkop CT, Maggio LA, Harvey EJ, Torre DM. Seeing Complexity: Cultural Historical Activity Theory (CHAT) As a Lens for Shared Decision Making. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:1540-1545. [PMID: 33983138 DOI: 10.1097/acm.0000000000004157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Shared decision making, a collaborative approach between patient and provider that considers the patient's values and preferences in addition to the scientific evidence, is a complex clinical activity that has not realized its full potential. Gaps in education and training have been cited as barriers to shared decision making, and evidence is inconsistent on effective educational interventions. Because individual agents with their own social and behavioral contexts co-construct a shared decision, the educational approach may need to consider the role of patient agency and sociocultural influences. To address the inherent complexity in shared decision making, the authors identified cultural historical activity theory (CHAT) as a framework for analysis. Although certainly not the only relevant theory, CHAT offers an appropriate lens through which the multivoiced nature of shared decision making can be more clearly appreciated. In this article, the authors demonstrate the application of CHAT as a lens for researchers and educators to examine the complexity of shared decision making. The fictitious case presented in this article describes the use of CHAT with a patient who experiences 2 clinical encounters; during the second, shared decision making takes place. Elements of the case are threaded through the article, demonstrating a sample analysis of the interacting activity systems of the patient and physician and highlighting inherent tensions and contradictions. The authors propose CHAT as a tool for future research around the role of agency in shared decision making and other complex topics and as a framework for design of novel instructional strategies. Although not applicable to all topics and settings, CHAT has significant potential within health professions education.
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Affiliation(s)
- Catherine T Witkop
- C.T. Witkop is professor of preventive medicine and obstetrics/gynecology and associate dean for medical education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0001-5366-2663
| | - Lauren A Maggio
- L.A. Maggio is professor of medicine and associate director of scholarly communication, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-2997-6133
| | - Emily J Harvey
- E.J. Harvey is research and teaching associate, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, and contractor, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-3685-6279
| | - Dario M Torre
- D.M. Torre is professor of medicine and associate director of evaluation and long-term outcomes, Graduate Programs in Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: http://orcid.org/0000-0002-4924-4888
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Stoffels M, van der Burgt SME, Stenfors T, Daelmans HEM, Peerdeman SM, Kusurkar RA. Conceptions of clinical learning among stakeholders involved in undergraduate nursing education: a phenomenographic study. BMC MEDICAL EDUCATION 2021; 21:520. [PMID: 34607586 PMCID: PMC8491399 DOI: 10.1186/s12909-021-02939-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND To prepare nursing students to become critical, autonomous members of the workforce, an agreement among stakeholders on how this can be achieved in the clinical setting is needed. However, a critical discussion of the clinical learning process in relation to actual and desirable outcomes is lacking in the nursing education literature. This study aimed to map conceptions of the desired process and outcomes of clinical learning among stakeholders involved in undergraduate clinical nursing education. METHODS Twenty-five semi-structured interviews about their understanding of clinical learning were conducted with nursing students, supervisors, clinical educators and higher education institute professionals involved in clinical nursing education in a Dutch academic medical center. Data were analyzed using a phenomenographic approach. RESULTS Four conceptions were identified: clinical learning as a process to 1) meet curricular demands, 2) learn to deliberately deliver patient care, 3) learn to deliver patient care within the larger (healthcare) context, and 4) become a continuously developing professional. Conceptions 3 and 4 represented a broader, more inclusive perspective on clinical learning than conception 1 and 2. Conceptions were distinguished by five dimensions: role of guidelines from the school; learning opportunities, focus of supervisor; focus of reflection; desirable outcomes of clinical learning. CONCLUSIONS Those directly involved in clinical learning in nursing may have qualitatively different understandings of its desired nature and outcomes. Two patterns across conceptions could be discerned: a) a shift in focus from learning as following standards, to following an individualized learning trajectory and b) a shift in focus from increasing patient load, to understanding oneself and the patient within the healthcare context. To prepare nursing students for the future workforce, a flexible, social form of self-regulated learning is warranted, as well as an understanding of one's own role within the healthcare system and a critical attitude towards healthcare. Schools and hospitals should collaborate to integrate these values in the curriculum. The current study adds different ways of applying self-regulated learning as a relevant dimension in understanding clinical learning to the literature. Through the phenomenographic approach we identified conceptions that can be a basis for training and policy development.
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Affiliation(s)
- Malou Stoffels
- Faculty of Medicine, Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Amsterdam UMC, Amstel Academy, Institute for Education and Training, Amsterdam, The Netherlands.
- LEARN! research institute for learning and education. Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands.
| | | | - Terese Stenfors
- Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Amsterdam, The Netherlands
| | - Hester E M Daelmans
- Faculty of Medicine, Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Faculty of Medicine, Department of skills training, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Saskia M Peerdeman
- Faculty of Medicine, Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- AmsterdamUMC, Location AMC, Institute for education and training, Amsterdam, The Netherlands
- Department of Neurosurgery, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Faculty of Medicine, Research in Education, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! research institute for learning and education. Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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Abstract
This article introduces key concepts of activity theory and expansive learning. Expansive learning builds on the foundational ideas of the cultural-historical activity theory (CHAT). It is a research approach designed for studying the complexities and contradictions in authentic workplace environments. Change Laboratory is a formative intervention method developed for studying workplaces in transition and for stimulating collaborative efforts to design improved patterns of activity. We present concrete examples of formative interventions in healthcare, where good patient care was compromised by the fragmentation of care and disturbances in collaboration between the healthcare experts. This implies that physicians are challenged to develop collaborative and transformative expertise. We present three spearheads into a zone of proximal development, representing opportunities for change of medical expertise: (1) reconceptualizing expertise as object-oriented and contradiction-driven activity systems, (2) pursuing expertise as negotiated knotworking, and (3) building expertise as expansive learning. While medical expertise needs to expand, medical education must also look for ways to evolve and meet the challenges of the surrounding society. We call for adopting an interventionist approach for developing medical education and intensifying collaboration with the practitioners in healthcare units, their patients, and target communities.
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Affiliation(s)
- Yrjö Engeström
- Center for Research on Activity, Development and Learning, University of Helsinki, Helsinki, Finland
| | - Eeva Pyörälä
- Center for University Teaching and Learning, University of Helsinki, Helsinki, Finland
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Skipper M, Nøhr SB, Engeström Y. The change laboratory in medical education: Two examples of tackling contradictory challenges. MEDICAL EDUCATION 2021; 55:93-100. [PMID: 32722852 DOI: 10.1111/medu.14298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Medical education and workplace learning is bound to develop through tensions between providing high quality patient care and providing training of the future specialist healthcare workforce. This paper on the Change Laboratory and the theoretical framework supporting it, shows examples on how to explore inherent and contradictory tensions in medical education and healthcare and use them as a driving force for change. We argue that the traditional tools and theories for change and fixing tensions are inadequate and therefore suggest an alternative strategy found in Cultural-Historical Activity Theory (CHAT) and the Change Laboratory method. METHODS The Change Laboratory intervention method builds on the theoretical framework of CHAT and specifically the theory of expansive learning. The Change Laboratory intervention method uses well-defined steps for participants in collaboration with researchers/facilitators to co-construct and develop new ways of going about their work practice. RESULTS Drawing on our own research on implementing the Change Laboratory intervention method we present two case examples of interventions in respectively a Finnish surgical unit and a Danish paediatric outpatient clinic. CONCLUSIONS The Change Laboratory intervention offers ways to systematically leverage tensions in medical education and thus could be effective in developing and designing organisational and professional change. It is not a quick fix solution as participators must be motivated and engaged in uncovering inherent contradictions in their activity systems (workplace) and get familiar with the concepts and theory underlying the intervention and its procedures. Profound knowledge and transformative agency emerges when participants and facilitators/researchers are given the time and opportunity to analyse both historical practice, current data on practice, and organisational issues collaboratively in order to envision and redesign their practice and learning environment.
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Affiliation(s)
- Mads Skipper
- Ringgold Standard Institution, Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- Postgraduate Medical Education Region North, Viborg, Denmark
| | - Susanne Backman Nøhr
- Ringgold Standard Institution, Centre for Health Sciences Education, Aarhus University, Aarhus, Denmark
- Department for Postgraduate Education, Ringgold Standard Institution, Aalborg University Hospital, Aalborg, Denmark
| | - Yrjö Engeström
- Faculty of Educational Sciences, Ringgold Standard Institution, CRADLE, University of Helsinki, Helsinki, Finland
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Sawatsky AP, Halvorsen AJ, Daniels PR, Bonnes SL, Issa M, Ratelle JT, Stephenson CR, Beckman TJ. Characteristics and quality of rotation-specific resident learning goals: a prospective study. MEDICAL EDUCATION ONLINE 2020; 25:1714198. [PMID: 31941433 PMCID: PMC7006652 DOI: 10.1080/10872981.2020.1714198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/23/2019] [Accepted: 01/02/2020] [Indexed: 06/10/2023]
Abstract
Background: Residents are expected to develop the skills to set learning goals. Setting learning goals is part of self-regulated learning, setting the foundation for creating a learning plan, deploying learning strategies, and assessing their progress to those goals. While effective goal setting is essential to resident self-regulated learning, residents struggle with setting learning goals and desire faculty assistance with goal setting.Objective: We aimed to characterize the topics and quality of residents' rotation-specific learning goals.Design: We conducted a prospective study of 153 internal medicine residents, assessing 455 learning goals for general medicine inpatient rotations. We coded learning goal themes, competencies, and learning domains, and assessed quality using the validated Learning Goal Scoring Rubric. We compared topic categories, competencies, learning domains, and quality between the first and second months of postgraduate (PGY)-1 residents and between PGY-1 and PGY-3 residents. We assessed factors associated with learning goal completion.Results: The overall response rate was 80%. The top three learning goal categories were patient management, specific diseases related to general medicine, and teaching skills. There were no changes in learning goal characteristics between PGY-1 months (p ≥ 0.04). There were differences between PGY-1 and PGY-3 residents' learning goals in patient management (28% vs 6%; p < .001), specific disease conditions (19% vs 3%; p < .001), and teaching skills (2% vs 56%; p < .001). There was no difference in learning goal quality between PGY-1 months (1.63 vs. 1.67; p = 0.82). The PGY-3 learning goals were of higher quality than PGY-1 learning goals for the 'specific goal' item (1.38 vs. 0.98, p = 0.005), but not for other items or overall (all p ≥ 0.02). Residents reported 85% (297/347) learning goal completion.Conclusions: Resident rotation-specific learning goals reflect a broad array of topics. Residents' learning goal quality was low and residents may benefit from guidance to support residents' learning goals.
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Affiliation(s)
- Adam P. Sawatsky
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Paul R. Daniels
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sara L. Bonnes
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Meltiady Issa
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - John T. Ratelle
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas J. Beckman
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
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20
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Brydges R, Tran J, Goffi A, Lee C, Miller D, Mylopoulos M. Resident learning trajectories in the workplace: A self-regulated learning analysis. MEDICAL EDUCATION 2020; 54:1120-1128. [PMID: 32614455 DOI: 10.1111/medu.14288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
CONTEXT Research in workplace learning has emphasised trainees' active role in their education. By focusing on how trainees fine-tune their strategic learning, theories of self-regulated learning (SRL) offer a unique lens to study workplace learning. To date, studies of SRL in the workplace tend to focus on listing the factors affecting learning, rather than on the specific mechanisms trainees use to regulate their goal-directed activities. To inform the design of workplace learning interventions that better support SRL, we asked: How do residents navigate their exposure to and experience performing invasive procedures in intensive care units? METHODS In two academic hospitals, we conducted post-call debriefs with residents coming off shift and later sought their elaborated perspectives via semi-structured interviews. We used a constant comparative methodology to analyse the data, to iteratively refine data collection, and to inform abductive coding of the data, using SRL principles as sensitising concepts. RESULTS We completed 29 debriefs and nine interviews with 24 trainees. Participants described specific mechanisms: identifying, creating, avoiding, missing and competing for opportunities to perform invasive procedures. While using these mechanisms to engage with procedures (or not), participants reported: distinguishing trajectories (i.e. becoming attuned to task-relevant factors), navigating trajectories (i.e. creating and interacting with opportunities to perform procedures), and co-constructing trajectories with their peers, supervisors and interprofessional team members. CONCLUSIONS We identified specific SRL mechanisms trainees used to distinguish and navigate possible learning trajectories. We also confirmed previous findings, including that trainees become attuned to interactions between personal, behavioural and environmental factors (SRL theory), and that their resulting learning behaviours are constrained and guided by interactions with peers, supervisors and colleagues (workplace learning theory). Making learning trajectories explicit for clinician teachers may help them support trainees in prioritising certain trajectories, in progressing along each trajectory, and in co-constructing their plans for navigating them.
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Affiliation(s)
- Ryan Brydges
- Allan Waters Family Simulation Centre, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
| | - Judy Tran
- Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Alberto Goffi
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Critical Care Medicine, Unity Health Toronto, Toronto, ON, Canada
| | - Christie Lee
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Critical Care Medicine, Sinai Health System, Toronto, ON, Canada
| | - Daniel Miller
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
| | - Maria Mylopoulos
- Wilson Centre for Research in Education, University Health Network, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Hendriks RA, de Jong PGM, Admiraal WF, Reinders MEJ. Uncovering motivation and self-regulated learning skills in integrated medical MOOC learning: a mixed methods research protocol. BMJ Open 2020; 10:e038235. [PMID: 33109653 PMCID: PMC7592287 DOI: 10.1136/bmjopen-2020-038235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/28/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Massive Open Online Courses (MOOCs) are informal learning environments. Since a few years, MOOCs are being reused and integrated in formal medical education. However, what constitutes optimal integration is still unclear. In this mixed methods study protocol we describe how we will investigate three MOOC integration designs using the same MOOC. THIS STUDY HOLDS MULTIPLE OBJECTIVES: (1) Describe motivation profiles in medical students that learn in integrated MOOCs, and discern if motivation profiles are associated with specific MOOC integration designs; (2) investigate how psychological needs of medical students are satisfied or frustrated in different MOOC integration designs; (3) investigate the relationship between autonomous motivation to learn in an integrated MOOC and use of self-regulated learning skills in that MOOC; (4) uncover processes that are involved in goal acceptance or rejection of medical students in integrated medical MOOC designs with assigned learning goals; and (5) identify obstacles medical students encounter when learning with assigned learning goals in integrated medical MOOCs. METHODS AND ANALYSIS Objectives 1 and 2 will be pursued with a cross-sectional study design, objective 3 with an observational cohort study design and objectives 4 and 5 with a qualitative interview study design. All medical students in one of three MOOC integration designs at Leiden University Medical Center (LUMC) will be invited to participate. Primary endpoints for objectives 1 and 2 are motivation profiles, and variety in need satisfaction and frustration. For objective 3 the primary endpoints are autonomous motivation and self-regulated online learning. For objectives 4 and 5 primary endpoints are process themes regarding goal acceptance or rejection, and perceived obstacles when working with assigned online learning goals. ETHICS AND DISSEMINATION This study has been approved by the Educational Research Review Board of the LUMC. Planned dissemination of findings include three presentations at (inter)national conferences and three research articles.
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Affiliation(s)
- Renée A Hendriks
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter G M de Jong
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Wilfried F Admiraal
- ICLON Leiden University Graduate School of Teaching, Leiden University, Leiden, The Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
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Kiger ME, Riley C, Stolfi A, Morrison S, Burke A, Lockspeiser T. Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students. TEACHING AND LEARNING IN MEDICINE 2020; 32:399-409. [PMID: 32141336 DOI: 10.1080/10401334.2020.1713790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Self-regulated learning theory suggests that individualized learning plans can benefit medical trainees by providing a structured means of goal setting, self-monitoring, and self-evaluation. External feedback also plays an important role in affecting learner motivations, perceptions, and self-evaluations. Accordingly, having learners share individualized learning plans with preceptors might promote self-regulated learning by helping align the feedback they receive with their learning goals. Hypothesis: We hypothesized having medical students share individualized learning plans with attendings and residents would improve the quality of the feedback they received, increase the likelihood that feedback correlated to their learning goals, and improve their perceptions of feedback received. Method: In this multisite study, third-year medical students on their pediatric clerkship created individualized learning plans and shared them with residents and attendings by writing a learning goal on at least one of their required faculty feedback forms. The quality of feedback on forms with versus without a learning goal written on top was scored using a validated scoring tool and compared using a Wilcoxon signed-ranks test, and the frequency with which feedback directly correlated to a student learning goal on forms with versus without a learning goal written on top was compared using a chi-square test. Students completed a post-clerkship survey rating the quality of feedback and teaching they received, perceptions of the individualized learning plans, progress toward achieving learning goals, and whether or not they received teaching and/or feedback related to learning goals. Results: Thirty-six students completed a total of 108 learning goals and 181 feedback forms, of which 42 forms (23.2%) had a learning goal written on top. The mean (SD) feedback score between forms with [3.9 (0.9)] versus without [3.6 (0.6)] a learning goal written on top was not different (p = .113). Feedback on forms with a learning goal written on top was more likely to correlate to a student learning goal than feedback on forms without a learning goal (92.9% vs 23.0% respectively, p < .001). Student perceptions of the usefulness of learning goals did not differ between students who reported receiving teaching or feedback related to a learning goal and those who did not. Conclusions: Sharing individualized learning plans with preceptors helped align feedback with learning goals but did not affect the quality of feedback. Further research should examine the bidirectional relationship between individualized learning plans and feedback in light of other contextual and interpersonal factors.
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Affiliation(s)
- Michelle E Kiger
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Caylin Riley
- Department of Pediatrics, Wright State University, Dayton, Ohio, USA
| | - Adrienne Stolfi
- Department of Pediatrics, Wright State University, Dayton, Ohio, USA
| | | | - Ann Burke
- Department of Pediatrics, Wright State University, Dayton, Ohio, USA
| | - Tai Lockspeiser
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
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Saukkoriipi M, Tuomikoski AM, Sivonen P, Kärsämänoja T, Laitinen A, Tähtinen T, Kääriäinen M, Kuivila HM, Juntunen J, Tomietto M, Mikkonen K. Clustering clinical learning environment and mentoring perceptions of nursing and midwifery students: A cross-sectional study. J Adv Nurs 2020; 76:2336-2347. [PMID: 32538497 DOI: 10.1111/jan.14452] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/27/2020] [Accepted: 05/26/2020] [Indexed: 12/01/2022]
Abstract
AIMS This study aimed to explore nursing and midwifery students' evaluation of the clinical learning environment and mentoring and to identify distinct student profiles relating to their perceptions. DESIGN This study employed a cross-sectional design. SETTINGS The study population included nursing and midwifery students in a university hospital in Finland. PARTICIPANTS All nursing and midwifery students who completed their clinical placement were invited to take part in the study in the academic year 2017-2018. METHODS The data (N = 2,609) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale. The data were analysed using a K-mean cluster algorithm to identify nursing and midwifery students' profiles. RESULTS The findings from this study indicate four distinct profiles (A, B, C, & D) of nursing and midwifery students in relation to the clinical learning environment and mentoring. Profile A (N = 1,352) students evaluated their clinical learning environment and mentoring to the highest level (mean varied from 9.44-8.38); and Profile D (N = 151)- to the lowest (mean varied from 5.93-4.00). CONCLUSION The findings highlight that nursing and midwifery students evaluate their clinical learning environment and mentoring more highly when: they have a named mentor, student and mentor discuss learning goals, there is a final assessment in clinical learning, the mentor's guidance skills support student learning, the clinical learning supports the student's professional development and pre-clinical teaching in an educational institution supports learning in the clinical placement. IMPACT Clinical learning plays an important role in nurse and midwifery education. Mentoring of clinical practice was shown to have a great influence on students' perceptions of their success in clinical learning. We suggest that clinical practice should be strengthened by the building of collaboration between nursing teachers and registered nurses.
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Affiliation(s)
- Mari Saukkoriipi
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Oulu University of Applied Sciences, Oulu, Finland
| | | | | | | | | | - Maria Kääriäinen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland.,Epidemiological Monitoring Team for Regional Healthcare System, Direzione Centrale Salute, Regione Friuli-Venezia-Giulia, Oulu, Finland
| | - Heli-Maria Kuivila
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jonna Juntunen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | - Kristina Mikkonen
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
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Bransen D, Govaerts MJB, Sluijsmans DMA, Driessen EW. Beyond the self: The role of co-regulation in medical students' self-regulated learning. MEDICAL EDUCATION 2020; 54:234-241. [PMID: 31788840 PMCID: PMC7065189 DOI: 10.1111/medu.14018] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/10/2019] [Indexed: 05/09/2023]
Abstract
CONTEXT Medical students are expected to self-regulate their learning within complex and unpredictable clinical learning environments. Research increasingly focuses on the effects of social interactions on the development of self-regulation in workplace settings, a notion embodied within the concept of co-regulated learning (CRL). Creating workplace learning environments that effectively foster lifelong self-regulated learning (SRL) requires a deeper understanding of the relationship between CRL and SRL. The aim of this study was therefore to explore medical students' perceptions of CRL in clinical clerkships and its perceived impact on the development of their SRL. METHODS We conducted semi-structured interviews with 11 purposively sampled medical students enrolled in clinical clerkships at one undergraduate competency-based medical school. Data collection and analysis were conducted iteratively, informed by principles of constructivist grounded theory. Data analysis followed stages of open, axial and selective coding, which enabled us to conceptualise how co-regulation influences the development of students' self-regulation. RESULTS Data revealed three interrelated shifts in CRL and SRL as students progressed through clerkships. First, students' CRL shifted from a focus on peers to co-regulation with clinician role models. Second, self-regulated behaviour shifted from being externally driven to being internally driven. Last, self-regulation shifted from a task-oriented approach towards a more comprehensive approach focusing on professional competence and identity formation. Students indicated that if they felt able to confidently and proactively self-regulate their learning, the threshold for engaging others in meaningful CRL seemed to be lowered, enhancing further development of SRL skills. CONCLUSIONS Findings from the current study emphasise the notion that SRL and its development are grounded in CRL in clinical settings. To optimally support the development of students' SRL, we need to focus on facilitating and organising learners' engagement in CRL from the start of the medical curriculum.
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Affiliation(s)
- Derk Bransen
- School of Health Professions EducationMaastricht UniversityMaastrichtthe Netherlands
| | - Marjan J. B. Govaerts
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
| | | | - Erik W. Driessen
- Department of Educational Development and ResearchFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtthe Netherlands
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25
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Naylor KA, Torres KC. Translation of learning objectives in medical education using high-and low-fidelity simulation: Learners' perspectives. J Taibah Univ Med Sci 2020; 14:481-487. [PMID: 31908634 PMCID: PMC6940622 DOI: 10.1016/j.jtumed.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/04/2022] Open
Abstract
Objectives The mastering of learnt procedures by medical students is triggered by numerous elements, including the ability to understand educational goals for specific tasks. In this study, the authors investigated the processes for identifying learning objectives set forth by medical students and the possibility of the chosen simulation fidelity influencing this ability in Basic Clinical Skills and Elderly Medicine courses at the Medical University of Lublin. Methods A total of 121 medical students assessed the extent to which learning objectives were implemented in two courses with high- and low-fidelity simulation. Using an online survey with closed-ended questions, a list of learning objectives assigned to the courses was sent to participants. The authors evaluated how the courses were generally assessed in terms of their substantive value and general applicability. The Spearman rank correlation (Spearman's rho), χ2, and descriptive statistics were used for investigating research problems. Results Students correctly identified established learning objectives embedded in the courses and positively assessed both courses. Participants' affirmative opinions were related to the high substantive value of both courses. Conclusions Teachers and course creators could benefit from students' feedback about the clarity of learning objectives. The application of some of their ideas would promote a student-centred approach in medical simulation. This approach could be considered input for task selection and optimisation of learning.
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Affiliation(s)
- Katarzyna A Naylor
- Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
| | - Kamil C Torres
- Department of Didactics and Medical Simulation, Medical University of Lublin, Lublin, Poland
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Palermo C, Allen L, Dart J, Beck EJ, Daniels L, Ash S. Hidden Jedi: A critical qualitative exploration of the Fellow credential and advanced expertise. Nutr Diet 2019; 77:167-176. [PMID: 31762192 DOI: 10.1111/1747-0080.12597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/21/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
AIM The present study aimed to describe the characteristics of a Fellow and critically review factors relevant to recognition and promotion of excellence within the profession of dietetics in Australia. METHODS Through the development of revised Competency Standards for the Fellow credential, a critical qualitative approach drawing on action research was used whereby members of the profession were given a voice in the research process. Six focus groups with a total of 30 participants explored descriptions of expertise and perceptions of Fellow by the profession and determinants of uptake. Focus groups were conducted during February and March 2018. Data were examined using a thematic analysis approach, with additional meaning explored through cultural historical activity theory. Participants/setting - A purposive sample of Australian dietitians. RESULTS Fellows embodied leadership, impact, influence, innovation and inspiration, internal and external to the profession and this was reflected in the revised Competency Standards. Potential Fellows perceived they were not capable of achieving the standard required. A lack of recognition of the credential both from within the community of dietetics, and externally, was identified. The role of the social system in which these credentials operate including the role of the professional association in awarding the credential are relevant. CONCLUSIONS Changes to the standards, and the system, may improve perceptions and uptake of the credential. This example provides highly relevant insights for the profession internationally.
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Affiliation(s)
- Claire Palermo
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia.,Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Louise Allen
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
| | - Janeane Dart
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
| | - Eleanor J Beck
- The School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lynne Daniels
- School of Exercise Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Susan Ash
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia.,School of Exercise Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
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Manzone J, Regehr G, Garbedian S, Brydges R. Assigning Medical Students Learning Goals: Do They Do It, and What Happens When They Don't? TEACHING AND LEARNING IN MEDICINE 2019; 31:528-535. [PMID: 30990131 DOI: 10.1080/10401334.2019.1600520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Theory: Medical curricula now include more time for trainees to manage their studying independently, yet evidence suggests that time is not well spent without guidance. Social-cognitivist models of self-regulated learning suggest value when guiding learners to set goals related to their performance processes (actions producing outcomes) versus their performance outcomes (products of performance). Hypotheses: We expected participants oriented to set process goals would demonstrate better suturing skill retention compared with participants oriented to set outcome goals. Method: We randomly assigned 41 medical students to two groups: outcome oriented or process oriented. They self-scored their performance using a visual analog scale on every third trial during 25 training trials, and during 10 retention trials 2 weeks later. Two raters assessed participants' suturing performances (process) and final products (outcome). After finding weak support for our hypothesis, we calculated a "self-monitoring calibration coefficient" as the Pearson's correlation between the raters' average score and each participant's self-scores. We used a mixed-effects analysis of variance to compare participants' performance scores as well as t tests and an analysis of variance to compare their self-monitoring calibration coefficients. Results: Analysis of skill retention data revealed a significant Group × Trial interaction, suggesting a benefit for the process group only for the 10th retention trial (p = .03). During training, the process group had significantly better (p = .02) self-monitoring calibration (r = .71 ± .29) than the outcome group (r = .38 ± .55). In retention, participants in both groups were significantly better calibrated (p = .04) with rater's scores of performance processes (r = .39 ± .60) versus performance outcomes (r = .11 ± .63). Conclusions: Our findings provide limited evidence for our original hypothesis. Perhaps more important, however, our self-monitoring calibration data highlighted inconsistencies between our interventions and our participants' apparent preferences. Not all participants adopted their assigned goal setting orientation, showing that researchers and educators must consider the extent to which trainees adopt imposed instructions in any educational intervention.
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Affiliation(s)
- Julian Manzone
- Wilson Centre, University Health Network; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Glenn Regehr
- Centre for Health Education Scholarship and Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ryan Brydges
- Wilson Centre, University Health Network; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto and Allan Waters Family Simulation Centre, St. Michael's Hospital, Toronto, Ontario, Canada
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Hoogland MA. How Medical Students Discover and Use Medical Information Tools. Med Ref Serv Q 2019; 38:347-357. [PMID: 31687903 DOI: 10.1080/02763869.2019.1661197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Many studies have examined how medical faculty and fourth-year medical students use information tools. Few studies have investigated how first, second, and third-year medical students discover and use information tools. In fall 2018, first, second, and third-year medical students received emails describing a study, which included a three-question survey and four interview questions. Of the 525 students, 122 completed the survey and 18 completed interviews. Results showed that clinical students most frequently use UpToDate, but preclinical students use multiple information tools. This report shows librarians can positively influence how preclinical students use information tools during medical school.
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Farrell L, Bourgeois-Law G, Buydens S, Regehr G. Your Goals, My Goals, Our Goals: The Complexity of Coconstructing Goals with Learners in Medical Education. TEACHING AND LEARNING IN MEDICINE 2019; 31:370-377. [PMID: 30873879 DOI: 10.1080/10401334.2019.1576526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Despite a long-standing recognition of the importance of learning goals in feedback, there has been relatively little research on how to address mismatches between learner goals and preceptor goals in medical education. Our study addresses this gap by reporting on challenges and strategies around goal coconstruction as identified by clinical educators who were learning and attempting to implement a goal-oriented feedback approach in their own teaching contexts. Approach: We employed a qualitative, design-based research methodology to study how 5 clinician educators incorporated goal-oriented feedback into their teaching practice. Participants attended workshops on goal-oriented feedback and reflective writing. They then narratively reflected over a 6-month period on their attempts with goal-oriented feedback and shared these reflections in periodic facilitated group discussions. Themes were developed using iterative thematic analysis of group discussions and individual exit interviews. Findings: Participants identified several benefits of goal setting in all environments. They perceived improved rapport with learners and developed empathy for the vastness of learner goals. However, they experienced several struggles especially when learner and preceptor goals did not match. These included (a) how to address learner goals that were not easily amenable to a coconstruction, (b) how to coconstruct goals while actively running a clinical practice, and (c) how to remain learner centered while raising preceptor goals based on perceived gaps. Insights: Mismatches between learner and preceptor goals are inevitable and frequent. Preceptors must find ways to coconstruct goals with learners in various learning environments. That said, in enacting goal-oriented feedback, preceptors are effectively using feedback throughout the teaching and learning interaction to coconstruct the learning environment, resulting in improved rapport with learners and emphasizing why it is important to focus feedback around goals.
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Affiliation(s)
- Laura Farrell
- a Department of Medicine, University of British Columbia , Victoria , British Columbia , Canada
| | - Gisele Bourgeois-Law
- b Department of Obstetrics and Gynecology, University of British Columbia , Vancouver , British Columbia , Canada
| | - Sarah Buydens
- c Department of Family Practice, Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Glenn Regehr
- c Department of Family Practice, Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
- d Department of Surgery, Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
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30
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Kajamaa A, Mattick K, Parker H, Hilli A, Rees C. Trainee doctors' experiences of common problems in the antibiotic prescribing process: an activity theory analysis of narrative data from UK hospitals. BMJ Open 2019; 9:e028733. [PMID: 31189683 PMCID: PMC6576120 DOI: 10.1136/bmjopen-2018-028733] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/25/2019] [Accepted: 05/15/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Prescribing antibiotics is an error-prone activity and one of the more challenging responsibilities for doctors in training. The nature and extent of challenges experienced by them at different stages of the antibiotic prescribing process are not well described, meaning that interventions may not target the most problematic areas. OBJECTIVES Our aim was to explore doctors in training experiences of common problems in the antibiotic prescribing process using cultural-historical activity theory (CHAT). Our research questions were as follows: What are the intended stages in the antibiotic prescribing process? What are the challenges and where in the prescribing process do these occur? METHODS We developed a process model based on how antibiotic prescribing is intended to occur in a 'typical' National Health Service hospital in the UK. The model was first informed by literature and refined through consultation with practising healthcare professionals and medical educators. Then, drawing on CHAT, we analysed 33 doctors in training narratives of their antibiotic prescribing experiences to identify and interpret common problems in the process. RESULTS Our analysis revealed five main disturbances commonly occurring during the antibiotic prescribing process: consultation challenges, lack of continuity, process variation, challenges in patient handover and partial loss of object. Our process model, with 31 stages and multiple practitioners, captures the complexity, inconsistency and unpredictability of the process. The model also highlights 'hot spots' in the process, which are the stages that doctors in training are most likely to have difficulty navigating. CONCLUSIONS Our study widens the understanding of doctors in training prescribing experiences and development needs regarding the prescribing process. Our process model, identifying the common disturbances and hot spots in the process, can facilitate the development of antibiotic prescribing activities and the optimal design of interventions to support doctors in training.
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Affiliation(s)
- Anu Kajamaa
- Faculty of Educational Sciences, University of Helsinki, Finland
| | - Karen Mattick
- Centre for Research in Professional Learning, University of Exeter, Exeter, UK
| | - Hazel Parker
- Pharmacy Department, Royal Devon & Exeter Hospital, Exeter, UK
| | - Angelique Hilli
- Centre for Research in Professional Learning, University of Exeter, Exeter, UK
| | - Charlotte Rees
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
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Larsen DP. Expanding the definition of learning: from self to social to system. MEDICAL EDUCATION 2019; 53:539-542. [PMID: 31025769 DOI: 10.1111/medu.13893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Douglas P Larsen
- Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
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Nordquist J, Chan MK, Maniate J, Cook D, Kelly C, McDougall A. Examining the clinical learning environment through the architectural avenue. MEDICAL TEACHER 2019; 41:403-407. [PMID: 30761930 DOI: 10.1080/0142159x.2019.1566603] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Medical education has traditionally focused on the learners, the educators, and the curriculum, while tending to overlook the role of the designed environment. Experience indicates, however, that processes and outcomes of medical education are sensitive to the qualities and disposition of the spaces in which it occurs. This includes the clinical education within the patient care environment, termed the clinical learning environment (CLE). Recognition of this has informed the design of some new clinical learning spaces for the past decade. Competency-based clinical education can drive design requirements that differ materially from those associated with general purpose educational or clinical spaces. In this article, we outline two conceptual frameworks: (i) materialist spatiality and (ii) actor-network theory and consider how they can guide the design of spaces to support competency-based medical education and to guide the evaluation and discussion of the educational impacts of the spaces once built. We illustrate the use of these frameworks through discussion of the educational ambitions that underpinned the design of some recent clinical educational spaces. We close with practical points for consideration by educators and designers.
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Affiliation(s)
- Jonas Nordquist
- a Department of Medicine (Huddinge) , Karolinska Institutet , Stockholm , Sweden
- b Department of Research and Education , Karolinska University Hospital , Stockholm , Sweden
| | - Ming-Ka Chan
- c Department of Paediatrics , University of Manitoba , Manitoba , Canada
| | - Jerry Maniate
- d Department of Medicine and Department of Innovation in Medical Education , University of Ottawa , Ottawa , Canada
- e Department of Education , The Ottawa Hospital , Ottawa , Canada
| | - David Cook
- f Sydney Medical School, University Sydney , Sydney , Australia
| | - Cathal Kelly
- g Royal College of Surgeons of Ireland , Dublin , Ireland
| | - Allan McDougall
- h Faculty of Education , University of Ottawa , Ottawa , Canada
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Elmberger A, Björck E, Liljedahl M, Nieminen J, Bolander Laksov K. Contradictions in clinical teachers' engagement in educational development: an activity theory analysis. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:125-140. [PMID: 30284068 PMCID: PMC6373255 DOI: 10.1007/s10459-018-9853-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 09/19/2018] [Indexed: 05/13/2023]
Abstract
Many medical universities offer educational development activities to support clinical teachers in their teaching role. Research has focused on the scope and effectiveness of such activities and on why individual teachers attend. However, systemic perspectives that go beyond a focus on individual participants are scarce in the existing literature. Employing activity theory, we explored how clinical teachers' engagement in educational development was affected by the systems they act within. Three focus groups were held with clinical teachers from different professions. A thematic analysis was used to map the contradictions between the systems that the participants were part of and the manifestations of these contradictions in the system of education. In our model, clinical teachers were part of three activity systems directed by the objects of patient care, research and education respectively. Contradictions arose between these systems as their objects were not aligned. This manifested through the enacted values of the academic hospital, difficulties establishing educational discussions in the clinical workplace, the transient nature of educational employments, and impediments to developing a teacher identity. These findings offer insights into the complexities of engaging in educational development as clinical teachers' priorities interact with the practices and values of the academic hospital, suggesting that attention needs to shift from individual teachers to developing the systems in which they work.
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Affiliation(s)
- Agnes Elmberger
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Erik Björck
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Matilda Liljedahl
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Primary Health Care Unit, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Juha Nieminen
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Klara Bolander Laksov
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Department of Education, Stockholm University, Stockholm, Sweden
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Affiliation(s)
- Reshma Bharamgoudar
- Department of Medicine; University of Birmingham College of Medical and Dental Sciences; Birmingham UK
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Bowen JL, O'Brien BC, Ilgen JS, Irby DM, Ten Cate O. Chart stalking, list making, and physicians' efforts to track patients' outcomes after transitioning responsibility. MEDICAL EDUCATION 2018; 52:404-413. [PMID: 29383741 DOI: 10.1111/medu.13509] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/14/2017] [Accepted: 10/16/2017] [Indexed: 05/23/2023]
Abstract
CONTEXT Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians' activities in practice as they sought follow-up information about patients. METHODS Using a constructivist grounded theory approach, semi-structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants' strategies when deliberately conducting follow-up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow-up. RESULTS The authors identified three themes related to follow-up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow-up. Analysis of participants' follow-up processes as an activity system highlighted key tensions in the system and participants' work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients' outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients' health information (rules) led to rule-breaking or abandoning activities of locating information. Finding time to conduct desired follow-up produced tension between this and other activity systems. CONCLUSION In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow-up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians' skill development in developing and maintaining tracking systems for follow-up; (iii) dedicate time in physicians' work schedules for conducting follow-up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians' learning and respect patients' privacy.
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Affiliation(s)
- Judith L Bowen
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Bridget C O'Brien
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jonathan S Ilgen
- Department of Emergency Medicine, and Associate Director, Center for Leadership and Innovation in Medical Education, University of Washington, School of Medicine, Seattle, Washington, USA
| | - David M Irby
- Department of Medicine, University of California, San Francisco, California, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Varpio L, Farnan JM, Park YS. Summary: Research Diseases Need Holistic Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:S7-S11. [PMID: 29065017 DOI: 10.1097/acm.0000000000001923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Lara Varpio
- L. Varpio is associate professor, Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland. J.M. Farnan is associate professor of medicine and assistant dean of curriculum development and evaluation, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Y.S. Park is associate professor, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois
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Larsen DP. Translating Intentions Into Actions: A Missing Piece of the Puzzle in Improving Residents' Self-Regulated Learning. J Grad Med Educ 2017; 9:458-460. [PMID: 28824758 PMCID: PMC5559240 DOI: 10.4300/jgme-d-17-00357.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Gandomkar R, Sandars J. Unravelling the challenge of using student learning goals in clinical education. MEDICAL EDUCATION 2017; 51:676-677. [PMID: 28924990 DOI: 10.1111/medu.13337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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