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Jenq CC, Lin JR, Quattri F, Monrouxe L. Medical students', residents', and nurses's feedback to clinical educators in Taiwan: A qualitative study. MEDICAL EDUCATION 2024. [PMID: 38766732 DOI: 10.1111/medu.15429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 04/18/2024] [Accepted: 04/27/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Feedback is a crucial element in learning. While studies in the field of healthcare professions education have highlighted the process of educators feeding back to learners, relatively little investigation exists on learners feeding back to educators in Asian cultures. Studies show that recipients of effective feedback develop educational skills and reflective practice, but the process of giving feedback seems to have been mainly studied through surveys and questionnaires. Such research offers little to no insights on feedback providers' and recipients' experiences of feedback. To fill the gap, in the context of multi-source feedback, we investigate medical students, residents, and nurses feedback giving to clinical educators (and their receiving of this) following a case presentation training course. We aim to understand the facilitators and inhibitors that encourage and/or prevent feedback provision alongside educators' uptake and reactions. METHODS We used semi-structured group interviews. Participants comprised five different categories of participants: year-4 medical students (n = 6); residents (n = 5); nurses (n = 4); junior clinical educators (n = 9); senior clinical educators (n = 3). We asked them about their experiences of providing feedback to educators and educators receiving of feedback on their teaching. Group interviews were conducted in the largest healthcare institution in Taiwan. Data were analysed using thematic Framework Analysis and managed in ATLAS.ti 8.0. RESULTS We identified two major themes with respective sub-themes: (1) Factors affecting feedback giving (including desire for improvement, feedback content, process of feedback, feedback fears, feedback prevention and medical hierarchy); and (2) Educators' reactions to receiving feedback (including validity of feedback, face-saving and emotional reactions to receiving feedback). CONCLUSIONS Feedback provision to educators on their teaching, and educators' receiving of this feedback in an Asian culture brings forth issues around medical hierarchy, in-person feedback and face-saving, which have important implications for effective and optimal delivery of feedback. Curricular developers should consider the context of feedback (e.g. anonymously online), facilitating students as active participants for the development of educational quality, and educators' mindful practice when engaging with student feedback.
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Affiliation(s)
- Chang-Chyi Jenq
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taiwan
- Chang Gung University College of Medicine, Taoyuan, Taiwan
- Chang Gung Medical Education Research Centre, (CG-MERC), Taiwan
| | - Jiun-Ren Lin
- Chang Gung Medical Education Research Centre, (CG-MERC), Taiwan
| | - Francesca Quattri
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Lynn Monrouxe
- Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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Liao KC, Ajjawi R, Peng CH, Jenq CC, Monrouxe LV. Striving to thrive or striving to survive: Professional identity constructions of medical trainees in clinical assessment activities. MEDICAL EDUCATION 2023; 57:1102-1116. [PMID: 37394612 DOI: 10.1111/medu.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/15/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023]
Abstract
CONTEXT Assessment plays a key role in competence development and the shaping of future professionals. Despite its presumed positive impacts on learning, unintended consequences of assessment have drawn increasing attention in the literature. Considering professional identities and how these can be dynamically constructed through social interactions, as in assessment contexts, our study sought to understand how assessment influences the construction of professional identities in medical trainees. METHODS Within social constructionism, we adopted a discursive, narrative approach to investigate the different positions trainees narrate for themselves and their assessors in clinical assessment contexts and the impact of these positions on their constructed identities. We purposively recruited 28 medical trainees (23 students and five postgraduate trainees), who took part in entry, follow-up and exit interviews of this study and submitted longitudinal audio/written diaries across nine-months of their training programs. Thematic framework and positioning analyses (focusing on how characters are linguistically positioned in narratives) were applied using an interdisciplinary teamwork approach. RESULTS We identified two key narrative plotlines, striving to thrive and striving to survive, across trainees' assessment narratives from 60 interviews and 133 diaries. Elements of growth, development, and improvement were identified as trainees narrated striving to thrive in assessment. Neglect, oppression and perfunctory narratives were elaborated as trainees narrated striving to survive from assessment. Nine main character tropes adopted by trainees with six key assessor character tropes were identified. Bringing these together we present our analysis of two exemplary narratives with elaboration of their wider social implications. CONCLUSION Adopting a discursive approach enabled us to better understand not only what identities are constructed by trainees in assessment contexts but also how they are constructed in relation to broader medical education discourses. The findings are informative for educators to reflect on, rectify and reconstruct assessment practices for better facilitating trainee identity construction.
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Affiliation(s)
- Kuo-Chen Liao
- Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital (CGMH), Linkou, Taiwan (ROC)
- Chang Gung Medical Education Research Centre, CGMH, Linkou, Taiwan (ROC)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan (ROC)
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
| | - Chang-Hsuan Peng
- Chang Gung Medical Education Research Centre, CGMH, Linkou, Taiwan (ROC)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan (ROC)
| | - Chang-Chyi Jenq
- Chang Gung Medical Education Research Centre, CGMH, Linkou, Taiwan (ROC)
- Department of Nephrology, CGMH, Linkou, Taiwan (ROC)
- Medical Humanities Center, CGMH, Linkou, Taiwan (ROC)
- Department of Medical Humanities and Social Sciences, School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan (ROC)
| | - Lynn V Monrouxe
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Jansen I, Silkens MEWM, Galema G, Vermeulen H, Geerlings SE, Lombarts KMJMH, Stalmeijer RE. Exploring nurses' role in guiding residents' workplace learning: A mixed-method study. MEDICAL EDUCATION 2023; 57:440-451. [PMID: 36226355 DOI: 10.1111/medu.14951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g. feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions. METHODS This mixed-method study was conducted at four Dutch university medical centres in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likert-scale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using anova. The thematically analyzed qualitative open comments explored respondents' reasons for their perceptions. RESULTS Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, nurses indicated that attending physicians did not always involve them in guiding residents, whereas residents perceived nurses were being involved (p < .001). Themes suggest that nurses and residents could be divided into two groups: (i) respondents who felt that guiding was inextricably linked to good interprofessional collaboration and patient care and (ii) respondents who saw the guiding role as limited and emphasised the distinct fields of expertise between nurses and physicians. CONCLUSIONS Residents and nurses felt that nurses played an important role in guiding residents' workplace learning. However, some residents did not always perceive to be guided. To further capitalise on nurses' guiding role, we suggest that residents can be encouraged to engage in the learning opportunities nurses provide to achieve optimal team-based patient care.
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Affiliation(s)
- Iris Jansen
- Professional Performance and Compassionate Care Research Group, Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Milou E W M Silkens
- Centre for Healthcare Innovation Research, City University of London, London, UK
| | - Gerbrich Galema
- University Medical Center Groningen, Department of Anesthesiology, University of Groningen, Groningen, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Suzanne E Geerlings
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Kiki M J M H Lombarts
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Ohta R, Sano C. Bedside Teaching in Rural Family Medicine Education in Japan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116807. [PMID: 35682389 PMCID: PMC9180610 DOI: 10.3390/ijerph19116807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 12/02/2022]
Abstract
Bedside teaching is essential in family medicine education so that residents may learn about various clinical conditions and develop professional skills. In particular, bedside teaching is useful in a rural context because rural family medicine deals with a broad scope of biopsychosocial problems among older patients. Accordingly, based on an inductive thematic analysis, we propose a framework for bedside teaching in rural family medicine education, which consists of four themes: accommodation of different learners, near-peer learning, the change in engagement of medical teachers in bedside teaching, and driving interpersonal collaboration. Bedside teaching can promote interactions between different medical learners. Near-peer learning in bedside teaching compensates for the limited availability of educators and improves learners’ motivation for self-directed learning. Through bedside teaching, medical learners can observe each other and provide constructive feedback, thereby improving their relationships and learning. For effective bedside teaching, medical educators should facilitate learners and collaborate with other medical professionals. Additionally, bedside teaching should accommodate a variety of learners, facilitate near-peer and self-directed learning, educators’ involvement based on cognitive apprenticeship, along with interprofessional collaboration with nurses. Interprofessional collaboration between rural family medicine teachers, learners, and nurses may improve the quality of patient care due to the increased understanding between patients and other medical staff in hospitals.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-90-5060-5330
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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Ohta R, Maejma S, Sano C. Nurses’ Contributions in Rural Family Medicine Education: A Mixed-Method Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053090. [PMID: 35270782 PMCID: PMC8910758 DOI: 10.3390/ijerph19053090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/25/2022] [Accepted: 03/04/2022] [Indexed: 01/27/2023]
Abstract
Family medicine residents frequently collaborate with nurses regarding clinical decisions and treatments, which contributes to their education. In rural areas, these residents experience a wider scope of practice by collaborating with nurses. However, nurses’ contributions to rural family medicine education have not been clarified. This study measured the contributions of 88 rural community hospital nurses to family medicine education using a quantitative questionnaire and interviews. The interviews were recorded, transcribed verbatim, and analyzed using the grounded theory approach. Nurses’ average clinical experience was 20.16 years. Nurses’ contributions to the roles of teacher and provider of emotional support were statistically lower among participants working in acute care wards than those working in chronic care wards (p = 0.024 and 0.047, respectively). The qualitative analysis indicated that rural nurses’ contributions to family medicine education focused on professionalism, interprofessional collaboration, and respect for nurses’ working culture and competence. Additionally, nurses struggled to educate medical residents amid their busy routine; this education should be supported by other professionals. Rural family medicine education should incorporate clinical nurses as educators for professionalism and interprofessional collaboration and as facilitators of residents’ transition to new workplaces. Subsequently, other professionals should be more actively involved in improving education quality.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
- Correspondence: ; Tel.: +81-9050605330
| | - Satoko Maejma
- Department of Nursing, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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Monrouxe LV, Bloomfield JG. Specialty Grand Challenge: Diversity Matters in Healthcare Professions Education Research. Front Med (Lausanne) 2021; 8:765443. [PMID: 34869474 PMCID: PMC8634362 DOI: 10.3389/fmed.2021.765443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lynn V Monrouxe
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Jacqueline G Bloomfield
- Faculty of Medicine and Health, School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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