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Garth B, Kirby C, Nestel D, Brown J. Becoming a general practice supervisor: A longitudinal multi-case study exploring key supportive factors. CLINICAL TEACHER 2024; 21:e13738. [PMID: 38302185 DOI: 10.1111/tct.13738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Supervision of trainees in the health care professions is recognised internationally as core to safe and effective patient care. A supervisor workforce in general practice (GP) is critical to the profession and to the communities where they work and can be demanding as general practitioners incorporate workplace-based education and support of their trainees into their daily consulting work. Little is known about how this is experienced by new supervisors; therefore, this research sought to understand factors that play a significant role in the first semester of becoming a supervisor. METHODS An exploratory multi-case study design was used; new general practice supervisors were the unit of analysis. Four data sources were captured longitudinally: semi-structured interviews at the beginning and end of the semester, audio diaries throughout and a mid-semester focus group. Template analysis was used, sensitised by a community of practice theoretical framework. RESULTS Seven new supervisors participated. Five interdependent key factors played a significant role in general practitioners becoming supervisors: (1) making meaning of the role, (2) reconciling multiple roles, (3) building a relationship with the trainee, (4) receiving support from the training practice and the training programme and (5) joining peer communities of new and experienced supervisors. CONCLUSION Becoming a general practice supervisor is situated in the context of a workplace delivering clinical services, a training programme and personal life circumstances. It can be challenging and rewarding. Insufficient support may result in unintended attrition. Learning in this role is facilitated by enabling the new supervisor to find meaning in the role; structured allocation of time to engage effectively; a positive trainee-supervisor relationship; administrative support by practices; information, advice and remuneration from the training programme; and interactions with new and experienced supervisor peers.
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Affiliation(s)
- Belinda Garth
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | | | - Debra Nestel
- School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Surgery (Austin), University of Melbourne, Melbourne, Victoria, Australia
| | - James Brown
- School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Royal Australian College of General Practitioners, Melbourne, Victoria, Australia
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Scallan S. What is the role of 'theory' in training GP trainers? EDUCATION FOR PRIMARY CARE 2024; 35:2-6. [PMID: 37671666 DOI: 10.1080/14739879.2023.2253539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/27/2023] [Indexed: 09/07/2023]
Abstract
A recent evaluation paper of the London General Practitioner Trainer Course by Knight et al questions the importance of educational theory in preparing GPs to become trainers and asks 'how much educational theory do GP trainers need to know in order to train effectively?' This paper places the authors' question under consideration, arguing that before the relationship between the theory and practice of education can be considered, the nature of 'educational practice' needs examination. There then follows a discussion of the work of Della Fish which presents two conceptualisations of educational practice in the context of postgraduate medical education in order to shed light on the different inferences contrasting epistemological and ontological conceptions can have, and the implications for curricula. This discussion is illustrated by offering the reader connections to papers in the field as evidence. At the heart of the paper is a conclusion that curriculum development and enquiry need to be sensitive to epistemological and ontological positionality as well as experiences and perceptions.
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Affiliation(s)
- Samantha Scallan
- Faculty of Health and Wellbeing, University of Winchester, Winchester, UK
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McMains KC, Durning SJ, Norton C, Meyer HS. The Making of an Educator: Professional Identity Formation Among Graduate Medical Education Faculty Through Situated Learning Theory. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:254-260. [PMID: 37201556 DOI: 10.1097/ceh.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators? METHODS The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators. RESULTS Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct. DISCUSSION The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.
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Affiliation(s)
- Kevin C McMains
- Dr. McMains : Professor, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD. Dr. Durning : Director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD, and Professor, Department of Medicine. Norton : Instruction Librarian, Division of Library Services, National Institutes of Health Library, Bethesda, MD. Dr. Meyer : Assistant Professor, Department of Medicine, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, MD
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Yang L, Zou J, Gao J, Fan X. Assessing the effectiveness of massive open online courses on improving clinical skills in medical education in China: A meta-analysis. Heliyon 2023; 9:e19263. [PMID: 37664759 PMCID: PMC10470193 DOI: 10.1016/j.heliyon.2023.e19263] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/13/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Massive Open Online Courses (MOOCs) are a new phenomenon in education worldwide. In China, MOOCs have been widely used in medical courses. However, the effects of MOOCs on improving clinical skills are controversial. Therefore, we conducted the study to verify whether the application of MOOCs in medical courses can improve participants' clinical skills in China. A systematic literature search was carried out using the PubMed, Embase, Web of Science, CNKI and Wanfang databases according to the predetermined criteria. The Hedges' g and its corresponding 95% confidence interval were selected to assess the effects of MOOCs on participants' clinical skills. Subgroup analyses, sensitivity analysis and publication bias test were performed in the study. A total of thirty-two records (thirty-two studies) with 3422 participants were identified in our study. There was a significant improvement in clinical skill scores of participants in the MOOC group compared with the control group. Subgroup analyses showed similar results in different student groups. Our study supported the notion that the MOOC-based teaching method appeared to be a more effective method than the conventional teaching technique for the improvement of participants' clinical skills in China.
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Affiliation(s)
| | | | - Junwei Gao
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiaotang Fan
- Department of Military Cognitive Psychology, School of Psychology, Third Military Medical University (Army Medical University), Chongqing, 400038, China
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Dace W, Purdy E, Brazil V. Wearing hats and blending boundaries: harmonising professional identities for clinician simulation educators. Adv Simul (Lond) 2022; 7:35. [PMID: 36303245 PMCID: PMC9615167 DOI: 10.1186/s41077-022-00229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/24/2022] [Indexed: 11/10/2022] Open
Abstract
Many clinicians working in healthcare simulation struggle with competing dual identities of clinician and educator, whilst those who harmonise these identities are observed to be highly effective teachers and clinicians. Professional identity formation (PIF) theories offer a conceptual framework for considering this dilemma. However, many clinician simulation educators lack practical guidance for translating these theories and are unable to develop or align their dual identities. An unusual experience involving the first author’s suspension of disbelief as a simulation facilitator sparked a novel reflection on his dual identity as a clinician and as a simulation educator. He re-framed his clinician and simulation ‘hats’ as cooperative and fluid rather than competing and compartmentalised. He recognised that these dual identities could flow between clinical and simulation environments through leaky ‘blended boundaries’ rather than being restricted by environmental demarcations. This personal story is shared and reflected upon to offer a practical ‘hats and boundaries’ model. Experimenting with the model in both clinical and simulation workplaces presents opportunities for PIF and alignment of dual identities. The model may help other clinician simulation educators navigate the complexities of merging their dual identities.
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Affiliation(s)
- William Dace
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.
| | - Eve Purdy
- Gold Coast University Hospital Emergency Department, Southport, Queensland, Australia.,Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Victoria Brazil
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
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Shah R, Clarke R, Ahluwalia S, Launer J. Finding meaning in the hidden curriculum - the use of the hermeneutic window in medical education. EDUCATION FOR PRIMARY CARE 2022; 33:132-136. [PMID: 35272579 DOI: 10.1080/14739879.2022.2047112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We have published a model of the GP consultation where biomedical and humanistic elements of the consultation are seen as complementary and where hermeneutics, the discovery and creation of meaning, plays an integral role in enriching the conversation between clinicians and patients. The relationship between teachers and learners shows strong parallels with the relationship between practitioners and patients. We therefore explore how a similar analysis can enhance the relationship between teachers and learners and propose that hermeneutics can be particularly powerful in exploring and making explicit elements of the hidden curriculum.
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Affiliation(s)
- Rupal Shah
- GP Partner Bridge Lane Group Practice, Associate Dean Professional Development Team Health Education England, London, England
| | | | - Sanjiv Ahluwalia
- Head of School of Medicine, Anglia Ruskin University, Chelmsford, England
| | - John Launer
- Programme Director for Innovation, Health Education England, London, England
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van Lankveld T, Thampy H, Cantillon P, Horsburgh J, Kluijtmans M. Supporting a teacher identity in health professions education: AMEE Guide No. 132. MEDICAL TEACHER 2021; 43:124-136. [PMID: 33153338 DOI: 10.1080/0142159x.2020.1838463] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This guide provides an understanding of what teacher identity is and how it can be developed and supported. Developing a strong teacher identity in the context of health professions education is challenging, because teachers combine multiple roles and the environment usually is more supportive to the identity of health practitioner or researcher than to that of teacher. This causes tensions for those with a teaching role. However, a strong teacher identity is important because it enhances teachers' intention to stay in health professions education, their willingness to invest in faculty development, and their enjoyment of the teaching role. The guide offers recommendations on how to establish workplace environments that support teacher identity rather than marginalise it. Additionally, the guide offers recommendations for establishing faculty development approaches that are sensitive to teacher identity issues. Finally, the guide provides suggestions for individual teachers in relation to what they can do themselves to nurture it.
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Affiliation(s)
- Thea van Lankveld
- Department of Education, Utrecht University, Utrecht, The Netherlands
| | | | - Peter Cantillon
- Discipline of General Practice, School of Medicine, Galway, Ireland
| | - Jo Horsburgh
- Centre for Higher Education Research and Scholarship, Imperial College, South Kensington, London
| | - Manon Kluijtmans
- Center for Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Chapman L, Mysko C, Coombridge H. Development of teaching, mentoring and supervision skills for basic training registrars: a frustrated apprenticeship? Intern Med J 2020; 51:1847-1853. [PMID: 32510770 DOI: 10.1111/imj.14935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Teaching, mentoring and supervision (TMS) are fundamental skills with a specific commitment within the Royal Australasian College of Physicians professional practice framework. The new basic training standards include 'use of appropriate educational techniques to facilitate the learning of peers, junior colleagues and other health professionals and to provide supervision for junior colleagues' but it is unclear how basic physician trainees and equivalent grade doctors (hereinafter 'registrars') will provide, learn or develop TMS skills. AIMS To explore how registrars provide, learn and develop TMS skills. METHODS Mixed methods approach. New Zealand registrars were invited to participate in anonymous survey regarding TMS experiences and learning. Focus groups explored skill acquisition and development more deeply. RESULTS A total of 121 registrars from 16 District Health Boards responded. Registrars supervise two juniors daily (range 0-4+). Fewer than 1:4 have formal training in TMS skills. Free text and focus group themes include: informal development by observing role models plus personal experience of giving and receiving TMS, inequitable access to development opportunities and formal training, barriers include workload and unsupportive learning cultures. Some registrars lack confidence in delivering TMS. CONCLUSIONS Registrars are expected to teach, mentor and supervise junior colleagues but experience a 'frustrated apprenticeship': formal training is minimal and informal training is dependent on variable role models, opportunities and systematic support. Registrars feel unprepared and lack confidence despite wanting to succeed in this domain. Suggestions for improvement include baseline formal training, purposeful role modelling by seniors and equitable promotion of TMS opportunities.
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Affiliation(s)
- Laura Chapman
- Department of Medicine, University of Auckland, Auckland, New Zealand.,Department of General Medicine, Waitemata District Health Board, Auckland, New Zealand
| | - Christopher Mysko
- Department of General Medicine, Waitemata District Health Board, Auckland, New Zealand
| | - Hannah Coombridge
- Department of General Medicine, Waitemata District Health Board, Auckland, New Zealand
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Cantillon P, Dornan T, De Grave W. Becoming a Clinical Teacher: Identity Formation in Context. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1610-1618. [PMID: 30113365 DOI: 10.1097/acm.0000000000002403] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Most clinical teachers have not been trained to teach, and faculty development for clinical teachers is undermined by poor attendance, inadequate knowledge transfer, and unsustainability. A crucial question for faculty developers to consider is how clinicians become teachers "on the job." Such knowledge is important in the design of future workplace-based faculty development initiatives. The authors conducted a scoping review of research on the relationship between becoming a clinical teacher and the clinical environments in which those teachers work. METHOD In June 2017, using the scoping review design described by Levac et al (2010), the authors searched 12 databases. They subjected the articles discovered to four phases of screening, using iteratively developed inclusion/exclusion criteria. They charted data from the final selection of articles and used thematic analysis to synthesize findings. RESULTS Thirty-four research reports met the inclusion criteria. Most (n = 24) took an individualist stance toward identity, focusing on how teachers individually construct their teacher identity in tension with their clinician identities. Only 10 studies conceptualized clinical teacher identity formation as a social relational phenomenon, negotiated within hierarchical social structures. Twenty-nine of the included studies made little or no use of explicit theoretical frameworks, which limited their rigor and transferability. CONCLUSIONS Clinicians reconciled their identities as teachers with their identities as clinicians by juggling the two, finding mutuality between them, or forging merged identities that minimized tensions between educational and clinical roles. They did so in hierarchical social settings where patient care and research were prioritized above teaching.
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Affiliation(s)
- Peter Cantillon
- P. Cantillon is professor of primary care, Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland; ORCID: https://orcid.org/0000-0003-3776-9537. T. Dornan is professor of medical education, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, United Kingdom; ORCID: http://orcid.org/0000-0001-7830-0183. W. De Grave is an educational psychologist, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Ong SY, Lee M, Lee LS, Lim I, Tham KY. Tensions in integrating clinician and educator role identities: a qualitative study with occupational therapists and physiotherapists. BMJ Open 2019; 9:e024821. [PMID: 30804031 PMCID: PMC6443068 DOI: 10.1136/bmjopen-2018-024821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Clinician educators (CEs) frequently report tensions in their professional identities as clinicians and educators, although some perceive a reciprocal relationship between clinical and teaching roles. However, it is unknown if the shared meanings of clinicians' multiple job roles translate to identity verification. We sought to examine CEs' perceptions of their clinician and educator roles and the influence of their perceptions on the salience of their professional identities. DESIGN Qualitative individual interviews and focus groups, analysed using framework analytic approach. SETTING AND PARTICIPANTS 23 occupational therapy (OT) and 16 physiotherapy (PT) educators from two acute hospitals and one rehabilitation unit in Singapore. RESULTS PT and OT CEs constructed shared meanings of their clinician and educator roles through overcoming feelings of unease and inadequacy, discovering commonalities and establishing relevance. However, shared meanings between clinician and educator roles might not necessarily lead to mutual verification of their professional identities. Individuals' cognitive flexibility and openness to additional roles, and organisations' expectations had a mediating effect on the identity integration process. Less experienced CEs reported feelings of distress juggling the competing demands of both clinician and educator roles, whereas more experienced CEs appeared to be more capable of prioritising their job roles in different situations, which could be a result of differences in adaptation to frequent interruptions in clinical setting. Emphasis on patient statistics could result in failure in achieving identity verification, leading to feelings of distress. CONCLUSION Faculty developers should take into consideration the episodic nature of the educator identity construction process and develop induction programmes to assist CEs in building integrated identities.
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Affiliation(s)
- Sik Yin Ong
- HOMER (Health Outcomes and Medical Education Research), Group Education, National Healthcare Group, Singapore, Singapore
| | - Mary Lee
- HOMER (Health Outcomes and Medical Education Research), Group Education, National Healthcare Group, Singapore, Singapore
| | - Lee Sian Lee
- Occupational Therapy, Institute of Mental Health, Singapore, Singapore
| | - Issac Lim
- HOMER (Health Outcomes and Medical Education Research), Group Education, National Healthcare Group, Singapore, Singapore
| | - Kum Ying Tham
- Emergency, Tan Tock Seng Hospital, Singapore, Singapore
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Feeley I, Kelly M, Healy EF, Murray F, O’Byrne JM. Surgical tuition within Irish hospitals: a national survey. Ir J Med Sci 2017; 187:177-182. [DOI: 10.1007/s11845-017-1610-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/27/2017] [Indexed: 10/19/2022]
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