Learning contracts in higher professional training: a user's guide

Is learning being supported when information is provided to informal carers during inpatient stroke rehabilitation? A qualitative study

Purpose: To explore how health professionals provide information to informal carers during inpatient stroke rehabilitation and whether these practices align with adult learning principles.Methods: Informal carers and survivors of stroke who had completed inpatient rehabilitation, and health professionals working in inpatient stroke rehabilitation were interviewed. Directed qualitative content analysis was conducted using an adult learning model, to determine how closely reported practices aligned to adult learning principles.Results: 14 carers, 6 survivors of stroke and 17 health professionals participated. Carers (79% female, 57% spouse/partner) reported having incomplete knowledge during rehabilitation, lacking information about mechanisms of stroke recovery, rehabilitation processes, long-term effects of stroke, and navigating post-discharge services. Health professionals supported carers to address their learning needs related to safety of caring for stroke survivors. Carers indicated they were responsible for their own non-safety related learning. Health professionals tended not to check carers' understanding of information provided nor offer learning opportunities beyond written or verbal information.Conclusions: Health professionals consistently provide certain information to carers during inpatient rehabilitation, but adult learning principles are not routinely applied when information is provided. Fostering adult learning among informal carers may improve preparedness of carers to support stroke survivors after discharge from inpatient rehabilitation.

Public health practicum: a scoping review of current practice in graduate public health education

OBJECTIVES

The objectives of this study are to (1) identify Graduate Public Health (GPH) programmes with an integrated practicum, (2) determine current practice for practicum design and (3) use the information to make recommendations to inform the design of Public Health Graduate programme practicums.

DESIGN

Scoping review.

DATA SOURCES

Academic Ranking World Universities 2019 was used to identify top 10 institutions in each geographical hub offering GPH programmes. Each GPH programme website was searched for practicum information.

ELIGIBILITY CRITERIA

GPH programmes offering a practice-based component as a requirement in their curriculum.

DATA EXTRACTION AND SYNTHESIS

One reviewer screened GPH websites for eligibility and extracted data. Verification of data for accuracy and completeness was done on 10% of the sample by the second author. Data were compiled into an Excel file and were analysed to describe the duration, timing, credit, contact hours, preceptor requirements, prerequisites, objectives, deliverables and methods of evaluation of the practice-based component.

RESULTS

Out of the 108 GPH programmes screened, a total of 35 programmes were included. There was a significant variation in required practicum duration ranging from 4 to 16 weeks. Only 31% specifically outlined prerequisites to be completed before the initiation of the practicum. More than half (57%) had a published list of core competencies. A majority of practicum did not provide criteria for appropriate preceptors (63%) and their responsibilities (66%). All programmes listed assessment criteria however the majority (57%) did not specify if the practicum was graded or a for-credit component.

CONCLUSIONS

The integration of practical components into curricula is inconsistent. This research resulted in 14 recommendations intended to guide GPH practicum design. We propose that this study be used as a tool to spark a global dialogue about best practices in GPH education through the identification of common practices and opportunities for improvement.

Teaching at the Bedside. Maximal Impact in Minimal Time

Academic physicians encounter many demands on their time including patient care, quality and performance requirements, research, and education. In an era when patient volume is prioritized and competition for research funding is intense, there is a risk that medical education will become marginalized. Bedside teaching, a responsibility of academic physicians regardless of professional track, is challenged in particular out of concern that it generates inefficiency, and distractions from direct patient care, and can distort physician-patient relationships. At the same time, the bedside is a powerful location for teaching as learners more easily engage with educational content when they can directly see its practical relevance for patient care. Also, bedside teaching enables patients and family members to engage directly in the educational process. Successful bedside teaching can be aided by consideration of four factors: climate, attention, reasoning, and evaluation. Creating a safe environment for learning and patient care is essential. We recommend that educators set expectations about use of medical jargon and engagement of the patient and family before they enter the patient room with trainees. Keep learners focused by asking relevant questions of all members of the team and by maintaining a collective leadership style. Assess and model clinical reasoning through a hypothesis-driven approach that explores the rationale for clinical decisions. Focused, specific, real-time feedback is essential for the learner to modify behaviors for future patient encounters. Together, these strategies may alleviate challenges associated with bedside teaching and ensure it remains a part of physician practice in academic medicine.

Strategies for effective feedback

Provision of regular feedback to trainees on clinical performance by supervising providers is increasingly recognized as an essential component of undergraduate and graduate health sciences education; however, many individuals have not been formally trained in this pedagogical skill. At the bedside or in the clinic, effective performance feedback can be accomplished by following four key steps. Begin by setting expectations that incorporate the trainee's personal goals and external objectives. Delineate how and when you will provide feedback to the learner. Next, directly observe the trainee's performance. This can be challenging while engaged on a busy clinical service, but a focus on discrete activities or interactions (e.g., family meeting, intravascular volume assessment using bedside ultrasound, or obtaining informed consent) is helpful. The third step is to plan and prioritize the feedback session. Feedback is most effective when given in a timely fashion and delivered in a safe environment. Limit the issues addressed because learners often disengage if confronted with too many deficiencies. Finally, when delivering feedback, begin by listening to the trainee's self-evaluation and then take a balanced approach. Describe in detail what the trainee does well and discuss opportunities for improvement with emphasis on specific, modifiable behaviors. The feedback loop is completed with a plan for follow-up reassessment. Through the use of these relatively simple practices, both the trainee and teacher can have a more productive learning experience.

The Academic Support Process (ASP) website: helping preceptors develop resident learning plans and track progress

BACKGROUND

At times, preceptors struggle with aspects of resident education. Many are looking for more support and faculty development in this area.

AIMS

To address preceptors' needs for resources and provide a proactive framework for their teaching, the Academic Support Process (ASP) website was developed and evaluated. Preceptors' (N = 35) experiences using the ASP website, as well as their perceptions of its usefulness in supporting resident education, were identified.

METHODS

The research comprised two phases: a self-directed workshop involving the creation of a web-based learning plan for a standardised scenario of a resident in difficulty followed by 3 months use of the ASP website with residents in their practice. Information on their experiences was solicited via surveys and focus group interviews.

RESULTS

Findings revealed the ASP website enabled preceptors to find words for their concerns around resident competency, gave them a proactive teaching framework, expanded their arsenal of teaching strategies, and supported a customised approach for all learners along the performance spectrum. However, there were a number of challenges encountered by the preceptors that affected site use and buy in.

CONCLUSIONS

Results are promising. Next steps involve developing a clear strategy for adoption.

The role of interactive training skills courses in medical education at the Ankara University School of Medicine

BACKGROUND

The Department of Medical Education at Ankara University School of Medicine offered a teaching program for their physician educators. One hundred and fifty professors from different disciplines attended this 5-day training course.

DESCRIPTION

Two certified master trainers designed the program, which consisted of the following topics: adult learning principles, creating a positive training climate, interactive training techniques, clinical demonstration, coaching principles, effective use of audiovisual materials, developing and using knowledge and competency-based assessment instruments, and organizing training sessions. Master trainers managed all the courses and guided the other trainers according to the principles of group dynamics. Of the overall participants, 30% attended voluntarily (n = 45) and 70% attended compulsorily (n = 105).

EVALUATION

In general, 97.5% to 100% assessed the course as either good or very good, with no difference in assessment between the two groups (p > .05; one-way analysis of variance). Course topics and time arrangements for each training session were rated optimal by 82% of participants, and all of them recommended that "all faculty should attend this course."

CONCLUSION

The positive effects of these courses have led the School of Medicine's academic council to agree by consensus to accept the training skills course certificate as a criterion for eligibility to become a trainer at the School of Medicine. They also decided to institute educational reform, including changing the curriculum and using new educational methodology such as interactive techniques and problem-based learning.