Intraprofessional workplace learning in postgraduate medical education: a scoping review

Rethinking how to deal with demand and supply in CAP: a European training perspective

Mental health care is suffering from a substantial gap between current service provision capacity and demand. For the generation of young doctors in psychiatry training programs today, this means they face substantial and potentially overwhelming challenges in their clinical practice. This situation calls for creative solutions in psychiatry training to prepare them best for these challenges. Perspectives of European trainers in child and adolescent psychiatry (CAP) were collected and analysed following an iterative procedure in three rounds using thematic analysis of focus groups. The three iterative rounds resulted in five proposed strategies for meeting the challenges of current and future demand in CAP specifically addressing implications for CAP training. Examples were provided illustrating how these strategies could be put into daily training practices. Four strategies aimed mainly at increasing capacity: efficiency (making best use of the existing CAP workforce); consultation (task-sharing); innovation (practicing differently); and wellbeing of the CAP workforce. An additional strategy focusing on prevention and early intervention was identified to decrease demand upstream. Rethinking CAP training practices through a European perspective on the balance between capacity and demand yielded strategies for aspects of training that are not yet universally applied. Implementation is partly dependent on the larger service provision system of care while training has leverage for future capacity and quality of care.

Public e-learning opportunities in anesthesia on YouTube

Background

The increasing knowledge in medicine makes continuous education for clinicians necessary more than ever. The range of skills to be covered in anesthesia is constantly growing. How to optimize complex training in practical skills in an increasingly economized environment remains unclear. The extent and suitability to which video platforms assist in learning basic skills in anesthesia has not been investigated yet.

Methods

To identify appropriate videos on YouTube, we conducted a search (May 1st 2023), including common combinations of synonymous terms, and checked up to the 50th result for relevance. Videos initially deemed suitable were archived and evaluated to exclude duplicates. All included videos were subsequently scrutinized for content. For this purpose, a validated checklist to assess procedural and didactic content was used. Data analysis involved assessing interrater reliability, Spearman's rho test, and linear regression analysis.

Results

We were able to include 222 videos related to 16 basic skills. The low number of videos found on specific skills was striking. The level of fulfillment illustrating a practical skill was repeatedly found <60%. The consistency of the questionnaire was moderate (Fleiss kappa 0.59). Video runtime displayed a significant correlation (p < 0.001) with the number of items accomplished on procedural (|ρ| = 0.442, R 2 = 0.196) and didactic items (|ρ| = 0.452, R 2 = 0.153). The professional context of the content creators showed no influence.

Conclusion

The quantity of available material on specific basic anesthesiologic skills varied drastically. In addition, the videos available often revealed significant shortcomings, making it challenging to easily assess the quality of the content. The vast majority of evaluated videos did not reflect the intended approach in a scientifically correct manner or were entirely unsuitable for displaying the procedural requirements.

Quality and impact of pharmacology digital simulation education on pre-registration healthcare students: A systematic literature review

OBJECTIVE

This review aimed to assess the quality and nature of the literature related to digital simulation-based pharmacology education. Specifically, we sought to understand the influence of simulations on the knowledge, satisfaction, and confidence of pre-registration nurses and other healthcare students participating in such educational programs.

DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. This study was registered in the Prospective Register of Systematic Reviews (PROSPERO, reg no: CRD42023437570).

DATA SOURCES

PubMed, MEDLINE, APA PsycInfo, ProQuest, Web of Science, ScienceDirect, and CINHAL databases were searched.

REVIEW METHODS

The review focused on the quantitative findings from the studies published from 2016 to 2023. Only the studies that assessed the impact of digital simulation-based pharmacology education on pre-registration healthcare students' knowledge, satisfaction, and confidence were selected for review. Data were synthesized using a narrative approach. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included articles. This was followed by a narrative synthesis to consolidate the themes.

RESULT

Out of 1587 articles,16 met the inclusion criteria. A wide variety of digital technologies have been utilised, such as virtual simulation, computer simulation (2D/3D), mixed reality, and augmented reality, with the majority using virtual simulation. All studies implemented single-user simulations. The themes emerging from the narrative synthesis suggest that a digital simulation-based pharmacology course is an effective tool for enhancing students' knowledge, confidence, and satisfaction in learning pharmacological concepts. Furthermore, simulation-based teaching with a blended approach was found to be beneficial. However, the integration of the polypharmacy concept and the intra and interprofessional approach to teaching and learning was not evident in these studies.

CONCLUSION

This systematic literature review provides evidence of the potential of digital simulation-based education in pharmacology teaching among healthcare pre-registration students. In future studies, the integration of polypharmacy content with an intra and interprofessional teaching-learning approach is recommended.

Long-term quality improvement in radiology specialty training at a tertiary cardiothoracic centre

OBJECTIVES

This quality improvement project (QIP) aimed to foster radiology training at a regional tertiary cardiothoracic centre that had very low trainee satisfaction rankings.

METHODS

To study the problem and intervene timely, multiple methods were applied, including a local feedback survey, placement reorganisation, consultant encouragement to train as accredited supervisors, followed by departmental education portal creation and start of externally funded Visiting Fellowships and salaried Clinical Fellowships. The regional rating was monitored. The local feedback survey was distributed and analysed using descriptive statistics. Alongside the QIP, service expansion occurred.

RESULTS

The site regionally ranked 9/19 in 2 years. Local survey responses (53) showed continuous improvement; cardiothoracic subspecialty interest (+39%) and audit/academic involvement (+36%) increased. Multiple Fellowships were completed; internationally reputable placements were agreed upon. Most consultants trained as supervisors. Per increased demand, compulsory deanery posts were changed to motivation-based, and an additional salaried position was offered. Five fellows stayed in the region as subspecialist consultants. Unexpected challenges included space and workstation loss with service expansion, lack of regional surveys since 2019, and the global pandemic. Regardless, the results were positive with subspecialty interest and projected reputational effect increase. Local long-term survey provided sustainable data in detecting improvement areas.

CONCLUSIONS

Given the national radiologist shortage, this quality improvement project shows a possible positive impact of similar interventions, including workforce retention/recruitment and thus improving patient care.

ADVANCES IN KNOWLEDGE

Continuous feedback and quality improvement maintenance are valuable to enhance training quality locally and beyond.

Workplace-based learning opportunities in a South African family medicine training programme

BACKGROUND

Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. Different types of WBL opportunities have been described in high-income countries, but the opportunities in the district health systems of sub-Saharan Africa have not been characterised.

AIM

This study explored family physicians' (FPs) and registrars' perceptions of WBL opportunities in a decentralised postgraduate family medicine registrar training programme.

SETTING

The study was conducted at five decentralised training sites across two provinces affiliated with the University of the Witwatersrand in South Africa.

METHODS

This instrumental case study involved semi-structured qualitative interviews with 11 FPs and 11 registrars purposively sampled across the training sites. The verbatim transcripts were thematically analysed using Braun and Clark's six-step approach.

RESULTS

Workplace-based learning opportunities were grouped into four themes: Learning from interpersonal interactions, learning from district activities, self-directed learning and contextual influences on learning opportunities. Registrars learnt from patients, peers, FPs and other professionals. Feedback, self-reflection, portfolio use, involvement in various district events, such as student and staff teaching, and continuous medical education augmented learning. Contextual influences originated from health facilities, resource availability, district management and university support, excessive workload and a need for standardised district learning opportunities.

CONCLUSION

Registrars are exposed to several types of WBL opportunities in district health systems. Effective engagement with available opportunities and addressing contextual challenges could enhance registrar learning.Contribution: Maximising learning opportunities to promote registrars' acquisition of required skills and competencies to efficiently address community needs in a middle-income country such as South Africa.

[Academic satisfaction in residents of the north zone, Mexico City]

Background

Resident academic satisfaction has been linked to academic performance and quality of care.

Objective

To analyze the perception of academic satisfaction in medical residents of the North Decentralized Administrative Operation Body 2 of the Instituto Mexicano del Seguro Social (IMSS), north of Mexico City.

Material and methods

Cross-sectional analytical study. A total of 346 resident physicians of different specialties and academic degrees were found, enrolled in the residence halls in the northern zone of the IMSS, Mexico City from January to February 2022. The dependent variable was the level of academic satisfaction. Descriptive and inferential statistics and p ≤ 0.05 were produced for statistical significance.

Results

The level of high satisfaction was 80.6% and the level of poor or low satisfaction was 1.7%. The dimension most affected in the negative bases was that of "Perception of teaching" in which 13% of the doctors surveyed refer to the need for some retraining of teachers. The best qualified dimension was "Perception of the role of autonomies" where 35.3% have an excellent perception of their personal work. The highest degree of satisfaction decreased during the second year.

Conclusion

There is a high degree of satisfaction among resident doctors, however it is necessary to work to improve satisfaction in the remaining 20%.

Learning for doctor-to-doctor collaboration: a qualitative study exploring the experiences of residents and supervisors with intraprofessional workplace learning in complex tertiary care

BACKGROUND

To deliver high-quality care for individuals with complex medical conditions, residents need to be trained across the boundaries of their specialties. This study aimed to explore learning activities and influencing factors in intraprofessional workplace learning by residents in complex tertiary care.

METHODS

This qualitative study was conducted in a tertiary care children's hospital. In September - December 2017, fourteen individual and two focus group interviews were conducted with a purposive sample of residents and supervisors of various specialties. Transcribed interviews were thematically analyzed to describe learning activities and influencing factors that play a role in intraprofessional workplace learning in complex tertiary care settings during residency training.

RESULTS

Respondents described numerous activities that they considered opportunities for intraprofessional learning, both directly and not directly related to patient care. However, deliberate attention to intraprofessional learning often seemed to be lacking in clinical practice. Influencing factors on a system (macro), organization (meso) and personal and interpersonal level (micro) level were identified. Factors on the macro and meso level mainly determined whether intraprofessional learning opportunities arose, while micro level factors mainly influenced whether opportunities were seized.

CONCLUSIONS

There are ample opportunities for intraprofessional workplace learning in complex tertiary care for residents. Residents may benefit more from intraprofessional learning opportunities if these are made more intentional and deliberate. Influencing factors at the macro, meso and micro level provide targets for interventions aimed at enhancing intraprofessional workplace learning in postgraduate medical training.

Learning collaboration at the primary-secondary care interface: a dual-method study to define design principles for interventions in postgraduate training programmes

BACKGROUND

Collaboration between primary and secondary care (PSCC) is important to provide patient-centered care. Postgraduate training programmes should provide training to learn PSCC. With a design based research (DBR) approach design principles can be formulated for designing effective interventions in specific contexts. The aim of this study is to determine design principles for interventions aimed to learn PSCC in postgraduate training programmes.

METHODS

DBR is characterised by multi-method studies. We started with a literature review on learning collaboration between healthcare professionals from different disciplines within the same profession (intraprofessional) to extract preliminary design principles. These were used to inform and feed group discussions among stakeholders: trainees, supervisors and educationalists in primary and secondary care. Discussions were audiotaped, transcribed and analysed using thematic analysis to formulate design principles.

RESULTS

Eight articles were included in the review. We identified four preliminary principles to consider in the design of interventions: participatory design, work process involvement, personalised education and role models. We conducted three group discussions with in total eighteen participants. We formulated three design principles specific for learning PSCC in postgraduate training programmes: (1) The importance of interaction, being able to engage in a learning dialogue. (2) Facilitate that the learning dialogue concerns collaboration. (3) Create a workplace that facilitates engagement in a learning dialogue. In the last design principle we distinguished five subcategories: intervention emphasises the urge for PSCC and is based on daily practice, the presence of role models, the work context creates time for learning PSCC, learning PSCC is formalised in curricula and the presence of a safe learning environment.

CONCLUSION

This article describes design principles for interventions in postgraduate training programmes with the aim to learn PSCC. Interaction is key in learning PSCC. This interaction should concern collaborative issues. Furthermore, it is essential to include the workplace in the intervention and make adjacent changes in the workplace when implementing interventions. The knowledge gathered in this study can be used to design interventions for learning PSCC. Evaluation of these interventions is needed to acquire more knowledge and adjust design principles when necessary.

Investigating the Effects of Intraprofessional Learning in Nursing Education: Protocol for a Longitudinal Study

Interprofessional learning (IPL), where nursing students learn how to work with multiple health professionals in their future practice to deliver the highest quality of care, has become an essential feature of undergraduate nursing programs. Intraprofessional learning (IaPL) is where individuals of two or more disciplines within the same profession collaborate; however, there is a dearth of literature investigating its effects in nursing education. The aim of this study is to investigate the impact of IaPL on the development of nursing students' knowledge, skills, and attitudes for collaborative practice. The study will utilize a mixed methods approach with surveys conducted at six time points across two years of two nursing programs and focus groups at the end of the program. Participants will be recruited from the Diploma and Bachelor of Nursing programs at an Australian Training and Further Education institute. Four specific IaPL educational experiences incorporating simulation will be developed on aged care, mental health, complex care and acute care. The study will provide nursing students with multiple opportunities to develop the necessary capabilities for collaborative practice. It will longitudinally evaluate nursing students' attitudes towards IaPL and examine whether IaPL motivates Diploma of Nursing students to pathway into a Bachelor of Nursing degree. The study will also investigate awareness amongst nursing students of the scope of practice, roles and responsibilities of the nursing team.

Cross-sectoral collaboration among hospital professionals on rehabilitation for patients with neuromuscular diseases

Introduction: Living with a neuromuscular disease often leads to a need for specialized rehabilitation due to the complexity and progression of the diseases. Aim: To investigate cross-sectoral collaboration on rehabilitation for patients with neuromuscular diseases among hospital professionals to inform future targeted rehabilitation services. Patients & methods: The design was qualitative using the interpretive description methodology and the theoretical lens of symbolic interactionism. Ethnographic fieldwork was conducted, and 50 hospital professionals included, 19 of whom were interviewed. Results & conclusion: The results emphasize the importance of relations when collaborating across sectors. The professionals acted and made choices in relation to dilemmas and influences of diagnosis and progression, professional demarcations in multiprofessional teams, and cross-sectoral collaboration toward a mutual goal.

Dental students' attitudes and perceptions about intraprofessional collaboration/education

Objectives

To investigate dental students' attitudes and perceptions about intraprofessional collaboration/education (IPC/IPE) and shared learning, and to explore the impact of IPC/IPE on the personal and professional development of participating students.

Methods

A custom-designed questionnaire was used in this cross-sectional study. The questionnaire comprised 17 questions targeting to capture the student's perceptions about IPC/IPE using three factors: (1) dental students' preference/opinion about the IPC/IPE; (2) dental students' experience about the impact of IPC/IPE on learning outcomes and professional development; and (3) students' feedback about the significance of IPC/IPE in clinical/clinical simulation labs and workplace setting. The students rated each of the 17 statements on the 5-point Likert scale (range: 1 = strongly disagree to 5 = strongly agree).

Results

A total of 259 responses were analysed (response rate = 65%). All students were aware of IPC/IPE in the field of dentistry (mean score = 4.22). The students preferred collaborative/shared learning with their own classmates. There was a consensus among students about the positive impact of IPC/IPE on enhanced learning, enhancement of communication skills, and enrichment of professional relationships with supporting staff as well as with the patients. There was also improved analytical and psychomotor skills, understanding of complex problems in the clinic, and understanding of strengths and limitations leading to self-improvement and increased efficiency and productivity.

Conclusion

IPC/IPE had a compelling, powerful, and positive impact according to the experience of the participating dental students. It is recommended that a standardized curriculum be designed and guidelines set for IPC/IPE at dental institutions for effective interactions among students of all stages.

Studying intraprofessional and interprofessional learning processes initiated by an educational intervention applying a qualitative design with multimethod approach: a study protocol

INTRODUCTION

Interprofessional collaboration in education and practice has been highlighted as a premise for providing good care. Both the intraprofessional and interprofessional impacts have bearing on healthcare professionals' performance and learning. Likewise, from the perspective of work-integrated learning, intraprofessional and interprofessional learning play an enduring part in studies about the development of healthcare organisations and professional competence. Educational-intervention research has become significant, which may indicate challenges the healthcare, for example, the area of disabilities is confronting. Earlier studies on intraprofessional and interprofessional learning have often focused on the learning outcome, whereas the learning process remains unexplored. The learning process is complex and is normally influenced by several factors. Therefore, develop knowledge about the intraprofessional and interprofessional learning processes initiated by an educational-intervention and the factors influencing this process may contribute to educational-intervention research, which is also the aim of the forthcoming study.

METHODS AND ANALYSIS

An inductive qualitative study design with interpretivism as the epistemological stand will be applied. Professionals in healthcare services for people with intellectual disabilities in four residential settings in Sweden are included in the educational-intervention based on web-based training and structured group reflections. Intended data collections are videorecordings of group reflections and individual interviews. An ethnomethodological approach will be applied for studying the details of conversation and interaction in group reflections. The interviews will be analysed using qualitative content analysis to gain participants' viewpoints of the intervention.

ETHICS AND DISSEMINATION

Approval was obtained from the Swedish Ethical Review Authority, Dnr 35 517. In Addition, a supplemental application to the extended part of the intervention in the forthcoming study has been submitted and approval was received on 21 September 2021. Ethical principles following the Declaration of Helsinki will be strictly followed.

TRIAL REGISTRATION NUMBER

NCT03390868; Post-results.