Emerging Health Care Leaders: Lessons From a Novel Leadership and Community-Building Program

Background

Although there are guidelines and ideas on how to improve public health education, translating innovative approaches into actual training programs remains challenging. In this article, we provide an overview of some initiatives that tried to put this into action in different parts of the world, and present the Emerging Health Care Leader (EHCL), a novel training program developed in Switzerland.

Policy Options and Recommendations

Looking at the experience of the EHCL, we propose policymakers and other interested stakeholders who wish to help reform public health education to support these initiatives not only through funding, but by valuing them through the integration of early career healthcare leaders in projects where their developing expertise can be practically applied.

Conclusion

By openly sharing the experiences, strengths, weaknesses, and lessons learned with the EHCL program, we aim to foster a transparent debate on how novel training programs in public health can be organised.

Developing the agroecological niche in Nicaragua: The roles of knowledge flows and intermediaries

Supporting transitions to sustainable, resilient agri-food systems is important to ensure stable food supply in the face of growing climate extremes. Agroecology, or diversified farming systems based on ecological principles, can contribute to such systems. Based on a qualitative case study of Nicaragua, a forerunner in agroecology, this paper unpacks an ongoing transition to agroecology, focusing on how the transition has been shaped by knowledge flows and intermediary actors. Using a niche development framework based on knowledge processes, we analyze the growth of the agroecological niche in Nicaragua over three phases of niche development. The findings show how knowledge processes' emphases have shifted over time, as have functions enacted by intermediaries. Dedicated, diversified intermediaries have been key in creating momentum for agroecology, as have individual actors moving between niche and regime. Agency in niche development has come from both niche and regime actors. Finally, we find that Nicaragua's transition to agroecology has been ambiguous: While the niche has succeeded in changing the mainstream selection environment to its favor in some arenas, transition dynamics lag in others. Drawing lessons from this ambiguity, we suggest entry points for broader systems change, such as market stimulation, value chain development, phase-out policies, and supportive policy in related arenas. We also point out possible actions for niche actors such as integration of financial and commercial actors into niches and creation of dedicated market-focused intermediaries. Our results provide evidence of an ongoing transition and action points for supporting niche development in (sustainable agri-food) transitions around the globe.

Transformative Learning, Priming, and Simulation Timing: A Randomized Controlled Pilot Study Among Emergency Medicine Residents

Background Traditionally, learning is thought to occur best when prerequisite cognitive background information is delivered before simulation training. More recent studies have attempted to analyze the transformative nature of simulation by placing simulation before didactics. However, these studies were flawed as they provided background on the subject before the simulation itself. Our study aims to isolate the transformative effect of simulation and answer the question of whether lecture or simulation should come first. Methodology We designed a novel simulation session and accompanying lecture for 18 Emergency Medicine residents in all three years of training regarding a subject they were entirely unfamiliar with, the emergent management of a left ventricular assist device (LVAD). The residents were randomized into two groups. One group had the lecture (8/18) before their simulation, while the other group (10/18) had the simulation first and the lecture afterward, testing the motivational nature. Thereafter, both groups responded to a post-session survey with Likert-style and open-ended comment questions to assess the reaction to the session and a knowledge-based multiple-choice question test. Results Both groups did not score significantly differently on either the immediate post-test or a retention post-test that we administered four weeks later. Three of eight participants reported in open comments that they were much more comfortable with a lecture-first than a simulation-first format. Conclusions Despite controlling for some of the limitations of previous studies, our results including learners' preferences do not support a transformation in the sequence of clinical skills learning. Until other larger studies prove the opposite, we recommend continuing with the lecture followed by the simulation sequence as per existing conceptual simulation learning frameworks.

Developing professional competence in an unfamiliar setting: Practice learning in Zambia

BACKGROUND

Higher education needs to provide students with competencies to meet the health and social needs of a society characterised by increased globalisation and diversity. Occupational therapy students from Norway expressed that learning experiences outside their comfort zone within Zambian placements, have had a profound impact on their professional competence.

AIMS AND OBJECTIVES

Enhanced understanding of how learning experiences in international placement impact on students' professional competence.

MATERIAL AND METHODS

Focus group interviews with three cohorts of students were analysed using thematic cross-case analysis integrated with an iterative reflexive process. Transformative learning was used as a theoretical framework for this analysis.

RESULTS

Three themes emerged from the analysis; 1) Feelings of uncertainty and emotional distress; 2) Drawing on available resources to meet the challenges; 3) Handling challenges promote professional competence.

CONCLUSION

Learning experiences significant for developing professional competence goes beyond students' habitual practice and previous mindset. Students develop generic skills, such as tolerance, flexibility, creativity, awareness of sustainability and professional confidence.

SIGNIFICANCE

New and more appropriate understandings of students' placement experiences leading to more adequate and relevant strategies, are in consistence with skills required for twenty first century occupational therapy practice.

Transformative learning in clinical reasoning: a meta-synthesis in undergraduate primary care medical education

Clinical reasoning is a vital medical education skill, yet its nuances in undergraduate primary care settings remain debated. This systematic review explores clinical reasoning teaching and learning intricacies within primary care. We redefine clinical reasoning as dynamically assimilating and prioritising synthesised patient, significant other, or healthcare professional information for diagnoses or non-diagnoses. This focused meta-synthesis applies transformative learning theory to primary care clinical reasoning education. A comprehensive analysis of 29 selected studies encompassing various designs made insights into clinical reasoning learning dimensions visible. Primary care placements in varying duration and settings foster diverse instructional methods like bedside teaching, clinical consultations, simulated clinics, virtual case libraries, and more. This review highlights the interplay between disease-oriented and patient-centred orientations in clinical reasoning learning. Transformative learning theory provides an innovative lens, revealing stages of initiation, persistence, time and space, and competence and confidence in students' clinical reasoning evolution. Clinical teachers guide this transformation, adopting roles as fortifiers, connoisseurs, mediators, and monitors. Patient engagement spans passive to active involvement, co-constructing clinical reasoning. The review underscores theoretical underpinnings' significance in shaping clinical reasoning pedagogy, advocating broader diversity. Intentional student guidance amid primary care complexities is vital. Utilising transformative learning, interventions bridging cognitive boundaries enhance meaningful clinical reasoning learning experiences. This study contributes insights for refining pedagogy, encouraging diverse research, and fostering holistic clinical reasoning development.

Didactic dissonance-embracing the tension between classroom and clinical education

The United States is undergoing a transformation in the way pain is viewed and treated. This transformation affects pain education, as some degree of disconnect will be expected between what is taught in classroom settings and what learners observe in clinical settings. We term this disconnect "didactic dissonance" and propose a novel process to harness it as a learning tool to further pain education. Based on principles of transformative learning theory, we describe a structured, three-step process beginning with (1) priming learners to recognize didactic dissonance and identify specific examples from their education, followed by (2) encouraging learners to search the primary literature to resolve observed dissonance and reflect on the system factors that created and perpetuated the disconnect, and then (3) providing an opportunity for learner reflection and planning for how they will address similar situations in future practice and teaching environments. Fostering an environment conducive to learning-through modeling the intellectual virtues of curiosity, humility, and creativity-is a critical task for educators when implementing this process. Recognizing challenges faced by educators in both classroom and clinical settings, it may be a more feasible first step to integrate the concept of didactic dissonance into existing curricular elements. For programs able to implement the full three-step process, a discussion guide along with an example of a facilitated discussion have been provided. While proposed in the context of pain education, this transformational approach can be utilized across all topics in medical education to foster autonomous lifelong learning.

Revisiting a Time of Study: Older Adults Learning Through Grieving

A brief reflection of encountering four older adult women who claimed self-transformation through learning in late life grief.

Immigrant academic mothers negotiating ideal worker and mother norms during the COVID-19 pandemic: Duoethnography as a co-mentoring tool for transformative learning

How are immigrant academic mothers negotiating the confounding terrains of work and family during the pandemic? How can they support each other in learning how to resist the prevalent notions of ideal working and mothering amidst the demanding schedule of working remotely and parenting? This study addresses these questions through sharing a narrative of how two immigrant mothers in academia challenged and began the journey of transforming their gendered work and family identities. Building on personal essays and 6 weeks of extensive journaling that reflected our positionalities and experiences of motherhood, work-life, and intersections between work and home during the pandemic, we offer a fine-grained understanding of how we helped each other as co-mentors to identify moments of our lived experiences as triggers for transformative learning. In doing so, we realized how duoethnography could be more than just a research methodology in helping us co-construct a relational space to empathize and challenge each other's perspectives about our roles as mothers and professors and the gendered nature of social forces shaping those roles.

"I Need to Be the First One with a Different Approach and to Make a Difference to the People": A Mixed Methods Pilot Study on Non-Physician Clinicians Training in Malawi

PURPOSE

To improve child health care depends on the availability of sufficient numbers of skilled healthcare workers. To achieve this, the German Society of Tropical Paediatrics & International Child Health supported the existing three-year Bachelor of Science in Paediatrics and Child Health training for Clinical Officers, a non-physician clinician cadre, from 09/2017 to 08/2019. This study aims to evaluate the project to inform forthcoming training.

METHODS

All 17 students who were in training took part in this study. Quantitative data collection took place between 01/2018 to 06/2019 using the post-self-assessment bloc course survey, Research Self-Efficacy Scale (RSES), and Stages of Change (SOC) model. Students and key informants participated in three focus group discussions and five in-depth interviews during April 1-10, 2019.

RESULTS

Students mostly perceived bloc course contents "At their level" (92%) and "Very important/relevant" (61%) with "Good quality" teaching (70.5%). The mean (SD) score for RSES (10-point scale) was 9.10 (0.91). The SOC (4-point scale) scores were higher for "Attitude" and "Intention" statements than "Action". Students found the program well-paced, felt that their clinical knowledge and skills had improved, and valued the acquired holistic disease management approach. They reported increased confidence and being more prepared for leadership roles in their future work. The involvement of international teachers and supervisors enriched their global perspectives.

CONCLUSION

Students improved their clinical and non-clinical skills, developed self-efficacy and attitudes toward research, and were confident to build and utilize their networks. These transformative experiences could facilitate the development of change agents among current and future trainees.

"I Learned More Because I Became More Involved": Teacher's and Students' Voice on Gamification in Physical Education Teacher Education

Higher education plays a critical role in achieving the Sustainable Development Goals established in the 2030 Agenda, especially the fourth goal (quality and equality in higher education). Therefore, teacher education must play a central role in providing transformative learning experiences for future teachers that can lead the change to create high quality programs in every school. The purpose of this study was to conduct a gamified experience in Physical Education Teacher Education with two goals: assess the students' views on the framework and evaluate the teachers' feelings and thoughts. One teacher-researcher (36 years) and 74 students (19-27 years) enrolled in a Spanish university agreed to participate. A qualitative descriptive method and an action-research design were used. The teacher-researcher completed a personal diary, while the students answered two open-ended questions. From the students' responses emerged three positive themes (framework, motivation, and transference) and two negatives (boredom and group work); from the teacher-researcher, we received three positive responses (mixed emotions, expectations, and students' motivation) and one negative (workload). As a conclusion, gamification could be considered a framework that promotes transformative learning.

Research as care: practice-based knowledge translation as transformative learning through video-reflexive ethnography

Collaborative approaches to knowledge translation seek to make research useful and applicable, by centring the perspectives and concerns of healthcare actors (rather than researchers) in problem formulation and solving. Such research thus involves multiple actors, in interaction with pre-existing ecologies of knowledge and expertise. Although collaboration is emphasised, conflict, dissonance, and other tensions, may arise from the multiplicity of perspectives and power dynamics involved. Our article examines knowledge translation in this space, as both empirical focus and research methodology. Drawing from practice theory and critical pedagogy, we describe knowledge translation as a situated and social process of transformative learning, enabled by reflexive dialogue about practice, and supported by care. With examples from five studies across two countries, we show that practice-based knowledge translation can be mediated by researchers, using video-reflexive ethnography. We describe the importance (and features) of practices of care in these studies, that created psychological safety for transformative learning. We argue that attempts to transform and improve healthcare must account for sustained and reciprocal care, both for, and between, those made vulnerable in the process, and that knowledge translation can, and should, be a process of capacity strengthening, with care as a core principle and practice.

The process of Transformative Learning in Dialog Café with Health Professionals and Citizens/Patients

INTRODUCTION

Dialogue Café, which is an inclusive process that provides a platform for the exchange of ideas or perspectives on certain issues, is a suitable approach to facilitating mutual understanding between health professionals and citizens/patients. However, little is known about the effects of the Dialogue Café on participants in the context of health communication. Previous studies suggest that transformative learning occurs after dialogue.

OBJECTIVES

This study aimed to clarify the process of the transformative learning process among participants of the Dialog Café and to evaluate whether their transformative learning would lead to an understanding of others' perspectives.

METHODS

We conducted a psychometric analysis of a web-based questionnaire consisting of 72 items for participants of Dialog Café held from 2011 to 2013 in Tokyo and studied the relationships between various concepts using structural equation modeling (SEM). To evaluate the validity and reliability of concept measurement, we conducted an exploratory factor analysis and a confirmatory factor analysis.

RESULTS

The questionnaire response rate was 39.5% (141/357), of which 80 (56.7%) respondents were health professionals and 61 (43.3%) respondents were citizens/patients. The SEM analysis revealed that transformative learning occurred in both groups. The process of transformative learning consisted of 2 types; one process leading directly to "perspective transformation" and the other leading to "perspective transformation" via "critical self-reflection" and "disorienting dilemmas." "Perspective transformation" was related to "understanding others" in both groups. Among health professionals, "perspective transformation" was related to "transformation of awareness toward patients/users."

CONCLUSION

Dialog Café can facilitate the process of transformative learning among participants, and transformative learning may lead to mutual understanding between health professionals and citizens/patients.

Beyond the safe and censored: outcomes from student experiences within a pedagogy of discomfort

Educators continue to seek teaching and learning strategies to augment student self-empowerment, agency and professional skills. This qualitative study analysed students' own evolving perspectives when Boler's pedagogy of discomfort was used to redevelop curriculum. Changes over time were examined regarding personal and professional development in public health and health promotion, including those most significant to the students themselves. Participants were final-year Australian undergraduate health students (n = 91) who applied a thematic analysis to their regular online 'blogs', articulating their thoughts and opinions about what they observed regarding unit content and tasks throughout the trimester. The researchers then conducted their own analysis to identify patterns and trends within the depth and breadth of student perceptions. Findings revealed that the personal and professional growth educators seek to instil arose spontaneously from students' increasing self-awareness, rather than classroom prompting or instruction and occurred in specific ways. This study chartered the course of how students challenged their own typical values and limiting beliefs, becoming more aligned and reflective of health promotion competencies. Other positive self-transformation was also identified, such as cultivating an open mind, shifts from victim-blaming to increasing compassion and empathy, through to the importance of finding their own voice. Future comparable studies including postgraduate students and diverse student groups are encouraged.

Transforming Perspectives Through Virtual Exchange: A US-Egypt Partnership Part 2

Collaborative online international learning programs, such as virtual exchange, that utilize telecollaborative activities have been integrated into more classrooms within the higher education setting. These programs provide students exposure to international cultures, perspectives, and ideas is no longer considered "value added", but a prerequisite to entering many workforces. These programmatic objectives compliment Mezirow's Transformative Learning Theory, that substantiates two major elements of transformative learning are critical reflection and dialectical discourse. This study presents the second half of a qualitative inquiry into the prominent themes that arose during a virtual exchange that was conducted in March 2021 between students in the United States (US) enrolled in a global public health course and Egyptian microbiology students. This study sought to expand upon the Transformative Learning Theory through inductive analysis procedures to offer a modernized adaptation of the theoretical framework within international learning environments. Student responses enrolled in an undergraduate global public health course were collected and analyzed by two coders using inductive/open coding to identify salient codes. These codes were then summarized into categories and subsequently defined. Resulting themes include Connectedness, Openness, Acquisition of Knowledge and Skills, Communication, Cultural Identity, Anticipation of Options for New Roles, Relationships, and Actions, and Absence of Change. Several themes have corresponding categories and subcategories. Adult learning environments such as the modern college classroom have changed with the introduction and reliance upon online learning domains, as well as the diversification of higher education student demographics, accentuating the need to inductively analyze student learning processes and outcomes. In doing so, our findings provide a modernized adaptation of the Transformative Learning Theory that allows for adult learning theorists, researchers, and scholars to integrate tenets of transformative learning more appropriately. As such, this provides an opportunity for educators to coalesce the identified mechanisms (e.g., openness, cultural background, anticipation of roles and relationships) to bolster student's willingness and ability to engage in transformative critical reflections. By capitalizing on students' innate characteristics, such as open-mindedness predispositions and cultural background, educators are able to augment transformative learning strategies through tailored assignments and course activities.

Community Learning Centres (CLCs) for Adult Learning and Education (ALE): development in and by communities

Institutionalised forms of adult learning and education (ALE) such as community learning centres (CLCs) and related models are found in most parts of the world. These are spaces offering opportunities for literacy and skills training, health and citizenship, general, liberal and vocational education, in line with fuller recognition of the meaning of lifelong learning, and in the context of local communities. Often these institutions form the basis for even more informal and participatory learning, like study circles and community groups. They may share facilities like libraries and museums, clubs and sports centres, which are not within the remit of the Ministry of Education. This article reviews relevant literature and identifies recent studies and experiences with a particular focus on the Asia-Pacific and Africa regions, but also considers insights related to interventions at the global level. Findings point to low levels of participation of adults in general, and more specifically so for vulnerable and excluded groups which can hardly cross respective barriers. The authors' discussion is guided by the question What conditions are conducive to having more and better ALE for lifelong learning - and which roles can CLCs and other community-based ALE institutions play? This discussion is timely - the authors argue that CLCs need to be given more attention in international commitments such as those made in the context of the International Conferences of Adult Education (CONFINTEA) and the United Nations 17 Sustainable Development Goals (SDGs). CLCs, they urge, should be part of transformative discourse and recommendations at CONFINTEA VII in 2022.

Transformative learning in the setting of religious healers: A case study of consultative mental health workshops with religious healers, Ethiopia

OBJECTIVE

Psychiatric interventions that consider the socio-cultural and spiritual traditions of patients are needed to address stigma and improve access to mental health services. Productive collaboration between traditional healers and biomedical practitioners hold promise in such efforts, and applying tenets of transformative learning hold potential for mitigating an overemphasis on biomedical models in such collaboration. We present a framework for how to engage in health system reform to enhance mental health services in communities that are distrustful of, or unfamiliar with biomedical approaches. Our research question was how to bridge two seemingly opposing paradigms of mental health care, and we sought to understand how the theory of transformational learning (TLT) can be applied to learning among Religious healers and biomedical practitioners in culturally appropriate ways to improve collaboration.

METHODS

TLT informed the development, implementation, and evaluation of an educational intervention in Addis Ababa, Ethiopia that aimed to improve delivery of mental health services at two Holy water sites. The initiative involved both psychiatrists and religious healers with extensive experience providing care to mentally ill patients. Using a focused ethnographic approach that incorporates document analysis methodology, this qualitative study examined recordings and minutes of stakeholder meetings, workshops and informal interviews with participants, analyzed for evidence of Mezirow's 11 stages of transformative learning. A participatory action approach was used to encourage practice change.

RESULTS

All participants exhibited a high degree of engagement with the of the collaborative project and described experiencing "disorienting dilemmas" by Mezirow's classic description. Opportunities to reflect separately and in large groups encouraged a re-examination of attitudes previously contributing to siloed approaches to care and led to instrumental changes in mental health care delivery and a higher degree of coordination and collaboration between psychiatrists and traditional healers.

CONCLUSION

Our study demonstrates the utility of TLT in both the design and evaluation of initiatives aiming to bridge cross-cultural and cross-professional divides. The learning process was further enhanced by a collaborative participatory action model adjusted to accommodate Ethiopian socio-political and cultural relations.

Developing Future Physical Education Teachers' Intercultural Competence: The Potential of Intertwinement of Transformative, Embodied, and Critical Approaches

Purpose: This article is based on a study that explored learning processes related to intercultural competence of PE teacher trainees. The context of the study was the Faculty of Sport and Health Sciences at the University of Jyväskylä, Finland. The study was conducted in connection to two courses that focused on equality in physical education and sport in 2020-2021. Methods: Adopting an interpretive, as well as a critical approach, the authors focused on how the students described their conceptions and learning experiences. Based on their analysis they have then aimed to shed light on how interculturality, equality, equity, and diversity may be addressed in higher education in a more profound manner. The students' accounts were analyzed first through an open reading and subsequently through a more critical lens. The analysis was supported by theories of transformative learning, embodied learning, and intercultural education. Results: Students' initial interest toward equity, equality, and interculturality seemed to expand during the courses. They increasingly reflected on the complexity of these issues and discussed the widening professional responsibilities of future PE teachers in promoting equality and supporting pupils in cultural heterogeneous classes. Discussions and practical activities that involved emotional and embodied elements seemed to be important in facilitating their learning processes. However, it is difficult to foresee how permanent the changes in their habits of mind and subsequent actions are. Discussion: The authors suggest that embodied, practical approaches where the student is fully engaged in the learning process, and where conceptual, reflective, emotional, and affective levels are connected, may be a key in developing teachers' intercultural competence. They also suggest that it is crucial to revise higher education curricula from the perspectives of intercultural competence and structural inequality. In addition to separate courses, equality, equity, and diversity should be seen as red threads throughout higher education.

Fostering Cultural Safety in Nursing Education: Experiential Learning on an American Indian Reservation

BACKGROUND

To improve health equity, especially for American Indian/Alaska Native peoples, cultural safety must be included in the nursing education curricula. Cultural safety requires self-reflection with an examination of one's own culture and an ongoing analysis of biases and power imbalances.

METHODS

Using a case study approach, a description and discussion of an ongoing Baccalaureate nursing clinical immersion experience on an American Indian Reservation is presented. With travel to the Pine Ridge Reservation, nursing students offer health promotion at community events and partner sites, with a focus on prevention of heart disease, diabetes, and unintentional injury. Transformative Learning Theory provides the foundation for the nursing clinical immersion experience at the Pine Ridge Reservation. Nursing students reflect throughout and after the Pine Ridge clinical experience via blogging.

RESULTS

Cultural safety themes identified in nursing student reflections include critical consciousness; providing a safe place; seeking to understand historical trauma; and acknowledging power imbalances. Satisfaction surveys are completed by Lakota screening participants, and results provide further evidence of emerging cultural safety.

IMPACT STATEMENT

A clinical immersion experience at an American Indian Reservation can foster cultural safety while also encouraging transformative learning.

CONCLUSIONS

Nursing educators should consider clinical experiences focused on American Indian/Alaska populations. With a service component, the clinical immersion at the Pine Ridge Reservation requires that participants reflect on their experiences. A transformative change in perspective, required for cultural safety, is often the end result for nursing student participants.

Medical students' experiences of a longitudinal integrated clerkship: a threshold concepts analysis

Longitudinal Integrated Clerkships (LIC) are known to provide several pedagogical advantages including transformational educational experiences. The study explored the learning experience of undergraduate medical students who undertook a rural LIC in a Scottish primary care setting. This paper presents an analysis of the transformative role of LIC placements using the Threshold Concept (TC) theory. This qualitative study gathered students' perceptions of their LIC experience longitudinally through written and audio diaries over a period of 1-2 months. The issues narrated in diaries were followed-up in individual semi-structured interviews. Transcripts were thematically analysed to identify key characteristics of TCs using a criterion-based approach. Data from 12 audio and nine written diaries, and five interviews led to identification of three inter-connected themes associated with the LIC year: professional identity formation, becoming an agentic learner and comfort with uncertainty. These appeared transformative in nature and resembled threshold concepts in their character and effect. An active and legitimate role in the healthcare team, longitudinality and transdisciplinary learning during LIC placements were contributary towards navigating these thresholds. The LIC exposure provided transformative learning experiences, and a stable environment that facilitated acquisition of specific TCs in the medical students' journey towards becoming a doctor. LIC affordances fostered a transformed view of self, which was more confident in dealing with uncertainty, comfortable in the emerging professional identity, and described having enhanced agentic capabilities.

Studying phenological phenomena in subarctic biomes with international school pupils as citizen scientists

Citizen science can facilitate in-depth learning for pupils and students, contribute to scientific research, and permit civic participation. Here, we describe the development of the transnational school-based citizen science project Phenology of the North Calotte. Its primary goal is to introduce pupils (age 12-15; grades 7-10) in northern Norway, Russia, and Finland to the local and global challenges of climate change resulting in life cycle changes at different trophic and ecosystem levels in their backyards. Partnerships between regional scientists and staff from NIBIO Svanhovd, State nature reserves, national parks, and teachers and pupils from regional schools aim to engage pupils in project-based learning. The project uses standardized protocols, translated into the different languages of participating schools. The phenological observations are centered around documenting clearly defined life cycle phases (e.g., first appearance of species, flowering, ripening, leaf yellowing, snow fall, and melt). The observations are collected either on paper and are subsequently submitted manually to an open-source online database or submitted directly via a newly developed mobile app. In the long term, the database is anticipated to contribute to research studying changes in phenology at different trophic levels. In principle, guided school-based citizen science projects have the potential to contribute to increased environmental awareness and education and thereby to transformative learning at the societal level while contributing to scientific progress of understudied biomes, like the northern taiga and (sub)arctic tundra. However, differences in school systems and funding insecurity for some schools have been major prohibiting factors for long-term retention of pupils/schools in the program. Project-based and multidisciplinary learning, although pedagogically desired, has been partially difficult to implement in participating schools, pointing to the need of structural changes in national school curricula and funding schemes as well as continuous offers for training and networking for teachers.

Real-Time Lived Experience of Social Work Students in Their Field Training during the Coronavirus Crisis: Insights from Photovoice-Based Research

The present paper is based on a photovoice study conducted with sixteen undergraduate social work students in their third year of study, examining their real-time lived experience of their fieldwork training in the immediate aftermath of the outbreak of the coronavirus pandemic. The findings of the study, based on an analysis of sixty-six photovoices, indicate four main narratives encapsulating the students’ real-time lived experiences: (i) the challenges of encountering the crisis; (ii) conceptualizing the experience; (iii) coping practices; (iv) perspectives for the future. The findings are discussed in the light of shared traumatic reality theory and transformative learning theory. Following the use of the photovoice methodology, the research conclusions encourage the assimilation of creative and entrepreneurial models of teaching and practice, in order to enable the inclusion of different types of knowledge and life experiences in different learning and research spaces.

The Experience of Colombian Medical Students in a Pilot Cultural Safety Training Program: A Qualitative Study Using the Most Significant Change Technique

Problem: The Colombian government provides health services grounded in the Western biomedical model, yet 40% of the population use cultural and traditional practices to maintain their health. Adversarial interactions between physicians and patients from other cultures hinder access to quality health services and reinforce health disparities. Cultural safety is an approach to medical training that encourages practitioners to examine how their own culture shapes their clinical practice and how to respect their patients' worldviews. This approach could help bridge the cultural divide in Colombian health services, improving multicultural access to health services and reducing health disparities. Intervention: In 2016, we conducted a pilot cultural safety training program in Cota, Colombia. A five-month training program for medical students included: (a) theoretical training on cultural safety and participatory research, and (b) a community-based intervention, co-designed by community leaders, training supervisors, and the medical students, with the aim of strengthening cultural practices related to health. Evaluation used the Most Significant Change narrative approach, which allows participants to communicate the changes most meaningful to them. Using an inductive thematic analysis, the authors analyzed the stories and discussed these findings in a debriefing session with the medical students. Context: Cota is located only 15 kilometers from Bogota, the national capital and biggest city of Colombia, so the small town has gone through rapid urbanization and cultural change. A few decades ago, inhabitants of Cota were mainly peasants with Indigenous and European traditions. Urbanization displaced agriculture with industrial and commercial occupations. One consequence of this change was loss of cultural health care practices and resources, for example, medicinal plants, that the community had used for centuries. Impact: A group of 13 final-year medical students (ten female and three male, age range 20-24) participated in the study. The medical students listed four areas of change after their experience: increased respect for traditional health practices to provide better healthcare; increased recognition of traditional practices as part of their cultural heritage and identity; a desire to deepen their knowledge about cultural practices; and openness to incorporate cultural practices in healthcare. Lessons Learned: Medical students reported positive perceptions of their patients' cultural practices after participating in this community-based training program. The training preceded a positive shift in perceptions and was accepted by Colombian medical students. To the best of our knowledge, this was the first documented cultural safety training initiative with medical students in Colombia and an early attempt to apply the cultural safety approach outside the Indigenous experience.

Remediation Through Transformation: Applying Educational Theory to the Struggling Resident

The struggling medical resident is faced with many adaptive challenges that may require change in mindset. However, formal remediation within graduate medical education (GME) often employs overly structured technical solutions to address trainee deficiencies. These strategies may ultimately fail to result in sustained improvement. Transformative learning (TL) is an educational theory that has recently been explored as a teaching modality in health professions education. In 2013, Cranton published a three-part framework for TL. This framework, composed of the cognitive perspective, beyond rational TL, and TL for social change, has potential applications to GME remediation, specifically in helping individuals to overcome adaptive challenges. These strategies may be particularly useful within the traditionally difficult-to-remediate competencies of systems-based practice, practice-based learning and improvement, and professionalism. The authors provide a descriptive overview of each of Cranton's perspectives, introducing concrete examples drawn from the medical literature. This article will contrast current remediation strategies with those using TL theory in order to assist graduate medical educators in applying these principles to the remediation of their own struggling residents.

Transformative learning in an interprofessional student-run clinic: a qualitative study

Student-run free clinics are increasingly seen as a way for students in health professions to have early authentic exposures to providing care to marginalized populations, often in the context of interprofessional teams. However, few studies characterize what and how students may learn from volunteering at a student-run free clinic. We aimed to examine shifts in attitude or practice that volunteers report after completing a placement at an interprofessional student-run clinic in Toronto, Ontario, Canada. Transcripts from semi-structured reflective focus groups were analyzed in an exploratory thematic manner and from the perspective of transformative learning theory. Volunteers reported attitude shifts toward greater self-awareness of assumptions, recognition of the need for systemic interventions, and seeing themselves as learning and contributing meaningfully in a team even without direct-client contact. Practice shifts emerged of individualizing assessment and treatment of patients as well as increased comfort working in interprofessional teams. Attitude and practice shifts were facilitated by authentic interactions with individuals from marginalized populations, taking a patient-centered approach, and an interprofessional context. Interprofessional student-run free clinics are suited to triggering disorienting dilemmas that set the stage for transformative learning, particularly when volunteers are guided to reflect.

Transforming our relationship with the social determinants of health: a scoping review of social justice interventions in Canadian Medical Schools

This article was migrated. The article was marked as recommended. Background/Purpose: Physicians are in a powerful position to improve the health status of communities through mitigating disparities rooted in social inequities. However, it is uncertain whether medical schools are preparing future physicians with the skills needed to care for diverse populations. The current scoping review aimed to describe how Canadian medical schools teach social justice, comparing pedagogical strategies. Methods: A search was performed using OVID to identify published studies of implemented and evaluated social justice-based interventions within Canadian medical school curricula. Results: Six studies were included. Common themes included increased content knowledge, greater understanding of SDoH, acknowledgement of power and privilege imbalances, identification of physicians' roles as advocates, emphasis on the importance of interdisciplinary care, and increased capacity for self-reflection and personal growth. Experiential interventions were associated with greater personal transformation, but had limited accessibility. Conclusion: Despite the widespread recognition of physicians' roles as health advocates, there is a lack of consensus about an effective strategy for teaching social justice in medical education in Canada. While additional research focusing on the relative merits of didactic versus experiential learning is needed, these preliminary results suggest that experiential learning emphasizing self-reflection and personal growth may be optimal when approaching transformative learning.

Impact of Co-Designed Game Learning on Cultural Safety in Colombian Medical Education: Protocol for a Randomized Controlled Trial

Background

Cultural safety encourages practitioners to examine how their own culture shapes their clinical practice and to respect their patients’ worldviews. Lack of cultural safety in health care is linked to stigma and discrimination toward culturally diverse patients. Training in cultural safety poses considerable challenges. It is an unappealing subject for medical students and requires behavioral changes in their clinical practice. Game jams—collaborative workshops to create and play games—have recently shown effectiveness and engaging potential in university-level education.

Objective

The trial aims to determine if medical students’ participation in a game jam to design an educational game on cultural safety is more effective than a standard lesson on cultural safety in terms of change in the students’ self-reported intended patient-oriented behavior.

Methods

A parallel-group, 2-arm randomized controlled trial with a 1:1 allocation ratio will randomize 340 medical students and 60 medical interns (n=400) at the Faculty of Medicine at La Sabana University, Colombia (170 students and 30 medical interns to each arm). The intervention group will participate in an 8-hour game jam comprising (1) a preliminary lecture on cultural safety and game design, (2) a game building session where groups of students will create educational games about cultural safety, and (3) a play-test session in which students will play and learn from each other’s games. The control group will receive a standard lesson, including a 2-hour lecture on cultural safety, followed by a 6-hour workshop to create posters about cultural safety. Web-based self-administered 30-item Likert-type questionnaires will assess cultural safety self-reported intended behavior before, immediately after, and 6 months after the intervention. An intention-to-treat approach will use a t-test with 95% CIs to determine the significance of the effect of the intervention, including within- and between-group comparisons. The qualitative most significant change technique will explore the impact of the intervention on the clinical experience of the students.

Results

Study enrollment began in July 2019. A total of 531 students completed the baseline survey and were randomized. Data collection is expected to be complete by July 2020, and results are expected in October 2020. The study was approved by the institutional review board of the Faculty of Medicine at McGill University (May 31, 2017) and by the Subcommittee for Research of the Faculty of Medicine at La Sabana University (approval number 445).

Conclusions

The research will develop participatory methods in game-based learning co-design that might be relevant to other subjects. Ultimately, it should foster improved cultural safety skills for medical students, improve the quality of health services for diverse cultural groups, and contribute to enhanced population health. Game learning may provide an innovative solution to a long-standing and neglected problem in medical education, helping to meet the educational expectations and needs of millennial medical students.

Trial Registration

ISRCTN Registry ISRCTN14261595; http://www.controlled-trials.com/ISRCTN14261595

What motivates medical students to learn about traditional medicine? A qualitative study of cultural safety in Colombia

OBJECTIVES

This study explored motivation dynamics of medical students engaging with traditional medicine in Colombia.

METHODS

We conducted a qualitative descriptive study as part of a larger participatory research effort to develop a medical education curriculum on cultural safety. Four final-year medical students participated in a five-month program to strengthen knowledge of traditional medicinal plants with schoolchildren in Cota, a municipality outside Bogota with a high proportion of traditional medicine users. Students and schoolteachers co-designed the program aimed to promote the involvement of school children with traditional medicine in their community. The medical students shared written narratives describing what facilitated their work and discussed experiences in a group session. Inductive thematic analysis of the narratives and discussion derived categories of motivation to learn about traditional medicine.

RESULTS

Five key learning dynamics emerged from the analysis: (1) learning from/with communities as opposed to training them; (2) ownership of medical education as a result of co-designing the exercise; (3) rigorous academic contents of the program; (4) lack of cultural safety training in university; and (5) previous contacts with traditional knowledge.

CONCLUSIONS

We identified potential principles for engaged cultural safety training for medical students. We will use these in our larger training program. Our results may be relevant to other researchers and medical educators wanting to improve the interaction of medical health professionals in multicultural settings with people and communities who use traditional medicine. We expect these professionals will be better prepared to recognize and address intercultural challenges in their clinical practice.

"It's Okay to Say 'I Don't Know'": Medical Students Use Transformative Thinking to Cope with Ambiguity and Uncertainty

This article was migrated. The article was marked as recommended. Uncertainty refers to the internal tension of not fully knowing or understanding a situation and is a concept that physicians must learn to deal with in order to become an effective provider. Ambiguity refers to the situation that is not fully known. Mezirow proposed that transformative learning occurs in response to a "disorienting dilemma" during which the students' frames of reference are challenged. We used his model to explain how clerkship students learn to cope with ambiguity and uncertainty. We analyzed third year medical students reflective practice essays for encounters with clinical uncertainty and ambiguity and examined how they reacted to these dilemmas. Our study is unique in its robust data set which included 273 essays.

A Case for Transformative Learning in Medical Ethics Education

In this article, we discuss the current state of medical ethics education. In Higher Education, ethics is taught predominantly through discussion and case study-based teaching formats. At present, however, only little can be said about the adequacy of these teaching methods in attaining complex educational objectives as ethics education poses challenges regarding meaningful student assessment and evaluation of educational methods. Output-oriented evaluation and assessment paradigms that centre quantified student performance fail to meaningfully capture the learning of ethics. Currently, we argue that comparatively small efforts are being devoted to the advancement of innovative and adequate approaches to teaching and assessment in ethics education. In response to these shortcomings, drawing from educational traditions that focus on preparatory activities, we work towards a new approach to evaluate teaching methods and assessing the learning in ethics.

Promoting Students' Sense of Coherence in Medical Education Using Transformative Learning Activities

OBJECTIVE

Transformative learning theory offers medical educators a particularly relevant insight into student learning. Transformative learning involves critically reflecting on assumptions and actions using empirical research methods and participating in a continuing discourse to validate the best reflective judgement and act according to new insights. The purpose of this paper is to investigate medical students' experiences with transformative learning activities and empirically and theoretically explain how these activities contribute to their understanding of the interplay between theoretical knowledge and professional practice, thereby creating a sense of coherence in medical education.

METHODS

This paper analyzes the data from interviews with 40 medical students derived from a qualitative longitudinal research project in Norway from 2012 through 2018.

RESULTS

Students characterize linking theoretical knowledge with professional practice, experiencing authentic placement situations with real patients, and discussing and critically reflecting on cases and professional practice with experienced doctors as learning activities that transformed their understanding of professional practice. These transformative learning activities influenced students' perceptions of educational content and demands as being comprehensible, manageable, and meaningful, which are the core components of "sensing coherence" in professional education. Moreover, experiencing a lack of knowledge in either case-based learning on campus or when meeting patients in clinical placements motivates students to pursue further theoretical studies.

CONCLUSION

Medical education includes rich opportunities to use transformative learning activities both on campus and at clinical placement sites, but it is not given that these types of learning activities are present in the teaching offered at all the various learning sites; thus, enhanced awareness of why and how to promote transformative learning is required among medical educators.

The 2019 WACEM Expert Document on Hybrid Simulation for Transforming Health-care Simulation Through "Mixing and Matching"

With the multitude of options available under the umbrella of "simulation" today, we have a larger repertoire of choices in our educational journey and outreach. These provide a platform for us to really transform health-care simulation from the traditional, unimodality simulation, to more complex, high fidelity, integrated, and engaging multimodality techniques. The main thrust must be to enhance clinical decision-making in patient care, to solve real-world clinical problems. Hybrid simulation (HS) utilizes at least two different simulation modalities, whereby combining them will enable one type of simulation modality to enhance the other, with the proper alignment, coordination, and interfacing between the modalities. Although the term is often used interchangeably, HS is slightly different from multimodality simulation. The latter refers to the use of multiple types of simulation in the same scenario or place. The main objectives for using HS have to be as follows: (1) for the acquisition of knowledge and skills by the best combination of methodologies, (2) for clinical performance improvement at all levels of care through the creation of as close as possible to real-world situation and problems, (3) to be able to sustain motivation and passion of our spectrum learners in their educational continuum, and (4) to provide a rich, exciting, and stimulating learning platform and environment, which can trigger deep learning and understanding. This article will also share some examples and cases utilizing HS in transforming health-care simulation.

Becoming Aware of Compassionate Care Through a Patient's Story: Reflections From First-Year Nursing Students

The purpose of this qualitative descriptive study was to understand how faculty members can use literature to teach first-year nursing students about compassionate care and the nursing role. A group of first-year nursing students wrote letters to the author of a book that details his experiences following a catastrophic motor vehicle accident. Thematic analysis of the letters revealed three major themes: Lessons about Compassion through Literature; Changing Personal, Professional, and Educational Perspectives; and Connecting to the Story on a Personal Level. The data was interpreted with the use of Mezirow's Transformative Learning Theory (1997). The results of the study show that students' beliefs about the profession of nursing, the role of the nurse in providing compassionate care, and their own education, were transformed. Additionally, using literature was shown to be an effective teaching strategy.

Learning about Aboriginal health and wellbeing at the postgraduate level: novel application of the Growth and Empowerment Measure

INTRODUCTION

Public health education strives to transform and empower students to engage in policy and practice improvement. However, little is known of the nature of such change among students, especially when studying Aboriginal health and wellbeing, which may involve disrupting long held assumptions and prejudices. This article reports findings regarding the feasibility, specificity and sensitivity of the Growth and Empowerment Measure (GEM) in the evaluation of two innovative Australian 13-week postgraduate public health electives focused on Aboriginal health and wellbeing. The GEM's 14-item Emotional Empowerment Scale (EES14) and its subscales Inner Peace and Self-Capacity, and 12 Scenarios (S12) and its subscales Healing and Growth and Connection and Purpose were used to examine transformative experiences. A new short form of the S12, the Core6, was also trialled as a briefer measure of functional empowerment.

METHODS

Pre-course GEM responses and demographic information were collected from consenting students during the mandatory, face-to-face workshops of the Aboriginal public health Perspectives course and the Aboriginal empowerment and wellbeing Lifespan course. The two-day Perspectives course workshop introduced a group scenario-building activity towards ending health inequality. Lifespan students experienced a 3-day immersion based on Stage 1 of the Aboriginal Family Well Being empowerment program. Insights from both workshops were further integrated through structured online discussions and written assessments. At the end of semester, a post-course GEM was mailed to students for completion and return. Students could also provide feedback through evaluation surveys and semi-structured focus groups. Effect sizes were assessed using paired t-tests, Wilcoxon signed-rank tests and multiple ANOVA. Cronbach's alpha confirmed internal consistency.

RESULTS

Baseline GEM data was provided for 147 out of a total of 194 workshop experiences from participating students. Twenty students attended workshops for both Perspectives and Lifespan. Fifty-five matched pairs (representing 52 individual participants) were obtained from 170 students who completed one or both courses. Statistically significant positive change of small to medium effect size was detected in all GEM scales, subscales and some individual items. Lifespan yielded larger effects than Perspectives, most markedly on two subscales: Inner Peace, and Connection and Purpose. Participating students reported significant growth in the Scenario item 'knowing and being who I am' following Perspectives and Lifespan. Those completing Perspectives also reported a significant increase in 'gaining voice and being heard', consistent with its action-oriented scenario-building assessment. In contrast, the psychosocial development approach embedded in Lifespan stimulated strong development in spirituality, responding constructively to judgement, appreciating empowerment in their communities and skills to make changes in their lives. Feedback indicated that students valued these personal and professional growth experiences.

CONCLUSION

The GEM was sensitive and specific in measuring components of empowering change among participants. Challenges included low post-course response rates that limited extrapolation to overall course impact, and attention needed to starting point when comparing the increment of change. The GEM is a promising tool for studying postgraduate courses designed to stimulate transformative learning, wellbeing and cultural competence through empowerment, and relevant in the education of health professionals in the fields of Aboriginal and rural health.

Improving Body Mechanics Using Experiential Learning and Ergonomic Tools in Massage Therapy Education

INTRODUCTION

Current industry data suggest that the rise in occupational injuries for massage therapists is contributing to a significant number leaving the profession after a few short years. While many massage therapists are taught methods for proper body mechanics and self-care within their career educational programs, there are few consistencies in the theoretical approaches to these concepts, even though it is a required component in massage therapy career training.

PURPOSE

This study demonstrates a measurable and effective teaching method using a combination of experiential and transformative learning theory models and authentic ergonomics measurement tools to teach effective body mechanics in entry level career training that may be sustainable for new massage therapists entering the field.

METHODS

Four cohorts of students (N = 17) enrolled in a kinesiology course for massage therapists were studied using a mixed-methods time series experimental design. A pre- and post-test was conducted by utilizing two industry standard ergonomics risk factor assessment tools as measurable data for score comparison, to denote improvements in each student's risk factor tendencies and provide evidentiary support of learning transfer. Between the pre- and post-test, students participated in a series of experiential learning exercises within class sessions during the semester and completed two reflection journals discussing their experiences.

RESULTS

The results showed that there was a statistically significant reduction in ergonomics risk factor scores for all students studied.

CONCLUSION

The success of this study demonstrates that the instructional design using experiential and transformative educational theory and general ergonomics concepts is an effective approach to teaching proper body mechanics to massage therapy students which can be adopted into universally accepted curriculum on many levels and could eventually contribute to reduction of occupational injury in the future.

'Fostering transformative learning, self-reflexivity and medical citizenship through guided tours of disadvantaged neighborhoods'

BACKGROUND AND OBJECTIVES

Medical school curricula increasingly seek to promote medical students' commitment to redressing health disparities, but traditional pedagogical approaches have fallen short of this goal. The objective of this work was to assess the value of using community-based guided tours of disadvantaged neighborhoods to fill this gap.

METHODS

A total of 50 second-year medical students participated in a guided tour of disadvantaged public housing neighborhoods in Richmond, Virginia. Students completed self-reflexive writing exercises during a post-tour debriefing session. Student writings were analyzed to assess the tour's effect on their awareness of poverty's impact on vulnerable populations' health and wellbeing, and their personal reactions to the tour.

RESULTS

Student writings indicated that the activity fostered transformative learning experiences around the issue of poverty and its effects on health and stimulated a personal commitment to working with underserved populations. Themes from qualitative analysis included: increased awareness of the extent of poverty, enhanced self-reflexive attitude towards personal feelings, biases and misperceptions concerning the poor, increased intentional awareness of the effects of poverty on patient health and well-being, and, encouragement to pursue careers of medical service.

CONCLUSIONS

This pilot demonstrated that incorporating self-reflexive learning exercises into a brief community-based guided tour can enhance the social consciousness of medical students by deepening understandings of health disparities and promoting transformative learning experiences.

Ethical learning on international medical electives: a case-based analysis of medical student learning experiences

BACKGROUND

Students on international medical electives face complex ethical issues when undertaking clinical work. The variety of elective destinations and the culturally specific nature of clinical ethical issues suggest that pre-elective preparation could be supplemented by in-elective support.

METHODS

An online, asynchronous, case-based discussion was piloted to support ethical learning on medical student electives. We developed six scenarios from elective diaries to stimulate peer-facilitated discussions during electives. We evaluated the transcripts to assess whether transformative, experiential learning took place, assessing specifically for indications that 1) critical reflection, 2) reflective action and 3) reflective learning were taking place. We also completed a qualitative thematic content analysis of the discussions.

RESULTS

Of forty-one extended comments, nine responses showed evidence of transformative learning (Mezirow stage three). The thematic analysis identified five themes: adopting a position on ethical issues without overt analysis; presenting issues in terms of their effects on students' ability to complete tasks; describing local contexts and colleagues as "other"; difficulty navigating between individual and structural issues, and overestimation of the impact of individual action on structures and processes.

CONCLUSION

Results suggest a need to: frame ethical learning on elective so that it builds on earlier ethical programmes in the curriculum, and encourages students to adopt structured approaches to complex ethical issues including cross-cultural negotiation and to enhance global health training within the curriculum.

Concept Analysis of Posttraumatic Stress Disorder

PURPOSE

Mental health nursing is not the same as psychiatry, so it is important for nurses to have an understanding of the defining attributes, antecedents, consequences, model cases, and empirical referents of post-traumatic stress disorder (PTSD).

METHOD

Walker and Avant's (2005) method is used to guide this concept analysis of PTSD.

FINDINGS

Four attributes arise from this concept analysis, which are addressed through both the DSM-IV and DSM-5 (American Psychiatric Association, /): triggering event or events, re-experiencing, fear, and helplessness. Though a majority of the defining attributes are addressed through both versions of the DSM, a key fifth attribute arises through this concept analysis: a disruption of meaning.

CONCLUSIONS

A better understanding of PTSD from a nursing perspective will help inform appropriate nursing interventions and prevention strategies, while expanding the knowledge synthesis and contribution of the nursing profession.

PRACTICE IMPLICATIONS

A model case, borderline case, and contrary case of PTSD are provided. Discussion of the importance of a lack or loss of meaning in PTSD is included, along with exploration of transformative learning theory to inform clinical practice for nurses addressing a disruption of meaning.

Learning and the transformative potential of citizen science

The number of collaborative initiatives between scientists and volunteers (i.e., citizen science) is increasing across many research fields. The promise of societal transformation together with scientific breakthroughs contributes to the current popularity of citizen science (CS) in the policy domain. We examined the transformative capacity of citizen science in particular learning through environmental CS as conservation tool. We reviewed the CS and social-learning literature and examined 14 conservation projects across Europe that involved collaborative CS. We also developed a template that can be used to explore learning arrangements (i.e., learning events and materials) in CS projects and to explain how the desired outcomes can be achieved through CS learning. We found that recent studies aiming to define CS for analytical purposes often fail to improve the conceptual clarity of CS; CS programs may have transformative potential, especially for the development of individual skills, but such transformation is not necessarily occurring at the organizational and institutional levels; empirical evidence on simple learning outcomes, but the assertion of transformative effects of CS learning is often based on assumptions rather than empirical observation; and it is unanimous that learning in CS is considered important, but in practice it often goes unreported or unevaluated. In conclusion, we point to the need for reliable and transparent measurement of transformative effects for democratization of knowledge production.

Teaching health science students foundation motivational interviewing skills: use of motivational interviewing treatment integrity and self-reflection to approach transformative learning

BACKGROUND

Many undergraduate and graduate-entry health science curricula have incorporated training in motivational interviewing (MI). However, to effectively teach skills that will remain with students after they graduate is challenging. The aims of this study were to find out self-assessed MI skills of health students and whether reflecting on the results can promote transformative learning.

METHODS

Thirty-six Australian occupational therapy and physiotherapy students were taught the principles of MI, asked to conduct a motivational interview, transcribe it, self-rate it using the Motivational Interviewing Treatment Integrity (MITI) tool and reflect on the experience. Student MI skills were measured using the reported MITI subscores. Student assignments and a focus group discussion were analysed to explore the student experience using the MITI tool and self-reflection to improve their understanding of MI principles.

RESULTS

Students found MI challenging, although identified the MITI tool as useful for promoting self-reflection and to isolate MI skills. Students self-assessed their MI skills as competent and higher than scores expected from beginners.

CONCLUSIONS

The results inform educational programs on how MI skills can be developed for health professional students and can result in transformative learning. Students may over-state their MI skills and strategies to reduce this, including peer review, are discussed. Structured self-reflection, using tools such as the MITI can promote awareness of MI skills and compliment didactic teaching methods.

Measuring Curricular Impact on Dental Hygiene Students' Transformative Learning

Previous research has suggested that transformative learning can be fostered in higher education by creating active learning experiences that are directly related to content taught, are personally engaging, and can stimulate reflection. The aim of this qualitative study was to assess changes experienced by students in an e-learning dental hygiene degree completion program beyond attainment of competence-changes that may be described as transformative learning. The data used were transcripts of focus groups that had been conducted with each of the first five cohorts of students to graduate from the program; a total of 30 of the 42 students in the five cohorts (71%) participated. Using their previously developed Transformation Rubric for Engaged Learning, the authors categorized focus group data to identify changes in students' confidence, pride, skills, perceptions of the world, and personal identity at the transformative and nontransformative levels. Every participant reported at least one change; overall, the students averaged 8.3 changes. The vast majority (84%) of these changes were transformative. Middle-performing students showed a disproportionately higher rate of transformational changes in the areas of confidence and pride. The e-learning program appeared to have had a significant transformative impact on students, but additional research on the effect on middle-performing students is warranted.

Connecting narrative with mental health learning through discussion and analysis of selected contemporary films

In a recently completed qualitative study of nursing leaders' views of requirements for practice, seven aspects of recovery practice were revealed as central for graduates to learn. It is challenging to provide an in-depth understanding of recovery in a nursing curriculum because there are so many competing content areas and, as a result, time is constrained. However, because it is so vital to understand, educators would benefit from developing and sharing teaching strategies that explore recovery deeply, memorably, and engagingly, in order to encourage theory to be put into practice. Recent research into narrative pedagogy suggests that better use of stories, especially those that have strong emotional pull, such as well-made films and memoirs, may offer solutions to creative educators. Stories can have transformative potential, because once heard and heeded, the person can never go back to exactly how they were before. Recovery learned in this way becomes a threshold concept for the mental health curriculum. This paper outlines an engaging and time-efficient teaching strategy to develop these skills, drawing on the concept of narrative pedagogy.

The feasibility of ethnodrama as intervention to highlight late-life potential for nursing students and older adults

One barrier to the expansion of geriatric health care providers is the limited desire of nursing students to work with older adults. The purpose of this study is to evaluate the feasibility of using ethnodrama as an intervention to highlight late-life potential. Twelve baccalaureate nursing students were paired with 12 residents of an assisted living facility to complete transformative learning activities focused on the topic of late-life potential culminating in a performance of an ethnodrama developed from these data. Transcripts of initial student meetings, self-reflections, the performance, postperformance discussion, and open-ended survey questions were analyzed using in vivo and pattern coding. Older adult participants recognized and emphasized positive late-life potential, whereas students explored potential throughout the life span and reflected on its meaning in their own lives. Increasing discussion about late-life potential may alter the stigma associated with aging.