Development and validation of the Workplace Learning Inventory in Health Sciences Education: a multimethod study

Health sciences students face many challenges in regard to clinical practical learning. A better understanding of student learning is required to address student needs in this crucial phase. The theory of self-regulated learning provides a comprehensive view of learning and could serve as a basis for further research. There are instruments to assess self-regulated learning in preclinical academic learning. However, there are no such instruments for workplace learning. The aim of the present study is to provide a comprehensive inventory from which researchers can select those scales that are relevant to their research questions in the investigation of workplace learning. Hence, the aim is to develop and validate a set of scales to assess undergraduates' workplace learning in health sciences education in four areas (cognition, motivation, emotion, and context) on two levels (the learning process level and the metalevel). Study 1 is a qualitative multimethod study to identify indicators and develop items. It integrates the perspectives of students, teachers, and researchers and includes six steps: literature review, interviews, synthesis, item development, expert review, and cognitive pretesting. This study yields a set of scales for each area on both levels. Study 2 is a quantitative study to assess the psychometric properties. The results show acceptable values in terms of unidimensionality, reliability and validity for each of the 31 scales. The newly developed Workplace Learning Inventory is comprehensive; the scales are relevant to workplace learning and short enough that their administration is feasible in the workplace setting. The rigorous process of questionnaire development contributes to the validity of scales. By providing the Workplace Learning Inventory, we hope to encourage research on workplace learning in health sciences education from an educational psychology perspective.

Professional identity research in the health professions-a scoping review

Professional identity impacts the workforce at personal, interpersonal and profession levels however there is a lack of reviews of professional identity research across practising health professionals. To summarise professional identity research in the health professions literature and explore how professional identity is described a scoping review was conducted by searching Medline, Psycinfo, Embase, Scopus, CINAHL, and Business Source Complete using "professional identity" and related terms for 32 health professions. Empirical studies of professional identity in post-registration health professionals were examined with health profession, career stage, background to research, theoretical underpinnings and constructs of professional identity being extracted, charted and analysed using content analysis where relevant. From 9941 studies, 160 studies across 17 health professions were identified, with nursing and medicine most common. Twenty studies focussed on professional identity in the five years post-entry to the workforce and 56 studies did not state career stage. The most common background for the research was the impact of political, social and healthcare reforms and advances. Thirty five percent of studies (n = 57) stated the use of a theory or framework of identity, the most common being classified as social theories. Individual constructs of professional identity across the research were categorised into five themes-The Lived Experience of Professional Identity; The World Around Me; Belonging; Me; and Learning and Qualifications. Descriptions of professional identity are broad, varied, rich and multi-layered however the literature is under theorised with current theories potentially inadequate to capture its complexity and make meaningful contributions to the allied health professions.

Health Sciences students' experience of COVID-19 case management and contact tracing in Cape Town, South Africa

BACKGROUND

COVID-19 has challenged health and higher education systems globally. Managing the epidemic in Cape Town, South Africa (SA), required partnerships with universities and setting up of de novo systems for mass case and contact tracing (C&CT). Health sciences, predominantly medical students, as well as social work and psychology students formed the core of this telephone-based work over the 18 months when SARS-CoV-2 caused severe disease.

METHODS

This qualitative study aimed to elicit students' motivations for becoming involved in C&CT, their experiences, and recommendations for C&CT and curricula. After Cape Town's first COVID-19 wave, six on-line focus groups comprising 23 students were conducted, and a further four were conducted with 13 students after the second wave. As the researchers were predominantly educators previously involved in undergraduate health sciences education, the study's purpose was to reflect on students' experiences to make educational and health system recommendations.

RESULTS

Students were largely motivated to mitigate the impact of the epidemic on society and support people affected by COVID-19, as well as hone their professional skills. While these motivations were realised, students also needed to learn new skills - to autonomously work remotely, using novel communication strategies to engage those affected and use virtual groups to connect with colleagues. They managed responsibilities within the healthcare systems that did not always work smoothly, distressed cases who were financially insecure, difficult employers, and language barriers. They were prepared through training, and supported by virtual, yet effective teamwork and debriefing opportunities. Although the work was sometimes physically and emotionally exhausting, students found the work personally meaningful. They embraced public health's role to protect population and individuals' health.

CONCLUSION

New teaching and learning practices adopted due to Covid-19 lockdowns enabled this digital C&CT project. It facilitated students to become confident, work autonomously and navigate challenges they will encounter as young professionals. The programme demonstrated that novel opportunities for rich student learning, such as in telehealth, can be embedded into public health and clinical functions of health services in contexts such as in SA, deepening partnerships between the health services and universities, to mutual benefit.

Where we've come from, where we might go

The paper reviews 50 years of research in health sciences education and identifies several recurring controversies-formative versus summative assessment, high and low fidelity simulation, expertise as knowledge versus skills, and the impact of teaching versus curriculum. I then look at the role these may play in the current situation where COVID has necessitated rapid change to distance learning. I then posit an essential role for research in teaching and learning, using multiple methods from qualitative to neuropsychological to better understand the dimensions of effective teaching. The ultimate goal is to operationalize these findings in creation of distance learning modules.

Healthcare systems and the sciences of health professional education

Health professions education is that part of the education system which applies educational philosophy, theory, principles and practice in a complex relationship with busy clinical services, where education is not the primary role. While the goals are clear-to produce the health workforce that society needs to improve health outcomes-both education and healthcare systems continue to evolve concurrently amidst changes in knowledge, skills, population demographics and social contracts. In observing a significant anniversary of this journal, which sits at the junction of education and healthcare systems, it is appropriate to reflect on how the relationship is evolving. Health professions educators must listen to the voices of regulators, employers, students and patients when adapting to new service delivery models that emerge in response to pressures for change. The recent COVID-19 pandemic is one example of disruptive change, but other factors, such as population pressures and climate change, can also drive innovations that result in lasting change. Emerging technology may act as either a servant of change or a disruptor. There is a pressing need for interdisciplinary research that develops a theory and evidence base to strengthen sustainability of change.

Role of team dynamics in the learning process: a mixed-methods evaluation of a modified team-based learning approach in a behavioral research methods course

Health sciences education is increasingly focusing on building students' skills to work collaboratively. Therefore, instructors must intentionally incorporate team-based skill building into their courses, using teaching strategies like team-based learning (TBL). An assumption of TBL is that team dynamics facilitate learning; however, limited research has examined this connection. The primary purposes of this mixed-methods evaluation were: (a) to describe the characteristics of team dynamics in a graduate-level research methods course that employs a modified TBL approach, and (b) to examine the association between team dynamics and student grades. Given the importance of preparing health professional students to work collaboratively in their careers, a secondary aim was to examine how team skills developed through a team-based learning approach could be transferred to other courses and to future jobs. We conducted surveys on team dynamics at mid-semester (n = 64) and the end of the semester (n = 66), collected students' grades for the final paper and overall course, and conducted 4 focus groups with Master of Public Health students (n = 25). Paired t tests were used to examine change in team dynamics and correlations were conducted to assess the relationship between team dynamics and grades. Thematic analysis was used to identify themes related to team dynamics from the focus group data. Overall, students reported experiencing positive and beneficial team dynamics. The findings support two main underlying categories of team dynamics, interpersonal team processes and task orientation, and the linkages between the categories that allow teams to function. Team dynamics scores were not associated with student grades. However, students recognized the value of practicing team skills in preparation for future group work and jobs. These findings suggest that active learning approaches, such as TBL, can help to facilitate the acquisition of collaborative skills.

Anatomical Sciences Education Among Biological Anthropology Graduates: a Solution to the Dearth of Anatomy Educators?

The need for anatomical knowledge is increasingly in demand as new medical and allied-health professions programs continue to open, but there is a growing dearth of educators with formal training in the anatomical sciences. Several sources for anatomy faculty have been suggested, including surgeons, but few have considered a more obvious, alternative approach to this shortage: hiring qualified faculty from other PhD departments/programs whose graduates receive formal training in anatomy, including biological anthropologists. This study surveyed 305 biological anthropology graduates to assimilate information about the nature and extent of training among biological anthropology graduates in the core anatomy disciplines (anatomy, histology, embryology, histology, neuroanatomy), and to determine whether biological anthropology graduates value and apply anatomy training. Only 36% of PhDs reported that anatomy was a required course, but 72% of PhD graduates took an anatomy course (usually gross anatomy with a human cadaveric dissection laboratory). Histology, embryology, and neuroanatomy also were not required to obtain a PhD, though some of this material was covered during the anatomy course, and some students opted to take these courses as electives. Forty-five percent of PhD students reported teaching experience in gross anatomy courses with cadaveric dissection. Ninety-four percent of biological anthropology PhD graduates are prepared to teach human osteology, and 48% are comfortable teaching gross anatomy. Biological anthropology graduates bring unique expertise, training, and research experience to medical education programs, and many are well-suited to fill the growing number of anatomy faculty positions.

'There's so much to it': the ways physiotherapy students and recent graduates experience practice

Health science courses aim to prepare students for the demands of their chosen profession by learning ways appropriate to that profession and the contexts they will work and live in. Expectations of what students should learn become re-contextualised and translated into entry-level curriculum, with students operating as a connection between what is intended and enacted in curriculum, and required in the real world. Drawing on phenomenology, this paper explores how students understand practice-the collective, purposeful knowing, doing and being of a community-in entry-level physiotherapy programs. Ways of thinking and practising (WTP)-a framework attentive to the distinctive nature of a discipline, its values, philosophies and world-view (McCune and Hounsell in High Educ 49(3):255-289, 2005)-provides the conceptual lens. Six themes describing how students see the WTP of physiotherapy practice emerged from the analysis: discovery of new knowledge; problem solving client related contexts; adopting a systems based approach to the body; contributing to a positive therapeutic alliance; developing a sense of self and the profession; and the organisation of the workforce. The study produces knowledge about practice by focusing on physiotherapy students' experiences of disciplinary learning. Including students in educational research in this way is an approach that can help students realise their potential as part of a community of practice.

Monitoring progression of clinical reasoning skills during health sciences education using the case method - a qualitative observational study

BACKGROUND

Outcome- or competency-based education is well established in medical and health sciences education. Curricula are based on courses where students develop their competences and assessment is also usually course-based. Clinical reasoning is an important competence, and the aim of this study was to monitor and describe students' progression in professional clinical reasoning skills during health sciences education using observations of group discussions following the case method.

METHODS

In this qualitative study students from three different health education programmes were observed while discussing clinical cases in a modified Harvard case method session. A rubric with four dimensions - problem-solving process, disciplinary knowledge, character of discussion and communication - was used as an observational tool to identify clinical reasoning. A deductive content analysis was performed.

RESULTS

The results revealed the students' transition over time from reasoning based strictly on theoretical knowledge to reasoning ability characterized by clinical considerations and experiences. Students who were approaching the end of their education immediately identified the most important problem and then focused on this in their discussion. Practice knowledge increased over time, which was seen as progression in the use of professional language, concepts, terms and the use of prior clinical experience. The character of the discussion evolved from theoretical considerations early in the education to clinical reasoning in later years. Communication within the groups was supportive and conducted with a professional tone.

CONCLUSIONS

Our observations revealed progression in several aspects of students' clinical reasoning skills on a group level in their discussions of clinical cases. We suggest that the case method can be a useful tool in assessing quality in health sciences education.