ORCID Profile
0000-0003-0651-3870
Current Organisation
Deakin University
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Publisher: Wiley
Date: 29-03-2020
DOI: 10.1111/MEDU.14129
Publisher: Springer Science and Business Media LLC
Date: 09-11-2020
Publisher: Informa UK Limited
Date: 03-02-2014
Publisher: Wiley
Date: 21-12-2012
DOI: 10.1111/MEDU.12109
Publisher: Wiley
Date: 21-11-2012
DOI: 10.1111/MEDU.12067
Publisher: Informa UK Limited
Date: 07-09-2023
Publisher: Wiley
Date: 28-07-2022
DOI: 10.1111/MEDU.14881
Abstract: Fostering trainee psychological safety is increasingly being recognised as necessary for effective feedback conversations. Emerging literature has explored psychological safety in peer learning, formal feedback and simulation debrief. Yet, the conditions required for psychologically safe feedback conversations in clinical contexts, and the subsequent effects on feedback, have not been explored. We conducted a qualitative study using interviews and longitudinal audio‐diaries with 12 rural general practice trainees. The data were analysed using framework thematic analysis to identify factors across the data and as in idual participant case studies with illustrative vignettes of dynamic interleaving of factors in judgements about feedback conversations. Findings identify the influence of intrapersonal (e.g. confidence and comfort to seek help), interpersonal (e.g. trust and relationship) and sociocultural factors (e.g. living and working in a rural community) that contribute to psychological safety in the context of everyday feedback conversations. Multiple factors interplayed in feedback conversations where registrars could feel safe and unsafe within one location and even at the one time. Participants felt psychologically safe to engage their educators in sanctioned systems of conversation related to the immediate care of the patient and yet unsafe to engage in less patient related performance conversations despite the presence of multiple positive interpersonal factors. The concept of a safe ‘container’ (contained space) is perhaps idealised when it comes to feedback conversations about performance in the informal and emergent spaces of postgraduate training. More research is needed into understanding how clinical environments can sanction feedback conversations in clinical environments.
Publisher: Springer Science and Business Media LLC
Date: 09-02-2016
Publisher: Informa UK Limited
Date: 21-09-2023
Publisher: Springer Singapore
Date: 30-12-2016
Publisher: Springer International Publishing
Date: 2020
Publisher: Wiley
Date: 16-02-2011
Publisher: Informa UK Limited
Date: 19-05-2019
Publisher: SAGE Publications
Date: 19-03-2010
Abstract: Prescribing is a fundamental activity of general practice and prescriptions are a major cost to the health service. Yet the art and practical details of prescribing are rarely learnt in medical school junior doctors lack confidence in writing prescriptions ( Illing, 2008 ). Prescribing is not straightforward and involves a complicated decision-making process, by both patient and doctor, whose intricacies and governing factors are not yet well understood but where inadequate skills translate to suboptimal prescribing (Jackson et al., 2002). The prescribing process is not simply about choosing a medicine and writing a prescription.
Publisher: Informa UK Limited
Date: 18-10-2022
Publisher: Springer International Publishing
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 15-12-2022
DOI: 10.1007/S10734-022-00976-9
Abstract: COVID-19 forced the digitalisation of teaching and learning in a response often described as emergency remote teaching (ERT). This rapid response changed the social, spatial, and temporal arrangements of higher education and required important adaptations from educators and students alike. However, while the literature has examined the constraints students faced (e.g. availability of the internet) and the consequences of the pandemic (e.g. student mental health), students’ active management of these constraints for learning remains underexplored. This paper aims to “think with” COVID-19 to explore student agency in home learning under constrained circumstances. This qualitative study used semi-structured interviews to understand the day-to-day actions of nineteen undergraduate students managing their learning during the COVID-19 lockdowns in Victoria, Australia. Emirbayer and Mische’s multiple dimensions of agency — iterative, projective, and practical-evaluative — are used to explore student experience. The findings illustrate students’ adaptability and agency in navigating life-integrated learning, with most of their actions oriented to their present circumstances. This practical evaluative form of agency was expressed through (1) organising self, space, time, and relationships (2) self-care and (3) seeking help. Although this study took place in the context of ERT, it has implications beyond the pandemic because higher education always operates under constraints, and in other circumstances, many students still experience emotionally and materially difficult times.
Publisher: Informa UK Limited
Date: 10-12-2021
Publisher: Wiley
Date: 16-12-2020
DOI: 10.1111/MEDU.14413
Abstract: Ever wondered why academics make things so difficult? Ajjawi and Eva explain with their introduction of the 2021 State of the Science issue and this year's theme of Solution‐ism.
Publisher: Informa UK Limited
Date: 09-10-2020
Publisher: Informa UK Limited
Date: 13-07-2021
Publisher: Wiley
Date: 05-05-2016
DOI: 10.1111/TCT.12552
Publisher: Routledge
Date: 08-12-2022
Publisher: Springer Science and Business Media LLC
Date: 16-12-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 21-01-2022
DOI: 10.1161/CIRCRESAHA.120.317107
Abstract: Dextro-transposition of the great arteries (D-TGA) is a severe congenital heart defect which affects approximately 1 in 4,000 live births. While there are several reports of D-TGA patients with rare variants in in idual genes, the majority of D-TGA cases remain genetically elusive. Familial recurrence patterns and the observation that most cases with D-TGA are sporadic suggest a polygenic inheritance for the disorder, yet this remains unexplored. We sought to study the role of common single nucleotide polymorphisms (SNPs) in risk for D-TGA. We conducted a genome-wide association study in an international set of 1,237 patients with D-TGA and identified a genome-wide significant susceptibility locus on chromosome 3p14.3, which was subsequently replicated in an independent case-control set (rs56219800, meta-analysis P=8.6x10 -10 , OR=0.69 per C allele). SNP-based heritability analysis showed that 25% of variance in susceptibility to D-TGA may be explained by common variants. A genome-wide polygenic risk score derived from the discovery set was significantly associated to D-TGA in the replication set (P=4x10 -5 ). The genome-wide significant locus (3p14.3) co-localizes with a putative regulatory element that interacts with the promoter of WNT5A , which encodes the Wnt Family Member 5A protein known for its role in cardiac development in mice. We show that this element drives reporter gene activity in the developing heart of mice and zebrafish and is bound by the developmental transcription factor TBX20. We further demonstrate that TBX20 attenuates Wnt5a expression levels in the developing mouse heart. This work provides support for a polygenic architecture in D-TGA and identifies a susceptibility locus on chromosome 3p14.3 near WNT5A . Genomic and functional data support a causal role of WNT5A at the locus.
Publisher: Wiley
Date: 20-04-2017
DOI: 10.1111/MEDU.13290
Abstract: Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the in idual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery.
Publisher: Wiley
Date: 04-05-2023
DOI: 10.1111/MEDU.15118
Abstract: Specialty trainees often struggle to understand how well they are performing, and feedback is commonly seen as a solution to this problem. However, medical education tends to approach feedback as acontextual rather than located in a specialty‐specific cultural world. This study therefore compares how specialty trainees in surgery and intensive care medicine (ICM) make meaning about the quality of their performance and the role of feedback conversations in this process. We conducted a qualitative interview study in the constructivist grounded theory tradition. We interviewed 17 trainees from across Australia in 2020, eight from ICM and nine from surgery, and iterated between data collection and analytic discussions. We employed open, focused, axial and theoretical coding. There were significant ergences between specialties. Surgical trainees had more opportunity to work directly with supervisors, and there was a strong link between patient outcome and quality of care, with a focus on performance information about operative skills. ICM was a highly uncertain practice environment, where patient outcome could not be relied upon as a source of performance information valued performance information was diffuse and included tacit emotional support. These different ‘specialty feedback cultures’ strongly influenced how trainees orchestrated opportunities for feedback, made meaning of their performance in their day‐to‐day patient care tasks and ‘patched together’ experiences and inputs into an evolving sense of overall progress. We identified two types of meaning‐making about performance: first, trainees' understanding of an immediate performance in a patient‐care task and, second, a ‘patched together’ sense of overall progress from incomplete performance information. This study suggests approaches to feedback should attend to both, but also take account of the cultural worlds of specialty practice, with their attendant complexities. In particular, feedback conversations could better acknowledge the variable quality of performance information and specialty specific levels of uncertainty.
Publisher: Wiley
Date: 11-10-2022
DOI: 10.1111/MEDU.14942
Abstract: Longitudinal coaching in residency programmes is becoming commonplace and requires iterative and collaborative discussions between coach and resident, with the shared development of goals. However, little is known about how goal development unfolds within coaching conversations over time and the effects these conversations have. We therefore built on current coaching theory by analysing goal development dialogues within resident and faculty coaching relationships. This was a qualitative study using interpretive description methodology. Eight internal medicine coach–resident dyads consented to audiotaping coaching meetings over a 1‐year period. Transcripts from meetings and in idual exit interviews were analysed thematically using goal co‐construction as a sensitising concept. Two themes were developed: (i) The content of goals discussed in coaching meetings focused on how to be a resident, with little discussion around challenges in direct patient care, and (ii) co‐construction mainly occurred in how to meet goals, rather than in prioritising goals or co‐constructing new goals. In analysing goal development in the coach–resident relationships, conversations focused mainly around how to manage as a resident rather than how to improve direct patient care. This may be because academic coaching provides space separate from clinical work to focus on the stage‐specific professional identity development of a resident. Going forward, focus should be on how to optimise longitudinal coaching conversations to ensure co‐regulation and reflection on both clinical competencies and professional identity formation.
Publisher: Wiley
Date: 25-11-2022
DOI: 10.1111/MEDU.14700
Abstract: Like medicine and health care, feedback is a practice imbued with emotions: saturated with feelings relevant to one's identity and status within a given context. Often this emotional dimension of feedback is cast as an impediment to be ignored or managed. Such a perspective can be detrimental to feedback practices as emotions are fundamentally entwined with learning. In this critical review, we ask: What are the discourses of emotion in the feedback literature and what ‘work’ do they do? We conducted a critical literature review of emotion and feedback in the three top journals of the field: Academic Medicine , Medical Education and Advances in Health Sciences Education . Analysis was informed by a Foucauldian critical discourse approach and involved identifying discourses of emotion and interpreting how they shape feedback practices. Of 32 papers, four overlapping discourses of emotion were identified. Emotion as physiological casts emotion as internal, biological, ever‐present, immutable and often problematic. Emotion as skill positions emotion as internal, mainly cognitive and amenable to regulation. A discourse of emotion as reflexive practice infers a social and interpersonal understanding of emotions, whereas emotion as socio‐cultural discourse extends the reflexive practice discourse seeing emotion as circulating within learning environments as a political force. Drawing on scholarship within the sociology of emotions, we suggest the merits of studying emotion as inevitable (not pathological), as potentially paralysing and motivating and as situated within (and often reinforcing) a hierarchical social health care landscape. For future feedback research, we suggest shifting towards recognising the discourse‐theory‐practice connection with emotion in health professional education drawing from reflexive and socio‐cultural discourses of emotion.
Publisher: Wiley
Date: 16-03-2023
DOI: 10.1111/MEDU.15078
Abstract: Farrell details the importance of coaches developing a shared conceptualization of identity and willingingness to cede control of discussion to allow for the emergence of creative and open conversations with coachees.
Publisher: Wiley
Date: 19-09-2012
Publisher: Informa UK Limited
Date: 04-05-2022
Publisher: Informa UK Limited
Date: 02-03-2021
Publisher: Informa UK Limited
Date: 25-02-2021
Publisher: Ubiquity Press, Ltd.
Date: 03-06-2019
DOI: 10.1007/S40037-019-0513-6
Abstract: Medical education is a messy tangle of social and material elements. These material entities include tools, like curriculum guides, stethoscopes, cell phones, accreditation standards, and mannequins natural elements, like weather systems, disease vectors, and human bodies and, objects, like checklists, internet connections, classrooms, lights, chairs and an endless array of others. We propose that sociomaterial approaches to ethnography can help us explore taken for granted, or under-theorized, elements of a situation under study, thereby enabling us to think differently. In this article, we describe ideas informing Actor-Network Theory approaches, and how these ideas translate into how ethnographic research is designed and conducted. We investigate epistemological (what we can know, and how) positioning of the researcher in an actor-network theory informed ethnography, and describe how we tailor ethnographic methods—document and artefact analysis observation and interviews—to align with a sociomaterial worldview. Untangling sociomaterial scenarios can offer a novel perspective on myriad contemporary medical education issues. These issues include examining how novel tools (e.g. accreditation standards, assessment tools, mannequins, videoconferencing technologies) and spaces (e.g. simulation suites, videoconferenced lecture theatres) used in medical education impact how teaching and learning actually happen in these settings.
Publisher: Informa UK Limited
Date: 19-10-2023
Publisher: Springer Science and Business Media LLC
Date: 23-03-2017
Publisher: Elsevier BV
Date: 2022
DOI: 10.1016/J.NEPR.2021.103255
Abstract: This integrative review aims to explore the relationship between feedback and evaluative judgement in undergraduate nursing and midwifery education. Research in higher education has shown that feedback practices can lead to students' developing evaluative judgement thought critical for performance improvement and life-long learning. While literature in nursing and midwifery education has not yet employed the term 'evaluative judgement' explicitly, there might be similar concepts and practices that seek to develop students' judgement of performance that sustain learning beyond the immediate task. An integrative review of the nursing and midwifery feedback literature. In February 2020, six online databases (CINAHL, ProQuest, Scopus, ERIC, PsycINFO, Ovid MEDLINE) were systematically searched for literature published between January 1989-February 2020. Synonyms for feedback and evaluative judgement were used to inform our search. This review included a rigorous team-based, five-stage approach: (1) identifying the problem (2) conducting the search (3) evaluating the data (4) analysing the data and (5) presenting the integrative review. A total of 1408 studies were initially retrieved with 543 duplicates. 865 abstracts were screened using eligibility criteria, resulting in the exclusion of 835 studies. Thirty full-text studies were appraised for quality. Eighteen studies with erse methodologies achieved a medium-high quality score for inclusion in data analysis. Conceptions of feedback and evaluative judgement were identified in all studies despite none using the term 'evaluative judgement' explicitly. Thematic analysis of the studies resulted in seven themes: conceptions of feedback, purposes of feedback, sources of feedback, modes of feedback, conceptions of evaluative judgement, purposes of evaluative judgement and relationships between feedback and evaluative judgement. While our findings supported contemporary higher education research, the feedback-evaluative judgement relationship is novel in nursing education. We encourage educators to design feedback activities privileging students' active engagement through dialogic feedback, reflection and self-assessment, to develop their evaluative judgement of practice.
Publisher: Wiley
Date: 26-08-2016
DOI: 10.1111/MEDU.13063
Abstract: Several recent studies have documented the fact that, in considering feedback, learners are actively making credibility judgements about the feedback and its source. Yet few have intentionally explored such judgements to gain a deeper understanding of how the process works or how these judgements might interact to influence engagement with and interpretation of feedback. Using the educational alliance framework, we sought to elaborate an understanding of learners' credibility judgements and their consequences. Using constructivist grounded theory we conducted semi-structured interviews with psychiatry residents. We used a theoretical s ling approach that invited participants with erse scores based on a previously published feedback survey and an investigator-developed educational alliance inventory. Consistent with the principles of grounded theory analysis, data were collected and analysed in an iterative process to identify themes. Participants depicted themselves as actively contemplating feedback and considering it thoughtfully in light of complex judgements regarding their supervisor, the relationship with their supervisor and the larger context in which the feedback interactions were occurring. These judgements focused on the supervisor's credibility both as a clinician and as a partner in the educational alliance. The educational alliance is judged by trainees in relation to the supervisor's engagement as an educator, commitment to promoting growth of residents and positive attitude toward them. Our findings suggest that credibility is a multifaceted judgement that occurs not only at the moment of the feedback interaction but early in and throughout an educational relationship. It not only affects a learner's engagement with a particular piece of feedback at the moment of delivery, but also has consequences for future engagement with (or avoidance of) further learning interactions with the supervisor. These findings can help medical educators develop a more meaningful understanding of the context in which feedback takes place.
Publisher: Informa UK Limited
Date: 10-11-2022
Publisher: Springer Science and Business Media LLC
Date: 24-10-2023
DOI: 10.1007/S10734-022-00937-2
Abstract: Artificial intelligence (AI) holds significant implications for higher education however, references to AI in the literature are often vague and open to debate. In order to understand how to progress AI-related research and analysis, this critical review systematically searched top higher education journals for references to the term ‘artificial intelligence’. We reviewed definitions and conducted a discourse analysis of included texts. Our findings identify few, confusing definitions and little overt reference to AI as a research object. We delineated two Discourses. The Discourse of imperative change outlines how AI is seen as an inevitable change to which all must respond. Additionally, the Discourse of altering authority describes how texts position AI as decentring the teacher and spreading authority across staff, machines, corporations and students. Our analysis prompts a call for new research foci that attend to the social implications of AI, including tracing accountability in AI-mediated practices and exploring how AI influences learning and teaching relationships.
Publisher: BMJ
Date: 23-06-2016
DOI: 10.1136/EMERMED-2015-205650
Abstract: Emergency medicine (EM) has a high case turnover and acuity making it a demanding clinical reasoning domain especially for junior doctors who lack experience. We aimed to better understand their clinical reasoning using dual cognition as a guiding theory. EM junior doctors were recruited from six hospitals in the south of England to participate in semi-structured interviews (n=20) and focus groups (n=17) based on recall of two recent cases. Transcripts were analysed using a grounded theory approach to identify themes and to develop a model of junior doctors' clinical reasoning in EM. Within cases, clinical reasoning occurred in three phases. In phase 1 (case framing), initial case cues and first impressions were predominantly intuitive, but checked by analytical thought and determined the urgency of clinical assessment. In phase 2 (evolving reasoning), non-analytical single cue and pattern recognitions were common which were subsequently validated by specific analytical strategies such as use of red flags. In phase 3 (ongoing uncertainty) analytical self-monitoring and reassurance strategies were used to precipitate a decision regarding discharge. We found a constant dialectic between intuitive and analytical cognition throughout the reasoning process. Our model of clinical reasoning by EM junior doctors illustrates the specific contextual manifestations of the dual cognition theory. Distinct diagnostic strategies are identified and together these give EM learners and educators a framework and vocabulary for discussion and learning about clinical reasoning.
Publisher: BMJ
Date: 03-2017
Publisher: Wiley
Date: 17-08-2010
Publisher: Wiley
Date: 23-12-2019
DOI: 10.1111/MEDU.14037
Abstract: The notion of culture is increasingly invoked in the medical education literature as a key influence on how educational strategies unfold, and culture change is frequently identified as a necessary precursor to progress. A meaningful perspective on what culture means is often missing from these discussions, however. Without a theoretically grounded notion of culture, calls for culture change are challenging to interpret and to act upon. In this cross-cutting edge paper, we explore how culture has been defined and theorised using three lenses: the organisational perspective the identity perspective, and the practice perspective. We consider what each perspective might offer to medical education researchers. Each of these perspectives draws on a range of disciplinary influences, and none represents a singular theory of culture. Broadly, the organisational perspective directs our attention to the shared assumptions and values that bind in iduals within an organisation. It tends to view culture through a strategic lens culture may be either a barrier to or a facilitator of the changes that are inevitably required of an organisation if it is to maintain its relevance. The identity perspective, particularly the notion of figured worlds, alerts us to the power of communal narratives to shape how in iduals see themselves within particular cultural worlds. The practice perspective emphasises what actually occurs in practice, avoiding symbolic ideas about culture and shared values and instead privileging activity and human-material networks or arrangements. These erse perspectives share a common thread- they shift our research gaze beyond the in idual, allowing us instead to see how those in iduals form organisations, inhabit cultural worlds and constitute practices. They afford substance and direction for explorations of culture, and thus offer the promise of a more nuanced understanding of some of medical education's most challenging problems.
Publisher: Springer Science and Business Media LLC
Date: 21-03-2016
Publisher: Wiley
Date: 19-12-2022
DOI: 10.1111/MEDU.15007
Abstract: In this commentary, Ajjawi and Gravett examine the role of space in learning and urge the field to research learning spaces from a more theoretically informed position.
Publisher: Springer Science and Business Media LLC
Date: 26-04-0005
DOI: 10.1007/S10459-016-9686-5
Abstract: Supervision in the outpatient context is increasingly in the form of single day interactions between students and preceptors. This creates difficulties for effective feedback, which often depends on a strong relationship of trust between preceptor and student. Building on feedback theories focusing on the relational and dialogic aspects of feedback, this study explored the use of goal-oriented feedback in brief encounters with learners. This study used autoethnography to explore one preceptor's feedback interactions over an eight-month period both in the ambulatory setting and on the wards. Data included written narrative reflections on feedback interactions with twenty-three learners informed by discussions with colleagues and repeated reading of feedback literature. Thematic and narrative analyses of data were performed iteratively. Data analysis emphasized four recurrent themes. (1) Goal discussions were most effective when initiated early and integrated throughout the learning experience. (2) Both learner and preceptor goals were multiple and varied, and feedback needed to reflect this complexity. (3) Negotiation or co-construction of goals was important when considering the focus of feedback discussions in order to create safer, more effective interactions. (4) Goal oriented interactions offer potential benefits to the learner and preceptor. Goal oriented feedback promotes dialogue as it requires both preceptor and learner to acknowledge and negotiate learning goals throughout their interaction. In doing so, feedback becomes an explicit component of the preceptor-learner relationship. This enhances feedback interactions even in relatively brief encounters, and may begin an early educational alliance that can be elaborated with longer interactions.
Publisher: Wiley
Date: 05-2020
DOI: 10.1111/MEDU.14156
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2014
Publisher: Elsevier BV
Date: 2020
Publisher: Informa UK Limited
Date: 15-07-2019
Publisher: Wiley
Date: 17-01-2022
DOI: 10.1111/MEDU.14724
Abstract: A taskforce established by Medical Education asks readers to engage in discussion about how the journal and field can do better to ensure that health professional education publishing is inclusive of erse knowledge and perspectives.
Publisher: Informa UK Limited
Date: 09-05-2023
Publisher: Mary Ann Liebert Inc
Date: 12-2010
Abstract: Homeopathy is a major modality in complementary and alternative medicine. Significant tensions exist between homeopathic practice and education, evident in the ersity of practice styles and pedagogic models. Utilizing clinical reasoning knowledge in conventional medicine and allied health sciences, this article seeks to identify and critique existing research in this important area. A literature search utilizing MEDLINE,(®) Allied and Complementary Medicine (AMED), and CINAHL(®) (Cumulative Index to Nursing and Allied Health Literature) was conducted. Key terms including clinical thinking, clinical reasoning, decision-making, homeopathy, and complementary medicine were utilized. A critical appraisal of the evidence was undertaken. Four (4) studies have examined homeopathic clinical reasoning. Two (2) studies sought to measure and quantify homeopathic reasoning. One (1) study proposed a reasoning model, based on pattern recognition, hypothetico-deductive reasoning, intuition, and remedy-matching (PHIR-M), resembling much that has been previously mapped in conventional medical reasoning research. The fourth closely investigated the meaning and use of intuition in homeopathic decision-making. Taken together, these four studies provide valuable insight into what is currently known about homeopathic clinical reasoning. However, despite the history and breadth of practice, little is known about homeopathic clinical reasoning and decision-making. Building on the research would require viewing clinical reasoning not only as a cognitive phenomenon but also as a situated and interactive one. Further research into homeopathic clinical reasoning is indicated.
Publisher: BMJ
Date: 10-2018
DOI: 10.1136/BMJOPEN-2017-020570
Abstract: To better understand the potential of a needs assessment approach using qualitative data from manikin-based and virtual patient simulation debriefing sessions compared with traditional data collection methods (ie, focus groups and interviews). Original data from simulation debrief sessions was compared and contrasted with data from an earlier assessment of critical care needs in a community setting (using focus groups and interviews), thus undertaking secondary analysis of data. Time and cost data were also examined. Debrief sessions were coded using deductive and inductive techniques. Matrices were used to explore the commonalities, differences and emergent findings across the methods. Critical care unit in a community hospital setting. Interviews and focus groups yielded 684 and 647 min of audio-recordings, respectively. The manikin-based debrief recordings averaged 22 min (total=130 min) and virtual patient debrief recordings averaged 31 min (total=186 min). The approximate cost for the interviews and focus groups was $13 560, for manikin-based simulation debriefs was $4030 and for the virtual patient debriefs was $3475. Fifteen of 20 total themes were common across the simulation debriefs and interview/focus group data. Simulation-specific themes were identified, including fidelity (environment, equipment and psychological) and the multiple roles of the simulation instructor (educative, promoting reflection and assessing needs). Given current fiscal realities, the dual benefit of being educative and identifying needs is appealing. While simulation is an innovative method to conduct needs assessments, it is important to recognise that there are trade-offs with the selection of methods.
Publisher: Informa UK Limited
Date: 12-08-2022
Publisher: Informa UK Limited
Date: 07-06-2022
Publisher: Informa UK Limited
Date: 29-10-2015
Publisher: Springer Science and Business Media LLC
Date: 12-07-2019
DOI: 10.1007/S13318-019-00568-6
Abstract: Critically ill children exhibit altered pharmacokinetic parameters of vancomycin, mainly due to altered renal excretion and volume of distribution (as a result of altered plasma protein concentrations). We assessed the pharmacokinetic parameters of vancomycin in this subpopulation. Vancomycin trough concentrations in critically ill children were obtained following first dose and at steady state. Using a one-compartment model, clearance (CL), volume of distribution (Vd), elimination half-life (t Twenty-two s les were evaluated for first-dose and 182 for steady-state pharmacokinetics, and similar pharmacokinetic parameter values were observed at first dose and at steady state. Only 36.4% and 47.3% of the s les attained the recommended AUC Vancomycin dosing strategies in younger children should be revisited, and increased doses should be considered for critically ill children with ARC in order to achieve therapeutic concentrations of AUC
Publisher: Informa UK Limited
Date: 21-02-2022
Publisher: Emerald
Date: 2008
DOI: 10.3316/QRJ0802148
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2018
DOI: 10.1097/ACM.0000000000001994
Abstract: Learning can be conceptualized as a process of “becoming,” considering in iduals, workplace participation, and professional identity formation. How postgraduate trainees learn palliative care, encompassing technical competence, compassion, and empathy, is not well understood or explained by common conceptualizations of learning as “acquisition” and “participation.” Learning palliative care, a practice that has been described as a cultural shift in medicine challenging the traditional role of curing and healing, provided the context to explore learning as “becoming.” The authors undertook a qualitative narrative study, interviewing 14 residents from the University of Ottawa Family Medicine Residency Program eliciting narratives of memorable learning (NMLs) for palliative care. Forty-five NMLs were analyzed thematically. To illuminate the interplay among themes, an in-depth analysis of the NMLs was done that considered themes and linguistic and paralinguistic features of the narratives. Forty-five NMLs were analyzed. The context of NMLs was predominantly a variety of clinical workplaces during postgraduate training. Themes clustered around the concept of palliative care and how it contrasted with other clinical experiences, the emotional impact on narrators, and how learning happened in the workplace. Participants had expectations about their identities as doctors that were challenged within their NMLs for palliative care. NMLs for palliative care were a complex entanglement of in idual experience and social and workplace cultures highlighting the limitations of the “acquisition” and “participation” metaphors of learning. By conceptualizing learning as “becoming,” what occurs during memorable learning can be made accessible to those supporting learners and their professional identity formation.
Publisher: Ubiquity Press, Ltd.
Date: 27-08-2020
DOI: 10.1007/S40037-020-00608-X
Abstract: Introduction Patient demographics demand physicians who are competent in and embrace palliative care as part of their professional identity. Published literature describes ways that learners acquire knowledge, skills and attitudes for palliative care. These studies are, however, limited by their focus on the in idual where learning is about acquisition. Viewing learning as a process of becoming through the interplay of in idual, social relationships and cultures, offers a novel perspective from which to explore the affordances for professional identity development. Methods Qualitative narrative methods were used to explore 45 narratives of memorable learning (NMLs) for palliative care recounted by 14 graduating family medicine residents in one family medicine residency program. Thematic and narrative analyses identified the affordances that support and constrain the dynamic emergence of professional identity. Results Participants recounted affordances that supported and/or constrained their learning acting on personal (e.g. past experiences of death), interpersonal (e.g. professional support) and systemic (e.g. patient continuity) levels. Opportunities for developing professional identity were dynamic: factors acted in harmony, were misaligned, or colliding to support or constrain an emerging professional identity for palliative care practice. Conclusion Findings highlight how in idual factors interplay with interpersonal and structural conditions in the workplace in dynamic and emergent ways that may support or constrain the emergence of professional identity.
Publisher: Wiley
Date: 22-05-2023
DOI: 10.1111/BJET.13337
Abstract: Artificial intelligence (AI) is increasingly integrating into our society. University education needs to maintain its relevance in an AI‐mediated world, but the higher education sector is only beginning to engage deeply with the implications of AI within society. We define AI according to a relational epistemology, where, in the context of a particular interaction, a computational artefact provides a judgement about an optimal course of action and that this judgement cannot be traced . Therefore, by definition, AI must always act as a ‘black box’. Rather than seeking to explain ‘black boxes’, we argue that a pedagogy for an AI‐mediated world involves learning to work with opaque, partial and ambiguous situations, which reflect the entangled relationships between people and technologies. Such a pedagogy asks learners locate AI as socially bounded, where AI is always understood within the contexts of its use. We outline two particular approaches to achieve this: (a) orienting students to quality standards that surround AIs, what might be called the tacit and explicit ‘rules of the game’ and (b) providing meaningful interactions with AI systems. What is already known about this topic Artificial intelligence (AI) is conceptualised in many different ways but is rarely defined in the higher education literature. Experts have outlined a range of graduate capabilities for working in a world of AI such as teamwork or ethical thinking. The higher education literature outlines an imperative need to respond to AI, as underlined by recent commentary on ChatGPT. What this paper adds A definition of an AI that is relational: A particular interaction where a computational artefact provides a judgement about an optimal course of action, which cannot be easily traced. Focusing on working with AI black boxes rather than trying to see inside the technology. Describing a pedagogy for an AI‐mediated world that promotes working in complex situations with partial and indeterminate information. Implications for practice and/or policy Focusing on quality standards helps learners understand the social regulating boundaries around AI. Promoting learner interactions with AI as part of a sociotechnical ensemble helps build evaluative judgement in weighting AI's contribution to work. Asking learners to work with AI systems prompts understanding of the evaluative, ethical and practical necessities of working with a black box.
Publisher: Informa UK Limited
Date: 14-12-2023
Publisher: Springer Science and Business Media LLC
Date: 21-11-2017
Publisher: Springer Singapore
Date: 2019
Publisher: Springer Fachmedien Wiesbaden
Date: 22-11-2019
DOI: 10.1007/978-3-658-27602-7_6
Abstract: This chapter provides a commentary on the potential choices, processes, and decisions involved in undertaking a systematic review. It does this through using an illustrative case ex le, which draws on the application of systematic review principles at each stage as it actually happened. The chapter firstly introduces the topic of ‘student engagement’ and explains why a review was decided appropriate for this topic. The chapter then provides an exploration of the methodological choices and methods we used within the review. Next, the issues of results management and presentation are discussed. Reflections on the process, and key recommendations for undertaking systematic reviews on education topics are made, on the basis of this review, as well as the authors’ prior experiences as researchers and authors of review papers.
Publisher: Wiley
Date: 09-2020
DOI: 10.1111/MEDU.13802
Abstract: Research suggests that feedback in the health professions is less useful than we would like. In this paper, we argue that feedback has become reliant on myths that perpetuate unproductive rituals. Feedback often resembles a discrete episode of an educator "telling," rather than an active and iterative involvement of the learner in a future-facing process. With this orientation towards past events, it is not surprising that learners become defensive or disengaged when they are reminded of their deficits. We tackle three myths of feedback: (a) feedback needs praise-criticism balancing rules (b) feedback is a skill residing within the teacher and (c) feedback is an input only. For each myth we provide a reframing with supporting ex les from the literature. Equipping learners to engage in feedback processes may reduce the emotional burden on both parties, rendering techniques such as the feedback sandwich redundant. We also highlight the benefits for learners and teachers of conceptualising feedback as a relational activity, and of tracing the effects of information exchanges. These effects may be immediate or latent, and may manifest in different forms such as changes in learner evaluative judgement or professional identity.
Publisher: Wiley
Date: 06-2018
DOI: 10.1111/MEDU.13527
Publisher: Springer Science and Business Media LLC
Date: 25-01-2016
Publisher: Informa UK Limited
Date: 07-2013
Publisher: BRILL
Date: 05-08-2019
Publisher: Springer Science and Business Media LLC
Date: 16-11-2021
Publisher: BMJ
Date: 08-2019
DOI: 10.1136/BMJOPEN-2019-031577
Abstract: Supporting medical students’ and junior doctors’ development in busy clinical settings is challenging. As opportunities for developing trainees, for ex le, traditional bedside teaching, are decreasing, teaching outside of clinical practice is increasing. However, evidence suggests that effective learning through practice arises via an interplay between, first, what experiences are afforded by clinical settings and, second, how trainees engage with these affordances. Many studies investigating clinician learning through practice focus on only one of these two factors. Yet, a well-recognised methodological challenge of enabling learners to articulate how and what they are learning through practice exists. We need, therefore, to understand how this relationship plays out in practice in ways that enrich learning. This protocol describes a video reflexive ethnographic approach to illuminate how learning through practice in hospital settings occurs and can be enriched. The study will be conducted in two phases. In phase I, senior clinicians from emergency medicine, medicine and surgical specialties will be interviewed about how they guide trainees’ learning through practice. These forms of guidance, analysed using the framework method, will inform phase II comprising observations of practice in: (1) emergency, (2) medical and (3) surgical departments. Video recorded episodes of clinicians’ guiding learning through practice will be shared and appraised in reflexive sessions with each clinical team. Relational interdependent learning theory informs the design and data analyses to elicit and evaluate strategies for guiding learning through practice. Ethical approval has been received from both healthcare and university settings. The findings should provide important insights for clinicians about workplace learning practices. Findings will be disseminated across the project phases and to erse audiences—locally, nationally and internationally. The dissemination strategy will use seminars, grand rounds, conference presentations and academic papers to articulate practical, theoretical and methodological findings.
Publisher: Informa UK Limited
Date: 14-10-2019
Publisher: Wiley
Date: 16-12-2016
DOI: 10.1111/MEDU.13124
Abstract: Qualitative research is widely accepted as a legitimate approach to inquiry in health professions education (HPE). To secure this status, qualitative researchers have developed a variety of strategies (e.g. reliance on post-positivist qualitative methodologies, use of different rhetorical techniques, etc.) to facilitate the acceptance of their research methodologies and methods by the HPE community. Although these strategies have supported the acceptance of qualitative research in HPE, they have also brought about some unintended consequences. One of these consequences is that some HPE scholars have begun to use terms in qualitative publications without critically reflecting on: (i) their ontological and epistemological roots (ii) their definitions, or (iii) their implications. In this paper, we share our critical reflections on four qualitative terms popularly used in the HPE literature: thematic emergence triangulation saturation, and member checking. We discuss the methodological origins of these terms and the applications supported by these origins. We reflect critically on how these four terms became expected of qualitative research in HPE, and we reconsider their meanings and use by drawing on the broader qualitative methodology literature. Through this examination, we hope to encourage qualitative scholars in HPE to avoid using qualitative terms uncritically and non-reflexively.
Publisher: Wiley
Date: 24-07-2018
DOI: 10.1111/MEDU.13643
Publisher: Wiley
Date: 10-04-2013
DOI: 10.1111/MEDU.12158
Publisher: Informa UK Limited
Date: 16-02-2015
Publisher: Wiley
Date: 13-12-2018
DOI: 10.1111/MEDU.13777
Publisher: Informa UK Limited
Date: 15-06-2022
Publisher: Informa UK Limited
Date: 02-02-2018
Publisher: Springer International Publishing
Date: 2019
Publisher: Springer International Publishing
Date: 2019
Publisher: Springer Science and Business Media LLC
Date: 03-06-2011
DOI: 10.1007/S10459-011-9302-7
Abstract: Communication is an important area in health professional education curricula, however it has been dealt with as discrete skills that can be learned and taught separate to the underlying thinking. Communication of clinical reasoning is a phenomenon that has largely been ignored in the literature. This research sought to examine how experienced physiotherapists communicate their clinical reasoning and to identify the core processes of this communication. A hermeneutic phenomenological research study was conducted using multiple methods of text construction including repeated semi-structured interviews, observation and written exercises. Hermeneutic analysis of texts involved iterative reading and interpretation of texts with the development of themes and sub-themes. Communication of clinical reasoning was perceived to be complex, dynamic and largely automatic. A key finding was that articulating reasoning (particularly during research) does not completely represent actual reasoning processes but represents a (re)construction of the more complex, rapid and multi-layered processes that operate in practice. These communications are constructed in ways that are perceived as being most relevant to the audience, context and purpose of the communication. Five core components of communicating clinical reasoning were identified: active listening, framing and presenting the message, matching the co-communicator, metacognitive aspects of communication and clinical reasoning abilities. We propose that communication of clinical reasoning is both an inherent part of reasoning as well as an essential and complementary skill based on the contextual demands of the task and situation. In this way clinical reasoning and its communication are intertwined, providing evidence for the argument that they should be learned (and explicitly taught) in synergy and in context.
Publisher: Wiley
Date: 02-07-2023
DOI: 10.1111/MEDU.15152
Abstract: Assessment plays a key role in competence development and the shaping of future professionals. Despite its presumed positive impacts on learning, unintended consequences of assessment have drawn increasing attention in the literature. Considering professional identities and how these can be dynamically constructed through social interactions, as in assessment contexts, our study sought to understand how assessment influences the construction of professional identities in medical trainees. Within social constructionism, we adopted a discursive, narrative approach to investigate the different positions trainees narrate for themselves and their assessors in clinical assessment contexts and the impact of these positions on their constructed identities. We purposively recruited 28 medical trainees (23 students and five postgraduate trainees), who took part in entry, follow‐up and exit interviews of this study and submitted longitudinal audio/written diaries across nine‐months of their training programs. Thematic framework and positioning analyses (focusing on how characters are linguistically positioned in narratives) were applied using an interdisciplinary teamwork approach. We identified two key narrative plotlines, striving to thrive and striving to survive , across trainees' assessment narratives from 60 interviews and 133 diaries. Elements of growth, development , and improvement were identified as trainees narrated striving to thrive in assessment. Neglect, oppression and perfunctory narratives were elaborated as trainees narrated striving to survive from assessment. Nine main character tropes adopted by trainees with six key assessor character tropes were identified. Bringing these together we present our analysis of two exemplary narratives with elaboration of their wider social implications. Adopting a discursive approach enabled us to better understand not only what identities are constructed by trainees in assessment contexts but also how they are constructed in relation to broader medical education discourses. The findings are informative for educators to reflect on, rectify and reconstruct assessment practices for better facilitating trainee identity construction.
Publisher: Wiley
Date: 18-08-2017
DOI: 10.1111/MEDU.13371
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2020
DOI: 10.1097/ACM.0000000000003716
Abstract: Feedback pedagogies and research tend to focus on immediate corrective actions rather than learning for the longer term. This approach means that feedback may not support trainees who are managing complex, competing, and ambiguous practice situations, often with limited supervision. There is an opportunity to consider how feedback can help medical trainees sustain their own development into the future, including when they have completed formal training. This article explores how feedback pedagogies can facilitate medical trainees’ abilities to develop challenging aspects of practice across multiple clinical environments to eventually practice without supervision. From a sociocultural perspective, clinical training takes place within a practice curriculum each clinical environment offers varying opportunities, which the trainees may choose to engage with. The authors propose feedback as an interpersonal process that helps trainees make sense of both formal training requirements and performance relevant information, including workplace cues such as patient outcomes or colleagues’ comments, found within any practice curriculum. A significant pedagogic strategy may be to develop trainees’ evaluative judgment or their capability to identify and appraise the qualities of good practice in both themselves and others. In this way, feedback processes may help trainees surmount complex situations and progressively gain independence from supervision.
Publisher: Queensland University of Technology
Date: 13-12-2019
Abstract: Ensuring student success has long been on the research agenda in higher education. In this study, we seek to understand if the changes students make in light of academic failure are consistent with this literature. Little is known about students who fail but subsequently persist in their studies. Through an online survey with students who had failed and persisted, we identified drivers for persistence and how students adapted in response to academic failure. Thematic analysis showed that the majority of students did not seek institutional support following academic failure but they did seek support from peers, family and friends. These adaptations occurred at multiple levels: dispositional, situational and institutional. Drivers reported were internal (desire to complete) and external (desire to meet expectations). Although the majority of our students showed positive adaptations following academic failure, a significant portion reported no changes to their academic strategies. The paper poses the question of how students who fail can be better supported to continue successfully.
Publisher: Wiley
Date: 27-09-2020
DOI: 10.1111/MEDU.14348
Publisher: Springer Science and Business Media LLC
Date: 12-2010
Publisher: Informa UK Limited
Date: 20-06-2022
Publisher: Elsevier BV
Date: 12-2016
Publisher: Wiley
Date: 18-08-2011
Publisher: Routledge
Date: 08-12-2022
Publisher: Emerald
Date: 11-05-2015
Abstract: – This paper aims to explore how opportunities for learning clinical skills are negotiated within bedside teaching encounters (BTEs). Bedside teaching, within the medical workplace, is considered essential for helping students develop their clinical skills. – An audio and/or video observational study examining seven general practice BTEs was undertaken. Additionally, audio-recorded, semi-structured interviews were conducted with participants. All data were transcribed. Data analysis comprised Framework Analysis informed by Engeström’s Cultural Historical Activity Theory. – BTEs can be seen to offer many learning opportunities for clinical skills. Learning opportunities are negotiated by the participants in each BTE, with patients, doctors and students playing different roles within and across the BTEs. Tensions emerged within and between nodes and across two activity systems. – Negotiation of clinical skills learning opportunities involved shifts in the use of artefacts, roles and rules of participation, which were tacit, dynamic and changing. That learning is constituted in the activity implies that students and teachers cannot be fully prepared for BTEs due to their emergent properties. Engaging doctors, students and patients in reflecting on tensions experienced and the factors that influence judgements in BTEs may be a useful first step in helping them better manage the roles and responsibilities therein. – The paper makes an original contribution to the literature by highlighting the tensions inherent in BTEs and how the negotiation of roles and ision of labour whilst juggling two interacting activity systems create or inhibit opportunities for clinical skills learning. This has significant implications for how BTEs are conceptualised.
Publisher: Springer Science and Business Media LLC
Date: 16-02-2018
DOI: 10.1007/S10459-018-9814-5
Abstract: Demand for postgraduate qualifications in medical education can be judged by the increase in providers worldwide over the last two decades. However, research into the impact of such courses on identity formation of healthcare professionals is limited. This study investigates the influence of such programmes on graduates' educational identities, practices and career progression. Informed by constructivist grounded theory (CGT), semi-structured interviews were conducted with 27 graduates (2008-2012) from one postgraduate programme, who were at different stages in their careers worldwide. The audio data were transcribed and analysed using a CGT approach. Participants enrolled in award-bearing medical education courses for various intrinsic and extrinsic reasons. The findings from this study highlight their development as educators, and educational researchers, leaders and learners, as their self-efficacy in educational practices and engagement in scholarly activities increased. Graduates attributed career progression to the qualification, with many being promoted into senior positions. They also described substantial performance attainments in the workplace. The findings contribute to understanding the complexity and nuances of educational identity formation of healthcare professionals. A qualification in medical education encouraged transformational changes and epistemological development as an educator. Awareness of these findings will inform both those considering enrolment and those supporting them of potential benefits of these programmes.
Publisher: SensePublishers
Date: 2013
Publisher: Informa UK Limited
Date: 08-08-2019
Publisher: Springer Science and Business Media LLC
Date: 12-10-2017
DOI: 10.1007/S10459-017-9797-7
Abstract: The Objective Structured Clinical Examination (OSCE) is a ubiquitous part of medical education, although there is some debate about its value, particularly around possible impact on learning. Literature and research regarding the OSCE is most often situated within the psychometric or competency discourses of assessment. This paper describes an alternative approach: Actor-network-theory (ANT), a sociomaterial approach to understanding practice and learning. ANT provides a means to productively examine tensions and limitations of the OSCE, in part through extending research to include social relationships and physical objects. Using a narrative ex le, the paper suggests three ANT-informed insights into the OSCE. We describe: (1) exploring the OSCE as a holistic combination of people and objects (2) thinking about the influences a checklist can exert over the OSCE and (3) the implications of ANT educational research for standardisation within the OSCE. We draw from this discussion to provide a practical agenda for ANT research into the OSCE. This agenda promotes new areas for exploration in an often taken-for-granted assessment format.
Publisher: Informa UK Limited
Date: 17-03-2023
Publisher: Informa UK Limited
Date: 03-09-2015
DOI: 10.1080/14739879.2015.1079017
Abstract: Standards for undergraduate medical education in the UK, published in Tomorrow's Doctors, include the criterion 'everyone involved in educating medical students will be appropriately selected, trained, supported and appraised'. To establish how new general practice (GP) community teachers of medical students are selected, initially trained and assessed by UK medical schools and establish the extent to which Tomorrow's Doctors standards are being met. A mixed-methods study with questionnaire data collected from 24 lead GPs at UK medical schools, 23 new GP teachers from two medical schools plus a semi-structured telephone interview with two GP leads. Quantitative data were analysed descriptively and qualitative data were analysed informed by framework analysis. GP teachers' selection is non-standardised. One hundred per cent of GP leads provide initial training courses for new GP teachers 50% are mandatory. The content and length of courses varies. All GP leads use student feedback to assess teaching, but other required methods (peer review and patient feedback) are not universally used. To meet General Medical Council standards, medical schools need to include equality and ersity in initial training and use more than one method to assess new GP teachers. Wider debate about the selection, training and assessment of new GP teachers is needed to agree minimum standards.
Publisher: Informa UK Limited
Date: 29-04-2021
Publisher: Informa UK Limited
Date: 28-05-2022
Publisher: Elsevier BV
Date: 12-2018
Publisher: Informa UK Limited
Date: 26-08-2021
Publisher: Springer International Publishing
Date: 2019
Publisher: BMJ
Date: 04-2016
Publisher: Springer International Publishing
Date: 2019
Publisher: Springer International Publishing
Date: 2019
Publisher: Springer International Publishing
Date: 2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2020
DOI: 10.1097/ACM.0000000000003143
Abstract: Sociomaterial perspectives in research are those that encourage researchers to focus their inquiry on the relationships between people (social) and things (material), rather than focusing solely on people. The unique possibility of sociomaterial perspectives is increasingly recognized in health professions education scholarship. In an effort to support those who may be interested in engaging with the principles of sociomaterialism in their own work, the authors have developed a primer on this paradigm of research. This Invited Commentary—one of several exploring different philosophies of science—offers an overview of the ontological, epistemological, axiological, and methodological foundations of sociomateriality. The authors then put these ideas into action, highlighting the philosophical foundations of sociomaterial perspectives in a s le case study that tells the story of Lee, a resident involved in a medical error.
Publisher: Springer Science and Business Media LLC
Date: 08-02-2007
DOI: 10.1007/S10459-006-9032-4
Abstract: One of the key attributes that health professional students and new graduates develop during professional socialisation is clinical reasoning ability. Clinical reasoning is a complex skill that is essential for professional practice. There is limited research specifically addressing how physiotherapists learn to reason in the workplace. The research reported in this paper addressed this gap by investigating how experienced physiotherapists learned to reason in daily practice. This learning journey was examined in the context of professional socialisation. A hermeneutic phenomenological research study was conducted using multiple methods of data collection including observation, written reflective exercises and repeated, semi-structured interviews. Data were analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Twelve physiotherapists with clinical and supervisory experience were recruited from the areas of cardiopulmonary, musculoskeletal and neurological physiotherapy to participate in this study. Participants' learning journeys were erse, although certain episodes of learning were common or similar. Role models, mentors and colleagues were found to be influential in the development of reasoning. An important implication for the professional socialisation of physiotherapists and other health professionals and for those involved in practice development is the need to recognise and enhance the role of practice communities in the explicit learning of clinical reasoning skills.
Publisher: Wiley
Date: 16-01-2013
DOI: 10.1111/MEDU.12055
Abstract: Bedside teaching is essential for helping students develop skills, reasoning and professionalism, and involves the learning triad of student, patient and clinical teacher. Although current rhetoric espouses the sharing of power, the medical workplace is imbued with power asymmetries. Power is context-specific and although previous research has explored some elements of the enactment and resistance of power within bedside teaching, this exploration has been conducted within hospital rather than general practice settings. Furthermore, previous research has employed audio-recorded rather than video-recorded observation and has therefore focused on language and para-language at the expense of non-verbal communication and human-material interaction. A qualitative design was adopted employing video- and audio-recorded observations of seven bedside teaching encounters (BTEs), followed by short in idual interviews with students, patients and clinical teachers. Thematic and discourse analyses of BTEs were conducted. Power is constructed by students, patients and clinical teachers throughout different BTE activities through the use of linguistic, para-linguistic and non-verbal communication. In terms of language, participants construct power through the use of questions, orders, advice, pronouns and medical/health belief talk. With reference to para-language, participants construct power through the use of interruption and laughter. In terms of non-verbal communication, participants construct power through physical positioning and the possession or control of medical materials such as the stethoscope. Using this paper as a trigger for discussion, we encourage students and clinical teachers to reflect critically on how their verbal and non-verbal communication constructs power in bedside teaching. Students and clinical teachers need to develop their awareness of what power is, how it can be constructed and shared, and what it means for the student-patient-doctor relationship within bedside teaching.
Publisher: Wiley
Date: 03-2009
DOI: 10.1111/J.1365-2923.2008.03280.X
Abstract: Internationally, there are a number of universities at which medical and dental education programmes share common elements. There are no studies about the experiences of medical and dental students enrolled in different programmes who share significant amounts of learning and teaching. Semi-structured interviews and focus groups were conducted with 36 students and staff in a learning programme shared between separate medical and dental faculties. They were transcribed and an iterative process of interpretation and analysis within the theoretical framework of the contact hypothesis and social identity theory was used to group data into themes and sub-themes. Dental students felt 'marginalised' and felt they were treated as 'second-class citizens' by medical students and medical staff in the shared aspects of their programmes. Contextual factors such as the geographical location of the two schools, a medical : dental student ratio of almost 3 : 1, along with organisational factors such as curriculum overload, propagated negative attitudes towards and professional stereotyping of the dental students. Lack of understanding by medical students and faculty of dental professional roles contributed further. Recommendations for reducing the marginalisation of dental students in this setting include improving communication between faculties and facilitating experiential contact. This might be achieved through initiating a common orientation session, stronger social networks and integrated learning activities, such as interprofessional problem-based learning and shared clinical experiences.
No related grants have been discovered for Rola Ajjawi.