#any use? What do we know about how teachers and doctors learn through social media use?

This scoping literature review describes the landscape of recent publications (2007-2016) about how teachers and doctors learn through social media to identify whether learning was being considered and, if so, how evidence was collected (N=162). Sixty-seven percent (N=108) were teacher-related and thirty-three percent (N=54) doctor-related, covering empirical studies, literature reviews, position articles and letters to academic journals. Empirical studies were dominant – ninety-one percent (N=98) of teacher-related and sixty-one percent (N=33) of doctor-related – with both fields dominated by in-course evaluations and use/attitude studies. Although doctor-related articles focused on professional online behaviour, rather than professional learning, conference communication and information evaluation were interesting areas of enquiry. Despite professional interest in social media in these professions, there is a dearth of academic studies about their benefits for teacher and doctor learning

A paradigmatic map of professional education research

This article maps out research in professional education with reference to a threefold typology of paradigms i.e. the positivist, interpretivist and critical paradigms. The rationale for such an endeavour is fourfold. First, it directs attention to the neglected territory of methodology which is essential for researcher reflexivity. Second, it shows that most research in social work education has been situated within the positivist or interpretivist paradigms, and the relative dearth of studies in the critical paradigm raises important questions about anti-oppressive practice in research. Third, a comparison of studies in different spheres of professional education indicates that research into social work education has often not been as rich or robust as research into medicine or teaching, and this deserves further reflection. Finally, there is a practical rationale – although this exercise casts doubt upon our current capacity to develop evidence-based educational reforms, it should also signpost fruitful avenues for future research

Boosting clinical performance: The impact of enhanced final year placements.

BACKGROUND: This study follows on from a study that investigated how to develop effective final year medical student assistantship placements, using multidisciplinary clinical teams in planning and delivery. AIMS: This study assessed the effects on objective structured clinical examination (OSCE) performance of the in-course enhanced "super-assistantship" placement introduced to a randomly selected sample of 2013-14 final year medical students at Leeds medical school. METHODS: Quantitative data analysis was used to compare the global grades of OSCE stations between students who undertook this placement against those who did not. RESULTS: There was a small overall improvement in the "super-assistantship" student scores across the whole assessment (effect size = 0.085). "Pre-op Capacity", "Admissions Prescribing" and "Hip Pain" stations had small-medium effect sizes (0.226, 0.215, and 0.214) in favor of the intervention group. Other stations had small effect sizes (0.107-0.191), mostly in favor of the intervention group. CONCLUSIONS: The "super-assistantship" experience characterized by increasing student responsibility on placement can help to improve competence and confidence in clinical decision-making "in a simulated environment". The clinical environment and multidisciplinary team must be ready and supported to provide these opportunities effectively. Further in-course opportunities for increasing final year student responsibility should be developed

A concept analysis of ‘GP trainer’ : a misnomer?

This article analyses the concept of the GP trainer. The framework developed by Walker and Avant (2005) is used. The aims were: 1) to clarify the concept and its fundamental qualities; and 2) to question whether the term trainer is apposite to the concept it represents. A literature search was performed in three databases and a search engine for the keywords [GP OR general practitioner] AND [trainer OR educational supervisor]. An online dictionary was used to define the noun trainer and the verb train. In addition, three colleagues were interviewed about how they conceptualised the GP trainer. Only six articles were found that address the desirable characteristics of the GP trainer. However, a large list of qualities was obtained from these studies and the other methods mentioned. The characteristics of the GP trainer were grouped using phenomenological tools into the three main categories of personal, professional and teaching attributes. Each category was further subdivided into the domains of knowledge, skills and attitudes. The GP trainer incorporates the three facets of ‘wise person’, ‘accomplished GP’ and ‘gifted teacher’. It is shown that the term educational supervisor describes the complex educational role of a teacher of GPs better than trainer.peer-reviewe

Medical students writing on death, dying and palliative care : a qualitative analysis of reflective essays

Background: Medical students and doctors are becoming better prepared to care for patients with palliative care needs and support patients at the end of life. This preparation needs to start at medical school. Objective: To assess how medical students learn about death, dying and palliative care during a clinical placement using reflective essays and to provide insights to improve medical education about end of life care and/or palliative care. Methods: Qualitative study in which all reflective essays written by third year medical students in one year from a UK medical school were searched electronically for those that included ‘death’, ‘dying’ and ‘palliative care’. The anonymised data were managed using QSR NVivo 10 software, and a systematic analysis was conducted in three distinct phases: (1) open coding; (2) axial coding and (3) selective coding. Ethical approval was received. Results: Fifty-four essays met the inclusion criteria from 241 essays screened for the terms ‘death’, ‘dying’ or ‘palliative’, 22 students gave consent for participation and their 24 essays were included. Saturation of themes was reached. Three overarching themes were identified: emotions, empathy, and experiential and reflective learning. Students emphasised trying to develop a balance between showing empathy and their emotional state. Students learned a lot from clinical encounters and watching doctors manage difficult situations, as well as from their refection during and after the experience. Conclusions: Reflective essays give insights into the way students learn about death, dying and palliative care and how it affects them personally as well as the preparation that is needed to be better equipped to deal with these kinds of experiences. Analysis of the essays enabled the proposal of new strategies to help make them more effective learning tools and to optimise students’ learning from a palliative care attachment

Medical student confidence to care for a dying patient and their family: a systematic review

Background: The General Medical Council expects medical graduates to care for dying patients with skill, clinical judgement and compassion. UK surveys continually demonstrate low confidence and increasing distress amongst junior doctors when providing care to the dying. Aim: This systematic review aims to determine what has been evidenced within worldwide literature regarding medical undergraduate confidence to care for dying patients. Design: A systematic electronic search was undertaken. Data extraction included measurements of baseline confidence, associated assessment tools, and details of applied educational interventions. Pre/post-intervention confidence comparisons were made. Factors influencing confidence levels were explored. The review was prospectively registered via PROSPERO (CRD42019119057). Data sources: MEDLINE, CINAHL, EMBASE, ISI Web of Science, ERIC, PsychINFO, British Education Index and Cochrane Review databases were accessed, with no restrictions on publication year. Eligible studies included the terms ‘medical student’, ‘confidence’, and ‘dying’, alongside appropriate MeSH headings. Study quality was assessed using the Mixed Methods Appraisal Tool. Results: Fifteen eligible studies were included, demonstrating a diversity of assessment tools. Student confidence was low in provision of symptom management, family support, and psycho-spiritual support to dying patients. Eight interventional studies demonstrated increased post-interventional confidence. Lack of undergraduate exposure to dying patients and lack of structure within undergraduate palliative care curricula were cited as factors responsible for low confidence. Conclusion: This review clarifies the objective documentation of medical undergraduate confidence to care for the dying. Identifying where teaching fails to prepare graduates for realities in clinical practice will help inform future undergraduate palliative care curriculum planning

Using a virtue ethics lens to develop a socially accountable community placement programme for medical students

Background: Community-based education (CBE) involves educating the head (cognitive), heart (affective), and the hand (practical) by utilizing tools that enable us to broaden and interrogate our value systems. This article reports on the use of virtue ethics (VE) theory for understanding the principles that create, maintain and sustain a socially accountable community placement programme for undergraduate medical students. Our research questions driving this secondary analysis were; what are the goods which are internal to the successful practice of CBE in medicine, and what are the virtues that are likely to promote and sustain them? Methods: We conducted a secondary theoretically informed thematic analysis of the primary data based on MacIntyre’s virtue ethics theory as the conceptual framework. Results: Virtue ethics is an ethical approach that emphasizes the role of character and virtue in shaping moral behavior; when individuals engage in practices (such as CBE), goods internal to those practices (such as a collaborative attitude) strengthen the practices themselves, but also augment those individuals’ virtues, and that of their community (such as empathy). We identified several goods that are internal to the practice of CBE and accompanying virtues as important for the development, implementation and sustainability of a socially accountable community placement programme. A service-oriented mind-set, a deep understanding of community needs, a transformed mind, and a collaborative approach emerged as goods internal to the practice of a socially accountable CBE. The virtues needed to sustain the identified internal goods included empathy and compassion, connectedness, accountability, engagement [sustained relationship], cooperation, perseverance, and willingness to be an agent of change. Conclusion: This study found that MacIntyre’s virtue ethics theory provided a useful theoretical lens for understanding the principles that create, maintain and sustain CBE practice

Can acquisition of expertise be supported by technology?

Professional trainees in the workplace are increasingly required to demonstrate specific standards of competence. Yet, empirical evidence of how professionals acquire competence in practice is lacking. The danger, then, is that efforts to support learning processes may be misguided. We hypothesised that a systemic view of how expertise is acquired would support more timely and appropriate development of technology to support workplace learning. The aims of this study were to provide an empirically based understanding of workplace learning and explore how learning could be facilitated through suitable application of technology. We have used the medical specialist trainee as an exemplar of how professionals acquire expertise within a complex working environment. We describe our methodological approach, based on the amalgam of systems analysis and qualitative research methods. We present the development of a framework for analysis and early findings from qualitative data analysis. Based on our findings so far, we present a tentative schema representing how technology can support learning with suggestions for the types of technology that could be used

Multidisciplinary teams, and parents, negotiating common ground in shared-care of children with long-term conditions: A mixed methods study

Background: Limited negotiation around care decisions is believed to undermine collaborative working between parents of children with long-term conditions and professionals, but there is little evidence of how they actually negotiate their respective roles. Using chronic kidney disease as an exemplar this paper reports on a multi-method study of social interaction between multidisciplinary teams and parents as they shared clinical care. Methods. Phases 1 and 2: a telephone survey mapping multidisciplinary teams' parent-educative activities, and qualitative interviews with 112 professionals (Clinical-psychologists, Dietitians, Doctors, Nurses, Play-specialists, Pharmacists, Therapists and Social-workers) exploring their accounts of parent-teaching in the 12 British children's kidney units. Phase 3: six ethnographic case studies in two units involving observations of professional/parent interactions during shared-care, and individual interviews. We used an analytical framework based on concepts drawn from Communities of Practice and Activity Theory. Results: Professionals spoke of the challenge of explaining to each other how they are aware of parents' understanding of clinical knowledge, and described three patterns of parent-educative activity that were common across MDTs: Engaging parents in shared practice; Knowledge exchange and role negotiation, and Promoting common ground. Over time, professionals had developed a shared repertoire of tools to support their negotiations with parents that helped them accomplish common ground during the practice of shared-care. We observed mutual engagement between professionals and parents where a common understanding of the joint enterprise of clinical caring was negotiated. Conclusions: For professionals, making implicit knowledge explicit is important as it can provide them with a language through which to articulate more clearly to each other what is the basis of their intuition-based hunches about parents' support needs, and may help them to negotiate with parents and accelerate parents' learning about shared caring. Our methodology and results are potentially transferrable to shared management of other conditions. © 2013 Swallow et al.; licensee BioMed Central Ltd