Factors affecting general practitioners' decisions about plain radiography for back pain: implications for classification of guideline barriers – a qualitative study

BACKGROUND: General practitioners often diverge from clinical guidelines regarding spine radiography. This study aimed to identify and describe A) factors general practitioners consider may affect their decisions about ordering plain radiography for back pain and B) barriers to guideline adherence suggested by such factors. METHODS: Focus group interviews regarding factors affecting ordering decisions were carried out on a diverse sample of Norwegian general practitioners and were analysed qualitatively. Results of this study and two qualitative studies from the Netherlands and USA on use of spine radiography were interpreted for barriers to guideline adherence. These were compared with an existing barrier classification system described by Dr Cabana's group. RESULTS: The factors which Norwegian general practitioners considered might affect their decisions about ordering plain radiography for back pain concerned the following broader issues: clinical ordering criteria, patients' wishes for radiography and the general practitioner's response, uncertainty, professional dignity, access to radiology services, perception of whether the patient really was ill, sense of pressure from other health care providers/social security, and expectations about the consequences of ordering radiography. The three studies suggested several attitude-related and external barriers as classified in a previously reported system described by Dr Cabana in another study. Identified barriers not listed in this system were: lack of expectancy that guideline adherence will lead to desired health care process, emotional difficulty with adherence, improper access to actual/alternative health care services, and pressure from health care providers/organisations. CONCLUSIONS: Our findings may help implement spine radiography guidelines. They also indicate that Cabana et al.'s barrier classification system needs extending. A revised system is proposed

Ricoeur’s triple mimesis and the zone of proximal development in the learning processes of interprofessional student teams

It has been reported that the temporal aspects of the zone of proximal development (ZPD) are underanalyzed. The aim of this article is to use the literary science concept of Paul Ricoeur’s triple mimesis to elucidate unanalyzed aspects of the temporal living and learning processes of interprofessional teams in the ZPD. Both mimesis2 and ZPD are temporal constructs embedded in the present of time, and for both mimesis2 and ZPD, activity is created and carried by the actors. While the internal processes in ZPD have remained unanalyzed to date, Ricoeur provides emplotment with its procedural mechanisms for the activity in mimesis2. Being narrating beings, humans have an affinity for narrative emplotments that then structure the activities in the ZPD. Because mimesis2 is based on narrative time, the basic requirement for employing mimesis2 in ZPD is that the ZPD has a narrative base, which is probable when health students are the actors and the case they are working on is a patient.publishedVersio

Reflexivity in Interprofessional Workplace Learning

Despite a vast literature oninterprofessional teamwork, it is still unclear how learning in interprofessional student teams proceed at the workplace. We aim to elucidate reflexivity conceptually in interprofessional workplace learning and describe some possibilities for how reflexivity may drive learning in interprofessional teams. We define reflexivity as the regular exercise of the mental ability shared by all normal people, to consider themselves in relation to their (social) contexts and vice versa. We elaborate reflexivity conceptually through existing theoriesand seekto construct new aspects of the concept for increased meaning and understanding of the role of reflexivity in interprofessional team learning. We describe how different modes of individuals may interplay, driving the teamwork and the tasks further. The different modes of reflexivity resulting from our analysis may be usefulfor elucidatinghow interprofessional learning proceed in a course, and thereby our results be of use for course organizers.publishedVersio

Team reflexivity and the shared mind in interprofessional learning

In interprofessional (IP) workplace education, course and project leaders need a deeper understanding of how students learn. Basically, in IP workplace learning students learn from each other, from the affected agents (patients, clients, children, youth, or elderly), from the staff, and from using multitudes of artifacts. Most of these interpersonal processes are largely tacit, and we therefor decided on elucidating their possible parts in IP learning theoretically, focusing on central interpersonal aspects of team learning processes; team reflexivity and intersubjectivity. Consequently, our study aim was to elucidate possible associations between team reflexivity and the shared mind when students in the IP team interact within each other, with the people and with the artifacts around them. In this article we investigate, elaborate, and conceptualize relevant social theories which address aspects of team reflexivity and intersubjective activities. We will then elaborate and conceptualize consequences for increased understanding IP team learning. Based on our mutual libraries, we have searched in PubMed and Google Scholar for team reflexivity, intersubjectivity, shared mind and their combinations. We came to understand reflexivity and team reflexivity as mostly tacit activities which may be regarded as being interpersonal and self-pacing. Intersubjectivity is however based on the free interaction between minds, orchestrating each other with common ideas, thoughts, attitudes, and bodily actions. Intersubjectivity is created when team members’ verbal and non-verbal activities resonate, giving a shared feeling of developing mutual and common ideas, concepts, and understanding. Team reflexivity, and intersubjectivity are necessary aspects in understanding the learning processes in IP student teams, and we have sketched some consequences for IP course design.publishedVersio

HUBUNGAN ANTARA IMPLEMENTASI PERPADUAN SISTEM PENDIDIKAN PESANTREN MODERN DAN TRADISIONAL DENGAN MOTIVASI DAN PRESTASI BELAJAR SANTRI (Studi Kasus di Pesantren Sabilunnajat KecamatanRancahKabupaten Ciamis)

Aip Syarifudin NIM 505810002: Hubungan Implementasi Pola Pendidikan Pesantren Tradisional dan Modern dengan Motivasi Belajar dan Prestasi Belajar Santri di Pesantren Sabilunnajat Rancah Kabupaten Ciamis Berdasarkan studi pendahuluan yang penulis lakukan di Pesantren Sabilunnajat Rancah Kabupaten Ciamis telah menerapkan perpaduan pola pendidikan pesantren tradisional dan modern. Implementasi ini dilakukan dengan memasukan kurikulum pendidikan umum yang dikolaborasikan dengan pendidikan agama. Implementasi perpaduan ini juga dilakukan dengan mendirikan lembaga pendidikan formal mulai dari tingkat RA sampai SMK. Dalam praktiknya, pola ini masih harus diuji dan dibuktikan pengaruhnya terhadap peningkatan motivasi dan prestasi belajar santri. Tujuan dari penelitian ini adalah untuk: 1). Menjelaskan implementasi perpaduan pola pendidikan pesantren tradisional dan pesantren; 2). Menjelaskan motivasi dan prestasi Belajar Santri di Pesantren Sabilunnajat Rancah Kabupaten Ciamis; dan 3). Mengetahui seberapa besar hubungan Implementasi Pola Pendidikan Pesantren Tradisional dan Modern dengan Motivasi Belajar dan Prestasi Belajar Santri di Pesantren Sabilunnajat Rancah Kabupaten Ciamis. Dasar pemikiran penelitian ini adalah isu pembaharuan pendidikan di pesantren yang selama ini di kenal dengan pesantren tradisional (salafy) sudah mulai marak. Pembaharuan ini dilakukan dengan pertimbangan semakin pesatnya zaman menuntut lembaga pendidikan untuk merespons dengan penerapan kurikulum berbasis pasar. Hal ini mendorong beberapa pesantren tradisional untuk melakukan inovasi dengan mengkombinasikan pendidikan tradisional khas pesantren dan modern yang banyak mengadopsi dari pendidikan formal. Metode yang digunakan dalam penelitian ini adalah metode observasi, angket dan studi dokumentasi. Metode survey adalah penelitian yang dilakukan pada populasi besar maupun kecil, tetapi data yang dipelajari adalah data dari sampel yang diambil dari populasi tersebut. Metode survey biasanya digunakan untuk menjelaskan hubungan-hubungan korelasional antara satu variabel dengan variabel lainnya (corelational relationship), disamping untuk menguji hipotesis dan signifikansinya Hasil Penelitian ini yaitu; [1] implementasi perpaduan pola pendidikan pesantren tradisional dan modern di Pesantren Sabilunnajat Rancah Kabupaten Ciamis berdasarkan hasil angket termasuk dalam Kriteria baik. Hal ini dapat diketahui dari pola pendidikan yang ada terbukti telah berjaalan dengan baik. [2] Motivasi belajar belajar santri di Pesantren Sabilunnajat Rancah Kabupaten Ciamis berdasarkan angket termasuk dalam kriteria baik. Dimana 80% santri memiliki nilai rata-rata 90. [3] Hubungan Motivasi Belajar santri dan Prestasi Belajar Santri dengan pola pendidikan di Pesantren Sabilunnajat Rancah Kabupaten Ciamis terdapat korelasi yang signifikan (0,517) dengan kisaran hubungan korelasional sebesar 26%. Hasil pengujian hipotesis antar variabel Motivasi Belajar dan Prestasi Belajar Santri berhubungan positif dan signifikan

A few more minutes make a difference? The relationship between content and length of GP consultations

Objectives. To investigate the relationship between the length of a medical consultation in a general practice setting and the biopsychosocial information obtained by the physician, and to explore the characteristics of young physicians obtaining comprehensive, especially psychosocial information. Design. A prospective, longitudinal follow-up study. Setting. Videotaped consultations with standardized patients on two occasions were scored for the amount of biopsychosocial information obtained. Consultation length was recorded in minutes. Subjects. Final-year (T-1) medical school students (n = 111) participated in the project. On completion of their internship one and a half years later (T-2), 62 attended a second time, as young physicians. Main outcome measures. Content lists. Results. Pearson's r correlations between content and length at T-1 and T-2 were 0.27 and 0.66, respectively (non-overlapping confidence intervals). Psychosocial content increased significantly when consultations exceeded 13 minutes (15 minutes scheduled). Physicians using more than 13 minutes had previously, as hospital interns, perceived more stress in the emergency room and had worked in local hospitals. Conclusions. A strong association was found between consultation length and information, especially psychosocial information, obtained by the physicians at internship completion. This finding should be considered by faculty members and organizers of the internship period. Further research is needed to detect when, during the educational process, increased emphasis on communication skills training would be most beneficial for students/residents, and how the medical curriculum and internship period should be designed to optimize young physicians’ use of time in consultations.publishedVersio

Have medical students’ attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study

Background Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students’ training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students’ attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period. Methods The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning. Results Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys. Conclusions Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.publishedVersio

Analysis of role-play in medical communication training using a theatrical device the fourth wall

BACKGROUND: Communication training is a central part of medical education. The aim of this article is to explore the positions and didactic functions of the fourth wall in medical communication training, using a role-play model basically similar to a theatrical performance. METHOD: The empirical data stem from a communication training model demonstrated at an international workshop for medical teachers and course organizers. The model involves an actress playing a patient, students alternating in the role of the doctor, and a teacher who moderates. The workshop was videotaped and analyzed qualitatively. RESULTS: The analysis of the empirical material revealed three main locations of the fourth wall as it moved and changed qualities during the learning session: 1) A traditional theatre location, where the wall was transparent for the audience, but opaque for the participants in the fiction. 2) A "timeout/reflection" location, where the wall was doubly opaque, for the patient on the one side and the moderator, the doctor and the audience on the other side and 3) an "interviewing the character" location where the wall enclosed everybody in the room. All three locations may contribute to the learning process. CONCLUSION: The theatrical concept 'the fourth wall' may present an additional tool for new understanding of fiction based communication training. Increased understanding of such an activity may help medical teachers/course organizers in planning and evaluating communication training courses

Feedback on video recorded consultations in medical teaching: why students loathe and love it – a focus-group based qualitative study

BACKGROUND: Feedback on videotaped consultations is a useful way to enhance consultation skills among medical students. The method is becoming increasingly common, but is still not widely implemented in medical education. One obstacle might be that many students seem to consider this educational approach a stressful experience and are reluctant to participate. In order to improve the process and make it more acceptable to the participants, we wanted to identify possible problems experienced by students when making and receiving feedback on their video taped consultations. METHODS: Nineteen of 75 students at the University of Bergen, Norway, participating in a consultation course in their final term of medical school underwent focus group interviews immediately following a video-based feedback session. The material was audio-taped, transcribed, and analysed by phenomenological qualitative analysis. RESULTS: The study uncovered that some students experienced emotional distress before the start of the course. They were apprehensive and lacking in confidence, expressing fear about exposing lack of skills and competence in front of each other. The video evaluation session and feedback process were evaluated positively however, and they found that their worries had been exaggerated. The video evaluation process also seemed to help strengthen the students' self esteem and self-confidence, and they welcomed this. CONCLUSION: Our study provides insight regarding the vulnerability of students receiving feedback from videotaped consultations and their need for reassurance and support in the process, and demonstrates the importance of carefully considering the design and execution of such educational programs

Curriculum factors influencing knowledge of communication skills among medical students

Background Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students. Methods The study design was a cross-sectional survey performed in the four Norwegian medical schools with different curricula, spring 2003. A self-administered questionnaire regarding knowledge of communication skills (an abridged version of van Dalen's paper-and-pencil test) was sent to all students attending the four medical schools. A total of 1801 (59%) students responded with complete questionnaires. Results At the end of the 1st year of study, the score on the knowledge test was higher in students at the two schools running communication courses and providing early patient contact (mean 81%) than in the other two medical schools (mean 69–75%, P ≤ 0.001), with students studying a traditional curriculum scoring the lowest. Their scores increased sharply towards the end of the 3rd year, during which they had been subjected to extensive patient contact and had participated in an intensive communication course (77% vs. 72% the previous year, P ≤ 0.01). All students scored generally lower in academic years in which there was no communication training. However, at the end of the final year the difference between the schools was only 5% (81% vs. 86%, P ≤ 0.001). Conclusion The acquisition of knowledge regarding communication skills by medical students may be optimised when the training is given together with extensive supervised patient contact, especially if this teaching takes place in the initial years of the curriculum