Apprentissage par l’expérience, collaboration et réflexion : les ingrédients clés de la formation professorale longitudinale

Background: Longitudinal faculty development (LFD) may allow for increased uptake of teaching skills, especially in a forum where teachers can reflect individually and collectively on the new skills. However, the exact processes by which such interventions are effective need further exploration. Methods: This qualitative study examined an LFD initiative teaching a novel feedback approach attended by five family practice physicians. The initiative began with two 1.5-hour workshops: Goal-Oriented Feedback (as the teaching skill to be developed) and Narrative Reflection (as the tool to support personal reflection on the skill being learned). Over the subsequent six-months, the five participants iteratively applied the feedback approach in their teaching and engaged in narrative reflection at four 1-hour group sessions. Transcripts from the group discussions and exit interviews were analyzed using thematic analysis. Results: Iteratively trialing, individually reflecting on, and collectively exploring efforts to implement the new feedback approach resulted in the development of a learning community among the group. This sense of community created a safe space for reflection, while motivating ongoing efforts to learn the skill. Individual pre-reflection prepared individuals for group co-reflection; however, written narratives were not essential. Conclusion: LFD initiatives should include an emphasis on ensuring opportunities for iterative attempts of teaching skills, guided self-reflection, and collaborative group reflection and learning to ensure sustainable change to teaching practices. Contexte : La formation professorale longitudinale (FPL) peut faciliter l’acquisition d’habiletés pédagogiques, surtout dans le cadre d’un forum où les enseignants peuvent réfléchir individuellement et collectivement à ces nouvelles habiletés. Cependant, les processus exacts qui rendent ces interventions efficaces doivent être explorés davantage. Méthodes : Cette étude qualitative examine une initiative de FPL qui comprend l’enseignement d’une nouvelle approche de rétroaction à laquelle ont participé cinq médecins de famille. L’initiative a commencé avec la tenue de deux ateliers d’une heure et demie, le premier sur la rétroaction axée sur les objectifs (l’habileté d’enseignement à développer) et le deuxième sur la réflexion narrative (comme outil pour soutenir la réflexion personnelle sur cette habileté en apprentissage). Au cours des six mois suivants, les cinq participants ont appliqué de manière itérative l’approche de la rétroaction dans leur enseignement et se sont livrés à une réflexion narrative lors de quatre séances de groupe d’une heure. Des transcriptions des discussions de groupe et des entretiens de clôture ont fait l’objet d’une analyse thématique. Résultats : L’expérimentation itérative, la réflexion individuelle et l’exploration collective des efforts de mise en œuvre de la nouvelle approche de rétroaction ont permis de développer une communauté d’apprentissage au sein du groupe. Ce sentiment de communauté a créé un environnement sûr pour la réflexion, tout en motivant les efforts continus pour apprendre l’habileté. La préréflexion individuelle préparait les participants à la co-réflexion de groupe; cependant, les récits écrits n’étaient pas essentiels. Conclusion :  Les initiatives de FPL devraient mettre l’emphase sur les occasions de mise en application itérative des habiletés d’enseignement, d’autoréflexion guidée et de réflexion et d’apprentissage collaboratifs en groupe pour assurer un changement durable des pratiques d’enseignement

Autoethnography: introducing \u27I\u27 into medical education research

Context: Autoethnography is a methodology that allows clinician-educators to research their own cultures, sharing insights about their own teaching and learning journeys in ways that will resonate with others. There are few examples of autoethnographic research in medical education, and many areas would benefit from this methodology to help improve understanding of, for example, teacher-learner interactions, transitions and interprofessional development. Objectives: We wish to share this methodology so that others may consider it in their own education environments as a viable qualitative research approach to gain new insights and understandings. Methods: This paper introduces autoethnography, discusses important considerations in terms of data collection and analysis, explores ethical aspects of writing about others and considers the benefits and limitations of conducting research that includes self. Results: Autoethnography allows medical educators to increasingly engage in self-reflective narration while analysing their own cultural biographies. It moves beyond simple autobiography through the inclusion of other voices and the analytical examination of the relationships between self and others. Autoethnography has achieved its goal if it results in new insights and improvements in personal teaching practices, and if it promotes broader reflection amongst readers about their own teaching and learning environments. Conclusions: Researchers should consider autoethnography as an important methodology to help advance our understanding of the culture and practices of medical education. Discuss ideas arising from the article at www.mededuc.com discuss. © 2015 John Wile

An autoethnographic exploration of the use of goal oriented feedback to enhance brief clinical teaching encounters

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\u27s 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

Attitudes Towards Physicians Requiring Remediation:One-of-Us or Not-Like-Us?

Purpose The data for this paper were collected as part of a larger project exploring how the medical profession conceptualizes the task of supporting physicians struggling with clinical competency issues. In this paper, the authors focus on a topic that has been absent in the literature thus far-how physicians requiring remediation are perceived by those responsible for organizing remediation and by their peers in general. Method Using a constructivist grounded theory approach, the authors conducted semistructured interviews with 17 remediation stakeholders across Canada. Given that in Canada health is a provincial responsibility, the authors purposively sampled stakeholders from across provincial and language borders and across the full range of organizations that could be considered as participating in the remediation of practicing physicians. Results Interviewees expressed mixed, sometimes contradictory, emotions toward and perceptions of physicians requiring remediation. They also noted that their colleagues, including physicians in training, were not always sympathetic to their struggling peers. Conclusions The medical profession's attitude toward those who struggle with clinical competency-as individuals and as a whole-is ambivalent at best. This ambivalence grows out of psychological and cultural factors and may be an undiscussed factor in the profession's struggle to deal adequately with underperforming members. To contend with the challenge of remediating practicing physicians, the profession needs to address this ambivalence and its underlying causes

Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development

Background: Longitudinal faculty development (LFD) may allow for increased uptake of teaching skills, especially in a forum where teachers can reflect individually and collectively on the new skills. However, the exact processes by which such interventions are effective need further exploration.Methods: This qualitative study examined an LFD initiative teaching a novel feedback approach attended by five family practice physicians. The initiative began with two 1.5-hour workshops: Goal-Oriented Feedback (as the teaching skill to be developed) and Narrative Reflection (as the tool to support personal reflection on the skill being learned). Over the subsequent six-months, the five participants iteratively applied the feedback approach in their teaching and engaged in narrative reflection at four 1-hour group sessions. Transcripts from the group discussions and exit interviews were analyzed using thematic analysis.Results: Iteratively trialing, individually reflecting on, and collectively exploring efforts to implement the new feedback approach resulted in the development of a learning community among the group. This sense of community created a safe space for reflection, while motivating ongoing efforts to learn the skill. Individual pre-reflection prepared individuals for group co-reflection; however, written narratives were not essential.Conclusion: LFD initiatives should include an emphasis on ensuring opportunities for iterative attempts of teaching skills, guided self-reflection, and collaborative group reflection and learning to ensure sustainable change to teaching practices.Contexte : La formation professorale longitudinale (FPL) peut faciliter l’acquisition d’habiletés pédagogiques, surtout dans le cadre d’un forum où les enseignants peuvent réfléchir individuellement et collectivement à ces nouvelles habiletés. Cependant, les processus exacts qui rendent ces interventions efficaces doivent être explorés davantage.Méthodes : Cette étude qualitative examine une initiative de FPL qui comprend l’enseignement d’une nouvelle approche de rétroaction à laquelle ont participé cinq médecins de famille. L’initiative a commencé avec la tenue de deux ateliers d’une heure et demie, le premier sur la rétroaction axée sur les objectifs (l’habileté d’enseignement à développer) et le deuxième sur la réflexion narrative (comme outil pour soutenir la réflexion personnelle sur cette habileté en apprentissage). Au cours des six mois suivants, les cinq participants ont appliqué de manière itérative l’approche de la rétroaction dans leur enseignement et se sont livrés à une réflexion narrative lors de quatre séances de groupe d’une heure. Des transcriptions des discussions de groupe et des entretiens de clôture ont fait l’objet d’une analyse thématique.Résultats : L’expérimentation itérative, la réflexion individuelle et l’exploration collective des efforts de mise en oeuvre de la nouvelle approche de rétroaction ont permis de développer une communauté d’apprentissage au sein du groupe. Ce sentiment de communauté a créé un environnement sûr pour la réflexion, tout en motivant les efforts continus pour apprendre l’habileté. La préréflexion individuelle préparait les participants à la co-réflexion de groupe; cependant, les récits écrits n’étaient pas essentiels.Conclusion :  Les initiatives de FPL devraient mettre l’emphase sur les occasions de mise en application itérative des habiletés d’enseignement, d’autoréflexion guidée et de réflexion et d’apprentissage collaboratifs en groupe pour assurer un changement durable des pratiques d’enseignement