Preparing Medical and Nursing Students for Interprofessional Feedback Dialogues

Background: In healthcare education, preparing students for interprofessional feedback dialogues is vital. However, guidance regarding developing interprofessional feedback training programs is sparse. In response to this gap, the Westerveld framework, which offers principles for interprofessional feedback dialogue, was developed. Approach: Using the Westerveld framework, we developed and implemented an interprofessional feedback intervention for 4th-year nursing and 5th-year medical students. It encompasses two half-day workshops comprising small group sessions, interactive lectures, and a goal-setting assignment for the rotations. This paper describes the intervention and reflects on students’ self-reported goals, as learning outcomes, to inform future interprofessional feedback dialogue education. Outcomes:To understand student’s learning outcomes, we coded the content and specificity of 288 responses to the goal-setting assignment. Students indicated they mainly aimed to improve their feedback actionability, but contrastingly set – largely unspecific – goals, addressing the initiation of feedback dialogues. To better understand the process of setting these goals, we held three focus groups (N = 11): aside from the Westerveld framework, students used previous experience in rotations, outcome expectations, and personal characteristics as sources in their goal-setting process. Reflection: The contrast between students’ aims to improve their actionability and their goals to initiate dialogues, suggests that overcoming practice barriers to initiating dialogues are conditional to developing other feedback dialogue aspects. These and other goal conflicts in the workplace may hinder them setting specific feedback dialogue goals. We recommend explicit discussion of these challenges and conflicts in interprofessional feedback dialogue education.</p

The Westerveld framework for interprofessional feedback dialogues in health professions education

Interprofessional feedback dialogues play a crucial role in educating the adaptive team members that health care practice requires. The aim of this study is to develop principles for interprofessional feedback dialogues, to support healthcare education on feedback processes in an interprofessional context. A critical review of the literature on (interprofessional) feedback, and discussions with local experts resulted in an initial framework. This was input for a two-round expert panel with international, leading scholars in the fields of feedback (n = 5) and interprofessional education (n = 5). Experts showed increased agreement and consensus over the rounds resulting in a framework, called the Westerveld framework, structured around seven criteria: Open and respectful; Relevant; Timely; Dialogical; Responsive; Sense making; and Actionable. The framework contains columns with feedback dialogue principles for information givers and users, and columns with additions to be taken into account in an interprofessional healthcare context. Structuring the information giver and user columns around the same criteria, emphasises shared responsibility of participants in a feedback dialogue. The integration of interprofessional additions facilitates transfer to the healthcare context. The Westerveld framework can provide guidance to teachers and students in interprofessional education, contributing to both student and teacher feedback literacy

The interplay of curriculum structure and professional identity formation of medical students : Birds of a feather flock together

Professional identity formation (PIF) of medical trainees is defined as “a representation of self, achieved in stages over time during which the characteristics, values, and norms of the medical profession are internalized, resulting in an individual thinking, acting, and feeling like a physician”. Although important, medical education takes place within curricular structures that are often not deliberately created with PIF in mind. The thesis explores the interaction between curriculum structures and PIF in two recently introduced curricular structures: 1) The Bachelor-Master structure, providing an option to interrupt or terminate medical studies; 2) The final year of medical school designed as a transitional year to graduation, during which students work in authentic settings with the clinical responsibilities approaching the level of a starting resident, in elective rotations. We found that the Bachelor-Master structure does not stimulate students in any way to permanently stop their medical training, but there seems to be a tendency to insert a break in the program at the bachelor-master transition. This can also be seen as an interruption of PIF. For the transitional year, findings in the thesis suggest that transitional-year electives lead to early specialty preference streaming. We also found a relation between transitional-year characteristics and students identifying with members of the professional group, a process called ‘social identification’. Finally, we found relatively small differences between strength of identification with professional and interprofessional groups, suggesting that at this stage of training PIF does not seem to hamper interprofessional group processes

The interplay of curriculum structure and professional identity formation of medical students : Birds of a feather flock together

Professional identity formation (PIF) of medical trainees is defined as “a representation of self, achieved in stages over time during which the characteristics, values, and norms of the medical profession are internalized, resulting in an individual thinking, acting, and feeling like a physician”. Although important, medical education takes place within curricular structures that are often not deliberately created with PIF in mind. The thesis explores the interaction between curriculum structures and PIF in two recently introduced curricular structures: 1) The Bachelor-Master structure, providing an option to interrupt or terminate medical studies; 2) The final year of medical school designed as a transitional year to graduation, during which students work in authentic settings with the clinical responsibilities approaching the level of a starting resident, in elective rotations. We found that the Bachelor-Master structure does not stimulate students in any way to permanently stop their medical training, but there seems to be a tendency to insert a break in the program at the bachelor-master transition. This can also be seen as an interruption of PIF. For the transitional year, findings in the thesis suggest that transitional-year electives lead to early specialty preference streaming. We also found a relation between transitional-year characteristics and students identifying with members of the professional group, a process called ‘social identification’. Finally, we found relatively small differences between strength of identification with professional and interprofessional groups, suggesting that at this stage of training PIF does not seem to hamper interprofessional group processes

Medical students' preparation for the transition to postgraduate training through final year elective rotations

Objectives: This study adds to the ongoing discussion on how to ease the transition from undergraduate medical training to postgraduate training. In the Netherlands there is no central matching system for admission to residency. Medical school graduates just apply for a position in an open job market. Many choose to acquire general or specialty-specific clinical experiences after the medical degree before residency, to further explore career opportunities and to increase their chances to get into their preferred specialty. To shorten this gap between undergraduate and the start of postgraduate training, the sixth and final year of most Dutch medical schools is designed as a “transitional year”. Students work with more clinical responsibilities than in the earlier clerkships, and this year includes many elective options. Our study focuses on these elective options and explores how medical students use these transitional year electives to prepare for transition to postgraduate training.Methods: In 2012-2013 we asked all 274 graduating students at one Dutch medical school to complete an open-answer questionnaire with the following topics: Questionnaire results were coded by two researchers and were discussed with all members of the research team. Results: A total of 235 students responded (86%). Answers about motivation for choices revealed that most electives where chosen for career orientation and to optimize chances to get into a residency program. Students also focused on additional experiences in specialties related to their preferred specialty. Many students chose electives logically related to each other, e.g. combinations of surgery and radiology. About two-thirds of the respondents stated that their elective experiences did confirm their specialty preferences or resulted in a more clear insight.Conclusion: We conclude that students use the transitional year electives to focus on their future postgraduate training program, i.e. for orientation and to align their curriculum vitae with their preferred specialty, resulting in spontaneous early specialty streaming. To take advantages of this streaming, and to make sure students can transfer their experiences to other specialties if their career preferences change, individual elective Entrustable Professional Activities (EPAs), next to the core EPAs for all medical students, may serve to prepare a smooth transition to a specialty of choice and should be fully documented