Teaching and learning professionalism in medical education

Eeuwenlang hebben studenten Geneeskunde hun professionele normen en waarden ontwikkeld in een meester-gezel relatie met hun klinische docenten. Deze informele manier van leren lijkt niet voldoende meer om studenten voor te bereiden op werken als professional binnen de hedendaagse, complexe beroepspraktijk. Mede ingegeven door alarmerende berichten over dokters in de media, heerst het idee dat medische professionaliteit aan het afkalven is. Vandaar de roep om studenten expliciet te onderwijzen in professionaliteit. Professionaliteit is echter een complex te definiëren begrip. Dit maakt de vraag hoe professionaliteit nu het beste te leren en te onderwijzen is, lastig. In dit proefschrift wordt een overzicht gegeven van een geïntegreerde onderwijslijn professionele ontwikkeling. De rationale achter deze lijn is professionaliteit te beschouwen als een reflectieve, tweede orde competentie. Intervisiebijeenkomsten in kleine groepen – het ‘cement’ van deze lijn - waarin studenten gestructureerd zelfgekozen klinische ervaringen bespreken, lijken geschikt voor het ontwikkelen van deze reflectieve professionaliteit. Als onderdeel van een portfolio schrijven studenten reflectieve essays. Feedback hierop door de docent kan het beste geformuleerd worden als vraag, positief van toon zijn en zich richten op het verdiepen van het reflectieve niveau van de student. Docenten zijn belangrijke rolmodellen voor coassistenten, maar soms vertonen ze onprofessioneel gedrag in de docent-student relatie. Waar grenzen liggen tussen wat nog wel kan of juist niet, blijkt sterk individueel bepaald. Deze grote variatie in percepties maakt het moeilijk om eenduidige gedragscodes af te spreken. Aangeraden wordt studenten en docenten bewust te maken dat eigen grenzen wellicht heel anders zijn dan die van anderen.For centuries, medical students have developed their professional values and beliefs while participating in a traditional apprenticeship relationship with their clinical teachers. This implicit approach it is no longer felt to be sufficient to prepare students for professional practice. Prompted by alarming headlines in the media, the general public have come to realize that medical professionalism is under threat. Therefore, there is a widely acknowledged call for professionalism to be trained explicitly. However, the concept of professionalism is complex to define. This makes the question of how professionalism should be learned and taught a difficult one. In this thesis an overview is presented of a professional development course for clerks. The rationale underpinning the course is that professionalism is a reflective, second-order competence. Small group sessions in which students learn to reflect on self-selected topics provide a suitable training context in which professionalism can be developed. As part of their portfolio assignments, students have to write reflective essays. Our findings suggests that written feedback on students’ reflective essays should be formulated as questions, be positive in tone and tailored to the individual student’s reflective level in order to stimulate students to reflect at a slightly higher level. Teachers are important role models for young trainee doctors. Unfortunately, sometimes they show unprofessional behaviour. Perceptions of what is or is not appropriate behaviour differ largely. Applying a fixed code of conduct is there for troublesome. We recommend making students and teachers aware that other people’s boundaries might not be the same as their own

Teaching medicine of the person to medical students during the beginning of their clerkships.

This article describes how medicine of the person is taught to 4th year medical students in Groningen, The Netherlands, as part of the teaching programme ‘Professional Development’. In that year, the students start with their clerkships. In this transitional phase from medical student to young doctor, issues of professional identity are raised. It is an intense period with feelings of uncertainty and overwhelming experiences. Therefore, parallel to the clerkships we have organised 28 meetings of 2 hours with extra time dedicated to reflection and learning. These groups consist of 10-12 students with a rotating student chair under supervision of an experienced teacher, or, “coach”. We focus on personal and professional development by reflecting on work-based experiences. In the first hour the students discuss in a structured way a critical incident experienced by one of them. Learning experiences include personal learning (as emotions), skills (as empathy development) and professional learning (discovering the profession). In the second hour the students discuss set medical-ethical dilemmas. The coach facilitates the group discussion and oversees the group dynamics. During the year, the students work on their portfolio including writing a personal development plan. In 3 individual interviews with the coach this plan is monitored. In the final interview the students are assessed by their coach on their professional development during the year. In this paper we present the results of the evaluation of this programme ‘Professional Development’ by the students and The Netherlands Association for Medical Education

"My right-hand man" versus "We barely make use of them":change leaders talking about educational scientists in curriculum change processes-a Membership Categorization Analysis

Health professions education scholarship units (HPESUs) are increasingly becoming a standard for medical schools worldwide without having much information about their value and role in actual educational practices, particularly of those who work in these units, the educational scientists. We conducted a linguistic analysis, called Membership Categorization Analysis, of interviews with leaders of recent curriculum changes to explore how they talk about educational scientists in relation to these processes. The analysis was conducted on previously collected interview data with nine change leaders of major undergraduate medical curriculum change processes in the Netherlands. We analyzed how change leaders categorize HPESUs and educational scientists (use of category terms) and what they say about them (predicates). We noticed two ways of categorizing educational scientists, with observable different predicates. Educational scientists categorized by their first name were suggested to be closer to the change process, more involved in decisional practices and positively described, whereas those described in more generic terms were represented in terms of relatively passive and unspecified activities, were less explicit referenced for their knowledge and expertise and were predominantly factually or negatively described. This study shows an ambiguous portrayal of educational scientists by leaders of major curriculum change processes. Medical schools are challenged to establish medical curricula in consultation with a large, diverse and interdisciplinary stakeholder group. We suggest that it is important to invest in interpersonal relationships to strengthen the internal collaborations and make sure people are aware of each other's existence and roles in the process of curriculum development

Educators' experiences with governance in curriculum change processes; a qualitative study using rich pictures

In the midst of continuous health professions curriculum reforms, critical questions arise about the extent to which conceptual ideas are actually put into practice. Curricula are often not implemented as intended. An under-explored aspect that might play a role is governance. In light of major curriculum changes, we explored educators’ perspectives of the role of governance in the process of translating curriculum goals and concepts into institutionalized curriculum change at micro-level (teacher–student). In three Dutch medical schools, 19 educators with a dual role (teacher and coordinator) were interviewed between March and May 2018, using the rich pictures method. We employed qualitative content analysis with inductive coding. Data collection occurred concurrently with data analysis. Different governance processes were mentioned, each with its own effects on the curriculum and organizational responses. In Institute 1, participants described an unclear governance structure, resulting in implementation chaos in which an abstract educational concept could not be fully realized. In Institute 2, participants described a top–down and strict governance structure contributing to relatively successful implementation of the educational concept. However it also led to demotivation of educators, who started rebelling to recover their perceived loss of freedom. In Institute 3, participants described a relatively fragmentized process granting a lot of freedom, which contributed to contentment and motivation but did not fully produce the intended changes. Our paper empirically illustrates the importance of governance in curriculum change. To advance curriculum change processes and improve their desired outcomes it seems important to define and explicate both hard and soft governance processes