Workplace learning from a socio-cultural perspective: creating developmental space during the general practice clerkship

Workplace learning in undergraduate medical education has predominantly been studied from a cognitive perspective, despite its complex contextual characteristics, which influence medical students’ learning experiences in such a way that explanation in terms of knowledge, skills, attitudes and single determinants of instructiveness is unlikely to suffice. There is also a paucity of research which, from a perspective other than the cognitive or descriptive one, investigates student learning in general practice settings, which are often characterised as powerful learning environments. In this study we took a socio-cultural perspective to clarify how students learn during a general practice clerkship and to construct a conceptual framework that captures this type of learning. Our analysis of group interviews with 44 fifth-year undergraduate medical students about their learning experiences in general practice showed that students needed developmental space to be able to learn and develop their professional identity. This space results from the intertwinement of workplace context, personal and professional interactions and emotions such as feeling respected and self-confident. These forces framed students’ participation in patient consultations, conversations with supervisors about consultations and students’ observation of supervisors, thereby determining the opportunities afforded to students to mind their learning. These findings resonate with other conceptual frameworks and learning theories. In order to refine our interpretation, we recommend that further research from a socio-cultural perspective should also explore other aspects of workplace learning in medical education

Medical students’ creative projects on a third year pediatrics clerkship: a qualitative analysis of patient-centeredness and emotional connection

BACKGROUND: Increasingly, medical educators are incorporating reflective writing and original creative work into educational practices with the goals of stimulating student self-awareness, appreciation of multiple perspectives, and comfort with ambiguity and uncertainty. This study investigated students’ creative projects to assess the extent to which they adopted a patient/relationship-centered, emotionally connected position toward patients and families. METHODS: Over a 10 year period, students on a required third year pediatrics clerkship individually or in groups completed either a reflection or an education project using a creative medium. 520 projects (representing 595 students, 74.7 % of total eligible students) were qualitatively analyzed according to various thematic and emotion-based dimensions. RESULTS: The majority of projects were personal narrative essays and poetry. The largest number of project themes related to the importance of patient/relationship-centered medicine with patients. The next largest number of projects focused on health education of parents, patients, or classmates. In telling their stories, students were more likely to use a personal voice representing either their or the patient’s perspective than an objective, impersonal one. In terms of emotional tone, projects were more likely to be serious than humorous. The largest number of students’ emotions expressed an empathic tone. Students identified a large number and wide range of both negative and positive feelings in themselves and their patients. The majority of student emotions were positive, while the majority of patient and family emotions were negative. CONCLUSIONS: Students’ preference for patient-centered, relational themes, as well as their tendency to favor the first voice, empathic tone, and willingness to express a range of positive and negative emotions in presenting their projects, suggests that they valued emotional connection with patients and families during the pediatrics clerkship experience

Entrainment of the human circadian pacemaker to longer-than-24-h days

Entrainment of the circadian pacemaker to the light:dark cycle is necessary for rhythmic physiological functions to be appropriately timed over the 24-h day. Nonentrainment results in sleep, endocrine, and neurobehavioral impairments. Exposures to intermittent bright light pulses have been reported to phase shift the circadian pacemaker with great efficacy. Therefore, we tested the hypothesis that a modulated light exposure (MLE) with bright light pulses in the evening would entrain subjects to a light:dark cycle 1 h longer than their own circadian period (τ). Twelve subjects underwent a 65-day inpatient study. Individual subject's circadian period was determined in a forced desynchrony protocol. Subsequently, subjects were released into 30 longer-than-24-h days (daylength of τ + 1 h) in one of three light:dark conditions: (i) ≈25 lux; (ii) ≈100 lux; and (iii) MLE: ≈25 lux followed by ≈100 lux, plus two 45-min bright light pulses of ≈9,500 lux near the end of scheduled wakefulness. We found that lighting levels of ≈25 lux were insufficient to entrain all subjects tested. Exposure to ≈100 lux was sufficient to entrain subjects, although at a significantly wider phase angle compared with baseline. Exposure to MLE was able to entrain the subjects to the imposed sleep–wake cycles but at a phase angle comparable to baseline. These results suggest that MLE can be used to entrain the circadian pacemaker to non-24-h days. The implications of these findings are important because they could be used to treat circadian misalignment associated with space flight and circadian rhythm sleep disorders such as shift-work disorder

“A memorable consultation”: Writing reflective accounts articulates students’ learning in general practice

The Meeting between the Patient and the Doctor Experiences among Somali refugees and medical trainees Kristian Svenberg Abstract Background and aim. The overall aim of the thesis is to explore the patient‐doctor encounter based on experiences among Somali refugees and medical interns in Sweden. Though research in this area is scarce, it has demonstrated that the transcultural meeting in health care suffers shortcomings. This applies to treatment and rapport as well as to outcomes of treatment and care. Starting from the experiences of medical students reflecting on a memorable consultation (paper I), the thesis illuminates the experiences of health and illness and of encounters with Swedish health care of one group of patients, Somali refugees (papers II, III). The thesis further explores the experiences among Swedish vocational trainees in general practice of their encounters with patients from Somalia (paper IV). Method. The thesis is based on four qualitative studies. In paper I, data was gathered from written reflective accounts. In paper II and III, data was collected through individual interviews and in paper IV through focus group interviews. Data was analysed using qualitative content analysis (paper I), a hermeneutic‐phenomenological methodology (paper II, III) and phenomenography (paper IV). Findings. Paper I. Involving students in writing reflective accounts stimulated them in articulating practice experiences of the consultation. Main themes of students’ learning experiences were “The person beyond symptoms”, “Facing complexity” and “In search of a professional role”. Paper II. Somali refugees were interviewed as to their experiences in relation to health and illness. One essential theme emerged: “a life in exile”. This was expressed in thematic aspects dealing with longing for the homeland, experience of pain, discrimination and the comforting role of religion. Paper III illuminates the experiences of Somali refugees encountering Swedish health care. Ambiguous feelings of high expectations and disappointment were expressed including sentiments of being rejected and not taken seriously, often resulting in a decision to go abroad for medical care. In paper IV, vocational trainees in Swedish general practice give voice to their experiences of meeting Somali patients. In meeting the patient, they faced high expectations and noticed a certain cultural distance. Perceptions of being both pleased and confused were articulated. Obstacles in the meeting were expressed by a majority of the informants, on a linguistic level as well as of intricacies in understanding the patients’ problem in general. To control this situation, some conformed to an authoritarian strategy, whereas others used approaches coined by curiosity. Conclusion. Somali refugee patients, with problems and complaints frequently caused by a life in exile, often experience rejection in the medical encounter. A major finding of the thesis is the importance of seeing the patient as a person, thus throwing light on the complex web of factors influencing the patients’ symptoms. To promote this, strategies of curiosity and an interest in the patients’ personal history should be encouraged among health care providers. Key words. Medical encounter, experience, medical student, vocational trainee, Somali, refugee, health, illness ISBN 978‐91‐628‐8339‐3 http://hdl.handle.net/2077/2796