Factors shaping how clinical educators use their educational knowledge and skills in the clinical workplace: a qualitative study

© 2016 Kumar and Greenhill. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: In order to consolidate their educational knowledge and skills and develop their educational role, many clinicians undertake professional development in clinical education and supervision. It is well established that these educationally-focussed professional development activities have a positive impact. However, it is less clear what factors within the clinical workplace can shape how health professionals may use and apply their educational knowledge and skills and undertake their educational role. Looking through the lens of workplace affordances, this paper draws attention to the contextual, personal and interactional factors that impact on how clinical educators integrate their educational knowledge and skills into the practice setting, and undertake their educational role. METHODS: Data were gathered via a survey of 387 clinical educators and semi-structured interviews with 12 clinical educators and 6 workplace managers. In this paper, we focus on analysing and reporting the qualitative data gathered in this study. This qualitative data were subject to a thematic analysis and guided by theoretical constructs related to workplace affordances. RESULTS: Three key themes were identified including contextual, personal and interactional factors. Contextual elements referred to organisational structures and systems that impact on participants' educational role, how participants' clinical education role was articulated and configured within the organisation, and how the organisation shaped the educational opportunities available to clinicians. Personal factors encompassed clinicians' personal motivations and goals to teach and be involved in education, develop their own educational skills and function as a role model for students. Interactional factors referred to the professional interactions and networks through which clinicians shared their educational knowledge and skills and further consolidated their profile as educational advocates in their workplace. CONCLUSIONS: There are a number of contextual, personal and interactional factors which interrelate in complex ways and impact on how clinical educators use their educational knowledge and skills and undertake their educational role in the clinical setting. To fully realise the potential of and fulfil the requirements of their educational role, clinical educators need to be provided appropriate experiential and meaningful workplace opportunities and the guidance to use, share and reflect on their educational knowledge and skills in the clinical workplace

Longitudinal integrated rural placements: a social learning systems perspective

OBJECTIVES There is currently little theoretically informed exploration of how non-traditional clinical placement programmes that are longitudinal, immersive, based on community-engaged education principles and located in rural and remote settings may contribute to medical student learning. This paper aims to theoretically illustrate the pedagogical and socio-cultural underpinnings of student learning within a longitudinal, integrated, community-engaged rural placement. METHODS Data collected using semi-structured interviews with medical students, their supervisors and other health clinicians participating in a longitudinal rural placement programme were analysed using framework analysis. Data interpretation was informed by the theory of social learning systems (SLSs). RESULTS In a longitudinal, rural clinical placement students participate in an SLS with distinct yet interrelated learning spaces that contain embedded communities of practice (CoPs). These spaces are characterised by varying degrees of formality, membership and interaction, and different learning opportunities and experiences. They are situated within and shaped by a unique geography of place comprising the physical and social features of the placement setting. Within these learning spaces, students acquire clinical knowledge, skills and competencies, professional attitudes, behaviours and professional values. The process of connectivity helps explain how students access and cross the boundaries between these learning spaces and develop a more complex sense of professional identity. CONCLUSIONS Longitudinal, integrated clinical placement models can be understood as SLSs comprising synergistic and complementary learning spaces, in which students engage and participate in multiple CoPs. This occurs in a context shaped by unique influences of the geography of place. This engagement provides for a range of student learning experiences, which contribute to clinical learning and the development of a more sophisticated professional identity. A range of pedagogical and practical strategies can be embedded within this SLS to enhance student learning

What factors in rural and remote extended clinical placements may contribute to preparedness for practice, from the perspective of students and clinicians?

What factors in rural and remote extended clinical placements may contribute to preparedness for practice, from the perspective of students and clinicians? Michele Daly, David Perkins, Koshila Kumar, Chris Roberts and Malcolm Moore Background: Community based rural education opportunities have expanded in Australia, attracting more medical students to placements in rural and remote settings. Aim: To identify the factors in an integrated, community engaged rural placement that may contribute to preparedness for practice (P4P), from the perspective of students and clinicians Methods: Forty two semi-structured interviews with medical students, supervisors and clinicians analysed thematically. Results: Opportunities for clinical learning, personal and professional development and cultural awareness were reported by students and clinicians as key factors that contribute to preparedness for practice. Potential barriers in rural and remote settings included geographical and academic isolation, perceived educational risk and differing degrees of program engagement. Conclusions: A longitudinal clinical placement in a rural setting may enable development of enhanced competencies leading to P4P. A rural setting can help provide a unique experience through hands-on learning, enhanced personal and professional development opportunities and observation of the cultural and contextual impact on health

Interdisciplinary Health Research (IDHR): An analysis of the lived experience from the theoretical perspective of identity

Interdisciplinarity or interdisciplinary research involves the integration of theories, concepts, methodologies or methods from two or more academic disciplines or professional practice fields into a common research framework. Interdisciplinary Health Research (IDHR) refers specifically to the integration of frameworks and perspectives from multiple disciplines within or allied to health. The existing empirical literature including in the health research domain, has privileged a focus on the collaborative and interpersonal aspects of interdisciplinarity resulting in a focus on the processes and practices of collaboration and the interdisciplinary team as the unit of analysis. This has meant that researchers’ voices and stories regarding their personal journey and lived experience of interdisciplinarity have largely been absent from the literature. This thesis explores how IDHR is enacted, experienced and lived by health researchers in higher education, as well as the link between the lived experience of IDHR and identity. It uses hermeneutic phenomenological methods to gather rich idiographic data from twenty-one health researchers engaged in IDHR in the Australian higher education sector. Data interpretation occurs at two levels: a phenomenological analysis explores the essential characteristics of IDHR as a human phenomenon, while a theoretical analysis explicates issues related to identity and identification associated with health researchers’ lived experience. The phenomenological findings of this thesis illustrate that health researchers’ lived experience of IDHR is simultaneously enabling and disabling, and thus fundamentally paradoxical in nature. These findings also show the multiplicity of levels at which health researchers enact IDHR, including the social-relational and personal-embodied level. Theoretical interpretation of findings from the perspective of identity shows that health researchers’ engaged in IDHR encounter a tension between their institution-identity which is traditionally defined and legitimised in relation to a discipline, and their affinity-identity reflecting their personal values and preferences for interdisciplinary work. Using identity dissonance as a theoretical lens, this thesis illustrates that health researchers engaged in IDHR strive to reconcile the conflict in identities and associated feelings of vulnerability and discomfort, by constructing and negotiating their identity in different ways. Strategies health researchers use include: conformist practices aimed at aligning with dominant discipline-based values and expectations in the institution and the higher education sector; performative tactics aimed at presenting a favourable image of self to significant others; and resistive strategies aimed at affirming personal interdisciplinary preferences and values. In summary, this thesis illustrates that the lived experience of IDHR can be conceptualised as a conflicted space within which researchers’ identities are contested, constructed and negotiated. This is the first phenomenological and theoretical account of how IDHR is experienced, enacted and lived by health researchers in the higher Australian education setting. This thesis identifies a number of practical recommendations related to the need for individual researchers and research teams to articulate and constructively manage the ambiguities and conflict in identities characterising the lived experience of IDHR. This thesis also provides an important message about how higher education institutions and the sector more broadly can transform research cultures and practices in order to foster and support integrative and creative forms of working and thinking (including about self) that transcend discipline boundaries

Clinical supervisors' perspectives of factors influencing clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement: A qualitative study

Background Undergraduate nursing students from culturally and linguistically diverse backgrounds experience unique challenges with their learning needs during clinical placements. There is limited research on clinical supervisors' perspectives of the factors impacting clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement. Objectives This study sought to identify clinical supervisors' perspectives of the factors impacting on the clinical learning experience of nursing students from culturally and linguistically diverse backgrounds and strategies to overcome challenges. Design A qualitative research design using semi-structured interviews. Methods Nine nurses who had experience supervising culturally and linguistically diverse nursing students were interviewed as part of data collection. Thematic analysis was used for data interpretation. Results Identified factors include: Poor proficiency in English language, unfamiliarity with Australian slang and medical terminologies, cultural expectations interfering with professional responsibilities, incongruity with teaching delivery and learning style, short duration of placement, inconsistency with preceptor allocation and inadequate preceptor training. Conclusion Recommendations to facilitate the learning of nursing students from culturally and linguistically diverse (CALD) backgrounds on clinical placement include flexibility with assessments, modifying teaching styles according to learning needs, providing appropriate orientation, creating a welcoming environment, providing consistency with allocation of preceptors, and providing appropriate training for preceptors. Inconsistency in preceptor allocation was reported to have a negative influence on CALD student learning. A collaborative approach between Universities and the health care settings is essential in assisting clinical supervisors to address the unique learning needs of nursing students from culturally and linguistically diverse backgrounds while on clinical placement