Preparing medical students as agentic learners through enhancing student engagement in clinical education.

Publisher version made available in accordance with Publisher's copyright policy.Preparing medical students to be agentic learners is held to be increasingly important. This is because beyond sequencing, enhancing and varying of experiences across university and health care settings, medical students require epistemological agency to optimize their learning. The positioning of students in these settings, and their engagement with these is central to effective medical education. Consequently, when considering both the processes and outcomes of individuals’ learning to become a doctor, it is helpful to account for the interrelated pedagogical factors of affordance, guidance, and engagement. This paper focuses on the last set of concerns - the student’s engagement - with particular consideration to how they shape the relations between what experiences are afforded through the medical program and how they elect to engage with them. Evidence from a qualitative study is used to present five salient factors that are central to assist medical students prepare as agentic learners

The Curriculum and Pedagogic Properties of Practice-based Experiences: The Case of Midwifery Students

Author version made available in accordance with Publisher's copyright policy.This paper outlines curriculum considerations for the ordering, enactment and experiencing of practice-based experiences (e.g. practicums) in tertiary education programs developing occupational specific capacities. Increasingly, these programs are engaging students in practicum experiences (i.e. those in the circumstances of practice). These practice-based experiences require considerable investment on the part of all involved and so need to be used in ways that do justice to those invest- ments. However, such experiences are often provided and engaged in by students without consideration being given to their educational purposes; their likely contri- butions and how they can be sequenced and utilised to achieve those purposes. Here, the specific concern is to identify bases for considering these purposes and how these might be realised through the selection and sequencing of student experiences. A case study of two practicum experiences comprising midwifery students’ ‘follow-through’ experiences with birthing women and clinical placements is used to identify the kinds of learning that can arise through different kinds of practice-based experiences and how they might be most effectively organised. The concern, therefore, is to identify how the midwifery curriculum (i.e. pathways of experiences) can be ordered and augmented by particular pedagogic practices that assist realise the program’s intended learning outcomes. The two different practice-based experiences are found to gener- ate distinct learning outcomes for the students. The follow-throughs generate under- standings about the birthing process from the birthing mothers’ perspectives and provide goal states for midwifery work and understandings about midwifery practice, whereas the development of clinical capacities that arise through clinical placements. Consequently, the formers kinds of experiences might be best provides before, or in conjunction with second. Importantly, rather than viewing these experiences as being supplementary to what is provided within tertiary education institutions, they need to be consider as particular kinds of experiences on their own terms and engage with and utilise their contributions accordingly

Understanding and appraising medical students’ learning through clinical experiences: Participatory practices at work

© The contributors. This author accepted manuscript book chapter is made available after an embargo period of 18 months from date of publication (December 2018) in accordance with the publisher's archiving policy.This chapter explores the participatory practices of some medical students’ learning through their clinical experiences. Participatory practices are those that comprise a duality between what is afforded by the social institutions in which individuals participate (e.g. educational and healthcare settings), on the one hand, and how individuals elect to engage in and learn through those practices (i.e. their processes of experiencing), on the other. Privileged here is not only the contributions to learning from these social settings and what individuals already know, can do and value, but also the relations between them. Indeed, the explanatory account of these students’ learning is founded on the concept of relational interdependence. That is, the relational nature of the interdependence between the social norms, forms and practices that individuals are afforded in these settings, and their experiencing of, and learning from what is afforded them. These concepts offer an account of the learning process associated with medical education, in which judgements about the educational worth of these programs are founded on the kinds and qualities of experiences provided for students, their relationships with the kinds of learning that arise from them, and ultimately, how students come to engage within them. This engagement includes, but is not wholly dependent upon, how students perceive the invitational qualities of these experiences

Understanding and appraising medical students’ learning through clinical experiences: Participatory practices at work

© The contributors. This author accepted manuscript book chapter is made available after an embargo period of 18 months from date of publication (December 2018) in accordance with the publisher's archiving policy.This chapter explores the participatory practices of some medical students’ learning through their clinical experiences. Participatory practices are those that comprise a duality between what is afforded by the social institutions in which individuals participate (e.g. educational and healthcare settings), on the one hand, and how individuals elect to engage in and learn through those practices (i.e. their processes of experiencing), on the other. Privileged here is not only the contributions to learning from these social settings and what individuals already know, can do and value, but also the relations between them. Indeed, the explanatory account of these students’ learning is founded on the concept of relational interdependence. That is, the relational nature of the interdependence between the social norms, forms and practices that individuals are afforded in these settings, and their experiencing of, and learning from what is afforded them. These concepts offer an account of the learning process associated with medical education, in which judgements about the educational worth of these programs are founded on the kinds and qualities of experiences provided for students, their relationships with the kinds of learning that arise from them, and ultimately, how students come to engage within them. This engagement includes, but is not wholly dependent upon, how students perceive the invitational qualities of these experiences

Clinical Relevance of Dissolution Testing in Quality by Design

Quality by design (QbD) has recently been introduced in pharmaceutical product development in a regulatory context and the process of implementing such concepts in the drug approval process is presently on-going. This has the potential to allow for a more flexible regulatory approach based on understanding and optimisation of how design of a product and its manufacturing process may affect product quality. Thus, adding restrictions to manufacturing beyond what can be motivated by clinical quality brings no benefits but only additional costs. This leads to a challenge for biopharmaceutical scientists to link clinical product performance to critical manufacturing attributes. In vitro dissolution testing is clearly a key tool for this purpose and the present bioequivalence guidelines and biopharmaceutical classification system (BCS) provides a platform for regulatory applications of in vitro dissolution as a marker for consistency in clinical outcomes. However, the application of these concepts might need to be further developed in the context of QbD to take advantage of the higher level of understanding that is implied and displayed in regulatory documentation utilising QbD concepts. Aspects that should be considered include identification of rate limiting steps in the absorption process that can be linked to pharmacokinetic variables and used for prediction of bioavailability variables, in vivo relevance of in vitro dissolution test conditions and performance/interpretation of specific bioavailability studies on critical formulation/process variables. This article will give some examples and suggestions how clinical relevance of dissolution testing can be achieved in the context of QbD derived from a specific case study for a BCS II compound

Participatory practices at work: Understanding and appraising healthcare students' learning through workplace experiences

Given the extent of resources directed to healthcare professional education, it is essential to understand how learning to be a healthcare professional arises, so that those education processes can be optimized. In this chapter, one aspect of that learning is given attention: students' learning through healthcare practice, or how students learn in workplaces. Drawing on findings from studies of medical and midwifery students, the chapter outlines how these invitational qualities of physical and social circumstances can be understood in terms of 'affordances' and how learning is dependant in terms of 'engagement' or rather than on how students engage with what is afforded to them. Understanding these practices might help make healthcare students' educational experiences more effective. Workplace-based affordances can comprise the opportunity to engage in practice experiences, but can also be encouraging or inhibiting of access to the kinds of knowledge required for work

Preparing medical students as agentic learners through enhancing student engagement in clinical education

Preparing medical students as agentic learners through enhancing student engagement in clinical educatio