Developing occupational therapists' capabilities for decision-making capacity assessments: how does a support role facilitate workplace learning?

Introduction: Healthcare practitioners are required to develop capabilities in an effective and efficient manner. Yet, developing capabilities in healthcare settings can be challenging due to the unpredictable nature of practice and increasing workloads. Unsurprisingly, healthcare practitioner development is often situated outside of practice, for example in formal teaching sessions. Supporting practitioners to develop capabilities through engagement with day-to-day practice, whilst advantageous in terms of authenticity and being highly valued, remains a\ua0key challenge for healthcare educators. This qualitative interview study aimed to explain, from the learner’s perspective, how a\ua0dedicated support role develops occupational therapists’ capability to contribute to decision-making capacity assessments. Methods: Individual semi-structured interviews were conducted with a\ua0purposive sample of 12\ua0occupational therapists. Informed by workplace learning theory, interview transcripts were analyzed using thematic analysis process. Results: Participants provided rich descriptions of how they developed in their capability to engage in decision-making capacity assessments. Participants reported that their learning was facilitated by the dedicated support role in three key ways: 1)\ua0structuring a\ua0journey of learning, 2)\ua0providing tailored guidance, and 3)\ua0fostering a\ua0supportive learning environment. Discussion: Participants valued the authentic workplace learning opportunities afforded by the dedicated support role. Findings suggest that capabilities, such as decision-making capacity assessment, can be developed through practice when enriched by a\ua0dedicated support role. However, further research examining the sustainability and transferability of this model and its application to other capabilities are warranted

How do trainee doctors learn about research? Content analysis of Australian specialist colleges' intended research curricula

Objectives: Patients do better in research-intense environments. The importance of research is reflected in the accreditation requirements of Australian clinical specialist colleges. The nature of college-mandated research training has not been systematically explored. We examined the intended research curricula of Australian trainee doctors described by specialist colleges, their constructive alignment and the nature of scholarly project requirements. Design: We undertook content analysis of publicly available documents to characterise college research training curricula. Setting: We reviewed all publicly accessible information from the websites of Australian specialist colleges and their subspecialty divisions. We retrieved curricula, handbooks and assessment-related documents. Participants: Fifty-eight Australian specialist colleges and their subspecialty divisions. Primary and secondary outcome measures: Two reviewers extracted and coded research-related activities as learning outcomes, activities or assessments, by research stage (using, participating in or leading research) and competency based on Bloom’s taxonomy (remembering, understanding, applying, analysing, evaluating, creating). We coded learning and assessment activities by type (eg, formal research training, publication) and whether it was linked to a scholarly project. Requirements related to project supervisors’ research experience were noted. Results: Fifty-five of 58 Australian college subspecialty divisions had a scholarly project requirement. Only 11 required formal research training; two required an experienced research supervisor. Colleges emphasised a role for trainees in leading research in their learning outcomes and assessments, but not learning activities. Less emphasis was placed on using research, and almost no emphasis on participation. Most learning activities and assessments mapped to the ‘creating’ domain of Bloom’s taxonomy, whereas most learning outcomes mapped to the ‘evaluating’ domain. Overall, most research learning and assessment activities were related to leading a scholarly project. Conclusions: Australian specialist college research curricula appear to emphasise a role for trainees in leading research and producing research deliverables, but do not mandate formal research training and supervision by experienced researchers

The Effect of Loyalty Program Fees on Program Perceptions and Engagement

Retailers may introduce loyalty program enrollment fees for several reasons, including to offset the costs of the program. The principle of commitment-consistency and sunk cost effects suggest consumers who pay a fee have a higher value to the firm and exhibit behavioral loyalty, while the zero-price effect predicts the opposite. Three studies show: consumers who pay to participate in a loyalty program have more favorable attitudes, more positive evaluations of value for the money and benefits than non-paying members (Study 1); and altering the wording of denominations of accrual can affect willingness to join fee-based programs (Studies 2 and 3). The results suggest a boundary effect to the numerosity heuristic. Presenting reward credit accumulations in higher numbers may be advantageous when program fees are high, since it shifts the focus of processing from the fee to the rewards. However, standard units may be more favorable when program fees are low

Developing residents’ feedback literacy in emergency medicine: Lessons from design-based research

Objectives: Residents in emergency medicine have reported dissatisfaction with feedback. One strategy to improve feedback is to enhance learners’ feedback literacy—i.e., capabilities as seekers, processors, and users of performance information. To do this, however, the context in which feedback occurs needs to be understood. We investigated how residents typically engage with feedback in an emergency department, along with the potential opportunities to improve feedback engagement in this context. We used this information to develop a program to improve learners’ feedback literacy in context and traced the reported translation to practice. Methods: We conducted a year-long design-based research study informed by agentic feedback principles. Over five cycles in 2019, we interviewed residents and iteratively developed a feedback literacy program. Sixty-six residents participated and data collected included qualitative evaluation surveys (n = 55), educator-written reflections (n = 5), and semistructured interviews with residents (n = 21). Qualitative data were analyzed using framework analysis. Results: When adopting an agentic stance, residents reported changes to the frequency and tenor of their feedback conversations, rendering the interactions more helpful. Despite reporting overall shifts in their conceptions of feedback, they needed to adjust their feedback engagement depending on changing contextual factors such as workload. These microsocial adjustments suggest their feedback literacy develops through an interdependent process of individual intention for feedback engagement—informed by an agentic stance—and dynamic adjustment in response to the environment. Conclusions: Resident feedback literacy is profoundly contextualized, so developing feedback literacy in emergency contexts is more nuanced than previously reported. While feedback literacy can be supported through targeted education, our findings raise questions for understanding how emergency medicine environments afford and constrain learner feedback engagement. Our findings also challenge the extent to which this contextual feedback know-how can be “developed” purposefully outside of the everyday work.</p

Outcomes of a funding initiative to promote allied health research activity: a qualitative realist evaluation

Providing funding for clinicians to have protected time to undertake research can address a commonly cited barrier to research - lack of time. However, limited research has evaluated the impact or mechanisms of such funding initiatives. In the current economic environment, it is important that funding is used efficiently and judiciously and that mechanisms and contexts that may assist with maximising outcomes of funding initiatives are identified. This study aimed to describe the medium-term outcomes of a funding initiative to promote allied health research activity and to identify the key mechanisms and contexts that facilitated these outcomes.We used a qualitative research design informed by a realist evaluation, to conduct 10 semi-structured interviews with allied health professionals who had participated in a funding initiative 1-3 years ago. Questions explored outcomes, mechanisms and contexts of the funding initiative. Data was thematically coded into context-mechanism-outcome configurations.Medium term outcomes included increased individual research opportunities, influence on team research culture and impact on clinical work/practice. Other outcomes included increased clinician confidence, knowledge and skill, and research outputs. However, some participants still had difficulties progressing research. Four context-mechanism-outcome configurations were identified to explain which contexts and mechanisms produced these outcomes. Examples of contexts included perception of managerial support, undertaking a research-based higher degree and joint applications, while mechanisms included accessing infrastructure and resources as well as individual researcher factors like motivation.Providing funding to allied health professionals to undertake and complete research can lead to important outcomes, including increased research opportunities, capacity and culture, increased research outputs, and changes to clinical practice. Outcomes are influenced by unique contexts and mechanisms and these should be considered in future implementation of similar funding initiatives

The role of feedback in supporting trainees who underperform in clinical environments

IntroductionUnderperformance in clinical environments can be costly and emotional for all stakeholders. Feedback is an important pedagogical strategy for working with underperformance – both formal and informal strategies can make a difference. Feedback is a typical feature of remediation programs, and yet there is little consensus on how feedback should unfold in the context of underperformance.MethodsThis narrative review synthesises literature at the intersections of feedback and underperformance in clinical environments where service, learning and safety need to be considered. We do so with a critical eye towards generating insights for working with underperformance in the clinical environment.Synthesis and discussionThere are compounding and multi-level factors that contribute to underperformance and subsequent failure. This complexity overwrites simplistic notions of ‘earned’ failure through individual traits and deficit. Working with such complexity requires feedback that goes beyond educator input or ‘telling’. When we shift beyond feedback as input to process, we recognise that these processes are fundamentally relational, where trust and safety are necessary for trainees to share their weaknesses and doubts. Emotions are always present and they signal action. Feedback literacy might help us consider how to engage trainees with feedback so that they take an active (autonomous) role in developing their evaluative judgements. Finally, feedback cultures can be influential and take effort to shift if at all. A key mechanism running through all these considerations of feedback is enabling internal motivation, and creating conditions for trainees to feel relatedness, competence and autonomy. Broadening our perceptions of feedback, beyond telling, might help create environments for learning to flourish