Pedagogical strategies used in clinical medical education: an observational study

<p>Abstract</p> <p>Background</p> <p>Clinical teaching is a complex learning situation influenced by the learning content, the setting and the participants' actions and interactions. Few empirical studies have been conducted in order to explore how clinical supervision is carried out in authentic situations. In this study we explore how clinical teaching is carried out in a clinical environment with medical students.</p> <p>Methods</p> <p>Following an ethnographic approach looking for meaning patterns, similarities and differences in how clinical teachers manage clinical teaching; non-participant observations and informal interviews were conducted during a four month period 2004-2005. The setting was at a teaching hospital in Sweden. The participants were clinical teachers and their 4th year medical students taking a course in surgery. The observations were guided by the aim of the study. Observational notes and notes from informal interviews were transcribed after each observation and all data material was analysed qualitatively.</p> <p>Results</p> <p>Seven pedagogical strategies were found to be applied, namely: 1) Questions and answers, 2) Lecturing, 3) Piloting, 4) Prompting, 5) Supplementing, 6) Demonstrating, and 7) Intervening.</p> <p>Conclusions</p> <p>This study contributes to previous research in describing a repertoire of pedagogical strategies used in clinical education. The findings showed that three superordinate qualitatively different ways of teaching could be identified that fit Ramsden's model. Each of these pedagogical strategies encompass different focus in teaching; either a focus on the teacher's knowledge and behaviour or the student's behaviour and understanding. We suggest that an increased awareness of the strategies in use will increase clinical teachers' teaching skills and the consequences they will have on the students' ability to learn. The pedagogical strategies need to be considered and scrutinized in further research in order to verify their impact on students' learning.</p

Professional approaches in clinical judgements among senior and junior doctors: implications for medical education

<p>Abstract</p> <p>Background</p> <p>Clinical experience has traditionally been highly valued in medical education and clinical healthcare. On account of its multi-faceted nature, clinical experience is mostly difficult to articulate, and is mainly expressed in clinical situations as professional approaches. Due to retirement, hospitals in Scandinavia will soon face a substantial decrease in the number of senior specialist doctors, and it has been discussed whether healthcare will suffer an immense loss of experienced-based knowledge when this senior group leaves the organization. Both senior specialists and junior colleagues are often involved in clinical education, but the way in which these two groups vary in professional approaches and contributions to clinical education has not been so well described. Cognitive psychology has contributed to the understanding of how experience may influence professional approaches, but such studies have not included the effect of differences in position and responsibilities that junior and senior doctors hold in clinical healthcare. In the light of the discussion above, it is essential to describe the professional approaches of senior doctors in relation to those of their junior colleagues. This study therefore aims to describe and compare the professional approaches of junior and senior doctors when making clinical judgements.</p> <p>Methods</p> <p>Critical incident technique was used in interviews with nine senior doctors and nine junior doctors in internal medicine. The interviews were subjected to qualitative content analysis.</p> <p>Result</p> <p>Senior and junior doctors expressed a variety of professional approaches in clinical judgement as follows: use of theoretical knowledge, use of prior experience of cases and courses of events, use of ethical and moral values, meeting and communicating with the patient, focusing on available information, relying on their own ability, getting support and guidance from others and being directed by the organization.</p> <p>Conclusion</p> <p>The most prominent varieties of professional approaches were seen in use of knowledge and work-related experience. Senior doctors know how the organization has worked in the past and have acquired techniques with respect to long-term decisions and their consequences. Junior doctors, on the other hand, have developed techniques and expertise for making decisions based on a restricted amount of information, in relation to patients' wellbeing as well as organizational opportunities and constraints. This study contributes to medical education by elucidating the variation in professional approaches among junior and senior doctors, which can be used as a basis for discussion about clinical judgement, in both pre-clinical and clinical education. Further research is required to explain how these professional approaches are expressed and used in clinical education.</p

You are the doctor now, you are in charge - Studies on the development and manifestation of professional knowledge among students and doctors

The overall purpose of this thesis was to contribute to the understanding of how doctors’ professional knowledge evolves during both their clinical training and professional life. In this thesis, this is achieved by describing the supervision of medical students and the professional approaches of active doctors when making clinical judgments. During supervision students are expected to develop professional knowledge and to become socialised into the profession. Professional knowledge is personal, is developed throughout life, and is infl uenced by the person’s education, experiences and generation group, and by organisational conditions. The profession’s culture and attitudes also infl uence what knowledge is focused on, considered valid and appropriate. The professional knowledge of a doctor changes continuously as he or she gains clinical experience. The overall theoretical perspective of the thesis is symbolic interactionism, meaning that professional knowledge and socialisation are described based on how they appear and create meaning for medical students and active doctors. The thesis is based on data from two separate data collection efforts. In studies I, II and III, the focus was on the supervision of medical students in a surgical training program. The empirical data consisted of fi eld notes from approximately 100 hours of observations and informal discussions. This group of ethnographic studies generated three separate thematic areas that were described: what was identifi ed as contents during supervision, attitudes conveyed in supervision and pedagogical strategies used by supervisors. In study IV the focus was on professionally active doctors’ clinical judgements and the study was based on interviews with nine junior and nine senior internal medicine doctors. This study made it possible to describe the way in which junior and senior doctors´ professional approaches vary when making clinical judgements. The four studies show that master-apprentice-like learning occurs both between supervisors and medical students and between more experienced and less experienced doctors. It emerges that it is not entirely clear what students are expected to learn and develop during the supervision. Moreover, the content is not adapted to the students’ level of knowledge and experience. The students are abandoned to structure and prioritise the contents according to the clinical situations encountered. The students are expected to cope with attitudes that sometimes may be perceived as demanding or demeaning, and which may be diffi cult to adapt to patient- and team-centred care. Both students and junior doctors are placed in diffi cult and challenging situations in relation to their experience and skills. Making clinical judgments is an important aspect of a doctor’s professional knowledge. This knowledge is complex and grows with the extent of the clinical experience and it varies depending on the context in which it has been gained. The level of professional knowledge and clinical judgment-making ability is also increased by observing how more senior and experienced doctors act and behave. Therefore, it would be of interest for both students and for the health care organisation at large to develop the pedagogical approach of both supervisors and active doctors

Kliniskt basår för nyutexaminerade sjuksköterskor inom Västra Götalandsregionen : en utvärderingsrapport

Newly graduate nurses (NGN) transition between basic education and work in a complex health care practice, as well as their intention of leaving the profession during the first year of work and how this can be prevented, is a global concern. NGN experience difficulties integrating workplace environment, expectations, and educational experiences. This is an evaluation study of a one-year transition program, which was implemented as a project during 2016-17, at six hospitals in Sweden. An explorative research design was used and data consist of focus group and individual interviews with NGNs, interviews with first-line managers, observations of simulation training, and survey material from the hospitals. Data was analyzed using thematic analysis. Results show an overarching structure for all hospitals in the region, the NGNs are engaged in the following learning activities; introduction at the ward and a senior RN as preceptor, lectures and/or simulations, change of ward, process-oriented reflection seminars and mentorship. The different learning activities contribute to the overall learning in different ways. Continuous supervision and structured reflection are central to NGNs professional learning. Organizational conditions create prerequisites for learning during the transition program and a change of ward is a particular challenge to get organized. The results, also provides a deeper understanding of the foundational components in NGNs early development of expertise, security as professionals, and essential knowledge for bridging the practices of the first cycle program and healthcare practice at hospitals

Att forma en medarbetare eller att undervisa en student

Genom cooperative education (co-op) ges studenter möjlighet att inom utbildningen, praktiskt tillämpa sina kunskaper på en arbetsplats. Under co-op tilldelas studenten en av arbetsgivaren utsedd handledare. Co-op är ett trepartssamarbete mellan högskola, student och arbetsplats. Merparten av tidigare studier fokuserar studenternas upplevelse av co-op eller vad co-op kan innebära för studentens studiemotivation, framtida karriär och möjlighet till arbete. Syftet med denna fenomenografiska studie är att beskriva handledares uppfattning om handlednings syfte. Studien kan därmed bidra till kunskap om den utbildningssituationen studenter ställs inför i co-op. Studiens resultat, som är baserad på intervjuer, visar fyra olika uppfattningar om handlednings syfte: Stödja in i gemenskapen, Delge specifikt kunskapsinnehåll, Att få möjlighet att lära och Bidra till produktionen. Handledarnas uppfattningar indikerar att studenten förväntas praktiskt tillämpa teoretisk kunskap och få arbets- och yrkesrelaterade erfarenheter genom ett socialt lärande. Variationerna i handledarnas uppfattningar antyder även att det samlade kunskapsinnehållet som studenten får ta del av under co-op kan variera stort. Utifrån resultatet diskuteras möjligheter och hinder för studentens lärande under co-op

Program coordinators’ perspectives on implementing a transition program for newly graduated nurses : a qualitative interview study

Purpose While transition programs are widely used to facilitate newly graduated nurses transition to healthcare settings, knowledge about preconditions for implementing such programs in the hospital context is scarce. The purpose of this study was to explore program coordinators’ perspectives on implementing a transition program for newly graduated nurses. Design/methodology/approach  An explorative qualitative study using individual interviews. Total of 11 program coordinators at five acute care hospital administrations in a south-west region in Sweden. Data was subjected to thematic analysis, using NVivo software to promote coding. Findings The following two themes were identified from the analysis: Create a shared responsibility for introducing newly graduated nurses, and establish legitimacy of the program. The implementation process was found to be a matter of both educational content and anchoring work in the hospital organization. To clarify the what and why of implementing a transition program, where the nurses learning processes are prioritized, was foundational prerequisites for successful implementation. Originality/value  This paper illustrates that implementing transition programs in contemporary hospital care context is a valuable but complex process that involves conflicting priorities. A program that is well integrated in the organization, in which responsibilities between different levels and roles in the hospital organization, aims and expectations on the program are clarified, is important to achieve the intentions of effective transition to practice. Joint actions need to be taken by healthcare policymakers, hospitals and ward managers, and educational institutions to support the implementation of transition programs as a long-term strategy for nurses entering hospital care.CC BY 4.0</p

The value of simulation-based education in developing preparedness for acute care situations : An interview study of new graduate nurses’ perspectives

Aim This study aimed to explore how new graduated nurses experience a one-day simulation based education, contributing to providing care in acute situations two months after completion. Background Simulation-based education is often offered to new graduated nurses as part of important workplace learning. Simulation-based education is a valid learning and teaching strategy and is suggested as a measure to improve nurses’ ability in acute situations. However, studies are often conducted as pre-post evaluations immediately after completion of a simulation. Thus, knowledge of the clinical impact of simulation-based education on actual acute care situations could benefit both research and practice. Design/method During the winter of 2021–2022, 14 semi-structured interviews were conducted with newly graduated nurses two months after they completed the simulation-based education and the interviews were analyzed using thematic analysis. Results The results are presented in three themes: a structured and shared strategy to handle acute situations, a developed role in acute situations and a more comprehensive understanding of acute situations. The results revealed that simulation-based education can contribute to the ability to care in acute situations in terms of action readiness and broad contextual understanding. Conclusion Simulation-based education can help develop the ability to care for patients in acute situations. However, differences in participant experiences must be acknowledged and processed in order for the implementation and outcome to be successful.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).</p

Prepared to learn but unprepared for work : A cross sectional survey study exploring the preparedness, challenges, and needs of newly graduated nurses entering a hospital-based transition program

The study aims to investigate new graduate nurses the perceptions of educational preparedness, their challenges, and their expectations during their transition to hospital care and introduction to work. Background: Previous research has raised questions about new graduate nurses’ (NGNs) preparedness for work in the clinical setting, and transition programs have been implemented to smooth the transition process. Information about NGNs’ expectations of both transition programs and their introduction to work when first entering the nursing profession is scarce. Design: A cross-sectional survey design was used. Method: NGNs enrolled in a regional transition program in six hospitals were recruited from three-cohorts during September 2021, January 2022 and September 2022. After responding to a survey both a qualitative and quantitative approach was used when analyzing responses. Results: Quantitative and qualitative findings derived from 248 NGNs responses showed that 65% of the NGNs perceived that nursing education in general prepared them for clinical work, that they were prepared for and committed to workplace learning but require support from a well-designed transition program as well as from colleagues and managers in their ward unit. The conclusion is that the preparation provided by nursing education as well as organizational factors in the healthcare workplace influence new graduate nurses’ readiness for clinical work, the challenges they perceive, and their needs for learning and suppCC BY 4.0</p

Paediatric on-call consultants’ learning within and beyond the objectives of a coherent CPD program

Background: Evaluations, using questionnaires, of a two-year long CPD program for on-call consultant paediatricians, showed that the overall objective of the program was largely met. We stipulate that the coherency of the CPD program contributed to the learning. To gains a deeper understanding of the participants learning within and beyond the overall objectives of the program, we decided to conduct an interview study enrolling participants from the frst two CPD courses. Methods: Nine experienced paediatric consultants were interviewed 1-4 years after completing a coherent two-year long CPD program, focusing on what and how they learned. The interviews were audio-recorded and transcribed as text, analysed, and categorised using qualitative content analysis. Results: What the participants learned: improved medical competences, greater confdence in the role of an on-call consultant, better understanding of the role of an on-call consultant and importance of professional networks. Several categories were outside the overall objective, at personal level: an understanding of one’s own and other’s competences, taking responsibility for one’s own CPD and managing things one does not know. At professional level: more secure as an individual and with colleagues.How it was learned: relevant objectives, preparatory material and case discussions were important. Participants learned by preparing, repeating, refecting, and participating actively, and by applying what they learned in clinical practice. The participants learned from one other over a period of two years, when they also got to know one another and created networks. A safe learning environment imposed demands and enabled participants to defne their competence and learn accordingly. Conclusions: This study describes what and how on-call consultant paediatricians learned during a coherent two year long CPD program. The learning took place within and beyond the framework of the overall objectives. The study suggests that evaluation methods based on objectives may be blind to important areas of learning and need to be combined with qualitative methods that examine a broad impact of learning. Taken together, the analysis of what and how the participants learned shows that they were better equipped to work as consultant on call and deal with the things they did not know.FundingThis research received fnancial support from: The Healthcare Board Region Västra Götaland and the Projekt: Pediatric and Pedagogic Continuing Professional Development (CPD) for Paediatricians, funded by the Human Resources Sub-Committee, Region Västra Götaland.© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.</p