Being and becoming a teacher in medical education

Medical teachers’ conceptions of teaching have implications for student learning. The way teachers understand what it means to be a good teacher and what it means to develop as a teacher affect their aims and practice as teachers and their motivation for engaging in development activities. The aim of this thesis was to clarify how medical teachers understand being lecturers, clinical supervisors and mentors and also how they understand teaching and development as a teacher. In this thesis, the term medical teacher is used for everyone teaching or supervising undergraduate students in medicine or allied health professions at a university campus or associated hospitals. Thirty-nine medical teachers were interviewed. The interviews were semi-structured and analysed using a phenomenographic approach. The findings include qualitatively different ways of understanding: · Being a teacher in the teaching roles of being a lecturer, clinical supervisor and mentor (Study I and II) · Development as a teacher and of teaching (Study III) · Teaching; particularly in relation to how opportunities and barriers for development are perceived (Study IV) The findings of the studies are further elaborated in three ways: 1) By using a model of learning and teaching to explore the different understandings of what it means to be and become a teacher. 2) By exploring perceived differences and similarities between the three teaching roles as described by the individual respondents, 3) By analysing the relationship between different ways of understanding the phenomena studied on an individual level. The way being and becoming a teacher is understood is dynamic and changes over time. Teachers’ understanding of their role constitutes a fundamental dimension of their development as teachers and exerts a significant influence on their teaching. By exploring the effects of various contexts and perceptions of different facets of the teacher role, aspects important to supporting student learning can be addressed

The “Handling” of power in the physician-patient encounter: perceptions from experienced physicians

Background: Modern healthcare is burgeoning with patient centered rhetoric where physicians “share power” equally in their interactions with patients. However, how physicians actually conceptualize and manage their power when interacting with patients remains unexamined in the literature. This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians. It is necessary to examine physicians’ awareness of power in the context of modern healthcare that espouses values of dialogic, egalitarian, patient centered care. Methods Thirty physicians with a minimum five years’ experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul’s three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu’s social theory served as analytic tools for achieving an understanding of physicians’ perceptions of power in their interactions with patients. Results The analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians’ responses fell under three broad categories: (1) Perceptions of holding and managing power, (2) Perceptions of power as waning, and (3) Perceptions of power as non-existent or irrelevant. Conclusions Although the “sharing of power” is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.Medicine, Faculty ofNon UBCOccupational Science and Occupational Therapy, Department ofReviewedFacult

Common concepts in separate domains? Family physicians’ ways of understanding teaching patients and trainees, a qualitative study

Background: Medical education is increasingly expanding into new community teaching settings and the need for clinical teachers is rising. Many physicians taking on this new role are already skilled patient educators. The purpose of this research was to explore how family physicians conceptualize teaching patients compared to the teaching of trainees. Our aim was to understand if there is any common ground between these two roles in order to support faculty development based on already existing skills. Methods: Semi-structured interviews with twenty-five family physician preceptors were conducted in Vancouver, Canada and thematically analyzed. Results: We identified four key areas of overlap between the two fields (being learner-centered; supporting the acquisition, application and integration of knowledge; role modeling and self-disclosure; and facilitating autonomy) and three areas of divergence (aim of teaching and setting the learning objectives; establishing rapport; and providing feedback). Conclusions: Finding common ground between these two teaching roles would support knowledge translation and inquiry between the domains of teaching patients and trainees. It would furthermore open up new avenues for improving training and practice for clinical teachers by better linking faculty development and continuing medical education (CME).Medicine, Faculty ofOther UBCReviewedFacult

Exploring dimensions of change : the case of MOOC conceptions

This paper addresses a relatively new phenomenon in higher education, Massive Open Online Courses (MOOCs), and explores conceptions around this new and emerging development from the perspective of a number of stakeholders in the university. A phenomenographic approach is adopted. The study explores how different stakeholders at a university perceive the MOOC phenomenon, and reflects on how the many conceptions stakeholders adhere to are made meaningful for academic developers in their role as ‘partners in arms’. The conceptions run across a continuum from the local and narrow to the global and broad. The study identifies challenges to change agency in a higher education institution

Kaizen practice in healthcare : a qualitative analysis of hospital employees' suggestions for improvement

OBJECTIVES: Kaizen, or continuous improvement, lies at the core of lean. Kaizen is implemented through practices that enable employees to propose ideas for improvement and solve problems. The aim of this study is to describe the types of issues and improvement suggestions that hospital employees feel empowered to address through kaizen practices in order to understand when and how kaizen is used in healthcare. METHODS: We analysed 186 structured kaizen documents containing improvement suggestions that were produced by 165 employees at a Swedish hospital. Directed content analysis was used to categorise the suggestions into following categories: type of situation (proactive or reactive) triggering an action; type of process addressed (technical/administrative, support and clinical); complexity level (simple or complex); and type of outcomes aimed for (operational or sociotechnical). Compliance to the kaizen template was calculated. RESULTS: 72% of the improvement suggestions were reactions to a perceived problem. Support, technical and administrative, and primary clinical processes were involved in 47%, 38% and 16% of the suggestions, respectively. The majority of the kaizen documents addressed simple situations and focused on operational outcomes. The degree of compliance to the kaizen template was high for several items concerning the identification of problems and the proposed solutions, and low for items related to the test and implementation of solutions. CONCLUSIONS: There is a need to combine kaizen practices with improvement and innovation practices that help staff and managers to address complex issues, such as the improvement of clinical care processes. The limited focus on sociotechnical aspects and the partial compliance to kaizen templates may indicate a limited understanding of the entire kaizen process and of how it relates to the overall organisational goals. This in turn can hamper the sustainability of kaizen practices and results