Practice-based Learning Across and Between the Health professions: A Conceptual Exploration of Definitions and Diversity and their Impact on Interprofessional Education

Practice-based learning (PrBL) occurs in all health professional training but there are intra- and interprofessional differences depending on context, location and professional identity. In this position paper I will explore the definition, context and elements of PrBL across the health professions, and their implications for interprofessional education (IPE). IPE is a particular focus because of its increasing prominence globally in response to the changing nature of health care delivery as the population ages, the incidence of long term and chronic conditions increases and health and social care delivery is undertaken increasingly in multidisciplinary teams. PrBL aims to facilitate the transfer of theory into the workplace through situated and experiential learning. But it is not solely about preparing for practice after qualification; rather it is about learning in and about practice through authentic experience and becoming part of a community of practice. Best PrBL requires the alignment of explicit learning outcomes with clinically situated and supervised learning activities, and then with valid and reliable assessment. There are still questions about the optimal length and timing of rotations/attachments, and the nature of work-based assessment. The majority of an individual student’s PrBL is uniprofessional but there is a global trend towards increasing and enhancing the provision of interprofessional PrBL, despite the logistical and resource implications. This paper is an overview of current trends in PrBL and raises questions about future research and developments.‘In everyday organizational life, work, learning, innovation, communication, negotiation, conflict over goals, their interpretation, and history, are co-present in practice. They are part of human existence’ (Gherardi 2000, p214).In this position paper I explore the aims, nature and delivery of practice-based learning (PrBL) in order to introduce the scope of the journal and consider areas for further exploration

Practice-based Learning Across and Between the Health professions: A Conceptual Exploration of Definitions and Diversity and their Impact on Interprofessional Education

Practice-based learning (PrBL) occurs in all health professional training but there are intra- and interprofessional differences depending on context, location and professional identity. In this position paper I will explore the definition, context and elements of PrBL across the health professions, and their implications for interprofessional education (IPE). IPE is a particular focus because of its increasing prominence globally in response to the changing nature of health care delivery as the population ages, the incidence of long term and chronic conditions increases and health and social care delivery is undertaken increasingly in multidisciplinary teams. PrBL aims to facilitate the transfer of theory into the workplace through situated and experiential learning. But it is not solely about preparing for practice after qualification; rather it is about learning in and about practice through authentic experience and becoming part of a community of practice. Best PrBL requires the alignment of explicit learning outcomes with clinically situated and supervised learning activities, and then with valid and reliable assessment. There are still questions about the optimal length and timing of rotations/attachments, and the nature of work-based assessment. The majority of an individual student’s PrBL is uniprofessional but there is a global trend towards increasing and enhancing the provision of interprofessional PrBL, despite the logistical and resource implications. This paper is an overview of current trends in PrBL and raises questions about future research and developments.‘In everyday organizational life, work, learning, innovation, communication, negotiation, conflict over goals, their interpretation, and history, are co-present in practice. They are part of human existence’ (Gherardi 2000, p214).In this position paper I explore the aims, nature and delivery of practice-based learning (PrBL) in order to introduce the scope of the journal and consider areas for further exploration

Open Access and the Graduate Author: A Dissertation Anxiety Manual

The process of completing a dissertation is stressful—deadlines are scary, editing is hard, formatting is tricky, and defending is terrifying. (And, of course, postgraduate employment is often uncertain.) Now that dissertations are deposited and distributed electronically, students must perform yet another anxiety-inducing task: deciding whether they want to make their dissertations immediately open access (OA) or, at universities that require OA, coming to terms with openness. For some students, mostly in the humanities and some of the social sciences, who hope to transform their dissertations into books, OA has become a bogeyman, a supposed saboteur of book contracts and destroyer of careers. This chapter examines the various access-related anxieties that plague graduate students. It is a kind of diagnostic and statistical manual of dissertation anxieties—a Dissertation Anxiety Manual, if you will—describing anxieties surrounding book contracts, book sales, plagiarism, juvenilia, the ambiguity of the term online, and changes in scholarly research and production

Shared decision making between registrars and patients : web based decision aids

BACKGROUND: Current evidence suggests that doctors do not always involve patients in decisions; this may be due to lack of training. This study explores the feasibility of using web based decision aids (DAs) to improve the skills of general practice registrars in sharing decisions with patients. METHOD: Interviews were conducted with registrars to explore their attitudes to shared decision making. Following an educational intervention, registrars were asked to adopt shared decision making within their consultations using DAs as appropriate. The registrars were interviewed again to explore their experiences and any barriers to the process. RESULTS: Registrars had positive views about the shared decision making process but required more training. They had mixed opinions about the use of DAs and identified several barriers to their use. They felt that they had learned from the project and process without necessarily wanting to pursue the use of DAs as interactive tools, preferring to use them as educational resources

Conflict in Practice-based Settings: Nature, Resolution and Education

In this masterclass we review the evidence regarding the nature of conflict within healthcare practice settings, discuss ways of preventing and resolving conflict, and consider how practice-based education, focusing on conflict and negotiation, may help learners achieve positive outcomes. Conflict is a serious state, which is often prolonged and arises from incompatibility or divergent interests and values. However, conflict may also be used as a productive force for change. Conflict has been included as a core competence for healthcare professionals in a number of competency frameworks because of the recognition that inter- and intra-professional conflict affect patient safety and outcomes, as well as having detrimental effects on staff morale, and on physical and mental health. We discuss how conflict may arise from several triggers – personal, professional and organisational. In particular, disparities in values may lead to conflict, while good communication is fundamental to optimal practice. The history of the development of the health professions includes many examples of conflict between professional groups. A healthy practice environment should encourage constructive conflict management, recognising that conflict will always arise. Early experiences of working and learning together represent important learning opportunities for students, enabling the development and practice of teamwork skills, as well as helping them to recognise and understand the different values, perspectives, roles and responsibilities of team members. Learning opportunities based on real-life scenarios and patient experiences provide a focus common to all professional groups, allowing students the opportunity to explore their differences and similarities. The key messages are: conflict occurs frequently in practice-based settings both inter- and intra-professionally, and learners need to be able to recognise and deal with conflict, including through negotiation

The one minute mentor : a pilot study assessing medical students’ and residents’ professional behaviours through recordings of clinical preceptors’ immediate feedback

Introduction: The assessment of professional development and behaviour is an important issue in the training of medical students and physicians. Several methods have been developed for doing so. What is still needed is a method that combines assessment of actual behaviour in the workplace with timely feedback to learners. Goal: We describe the development, piloting and evaluation of a method for assessing professional behaviour using digital audio recordings of clinical supervisors’ brief feedback. We evaluate the inter-rater reliability, acceptability and feasibility of this approach. Methods: Six medical students in Year 5 and three GP registrars (residents) took part in this pilot project. Each had a personal digital assistant (PDA) and approached their clinical supervisors to give approximately one minute of verbal feedback on professionalism-related behaviours they had observed in the registrar’s clinical encounters. The comments, both in transcribed text format and audio, were scored by five evaluators for competence (the learner’s performance) and confidence (how confident the evaluator was that the comment clearly described an observed behaviour or attribute that was relevant). Students and evaluators were surveyed for feedback on the process. Results: Study evaluators rated 29 comments from supervisors in text and audio format. There was good inter-rater reliability (Cronbach α around 0.8) on competence scores. There was good agreement (paired t-test) between scores across supervisors for assessments of comments in both written and audio formats. Students found the method helpful in providing feedback on professionalism. Evaluators liked having a relatively objective approach for judging behaviours and attributes but found scoring audio comments to be time-consuming. Discussion: This method of assessing learners’ professional behaviour shows potential for providing both formative and summative assessment in a way that is feasible and acceptable to students and evaluators. Initial data shows good reliability but to be valid, training of clinical supervisors is necessary to help them provide useful comments based on defined behaviours and attributes of students. In addition, the validity of the scoring method remains to be confirmed

\u27Compassion, the first emotion ditched when I\u27m busy\u27. The struggle to maintain our common humanity

Introduction: A considerable body of literature has been built around the socialisation of medical students and junior doctors into the culture of medicine, yet our appreciation of how their affective learning is shaped through practice, over time, continues to challenge our understanding and subsequent educational practice. This study addresses this gap by using compassion as a lens to unpack affective learning. Methods: This research asked interns undertaking their first year of medical practice “What have been the main influences (positive and/or negative) in how you have learned to express compassion for your patients when working in the clinical context? Their individual narratives, generated through reflective journals and unstructured interviews, when thematically analysed, told us how and why they struggled. Findings: The eight interns expressed their struggle to maintain their compassionate aspirations when confronted with the complexity and competing demands of their community of practice. Their emotional disquiet triggered their safety ethic resulting in their compassion, a prosocial moral emotion, being replaced by a more reductionist approach where patient care was reframed as patient management. Discussion: While neither inevitable nor static, the interns’ narratives tell a story where, after a year embedded in their community of practice, their increased self-efficacy, derived primarily from their perceived biomedical competence, enables them to revisit their original aspirations - to be both compassionate and competent - recognising that being a ‘good’ doctor does not have to eclipse being a kind and caring human being. Conclusions: The interns’ reflections uncovered a narrative of emotional vulnerability, where fearing failure and seeking perfection, contributed to a diminished self‑efficacy resulting in risk aversive behaviours protecting their doctor identity. In the recommendations the authors propose strategies for safe engaged connection, where self‑understanding replaces self‑criticism and self‑compassion is cultivated to guard against contempt and cynicism

Compassion: Wherefore Art Thou?

Compassion is a health professional value that has received a lot of attention recently. In this paper we consider the nature of compassion, its definition and its expression in practice. We further link compassion to patient-centred care. There is debate about whether compassion can be learned, and therefore assessed. There are similar discussions in relation to ‘professionalism’ and the effects of the hidden curriculum. We conclude that compassion is everyone’s business and that learners require early and sustained patient and client contact with time for reflection to enable the delivery of compassionate care

Developing and evaluating a professional development plan pilot for doctors in unaccredited posts: A pilot study

Purpose In Australia, doctors from their third-year post graduation who are not on specialist training pathways frequently work in unaccredited posts with varying amounts of education and support. In 2019, the New South Wales Ministry of Health (NSW Health) and the Health Education and Training Institute (HETI) agreed on a pilot process for these doctors to develop a professional development plan (PDP). The pilot aimed to implement the process and evaluate its feasibility and acceptability. Methodology/approach The process was piloted at four sites in 2021. The evaluation methodology was informed by the non-adoption, abandonment and challenges to scale-up, spread and sustainability (NASSS) framework with data derived from site meetings, interviews with doctors in unaccredited positions and PDP supervisors, and analysis of PDPs and time required. Findings A total of 42 doctors undertook the PDP process, of whom 25 were interviewed. Of the 28 supervisors recruited, 13 were interviewed. Three sites reported successful implementation, with most doctors having a PDP in progress. Despite challenges associated with the diversity of the workforce and workplaces, all sites were supportive of the process being rolled out with appropriate resourcing.  Research implications The research findings indicated that embedding a PDP process more widely across the state will be complex due to the diversity of the workforce and clinical workplaces. Practical implications The PDP process, while acceptable and feasible, needs to adapt to local circumstances, including the workforce, supervisory capacity and experience, individual doctor needs and available resources. Originality The evaluation supports the need for a supported PDP process for doctors in unaccredited positions. Limitations The findings may not be transferable to all NSW Health facilities or to other states or territories. Doctors who consented to be interviewed were more likely to be positive about the process than those who did not. The study did not include a cost evaluation or explore cost-effectiveness due to the short time frame