Can acquisition of expertise be supported by technology?

Professional trainees in the workplace are increasingly required to demonstrate specific standards of competence. Yet, empirical evidence of how professionals acquire competence in practice is lacking. The danger, then, is that efforts to support learning processes may be misguided. We hypothesised that a systemic view of how expertise is acquired would support more timely and appropriate development of technology to support workplace learning. The aims of this study were to provide an empirically based understanding of workplace learning and explore how learning could be facilitated through suitable application of technology. We have used the medical specialist trainee as an exemplar of how professionals acquire expertise within a complex working environment. We describe our methodological approach, based on the amalgam of systems analysis and qualitative research methods. We present the development of a framework for analysis and early findings from qualitative data analysis. Based on our findings so far, we present a tentative schema representing how technology can support learning with suggestions for the types of technology that could be used

You understand that whole big situation they\u27re in : Interpretative phenomenological analysis of peer-assisted learning

Abstract Background Peer-assisted learning (PAL) increasingly features within medical school curricula. While there is evidence of its effectiveness, less is known about how it promotes learning. Cognitive and social congruence between peer-tutor and student have been described as important concepts underpinning teaching and learning in PAL. We employed interpretative phenomenological analysis for an in-depth exploration of how medical students experience PAL sessions. Methods We conducted the study at The University of Manchester within a near-peer scheme aimed at developing clinical skills within clinical clerkship students. We conducted individual interviews with three peer tutors and five students. We undertook interpretive phenomenological analysis of interview transcripts. We subsequently synthesised an account of the study participants’ lived experiences of PAL sessions from individual personal accounts to explore how medical students experience peer-assisted learning. This analysis was then used to complement and critique a priori educational theory regarding the mechanisms underlying PAL. Results Students experienced PAL sessions as a safe and egalitarian environment, which shaped the type and style of learning that took place. This was facilitated by close relationships with peer-tutors, with whom they shared a strong sense of camaraderie and shared purpose. Peer-tutors felt able to understand their students’ wider sociocultural context, which was the most important factor underpinning both the PAL environment and tutor-student relationship. Participants contrasted this relative safety, camaraderie and shared purpose of PAL with teaching led by more senior tutors in clinical settings. Conclusions This study provides a rich description of the important factors that characterise medical students’ experiences of PAL sessions. Participants felt a strong sense of support in PAL sessions that took into account their wider sociocultural context. Multiple factors interplayed to create a learning environment and tutor-student relationship that existed in contrast to teaching led by more senior, clinical tutors. The insight generated via IPA complemented existing theory and raised new lines of enquiry to better understand how the peer relationship fosters learning in PAL at medical school. We make recommendations to use insights from PAL for faculty and curriculum development

Destabilising institutions to make healthcare more equitable: Clinicians, educators, and researchers co-producing change

Non peer reviewe

Supporting medical students’ workplace learning: Experience-based learning (ExBL)

Dornan, T., Scherpbier, A. J. J. A., & Boshuizen, H. P. A. (2009). Supporting medical students’ workplace learning: Experience-based learning (ExBL). The Clinical Teacher, 6(3), 167-171.This article describes levels of participation of students in contacts with real patients and how teachers can accelerate progression by creating conditions for students to participate at higher levels. Another role of clinical teachers is to open up opportunities for participation. Practical and emotional learning are mutually reinforcing, and reinforce the ability of students to participate

Medical students’ reactions to an experience-based learning model of clinical education

An experience-based learning (ExBL) model proposes: Medical students learn in workplaces by ‘supported participation’; affects are an important dimension of support; many learning outcomes are affective; supported participation influences students’ professional identity development. The purpose of the study was to check how the model, which is the product of a series of earlier research studies, aligned with students’ experiences, akin to the ‘member checking’ stage of a qualitative research project. In three group discussions, a researcher explained ExBL to 19 junior clinical students, who discussed how it corresponded with their experiences of clinical learning and were given a written précis of it to take away. One to 3 weeks later, they wrote 500-word reflective pieces relating to their subsequent experiences with ExBL. Four researchers conducted a qualitative analysis. Having found many instances of responses ‘resonating’ to the model, the authors systematically identified and coded respondents’ ‘resonances’ to define how they aligned with their experiences. 120 resonances were identified. Seventy (58 %) were positive experiences and 50 (42 %) negative ones. Salient experiences were triggered by the learning environment in 115 instances (96 %) and by learners themselves in 5 instances (4 %), consistent with a strong effect of environment on learning processes. Affective support was apparent in 129 of 203 statements (64 %) of resonances and 118 learning outcomes (58 %) were also affective. ExBL aligns with medical students’ experiences of clinical learning. Subject to further research, these findings suggest ExBL could be used to support the preparation of faculty and students for workplace learning

Identity text: an educational intervention to foster cultural interaction

Background: Sociocultural theories state that learning results from people participating in contexts where social interaction is facilitated. There is a need to create such facilitated pedagogical spaces where participants can share their ways of knowing and doing. The aim of this exploratory study was to introduce pedagogical space for sociocultural interaction using ‘Identity Text’. Methods: Identity Texts are sociocultural artifacts produced by participants, which can be written, spoken, visual, musical, or multimodal. In 2013, participants of an international medical education fellowship program were asked to create their own Identity Texts to promote discussion about participants’ cultural backgrounds. Thematic analysis was used to make the analysis relevant to studying the pedagogical utility of the intervention. Result: The Identity Text intervention created two spaces: a ‘reflective space’, which helped participants reflect on sensitive topics such as institutional environments, roles in interdisciplinary teams, and gender discrimination, and a ‘narrative space’, which allowed participants to tell powerful stories that provided cultural insights and challenged cultural hegemony; they described the conscious and subconscious transformation in identity that evolved secondary to struggles with local power dynamics and social demands involving the impact of family, peers, and country of origin. Conclusion: While the impact of providing pedagogical space using Identity Text on cognitive engagement and enhanced learning requires further research, the findings of this study suggest that it is a useful pedagogical strategy to support cross-cultural education

Embodied reflexivity in qualitative analysis: a role for selfies

This article introduces a case study on the use of selfies as a means to support embodied reflexivity in phenomenological research. There is a recognized need to make reflexive practice in qualitative health research more transparent. There is also a move towards an embodied type of reflexivity whereby researchers pay attention to their physical reactions as part of the research process. Being reflexive is especially challenging when researchers work in teams rather than as individuals, and when researchers and participants do not meet because data collection and analysis are separate from one another. We used FINLAY's (2005) model of reflexive embodied empathy to explain how taking selfies allowed an international team of researchers to engage reflexively with a participant when their primary access to her lifeworld was an interview transcript. Key concepts from FOUCAULT's (1988) theory of technologies of self, critical self-awareness and self-stylization, shed light on this phenomenon

What supervisors say in their feedback:construction of CanMEDS roles in workplace settings

The CanMEDS framework has been widely adopted in residency education and feedback processes are guided by it. It is, however, only one of many influences on what is actually discussed in feedback. The sociohistorical culture of medicine and individual supervisors' contexts, experiences and beliefs are also influential. Our aim was to find how CanMEDS roles are constructed in feedback in a postgraduate curriculum-in-action. We applied a set of discourse analytic tools to written feedback from 591 feedback forms from 7 hospitals, including 3150 feedback comments in which 126 supervisors provided feedback to 120 residents after observing their performance in authentic settings. The role of Collaborator was constructed in two different ways: a cooperative discourse of equality with other workers and patients; and a discourse, which gave residents positions of power-delegating, asserting and 'taking a firm stance'. Efficiency-being fast and to the point emerged as an important attribute of physicians. Patients were seldom part of the discourses and, when they were, they were constructed as objects of communication and collaboration rather than partners. Although some of the discourses are in line with what might be expected, others were in striking contrast to the spirit of CanMEDS. This study's findings suggest that it takes more than a competency framework, evaluation instruments, and supervisor training to change the culture of workplaces. The impact on residents of training in such demanding, efficiency-focused clinical environments is an important topic for future research

Manchester Clinical Placement Index (MCPI): Conditions for medical students’ learning in hospital and community placements

The drive to quality-manage medical education has created a need for valid measurement instruments. Validity evidence includes the theoretical and contextual origin of items, choice of response processes, internal structure, and interrelationship of a measure’s variables. This research set out to explore the validity and potential utility of an 11-item measurement instrument, whose theoretical and empirical origins were in an Experience Based Learning model of how medical students learn in communities of practice (COPs), and whose contextual origins were in a community-oriented, horizontally integrated, undergraduate medical programme. The objectives were to examine the psychometric properties of the scale in both hospital and community COPs and provide validity evidence to support using it to measure the quality of placements. The instrument was administered twice to students learning in both hospital and community placements and analysed using exploratory factor analysis and a generalizability analysis. 754 of a possible 902 questionnaires were returned (84% response rate), representing 168 placements. Eight items loaded onto two factors, which accounted for 78% of variance in the hospital data and 82% of variance in the community data. One factor was the placement learning environment, whose five constituent items were how learners were received at the start of the placement, people’s supportiveness, and the quality of organisation, leadership, and facilities. The other factor represented the quality of training—instruction in skills, observing students performing skills, and providing students with feedback. Alpha coefficients ranged between 0.89 and 0.93 and there were no redundant or ambiguous items. Generalisability analysis showed that between 7 and 11 raters would be needed to achieve acceptable reliability. There is validity evidence to support using the simple 8-item, mixed methods Manchester Clinical Placement Index to measure key conditions for undergraduate medical students’ experience based learning: the quality of the learning environment and the training provided within it. Its conceptual orientation is towards Communities of Practice, which is a dominant contemporary theory in undergraduate medical education

Prevalence, Nature, Severity and Risk Factors for Prescribing Errors in Hospital Inpatients : Prospective Study in 20 UK Hospitals

Funding This study was funded by the General Medical Council (GMC). The study funders had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of this manuscript or in the decision to submit the article for publication. Acknowledgements The EQUIP team would like to thank the following people: Members of the Expert Reference Group (Graham Buckley, Gary Cook, Dianne Parker, Lesley Pugsley and Mike Scott); Members of the Error Validation Group (Lindsay Harper, Katy Mellor, Steven Williams, Keith Harkins, Steve McGlynn, Ray George, Tim Dornan, Penny Lewis); Tribal Consulting Ltd. (Heather Heathfield, Emma Carter) for database design; Study co-ordinators at hospitals (Linda Aldred, Deborah Armstrong, Isam Badhawi, Kathryn Ball, Neil Caldwell, Vanya Fidling, Nicholas Fong, Heather Ford, Andrea Gill, Lindsay Harper, Jean Holmes, Sally James, Christopher Poole, Sally Shaw, Heather Smith, Julie Street, Atia Rifat, David Thornton, Tracey Thornton, Jane Warren, Steven Williams), and all pharmacists at the study sites who collected data for this study.Peer reviewedPublisher PD