Introduction: Postgraduate psychiatry training occurs in the workplace or situated learning settings. The Cognitive Apprenticeship Model [CAM] was introduced as an instructional model for situated learning. While undergraduate medical students' experience of the model has been tested, to our knowledge there has been no such reports from postgraduate psychiatry training. Methods: We surveyed 134 Oxford Deanery psychiatry trainees recruited between 2005 and 2013 through an online questionnaire. Respondents identified which CAM components [scaffolding, modelling coaching, articulation, reflection exploration] were the best aspects, and most needing improvement, in their clinical training. Results: Of 57 respondents, 80% were satisfied with and enjoyed [90%] their training. They recognised all individual CAM components; modelling and coaching were identified as the best methods. Exploration was identified as the one most in need of improvement. The behavioural [modelling, coaching and scaffolding] rather than the cognitive methods were identified as the best aspects of their training [54 v 35%, p < 0.001]. Conclusions: The results extend findings from undergraduate students in suggesting that the CAM is a useful model for training strategies. Greater awareness of the cognitive components may be needed. The training methods could be included as indicators of training quality in national quality assurance surveys

Bajorek, Tomasz

Ghazirad, Marjan

Hafferty, Jonathan

O'Leary, Denise

Quinlan, Kathleen M.

Shaddel, Farshad

Kent Academic Repository

Kent Academic RepositoryFull text document (pdf)Copyright & reuseContent in the Kent Academic Repository is made available for research purposes. Unless otherwise stated allcontent is protected by copyright and in the absence of an open licence (eg Creative Commons), permissions for further reuse of content should be sought from the publisher, author or other copyright holder. Versions of researchThe version in the Kent Academic Repository may differ from the final published version. Users are advised to check http://kar.kent.ac.uk for the status of the paper. Users should always cite the published version of record.EnquiriesFor any further enquiries regarding the licence status of this document, please contact: researchsupport@kent.ac.ukIf you believe this document infringes copyright then please contact the KAR admin team with the take-down information provided at http://kar.kent.ac.uk/contact.htmlCitation for published versionShaddel, Farshad and Ghazirad, Marjan and O'Leary, Denise and Quinlan, Kathleen M. and Hafferty,Jonathan and Bajorek, Tomasz  (2016) Cognitive apprenticeship in clinical practice; Can it beextended to postgraduate psychiatry training programmes?   Mathews Journal of Psychiatry andMental Health, 1  (2).    ISSN 2474-7564.DOILink to record in KARhttps://kar.kent.ac.uk/78568/Document VersionPublisher pdfResearch Article Mathews Journal of Psychiatry & Mental HealthCognitive Apprenticeship in Clinical Practice; Can it be Extended to Postgraduate Psychiatry Training Programmes?Farshad Shaddel1, Marjan Ghazirad2, Denis O’Leary3, Kathleen M Quinlan4, Jonathan Hafferty2, Tomasz Bajorek21Consultant Psychiatrist, Berkshire Health NHS Foundation Trust, UK.2Psychiatry Specialist Registrar, Oxford Deanery, UK.3Honorary Clinical Tutor, Medical Sciences Division, University of Oxford, UK.4Head, Educational Development Group, Oxford Learning Institute, UK.Corresponding Author: Farshad Shaddel, Consultant Psychiatrist, Berkshire Healthcare NHS Foundation Trust, UK, Tel: 0118 960 5115; Email: f_shaddel@yahoo.com 1Received Date: 25 Jul 2016Accepted Date: 30 Jul 2016Published Date: 03 Aug 2016Copyright © 2016 Shaddel FCitation: Shaddel F, Ghazirad M, O’Leary D, Quinlan KM, et al. (2016). Cognitive Apprenticeship in Clinical Practice; Can it be extended to Postgraduate Psychiatry Training Programmes? M J Psyc. 1(2):005.Citation:  Shaddel F, Ghazirad M, O’Leary D, Quinlan KM, et al. (2016). Cognitive Apprenticeship in Clinical Practice; Can it be extended to Postgraduate Psychiatry Training Programmes? M J Psyc. 1(2):005.ABSTRACTIntroduction: Postgraduate psychiatry training occurs in the workplace or situated learning settings. The Cognitive Ap-prenticeship Model [CAM] was introduced as an instructional model for situated learning. While undergraduate medical students’ experience of the model has been tested, to our knowledge there has been no such reports from postgraduate psychiatry training. Methods: We surveyed 134 Oxford Deanery psychiatry trainees recruited between 2005 and 2013 through an online questionnaire. Respondents identified which CAM components [scaffolding, modelling coaching, articulation, reflection exploration] were the best aspects, and most needing improvement, in their clinical training.Results: Of 57 respondents, 80% were satisfied with and enjoyed [90%] their training. They recognised all individual CAM components; modelling and coaching were identified as the best methods. Exploration was identified as the one most in need of improvement. The behavioural [modelling, coaching and scaffolding] rather than the cognitive methods were identified as the best aspects of their training [54 v 35%, p < 0.001]. Conclusions: The results extend findings from undergraduate students in suggesting that the CAM is a useful model for training strategies. Greater awareness of the cognitive components may be needed. The training methods could be in-cluded as indicators of training quality in national quality assurance surveys.KEYWORDS: Cognitive Apprenticeship; Postgraduate Psychiatry Training.INTRODUCTIONNational and specialty specific trainee surveys tend to focus on the structural aspects of training programmes rather than the training methods used by trainers per-se. Knowing what train-ing methods the clinical supervisor(s) use should be as valid for quality assurance purposes as well as knowing whether there is one or not [1-5]. As clinical training is mainly workplace-based we decided to use an instructional model of learning – the Cognitive Apprenticeship model (CAM), designed for situ-ational learning settings - as a theoretical basis for appropriate training methods [6-8]. In addition we considered the training methods (modelling, scaffolding, coaching, reflection, explo-ration and articulation) to reflect our experience of training methods in practise [face validity]. Notably, while the model has been suggested as a useful one for undergraduate medical teaching, to the best of our knowledge there are no reports of its use in postgraduate psychiatry training settings [9]. The ISSN: 2474-7564www.mathewsopenaccess.com2Citation:  Shaddel F, Ghazirad M, O’Leary D, Quinlan KM, et al. (2016). Cognitive Apprenticeship in Clinical Practice; Can it be extended to Postgraduate Psychiatry Training Programmes? M J Psyc. 1(2):005.aim of this paper therefore is to report on whether the com-ponents of the CAM model would be recognised by cohorts of trainees recruited to postgraduate training programmes in psychiatry, so extending findings from undergraduate settings and potentially informing the development of indicators for training assurance purposes. METHODSUsing the Oxford Deanery database we identified 134 doctors recruited to the basic or core psychiatry training programmes for the period 2005-2013. Trainees were contacted via the Survey Monkey portal from 15/02/2014 – 27/03/2014. The instructions specified that responses and personal data would be anonymised and cited ethical approval. After piloting, mi-nor amendments were made to the survey questionnaire and a protocol for contacting initial non-responders developed. The questionnaire design included open ended-questions and “free text” boxes. Respondents were asked to describe the best aspects of their training and those in need of improve-ment across the CAM components; they could identify as many of them as they wished. Baseline demographic data col-lected included: gender; age-range at time of survey comple-tion; UK graduation; English as first language; year of entering training programme; current post. The responses were analysed using basic descriptive statistics provided in Microsoft Excel and content analysis of qualitative data. The study protocol was approved by and registered with the Central University Research Ethics Committee (CUREC), University of Oxford.RESULTSThere was a 43.2% response rate (n = 57). 28 were male; 26 female; 3 did not specify their gender. Their ages ranged 26 to 50; the majority were between 26 and 35 years (59%). Thirty-nine (68%) obtained their primary medical education in the UK; 42 (74%) had English as their first language. Nine started core training in 2005 and 3, 8, 5, 3, 7, 7, 6, 9 in each year to 2013 inclusive. The distribution across current posts was: 12 consultants; 15 higher trainees; and 22 core trainees; 1 non-training grade. One was practising psychiatry outside the UK; six (11%) respondents had left psychiatry. In terms of overall satisfaction, 80% of respondents rated their training as “what they expected”; 90% agreed that they “en-joyed the job”. Respondents rated each of the CAM methods (range 27-63%). About two thirds rated modelling as the best training method; half rated coaching as the best. Exploration was the method rated by the highest proportion of respon-dents as in need of improvement. On average, 54% of respon-dents considered the behavioural elements of the CAM meth-ods [e.g. modelling, scaffolding and coaching) as the best part of training versus 34% for cognitive aspects (P = 0.000211). 31 respondents provided qualitative responses. These empha-sised the impact of the clinical supervisor (both positive and negative) e.g. “excellent supervisor” rather than the specific CAM training methods. Table 1: (n = 57): Rating of CAM methods considered “Best” and “In need of improvement”.Modelling Coaching Scaffolding Articulation Reflection Exploration Learning ClimateBest 63% 55% 43% 27% 43% 33% 43%Improvementneeded35% 35% 33% 19% 21% 40% 40%DISCUSSION The main aim of this paper is to report on whether the CAM can be used in to inform training methods in postgraduate psychiatry training settings. The period of observation in-cludes trainee cohorts recruited prior to and after a move away from an apprenticeship approach to training towards a competency-based curriculum in the UK [10]. We shall begin by discussing the limitations of the study. The main limitation is the relatively small sample size and modest response rate (43%). However, the range of response rates to unsolicited and non-compulsory surveys is 2- 57% [11]. In addition, we acknowledge the possibility of specialty and locality specific issues on the quality of training.As far as we are aware, this is the first report to extend the application of the cognitive apprenticeship model (CAM) to postgraduate settings. To provide context, most trainees (90%) enjoyed their training experience – a figure in line with the National Trainee survey satisfaction rates and the learning climate was identified as the best aspect of training by 43% of respondents. In keeping with the findings in undergradu-ate medicine, respondents were able to comment on each of the CAM training methods [9, 12]. Furthermore as with the undergraduate findings modelling and coaching were identi-fied most frequently as the best elements, suggesting some consistency across training pathways. However this similarly is less evident when the comparison is limited to those un-dergraduates who have spent more time with a single clinicalwww.mathewsopenaccess.com3Citation:  Shaddel F, Ghazirad M, O’Leary D, Quinlan KM, et al. (2016). Cognitive Apprenticeship in Clinical Practice; Can it be extended to Postgraduate Psychiatry Training Programmes? M J Psyc. 1(2):005.supervisor – more akin to the postgraduate setting in this programme. In the latter circumstance the students opted for scaffolding, reflection and coaching. This of course may reflect the greater need for scaffolding in the earlier aspects of the medical training pathway; reflection was identified as third most useful method in the psychiatry postgraduate cohorts, suggesting that it is appreciated by learners throughout their medical pathway. In addition to providing empirical support to the CAM theoretical framework in medical training, these training methods could be used as potential indicators of training quality, so providing more robust theoretical basis for quality assurance surveys nationally. Nevertheless the qualita-tive comments, while linked to the rating of the CAM training methods, most commonly referred to the general qualities of the clinical supervisor. This highlights to us the importance of the clinical supervisor role itself beyond just training methods [13-15]. The analysis showed that trainees’ choice of what they con-sidered as the best training methods within the model are significantly skewed toward apprenticeship teaching meth-ods (modelling, scaffolding and coaching) rather than those aspects that focus on the learner’s cognitive activities (articu-lation, reflection and exploration). Interestingly, when respon-dents were asked which component of training needs further improvement, they asked for more apprenticeship-based teaching methods rather than support for their own cognitive skills development. If substantiated this pattern of results sug-gests a need for greater emphasis within competency based education curricula on cognitive skills development. CONCLUSIONS The findings support the CAM as a useful model for training strategies in postgraduate training in psychiatry. They support previous suggestions that the model could provide a valuable basis for evaluation, feedback, self-assessment and develop-ment of clinical teachers, with a potential focus on develop-ing cognitive training skills. In addition its components are potential indicators in national assurance surveys of trainers’ teaching methods in the workplace. Clearly more studies are needed to explore the use of CAM in other branches of medi-cine and different contexts.REFERENCES1. Iobst WF, Sherbino J, Cate OT, Richardson DL, et al. (2010). Competency-based medical education in postgraduate medi-cal education. Medical Teacher. 32(8), 651-666.2. Barras C and Harris J. (2012). Psychiatry recruited you, but will it retain you? Survey of trainees’ opinions. Psychiatry Bul-letin. 36, 71-773. Rimmer A. (2014). Psychiatry may need run-through train-ing programmes, says Centre for Workforce Intelligence. BMJ careers. 4. GMC Quality Framework. (2010). General Medical Council, UK.5. Bizrah M, Iacoponi E, Parker E, Rymer J, et al. (2013). A novel method of assessing quality of postgraduate psychiatry training: experiences from a large training programme. BMC Med Educ. 6. Dornan T, Boshuizen H, King N and Scherpier A. (2007). Ex-perience-based learning: a model linking the processes and outcomes of medical students’ workplace learning. Med Educ. 41(1), 84-91. 7. Ericson K. (2004). Deliberate practice and acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine. 79(10), 70-81.8. Collins A, Brown JS and Holum A. (1991). Cognitive Appren-ticeship: Making Thinking Visible. American Educator, winter issue. 9. Stalmeijer RE, Dolmans DHJM, Wolfhagen IHAP and AJJA Scherpbier. (2009). Cognitive apprenticeship in clinical prac-tice: can it stimulate learning in the opinion of students? Adv Health Sci Educ Theory Pract. 4(4), 535-546.10.http://www.rcpsych.ac.uk/training/curriculum2010.aspx%20[accessed%20June%2030%202016]%20CBE11. Holbrook A, Krosnick J and Pfent A. (2007). The Causes and Consequences of Response Rates in Surveys by the News Me-dia and Government Contractor Survey Research Firms. Ad-vances in Telephone Survey Methodology. 499-528.12. National Training Survey. (2014). Key findings. General Medical Council.13. Van der Zwet J, Zwietering P, Teunissen P, Van der Vleuten C, et al. (2010). Workplace learning in general practice: Super-vision, patient mix and independence emerge from the black box once again. Med Teach. 32(7), 294-299. 14. Teunissen PW, Boor K, Scherpbier AJ, van der Vleuten CP, et al. (2007). Attending doctors’ perspectives on how resi-dents learn. Med Educ. 41(11), 1050-1058.15. Platt-Koch and Lois M. (1986). Clinical supervision for psy-chiatric nurses. Journal of Psychosocial Nursing and Mental Health Services. 24(1), 6-15.

Cognitive apprenticeship in clinical practice; Can it be extended to postgraduate psychiatry training programmes?

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Cognitive apprenticeship in clinical practice; Can it be extended to postgraduate psychiatry training programmes?

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