| 1. |
- Haffling, Ann-Christin, et al.
(författare)
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Early patient contact in primary care: a new challenge
- 2001
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 35:9, s. 901-908
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Tidskriftsartikel (refereegranskat)abstract
- Background The Medical School of Lund University, Sweden, has introduced an early patient contact course, including training in communication and examination skills. The course runs parallel with theoretical subjects during the students' first two-and-a-half years. General practitioner (GP) participation is gradually increasing, and in the last half-year of the course GPs in all health centres in the area are involved. Little is known about the GPs' interest, competence and time for this new task. Aim To describe the GPs' attitudes towards teaching and the rewards and problems they experience. Subjects 30 GPs teaching third-year medical students. Method Semistructured interview study. Data analysis by a method described by Malterud. Results The attitude towards teaching was mostly positive and the teachers were confident about teaching examination procedure. Among rewards of teaching, improved quality of, clinical practice was the main theme, but imparting knowledge to others, contact with enthusiastic students, and gains in self-esteem were also mentioned. Problems with teaching were mostly due to external factors such as lack of time and space, but concern about a negative effect on patient care was also recognized. Educational objectives of the course were not completely accepted. GPs were not fully aware about what to expect from the students, with subsequent problems concerning how to assess students' performance and how to give effective feedback. Conclusions The teaching of junior medical students is maintained by the GPs' enthusiasm for teaching. However, teacher training is required and the crucial issues of time and space have to be considered.
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| 2. |
- Mattheos, N, et al.
(författare)
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The interactive examination: assessing students' self-assessment ability
- 2004
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 38:4, s. 378-389
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND The ability to self-assess one's competence is a crucial skill for all health professionals. The interactive examination is an assessment model aiming to evaluate not only students' clinical skills and competence, but also their ability to self-assess their proficiency. METHODS The methodology utilised students' own self-assessment, an answer to a written essay question and a group discussion. Students' self-assessment was matched to the judgement of their instructors. As a final task, students compared their own essay to one written by an 'expert'. The differences pointed by students in their comparison documents and the accompanying arguments were analysed and categorised. Students received individual feedback on their performance and learning needs. The model was tested on 1 cohort of undergraduate dental students (year 2001, n = 52) in their third semester of studies, replacing an older form of examination in the discipline of clinical periodontology. RESULTS Students' acceptance of the methodology was very positive. Students tended to overestimate their competence in relation to the judgement of their instructors in diagnostic skills, but not in skills relevant to treatment. No gender differences were observed, although females performed better than males in the examination. Three categories of differences were observed in the students' comparison documents. The accompanying arguments may reveal students' understanding and methods of prioritising. CONCLUSIONS Students tended to overestimate their competence in diagnostic rather than treatment skills. The interactive examination appeared to be a convenient tool for providing deeper insight into students' ability to prioritise, self-assess and steer their own learning.
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| 3. |
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| 4. |
- Wachtler, Caroline, et al.
(författare)
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A hidden curriculum: mapping cultural competency in a medical programme.
- 2003
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 37:10, s. 861-868
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Tidskriftsartikel (refereegranskat)abstract
- Background Cultural competency can be understood as those learned skills which help us understand cultural differences and ease communication between people who have different ways of understanding health, sickness and the body. Recently, medical schools have begun to recognise a need for cultural competency training. However, few reports have been published that articulate and evaluate cultural competency in medical curricula. Aim This study was performed in order to evaluate the current status of cultural competency training at a medical school in southern Sweden. Methods We used a multimethod approach to curriculum evaluation. We reviewed the published list of learning objectives for the medical programme, interviewed curriculum directors and individual teachers for each term about course content and carried out focus group interviews with students in all stages of the medical programme. Results Cultural competency is a present but mostly hidden part of the curriculum. We found learning objectives about cultural competency. Teachers reported a total of 25 instances of teaching that had culture or cultural competency as the main theme or 1 of many themes. Students reported few specific learning instances where cultural competency was the main theme. Students and teachers considered cultural competency training to be integrated into the medical programme. Cultural competency was not assessed. Conclusion This evaluation showed places in the curriculum where cultural competency is a present, absent or hidden part of the curriculum. The differences between the 3 perspectives on the curriculum lead us to propose curriculum changes. This study illustrates how triangulation with a multifactorial methodology leads to understanding of the current curriculum and changes for the future.
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| 5. |
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| 6. |
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| 7. |
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| 8. |
- Antepohl, Wolfram, 1968-, et al.
(författare)
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A follow-up of medical graduates of a problem-based learning curriculum
- 2003
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 37:2, s. 155-162
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: There is little information available on the effects of problem-based undergraduate curricula on doctors and their performances after graduation. Therefore, we conducted a questionnaire study of all graduates of the new medical programme at the Faculty of Health Sciences, Link÷ping University. Methods: All 446 medical students who had graduated from the new programme were asked to fill in a questionnaire about selected activities during their studies and their careers after graduation. They were also asked to evaluate the quality of their undergraduate education retrospectively. Statistical analysis was performed using descriptive, multivariate and bivariate approaches. Results: A total of 77% of the graduates responded. They showed a high degree of overall contentment with their undergraduate education and felt well prepared for professional life during their preregistration period and specialist education (mean = 4.0 on a 6-point Likert scale ranging from 0 to 5). They felt especially well prepared in terms of skills for communication with patients, collaboration with other health professionals and development of critical thinking/scientific attitudes. The students' age at the beginning of their studies correlated positively with their contentment as graduates, especially in terms of preparation for patient communication and collaboration with other health professionals. No differences between students originally admitted via a local admission procedure and those admitted via a national procedure were detected concerning retrospective evaluation of undergraduate medical education. Conclusion: Graduates of the new curriculum showed a high degree of satisfaction with their undergraduate education and its preparation of them for medical practice. Specifically, they were very content with the particular emphases of the new curriculum.
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| 9. |
- Bergstrom, B, et al.
(författare)
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The influence of examination forms
- 2000
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Ingår i: Medical education. - : Wiley. - 0308-0110 .- 1365-2923. ; 34:4, s. 313-313
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 10. |
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| 11. |
- Birgegård, Gunnar, et al.
(författare)
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Change in student attitudes to medical school after the introduction of problem-based learning in spite of low ratings
- 1998
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 32:1, s. 46-49
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Tidskriftsartikel (refereegranskat)abstract
- Students' attitudes to, and opinions of, their studies at medical school were investigated with the help of a questionnaire. They were asked to what extent the medical school encouraged independent, critical thinking, problem-solving skills, decision-making, studying outside the textbook and other behaviours and skills that teachers in higher education usually put forward as important. It was found that students generally had a low opinion of the extent to which their education encouraged such virtues, mean figures ranging between 3.5 and 4.6 on a 10-grade scale. The students felt that their studies to a large extent encouraged focus on details and preparation for examinations. The questionnaire was given to the students after 2 1/2 years of traditional preclinical studies and at the end of the first clinical year. There were significant but numerically small differences for some of the items at the end of the year. However, when problem-based learning (PBL) was introduced during the first clinical year, there was a substantial change: there were now significant and numerically larger differences for seven of the nine items, even though the students were asked to give their opinion of the whole of their time at medical school on both occasions, not only of the last year. There were no other changes in the curriculum or the teaching methods other than the introduction of PBL. The change in attitudes did not depend on the student's appreciation of PBL; students' opinion of PBL was low, indicating that most of them disliked it.
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| 12. |
- Dahle, L. O., et al.
(författare)
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Problem-based medical education : development of a theoretical foundation and a science-based professional attitude
- 1997
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 31:6, s. 416-424
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Tidskriftsartikel (refereegranskat)abstract
- Problem-based learning, combined with early patient contact, integration between different subject areas, elements of multiprofessional education, and special emphasis on the development of communications skills has become the basis for the medical curriculum at the Faculty of Health Sciences in Linköping. Critics have questioned the depth of the scientific and theoretical aspects of the curriculum. Through a series of specific measures in the organization of the curriculum and examinations, and due to the pedagogical principles involved per se, our claim is that students graduating at Linköping do possess the required theoretical knowledge and a scientific attitude to the practice of medicine, at least equivalent to that obtained in a more conventional medical curriculum. One such specific measure is that all students perform one field study and two scientific studies during the course of the curriculum. An investigation of student opinions regarding the value of performing scientific projects of their own have shown that these projects have had a positive impact on the students' general scientific attitude and their willingness to engage in future scientific work. The specific skills acquired, as confirmed by oral examinations, were largely determined by the scientific nature of the chosen field of study. Our graduates have not yet progressed far enough in their careers for comparisons to be made on the basis of the Swedish Licensing Board Internship Examinations, but continuing evaluations of students, graduates and licensed doctors emerging from the curriculum will provide future evi-dence as to whether our present evaluation is correct.
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| 13. |
- Drinkwater, Jess, et al.
(författare)
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The effect of gender on medical students' aspirations : a qualitative study
- 2008
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 42:4, s. 420-426
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to explore the effect of gender on medical students' aspirations. METHODS: The study design included purposive sampling and interim data interpretation to guide recruitment of medical students with a wide spectrum of opinions. Data were collected through audio-recorded, semi-structured, in-depth exploratory interviews, which were transcribed verbatim. Qualitative analysis was carried out by a female medical student researcher. Her evolving interpretation was constantly compared against the original data by male (doctor) and female (pharmacist) staff researchers in a systematic search for internal corroboration or disconfirmation. Causal associations consistently present in the data are reported. RESULTS: Six male and six female medical students in Years 3 and 4 shared a wish to achieve a work-life balance that allowed them to devote time to bringing up children while contributing usefully to society as doctors. However, women were readier to compromise professional attainment within their personal work-life balances. Their readiness derived from gendered stereotypes of women's social and professional roles, a lack of female professional role models, womens' greater awareness of the tensions between career and family, various other informal social influences, and a lack of positive career advice to counterbalance these influences. CONCLUSIONS: Better career advice and more flexible work opportunities are needed if the two-thirds of medical students who are women are to contribute specialist as well as generalist expertise to the medical workforce.
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| 14. |
- Edelbring, Samuel, 1969-, et al.
(författare)
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Integrating virtual patients into courses: follow-up seminars and perceived benefit
- 2012
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Ingår i: Medical Education. - : Wiley-Blackwell Publishing Inc.. - 0308-0110 .- 1365-2923. ; 46:4, s. 417-425
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Tidskriftsartikel (refereegranskat)abstract
- Context: The use of virtual patients (VPs) suggests promising effects on student learning. However, currently empirical data on how best to use VPs in practice are scarce. More knowledge is needed regarding aspects of integrating VPs into a course, of which student acceptance is one key issue. Several authors call for looking beyond technology to see VPs in relation to the course context. The follow-up seminar is proposed as an important aspect of integration that warrants investigation.Methods: A cross-sectional explanatory study was performed in a clinical clerkship introduction course at four teaching hospitals affiliated to the same medical faculty. The VP-related activities were planned collaboratively by teachers from all four settings. However, each setting employed a different strategy to follow up the activity in the course. Sixteen questionnaire items were grouped into three scales pertaining to: perceived benefit of VPs; wish for more guidance on using VPs, and wish for assessment and feedback on VPs. Scale scores were compared across the four settings, which were ranked according to the level of intensity of students processing of cases during VP follow- up activities.Results: The perceived benefit of VPs and their usage were higher in the two intense-use settings compared with the moderate-and lowintensity settings. The wish for more guidance was high in the low-and one of the highintensity settings. Students in all settings displayed little interest in more assessment and feedback regarding VPs.Conclusions: High case processing intensity was related to positive perceptions of the benefit of VPs. However, the low interest in more assessment and feedback on the use of VPs indicates the need to clearly communicate the added value of the follow-up seminar. The findings suggest that a more intense follow-up pays off in terms of the benefit perceived by students. This study illustrates the need to consider VPs from the perspective of a holistic course design and not as isolated add‐ons.
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| 15. |
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| 16. |
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| 17. |
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| 18. |
- Lauffs, Monica, et al.
(författare)
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Cross-cultural adaptation of the Swedish version of Readiness for Interprofessional Learning Scale (RIPLS)
- 2008
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 42:4, s. 405-411
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Tidskriftsartikel (refereegranskat)abstract
- Context Interprofessional learning activities in health care are being gradually introduced on an international basis and therefore cross-cultural and internationally collaborative research into the outcomes of these activities is needed. Hence, it is necessary not only to translate research instruments into the language of the culture in which they are to be used, but also to adapt them culturally if they are to fulfil the testing purposes for which they are intended. It is also necessary to test a translated instrument in order to ensure that it retains its intended psychometric properties.Methods In the present study, the Readiness for Interprofessional Learning Scale (RIPLS) was adapted for use in a Swedish student population. Cross-cultural adaptation was performed according to recommended guidelines. The Swedish version was tested on a group of students from various health care professions (n = 214). Cronbach’s alpha coefficient was adopted to ensure internal consistency.Results Minor discrepancies during the different translation processes were identified and corrected. Confirmatory factor analysis suggests that the model had an acceptable fit, implying that the factor structure of the scale did not undergo any significant changes by being subjected to translation. The psychometric qualities of the instrument were comparable with those of the English-language version.Conclusions This study presents the cross-cultural adaptation of the RIPLS and demonstrates that its subscale Teamwork and Collaboration is the only reliable subscale. The other 2 subscales (Professional Identity, and Roles and Responsibilities) probably require further scrutiny and development, at least in the Swedish population.
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| 19. |
- Lindström, Ulf H., et al.
(författare)
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Medical students' experiences of shame in professional enculturation
- 2011
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Ingår i: Medical Education. - Oxford : Blackwell Science. - 0308-0110 .- 1365-2923. ; 45:10, s. 1016-1024
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Tidskriftsartikel (refereegranskat)abstract
- Context: Despite the intentions of caregivers not to harm, medical encounters may involve intimidation and induce emotions of shame. Reflection is a critical part of professional learning and training. However, the role of shame in medical education has scarcely been studied. The aim of this study was to explore medical students’ reflections on shame-related experiences in clinical situations and to examine how they tackled these experiences. Methods: A 24-credit course in Professional Development is held at the Medical School of Umeå University, Sweden. A 1-day seminar on the theme of shame, which involves individual reflections and group discussions, is held in term 9. Medical students were invited to individually consider and write down their memories of situations in which they had experienced shame in clinical encounters. Of a total of 133 students, 75 were willing to share their written reflections anonymously. Their essays were transcribed to computer text and analysed by means of qualitative content analysis. Results: Three themes emerged. These included: Difficulties in disclosing shame; Shame-inducing circumstances, and Avoiding or addressing shame. Initially, students experienced problems in recalling shameful incidents, but successively described various situations which related to being taken by surprise, being exposed, and being associated with staff imprudence. Students disclosed shame avoidance behaviours, but also gave examples of how addressing shame provided them with new insights and restored their dignity. Conclusions: Students’ reflections on shameful experiences elucidated the importance of attitudes, manners, standards and hierarchies in clinical situations. These are important issues to highlight in the professional enculturation of medical students; our emphasising of them may encourage medical teachers elsewhere to organise similar activities. Opportunities for mentoring medical students in tackling shame and adverse feelings, and in resolving conflict, are needed in medical curricula.
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| 20. |
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| 21. |
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| 22. |
- Nordström, Anna
(författare)
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An exercise in death notification
- 2011
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Ingår i: Medical Education. - Oxford : Blackwell Science. - 0308-0110 .- 1365-2923. ; 45:11, s. 1139-1140
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Tidskriftsartikel (refereegranskat)
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| 23. |
- Risberg, Gunilla, et al.
(författare)
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"Important...but of low status" : male education leaders´ views on gender in medicine
- 2011
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Ingår i: Medical Education. - : Blackwell Publishing. - 0308-0110 .- 1365-2923. ; 45:6, s. 613-624
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The implementation of and communication about matters associated with gender in medical education have been predominantly perceived as women's issues. This study aimed to explore attitudes towards and experiences of gender-related issues among key male members of faculties of medicine.Methods We conducted semi-structured interviews with 20 male education leaders from the six medical schools in Sweden. The interviews were analysed qualitatively using a modified grounded theory approach.Results The core category -'important... but of low status'- reflects ambivalent attitudes towards gender-related issues in medicine among male education leaders. All informants were able to articulate why gender matters. As doctors, they saw gender as a determinant of health and, as bystanders, they had witnessed inequalities and the wasting of women's competence. However, they had doubts about gender-related issues and found them to be overemphasised. Gender education was seen as a threat to medical school curricula as a consequence of the time and space it requires. Gender-related issues were considered to be unscientifically presented, to mostly concern women's issues and to tend to involve 'male bashing' (i.e. gender issues were often labelled as ideological and political). Interviewees asked for facts and knowledge, but questioned specific lessons and gender theory. Experiences of structural constraints, such as prejudice, hierarchies and homosociality, were presented, making gender education difficult and downgrading it.Conclusions The results indicate that male faculty leaders embrace the importance of gender-related issues, but do not necessarily recognise or defend their impact on an area of significant knowledge and competence in medicine. To change this and to engage more men in gender education, faculty measures are needed to counteract prejudice and to upgrade the time allocation, merits and status of gender implementation work. Based on our findings, we present and discuss possible ways to interest more men and to improve gender education in medicine.
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| 24. |
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| 25. |
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| 26. |
- Angelin, Martin, et al.
(författare)
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Illness and risk behaviour in health care students studying abroad
- 2015
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 49:7, s. 684-691
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Tidskriftsartikel (refereegranskat)abstract
- Context: The numbers of university students studying abroad increase every year. These students are not tourists as their studies require different types of travel that expose them to different risks. Moreover, health care students (HCSs) may be exposed to even greater risks according to their travel destinations and itineraries. Clearly, research-based pre-travel advice is needed.Methods: This study reports on a prospective survey conducted from April 2010 to January 2014 of health care and non-health care students from Swedish universities in Umeå, Stockholm and Gothenburg studying abroad.Results: Of the 393 students included in the study, 85% responded. Over half (55%) were HCSs. Pre-travel health information was received by 79% and information on personal safety by 49% of HCSs. The rate of illness during travel was 52%. Health care students more often travelled to developing regions and were at increased risk for travellers' diarrhoea. One in 10 experienced theft and 3% were involved in traffic accidents. One in five met a new sexual partner during travel and 65% of these practised safe sex. Half of all participants increased their alcohol consumption while abroad; high alcohol consumption was associated with increased risk for being a victim of theft, as well as for meeting a new sexual partner during travel.Conclusions: University authorities are responsible for the safety and well-being of students studying abroad. This study supplies organisers and students with epidemiological data that will help improve pre-travel preparation and increase student awareness of the potential risks associated with studying abroad.
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| 27. |
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| 28. |
- Barman, Linda, 1972-, et al.
(författare)
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Safeguarding fairness in assessments—How teachers develop joint practices
- 2022
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Ingår i: Medical Education. - : Wiley-Blackwell Publishing Inc.. - 0308-0110 .- 1365-2923. ; , s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Introduction - In light of reforms demanding increased transparency of student performance assessments, this study offers an in-depth perspective of how teachers develop their assessment practice. Much is known about factors that influence assessments, and different solutions claim to improve the validity and reliability of assessments of students' clinical competency. However, little is known about how teachers go about improving their assessment practices. This study aims to contribute empirical findings about how teachers' assessment practice may change when shared criteria for assessing students' clinical competency are developed and implemented.Methods - Using a narrative-in-action research approach grounded in narrative theory about human sense-making, one group including nine health professions teachers was studied over a period of 1 year. Drawing upon data from observations, interviews, formal documents and written reflections from these teachers, we performed a narrative analysis to reveal how these teachers made sense of experiences associated with the development and implementation of joint grading criteria for assessing students' clinical performances.Results - The findings present a narrative showing how a shared assessment practice took years to develop and was based on the teachers changed approach to scrutiny. The teachers became highly motivated to use grading criteria to ensure fairness in assessments, but more importantly, to fulfil their moral obligation towards patients. The narrative also demonstrates how these teachers reasoned about dilemmas that arose when they applied standardised assessment criteria.Discussion - The narrative analysis shows clearly how teachers' development and application of assessment standards are embedded in local practices. Our findings highlight the importance of teachers' joint discussions on how to interpret criteria applied in formative and summative assessments of students' performances. In particular, teachers' different approaches to assessing ‘pieces of skills’ versus making holistic judgements on students' performances, regardless of whether the grading criteria are clear and well-articulated on paper, should be acknowledged. Understanding the journey that these teachers made gives new perspectives as to how faculty can be supported when assessments of professionalism and clinical competency are developed.
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| 29. |
- Dahlgren, Lars-Ove, et al.
(författare)
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To be and to have a critical friend in medical teaching
- 2006
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 40:1, s. 72-78
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND In order to stimulate reflection and continuous professional development, a model of critical friends evaluating each other was introduced in medical education. OBJECTIVE To investigate whether the critical friend concept can serve as a pragmatic model for evaluation of medical teachers and as a fruitful tool for enhancing self-knowledge and professional development among medical educators. METHODS Three pairs of critical friends were formed, consisting of experienced medical teachers (n = 6) at the Karolinska Institutet. Each teacher was assigned to give 1 lecture and 1 seminar in his or her specific research or clinical field. The critical friend evaluated the performance in class, acting as an observer using a pre-formed protocol. The evaluation was communicated to the teacher during a 45-minute session within 48 hours after the teaching session. Each of the 6 teachers was criticised and gave criticism within the pair configurance. The outcome of the process was evaluated by an experimenter, not participating in the process, who performed a semistructured interview with each of the 6 teachers. RESULTS Each teacher had a different way of reflecting on teaching after the project than before and made changes in his or her way of teaching. We also noted that being a critical friend may be even more effective than having one. The majority of the feedback provided was positive and valuable. CONCLUSION To be and to have a critical friend is worth the extra workload. Therefore, the critical friend concept should be made part of regular teaching practice.
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| 30. |
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| 31. |
- Du, Xiangyun, et al.
(författare)
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Health educators' professional agency in negotiating their Problem-Based Learning (PBL) facilitator roles : Q study
- 2022
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Ingår i: Medical Education. - : John Wiley & Sons. - 0308-0110 .- 1365-2923. ; 56:8, s. 847-857
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: University educators are expected to cope with emerging situations and complex issues in teaching and learning, and this requires them to be agentic and proactive. While professional agency of health educators has not been investigated adequately, this study explores health educators' perception of their enactment of professional agency in the PBL facilitation process in a post-pandemic context.METHODS: Forty PBL facilitators from medical and dental programs in Qatar University participated in the study during the fall semester of 2021, after resuming in-person PBL sessions. To collect and analyze data both qualitatively and quantitatively Q methodology was employed. A 33-statement Q-set was established based on a proposed theoretical framework of professional agency in PBL facilitation, which included three dimensions - intrapersonal, action, and environment.RESULTS: Q factor analysis identified five significantly different viewpoints regarding how PBL facilitators perceive their professional agency sources, namely, 1) institutional resources, 2) policy guideline, 3) making efforts to improve support for students, 4) beliefs on PBL effectiveness, and 5) agentic actions. While four of the viewpoints were positive, participants with the second viewpoint reported negative perceptions and described lack of interest in facilitation work. All three dimensions of the framework were addressed and indicated complexity and interrelatedness of agency enactment. Consensus was observed regarding the need for more professional learning activities for faculty involved in PBL facilitation as source of professional agency.DISCUSSION: The results revealed a high variation of participants' perceptions of professional agency enactment throughout the three dimensions, indicating the need for establishing a common understanding of PBL facilitation work in a given context. For practical implications, further institutional efforts are required to support professional learning for PBL facilitation in a post-pandemic context. Alternate approaches highlighting enforcement of agentic actions in all dimensions of intrapersonal values, stance and action taking, and active interactions with students, colleagues and institutional environments are crucial. Q methodology provides new conceptual and empirical insights to explore the subjectivity of actors in health education.
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| 32. |
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| 33. |
- Dyar, Anna, et al.
(författare)
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What about the supervisor? Clinical supervisors' role in student nurses' peer learning : a phenomenographic study
- 2021
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Ingår i: Medical Education. - : John Wiley & Sons. - 0308-0110 .- 1365-2923. ; 55:6, s. 713-723
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Peer learning is increasingly used for healthcare students in the clinical setting. However, as peer learning between students involves students taking a teaching role, it is unclear what the supervisor's role then becomes. It is vital to determine the role of the supervisor in student peer learning to ensure high quality learning and patient safety.METHODS: Semi-structured interviews were performed with 15 student nurse supervisors (nurses and assistant nurses) from two hospital wards that practice peer learning to investigate the different ways clinical supervisors view their role in students' peer learning. Transcribed data were coded and analysed using a phenomenographic approach.RESULTS: Four hierarchical levels of the supervisor's understanding of their role in students' peer learning were identified: the teacher; the facilitator; the stimulator; and the team player. These categories represent an increasingly inclusive view of which people present on the ward play a role in enabling effective peer learning.CONCLUSIONS: The various understandings of supervisor roles have implications for how supervision of peer learning could be implemented in the future.
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| 34. |
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| 35. |
- Elmberger, Agnes, et al.
(författare)
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Faculty development participants' experiences of working with change in clinical settings
- 2023
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 57:7, s. 679-688
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Many universities offer faculty development to support teachers in developing and improving clinical education in the health professions. Although research shows outcomes on individual levels after faculty development, little is known about its contribution to change within the organisation. To advance current faculty development and ensure that it can support wider educational change in healthcare organisations, a better understanding of educational change practices in these settings is needed. This study therefore explores the experiences of working with educational change in clinical workplaces from the perspective of clinical educators that have undergone faculty development training. The study adopts perspectives on change as influenced by context to include the impact from clinical workplaces on individuals' change work.Methods: A collective case study design with a multi-institutional approach was applied and individual interviews with 14 clinical educators from two universities, one in Sweden and one in South Africa, were conducted. Data were analysed separately before a cross-case analysis was performed, synthesising the findings from both sites.Findings: Participants shared experiences of having limited opportunities to work with educational change beyond their own individual teaching practices within their clinical workplaces. Also, participants appeared to refrain from leading change and rather pursued change on their own or relied on indirect approaches to change. They described several workplace aspects influencing their work, including the organisation and management of teaching, the resources and incentives for teaching and the attitudes and beliefs about teaching within the clinical community.Conclusions: The study shows that clinical educators are part of communities and contexts that shape their approaches to educational change and influence which changes are feasible and which ones are not. It thus adds to the understanding of change as contextual and dynamic and contributes with implications for how to advance faculty development to better support change in practice.
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| 36. |
- Fenwick, Tara, et al.
(författare)
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Towards socio-material approaches in simulation-based education: lessons from complexity theory
- 2015
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Ingår i: Medical Education. - : Wiley: 12 months. - 0308-0110 .- 1365-2923. ; 49:4, s. 359-367
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Tidskriftsartikel (refereegranskat)abstract
- ContextReview studies of simulation-based education (SBE) consistently point out that theory-driven research is lacking. The literature to date is dominated by discourses of fidelity and authenticity - creating the real - with a strong focus on the developing of clinical procedural skills. Little of this writing incorporates the theory and research proliferating in professional studies more broadly, which show how professional learning is embodied, relational and situated in social - material relations. A key concern for medical educators concerns how to better prepare students for the unpredictable and dynamic ambiguity of professional practice; this has stimulated the movement towards socio-material theories in education that address precisely this question. Objectives and MethodsAmong the various socio-material theories that are informing new developments in professional education, complexity theory has been of particular importance for medical educators interested in updating current practices. This paper outlines key elements of complexity theory, illustrated with examples from empirical study, to argue its particular relevance for improving SBE. ResultsComplexity theory can make visible important material dynamics, and their problematic consequences, that are not often noticed in simulated experiences in medical training. It also offers conceptual tools that can be put to practical use. This paper focuses on concepts of emergence, attunement, disturbance and experimentation. These suggest useful new approaches for designing simulated settings and scenarios, and for effective pedagogies before, during and following simulation sessions. ConclusionsSocio-material approaches such as complexity theory are spreading through research and practice in many aspects of professional education across disciplines. Here, we argue for the transformative potential of complexity theory in medical education using simulation as our focus. Complexity tools open questions about the socio-material contradictions inherent in SBE, draw attention to important material dynamics of emergence, and suggest practical educative ways to expand and deepen student learning. Discuss ideas arising from the article at discuss.
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| 37. |
- Gleisner, Jenny, Fil. dr. 1982-, et al.
(författare)
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Approaching distressing or sensitive topics in medical school
- 2021
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Ingår i: Medical Education. - : John Wiley & Sons, Ltd. - 0308-0110 .- 1365-2923. ; 55:11, s. 1221-1222
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The authors encourage a continuous attentiveness to thinking and caring about the challenges medical students will encounter during sensitive discussions.
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| 38. |
- Gleisner, Jenny, Fil. dr. 1982-, et al.
(författare)
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Differences in teaching female and male intimate examinations : A qualitative study
- 2020
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Ingår i: Medical Education. - : John Wiley & Sons. - 0308-0110 .- 1365-2923. ; 54:4, s. 348-355
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Tidskriftsartikel (refereegranskat)abstract
- ContextTeaching intimate examinations to medical students has been recognised as difficult because of the anxious feelings that the students may experience. For their professional development, previously incorporated understandings need to be relearned: how to transgress boundaries that regulate intimacy and physical closeness, learning to examine and touch other peoples' bodies, and talking about things that are otherwise taboo.ObjectivesThis paper compares how students learn to perform two intimate examinations: (i) the digital rectal examination (DRE) of the prostate, and (ii) the bimanual pelvic examination (PE) and analyses how norms and expectations affect how students learn to approach them.MethodsThis study is based on ethnographic work: in‐depth qualitative interviews with two urologists and nine medical students in semesters four, eight and 11 of a medical education programme in Sweden, observations of three learning sessions where 16 students performed the PE on professional patients, and 2 days of observations at a urology outpatient clinic.ResultsThe educational approach to the PE and DRE differ. The PE is taught as sensitive and to be handled with care, using a well‐documented learning concept including interpersonal and technical skills. The patient's exposed position in the gynaecological chair, possible previous negative experiences of PE or sexual exploitation are taken into account. In contrast, there is no educational concept for teaching the DRE. The students perform their first DRE on a clinical patient. The DRE is also handled with care, but with less sensitivity. The patients' possible previous negative experiences are not discussed and are thus made invisible.ConclusionsWell‐established routines in performing the PE help doctors and students to be attentive to patients' emotions and previous experiences, and remind them to perceive the examination as sensitive. Aligning the teaching of the DRE with that of the PE will improve how the male prostate patient is approached.
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| 39. |
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| 40. |
- Koufidis, Charilaos, et al.
(författare)
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Grounding judgement in context : A conceptual learning model of clinical reasoning
- 2020
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 54:11, s. 1019-1028
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Tidskriftsartikel (refereegranskat)abstract
- ContextContemporary research on clinical reasoning focuses on cognitive problem‐solving processes. However, the decisive role that clinical context plays in clinical reasoning is often overlooked. We explored how novice learners make sense of the patient encounter in the clinical situation. In particular, we examined medical students' own judgements concerning diagnostic and management decisions and how the clinical context impacts on this. We aimed to produce a conceptual model of how students learn clinical reasoning in the clinical environment.MethodWe used grounded theory methodology to develop a conceptual learning model. A total of 23 medical students in their third academic year were recruited. Qualitative data were gathered from semi‐structured interviews, participant observations and field interviews, during clinical clerkships.ResultsLearners participating in the clinical environment experienced tensions, called ‘Disjunctions.’ These disjunctions emerged in the context of the student–patient encounter and in particular in situations where an element from the interaction with the patient was perceived as being inconsistent with existing frames of reference. We categorised the sources of disjunctions into four subcategories: (a) observing the manifestations of clinical signs in reality; (b) fitting the symptoms to a diagnosis; (c) considering management decisions, and (d) communicating a medical decision to the patient. Disjunctions involved an affective component and were associated with feelings of uncertainty. These tensions provoked reactions from the learners, leading them to reassess and modify held assumptions in order to accommodate the encountered inconsistent elements. This facilitated changes in judgement. When making a judgement, participants learned to take into consideration situational elements.ConclusionsStudents experience disjunctions in the clinical environment as they encounter situations that challenge their frames of reference. These disjunctions carry significant learning potential. This study can contribute to knowledge concerning the role of the patient encounter in advancing clinical reasoning by transforming problematic habits of the mind.
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| 41. |
- Koufidis, Charilaos, et al.
(författare)
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Representation, interaction and interpretation : Making sense of the context in clinical reasoning
- 2022
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Ingår i: Medical Education. - : John Wiley & Sons. - 0308-0110 .- 1365-2923. ; 56:1, s. 98-109
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAll thinking occurs in some sort of context, rendering the relation between context and clinical reasoning a matter of significant interest. Context, however, has a notoriously vague and contested meaning. A profound disagreement exists between different research traditions studying clinical reasoning in how context is understood. However, empirical evidence examining the impact (or not) of context on clinical reasoning cannot be interpreted without reference to the meaning ascribed to context. Such meaning is invariably determined by assumptions concerning the nature of knowledge and knowing. The epistemology of clinical reasoning determines in essence how context is conceptualised.AimsOur intention is to provide a sound epistemological framework of clinical reasoning that puts context into perspective and demonstrates how context is understood and researched in relation to clinical reasoning.DiscussionWe identify three main epistemological dimensions of clinical reasoning research, each of them corresponding to fundamental patterns of knowing: the representational dimension views clinical reasoning as an act of categorisation, the interactional dimension as a cognitive state emergent from the interactions in a system, while the interpretative dimension as an act of intersubjectivity and socialisation. We discuss the main theories of clinical reasoning under each dimension and consider how the implicit epistemological assumptions of these theories determine the way context is conceptualised. These different conceptualisations of context carry important implications for the phenomenon of context specificity and for learning of clinical reasoning.ConclusionThe study of context may be viewed as the study of the epistemology of clinical reasoning. Making sense of ‘what is going on with this patient’ necessitates reading the context in which the encounter is unfolding and deliberating a path of response justified in that specific context. Mastery of the context in this respect becomes a core activity of medical practice.
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| 42. |
- Lynöe, N, et al.
(författare)
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Informed consent in clinical training--patient experiences and motives for participating.
- 1998
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Ingår i: Medical Education. - 0308-0110 .- 1365-2923. ; 32:5, s. 465-71
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to assess patients' attitudes to and experiences of participating in the clinical training of medical students. Samples of patients (n = 582) selected at random from six different departments (gynaecology, psychiatry, internal medicine, paediatrics, urology and a health care centre with general practitioners) were interviewed by means of a questionnaire. The patients were selected from those who had consulted the actual departments in the last six months of 1995. Four hundred and forty-one patients (76%) answered the questionnaire. Seventy-one per cent of all patients had experience of participating; of these 41% had estimated that they had once or several times participated without being informed. Eighty per cent felt aggrieved if they were not informed. On average 88% were, in principle, positive to participating. Of those who were, in principle, negative a majority had negative experiences of participating. Elderly patients tended to accept participating more often without being informed. Almost all patients seemed to be positive to participating in the education of medical students, although a silent precondition might be that patients should be informed and given the opportunity to abstain.
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| 43. |
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| 44. |
- McGrath, Cormac, et al.
(författare)
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You say it, we say it, but how do we use it? Communities of practice: A critical analysis
- 2020
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 54:3, s. 188-195
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Tidskriftsartikel (refereegranskat)abstract
- Objectives As educational theories are increasingly used in medical education research there are concerns over how these theories are used, how well they are presented and what the authors intend. Communities of practice (CoP) is one example of an often-used theory and conceptual framework. This paper presents a critical analysis of how CoP theory is used in medical education research. Methods A critical literature analysis was undertaken of articles published between 1998 and 2018 in eight internationally recognised medical education journals. From a total of 541 articles, 80 articles met the inclusion criteria and were analysed and mapped according to various patterns of use. Results We discerned five categories of use, two misleading and cosmetic, off target and cosmeticising, and three functional, framing, lensing and transferring. A considerable number of articles either misrepresented the point of communities of practice or used it in a cosmetic fashion. The remainder used the theory to frame an ongoing study in relation to other work, as a lens through which to design the study and collect or analyse data, or as a way of discussing or demonstrating the transferability of the findings. Conclusions We conclude that almost half of the reviewed articles did not offer a functional and rigorous definition of what is meant by CoP; instead, they used it in a potentially misleading or cosmetic manner. This study therefore calls on editors, reviewers and authors alike to increase clarity and quality in the application of CoP theory in medical education.
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| 45. |
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| 46. |
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| 47. |
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| 48. |
- Ponzer, Sari, et al.
(författare)
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Interprofessional training in the context of clinical practice : goals and students' perceptions on clinical education wards
- 2004
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Ingår i: Medical Education. - : Wiley. - 0308-0110 .- 1365-2923. ; 38:7, s. 727-36
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. CONTEXT: A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. MATERIAL AND METHODS: A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). RESULTS: The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. CONCLUSIONS: The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members.
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| 49. |
- Stenfors-Hayes, Terese, et al.
(författare)
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A phenomenographic approach to research in medical education
- 2013
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Ingår i: Medical Education. - : Blackwell Publishing. - 0308-0110 .- 1365-2923. ; 47:3, s. 261-270
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Tidskriftsartikel (refereegranskat)abstract
- Context Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research.Methods This paper introduces phenomenography as a viable qualitative approach for use in medical education research.Results A phenomenographic study maps the qualitatively different ways in which people experience a phenomenon. This type of study can have an important impact on, for example, patient communication, clinical practice and health care education.Conclusion We suggest that a phenomenographic approach can be used to explore many medical education research issues, and can facilitate more solid links between research and educational development and change.
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| 50. |
- van Duin, Titia S., et al.
(författare)
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Junior doctors' experiences with interprofessional collaboration : Wandering the landscape
- 2022
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Ingår i: Medical Education. - : John Wiley & Sons. - 0308-0110 .- 1365-2923. ; 56:4, s. 418-431
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Tidskriftsartikel (refereegranskat)abstract
- Context The transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice that form the Landscape of Practice (LoP). This study aims to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice. Methods In this multicentre qualitative study, 13 junior doctors individually drew two rich pictures of IPC experiences, one positive and one negative. A rich picture is a visual representation, a drawing of a particular situation intended to capture the complex and non-verbal elements of an experience. We used semi-structured interviews to deepen the understanding of junior doctors' depicted IPC experiences. We analysed both visual materials and interview transcripts iteratively, for which we adopted an inductive constructivist thematic analysis. Results While transitioning into a doctor, junior doctors become foremost members of the physician CoP and shape their professional identity based on perceived values in their physician community. Interprofessional learning occurs implicitly, without input from the interprofessional team. As a result, junior doctors struggle to bridge the gap between themselves and the interprofessional team, preventing IPC learning from developing into an integrative process. This professional isolation leaves junior doctors wandering the landscape of practice without understanding roles, attitudes and expectations of others. Conclusions Learning IPC needs to become a collective endeavour and an explicit learning goal, based on multisource feedback to take advantage of the expertise already present in the LoP. Furthermore, junior doctors need a safe environment to embrace and reflect on the emotions aroused by interprofessional interactions, under the guidance of experienced facilitators.
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