Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
IntroductionSupporting medical students’ and junior doctors’ development in busy clinical settings is challenging. As opportunities for developing trainees, for example, traditional bedside teaching, are decreasing, teaching outside of... more
IntroductionSupporting medical students’ and junior doctors’ development in busy clinical settings is challenging. As opportunities for developing trainees, for example, traditional bedside teaching, are decreasing, teaching outside of clinical practice is increasing. However, evidence suggests that effective learning through practice arises via an interplay between, first, what experiences are afforded by clinical settings and, second, how trainees engage with these affordances. Many studies investigating clinician learning through practice focus on only one of these two factors. Yet, a well-recognised methodological challenge of enabling learners to articulate how and what they are learning through practice exists. We need, therefore, to understand how this relationship plays out in practice in ways that enrich learning.Methods and analysisThis protocol describes a video reflexive ethnographic approach to illuminate how learning through practice in hospital settings occurs and can...
Research Interests:
Research Interests: Marketing and Psychology
Research Interests:
Research Interests:
Research Interests:
Research Interests: Marketing and Psychology
To better understand the potential of a needs assessment approach using qualitative data from manikin-based and virtual patient simulation debriefing sessions compared with traditional data collection methods (ie, focus groups and... more
To better understand the potential of a needs assessment approach using qualitative data from manikin-based and virtual patient simulation debriefing sessions compared with traditional data collection methods (ie, focus groups and interviews). Original data from simulation debrief sessions was compared and contrasted with data from an earlier assessment of critical care needs in a community setting (using focus groups and interviews), thus undertaking secondary analysis of data. Time and cost data were also examined. Debrief sessions were coded using deductive and inductive techniques. Matrices were used to explore the commonalities, differences and emergent findings across the methods. Critical care unit in a community hospital setting. Interviews and focus groups yielded 684 and 647 min of audio-recordings, respectively. The manikin-based debrief recordings averaged 22 min (total=130 min) and virtual patient debrief recordings averaged 31 min (total=186 min). The approximate cost ...
Learning can be conceptualized as a process of "becoming," considering individuals, workplace participation, and professional identity formation. How postgraduate trainees learn palliative care, encompassing technical... more
Learning can be conceptualized as a process of "becoming," considering individuals, workplace participation, and professional identity formation. How postgraduate trainees learn palliative care, encompassing technical competence, compassion, and empathy, is not well understood or explained by common conceptualizations of learning as "acquisition" and "participation." Learning palliative care, a practice that has been described as a cultural shift in medicine challenging the traditional role of curing and healing, provided the context to explore learning as "becoming." The authors undertook a qualitative narrative study, interviewing 14 residents from the University of Ottawa Family Medicine Residency Program eliciting narratives of memorable learning (NMLs) for palliative care. Forty-five NMLs were analyzed thematically. To illuminate the interplay among themes, an in-depth analysis of the NMLs was done that considered themes and linguistic an...
Research Interests:
Research Interests:
The Objective Structured Clinical Examination (OSCE) is a ubiquitous part of medical education, although there is some debate about its value, particularly around possible impact on learning. Literature and research regarding the OSCE is... more
The Objective Structured Clinical Examination (OSCE) is a ubiquitous part of medical education, although there is some debate about its value, particularly around possible impact on learning. Literature and research regarding the OSCE is most often situated within the psychometric or competency discourses of assessment. This paper describes an alternative approach: Actor-network-theory (ANT), a sociomaterial approach to understanding practice and learning. ANT provides a means to productively examine tensions and limitations of the OSCE, in part through extending research to include social relationships and physical objects. Using a narrative example, the paper suggests three ANT-informed insights into the OSCE. We describe: (1) exploring the OSCE as a holistic combination of people and objects; (2) thinking about the influences a checklist can exert over the OSCE; and (3) the implications of ANT educational research for standardisation within the OSCE. We draw from this discussion ...
Research Interests:
Fellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an... more
Fellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an "invisible phase of postgraduate training" lacking standards for education and accreditation, as well as funding. We aimed to explore fellowship programs and examine the reasons to host and participate in fellowship training, seeking to inform the future development of fellowship education. During the 2013-14 academic year, we conducted interviews and focus groups to examine the current status of fellowship training from the perspectives of division heads, fellowship directors and current fellows at the Department of Medicine, University of Ottawa, Canada. Descriptive statistics were used to depict the prevailing status of fellowship training. A process of data reduction, data analysis and conclusions/verifications was performed to analyse the quantit...
Research Interests:
Research Interests:
Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice,... more
Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery.
Research Interests:
This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER. Scotland. In this two-stage online questionnaire study, we collected data with multiple... more
This study aimed to identify national dental education research (DER) priorities for the next 3-5 years and to identify barriers and enablers to DER. Scotland. In this two-stage online questionnaire study, we collected data with multiple dental professions (eg, dentistry, dental nursing and dental hygiene) and stakeholder groups (eg, learners, clinicians, educators, managers, researchers and academics). Eighty-five participants completed the Stage 1 qualitative questionnaire and 649 participants the Stage 2 quantitative questionnaire. Eight themes were identified at Stage 1. Of the 24 DER priorities identified, the top three were: role of assessments in identifying competence; undergraduate curriculum prepares for practice and promoting teamwork. Following exploratory factor analysis, the 24 items loaded onto four factors: teamwork and professionalism, measuring and enhancing performance, dental workforce issues and curriculum integration and innovation. Barriers and enablers existe...
Research Interests:
Previous studies have identified tensions medical faculty encounter in their roles but not specifically those with a qualification in medical education. It is likely that those with postgraduate qualifications may face additional tensions... more
Previous studies have identified tensions medical faculty encounter in their roles but not specifically those with a qualification in medical education. It is likely that those with postgraduate qualifications may face additional tensions (i.e., internal or external conflicts or concerns) from differentiation by others, greater responsibilities and translational work against the status quo. This study explores the complex and multi-faceted tensions of educators with qualifications in medical education at various stages in their career. The data described were collected in 2013-14 as part of a larger, three-phase mixed-methods research study employing a constructivist grounded theory analytic approach to understand identity formation among medical educators. The over-arching theoretical framework for the study was Communities of Practice. Thirty-six educators who had undertaken or were undertaking a postgraduate qualification in medical education took part in semi-structured interviews. Participants expressed multiple tensions associated with both becoming and being a healthcare educator. Educational roles had to be juggled with clinical work, challenging their work-life balance. Medical education was regarded as having lower prestige, and therefore pay, than other healthcare career tracks. Medical education is a vast speciality, making it difficult as a generalist to keep up-to-date in all its areas. Interestingly, the graduates with extensive experience in education reported no fears, rather asserting that the qualification gave them job variety. This is the first detailed study exploring the tensions of educators with postgraduate qualifications in medical education. It complements and extends the findings of the previous studies by identifying tensions common as well as specific to active students and graduates. These tensions may lead to detachment, cynicism and a weak sense of identity among healthcare educators. Postgraduate programmes in medical education can help their students identify these tensions in becoming and develop coping strategies. Separate career routes, specific job descriptions and academic workload models for medical educators are recommended to further the professionalisation of medical education. (Tensions, Fears, Healthcare Educators, Medical Education, Postgraduate Programmes, Identity, Career Choice, Faculty Development, Communities of Practice).
Research Interests:
Qualitative research is widely accepted as a legitimate approach to inquiry in health professions education (HPE). To secure this status, qualitative researchers have developed a variety of strategies (e.g. reliance on post-positivist... more
Qualitative research is widely accepted as a legitimate approach to inquiry in health professions education (HPE). To secure this status, qualitative researchers have developed a variety of strategies (e.g. reliance on post-positivist qualitative methodologies, use of different rhetorical techniques, etc.) to facilitate the acceptance of their research methodologies and methods by the HPE community. Although these strategies have supported the acceptance of qualitative research in HPE, they have also brought about some unintended consequences. One of these consequences is that some HPE scholars have begun to use terms in qualitative publications without critically reflecting on: (i) their ontological and epistemological roots; (ii) their definitions, or (iii) their implications. In this paper, we share our critical reflections on four qualitative terms popularly used in the HPE literature: thematic emergence; triangulation; saturation, and member checking. We discuss the methodological origins of these terms and the applications supported by these origins. We reflect critically on how these four terms became expected of qualitative research in HPE, and we reconsider their meanings and use by drawing on the broader qualitative methodology literature. Through this examination, we hope to encourage qualitative scholars in HPE to avoid using qualitative terms uncritically and non-reflexively.
Research Interests:
Several recent studies have documented the fact that, in considering feedback, learners are actively making credibility judgements about the feedback and its source. Yet few have intentionally explored such judgements to gain a deeper... more
Several recent studies have documented the fact that, in considering feedback, learners are actively making credibility judgements about the feedback and its source. Yet few have intentionally explored such judgements to gain a deeper understanding of how the process works or how these judgements might interact to influence engagement with and interpretation of feedback. Using the educational alliance framework, we sought to elaborate an understanding of learners' credibility judgements and their consequences. Using constructivist grounded theory we conducted semi-structured interviews with psychiatry residents. We used a theoretical sampling approach that invited participants with diverse scores based on a previously published feedback survey and an investigator-developed educational alliance inventory. Consistent with the principles of grounded theory analysis, data were collected and analysed in an iterative process to identify themes. Participants depicted themselves as actively contemplating feedback and considering it thoughtfully in light of complex judgements regarding their supervisor, the relationship with their supervisor and the larger context in which the feedback interactions were occurring. These judgements focused on the supervisor's credibility both as a clinician and as a partner in the educational alliance. The educational alliance is judged by trainees in relation to the supervisor's engagement as an educator, commitment to promoting growth of residents and positive attitude toward them. Our findings suggest that credibility is a multifaceted judgement that occurs not only at the moment of the feedback interaction but early in and throughout an educational relationship. It not only affects a learner's engagement with a particular piece of feedback at the moment of delivery, but also has consequences for future engagement with (or avoidance of) further learning interactions with the supervisor. These findings can help medical educators develop a more meaningful understanding of the context in which feedback takes place.
Research Interests:
Research Interests:
Supervision in the outpatient context is increasingly in the form of single day interactions between students and preceptors. This creates difficulties for effective feedback, which often depends on a strong relationship of trust between... more
Supervision in the outpatient context is increasingly in the form of single day interactions between students and preceptors. This creates difficulties for effective feedback, which often depends on a strong relationship of trust between preceptor and student. Building on feedback theories focusing on the relational and dialogic aspects of feedback, this study explored the use of goal-oriented feedback in brief encounters with learners. This study used autoethnography to explore one preceptor's feedback interactions over an eight-month period both in the ambulatory setting and on the wards. Data included written narrative reflections on feedback interactions with twenty-three learners informed by discussions with colleagues and repeated reading of feedback literature. Thematic and narrative analyses of data were performed iteratively. Data analysis emphasized four recurrent themes. (1) Goal discussions were most effective when initiated early and integrated throughout the learning experience. (2) Both learner and preceptor goals were multiple and varied, and feedback needed to reflect this complexity. (3) Negotiation or co-construction of goals was important when considering the focus of feedback discussions in order to create safer, more effective interactions. (4) Goal oriented interactions offer potential benefits to the learner and preceptor. Goal oriented feedback promotes dialogue as it requires both preceptor and learner to acknowledge and negotiate learning goals throughout their interaction. In doing so, feedback becomes an explicit component of the preceptor-learner relationship. This enhances feedback interactions even in relatively brief encounters, and may begin an early educational alliance that can be elaborated with longer interactions.
Research Interests:
A national survey was recently conducted to explore medical education research priorities in Scotland. The identified themes and underlying priority areas can be linked to current medical education drivers in the UK. The top priority area... more
A national survey was recently conducted to explore medical education research priorities in Scotland. The identified themes and underlying priority areas can be linked to current medical education drivers in the UK. The top priority area rated by stakeholders was: 'Understanding how to balance service and training conflicts'. Despite its perceived importance, a preliminary scoping exercise revealed the least activity with respect to published literature reviews. This protocol has therefore been developed so as to understand how patient care, other service demands and student/trainee learning can be simultaneously facilitated within the healthcare workplace. The review will identify key interventions designed to balance patient care and student/trainee learning, to understand how and why such interventions produce their effects. Our research questions seek to address how identified interventions enable balanced patient care-trainee learning within the healthcare workplace, for whom, why and under what circumstances. Pawson's five stages for undertaking a realist review underpin this protocol. These stages may progress in a non-linear fashion due to the iterative nature of the review process. We will: (1) clarify the scope of the review, identifying relevant interventions and existing programme theories, understanding how interventions act to produce their intended outcomes; (2) search journal articles and grey literature for empirical evidence from 1998 (introduction of the European Working Time Directive) on the UK multidisciplinary team working concerning these interventions, theories and outcomes, using databases such as ERIC, Scopus and CINAHL; (3) assess study quality; (4) extract data; and (5) synthesise data, drawing conclusions. A formal ethical review is not required. These findings should provide an important understanding of how workplace-based interventions influence the balance of trainee learning and service provision. They should benefit various stakeholders involved in workplace-based learning interventions, and inform the medical education research agenda in the UK.
Research Interests:
Reliance on surveys and qualitative studies of trainees to guide postgraduate education about palliative and end of life (EOL) communication may lead to gaps in the curriculum. We aimed to develop a deeper understanding of internal... more
Reliance on surveys and qualitative studies of trainees to guide postgraduate education about palliative and end of life (EOL) communication may lead to gaps in the curriculum. We aimed to develop a deeper understanding of internal medicine trainees' educational needs for a palliative and EOL communication curriculum and how these needs could be met. Mixed methods, including a survey and focus groups with trainees, and interviews with clinical faculty and medical educators, were applied to develop a broader perspective on current experiences and needs for further education. Quantitative descriptive and thematic analyses were conducted. Surveyed trainees were least confident and least satisfied with teaching in counseling about the emotional impact of emergencies and discussing organ donation. Direct observation with feedback, small group discussion, and viewing videos of personal consultations were perceived as effective, yet infrequently identified as instructional methods. Foc...
Postgraduate medical trainees are not well prepared difficult conversations about goals of care with patients and families in the acute care clinical setting. While contextual nuances within the workplace can impact communication,... more
Postgraduate medical trainees are not well prepared difficult conversations about goals of care with patients and families in the acute care clinical setting. While contextual nuances within the workplace can impact communication, research to date has largely focused on individual communication skills. Our objective was to explore contextual factors that influence conversations between trainees and patients/families about goals of care in the acute care setting. We conducted an exploratory qualitative study involving five focus groups with Internal Medicine trainees (n = 20) and a series of interviews with clinical faculty (n = 11) within a single Canadian centre. Thematic framework analysis was applied to categorize the data and identify themes and subthemes. Challenges and factors enabling goals of care conversations emerged within individual, interpersonal and system dimensions. Challenges included inadequate preparation for these conversations, disconnection between trainees, faculty and patients, policies around documentation, the structure of postgraduate medical education, and resource limitations; these challenges led to missed opportunities, uncertainty and emotional distress. Enabling factors were awareness of the importance of goals of care conversations, support in these discussions, collaboration with colleagues, and educational initiatives enabling skill development; these factors have resulted in learning, appreciation, and an established foundation for future educational initiatives. Contextual factors impact how postgraduate medical trainees communicate with patients/families about goals of care. Attention to individual, interpersonal and system-related factors will be important in designing educational programs that help trainees develop the capacities needed for challenging conversations.
Research Interests:
There has been a substantial body of research examining feedback practices, yet the assessment and feedback landscape in higher education is described as 'stubbornly resistant to change'. The aim of this paper is to present a case... more
There has been a substantial body of research examining feedback practices, yet the assessment and feedback landscape in higher education is described as 'stubbornly resistant to change'. The aim of this paper is to present a case study demonstrating how an entire programme's assessment and feedback practices were re-engineered and evaluated in line with evidence from the literature in the interACT (Interaction and Collaboration via Technology) project. Informed by action research the project conducted two cycles of planning, action, evaluation and reflection. Four key pedagogical principles informed the re-design of the assessment and feedback practices. Evaluation activities included document analysis, interviews with staff (n = 10) and students (n = 7), and student questionnaires (n = 54). Descriptive statistics were used to analyse the questionnaire data. Framework thematic analysis was used to develop themes across the interview data. InterACT was reported by studen...
Research Interests: Program Evaluation, Distance Education, Humans, Program Development, Scotland, and 9 moreGraduate medical education, Self Assessment, Public health systems and services research, Curriculum and Pedagogy, Formative Feedback, Internet, Translational Medical Research, Surveys and Questionnaires, and Organizational case studies
Much of a General Practitioner's (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS... more
Much of a General Practitioner's (GP) workload consists of managing patients with medically unexplained symptoms (MUS). GP trainees are often taking responsibility for looking after people with MUS for the first time and so are well placed to reflect on this and the preparation they have had for it; their views have not been documented in detail in the literature. This study aimed to explore GP trainees' clinical and educational experiences of managing people presenting with MUS. A mixed methods approach was adopted. All trainees from four London GP vocational training schemes were invited to take part in a questionnaire and in-depth semi-structured interviews. The questionnaire explored educational and clinical experiences and attitudes towards MUS using Likert scales and free text responses. The interviews explored the origins of these views and experiences in more detail and documented ideas about optimising training about MUS. Interviews were analysed using the framework analysis approach. Eighty questionnaires out of 120 (67%) were returned and a purposive sample of 15 trainees interviewed. Results suggested most trainees struggled to manage the uncertainty inherent in MUS consultations, feeling they often over-investigated or referred for their own reassurance. They described difficulty in broaching possible psychological aspects and/or providing appropriate explanations to patients for their symptoms. They thought that more preparation was needed throughout their training. Some had more positive experiences and found such consultations rewarding, usually after several consultations and developing a relationship with the patient. Managing MUS is a common problem for GP trainees and results in a disproportionate amount of anxiety, frustration and uncertainty. Their training needs to better reflect their clinical experience to prepare them for managing such scenarios, which should also improve patient care.
Research Interests:
Research Interests: General Practice, Focus Groups, Australia, Curriculum, Decision support system, and 16 moreCross-Cultural Comparison, Humans, Female, Point of Care, Male, Focus Group, Qualitative data analysis, Data Collection, Survey data, Adult, Public health systems and services research, Curriculum and Pedagogy, Internet, Quality use of medicines, National Survey, and Prescriptions
Research Interests: Marketing and Psychology
Standards for undergraduate medical education in the UK, published in Tomorrow's Doctors, include the criterion 'everyone involved in educating medical... more
Standards for undergraduate medical education in the UK, published in Tomorrow's Doctors, include the criterion 'everyone involved in educating medical students will be appropriately selected, trained, supported and appraised'. To establish how new general practice (GP) community teachers of medical students are selected, initially trained and assessed by UK medical schools and establish the extent to which Tomorrow's Doctors standards are being met. A mixed-methods study with questionnaire data collected from 24 lead GPs at UK medical schools, 23 new GP teachers from two medical schools plus a semi-structured telephone interview with two GP leads. Quantitative data were analysed descriptively and qualitative data were analysed informed by framework analysis. GP teachers' selection is non-standardised. One hundred per cent of GP leads provide initial training courses for new GP teachers; 50% are mandatory. The content and length of courses varies. All GP leads use student feedback to assess teaching, but other required methods (peer review and patient feedback) are not universally used. To meet General Medical Council standards, medical schools need to include equality and diversity in initial training and use more than one method to assess new GP teachers. Wider debate about the selection, training and assessment of new GP teachers is needed to agree minimum standards.
Research Interests:
Autoethnography is a methodology that allows clinician-educators to research their own cultures, sharing insights about their own teaching and learning journeys in ways that will resonate with others. There are few examples of... more
Autoethnography is a methodology that allows clinician-educators to research their own cultures, sharing insights about their own teaching and learning journeys in ways that will resonate with others. There are few examples of autoethnographic research in medical education, and many areas would benefit from this methodology to help improve understanding of, for example, teacher-learner interactions, transitions and interprofessional development. We wish to share this methodology so that others may consider it in their own education environments as a viable qualitative research approach to gain new insights and understandings. This paper introduces autoethnography, discusses important considerations in terms of data collection and analysis, explores ethical aspects of writing about others and considers the benefits and limitations of conducting research that includes self. Autoethnography allows medical educators to increasingly engage in self-reflective narration while analysing their own cultural biographies. It moves beyond simple autobiography through the inclusion of other voices and the analytical examination of the relationships between self and others. Autoethnography has achieved its goal if it results in new insights and improvements in personal teaching practices, and if it promotes broader reflection amongst readers about their own teaching and learning environments. Researchers should consider autoethnography as an important methodology to help advance our understanding of the culture and practices of medical education.
Research Interests:
Research Interests:
Research Interests:
In this paper we critically discuss the latest research in clinical reasoning, and apply the recommendations drawn from this research to realistic scenarios faced by physiotherapy educators in university and clinical settings. We argue... more
In this paper we critically discuss the latest research in clinical reasoning, and apply the recommendations drawn from this research to realistic scenarios faced by physiotherapy educators in university and clinical settings. We argue that the explicit development of clinical reasoning is a foundation requirement of entry level practice education and cannot be assumed to develop in the absence of specific educational strategies. Educating for clinical reasoning capability is more than knowledge acquisition and practical skill development, rather, it is addressing the ability to use a range of capabilities - cognitive, metacognitive, social and emotional - during clinical decision making. Therefore, educators need to create learning opportunities that make explicit to students the multidimensional nature of clinical reasoning and to support student development of these capabilities.
Research Interests:
Background: This paper reports findings of a pilot interprofessional problem based learning (PBL) study in the faculties of Medicine and Pharmacy at the University of Sydney, New South Wales. The aim of the research was to investigate... more
Background: This paper reports findings of a pilot interprofessional problem based learning (PBL) study in the faculties of Medicine and Pharmacy at the University of Sydney, New South Wales. The aim of the research was to investigate whether small group interprofessional learning activities with medical and pharmacy students can lead to: changes in attitude toward each other and toward interprofessional education (IPE); added value when learning together; and better understanding of each other’s professional roles. Methods: Nineteen medical and 20 pharmacy students participated in two, 2-hour PBL tutorials focussed on conducting a Home Medicines Review. The Attitudes to Health Professionals Questionnaire (AHPQ) was used to measure attitude change pre- and postinterprofessional PBL. Paired t-tests were used to analyse pre- and post-IPE data. Focus groups were conducted with the students after the PBL sessions. These were audio-recorded, transcribed and analysed. Results: Students re...