Residents’ transformational changes through self-regulated, experiential learning for professionalism

Purpose: Postgraduate trainees (‘residents”) are required to convey professional behaviours as they navigate complex clinical environments. However, little is known about experiential learning for professionalism. Thus, we asked residents about professionalism challenges within the clinical learning environment: 1) how challenges were identified, 2) what supported successfully addressing challenges and 3) the impact of addressing challenges to further inform resident education. Method: From 2015-2016, twenty-five residents across specialties and multiple university affiliated teaching hospitals participated in appreciative inquiry informed audio-taped semi-structured interviews. Transcripts were categorized deductively for the 2015 CanMEDS Professional Role element addressed (commitment to patients, society, the profession, and physician health). A pragmatic research paradigm focussed descriptive data analysis on actions and outcomes. Results: Residents actively identify opportunities for experiential learning of professionalism within the clinical workplace– addressing conflicting priorities with interprofessional clinicians to ensure excellent patient care, providing informal feedback regarding peers’ and other healthcare clinicians’ professionalism lapses and by gaining self-awareness and maintaining wellness. There were no descriptions of commitment to society. Values, relationships, and reflection supported professional behaviours. Many described transformative personal and professional growth as an outcome of addressing professionalism challenges. Conclusions: Residents self-regulated experiential learning for professionalism often results in transformational changes personally and professionally. Elucidation of how residents successfully navigate power dynamics and conflict to provide excellent patient care and feedback for professional regulatory behaviour will support professionalism education. An interprofessional research lens will be valuable to explore how best to incorporate commitment to society within clinical environments.

Perception regarding clinical learning environment among undergraduate nursing students

Clinical experience is an integral aspect of nursing education as it transforms the theoretical knowledge into practice and the cornerstone of nursing as a health profession. The experience gained through a good and supportive clinical environment includes the atmosphere of the clinical placement unit, and the relationships shared with clinical staff supervisors (staff nurses) and mentors (Clinical instructors) that will affect the students learning. Elements like good teaching, relationship with the clinical staff and opportunity to practice, need to be assessed to have an understanding of the student’s perception regarding clinical learning environment. The aim of the present study was to assess the clinical learning environment among undergraduate nursing students of various colleges of Punjab. Materials and methods: A non experimental, descriptive research design was used to assess the perception regarding clinical learning environment among undergraduate nursing students. SECEE inventory (student evaluation of clinical education environment) by Kari Jecklin - Sand was used to determine the clinical learning environment. Five Nursing institutions were selected conveniently to select 500 under graduate nursing students randomly. Results and Major Findings: The findings of the study revealed that Majority (68%) of the study subjects were satisfied with their clinical learning environment followed by 30.8% who were moderately satisfied and only 1.2% were unsatisfied with their clinical learning environment. As per the Personal Profile of the study subjects, age and gender were found highly significant with the perceived clinical environment score at the 0.01 level of significance whereas no significant association was found out with the habitat, marital status, type of family, place of stay during study and financing during study. As per the family background, mother’s occupation was found highly associated with the clinical learning environment score whereas no association was found with the annual income of parents, education of mother, education of father, father’s occupation and number of siblings.

Analysis of the Interprofessional Clinical Learning Environment for Quality Improvement and Patient Safety From Perspectives of Interprofessional Teams

ABSTRACT Background In 2018 the Clinical Learning Environment Review (CLER) Program reported that quality improvement and patient safety (QIPS) programs in graduate medical education (GME) were largely unsuccessful in their efforts to transfer QI knowledge and substantive interprofessional QIPS experiences to residents, and CLER 2.0 called for improvement. However, little is known about how to improve the interprofessional clinical learning environment (IP-CLE) for QIPS in GME. Objective To determine the current state of the IP-CLE for QIPS at our institution with a focus on factors affecting the IP-CLE and resident integration into interprofessional QIPS teams. Methods We interviewed an interprofessional group of residents, faculty, and staff of key units engaged in IP QIPS activities. We performed thematic analysis through general inductive approach using template analysis methods on transcripts. Results Twenty individuals from 6 units participated. Participants defined learning on interprofessional QIPS teams as learning from and about each other's roles through collaboration for improvement, which occurs naturally when patients are the focus, or experiential teamwork within QIPS projects. Resident integration into these teams had various benefits (learning about other professions, effective project dissemination), barriers (difficult rotations or program structure, inappropriate assumptions), and facilitators (institutional support structures, promotion of QIPS culture, patient adverse events). There were various benefits (strengthened relationships, lowered bar for further collaboration), barriers (limited time, poor communication), and facilitators (structured meetings, educational culture) to a positive IP-CLE for QIPS. Conclusions Cultural factors prominently affected the IP-CLE and patient unforeseen events were valuable triggers for IP QIPS learning opportunities.

Recommendations to guide Vice Chairs for Education in serving as effective leaders

Background: Vice Chairs for Education play an increasingly important role in academic medicine. They often serve in supportive roles overseeing educational initiatives and faculty development, ensuring that education remains prioritized. Literature in this area is limited, especially in obstetrics and gynecology. Prior literature has not been sufficiently directive in identifying best practices in role, mission, and scope for Vice Chairs for Education. Methods: We developed and facilitated a workshop at the Association of Professors of Gynecology and Obstetrics - Council on Resident Education in Obstetrics and Gynecology (APGO-CREOG) annual meeting in February 2020. We brought together a national group of medical education faculty to elucidate the role of Vice Chairs and offer recommendations. After utilizing a previously described technique for gathering and reporting group recommendations, notes from small- and large-group discussions were collated, coded, and collapsed. Results: Four broad recommendations resulted. First, role clarity must be ensured, ideally with co-developed guidelines for responsibility. Second, the Vice Chair for Education should be charged with identifying departmental educational initiatives, including faculty development, utilizing best educational practices. Third, Vice Chairs for Education should implement and evaluate educational initiatives to enhance faculty well-being and promote a robust clinical learning environment. Finally, they should integrate with other Vice Chairs for Education within their institution and as part of national organizations to collaborate and develop best practices. Conclusion: These serve as guidelines to establish success and increase impact and suggest the potential for a national body of Vice Chairs for Education leaders to improve local and national educational outcomes.

Healthcare educators’ experiences of challenging situations with their students during clinical practice: A qualitative study

During clinical practice, students become acquainted with the key work tasks associated with their professions. Students need more support from healthcare educators during clinical practice learning, particularly in challenging situations. This study aimed to describe healthcare educators’ experiences of challenging situations during clinical practice placements. A qualitative study design was used to collect data through interviews with ten healthcare educators from two higher education institutions. The data were analyzed with inductive content analysis. The SRQR reporting guidelines were used to improve the transparency of the study. Educator reactions commonly involved emotional, goal-oriented and pedagogical support towards their students. The interviewed educators felt that mentors – when facing a challenging situation during clinical practice – are tasked with creating an atmosphere that supports student learning. Students faced challenges that were related to self-evaluation, goal-oriented activities, and their attitudes towards feedback. The building of a safe clinical learning environment involves collaboration between students, their clinical mentors and educators.