Focus on Health Professional Education: A Multi-Professional Journal

A primer on participatory research for health professional education

Julie Paxino — 2024-09-30

Participatory research methodologies are gaining traction in health professional education research (HPER) due to their ability to foster collaboration and inclusivity with communities involved in or affected by the issues being studied. This paper provides an introduction for researchers new to participatory research in HPER. It aims to guide researchers in the thoughtful integration of participatory methods into their research practices. We define participatory research as a diverse approach that engages health professionals, students, patients and other community members as co-researchers actively involved in shaping the research process. Drawing on examples from the field, we explore the potential benefits of participatory research, including the co-production of knowledge, improved relevance of findings and enhanced impact on practice. However, we also acknowledge the complexities and challenges, including the need for researcher flexibility, ethical considerations and appropriate levels of participation, depending on project goals and funding constraints. To support researchers, we outline key questions that prompt critical deliberation when considering participatory approaches. Ultimately, this paper encourages researchers to reflect on the epistemic shifts required to adopt participatory methodologies and to consider how these approaches can foster more inclusive, collaborative and meaningful contributions to health professional education and research.

Student physical therapists’ confidence in appraising and applying research after participating in a weekly journal club

Thomas Almonroeder — 2024-09-30

Introduction: The objective of this study was to assess changes in student physical therapists’ confidence in their ability to critically appraise research and use research findings to inform their practice after completing a weekly journal club.

Methods: Thirty-four students in a doctoral-level physical therapist education program completed a questionnaire before and after participating in a weekly journal club. The questionnaire asked students to rate their confidence in critically appraising research and using research to inform their practice.

Results: Over the semester, there was significant improvement in students’ confidence in their ability to critically appraise research related to physical therapy practice and their confidence in using research to inform their practice.

Conclusions: In general, it appears that a course-based weekly journal club can be effective for improving student physical therapists’ confidence in their ability to perform some of the key functions required for evidence-based practice.

A comparison of approaches to teaching clinical skills

Conor Gilligan — 2024-09-30

Background: The most appropriate timing and mode for teaching clinical skills as preparation for medical students’ clinical rotations or clerkships is not widely agreed upon. Increasing pressure on placement opportunities has led to a shift towards simulation-based teaching in the early years of medical training.

Approach: A major curriculum renewal provided an opportunity for comparison of the effectiveness of a largely ward-based (early patient exposure) curriculum with a largely simulation-based one in preparing students for clinical rotations.

Evaluation: We surveyed students from two different programs and invited them to take part in voluntary objective structured clinical examinations (OSCEs) to compare their skills and self-reported preparedness. Qualitative data was also collected from focus groups with a small number of students.

Implications: The findings suggest that the more structured, simulation-based curriculum is at least equivalent to the ward-based approach in teaching clinical skills and preparing students for clinical rotations. Students’ clinical reasoning skills could be enhanced in a simulation-based curriculum through more explicit training to prepare them for being asked questions on clinical placement.

Health professional students’ emotional responses to effective and ineffective teamwork

Eileen McKinlay — 2024-09-30

Introduction: Pre-registration students learn interprofessional competencies for effective teamwork through interprofessional education (IPE), yet they do not always see effective teamwork in the clinical workplace or experience it in IPE learning activities. In this study, we explored: (1) what students recall of experiences of interprofessional teamwork interactions in workplace settings or in IPE learning activities and (2) what and how they describe the emotion attached to these experiences.

Methods: A pre- and post-test survey design was used, which included qualitative questions administered before and after a clinical workplace-based cancer and life-limiting illness IPE activity for two cohorts of students. We surveyed students about teamwork experiences in both workplace and IPE learning activities and how they felt about them emotionally. A content and thematic analysis was undertaken, the latter using a process adapted from Attride-Stirling (2001).

Results: For the before-IPE responses, 31 out of 50 students in the two cohorts responded (62%), and for the after-IPE responses, 29 out of 50 in the two cohorts responded (58%). There were two global themes: (1) students readily recognise both effective and ineffective teamwork and (2) ineffective teamwork experiences can evoke strong emotional responses.

Conclusion: Students’ emotional responses from being involved in or observing effective and ineffective teamwork may influence their future engagement in interprofessional teamwork and IPE activities.

Editorial FoHPE Journal Vol 25.3

Simone Gibson — 2024-09-30

Ethnic bias and the hidden curriculum: The impact of routine inclusion of ethnicity in medical education assessment

Suzanne Pitama — 2024-09-30

Introduction: In 2012, the University of Otago Medical School in New Zealand amended high stakes examination questions to routinely include ethnicity. This policy change was prompted by the assessment committee, including the Māori subcommittee. This study aimed to examine the portrayal of Māori patients and to explore the impact of routine inclusion of ethnicity.

Methods: A quantitative description of demographic variables of examination questions and responses (role-model answers, multiple-response preferred answer, guidelines for markers) from a pre policy (2009–2011), post policy (2012–2013) and follow-up period (2018–2019) was undertaken. A qualitative content analysis of Māori examination questions was conducted with consideration of trends over time.

Results: The majority (98%) of examination questions did not report ethnicity prior to the 2012 policy, whereas around 80% of cases did post policy implementation. Three themes were identified: the non-adherent Māori patient, determinants of health and the patient assigned Māori ethnicity. Examination questions and responses that portrayed Māori as being non-adherent were more common prior to the implementation of the policy. Post policy, many questions did not require students to consider the relevance of ethnicity but presented an increase in social and cultural contextual information of the patient over time.

Conclusion: Policy implementation by the assessment committee led to less racist stereotyping and “othering” of Māori patients and prompted further refinement of social and cultural determinants of health over time. Future recommendations include increasing representation of Māori as a reflection of the increased burden of disease alongside representing intersectionality using other socio-cultural indicators.

Women’s experience of participating in a storytelling intervention about abnormal uterine bleeding for medical student education

Parimala Kanagasabai — 2024-09-30

Introduction: Storytelling of lived experience could be an effective educational intervention to enhance empathic communication during medical training. The aim of this study is to describe women’s experiences of participating in a storytelling intervention for medical students, consisting of live online and recorded stories about their lived experience of abnormal uterine bleeding.

Methods: Semi-structured interviews were conducted with women who had lived experience of abnormal uterine bleeding and who participated in a storytelling intervention for medical students. Interviews were recorded and transcribed verbatim. A reflexive thematic analysis approach was used for analysing the data.

Results: Eight women participated in interviews, five online, two by telephone and one responding to interview questions by email. The analysis produced five themes: (1) empowered by opportunity to provide guidance to students, (2) empowered by advocating for women, (3) therapeutic to share and hear lived experiences, (4) preference for a pragmatic online format and (5) safe and comfortable setting for sharing experiences.

Conclusion: Women had a meaningful and therapeutic experience of participating in the storytelling intervention. Storytelling interventions for health professional education may work well for people with lived experience when a practical or flexible online format is offered, which contributes to a safe and comfortable environment.

The influence of clinical practice video on learning conversations in postgraduate medical education: A scoping review

Andrew Huang — 2024-09-30

Introduction: Studies of learning conversations in medical education suggest these interactions can be supervisor driven, monologic and may involve poor recall of events. Educators often use camouflaged comments to avoid upsetting learners, which can interfere with meaning making. Using video of clinical practice within learning conversations could address some of these potential limitations. Despite educators using video of clinical practice in learning conversations for decades, we could find no synthesis of empirical studies to provide insight into the influence of video in learning conversations. Therefore, we conducted a scoping review to answer the question “How does video of clinical practice influence learning conversations in post-graduate medical education?”

Methods: We employed a scoping review methodology. MEDLINE, Embase, PsycINFO and ERIC databases were searched for articles from 1 January 2010 to 1 January 2022. Major inclusion criteria were postgraduate medical learners and video of clinical practice that was used in a learning conversation. The qualitative data relating to video’s influence on learning conversations were synthesised and thematically analysed.

Results: Five articles were included in the synthesis. We generated four themes from the qualitative data about the influence of video on the learning conversation. Video: (1) captures performance data that can be co-analysed, (2) enables the learning conversation to take place in a different environment, (3) changes the teaching approaches of educators and (4) may promote learner agency and voice.

Conclusion: Video may influence learning conversations, and video’s influence is likely entangled with the educational design associated with its use. No study directly addressed the phenomenon of how video influences learning conversations, and further study is required in this area.

Exploration of medical students’ approach to progress test preparation

Michael Chieng — 2024-09-30

Introduction: Medical students are expected to develop competencies in applying clinical knowledge. Progress testing is an assessment for learning and is intended to assist in knowledge acquisition and to promote ongoing recall. This study explored student preparation for progress tests (PTs), relationships between approach and performance, and patterns that could assist with targeting learning support.

Methods: A cross-sectional survey exploring study approach and learning context, comprising multi-choice and open-ended responses, was administered to students during their clinical years (n = 297). Quantitative data was analysed using descriptive statistics and comparative analysis, and qualitative data was categorised.

Results: One hundred twenty-nine students responded (43.4%), with most demonstrating a stable PT performance over time. Twenty-two students had dynamic changes in their aggregate grades. Poor early PT performance was associated with developing an improvement strategy (χ² 6.954, p = 0.008). Students never falling below satisfactory were less likely to have a strategy (χ² 10.084, p = 0.001). All poorly performing students were using practice question banks, but this was not true for students who scored satisfactorily. The need for pastoral care was associated with poorer performance (χ² 4.701, p = 0.030).

Conclusions: Student approaches to PT preparation are diverse, however there are correlations between preparation factors and performance outcomes. Students with poor early performance demonstrated improved results over time that may be attributed to targeted support and preparation strategies. Widespread use of practice questions may not be sufficient to impact results without additional strategies. External impacts to performance were common, and barriers to accessing pastoral care were evident. The feedback dashboard was underutilised, suggesting a need to improve feedback literacy and ensure this is fit for purpose.

Australian medical regulations and strengthened continuing professional development (CPD): A policy implementation gap analysis with the specialist medical colleges

Carol Pizzuti — 2024-09-30

Introduction: Starting from 2023, Australian medical practitioners must meet new mandatory continuing professional development (CPD) requirements for registration renewal. In particular, each year they must complete 12.5 hours of educational activities and 25 hours of CPD activities related to reviewing performance and measuring outcomes, with a minimum of 5 hours each for reviewing performance and measuring outcomes activities, and they are encouraged to use patient health data and large eHealth datasets for better insights. Despite concerns regarding data accessibility and outcome measurement, specialist medical colleges are implementing these requirements. This study aims to explore factors influencing colleges’ efforts and provide recommendations for future research and action to enable data-driven CPD practices.

Methods: A policy implementation gap analysis employing semi-structured interviews as a standalone method was conducted with participating colleges. Four colleges agreed to participate, with a total of 18 participants recruited from either the colleges’ staff who are responsible for interpreting and implementing CPD regulatory policies or the colleges’ CPD committees. Interviews were analysed using inductive and deductive thematic analysis. Data collection, data analysis and final results were reported using the COREQ checklist.

Results: Three themes were identified from the interview analysis: (1) colleges' organisational structure and their roles and responsibilities within the Australasian CPD ecosystem, (2) challenges and enablers for policy implementation and (3) organisational needs and future actions at college level and necessary pre-conditions at ecosystemic level for strengthened CPD.

Conclusions: Internal and external organisational factors are hindering colleges’ efforts to implement policy. More research, a reassessment of colleges’ roles, responsibilities and structure, and collaboration among colleges and data holders are necessary to enable full policy implementation and strengthened CPD practices.