Is two a crowd? A qualitative analysis of dyad learning in an OBGYN clinical clerkship.
Journal
Medical education
ISSN: 1365-2923
Titre abrégé: Med Educ
Pays: England
ID NLM: 7605655
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
16
12
2020
received:
19
06
2020
accepted:
18
12
2020
pubmed:
29
12
2020
medline:
24
6
2021
entrez:
28
12
2020
Statut:
ppublish
Résumé
Dyad learning occurs when two students work together to acquire new skills and knowledge. Several studies have provided evidence to support the educational rationale for dyad learning in the controlled simulated setting. However, the role of dyad learning in the clinical setting remains uncertain. Unlike the simulated setting, learning in the clinical setting depends on a complex interplay between medical students, doctors, nurses and patients potentially making dyad learning less valuable in clerkships. The objective of this study was to explore how key stakeholders perceive the value of implementing dyad learning during medical students' clinical clerkships. In a constructivist qualitative study, we conducted 51 semi-structured interviews with 36 key stakeholders involved in dyad learning, including 10 medical students, 12 doctors, five nurses and nine patients. Data were coded inductively using thematic analysis, then coded deductively using stakeholder theory as a theoretical framework. We found that stakeholders generally perceived the educational impact of dyad learning in the clinical setting similarly but disagreed on its value. Students emphasised that dyad learning made them participate more actively during patient encounters and patients did not mind having two students present. Doctors and nurses considered dyad learning disruptive to the balance between service and training and reported that it did not resonate with their perception of good patient care. Dyad learning enables students to be more active during their clinical clerkships, but it easily disrupts the balance between service and training. This disruption may be exacerbated by the shifted balance in priorities and values between different stakeholder groups, as well as by making implicit teaching obligations more explicit for supervising doctors and nurses. Consequently, implementing dyad learning may not be perceived as valuable by doctors and nurses in the clinical setting, regardless of its pedagogical rationale.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
724-732Subventions
Organisme : Det Sundhedsvidenskabelige Fakultet, Københavns Universitet
Informations de copyright
© 2020 John Wiley & Sons Ltd and The Association for the Study of Medical Education.
Références
Wang C, Huang CC, Lin SJ, Chen JW. Effect of dyad training on medical students’ cardiopulmonary resuscitation performance. Medicine (Baltimore). 2017;96(13):e4079. https://doi.org/10.1097/MD.0000000000004079
Tolsgaard MG, Madsen ME, Ringsted C, et al. The effect of dyad versus individual simulation-based ultrasound training on skills transfer. Med Educ. 2015;49(3):286-295. https://doi.org/10.1111/medu.12624
Granados C, Wulf G. Enhancing motor learning through dyad practice: contributions of observation and dialogue. Res Q Exerc Sport. 2007;78(3):197-203. https://doi.org/10.1080/02701367.2007.10599417
Wulf G, Shea C, Lewthwaite R. Motor skill learning and performance: a review of influential factors. Med Educ. 2010;44(1):75-84. https://doi.org/10.1111/j.1365-2923.2009.03421.x
Shanks D, Brydges R, den Brok W, Nair P, Hatala R. Are two heads better than one? Comparing dyad and self-regulated learning in simulation training. Med Educ. 2013;47(12):1215-1222. https://doi.org/10.1111/medu.12284
Bjerrum AS, Eika B, Charles P, Hilberg O. Dyad practice is efficient practice: a randomised bronchoscopy simulation study. Med Educ. 2014;48(7):705-712. https://doi.org/10.1111/medu.12398
Räder SB, Henriksen AH, Butrymovich V. A study of the effect of dyad practice versus that of individual practice on simulation-based complex skills learning and of students’ perceptions of how and why dyad practice contributes to learning. Acad Med. 2014;89(9):1287-1294. https://doi.org/10.1097/ACM.0000000000000373
Tolsgaard MG, Bjørck S, Rasmussen MB, Gustafsson A, Ringsted C. Improving efficiency of clinical skills training: a randomized trial. J Gen Intern Med. 2013;28(8):1072-1077. https://doi.org/10.1007/s11606-013-2378-4
Tolsgaard MG, Rasmussen MB, Bjørck S, Gustafsson A, Ringsted CV. Medical students’ perception of dyad practice. Med Educ. 2014;3(6):500-507. https://doi.org/10.1007/s40037-014-0138-8
Tolsgaard MG, Kulasegaram KM, Ringsted CV. Collaborative learning of clinical skills in health professions education: the why, how, when and for whom. Med Educ. 2016;50:69-78. https://doi.org/10.1111/medu.12814
Chi MT, Wylie R. The ICAP framework: linking cognitive engagement to active learning outcomes. Educ Psychol. 2014;49(4):219-243. https://doi.org/10.1080/00461520.2014.965823
Scager K, Boonstra J, Peeters T, Vulperhorst J, Wiegant F. Collaborative learning in higher education: evoking positive interdependence. CBE Life Sci Educ. 2016;15(4):ar69. https://doi.org/10.1187/cbe.16-07-0219
Raat AN, Kuks JB, van Hell EA, Cohen-Schotanus J. Peer influence on students’ estimates of performance: social comparison in clinical rotations. Med Educ. 2013;47(2):190-197. https://doi.org/10.1111/medu.12066
Tai J, Haines T, Canny B, Molloy E. A study of medical students’ peer learning on clinical placements: what they have taught themselves to do. J Peer Learn. 2014;7:57-80.
Tai J, Molloy E, Haines T, Canny B. Same-level peer-assisted learning in medical clinical placements: a narrative systematic review. Med Educ. 2016;50(4):469-484. https://doi.org/10.1111/medu.12898
Hansen TB, Pape B, Thiesen PS, Jakobsen F. Interprofessional versus uniprofessional dyad learning for medical students in a clinical setting. Int J Med Educ. 2020;11:191-200. https://doi.org/10.5116/ijme.5f50.bc76
Lundsgaard KS, Tolsgaard MG, Mortensen OS, Mylopoulos M, Østergaard D. Embracing multiple stakeholder perspectives in defining trainee competence. Acad Med. 2019;94(6):838-846. https://doi.org/10.1097/ACM.0000000000002642
Freeman RE. Strategic Management: A Stakeholder Approach. Boston, MA: Pitman; 1984.
Freeman RE, Wicks AC, Parmar B. Stakeholder theory and “the corporate objective revisited”. Organ Sci. 2004;15(3):364-369. https://doi.org/10.1287/orsc.1040.0066
Werhane PH. Business ethics, stakeholder theory, and the ethics of healthcare organizations. Cambridge Q Health Ethics. 2000;9(2):169-181.
Fottler MD, Blair JD, Whitehead CJ, Laus MD, Savage GT. Assessing key stakeholders: who matters to hospitals and why? J Healthc Manag. 1989;34(4):525-546.
Ringsted C. Developmental aspects of medical competency and training: issues of curriculum design. Med Educ. 2011;45(1):12-16. https://doi.org/10.1111/j.1365-2923.2010.03869.x
Bryson JM. What to do when stakeholders matter: stakeholder identification and analysis techniques. Public Manag Rev. 2004;6(1):21-53.
Murdock A. Stakeholder theory, partnerships and alliances in the health care sector of the UK and Scotland. Int Public Manag Rev. 2004;5(1):21-40.
Eden C, Ackermann F. Making Strategy: The Journey of Strategic Management. London, UK: SAGE publications Ltd; 1998.
Mallon WT. Medical school expansion: déjà vu all over again? Acad Med. 2007;82(12):1121-1125. https://doi.org/10.1097/ACM.0b013e318159cca6
Hemmer PA, Ibrahim T, Durning SJ. The impact of increasing medical school class size on clinical clerkships: a national survey of internal medicine clerkship directors. Acad Med. 2008;83(5):432-437. https://doi.org/10.1097/ACM.0b013e31816bde59
Mann K, MacLeod A. Constructivism: learning theories and approaches to research. In: Cleland J, Durning SJ, eds. Researching Medical Education. West Sussex, UK: John Wiley & Sons; 2015:51-65.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.
Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;42(8):846-854. https://doi.org/10.1080/0142159X.2020.1755030
Laal M, Laal M. Collaborative learning: what is it?. Proc Soc Behav Sci. 2012;31:491-495. https://doi.org/10.1016/j.sbspro.2011.12.092
Kvale S, Brinkmann S. Interviews: Learning the Craft of Qualitative Research Interviewing. 2nd edn. Thousand Oaks, CA, London, UK: SAGE Publications; 2009.
Peltokorpi A, Alho A, Kujala J, Aitamurto J, Parvinen P. Stakeholder approach for evaluating organizational change projects. Int J Health Care Qual Assur. 2008;21(5):418-434. https://doi.org/10.1108/09526860810890413
Green J, Thorogood N. Qualitative Methods for Health Research, 4th edn. London, UK: Sage Publications Ltd; 2018.
Mills AE, Rorty MV, Werhane PH. Stakeholder expectations in practice-based medicine. J Contin Educ Health Prof. 2003;23(S1):19-26. https://doi.org/10.1002/chp.1340230406
Sholl S. Balance or tension? Walking the tightrope between training and patient care. Med Educ. 2018;52(3):248-249. https://doi.org/10.1111/medu.13511
Schwartz L. Is there an advocate in the house? The role of health care professionals in patient advocacy. J Med Ethics. 2002;28(1):37-40.
Langendyk V, Hegazi I. Imagining alternative professional identities: reconfiguring professional boundaries between nursing students and medical students. Acad Med. 2015;90(6):732-737. https://doi.org/10.1097/ACM.0000000000000714
Wilson I, Cowin LS, Johnson M, Young H. Professional identity in medical students: pedagogical challenges to medical education. Teach Learn Med. 2013;25(4):369-373. https://doi.org/10.1080/10401334.2013.827968
Malhotra T, Thomas S, Arora KS. Impact of medical students on patient satisfaction of pregnant women in labor and delivery triage. Matern Child Health J. 2019;23(11):1467-1472. https://doi.org/10.1007/s10995-019-02771-y
Smajdor A, Stöckl A, Salter C. The limits of empathy: problems in medical education and practice. J Med Ethics. 2011;37(6):380-383. https://doi.org/10.1136/jme.2010.039628
Harrison M, Milbers K, Hudson M, Bansback N. Do patients and health care providers have discordant preferences about which aspects of treatments matter most? Evidence from a systematic review of discrete choice experiments. BMJ Open. 2017;7(5):1-11. https://doi.org/10.1136/bmjopen-2016-014719
Austrai MJ, Baraki K, Doig AK. Collaborative learning using nursing student dyads in the clinical setting. Int J Nurs Educ Scholarsh. 2013;10(1):73-80. https://doi.org/10.1111/j.1365-2648.2011.05690.x
Ruth-Sahd LA. Student nurse dyads create a community of learning: proposing a holistic clinical education theory. J Adv Nurs. 2011;67(11):2445-2454. https://doi.org/10.1111/j.1365-2648.2011.05690.x
Harvey S, Uren CD. Collaborative learning: application of the mentorship model for adult nursing students in the acute placement setting. Nurse Educ Today. 2019;74:38-40. https://doi.org/10.1016/j.nedt.2018.11.022
Clarke D, Williamson GR, Kane A. Could students' experiences of clinical placements be enhanced by implementing a Collaborative Learning in Practice (CliP) model? Nurse Educ Pract. 2018;33:A3-A5. https://doi.org/10.1016/j.nepr.2018.03.002
Trueman G, Osuji J, El-Hussein MT. Baccalaureate nursing students' experience of dyadic learning in an acute care setting. J Nurs Educ. 2014;53(9):S65-S72. https://doi.org/10.3928/01484834-20140821-23
Cohen SR, Thomas CR, Gerard C. The clinical learning dyad model: an innovation in midwifery education. J Midwifery Womens Health. 2015;60(6):691-698. https://doi.org/10.1111/jmwh.12363
Sevenhuysen SL, Nickson W, Farlie MK, et al. The development of a peer assisted learning model for the clinical education of physiotherapy students. J Peer Learn. 2013;6(1):4.
O'Connor A, Cahill M, McKay EA. Revisiting 1: 1 and 2: 1 clinical placement models: student and clinical educator perspectives. Aust Occup Ther J. 2012;59(4):276-283.
Hall P. Interprofessional teamwork: professional cultures as barriers. J Interprof Care. 2005;19(suppl. 1):188-196. https://doi.org/10.1080/13561820500081745
Dornan T, Tan N, Boshuizen H, et al. How and what do medical students learn in clerkships? Experience based learning (ExBL). Adv Heal Sci Educ Theory Pract. 2014;19(5):721-749. https://doi.org/10.1007/s10459-014-9501-0
Lau JWC. Enriching stakeholder theory: student identity of higher education. Am J Ind Bus Manag. 2014;04(12):762-766. https://doi.org/10.4236/ajibm.2014.412082
Hong CZ. The feasibility of the application of stakeholder theory in higher education. 6th International Conference on Management Science and Management Innovation (MSMI 2019). Adv Econ Business Manage Res. 2019;84:272-276. https://doi.org/10.2991/msmi-19.2019.50.
Baecher-Lind LE, Chang K, Blanco MA. The learning environment in the obstetrics and gynecology clerkship: an exploratory study of students' perceptions before and after the clerkship. Med Educ Online. 2015;20:27273. https://doi.org/10.3402/meo.v20.27273
Pershing S, Fuchs VR. Restructuring medical education to meet current and future health care needs. Acad Med. 2013;88(12):1798-1801. https://doi.org/10.1097/ACM.0000000000000020
Baum KD, Resnik CD, Wu JJ, Roey SC. Implementing change in health professions education: Stakeholder analysis and coalition building. J Vet Med Educ. 2007;34(2):79-84. https://doi.org/10.3138/jvme.34.2.79
Yarris LM. Defining trainee competence: value is in the eye of the stakeholder. Acad Med. 2019;94(6):760-762. https://doi.org/10.1097/ACM.0000000000002643