Designing for student autonomy combining theory and clinical practice - a qualitative study with a faculty perspective.
Autonomy
Clinical practice
Educational intervention
Faculty development
Implementation
Students
Journal
BMC medical education
ISSN: 1472-6920
Titre abrégé: BMC Med Educ
Pays: England
ID NLM: 101088679
Informations de publication
Date de publication:
14 May 2024
14 May 2024
Historique:
received:
29
08
2023
accepted:
03
05
2024
medline:
15
5
2024
pubmed:
15
5
2024
entrez:
14
5
2024
Statut:
epublish
Résumé
Although extensive research exists about students' clinical learning, there is a lack of translation and integration of this knowledge into clinical educational practice. As a result, improvements may not be implemented and thus contribute to students' learning. The present study aimed to explore the nature of clinical faculty members' learning related to how they apply research about student autonomy. A course, "Designing learning for students' development of autonomy in clinical practice" was conducted for faculty responsible for students' clinical education. Within the frame of the course the participants designed a project and planned how they would implement it in their clinical context. Fourteen clinical faculty members participated in the study. The participants' interpretation of the educational intervention, which combines complex theory with the equally complex clinical practice, was explored by studying how the participants' approaches and understanding of the facilitation of autonomy were manifested in their projects. The projects in the form of reports and oral presentations were analyzed using qualitative content analysis together with an abductive approach. One identified domain was "Characteristics of the design and content of the projects". This domain was signified by two themes with different foci: Preparing the soil for facilitating student autonomy; and Cultivating opportunities for students to actively strive for autonomy. A second identified domain, "Embracing the meaning of facilitating autonomy" was connected to participants understanding of theories underlying how to support the development of autonomy. This domain contained two themes: Connection between activities and autonomy is self-evident and Certain factors can explain and facilitate development of autonomy. Education directed to strategic clinical faculty members to develop evidence-based approaches to student learning can be productive. To succeed there is a need to emphasize faculty members individual understanding of actual research as well as learning theories in general. Faculty trying to reinforce changes are dependent on their own mandate, the structure in the clinic, and recognition of their work in the clinical context. To achieve a potential continuity and sustainability of implemented changes the implementation processes must be anchored throughout the actual organization.
Sections du résumé
BACKGROUND
BACKGROUND
Although extensive research exists about students' clinical learning, there is a lack of translation and integration of this knowledge into clinical educational practice. As a result, improvements may not be implemented and thus contribute to students' learning. The present study aimed to explore the nature of clinical faculty members' learning related to how they apply research about student autonomy.
METHODS
METHODS
A course, "Designing learning for students' development of autonomy in clinical practice" was conducted for faculty responsible for students' clinical education. Within the frame of the course the participants designed a project and planned how they would implement it in their clinical context. Fourteen clinical faculty members participated in the study. The participants' interpretation of the educational intervention, which combines complex theory with the equally complex clinical practice, was explored by studying how the participants' approaches and understanding of the facilitation of autonomy were manifested in their projects. The projects in the form of reports and oral presentations were analyzed using qualitative content analysis together with an abductive approach.
FINDINGS
RESULTS
One identified domain was "Characteristics of the design and content of the projects". This domain was signified by two themes with different foci: Preparing the soil for facilitating student autonomy; and Cultivating opportunities for students to actively strive for autonomy. A second identified domain, "Embracing the meaning of facilitating autonomy" was connected to participants understanding of theories underlying how to support the development of autonomy. This domain contained two themes: Connection between activities and autonomy is self-evident and Certain factors can explain and facilitate development of autonomy.
CONCLUSION
CONCLUSIONS
Education directed to strategic clinical faculty members to develop evidence-based approaches to student learning can be productive. To succeed there is a need to emphasize faculty members individual understanding of actual research as well as learning theories in general. Faculty trying to reinforce changes are dependent on their own mandate, the structure in the clinic, and recognition of their work in the clinical context. To achieve a potential continuity and sustainability of implemented changes the implementation processes must be anchored throughout the actual organization.
Identifiants
pubmed: 38745245
doi: 10.1186/s12909-024-05514-y
pii: 10.1186/s12909-024-05514-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
532Informations de copyright
© 2024. The Author(s).
Références
Dornan T, Tan N, Boshuizen H, Gick R, Isba R, Mann K, Scherpbier A, Spencer J, Timmins E. How and what do medical students learn in clerkships? Experience based learning (ExBL). Adv Health Sci Education: Theory Pract. 2014;19(5):721–49. https://doi.org/10.1007/s10459-014-9501-0
doi: 10.1007/s10459-014-9501-0
Manninen K. (2014). Experiencing Authenticity- the core of student learning in clinical practice. Dissertation, Karolinska Institutet. Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden.
Fredholm A. (2017). Understanding the meaning of autonomy. Creating a learning space for professional becoming in clinical education. Dissertation. Karolinska Institutet. Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden.
van der Zwet J, Zwietering PJ, Teunissen PW, van der Vleuten CP, Scherpbier AJ. Workplace learning from a socio-cultural perspective: creating developmental space during the general practice clerkship. Adv Health Sci Education: Theory Pract. 2011;16(3):359–73. https://doi.org/10.1007/s10459-010-9268-x
doi: 10.1007/s10459-010-9268-x
Liljedahl M, Engqvist Boman L, Porthén Fält C, Bolander Laksov K. What students really learn: contrasting medical and nursing students’ experiences of the clinical learning environment. Adv Health Sci Educ Theory Pract. 2015;20:765–79.
doi: 10.1007/s10459-014-9564-y
Engqvist Boman L, Sundberg K, Petersson LM, Backman M, Silén C. A pedagogical model to enhance nurses’ ability to support patient learning: an educational design research study. Int J Med Educ. 2022;13:176–86. https://doi.org/10.5116/ijme.62c2.b9c4
doi: 10.5116/ijme.62c2.b9c4
Savin-Baden M, Learning Spaces. Creating opportunities for Knowledge Creation in Academic Life. The Society for Research into Higher Education & Open University; 2008.
Razack S, Philibert I. Inclusion in the clinical learning environment: building the conditions for diverse human flourishing. Med Teach. 2019;41(4):380–4. https://doi.org/10.1080/0142159X.2019.1566600
doi: 10.1080/0142159X.2019.1566600
Warne T, Johansson UB, Papastavrou E, Tichelaar E, Tomietto M, Van den Bossche K, Moreno MF, Saarikoski M. An exploration of the clinical learning experience of nursing students in nine European countries. Nurse Educ Today. 2010;30(8):809–15. https://doi.org/10.1016/j.nedt.2010.03.003
doi: 10.1016/j.nedt.2010.03.003
Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Finding a way forward: a literature review on the current debates around clinical supervision. Contemp Nurse. 2013;45(1):22–32. https://doi.org/10.5172/conu.2013.45.1.22
doi: 10.5172/conu.2013.45.1.22
Chan M, Snell L, Philibert I. The education avenue of the clinical learning environment: a pragmatic approach. Med Teach. 2019;41(4):391–7.
doi: 10.1080/0142159X.2019.1566602
Gruppen LD. Context and complexity in the clinical learning environment. Med Teach. 2019;41(4):373–4. https://doi.org/10.1080/0142159X.2019.1566599
doi: 10.1080/0142159X.2019.1566599
Elmberger A, Björck E, Liljedahl M, Nieminen J, Bolander Laksov K. Contradictions in clinical teachers’ engagement in educational development: an activity theory analysis. Adv Health Sci Education: Theory Pract. 2019;24(1):125–40. https://doi.org/10.1007/s10459-018-9853-y
doi: 10.1007/s10459-018-9853-y
Elmberger A, Blitz J, Björck E, Nieminen J, Bolander Laksov K. Faculty development participants’ experiences of working with change in clinical settings. Med Educ. 2022. https://doi.org/10.1111/medu.14992 . Advance online publication.
doi: 10.1111/medu.14992
Steinert Y, Mann K, Anderson B, Barnett BM, Centeno A, Naismith L, et al. A systematic review of faculty development initiatives designed to enhance teaching effectiveness: a 10-year update: BEME Guide 40. Med Teach. 2016;38(8):769–86.
doi: 10.1080/0142159X.2016.1181851
Miller-Young J, Poth CN. Complexifying’ our approach to evaluating educational development outcomes: bridging theoretical innovations with frontline practice. Int J Acad Dev Published Online Febr. 2021;25:1–14. https://doi.org/10.1080/1360144X.2021.1887876
doi: 10.1080/1360144X.2021.1887876
Alsiö Å, Pettersson A, Silén C. Health Care leaders’ perspectives on how continuous Professional Development can be promoted in a Hospital Organization. J Contin Educ Health Prof. 2022;42(3):159–63. https://doi.org/10.1097/CEH.0000000000000451
doi: 10.1097/CEH.0000000000000451
Silén C. Self-directed learning – a learning issue for students and faculty. Teach High Educ. 2008;13(4):461–75.
doi: 10.1080/13562510802169756
Silén C. Responsibility and independence in learning – what is the role of the educators and the framework of the educational programme? In: Rust C, editor. Improving student learning – theory, research and practice. Volume I. Oxford: The Oxford Centre for Staff and Learning Development; 2003. pp. 249–62.
Clouder L. Being responsible’: students’ perspectives on trust, risk and work-based learning. Teach High Educ. 2009;14(3):289–301.
doi: 10.1080/13562510902898858
Eneau J. Educational Reciprocity and Developing Autonomy: The Social dimension of Becoming oneself. In: Schneider K, editor. Becoming oneself. Wiesbaden: Verlag für Sozialwissenschaften; 2012.
Fredholm A, Henningsohn L, Savin-Baden M, Silén C. Autonomy as both challenge and development in clinical education. Learn Cult Social Interact. 2015;5:20–7.
doi: 10.1016/j.lcsi.2014.08.003
Clouder L, Jones M, Mackintosh S, Adefila A. Development of autonomy on placement: perceptions of physiotherapy students and educators in Australia and the United Kingdom. Physiother Theory Pract. 2022;38(12):2100–10.
doi: 10.1080/09593985.2021.1898066
Marton F, Booth S. (1997). Learning and awareness. Mahawa, N.J.: Lawrence Erlbaum Associates, Publishers; 1997.
Lee YM, Mann KV, Frank BW. What drives students’ self-directed learning in a hybrid PBL curriculum. Adv Health Sci Education: Theory Pract. 2010;15(3):425–37. https://doi.org/10.1007/s10459-009-9210-2
doi: 10.1007/s10459-009-9210-2
White CB, Fantone JC. Pass-fail grading: laying the foundation for self-regulated learning. Adv Health Sci Education: Theory Pract. 2010;15(4):469–77. https://doi.org/10.1007/s10459-009-9211-1
doi: 10.1007/s10459-009-9211-1
White CB. Smoothing out transitions: how pedagogy influences medical students’ achievement of self-regulated learning goals. Adv Health Sci Education: Theory Pract. 2007;12(3):279–97. https://doi.org/10.1007/s10459-006-9000-z
doi: 10.1007/s10459-006-9000-z
Fredholm A, Manninen K, Hjelmqvist H, Silén C. Authenticity made visible in medical students’ experiences of feeling like a doctor. Int J Med Educ. 2019;10:113–21. https://doi.org/10.5116/ijme.5cf7.d60c . PMID: 31203265; PMCID: PMC6766398.
doi: 10.5116/ijme.5cf7.d60c
Manninen K, Welin Henriksson E, Scheja M, Silén C. Authenticity in learning– nursing students’ experiences at a clinical education ward. Health Educ. 2013;113(2):32–143.
Levett-Jones T, Lathlean J. Belongingness: a prerequisite for nursing students’ clinical learning. Nurse Educ Pract. 2008;8(2):103–11. https://doi.org/10.1016/j.nepr.2007.04.003
doi: 10.1016/j.nepr.2007.04.003
Hauer KE, ten Cate O, Boscardin C, Irby DM, Iobst W, O’Sullivan PS. Understanding trust as an essential element of trainee supervision and learning in the workplace. Adv Health Sci Educ. 2013;19:435–56. https://doi.org/10.1007/s10459-013-9474-4
doi: 10.1007/s10459-013-9474-4
Bonnie LHA, Visser MRM, Kramer AWM, van Dijk N. Insight in the development of the mutual trust relationship between trainers and trainees in a workplace-based postgraduate medical training programme: a focus group study among trainers and trainees of the Dutch general practice training programme. BMJ Open. 2020;10e036593. https://doi.org/10.116/bmjopen-2019-036593.
Pront L, Gillham D, Schuwirth LWT. Competencies to enable learning-focused clinical supervision: a thematic analysis of the literature. Med Educ. 2016;50:485–95. https://doi.org/10.1111/medu.12854
doi: 10.1111/medu.12854
Kjaer LB, Schimdt Nielsen KJ, Krogh Christiansen M, Strand P. Patient-centred learning in practice. A mixed methods study of supervision and learning in student clinics. Patient Educ Couns. 2023;112:107717. https://doi.org/10.1016/j.pec.2023.107717
doi: 10.1016/j.pec.2023.107717
Marton F. Necessary conditions of learning. London: Routledge; 2014.
doi: 10.4324/9781315816876
Trede F, Macklin R, Bridges D. Professional identity development: a review of the higher education literature. Stud High Educ. 2012;37(3):365–84.
doi: 10.1080/03075079.2010.521237
Lindseth A, Norberg A. A phenomenological hermeneutical method for researching lived experience. Scand J Caring Sci. 2004;18(2):145–53. https://doi.org/10.1111/j.1471-6712.2004.00258.x
doi: 10.1111/j.1471-6712.2004.00258.x
Ricoeur P. Interpretation theory: discourse and the surplus of meaning. Fort Worth, TX: Texas Christian University; 1976.
Dewey J. Democracy and education: an introduction to the philosophy of education. New York: Mac Millan; 1916.
Illeris K. A comprehensive understanding of human learning. Contemporary theories of learning: Routledge; 2018. pp. 1–14.
Kolb DA. Experiential learning: experience as the source of learning and development: FT press. London: Pearson Education LTD; 2014.
Kaufman DM. Teaching and learning in medical education: how theory can inform practice. Understanding medical education: evidence, theory, and practice. In Swanwick, T., Forrest, K., O’Brien, editors. Understanding Medical Education: Evidence, Theory, and Practice, Third Edition, West Sussex: Wiley- Blackwell. 2018:37–69.
Mezirow J. An overview on transformative learning. In: Illeris K, editor. Contemporary theories of learning: learning theorists in their own words. New York: Routledge; 2009. pp. 91–105.
Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Educ Today. 2017;56:29–34. https://doi.org/10.1016/j.nedt.2017.06.002
doi: 10.1016/j.nedt.2017.06.002
Krippendorff K. Content analysis: an introduction to its methodology. Sage; 2018.
Tavory I, Timmermans S. Abductive Analysis, theorizing qualitative research. Chicago: The University of Chicago; 2014. p. 172.
doi: 10.7208/chicago/9780226180458.001.0001
Silén C, Kalén S, Lundh P, Mattson J, Manninen K. Students’ learning in clinical practice – a scoping review of characteristics of research in the nordic countries. Med Educ Online. 2023;28(1). https://doi.org/10.1080/10872981.2023.2279347
Hannah ST, Lester PB. A multilevel approach to building and leading learning organizations. Leadersh Quart. 2009;20:34–48.
doi: 10.1016/j.leaqua.2008.11.003
Caldwell R. Models of Change Agency: a fourfold classification. Br J Manag. 2003;14:131–42.
doi: 10.1111/1467-8551.00270
Mlambo M, Silén C, McGrath C. Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. BMC Nurs. 2021;20(1):62. https://doi.org/10.1186/s12912-021-00579-2
doi: 10.1186/s12912-021-00579-2