Challenges to acquire similar learning outcomes across four parallel thematic learning communities in a medical undergraduate curriculum.

BACKGROUND: To train physicians who are able to meet the evolving requirements from health care, the University of Groningen Medical Center adopted in 2014 a new curriculum named G2020. This curriculum combines thematic learning communities with competency-based medical education and Problem-based learning. In the learning community program, different learning tasks were used to train general competencies. The challenge of this program was whether students acquire similar levels of learning outcomes within the different variations of the program. METHOD: We used the assessment results of three cohorts for the first two bachelor years. We used progress tests and written tests to analyze knowledge development, and the assessment results of seven competencies to analyze competence development. Concerning knowledge, we used the cumulative deviation method to compare progress tests and used the Kruskal-Wallis H test to compare written test scores between programs. Descriptive statistics are used to present all assessments of the students' competencies. RESULTS: We observed similarly high passing rates both for competency and knowledge assessments in all programs. However, we did observe some differences. The two programs that focused more on competencies development underperformed the other two programs on knowledge assessment but outperformed on competencies assessment. CONCLUSION: This study indicates that it is possible to train students in different learning programs within one curriculum while having similar learning outcomes. There are however some differences in obtained levels between the different programs. The new curriculum still needs to improve by balancing variations in the programs and comparability of assessments across the programs.

What makes a nurse today? A debate on the nursing professional identity and its need for change.

In 2020, due to the Nightingale year and COVID-19 crisis, nursing is in the public eye more than ever. Nurses often are being seen as compassionate helpers. The public image of nursing, however, also consists of stereotypes such as nursing being a 'doing' profession and care being a 'female' characteristic. Next to that, nursing is associated with images from the past, such as 'the lady with the lamp'. Therefore, in the public eye at least, the nursing identity seems a simple and straightforward enough construct, but nothing less is true. Looking at what a professional identity consists of, historic and social developments influence a group identity as a construct. In addition, individual, professional and contemporary societal moralities, including stereotypes, play its role. Nurses themselves reinforce stereotypes in order to fit into what is expected, even when they believe professional behaviour encompasses other features. They may do so individually as well as in a group context. But nursing actually seems to be better off when viewed upon as a diverse, autonomous profession. Moral values such as compassion motivate nurses to enter the profession. Research shows that if such values are addressed in daily practice, nursing could perhaps be saved from nurses leaving the profession because of feeling unfulfilled. Another aspect concerns the huge nursing body of knowledge. If seen as the ground on which nursing behaviour is standing, it would contribute to a different image of nursing than simplified stereotypes, which do not acknowledge the complex nature of the profession. This paper challenges the idea that the nursing identity is unchangeable and the notion that 'a nurse will always be a nurse'. By doing so, the paper contributes to a debate on the supposed 'true' nature of the nursing identity and opens a discussion on the need for it to change.

Turnover prevention: The direct and indirect association between organizational job stressors, negative emotions and professional commitment in novice nurses.

AIMS: Getting insight in the most crucial organizational job stressors for novice nurses' professional commitment and whether the job stressors are mediated through negative emotions. DESIGN: The study used an observational cohort design. METHODS: Organizational job stressors were derived from 580 diary entries by 18 novice nurses combined with measures on emotions and commitment. The diaries were collected from September 2013-September 2014. RESULTS: Path modelling revealed that lack of support from colleagues, negative experiences with patients and confrontations with existential events were most strongly negatively related to professional commitment through negative emotions. Other indirectly and negatively related organizational job stressors to commitment were complexity of care, lack of control and work-life imbalance; only conflicting job demands, and lack of control related to professional commitment directly. CONCLUSION(S): To enhance professional commitment, it is important to reduce negative emotions in novice nurses by collegial support in dealing with negative experiences with patients, complexity of care and existential events and to prevent lack of control and an imbalance between private life and work. Nurse supervisors and managers can encourage nurses to share negative patient experiences, issues related to complexity of care and existential events. IMPACT: Considering the worldwide nursing shortage and early turnover, more understanding is needed about how negative emotions mediate the relationship between organizational negative job stressors and professional commitment and the relative impact of organizational job stressors to professional commitment. The study stresses the importance of a supportive role of supervisors and nurse managers to improve the work environment and hence increase novice nurses' commitment and retention.

The influence of mixing international and domestic students on competency learning in small groups in undergraduate medical education.

BACKGROUND: Medical curricula are increasingly internationalized, with international students being mixed with domestic students in small group learning. Small group learning is known to foster competency learning in undergraduate medical education, specifically Communication, Collaboration, Leadership, and Professionalism. However, it is unclear what happens with the learning of competencies when international students are introduced in small groups. This study explores if students in international small groups master the competencies Collaboration, Leadership and Professionalism at the same level as students in domestic groups in an undergraduate medical curriculum. METHOD: In total, 1215 Students of three academic year cohorts participated in the study. They were divided into four learning communities (LCs), per year cohort, in which tutor groups were the main instructional format. The tutorials of two learning communities were taught in English, with a mix of international and Dutch students. The tutorials of the other two learning communities were taught in Dutch with almost all domestic students. Trained tutors assessed three competencies (Collaboration, Leadership, Professionalism) twice per semester, as 'Not-on-track', 'On-track', or 'Fast-on-track'. By using Chi-square tests, we compared students' competencies performance twice per semester between the four LCs in the first two undergraduate years. RESULTS: The passing rate ('On-track' plus 'Fast-on-track') for the minimum level of competencies did not differ between the mixed and domestic groups. However, students in the mixed groups received more excellent performance evaluations ('Fast-on-track') than the students in the homogenous groups of Dutch students. This higher performance was true for both international and Dutch students of the mixed groups. Prior knowledge, age, gender, and nationality did not explain this phenomenon. The effect could also not be explained by a bias of the tutors. CONCLUSION: When students are educated in mixed groups of international and Dutch students, they can obtain the same basic competency levels, no matter what mix of students is made. However, students in the mixed international groups outperformed the students in the homogenous Dutch groups in achieving excellent performance scores. Future research should explore if these findings can be explained from differences in motivation, perceived grading or social network interactions.

The importance of contextual, relational and cognitive factors for novice nurses' emotional state and affective commitment to the profession. A multilevel study.

AIM: This study explored the effects of contextual, relational and cognitive factors derived from novice nurses' work experiences on emotions and affective commitment to the profession. BACKGROUND: With an increasing demand for well-trained nurses, it is imperative to investigate which work-related factors most affect their commitment to develop effective strategies to improve work conditions, work satisfaction and emotional attachment. DESIGN: A repeated measures within subjects design. METHODS: From September 2013-September 2014 eighteen novice nurses described work-related experiences in unstructured diaries and scored their emotional state and affective commitment on a scale. The themes that emerged from the 18 diaries (with 580 diary entries) were quantified as contextual, relational and cognitive factors. Contextual factors refer to complexity of care and existential events; relational factors to experiences with patients, support from colleagues, supervisors and physicians; cognitive factors to nurses' perceived competence. RESULTS: The first multilevel regression analysis, based on the 18 diaries with 580 entries, showed that complexity of care, lack of support and lack of competence were negatively related to novice nurses' affective commitment, whereas received support was positively related. The next multilevel regression analyses showed that all contextual, relational and cognitive factors were either related to negative or positive emotions. CONCLUSION: To retain novice nurses in the profession, it is important to provide support and feedback. This enables novice nurses to deal with the complexity of care and feelings of incompetence and to develop a professional commitment.

The voice of nurses: Novice nurses' first experiences in a clinical setting. A longitudinal diary study.

AIMS AND OBJECTIVES: To gain greater understanding of which personal and professional demands novice nurses are confronted with and what can be done to improve the transition from novice to professional staff nurse. BACKGROUND: Novice nurses are confronted with a lot of physical, emotional and intellectual changes in the role-transition process from student nurse to professional staff nurse, which are often related to feelings of confusion, uncertainty and stress. Few studies have investigated, on a longitudinal basis, the lived experiences of novice nurses in the clinical setting. DESIGN: The study adopted a qualitative longitudinal approach to investigate the described experiences of novice nurses during their first 2 years after graduation. Written diaries were selected for optimal data collection. METHODS: A sample of eighteen novice nurses was recruited from several wards at a University Medical Center in the Netherlands. The inclusion criteria were a Bachelor's degree in nursing, aged under 30, and no more than 1 year's work experience. Data were collected from weekly measurements from September 2013-September 2014. RESULTS: Eight major themes emerged from the diaries (n = 580): relatedness, competence, development, organisational context, existential events, goals, autonomy and fit. This study revealed that the need for relatedness was by far the most reported theme. Support and positive feedback from colleagues appeared to be crucial for novices starting work in a highly complex environment. CONCLUSION: This study showed that one of the strategies novice nurses use to deal with challenging and existential situations is to share their experiences with colleagues. Therefore, novice nurses should always work in a safe environment which enables this. RELEVANCE TO CLINICAL PRACTICE: Identification of key issues around understanding novice nurses' first clinical experiences may help to improve their transition from novice to professional staff nurse. The presence and support from supervisors and mentors are inevitable to keep novice nurses motivated for the profession.

The relationships between perceived individual and team characteristics, individual and team learning activities with effectiveness in nursing teams.

Introduction: Team learning plays a crucial role in addressing the shortage of nurses and ensuring that there are enough trained and capable nurses available during times of crisis. This study investigates the extent to which individual learning activities (1) contribute to knowledge sharing in teams and (2) impact the effectiveness of nursing teams. Furthermore, we want to obtain more insight into whether (3) the antecedents of individual psychological empowerment, teamwork preference, and team boundedness contribute to individual learning activities and knowledge sharing in nursing teams. Method: We conducted a cross-sectional questionnaire study of 149 gerontological nurses working in 30 teams in Germany. They completed a survey measuring knowledge sharing, teamwork preference, team boundedness, individual learning activities, psychological empowerment, and team effectiveness (as an indicator of performance). Results: The results from structural equation modeling revealed that individual learning activities contribute to knowledge sharing in teams and, as a result, enhance team effectiveness. In particular, psychological empowerment was found to be associated with individual learning activities, while teamwork preference and team boundedness were related to knowledge sharing. Discussion: The results indicated that the accomplishment of individual learning activities plays an important role in nursing teams, as it is linked to knowledge sharing and, as a result, contributes to team effectiveness.

A social network perspective on peer relationship formation of medical undergraduates within large-scale learning communities.

INTRODUCTION: Students' formal networks, which are formed by a formal curriculum design, such as formally organized study groups within learning communities (LCs), may benefit students' interactions and learning. It is unclear how large-scale LCs contribute to the formation of different informal peer relationships, which refers to student self-organized out-of-class relationships. Two mechanisms can explain relationship formation in LCs. Propinquity within formal networks and homophily of students' characteristics (nationality, sex, academic performance) may promote students' peer relationships. This study explores to what extent the formation of students' informal networks was determined by their formal networks (LCs) while controlling for students' characteristics and which mechanisms play an important role. METHODS: With online surveys, data were collected about five informal networks (help-seeking, collaboration, information sharing, friendship, and learn-from) from 69 first- and 51 second- bachelor year medical students (2890 relationships). Students were divided into four LCs in the formal curriculum. We compared students' five informal network structures between first- and second-year students, domestic and international students, within and between formal networks. Besides, we used Quadratic Assignment Procedure (QAP) Regression Analysis in Ucinet to investigate the associations between students' informal and formal networks (LCs) and students' characteristics. RESULTS: Propinquity (in the same LC) plays a role since students have more informal connections within LCs than between LCs. Furthermore, it seems to play a greater role for second-year students than for first-year students. Homophily of nationality is important in informal networking since students are more likely to connect with others of similar nationalities. CONCLUSION: Students become more connected within the LC when they remain in the same LC for a longer period. Formal networks enhance the students' informal interactions within LCs but seem to restrict the interactions among students from other LCs. International students need support in order to integrate with domestic students in LCs.

Influence of online collaborative learning on social network and academic performance of medical students: lessons learned from the COVID-19 pandemic.

Introduction: The social distancing restrictions due to the COVID-19 pandemic have changed students' learning environment and limited their social interactions. Therefore, the objective of this study was to investigate the influence of the social distancing restrictions on students' social networks, wellbeing, and academic performance. Methods: We performed a questionnaire study in which 102 students participated before and 167 students during the pandemic. They completed an online questionnaire about how they formed their five peer social networks (study-related support, collaboration, friendship, share information, and learn-from) out-of-class. We performed social network analysis to compare the sizes, structures, and compositions of students' five social networks before and during the pandemic, between first- and second-year students, and between international and domestic students. Additionally, we performed Kruskal-Wallis H test to compare students' academic performance before and during the pandemic. We performed thematic analysis to answers for two open-end questions in the online questionnaire to explore what difficulties students encountered during the COVID-19 pandemic and what support they needed. Results: The results showed that the size of students' social networks during the pandemic was significantly smaller than before the pandemic. Besides, the formation of social networks differed between first- and second-year students, and between domestic and international students. However, academic performance did not decline during the COVID-19 pandemic. Furthermore, we identified three key areas in which students experienced difficulties and needed support by thematic analysis: social connections and interactions, learning and studying, and physical and mental wellbeing. Conclusion: When institutions implement learning with social distancing, such as online learning, they need to consider changes in students' social networks and provide appropriate support.

Determinants of peer selection for collaborative group work of third-year bachelor students in a medical degree programme with learning communities.

The social capital theory reveals the importance of peer relationships on students' learning. However, it is unclear how students select their collaborators under the influence of their previous collaborations and backgrounds. This study explores to what extent students' free selection choices for collaborators among their peers are based on previous collaboration in formally structured groups (i.e., learning communities (LCs)) and based on different students' background characteristics. A parallel program was studied where students studied in one of four LCs for two years and after that, they have to find their own group members within or across LCs to finish their bachelor thesis in the third year. In total, 1152 students' selections of their peers were analyzed. This paper presents the percentages of students choosing group members within or across LCs. It also considered the influence of students' backgrounds, like sex, nationality, and academic performances on their peerchoices by logistic regression analysis. More than half of the students chose group members within their own LC, regardless of which LC they were in. Although the majority of the students chose collaborators within their own LC, still around 40% of students were willing to collaborate with others from different LCs with whom they had never collaborated before in the formal curriculum. Students' backgrounds (i.e., sex, and academic performance) were also associated with their decisions. A high frequency of collaboration within formally structured groups enhances the students' preference of group members from the same groups, but also informal peer relationships are crucial in students' choices for collaboration. Students' sex and academic performance influence their free choice of group members while nationality does not. Students with different academic levels have a higher chance to become group members when they collaborated before in formally structured groups than those students who had not had such a collaboration experience.