When routine becomes stressful: A qualitative study into resuscitation team members' perception of stress and performance.

Interprofessional teamwork is of high importance during stressful situations such as CPR. Stress can potentially influence team performance. This study explores the perception of stress and its stressors during performance under pressure, to be able to further adjust or develop training. Healthcare professionals, who are part of the resuscitation team in a large Dutch university medical center, discussed their experiences in homogeneous focus groups. Nine focus groups and one individual interview were conducted and analyzed thematically, in order to deepen our understanding of their experiences. Thematic analysis resulted in two scenarios, routine and stress and an analysis of accompanying team processes. Routine refers to a setting perceived as straightforward. Stress develops in the presence of a combination of stressors such as a lack of clarity in roles and a lack of knowledge on fellow team members. Participants reported that stress affects the team, specifically through an altering of communication, a decrease in situational awareness, and formation of subgroups. This may lead to a further increase in stress, and potentially result in a vicious cycle. Team processes in a stressful situation like CPR can be disrupted by different stressors, and might affect the team and their performance. Improved knowledge about the stressors and their effects might be used to design a training environment representative for the performance setting healthcare professionals work in. Further research on the impact of representative training with team-level stressors and the development of a "team brain" might be worthwhile.

Is reflection like soap? a critical narrative umbrella review of approaches to reflection in medical education research.

Reflection is a complex concept in medical education research. No consensus exists on what reflection exactly entails; thus far, cross-comparing empirical findings has not resulted in definite evidence on how to foster reflection. The concept is as slippery as soap. This leaves the research field with the question, 'how can research approach the conceptual indeterminacy of reflection to produce knowledge?'. The authors conducted a critical narrative umbrella review of research on reflection in medical education. Forty-seven review studies on reflection research from 2000 onwards were reviewed. The authors used the foundational literature on reflection from Dewey and Schön as an analytical lens to identify and critically juxtapose common approaches in reflection research that tackle the conceptual complexity. Research on reflection must deal with the paradox that every conceptualization of reflection is either too sharp or too broad because it is entrenched in practice. The key to conceptualizing reflection lies in its use and purpose, which can be provided by in situ research of reflective practices.

Appreciating small-group active learning: What do medical students want, and why? A Q-methodology study.

INTRODUCTION: For Small-Group Active Learning (SMAL) to be effective, students need to engage meaningfully in learning activities to construct their knowledge. Teachers can have difficulty engaging their students in this process. To improve engagement, we aimed to identify the diversity in medical students' appreciation of SMAL, using the concepts of epistemic beliefs and approaches to learning. METHOD: Q-methodology is a mixed-method research design used for the systematic study of subjectivity. We developed a set of 54 statements on active learning methods. In individual interviews, first-year medical students rank ordered their agreement with these statements and explained their reasons. Data were analyzed using a by-person factor analysis to group participants with shared viewpoints. RESULTS: A four-factor solution (i.e. profiles) fit the data collected from 52 students best and explained 52% of the variance. Each profile describes a shared viewpoint on SMAL. We characterized the profiles as 'understanding-oriented', 'assessment-oriented', 'group-oriented', and 'practice-oriented'. DISCUSSION: The four profiles describe how and why students differ in their appreciation of SMAL. Teachers can use the profiles to make better-informed decisions when designing and teaching their SMAL classes, by relating to students' epistemic beliefs, and approaches to learning. This may improve student motivation and engagement for SMAL.