Disciplinary boundaries and integrating care: using Q-methodology to understand trainee views on being a good doctor.

BACKGROUND: Rising numbers of patients with multiple-conditions and complex care needs mean that it is increasingly important for doctors from different specialty areas to work together, alongside other members of the multi-disciplinary team, to provide patient centred care. However, intra-professional boundaries and silos within the medical profession may challenge holistic approaches to patient care. METHODS: We used Q methodology to examine how postgraduate trainees (n = 38) on a range of different specialty programmes in England and Wales could be grouped based on their rankings of 40 statements about 'being a good doctor'. Themes covered in the Q-set include: generalism (breadth) and specialism (depth), interdisciplinarity and multidisciplinary team working, patient-centredness, and managing complex care needs. RESULTS: A by-person factor analysis enabled us to map distinct perspectives within our participant group (P-set). Despite high levels of overall commonality, three groups of trainees emerged, each with a clear perspective on being a good doctor. We describe the first group as 'generalists': team-players with a collegial and patient-centred approach to their role. The second group of 'general specialists' aspired to be specialists but with a generalist and patient-centred approach to care within their specialty area. Both these two groups can be contrasted to those in the third 'specialist' group, who had a more singular focus on how their specialty can help the patient. CONCLUSIONS: Whilst distinct, the priorities and values of trainees in this study share some important aspects. The results of our Q-sort analysis suggest that it may be helpful to understand the relationship between generalism and specialism as less of a dichotomy and more of a continuum that transcends primary and secondary care settings. A nuanced understanding of trainee views on being a good doctor, across different specialties, may help us to bridge gaps and foster interdisciplinary working.

Developmental guidelines for good chairside teaching ­ a consensus report from two conferences.

Developmental Guidelines for Chairside Teaching are a direct outcome of 10 years of research, originally prompted by feedback from undergraduate dental students who not only thought that the teaching they received was uneven and variable in quality, but also felt strongly that they learned more with educationally trained teachers than those with little or no teacher training. Workshops embracing the views of teaching colleagues from many other Dental Schools produced a consensus view that developmental guidelines for teachers would provide a valuable resource. A conference to consider all aspects on chairside teaching and learning was convened with delegates invited from all UK Dental Schools. This was subsequently followed by a second conference to develop specific guidelines for chairside teaching and learning. The Nominal Group Technique was used in the first chairside teaching conference, and Structured Small Expert Groups were used in the second. The overall consensus from these workshops and conferences were as follows: (i) developmental guidelines for chairside teaching can act as a useful resource for teachers to improve and maintain their standard of chairside teaching, (ii) developmental guidelines can be divided into themes of organisational issues and learner and teacher qualities, and (iii) Guidelines should be 'developmental' because they encourage chairside teachers to focus on the next immediate goal to maintain and improve quality and standards. These developmental guidelines could provide a universal toolkit for improved chairside teaching which would result in a better student learning experience. Set out in this way these guidelines have currency across academic and practical skills levels, different educational systems, philosophies and country boundaries.

'It's surprising how differently they treat you': a qualitative analysis of trainee reflections on a new programme for generalist doctors.

OBJECTIVES: An increase in patients with long-term conditions and complex care needs presents new challenges to healthcare providers around the developed world. In response, more broad-based training programmes have developed to better prepare trainees for the changing landscape of healthcare delivery. This paper focuses on qualitative elements of a longitudinal, mixed-methods evaluation of the postgraduate, post-Foundation Broad-Based Training (BBT) programme in England. It aims to provide a qualitative analysis of trainees' evaluations of whether the programme meets its intentions to develop practitioners adept at managing complex cases, patient focused care, specialty integration and conviction in career choice. We also identify unintended consequences. SETTING: 9 focus groups of BBT trainees were held over a 12-month period. Discussions were audio-recorded and subjected to directed content analysis. Data were collected from trainees across all 7 participating regions: East Midlands; West Midlands; Severn; Northern; North Western; Yorkshire and Humber; Kent, Surry and Sussex. PARTICIPANTS: Focus group participants (61 in total) from the first and second cohorts of BBT. RESULTS: Evidence from trainees indicated that the programme was meeting its aims: trainees valued the extra time to decide on their onward career specialty, having a wider experience and developing a more integrated perspective. They thought of themselves as different and perceived that others they worked alongside also saw them as different. Being different meant benefitting from novel training experiences and opportunities for self-development. However, unintended consequences were feelings of isolation, and uncertainty about professional identity. CONCLUSIONS: By spanning boundaries between specialties, trainee generalists have the potential to improve experiences and outcomes for patients with complex health needs. However, the sense of isolation will inhibit this potential. We employ the concept of 'belongingness' to identify challenges related to the implementation of generalist training programmes within existing structures of healthcare provision.

Educational innovations for dentistry.

Over the past four decades, teaching and learning in higher education has been informed by a variety of educational theories. The various initiatives that have been introduced as a consequence have all sought to improve students' educational experiences. However, such moves have not always been successful, as a series of three articles that the authors produced on dental chairside teaching have demonstrated. The first of these investigated the stakeholders' perceptions of this teaching at one dental school. The second evaluated chairside teaching on a UK wide scale, while the third provided educational tools to encourage collaboration among clinical educators to share good chairside teaching practices. What this paper seeks to do is to locate each of these themes within the wider context of a theoretical frame highlighting the need for dental education to be underpinned by such constructs. The aim of this paper is to help ensure that an informed learning experience is achieved for all students engaged in clinical dental education.

Chairside teaching and the perceptions of dental teachers in the UK.

This study outlines how dental tutors at the chairside view their teaching and describes what are considered important current issues, requirements and recommendations for good chairside teaching practice. A qualitative analysis was undertaken of stakeholder perceptions of chairside teaching from both a single dental school study and a UK wide evaluation workshop. The evaluation of good chairside teaching showed that training requirements might be quite different for different stakeholders in chairside teaching. Further, this evaluation process may serve as a process model for institutional change for improvements in chairside teaching. This article is the second of a series of three and evaluates chairside teaching on a UK wide scale. The first, investigated the perceptions of stakeholders of chairside teaching at a single dental school. The third provides educational tools to encourage collaboration and sharing good chairside teaching practice. A further accompanying article reviews some of the educational methodology and innovations in teaching and learning that may be applied to dentistry.

Stakeholder perceptions of chairside teaching and learning in one UK dental school.

As a hands-on clinical educational programme, undergraduate dentistry is an anomaly in higher education. This study aimed to evaluate the perceptions of chairside teaching of dental team stakeholders, including dental nurses, dental students and dental tutors at a single UK dental school. From this sample the penetration of current learning and teaching innovations within higher education into the specialist field of clinical dentistry could be evaluated. This article is the first of a series of four which investigates the perceptions of stakeholders of chairside teaching at a single dental school. The second evaluates chairside teaching on a UK wide scale. The third provides educational tools to encourage collaboration and sharing good chairside teaching practice. A further accompanying article reviews some of the educational methodology and innovations in teaching and learning that may be applied to dentistry.

Tools to share good chairside teaching practice: a clinical scenario and appreciative questionnaire.

This article provides a scenario for analysis of good chairside teaching practice to serve as a starting point for continued discussion in this complex field. Documented issues of good chairside teaching practice are cross-referenced to a clinical scenario with explanations in the form of a commentary. This provided the context for generating a set of questions that are provided as tools to support good chairside practice. These tools are designed to be used with 'Appreciative Inquiry', which claims that there is much to be gained by discovering where excellence is possible and elaborating upon this. Although this process can be carried out in single units or departments, it is proposed that collaboration between institutions would allow sharing of valuable innovations and greater understanding of educational training, production of good practice guidance and professional development of staff. This article is the third in a series of three and provides a scaffold for a scenario and questions to encourage collaboration in evolving and sharing good chairside teaching practice. The first article investigated the perceptions of stakeholders in chairside teaching at a single dental school and the second evaluated chairside teaching on a UK wide scale. A further accompanying article reviews some of the educational methodology and innovations in teaching and learning that may be applied to dentistry.