Towards inclusive learning environments in post-graduate medical education: stakeholder-driven strategies in Dutch GP-specialty training.

BACKGROUND: A recent study found that ethnic minority General Practice (GP)-trainees receive more negative assessments than their majority peers. Previous qualitative research suggested that learning climate-related factors play a pivotal role in unequal opportunities for trainees in post-graduate medical settings, indicating that insufficient inclusivity had put minority students at risk of failure and dropout. STUDY OBJECTIVES: We aimed to develop broadly supported strategies for an inclusive learning climate in Dutch GP-specialty training. METHODS: We employed Participatory Action Research (PAR)-methods, incorporating Participatory Learning and Action (PLA)-techniques to ensure equal voices for all stakeholders in shaping Diversity, Equity, and Inclusion (DEI)-strategies for GP-specialty training. Our approach engaged stakeholders within two pilot GP-specialty training institutes across diverse roles, including management, support staff, in-faculty teachers, in-clinic supervisors, and trainees, representing ethnic minorities and the majority population. Purposeful convenience sampling formed stakeholder- and co-reader groups in two Dutch GP-specialty training institutes. Stakeholder discussion sessions were based on experiences and literature, including two relevant frameworks, and explored perspectives on the dynamics of potential ethnic minority trainees' disadvantages and opportunities for inclusive strategies. A co-reader group commented on discussion outcomes. Consequently, a management group prioritized suggested strategies based on expected feasibility and compatibility. RESULTS: Input from twelve stakeholder group sessions and thirteen co-readers led to implementation guidance for seven inclusive learning environment strategies, of which the management group prioritized three: • Provide DEI-relevant training programs to all GP-specialty training stakeholders; • Appoint DEI ambassadors in all layers of GP-specialty training; • Give a significant voice to minority GP-trainees in their education. CONCLUSION: The study's participatory approach engaged representatives of all GP-specialty training stakeholders and identified seven inclusive learning climate strategies, of which three were prioritized for implementation in two training institutions.

Blended learning in CME: the perception of GP trainers.

INTRODUCTION: Blended learning (the combination of electronic methods with traditional teaching methods) has the potential to combine the best of traditional education with the best of computer-mediated training. We chose to develop such an intervention for GP trainers who were undertaking a Continuing Medical Education (CME) course in evidence-based medicine (EBM). This study reports on our experience and investigated the factors influencing the perception on usefulness and logistics of blended learning for learners in CME. METHODS: In total, 170 GP trainers participated in the intervention. We used questionnaires, observations during the four face-to-face meetings and evaluations in the e-course over one year. Additionally we organised focus groups to gain insight in some of the outcomes of the questionnaires and interpretations of the observations. RESULTS: The GP trainers found the design and the educational method (e-course in combination with meetings) attractive, instructive and complementary. Factors influencing their learning were (1) educational design, (2) educational method, (3) topic of the intervention, (4) time (planning), (5) time (intervention), (6) learning style, (7) technical issues, (8) preconditions and (9) level of difficulty. A close link between daily practice and the educational intervention was considered an important precondition for the success of the intervention in this group of learners. CONCLUSION: GP trainers were positive about blended learning: they found e-learning a useful way to gain knowledge and the meetings a pleasant way of transferring the knowledge into practice. Although some preconditions should be taken into consideration during its development and implementation, they would participate in similarly designed learning in the future.

Structural equation modeling of health-related quality-of-life data illustrates the measurement and conceptual perspectives on response shift.

OBJECTIVE: To illustrate different perspectives on response shift with cancer patients' health-related quality-of-life (HRQL) data. In measurement perspective, the focus is on bias in the measurement of HRQL. In conceptual perspective, the focus is on bias in the explanation of HRQL. STUDY DESIGN AND SETTING: Data came from a consecutive series of 202 newly diagnosed cancer patients, heterogeneous to cancer site, all undergoing surgery. A HRQL questionnaire was administered before and after surgery. Using structural equation modeling, biases and response shifts in measurement and explanation of HRQL were investigated with respect to patient's cancer site, health status, sex, age, optimism, and social comparison. RESULTS: Six measurement biases were found, five of which were considered response shift. The "general health" (GH) scale appeared most susceptible to response shift. For example, GH scores were not fully determined by HRQL but also by optimism before surgery and female sex and downward social comparison after surgery. Additionally, two explanation biases were found, neither of which were considered response shift-before and after surgery the mental component of HRQL was not only affected by cancer site and health status but also by optimism and downward social comparison. CONCLUSION: Our approach enables the distinction and testing of biases and response shifts in the measurement and explanation of HRQL.