Qualitative expert evaluation of an educational intervention outline aimed at developing a shared understanding of cross-border healthcare.

Objectives: Although cross-border healthcare benefits many patients and healthcare professionals, it also poses challenges. To develop a shared understanding of these opportunities and challenges among healthcare professionals, we designed an educational intervention outline and invited experts in healthcare and education to evaluate it. The proposed intervention was based on theoretical principles of authentic, team, and reflective learning. Methods: Experts (N=11) received a paper outline of the intervention, which was subsequently discussed in individual, semi-structured interviews. Results: Based on a thematic analysis of the interviews, we identified 4 themes: 1) using the experience you have, 2) learning with the people you work with, 3) taking the time to reflect on the past and future, and 4) adapting the intervention to its context. Conclusion: According to the experts, the proposed intervention and its three underlying principles can enhance a shared understanding of cross-border healthcare. To unlock its full potential, however, they suggested adjusting the application of learning principles to its specific context. By situating learning in landscapes of practice, the intervention could contribute to the continuous development of cross-border healthcare.

Situations that prompt teachers in problem-based curricula to reflect on their beliefs, identity and mission.

Teachers have different perceptions of how to enhance student learning. Whereas some take a teacher-centred perspective, others lean more towards a student-centred approach. Many studies in higher education have invoked Korthagen's onion model (2014) to explain how teachers' perspectives can impact their teaching practices. Spanning six interrelated layers, this model contains both outer (environment, behaviour, competencies) and inner (beliefs, identity, and mission) aspects. Focusing essentially on teachers' outer aspects, previous studies have paid scant attention to how particular situations affect teachers' inner aspects and, consequently, how teachers perceive student-centred learning. In this descriptive qualitative study, we explored situations that encouraged or discouraged teachers to embrace student-centred beliefs, identities and missions. We held three focus-group discussions with 18 teachers from two Indonesian medical schools, performing a thematic analysis of the data thus obtained. We found that certain situations made teachers reflect on their inner aspects, which either favourably or adversely affected their acceptance of a student-centred learning approach. Teachers' outer aspects (i.e. their prior problem-based teaching and learning experiences, learning situations from their own training as well as clinical duties) strongly interacted with their inner aspects, thereby shaping their teaching perspectives. Understanding how specific situations can influence teachers' inner aspects might help institutions to design faculty development programmes that address teachers' specific educational needs.

A scoping review of artificial intelligence in medical education: BEME Guide No. 84.

BACKGROUND: Artificial Intelligence (AI) is rapidly transforming healthcare, and there is a critical need for a nuanced understanding of how AI is reshaping teaching, learning, and educational practice in medical education. This review aimed to map the literature regarding AI applications in medical education, core areas of findings, potential candidates for formal systematic review and gaps for future research. METHODS: This rapid scoping review, conducted over 16 weeks, employed Arksey and O'Malley's framework and adhered to STORIES and BEME guidelines. A systematic and comprehensive search across PubMed/MEDLINE, EMBASE, and MedEdPublish was conducted without date or language restrictions. Publications included in the review spanned undergraduate, graduate, and continuing medical education, encompassing both original studies and perspective pieces. Data were charted by multiple author pairs and synthesized into various thematic maps and charts, ensuring a broad and detailed representation of the current landscape. RESULTS: The review synthesized 278 publications, with a majority (68%) from North American and European regions. The studies covered diverse AI applications in medical education, such as AI for admissions, teaching, assessment, and clinical reasoning. The review highlighted AI's varied roles, from augmenting traditional educational methods to introducing innovative practices, and underscores the urgent need for ethical guidelines in AI's application in medical education. CONCLUSION: The current literature has been charted. The findings underscore the need for ongoing research to explore uncharted areas and address potential risks associated with AI use in medical education. This work serves as a foundational resource for educators, policymakers, and researchers in navigating AI's evolving role in medical education. A framework to support future high utility reporting is proposed, the FACETS framework.

Observation of behavioural skills by medical simulation facilitators: a cross-sectional analysis of self-reported importance, difficulties, observation strategies and expertise development.

BACKGROUND: The association between team performance and patient care was an immense boost for team-based education in health care. Behavioural skills are an important focus in these sessions, often provided via a mannikin-based immersive simulation experience in a (near) authentic setting. Observation of these skills by the facilitator(s) is paramount for facilitated feedback with the team. Despite the acknowledgement that trained facilitators are important for optimal learning, insight into this observation process by facilitators is limited. OBJECTIVES: What are the self-reported current practices and difficulties regarding the observation of behavioural skills amongst facilitators during team training and how have they been trained to observe behavioural skills? METHODS: This cross-sectional study used a pilot-tested, content-validated, multi-linguistic online survey within Europe, distributed through a non-discriminative snowball sampling method. Inclusion was limited to facilitators observing behavioural skills within a medical team setting. RESULTS: A total of 175 persons filled in the questionnaire. All aspects of behavioural skill were perceived as very important to observe. The self-perceived difficulty of the behavioural skill aspects ranged from slightly to moderately difficult. Qualitative analysis revealed three major themes elaborating on this perceived difficulty: (1) not everything can be observed, (2) not everything is observed and (3) interpretation of observed behavioural skills is difficult. Additionally, the number of team members health care facilitators have to observe, outnumbers their self-reported maximum. Strategies and tools used to facilitate their observation were a blank notepad, co-observers and predefined learning goals. The majority of facilitators acquired observational skills through self-study and personal experience and/or observing peers. Co-observation with either peers or experts was regarded as most learn some for their expertise development. Overall, participants perceived themselves as moderately competent in the observation of behavioural skills during team training. CONCLUSIONS: Observation of behavioural skills by facilitators in health care remains a complex and challenging task. Facilitators' limitations with respect to attention, focus and (in)ability to perform concomitant tasks, need to be acknowledged. Although strategies and tools can help to facilitate the observation process, they all have their limitations and are used in different ways.

Opening the black box of team-based learning (TBL): A study of verbal interactions in online application sessions.

CONTEXT: In team-based learning (TBL), an instructional strategy that encourages in-depth team discussion and deep learning, interactions in terms of sharing, co-construction, constructive conflict and procedural interactions are important. Since TBL has also been applied online in recent years, the question is whether these interactions are sufficiently present in an online setting. AIM: Gain insight into the nature and extent of these types of interactions in online TBL application sessions and to what extent these vary between teams and sessions. METHODS: We made audiovisual recordings of 12 TBL teams in two online application sessions during assignments. Transcripts were coded and analyzed using a framework derived. RESULTS: Teams spent more than 85% of their time on all four types of interactions in both sessions. The largest proportion of time was spent on sharing and co-construction. Constructive conflict occurred to a limited extent. We observed variation in proportion of time spent on and the distribution of the four types of interactions between teams and sessions. DISCUSSION: All interactions important for achieving deep learning occurred in online TBL application sessions. However, the effective use of these types of interaction should not be left to chance.

Collaboration Scripts or Checklists to Engage Novice Observers in Immersive Simulation?

INTRODUCTION: In simulation, students often observe their peers perform a task. It is still unclear how different types of instructional guidance can turn the observational phase into an active learning experience for novices. This mixed-method study aims to understand similarities and differences between use of collaboration scripts and checklists by observers in terms of cognitive load and perception of learning. METHODS: Second-year pharmacy students ( N = 162) were randomly assigned to 1 of 4 conditions when observing a simulation: collaboration scripts (heuristic to analyze in dyads while observing), checklists, both, or no guidance. We measured observers' intrinsic and extraneous cognitive load and self-perceived learning and conducted focus group interviews. RESULTS: Intrinsic cognitive load was significantly lower for checklists (M = 3.6/10) than for scripts (M = 4.7/10) or scripts and checklists combined (M = 4.7/10). Extraneous cognitive load was significantly lower for checklists (M = 1.5/10) than for scripts combined with checklists (M = 2.6/10) or no guidance (M = 1.8/10). There was no statistical difference between conditions for self-perceived learning. Coding of focus group interviews revealed 6 themes on observers' perception of learning under different conditions of instructional guidance. Students explained that collaboration scripts felt more complex, whereas checklists were perceived as a simple fact-checking exercise. Observing the simulation, regardless of guidance, was a meaningful learning experience. CONCLUSIONS: With or without guidance, observers are actively engaged with the simulation, but their effort differed depending on instructions. When choosing between checklists or collaboration scripts, educators should be guided by the type of simulation task.

Longitudinal exploration of students' identity formation during the transition from pre-clinical to clinical training using research poetry.

BACKGROUND: Transitions are critical periods that can lead to growth and, or, distress. Transitions are a sociocultural process, yet most approaches to transitions in practice and research do not explore the social or developmental aspects of entering a new training phase. Wenger reminds us that identity development is crucial when newcomers navigate change. In this paper, we use Wenger's modes of identification: engagement, imagination and alignment to explore students' identity development (as a student and professional) during the transition from pre-clinical to clinical training. METHODS: We enrolled nine 2nd-year medical students who generated 61 entries comprising audio diary (or typed) reflections over 9 months (starting 3 months before clinical clerkships began) and interviewed them twice. We used research poems (transcripts reframed as poetry) to help construct a meaningful, emotive elicitation of our longitudinal data and analysed data using sensitising concepts from Wenger's modes of identification. RESULTS: Students described their transition as a journey filled with positive and negative emotions and uncertainty about their current and future careers. Students navigated the transition using three mechanisms: (1) becoming more engaged through taking charge, (2) shaping their image of self through engagement and finding role models and (3) learning to flexibly adapt to clerkship norms by managing expectations and adopting a journey mindset. CONCLUSIONS: We successfully narrated students' identity formation during their transition to clinical training. We learned that students became more engaged over time by learning to take charge. They shaped their image of self by engaging in team activities and reflecting on role models. They learnt to adapt flexibly to clerkship norms by managing expectations and adopting a journey mindset. We suggest that institutions provide a safe opportunity for medical students to reflect, allowing students' transition periods to be lived, reflected on and supported.

Task complexity and cognitive load in simulation-based education: A randomised trial.

INTRODUCTION: When designing simulation for novices, educators aim to design tasks and environments that are complex enough to promote learning but not too complex to compromise task performance and cause cognitive overload. This study aimed to determine the impact of modulating task and environment complexity on novices' performance and cognitive load during simulation. METHODS: Second-year pharmacy students (N = 162) were randomly assigned to one of four conditions (2 × 2 factorial design) in simulation: simple task in simple environment, complex task in simple environment, simple task in complex environment and complex task in complex environment. Using video recordings, two raters assessed students' performance during the simulation. We measured intrinsic cognitive load (ICL) and extraneous cognitive load (ECL) with questionnaires after the task and tested knowledge after task and debriefing. RESULTS: Mean performance scores in simple environment were 28.2/32 (SD = 3.8) for simple task and 25.8/32 (SD = 4.2) for complex task. In complex environment, mean performance scores were 24.6/32 (SD = 5.2) for simple task and 25.6/32 (SD = 5.3) for complex task. We found significant interaction effects between task and environment complexity for performance. In simple environment, mean ICL scores were 4.2/10 (SD = 2.2) for simple task and 5.7/10 (SD = 1.5) for complex task. In complex environment, mean ICL scores were 4.9/10 (SD = 1.8) for simple task and 5.1/10 (SD = 1.9) for complex task. There was a main effect of task complexity on ICL. For ECL, we found neither an interaction effect nor main effects of task and environment complexity. There was a main effect of task complexity on knowledge test after task and main effects of both task and environment complexity on knowledge after debriefing. CONCLUSIONS: Performance was good, and cognitive load remained reasonable in all conditions, which suggests that, despite increased complexity, students seemed to strategically manage their own cognitive load and learn from the simulations. Our findings also indicate that environmental complexity contributes to ICL.

Spiritual dimension in palliative medicine: a qualitative study of learning tasks: medical students, teachers, educationalists.

BACKGROUND: Palliative care is gaining importance within the physician's range of duties. In the undergraduate medical curriculum, education on the four dimensions of care is insufficient. The spiritual dimension is hardly addressed. Therefore, we developed a coherent set of learning tasks targeted at learning to communicate about the spiritual dimension. The learning tasks are based on educational principles of authentic learning, reflective learning and longitudinal integration in the curriculum. This article reports on the feasibility of using these learning tasks in the medical curricula. METHODS: Teachers and educational scientists were interviewed and students were asked to evaluate the learning tasks in focus groups. Interview transcripts were analysed by three independent researchers. RESULTS: The learning tasks encourage the students to reflect on the four dimensions of palliative care and their personal values. Learning was clearly organised around authentic learning tasks relevant to the later profession, using paper, video cases, as well as simulations and real patients. Participants suggest giving more attention to cultural diversity. As palliative care is an emotionally charged subject, the safety of both student and patient should be guaranteed. All participants indicated that the program should start in the bachelor phase and most agreed that it should be integrated vertically and horizontally throughout the undergraduate program, although there is some debate about the optimal moment to start. CONCLUSION: The tasks, are authentic, encourage the students to reflect on the spiritual dimension of palliative care and are suitable for integration in the undergraduate medical curriculum.

Continuous enhancement of educational quality - fostering a quality culture: AMEE Guide No. 147.

Internal quality assurance (IQA) is one of the core support systems on which schools in the health professions rely to ensure the quality of their educational processes. Through IQA they demonstrate being in control of their educational quality to accrediting bodies and continuously improve and enhance their educational programmes. Although its need is acknowledged by all stakeholders, creating a system of quality assurance has often led to establishing a 'tick-box' exercise overly focusing on quality control while neglecting quality improvement and enhancement. This AMEE Guide uses the concept of quality culture to describe the various dimensions that need to be addressed to move beyond the tick-box exercise. Quality culture can be defined as an organisational culture which consists of a structural/managerial aspect and a cultural/psychological aspect. As such this AMEE Guide addresses tools and processes to further an educational quality culture while also addressing ways in which individual and collective awareness of and commitment to educational quality can be fostered. By using cases within health professions education of both formal and informal learning settings, examples will be provided of how the diverse dimensions of a quality culture can be addressed in practice.

The imperative for (and opportunities of) research on adaptive expertise in health professions education.

In this editorial, three Advances in Health Sciences Education editors argue for the importance and impact of adaptive expertise on the future of health professions education and work. They present a sample of the broad range of theory-informed research currently contributing to understanding and applying adaptive expertise in health professions education. They reflect on the unique opportunities that interdisciplinarity offers this endeavour. Finally they offer potential ways forward for continued efforts to advance collective understanding of education, expert development and health professions practice.

Describing Ultrasound Skills Teaching by Near-Peer and Faculty Tutors Using Cognitive Apprenticeship.

Phenomenon: Ultrasound skills are becoming increasingly important in clinical practice but are resource-intensive to teach. Near-peer tutors often alleviate faculty teaching burden, but little is known about what teaching methods near-peer and faculty tutors use. Using the lens of cognitive apprenticeship, this study describes how much time faculty and near-peer tutors spend on different teaching methods during abdominal ultrasound skills training. Approach: Sixteen near-peer and 16 faculty tutors were videotaped during one 55-min practical ultrasound lesson with randomly assigned students. Videos were directly coded using Cognitive Apprenticeship teaching methods and activities. Segment durations were summed up and compared quantitatively. Findings: All 32 tutors spent most of the time on observing and helping students (Coaching, Median 29:14 minutes), followed by asking open and stimulating questions (Articulation, 12:04 minutes and demonstrating and giving explanations (Modeling, 04:50 minutes). Overall, distributions of teaching methods used were similar between faculty and near-peer tutors. However, faculty tutors spent more time on helping students manually, whereas near-peer tutors spent more time on exploring students' learning gaps and establishing a safe learning climate. Cognitive Apprenticeship was well suited as observational framework to describe ultrasound skills. Insights: Ultrasound train-the-tutor programs should particularly focus on coaching and articulation. Near-peers' similar use of teaching methods adds to the evidence that supports the use of near-peer teaching in ultrasound skills education.

Virtual interviewing for graduate medical education recruitment and selection: A BEME systematic review: BEME Guide No. 80.

BACKGROUND: The COVID-19 pandemic caused graduate medical education (GME) programs to pivot to virtual interviews (VIs) for recruitment and selection. This systematic review synthesizes the rapidly expanding evidence base on VIs, providing insights into preferred formats, strengths, and weaknesses. METHODS: PubMed/MEDLINE, Scopus, ERIC, PsycINFO, MedEdPublish, and Google Scholar were searched from 1 January 2012 to 21 February 2022. Two authors independently screened titles, abstracts, full texts, performed data extraction, and assessed risk of bias using the Medical Education Research Quality Instrument. Findings were reported according to Best Evidence in Medical Education guidance. RESULTS: One hundred ten studies were included. The majority (97%) were from North America. Fourteen were conducted before COVID-19 and 96 during the pandemic. Studies involved both medical students applying to residencies (61%) and residents applying to fellowships (39%). Surgical specialties were more represented than other specialties. Applicants preferred VI days that lasted 4-6 h, with three to five individual interviews (15-20 min each), with virtual tours and opportunities to connect with current faculty and trainees. Satisfaction with VIs was high, though both applicants and programs found VIs inferior to in-person interviews for assessing 'fit.' Confidence in ranking applicants and programs was decreased. Stakeholders universally noted significant cost and time savings with VIs, as well as equity gains and reduced carbon footprint due to eliminating travel. CONCLUSIONS: The use of VIs for GME recruitment and selection has accelerated rapidly. The findings of this review offer early insights that can guide future practice, policy, and research.

Task-based training to prevent surgical site infection: A formative evaluation.

Background: Lack of evidence-based training constitutes a serious impediment to preventing surgical site infections in low-middle income countries (LMIC). The purpose of this study was to design and implement an infection prevention training programme and investigate how it might work in an LMIC. Intended for healthcare professionals working in operating rooms, the programme was based on current instructional design principles of interprofessional, task-based learning. The second aim was to carry out a formative evaluation exploring participants' and facilitators' perceptions and experiences of the training. Methods: In undertaking this design-based research, we used a mixed-methods approach. The four session training was attended by anaesthesia and surgical trainees, registered nurses, technologists and included a video showing best practices, role plays, and peer-group reflection. We evaluated the programme through questionnaires, focus-group interviews with participants, written reflections by participants, and individual interviews with facilitators. Quantitative analysis was complemented by thematic analysis of focus-group and interview transcripts, reflections, and observer notes. Results: Our analysis revealed that participants had positive attitudes towards the training. They felt they had learned a lot from each other and the facilitators offered them the opportunity to interact with each other. Trainees especially valued the video presentation as it inspired them to revise old concepts and presented an excellent practical example of infection prevention in their specific setting. Conclusion: The training seemed to bridge the gap between knowledge and practice. However, direct observation of procedural skills and peer feedback could further reduce the gap, by enhancing the transfer of knowledge to practice.

Creativity: A viable and valuable competency in medicine? A qualitative exploratory study.

PURPOSE: To explore and describe medical students, postgraduate medical trainees, and medical specialists' perceptions of creativity, the importance they attach to creativity in contemporary healthcare, and, by extension, how they feel creativity can be taught in medical education. METHODS: The authors conducted seven semi-structured focus groups with medical students (n = 10), postgraduate medical trainees (n = 11) and medical specialists (n = 13). RESULTS: Participants had a trifurcated perception of creativity, which they described as a form of art that involves thinking and action processes. Facing complex patients in a rapidly changing healthcare landscape, doctors needed such a multifaceted perspective to be able to adapt and react to new and often complex situations that require creativity. Furthermore, participants identified conditions that were perceived to stimulate and inhibit creativity in healthcare and suggested several techniques to learn creativity. CONCLUSION: Participants perceived creativity as a form of art that involves thinking and action processes. Creativity is important to tackle the challenges of current and future workplaces, because it stimulates the search for original solutions which are needed in a rapidly changing healthcare landscape. Participants proposed different methods and techniques to promote creativity learning. However, we need further research to design and implement creativity in medical curricula.

Supervisors' transformational leadership style and residents' job crafting in surgical training: the residents' views.

Objectives: This study aims to explore the effects of three supervisors' leadership styles (transformational, transactional, and laissez-faire) on residents' job crafting. Methods: Sequential explanatory mixed-methods. First, a purposive sample of residents rated the leadership style of their supervisors and their own job crafting on the Multifactor Leadership Questionnaire and the Dutch Job Crafting Scale. The effects were tested through linear mixed effects regression analysis. Thereafter we conducted semi-structured interviews with residents and conducted a thematic analysis. Results: A total of 116 residents participated. A transformational style had a positive effect on residents' job crafting (b = .19, t(112) =3.76, p=. 009), whereas the transactional and laissez-faire styles did not. This could be explained by the fact that residents felt a positive influence of the supervisors with such style on the atmosphere for training, on the job resources available to them, and on their modelling function for how to handle the demands of the environment. Conclusions: A transformational style of the supervisor has a positive effect on residents' job crafting. Future research should explore the supervisors' perspective, as well as the effectiveness of leadership training for supervisors with a focus on resident outcomes, such as job crafting.

Reaching consensus on GP interprofessional competencies: a nominal group study.

BACKGROUND: As the requirements for collaboration in primary care increase, effective interprofessional teamwork between GPs and other primary care professionals is crucial. The need for more training in interprofessional collaborative competencies is widely recognised. However, existing competency frameworks do not sufficiently specify interprofessional collaboration to guide interprofessional competency development. AIM: To reach consensus among GPs and other primary care professionals on interprofessional competencies that GP and GP trainees should learn. DESIGN & SETTING: A qualitative consensus study among Dutch GPs and other primary care professionals, all with expertise in primary care interprofessional collaborative practice. METHOD: Three nominal group sessions were held, each resulting in its own group consensus on GP interprofessional collaborative competencies. The researchers conducted a content analysis to merge and thematise the prioritised competencies into one list. Participants prioritised this list of competencies. A pre-set cut-off point was applied to determine the overall consensus on core GP interprofessional competencies. RESULTS: Eighteen professionals from nine different disciplines participated. The content analysis resulted in 31 unique competencies, of which 14 competencies were prioritised in the final ranking into the following three main themes: (1) professional identity development and role definition by the GP (three competencies); (2) developing and executing shared care plans for individual patients (six competencies); and (3) initiating and maintaining interprofessional collaborative partnerships (five competencies). CONCLUSION: An interprofessional group of experts reached consensus on 14 competencies within three themes. This framework provides a stepping stone for GPs to focus on their development regarding interprofessional collaboration.

Design and evaluation of a team-based interprofessional practice placement: A design-based research approach.

INTRODUCTION: Team-based Interprofessional Practice Placements (TIPPs) are innovative training practices. Evidence to substantiate the design of TIPPs is limited. This study explores the design and evaluation of TIPPs to support undergraduate students in gaining a better understanding of the complexity of patient problems in primary care settings and of collaboration within interprofessional teams. METHOD: We implemented TIPPs at a University of Applied Sciences, Belgium based on three principles: (1) authentic tasks with real clients, (2) students collaborated in small interprofessional teams, and (3) students were supported by teachers. TIPPs were evaluated using focus groups (N = 5) that explored teachers' (N = 13) and students' (N = 22) experiences. Data were analysed thematically. RESULTS: Three themes were constructed. First, TIPPs enhance students' understanding of the complexity of clients' problems and what matters to the client. Second, TIPPs support students to value the expertise of interprofessional team members. Finally, to enhance students' learning, TIPPs must strike an appropriate balance between teacher support and student autonomy. CONCLUSION: The three design principles used to underpin the TIPPs were viable. Although students reported to receive sufficient support, they also felt this support should have been gradually withdrawn to offer more opportunities for autonomous learning. Teachers reported difficulties in balancing their support.

Creation and evaluation of a novel, interdisciplinary debriefing program using a design-based research approach.

BACKGROUND: The emergency department (ED) witnesses the close functioning of an interdisciplinary team in an unpredictable environment. High-stress situations can impact well-being and clinical practice both individually and as a team. Debriefing provides an opportunity for learning, validation, and conversation among individuals who may not typically discuss clinical experiences together. The current study examined how a debriefing program could be designed and implemented in the ED so as to help teams and individuals learn from unique, stressful incidents. METHODS: Based on the theory of workplace-based learning and a design-based research approach, the evolved nature of a debriefing program implemented in the real-life context of the ED was examined. Focus groups were used to collect data. We report the design of the debriefing intervention as well as the program outcomes in terms of provider's self-perceived roles in the program and program impact on provider's self-reported clinical practice as well as the redesign of the program based on said feedback. RESULTS: The themes of barriers to debriefing, provision of perspectives, psychological trauma, and nurturing of staff emerged from focus group sessions. Respondents identified barriers and concerns regarding debriefing, and based on this information, changes were made to the program, including offering of refresher sessions for debriefing, inclusion of additional staff members in the training, and remessaging the purpose of the program. CONCLUSIONS: Data from the study reinforced the need to increase the frequency and availability of debriefing didactics along with clarifying staff roles in the program. Future work will examine continued impact on provider practice and influence on departmental culture.

Medical Students' Socialization Tactics When Entering a New Clinical Clerkship: A Mixed Methods Study of Proactivity.

PURPOSE: Socialization into clinical clerkships is difficult in part due to ambiguity around students' new roles and expected behaviors. Being proactive reduces ambiguity and is essential to socialization. Proactive behavior can be taught and goes beyond having a proactive personality. Among students entering new undergraduate clinical clerkships, this study aimed to investigate (1) reported proactive behaviors and their association with social integration and (2) enabling and inhibiting factors for proactive behavior. METHOD: This study was conducted at the 5-year MBBS program at Western Sydney University during academic year 2019-2020. Using a convergent mixed methods approach, survey and interview data from third-, fourth-, and fifth-year students were collected. Surveys explored 5 proactive behaviors: feedback seeking, information seeking, task negotiation, positive framing, and relationship building. Interviews elicited descriptions of how students described their proactivity and what influenced students to be proactive when entering a new clerkship. Data were integrated using the following the thread and mixed methods matrix techniques. RESULTS: Students exhibited all 5 proactive behaviors. Survey data showed positive framing and task negotiation had the highest and lowest scores, respectively. Only positive framing correlated significantly with social integration scores (r = 0.27; P < .01), but this contrasted to interviews, in which students described how other proactive behaviors also led to social integration. Proactive behavior scores decreased across academic years. Integrated data showed 3 linked antecedents to whether students exhibited proactive behavior: feeling capable of being proactive, individual intention to be proactive, and the immediate environment and system-level factors. CONCLUSIONS: Students who framed the experience positively were more likely to report increased social integration. Initiating task negotiation was challenging for most students. The authors propose a conceptual model for proactivity and social integration to support socialization and learning during clinical transitions for future research and interventional design.