Exploring the Irish general practice training community's perceptions on how an entrustable professional activities dashboard implementation could facilitate general practice training in Ireland.

BACKGROUND: The Irish General Practitioner Training (GP) Programme is currently moving to Competency-Based Medical Education (CBME), facilitated by Programmatic Assessment (PA) and Entrustable Professional Activities (EPAs). These new assessment and feedback mechanisms may provide a rich and much sought-after dataset. However, given the possible number of feedback and assessment events, and the variety of modalities used, aggregating and interpreting these can be costly and difficult. Dashboard implementations (DI) have been purposed as a solution to bridge the gap between the large datasets and the training community at all levels. AIMS: To explore the Irish GP training community's perceptions on how an EPAs DI could facilitate the delivery of GP training in Ireland. METHODS: A qualitative approach was taken, using a focus group representative of different groups in the training community. Concurrently, an EPAs DI was developed. Focus group transcripts were analysed in an iterative fashion using Template Analysis to generate themes and subthemes. RESULTS: Numerous advantages were seen in relation to the implementation of an EPAs DI around entrustment decisions, constructive alignment and summative decision-making. These advantages, however, need to be tempered with the realisation that the EPAs DI is not and should not be misinterpreted as being the learning analytic panacea for GP training. CONCLUSION: This paper outlines the perceptions from a postgraduate medical education training community on an EPAs DI, which would be applicable to other training communities considering introducing similar mechanisms.

The role of teachers in a sustainable university: from digital competencies to postdigital capabilities.

An increase in online and hybrid education during and after the Covid-19 pandemic has rapidly accelerated the infiltration of digital media into mainstream university teaching. Global challenges, such as ecological crises, call for further radical changes in university teaching, requiring an even richer convergence of 'natural,' 'human' and 'digital'. In this paper, we argue that this convergence demands us to go beyond 'the great online transition' and reframe how we think about university, teachers' roles and their competencies to use digital technologies. We focus on what it takes to be a teacher in a sustainable university and consider emerging trends at three levels of the educational ecosystem-global developments (macro), teachers' local practices (meso), and daily activities (micro). Through discussion of examples of ecopedagogies and pedagogies of care and self-care, we argue that teaching requires a fluency to embrace different ways of knowing and collective awareness of how the digital is entwined with human practices within and across different levels of the educational ecosystem. For this, there is a need to move beyond person-centric theorisations of teacher digital competencies towards more holistic, ecological conceptualisations. It also requires going beyond functionalist views of teachers' roles towards enabling their agentive engagement with a future-oriented, sustainable university mission.

Making space to learn about teaching: expanding teaching horizons through postgraduate education.

Clinicians develop as teachers via many activities, from on-the-job training to formal academic programmes. Yet, understanding how clinicians develop the sensibilities of an educator and an appreciation of the complexity of educational environments is challenging. Studies of teacher development have maintained a relatively narrow definition of educational practice. A more expansive view encompasses clinical teachers' roles in relation to elements beyond learners or content, such as the cultures and other structures of healthcare institutions. In our online Postgraduate Certificate in Clinical Education, space and structure are intentionally created for teachers to think and talk about education with colleagues in other disciplinary contexts. We interviewed 17 students about how their approaches to teaching had changed over a year of part-time study, using their teaching philosophies, written at the start of the programme, as points of contrast. We took an abductive approach to data analysis, drawing on the literature and, unavoidably, our own reflexive interpretations of our practice outside of the research context, such as conversations with students and colleagues; our experiences of teaching and our concurrent research and scholarship. Our themes of repertoire building, perspective shifting, embodied practice, and appreciation of context, describe the increasing complexity of individuals' considerations of teaching. We use our analysis as the basis for a discussion of the blurring of boundaries between staff and students on such programmes as both groups are engaged in an ongoing continuum of development as all teachers, continue to be learners of educational practice. These insights can inform the ways in which postgraduate programmes can make space for clinical teachers to share and reflect on practices, perspectives and contexts.

A Matter of Trust: Online Proctored Exams and the Integration of Technologies of Assessment in Medical Education.

ISSUE:  Technology is pervasive in medicine, but we too rarely examine how it shapes assessment, learning, knowledge, and performance. Cultures of assessment also shape identities, social relations, and the knowledge and behavior recognized as legitimate by a profession. Therefore, the combination of technology and assessment within medical education is worthy of review. Online proctoring services have become more prevalent during the Covid-19 pandemic, as a means of continuing high-stakes invigilated examinations online. With criticisms about increased surveillance, discrimination, and the outsourcing of control to commercial vendors, is this simply "moving exams online", or are there more serious implications? What can this extreme example tell us about how our technologies of assessment influence relationships between trainees and medical education institutions? EVIDENCE:  We combine postdigital and postphenomenology approaches to analyze the written component of the 2020 online proctored United Kingdom Royal College of Physicians (MRCP) membership exam. We examine the scripts, norms, and trust relations produced through this example of online proctoring, and then locate them in historical and economic contexts. We find that the proctoring service projects a false objectivity that is undermined by the tight script with which examinees must comply in an intensified norm of surveillance, and by the interpretation of digital data by unseen human proctors. Nonetheless, such proctoring services are promoted by an image of data-driven innovation, a rhetoric of necessity in response to a growing problem of online cheating, and an aversion, within medical education institutions, to changing assessment formats (and thus the need to accept different forms of knowledge as legitimate). IMPLICATIONS:  The use of online proctoring technology by medical education institutions intensifies established norms, already present within examinations, of surveillance and distrust. Moreover, it exacerbates tensions between conflicting agendas of commercialization, accountability, and the education of trustworthy professionals. Our analysis provides an example of why it is important to stop and consider the holistic implications of introducing technological "solutions", and to interrogate the intersection of technology and assessment practices in relation to the wider goals of medical education.

How can inhabited institutionalism inform the analysis of medical education?

CONTEXT: Medical schools are complex organisations existing at the intersection of higher education and healthcare services. This complexity is compounded by many competing pressures and drivers from professional and regulatory bodies, the wider political environment and public expectations, producing a range of challenges for those involved in all stages of medical education. There are established approaches that have been used to address research questions related to these challenges; some focus on organisational structures, characteristics and performance; others on the interactions that take place in a particular setting. Less common are approaches that integrate data on macro-level structures with the micro-level interactions of the people who inhabit those structures. Looking at the interaction of the macro and the micro opens up possibilities for the new insights. FRAMEWORK: We propose using an approach with roots in social theory-Inhabited Institutionalism (II)-that is largely unexplored in medical education. II has been described as Janus-faced, looking both outwards, at the broader context of medical education, and inwards, at the ways in which meanings are constructed and re-constructed by participants within a particular setting. METHODS: After describing the theoretical framework of II, we explain how it can be used to understand medical education as subject to both broader societal structures (the macro level) and interactions between people (the micro level), as well as-crucially-their mutual influence. CONCLUSION: II offers the opportunity to combine macro- and micro-level perspectives, leading to a more expansive understanding of the operation of medical education which sees its form and function as neither entirely determined by structures nor a construction of individuals engaged in it. In doing so, it potentially offers a valuable way of considering the intractable problem of how to successfully manage change, offering a combined top-down and bottom-up perspective.

Development of entrustable professional activities for paediatric intensive care fellows: A national modified Delphi study.

Entrustable professional activities (EPAs), as a focus of learner assessment, are supported by validity evidence. An EPA is a unit of professional practice requiring proficiency in multiple competencies simultaneously, that can be entrusted to a sufficiently competent learner. Taken collectively, a set of EPAs define and inform the curriculum of a specialty training. The goal of this study was to develop a set of EPAs for Dutch PICU fellows. A multistage methodology was employed incorporating sequential input from task force members, a medical education expert, PICU fellowship program directors, and PICU physicians and fellows via a modified three-round Delphi study. In the first modified Delphi round, experts rated indispensability and clarity of preliminary EPAs. In the subsequent rounds, aggregated scores for each EPA and group comments were provided. In round two, respondents rated indispensability and clarity of revised EPAs. Round three was used to gain explicit confirmation of suitability to implement these EPAs. Based on median ratings and content validity index (CVI) analysis for indispensability in the first two rounds, all nine preliminary EPAs covered activities that were deemed essential to the clinical practice of PICU physicians. Based on median ratings and CVI analysis for clarity however, four EPAs needed revision. With an agreement percentage of 93-100% for all individual EPAs as well as the set as a whole, a high degree of consensus among experts was reached in the third round. The resulting nine PICU EPAs provide a succinct overview of the core tasks of Dutch PICU physicians. These EPAs were created as an essential first step towards developing an assessment system for PICU fellows, grounded in core professional activities. The robust methodology used, may have broad applicability for other (sub)specialty training programs aiming to develop specialty specific EPAs.

Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study.

BACKGROUND: Primary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees' preparation for, or experiences and perceptions of, them. AIM: To understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations. DESIGN & SETTING: A mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees. METHOD: A cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis. RESULTS: The survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R 2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations. CONCLUSION: This project sheds light on GP trainees' current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.

Using a theoretical framework to develop postgraduate health professions education research and practice.

This article was migrated. The article was marked as recommended. Healthcare education is complex and multifaceted, requiring study from different angles and with different lenses. We propose that the use of a meta-framework can help those teaching and researching postgraduate health professions education make holistic sense of their practice and findings from different projects. We discuss how we have employed Bronfenbrenner's ecological systems theory (EST) as an overarching theoretical framework for the scholarship of learning and teaching in the context of postgraduate health professions education. Taking a structured approach to pedagogical thinking and research through the use of a meta-framework opens up useful ways of framing findings and further questions, locating research projects within a bigger picture, and communicating to others the focus of a research programme. We address the problem of the under-theorizing of educational research in postgraduate health professions education, advocating both theoretical frameworks for individual research projects, and an overarching theoretical "meta-framework" to interrogate and draw together multiple studies. In doing so we build on, critique and further develop Bronfenbrenner's ecological systems theory.

Challenging assumptions about "moving online" in response to COVID-19, and some practical advice.

This article was migrated. The article was marked as recommended. COVID-19 is forcing many Universities to close for some time and programmes for medical, allied health, and nursing students are moving online. Based on our extensive collective experience teaching a variety of health professionals in clinical and academic settings, and of online learning, we want to question assumptions that seem apparent to us in some of the discourse around "moving teaching online". We write from the perspective of a team delivering a postgraduate programme for professionals working full time (in most cases) from around the world and different professions; however, we believe the issues raised are applicable to online education in general. There is a practical purpose to confronting these assumptions. It is our aim to help those delivering health professions education avoid some pitfalls that we think would result in poor quality experiences for all concerned. We do not believe that online education is inherently poorer nor, indeed, fundamentally distinct from on-campus education. However, there are certainly important considerations for learning to teach online, and we attempt to highlight some of these. We also provide some advice to those new to teaching online based on our experience, research, and the literature.

Using Bourdieu to explore graduate attributes in two online Master's programmes.

Within the expansion of postgraduate educational qualifications for health professionals, graduate attributes have become important markers of outcomes and value. However, it is not clear how or when graduate attributes develop, or how they are applied in professional practice after graduation. We interviewed 17 graduates from two online Master's programmes to explore their perceptions of how postgraduate study had influenced their practice and professional identity. Our thematic analysis produced three main themes (academic voice, infectious curiosity, and expanding worldview) which reflected changes in the participants' confidence, attitude, perspective, and agency across professional and academic settings. We then conducted a secondary phase of analysis using Bourdieu's concepts of 'field', 'capital', and 'habitus'. While graduate attributes have been conceptualised as the context-independent acquisition of traits that can be employed by individuals, Bourdieu's framework highlights their relational qualities: they are caught up in the cultural history and context of the student/professional, the reputation of the awarding institution, and the graduate's location within a network of professional peers.

Insights into teaching a complex skill: Threshold concepts and troublesome knowledge in electroencephalography (EEG).

BACKGROUND: Threshold concepts (TCs) are defined as ideas within a discipline that are often conceptually difficult ("troublesome"), but when learned, transform a learner's understanding. Electroencephalography (EEG) has been recognized as a conceptually difficult field in neurology, and a study of threshold concepts in EEG may provide insights into how it is taught and learned. METHODS: Semi-structured interviews were performed with 12 EEG experts in the US and Canada. Experts identified potential TCs and troublesome knowledge, and explored how these concepts were taught and learned. Interview transcripts were coded and analyzed using a general thematic analysis approach, based on the core elements of the threshold concepts framework. RESULTS: One concept (polarity) emerged most clearly as a threshold concept. Other troublesome areas included pattern interpretation and clinical significance, but these lacked some of the characteristics of TCs. Several themes emerged, including the role of TCs and troublesome knowledge in determining expertise and the role of prior experience. CONCLUSIONS: We have used the threshold concepts framework to explore potential barriers to learning, suggest ways to support learners, and identify potential points of emphasis for teaching and learning EEG. A similar approach could be applied to the study of teaching and learning in other conceptually difficult areas of medical education.

Reconciling the professional and student identities of clinical psychology trainees.

The study explored the ways in which qualified and trainee clinical psychologists perceived professional behaviour, as illustrated in a series of short vignettes, in student and clinical practice contexts. Comparisons were made to identify the extent to which ideas of professionalism differed across different learning contexts and between qualified and unqualified staff, with the aim of adding to the literature on which factors influence the development of professional identity in health professionals. An online questionnaire depicting a range of potentially unprofessional behaviours was completed by 265 clinical psychology trainees and 106 qualified clinical psychologists. The data were analysed using a general linear model with simultaneous entry in which rater (trainee vs qualified clinical psychologist), setting (student vs placement) and their interaction predicted acceptability ratings. We found that, in general, trainees and qualified staff agreed on those behaviours that were potentially unprofessional, although where significant differences were found, these were due to trainees rating the same behaviours as more professionally acceptable than qualified clinical psychologists. Despite trainees identifying a range of behaviours as professionally unacceptable, some percentage reported having engaged in a similar behaviour in the past. Irrespective of the status of the rater, the same behaviours tended to be viewed as more professionally unacceptable when in a placement (clinical) setting than in a student (university) setting. Generally, no support was found for a rater by setting interaction. The study suggests that trainee clinical psychologists are generally successful at identifying professional norms, although they do not always act in accordance with these. Conflicting student and professional norms may result in trainees viewing some potentially unprofessional behaviour as less severe than qualified staff. Health professional educators should be aware of this fact and take steps to shape trainee norms to be consistent with that of the professional group.

How to ensure e-portfolios are a valuable resource to students' learning.

Online technology has become an increasingly important part of all types of education, including that of student nurses. This article outlines some factors that need to be considered when introducing e-portfolios into nurse education and looks at issues such as ease of use, ownership, privacy, supervision and assessment.