RESUMO
PURPOSE: Learner handover is the sharing of learner-related information between supervisors involved in their education. The practice allows learners to build upon previous assessments and can support the growth-oriented focus of competency-based medical education. However, learner handover also carries the risk of biasing future assessments and breaching learner confidentiality. Little is known about learner handover's educational impact, and what is known is largely informed by faculty and institutional perspectives. The purpose of this study was to explore learner handover from the learner perspective. METHOD: Constructivist grounded theory was used to explore learners' perspectives and beliefs around learner handover. Twenty-nine semistructured interviews were completed with medical students and residents from the University of Ottawa and University of California, San Francisco. Interviews took place between April and December 2020. Using the constant comparative approach, themes were identified through an iterative process. RESULTS: Learners were generally unaware of specific learner handover practices, although most recognized circumstances where both formal and informal handovers may occur. Learners appreciated the potential for learner handover to tailor education, guide entrustment and supervision decisions, and support patient safety, but worried about its potential to bias future assessments and breach confidentiality. Furthermore, learners were concerned that information-sharing may be more akin to gossip rather than focused on their educational needs and feared unfair scrutiny and irreversible long-term career consequences from one shared mediocre performance. Altogether, these concerns fueled an overwhelming pressure to perform. CONCLUSIONS: While learners recognized the rationale for learner handover, they feared the possible inadvertent short- and long-term impact on their training and future careers. Designing policies that support transparency and build awareness around learner handover may mitigate unintended consequences that can threaten learning and the learner-supervisor relationship, ensuring learner handover benefits the learner as intended.
Assuntos
Internato e Residência , Transferência da Responsabilidade pelo Paciente , Humanos , Aprendizagem , Comunicação , Disseminação de InformaçãoRESUMO
BACKGROUND: Local grants programs are important since funding for medical education research is limited. Understanding which factors predict successful outcomes is highly relevant to administrators. The purpose of this project was to identify factors that contribute to the publication of local medical education grants in a Canadian context. METHODS: Surveys were distributed to previous Department of Innovation in Medical Education (DIME) and Department of Medicine (DOM) grant recipients (n = 115) to gather information pertaining to PI demographics and research outcomes. A backward logistic regression was used to determine the effects several variables on publication success. RESULTS: The overall publication rate was 64/115 (56%). Due to missing data, 91 grants were included in the logistic regression. Variables associated with a higher rate of publication; cross departmental compared to single department OR = 2.82 (p = 0.04), being presented OR = 3.30 (p = 0.01), and multiple grant acquisition OR = 3.85 (p = 0.005). CONCLUSION: Although preliminary, our data suggest that increasing research publications from local grants may be facilitated by pooling funds across departments, making research presentations mandatory, and allowing successful researchers to re-apply.
OBJECTIF: Les programmes de subventions locales sont importants car le financement de la recherche en éducation médicale est limité. Il est très important pour les administrateurs de comprendre quels sont les facteurs de réussite. Le but de ce projet était d'identifier les facteurs qui, dans le contexte canadien, contribuent à la publication d'articles à l'aide de subventions locales pour l'éducation médicale. MÉTHODES: Un sondage a été réalisé auprès des anciens récipidendaires de subventions du Department of Innovation in Medical Education (DIME) et du Department of Medicine (DOM) (n=115) afin de recueillir des informations relatives à la démographie des chercheurs principaux et aux résultats de la recherche. Une régression logistique descendante a été utilisée pour déterminer les effets de plusieurs variables sur le succès des publications. RÉSULTATS: Le taux de publication global était de 64/115 (56 %). En raison de données manquantes, 91 subventions ont été incluses dans la régression logistique. Variables associées à un taux de publication plus élevé; OR inter-départements comparé à un seul département = 2,82 (p = 0,04), soumis OR = 3,30 (p = 0,01) et OR l''obtention de plusieurs subventions = 3,85 (p = 0,005). CONCLUSION: Bien que préliminaires, nos données suggèrent que la publication de recherches à l'aide de subventions locales pourrait être facilitée en regroupant les fonds des divers départements, en rendant la présentation de recherches obligatoire et en permettant aux chercheurs dont l'article a été retenu de faire une nouvelle soumission.
RESUMO
PURPOSE: Learner handover is the sharing of information about learners between faculty supervisors. Learner handover can support longitudinal assessment in rotation-based systems, but there are concerns that the practice could bias future assessments or stigmatize struggling learners. Because successful implementation relies on an understanding of existing practices and beliefs, the purpose of this study was to explore how faculty perceive and enact learner handover in the workplace. METHOD: Using constructivist grounded theory, 23 semistructured interviews were conducted with faculty from 2 Canadian universities between August and December 2018. Participants were asked to describe their learner handover practices, including learner handover delivered or received about resident and student trainees either within or between clinical rotations. The authors probed to understand why faculty used learner handover and their perceptions of its benefits and risks. RESULTS: Learner handover occurs both formally and informally and serves multiple purposes for learners and faculty. While participants reported that learner handover was motivated by both learner benefit and patient safety, they primarily described motivations focused on their own needs. Learner handover was used to improve faculty efficiency by focusing teaching and feedback and was perceived as a "self-defense mechanism" when faculty were uncertain about a learner's competence and trustworthiness. Informal learner handover also served social or therapeutic purposes when faculty used these conversations to gossip, vent, or manage insecurities about their assessment of learner performance. Because of its multiple, sometimes unsanctioned purposes, participants recommended being reflective about motivations behind learner handover conversations. CONCLUSIONS: Learners are not the only potential beneficiaries of learner handover; faculty use learner handover to lessen insecurities surrounding entrustment and assessment of learners and to openly share their frustrations. The latter created tensions for faculty needing to share stresses but wanting to act professionally. Formal education policies regarding learner handover should consider faculty perspectives.