Establishing new medical schools in diverse contexts: A novel conceptual framework for success.

BACKGROUND: Establishing a new medical school is a significant venture involving many complex political, social, economic, educational, and organisational considerations. The published literature on the process of establishing a new medical school is, however, under-developed with minimal empirical research and no explicit reference to theory. This research sought to address these gaps and establish an empirical and theoretical evidence-base for the process of new medical school establishment in diverse contexts, particularly medically under-served areas. METHODS: A Critical Realist Multiple Case Study was undertaken to examine the establishment of new medical schools across three continents. Data were collected between 2016 and 2018 through observational data gathered on site visits to three medical schools in medically under-served areas, relevant documents/audio-visual materials, and semi-structured interviews with key founding personnel. Data were analysed using the Critical Realist approach. Institutional Entrepreneurship theory was applied, adapted, and extended to explore and explain the phenomenon of new medical school establishment in diverse contexts. RESULTS: This study identifies eight critical success factors underpinning new medical school establishment. Framed as the Eight C's Framework (8CF), these factors include Context (field conditions), Catalysts (institutional entrepreneurs), Conducing (helping to bring about a particular situation or outcome), Collecting (resources), Connecting (relationships), Convincing (rationales), Challenges, and Consequences (outcomes). 8CF highlights that new medical schools are successfully established when Catalysts act within their Contexts to undertake the tasks of Conducing, Convincing, Collecting, and Connecting in order to produce desired Consequences and overcome Challenges. CONCLUSIONS: The Eight C's Framework is a theory-based, empirically supported framework that can be applied across different contexts to strategically guide the successful establishment of new medical schools. Founding leaders and stakeholders could use 8CF to ensure their establishment efforts are underpinned by theory and scholarship.

Social media for learning: A qualitative exploration of the factors that impact clinical learners' attitudes and intentions.

BACKGROUND: Social media has created a revolution in learning and teaching. This study set out to provide a theory-informed exploration of the factors influencing medical students' perspectives of learning with social media using the theory of planned behaviour (TPB) as a framework. METHODS: The study collected data using semi-structured interviews from seven third year medical students at an undergraduate Australian medical school, who were in their first clinical year. The data were analysed inductively and deductively using TPB. RESULTS: Three themes emerged relating to the factors that influence medical students' attitudes and intentions regarding using social media for learning: (1) Social media aligns with the needs and preferences of the contemporary learner; (2) rise of medical professionals on social media during the COVID-19 pandemic; and (3) being an informed user of social media for learning. Participants had largely positive views and attitudes towards social media as a learning tool especially for preclinical content due to its capacity for multimodal information delivery and evolving social norms. However, this positivity was tempered by the challenges they faced in determining quality of resources, linking their learning to clinical medicine and accessing specialist content. CONCLUSION: Social media can play a significant role in medical students' learning. However, its potential as an educational tool can be enhanced by widening access to resources, and implementing strategies that help students increase their evaluative judgement skills to make informed decisions regarding the quality of social media resources and to translate their social media-mediated learning into clinical practice.

The hidden curriculum of peer teaching in developing a professional identity: Perspectives of medical students and junior doctors.

INTRODUCTION: Peer teaching has been utilised in the field of medical education to support learning of the curriculum in both pre-clinical and clinical contexts. The literature has shown that there is a hidden curriculum unique to peer teaching, but little is known about this from the peer learner perspective. This study explored the hidden curriculum of peer teaching and from the perspective of medical students and junior doctors. METHODS: Data was collected via one-on-one interviews with 10 participants including junior doctors and medical students (n = 10). The interviews were transcribed, and thematic analysis was used to interpret the data. RESULTS: Five themes were identified in relation to the hidden curriculum of peer teaching-specifically, learning how to be a professional; be a better learner; to care for self and others; to navigate career pathways; and to become a future teacher. CONCLUSION: Peer teaching is a powerful resource for professional identity development in medicine and can be better leveraged to deliver on this potential.

Exploring the learning environment afforded by an Aboriginal Community Controlled Health service in a rural longitudinal integrated clerkship.

OBJECTIVES: Despite the extensive literature regarding longitudinal integrated clerkships (LICs), there is very little evidence about this model in non-traditional settings, such as Aboriginal Community Controlled Health Organisations (ACCHOs). This study explored the key elements of the learning experience in a rural LIC programme, within an ACCHO from the perspective of multiple stakeholders including medical students, the general practice supervisory team, Aboriginal health workers (AHWs) and cultural mentors. METHODS: The study was conducted using a qualitative case-study design. Participants included Year 3 medical students and the health care team (general practitioners, practice nurse, AHWs, and a practice manager in the role of cultural mentor) from an ACCHO in regional Queensland. Data was collected through semi-structured interviews and analysed using inductive thematic analysis. RESULTS: Three key features were identified within the learning experience of students undertaking an LIC in the ACCHO setting. This study showed it was a safe context for learners to learn about 'culturally safe practice', 'putting relationships at the centre', and to 'try new things', reinforcing ACCHO as an invaluable site for learning. CONCLUSION: The extended clinical placement in an ACCHO setting afforded an increase in the number of opportunities to develop students' cultural safety, communication skills and relationships with patients and the supervisory team, including AHWs and cultural mentors.

'Everyone's nice, but ': A qualitative exploration of trainees' experiences of postgraduate geriatric medicine training in Australia.

OBJECTIVE: To understand the experiences of trainees who undertake geriatric medicine advanced training in Australia. METHODS: In this qualitative study, data were collected through semi-structured interviews with geriatric medicine advanced trainees. Data were analysed using a thematic analysis approach and data collection ceased when thematic saturation was achieved. RESULTS: Thirteen trainees participated. Trainees enjoyed the training program, supported each other and felt prepared for independent practice as a geriatrician. However, they noted the variability of supervision and feedback practices, and educational opportunities afforded to them across different clinical learning environments. They felt unable to give feedback on their training. The research project and concerns about employment after training were also substantial sources of stress. CONCLUSIONS: While geriatric medicine advanced trainees reported positively on much of their training, areas for improvement could include improved training for supervisors, improved support for research projects and more robust mechanisms for providing feedback.

How pharmacy and medicine students experience the power differential between professions: "Even if the pharmacist knows better, the doctor's decision goes".

Interprofessional Education (IPE) is one approach to improving communication and collaborative practice between professions, which are essential for the optimal delivery of healthcare. Common barriers include negative attitudes, professional stereotypes, professional cultures and power differentials between professional groups. The aim of this qualitative study was to explore how professional hierarchies and power differentials shape interprofessional interactions between preregistration pharmacy and medicine students. Data were gathered via semi-structured interviews and subject to thematic analysis. Four main themes were identified: Reproducing traditional hierarchies; Social norms around respect; Hierarchies in care values and goals; and Challenging the narrative is possible. Students' interactions with and views of the other profession largely reflected traditional stereotypes and power differentials. Hierarchy was evident in how respect was accorded and in how care values and goals were managed. Despite this, students overwhelmingly perceived and reported a sense of agency in changing the status quo. Emerging professional identity and conceptualisation of future roles is heavily influenced by the hierarchical relationship between the professions and can pose a significant barrier to collaborative practice. Greater support for collaborative interprofessional practice is needed at the level of policy and accreditation in health education and healthcare to ensure greater commitment to change.

Informal faculty development in health professions education: Identifying opportunities in everyday practice.

INTRODUCTION: Faculty development (FD) supports health professions educators to develop knowledge, skills, and expertise. Whilst formal FD is a focus in the health professions education (HPE) literature, little is known about how FD occurs informally. We sought to identify opportunities and constraints for informal FD amongst health professions educators in the academic (university) setting and understand how they engage with these opportunities. METHODS: This exploratory study was conducted in one Australian university. Interviews and focus groups were conducted with undergraduate and postgraduate teachers and assessors (teachers) (n = 10); teaching team and program leaders (mid-level leaders) (n = 8); and senior (university-level) leaders (n = 2). We analysed data thematically and applied situated cognition theory. RESULTS: We identified three everyday educational practices that provide opportunities for informal FD in the academic setting: (1) applying evidence to; (2) evaluating; and (3) sharing, educational practice. Engaging with these opportunities was shaped by individuals' motivation and proactivity to engage in professional learning (effectivities) and organisational culture and structures (constraints). CONCLUSION: Applying evidence to, evaluating, and sharing educational practice provide valuable contexts for ongoing learning in the academic setting. Assisting educators and organisations to recognise and leverage these 'in situ' FD opportunities is vital in fostering a continuous learning culture.

Clinical supervisors' perspectives of factors influencing clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement: A qualitative study.

BACKGROUND: Undergraduate nursing students from culturally and linguistically diverse backgrounds experience unique challenges with their learning needs during clinical placements. There is limited research on clinical supervisors' perspectives of the factors impacting clinical learning experience of nursing students from culturally and linguistically diverse backgrounds during placement. OBJECTIVES: This study sought to identify clinical supervisors' perspectives of the factors impacting on the clinical learning experience of nursing students from culturally and linguistically diverse backgrounds and strategies to overcome challenges. DESIGN: A qualitative research design using semi-structured interviews. METHODS: Nine nurses who had experience supervising culturally and linguistically diverse nursing students were interviewed as part of data collection. Thematic analysis was used for data interpretation. RESULTS: Identified factors include: Poor proficiency in English language, unfamiliarity with Australian slang and medical terminologies, cultural expectations interfering with professional responsibilities, incongruity with teaching delivery and learning style, short duration of placement, inconsistency with preceptor allocation and inadequate preceptor training. CONCLUSION: Recommendations to facilitate the learning of nursing students from culturally and linguistically diverse (CALD) backgrounds on clinical placement include flexibility with assessments, modifying teaching styles according to learning needs, providing appropriate orientation, creating a welcoming environment, providing consistency with allocation of preceptors, and providing appropriate training for preceptors. Inconsistency in preceptor allocation was reported to have a negative influence on CALD student learning. A collaborative approach between Universities and the health care settings is essential in assisting clinical supervisors to address the unique learning needs of nursing students from culturally and linguistically diverse backgrounds while on clinical placement.

Importance of research higher degree training availability in rural and remote regions.

AIMS: This commentary contends that research by higher degree research training is a sustainable strategy for capacity building the rural and remote health research workforce, provided they have equitable opportunity for access, participation and attainment. CONTEXT: The path for health professionals into academic roles, particularly in rural and remote areas, can be fraught. A strong research skill set might not form a significant component of a clinician's prior experience. Concurrently, university academic positions usually include the PhD as an essential qualification which is misaligned with the experience and skills of rural and remote applicants who are otherwise well-qualified. APPROACH: Higher degree researches are one mechanism for extending the research expertise and capabilities. However, non-traditional and remotely located cohorts such as the rural and remote health research workforce can face barriers to accessing, participating in and successfully completing formal research training. Barriers include the prevalence of the apprenticeship model of research training grounded in assumptions of colocation and face-to-face learning and supervision and a focus on the binary relationship between supervisors and students. In this commentary, the authors call for greater flexibility and equity in the higher degree research training system to cater for health professionals located in rural and remote practice contexts. CONCLUSION: Institutional investment in, and commitment to, a truly distributed higher degree research model would ensure a stronger rural and remote workforce who can aspire to a range of career options and thereby positively impacting on the health and research outcomes for rural and remote Australia.

Health Professions Educators' System-Oriented Roles as Educational Advocate, Quality Improver, and Broker.

INTRODUCTION: Health professionals have many facets to their educational role. Although the teaching and student support dimensions of health professionals' educational role are highly visible in the literature, other nontraditional elements are not. This study presents a broader conceptualization of health professionals' educational role, with a focus on the strategic dimensions of their role. METHODS: Participants were health professionals from different clinical backgrounds and teaching settings, with a formal role in education. Data were collected using a survey (n = 41) and interviews (n = 9), and this article focuses on reporting the qualitative findings of this study. Thematic analysis was used for data interpretation. RESULTS: Health professionals have three strategic dimensions to their educational role. The first strategic dimension is educational advocacy, which is aimed at championing education at different levels and parts of the educational system and building educational capacity. The second strategic dimension is educational quality improvement which is focused on shifting narratives around education and educational change in health service settings and leveraging educational evidence. The final strategic dimension is educational brokerage which is oriented at connecting clinical and educational communities and building trust and consensus. DISCUSSION: Beyond the microlevel of learning and teaching, health professionals engage in strategic work that is focused on the broader educational mission within health. Continuing professional development initiatives can empower health professionals to optimize these strategic and system-focused educational roles and responsibilities.

Education Needs of Australian Flight Nurses: A Qualitative Study.

OBJECTIVE: Flight nurses work in physically challenging environments, often alone, in the confines of moving aircraft at altitudes with limited resources. Although this challenging environment has been previously described, there are no Australian studies that outline flight nurses' learning needs and the education activities they find useful in learning about their role. METHODS: This was a qualitative exploratory study using one-on-one interviews with 8 currently practicing flight nurses from 1 air medical retrieval organization. Data were analyzed thematically. RESULTS: Four key themes emerged: flight nurses need to learn how to work autonomously in a resource-constrained air medical environment, flight nurses need to learn how to develop physical and mental resilience to work in the air medical environment, flight nurses need to learn nontechnical skills such as flexibility and adaptability, and flight nurses learn how to perform in their role through formal and informal learning strategies. CONCLUSION: Existing clinical knowledge aids decision making as a sole practitioner in the resource-limited air medical environment. Previously unreported nontechnical skills of mental resilience, adaptability, and flexibility were highlighted. Flight nurses learn how to prepare for their role through simulation, case reviews, in situ observation through buddy flights, and a range of socially situated learning activities.

Sonography education in the clinical setting: The educator and trainee perspective.

INTRODUCTION: Sonography is a complex clinical skill. However, in spite of its complexity, little has been published about how these skills are taught in Australia or internationally. This paper explores Australian sonographer educators' and trainees' perceptions regarding the teaching of sonography skills, with a specific focus on the procedural dimension of the process. A secondary aim is the identification of the Australian sonographer educator workforce and teaching settings. METHODS: Data were collected from trainee and educator sonographers via an online survey and semi-structured interviews, following ethics approval and informed consent. All data was anonymous or de-identified. Descriptive statistics were generated for quantitative data and qualitative data were analysed using thematic analysis. RESULTS: The online survey of 72 full responses found that a majority of Australian sonography education occurs in general sonography private practice (52%), with most practices employing up to three trainee sonographers concurrently (78%). Forty-nine per cent of sonographers self-identified as primary clinical supervisors, with the majority (58%) of these holding no teaching qualifications. Fifty per cent of participants reported using a five-step method of teaching the procedural dimension of the process. Qualitative findings revealed four themes related to sonography skills teaching including importance of repeated observation and practice, identification of the teaching model, providing opportunity for feedback and having flexibility to adapt the skill teaching model when applicable. CONCLUSION: This exploratory mixed-methods study highlights the educator and trainee perspectives of sonography skills teaching. Based on these findings, the authors propose that sonography skills teaching maximise the opportunities for trainees to engage in observation, hands-on learning and obtain constructive feedback. It is also suggested that sonography practices support educators to extend their education skills to ensure high-quality clinical teaching.

The clinical educator and complexity: a review.

BACKGROUND: Complexity science perspectives have helped in examining fundamental assumptions about learning and teaching in the health professions. The implications of complexity thinking for how we understand the role and development of the clinical educator is less well articulated. This review article outlines: the key principles of complexity science; a conceptual model that situates the clinical educator in a complex system; and the implications for the individual, organisation and the system. KEY FINDINGS: Our conceptual model situates the clinical educator at the centre of a complex and dynamic system spanning four domains and multiple levels. The four domains are: personal (encompassing personal/professional needs and expectations); health services (health agencies and their consumers); educational (educational institutions and their health students); and societal (local community/region and government). The system also comprises: micro or individual, meso or organisational, and macro or socio-political levels. CONCLUSION: Our model highlights that clinical educators are situated within a complex system comprising different agents and connections. It emphasises that individuals, teams and organisations need to recognise and be responsive to the unpredictability, interconnectedness and evolving nature of this system. Importantly, our article also calls for an epistemological shift from faculty development to capacity building in health professions education, aimed at developing individual, team, organisational and system capabilities to work with(in) complexity. Clinical educators are situated within a complex system comprising different agents and connections.

What does learning together mean for pharmacy and medicine students: is it really about from and with?

This article was migrated. The article was marked as recommended. Healthcare students from different professional backgrounds are often brought together under the banner of Interprofessional Education (IPE) in an effort to improve collaborative practice. Despite the demonstrated positive impact of IPE on students' knowledge, skills and attitudes, it is not clear what students think about learning with students from another health profession. The aim of this study was to explore pharmacy and medicine students' views and experiences of learning together. Participants were Year 3 Pharmacy and Year 4 Medicine students, with qualitative data gathered via a written reflection. Three main themes were identified. Students were accepting of learning with the other professional group. Learning about was evident, particularly in relation to each other's roles and contributions to patient care. Learning from another professional group was the most problematic as students tended to view and treat knowledge as a commodity to be acquired from another rather than something that could be jointly developed. While medicine and pharmacy students' valued learning with and about each other, they were less likely to engage in co-constructing and sharing new meanings and thus learn from one another. To provide a basis for meaningful collaborative practice, IPE needs to challenge students' fundamental assumptions, beliefs and values about learning with, from and about other professions.

Learning on the fly: How rural junior doctors learn during consultations with retrieval physicians.

OBJECTIVE: This study explores how rural junior doctors learn while consulting retrieval physicians about critically ill and injured patients, as well as the tensions characterising teaching and learning in this setting. METHODS: Data were collected via three focus groups, involving rural junior doctors (n = 8), rural senior doctors (n = 3) and retrievalists (n = 3). The discussions were transcribed and subject to multistage coding. RESULTS: Rural junior doctors believe they learn from interactions with retrieval physicians. Their learning was greatest when the retrieval physician explained his or her clinical reasoning and provided feedback. The level of stress was sometimes overwhelming and learning ceased. Both groups described limited time for teaching due to the medical needs of the patient and the needs of concurrent patients. Retrieval physicians were not certain that rural junior doctors wanted to learn. Rural junior doctors hold retrievalists in very high regard. CONCLUSION: Support provided by retrievalists extends the abilities of the junior doctors and often results in learning. When junior doctors are extended too far, they become overwhelmed and learning ceases. Junior doctors would like the retrievalists to spend more time explaining their actions and providing feedback. Even when both retrievalists and junior doctors are interested in teaching, it may not occur due to misunderstandings and differences in status.

A qualitative exploration of anesthesia trainees' experiences during transition to a children's hospital.

BACKGROUND: The stresses of starting a new job can make anyone feel tired and inefficient. In health care, this may impair the ability to learn at a time when there is most to learn, and increase the risk of error in a context where errors may lead to patient harm. AIM: The aim of this study was to understand issues which influence anesthesia trainees' transition to a pediatric setting. METHODS: This qualitative study utilized in-depth semi-structured interviews to gather data from 31 anesthesia trainees who had commenced work at a tertiary children's hospital between 4 and 6 weeks previously. Data were examined using thematic analysis. RESULTS: Two key themes were identified: feeling ineffective, which appeared to have both a cognitive component (feeling disoriented) and an emotional component (feeling useless), and feeling anxious or afraid. Trainees found the pediatric environment highly unfamiliar, which made them feel disoriented, inefficient, and at times incompetent. Many experienced difficulty identifying a useful role in a highly specialized area of practice, leading to loss of identity as an expert clinician. Many described an ever-present fear of making an anesthetic error or being unable to manage a rapidly evolving clinical situation. Some trainees developed a negative mindset, which was reinforced by subsequent perceived failures. Overall, these experiences impeded trainees' ability to concentrate and learn. CONCLUSIONS: The impact of disorientation and anxiety on anesthesia trainees as they adapt to a highly specialized clinical environment such as a children's hospital should not be underestimated. Study findings illustrate the importance of helping new trainees to feel less afraid, more useful, and more realistic in assessing their own performance during the transition period.

Factors shaping how clinical educators use their educational knowledge and skills in the clinical workplace: a qualitative study.

BACKGROUND: In order to consolidate their educational knowledge and skills and develop their educational role, many clinicians undertake professional development in clinical education and supervision. It is well established that these educationally-focussed professional development activities have a positive impact. However, it is less clear what factors within the clinical workplace can shape how health professionals may use and apply their educational knowledge and skills and undertake their educational role. Looking through the lens of workplace affordances, this paper draws attention to the contextual, personal and interactional factors that impact on how clinical educators integrate their educational knowledge and skills into the practice setting, and undertake their educational role. METHODS: Data were gathered via a survey of 387 clinical educators and semi-structured interviews with 12 clinical educators and 6 workplace managers. In this paper, we focus on analysing and reporting the qualitative data gathered in this study. This qualitative data were subject to a thematic analysis and guided by theoretical constructs related to workplace affordances. RESULTS: Three key themes were identified including contextual, personal and interactional factors. Contextual elements referred to organisational structures and systems that impact on participants' educational role, how participants' clinical education role was articulated and configured within the organisation, and how the organisation shaped the educational opportunities available to clinicians. Personal factors encompassed clinicians' personal motivations and goals to teach and be involved in education, develop their own educational skills and function as a role model for students. Interactional factors referred to the professional interactions and networks through which clinicians shared their educational knowledge and skills and further consolidated their profile as educational advocates in their workplace. CONCLUSIONS: There are a number of contextual, personal and interactional factors which interrelate in complex ways and impact on how clinical educators use their educational knowledge and skills and undertake their educational role in the clinical setting. To fully realise the potential of and fulfil the requirements of their educational role, clinical educators need to be provided appropriate experiential and meaningful workplace opportunities and the guidance to use, share and reflect on their educational knowledge and skills in the clinical workplace.

Rural and remote young people's health career decision making within a health workforce development program: a qualitative exploration.

INTRODUCTION: One strategy aimed at resolving ongoing health workforce shortages in rural and remote settings has been to implement workforce development initiatives involving the early activation and development of health career aspirations and intentions among young people in these settings. This strategy aligns with the considerable evidence showing that rural background is a strong predictor of rural practice intentions and preferences. The Broken Hill Regional Health Career Academy Program (BHRHCAP) is an initiative aimed at addressing local health workforce challenges by helping young people in the region develop and further their health career aspirations and goals. This article reports the factors impacting on rural and remote youths' health career decision-making within the context of a health workforce development program. METHODS: Data were collected using interviews and focus groups with a range of stakeholders involved in the BHRHCAP including local secondary school students, secondary school teachers, career advisors, school principals, parents, and pre-graduate health students undertaking a clinical placement in Broken Hill, and local clinicians. Data interpretation was informed by the theoretical constructs articulated within socio cognitive career theory. RESULTS: Young people's career decision-making in the context of a local health workforce development program was influenced by a range of personal, contextual and experiential factors. These included personal factors related to young people's career goals and motivations and their confidence to engage in career decision-making, contextual factors related to BHRHCAP program design and structure as well as the visibility and accessibility of health career pathways in a rural setting, and experiential factors related to the interaction and engagement between young people and role models or influential others in the health and education sectors. CONCLUSIONS: This study provided theoretical insight into the broader range of interrelating and complex personal, contextual and experiential factors impacting on rural and remote youths' career decision-making within a health workforce development initiative.