Designing feedback processes in the workplace-based learning of undergraduate health professions education: a scoping review.

BACKGROUND: Feedback processes are crucial for learning, guiding improvement, and enhancing performance. In workplace-based learning settings, diverse teaching and assessment activities are advocated to be designed and implemented, generating feedback that students use, with proper guidance, to close the gap between current and desired performance levels. Since productive feedback processes rely on observed information regarding a student's performance, it is imperative to establish structured feedback activities within undergraduate workplace-based learning settings. However, these settings are characterized by their unpredictable nature, which can either promote learning or present challenges in offering structured learning opportunities for students. This scoping review maps literature on how feedback processes are organised in undergraduate clinical workplace-based learning settings, providing insight into the design and use of feedback. METHODS: A scoping review was conducted. Studies were identified from seven databases and ten relevant journals in medical education. The screening process was performed independently in duplicate with the support of the StArt program. Data were organized in a data chart and analyzed using thematic analysis. The feedback loop with a sociocultural perspective was used as a theoretical framework. RESULTS: The search yielded 4,877 papers, and 61 were included in the review. Two themes were identified in the qualitative analysis: (1) The organization of the feedback processes in workplace-based learning settings, and (2) Sociocultural factors influencing the organization of feedback processes. The literature describes multiple teaching and assessment activities that generate feedback information. Most papers described experiences and perceptions of diverse teaching and assessment feedback activities. Few studies described how feedback processes improve performance. Sociocultural factors such as establishing a feedback culture, enabling stable and trustworthy relationships, and enhancing student feedback agency are crucial for productive feedback processes. CONCLUSIONS: This review identified concrete ideas regarding how feedback could be organized within the clinical workplace to promote feedback processes. The feedback encounter should be organized to allow follow-up of the feedback, i.e., working on required learning and performance goals at the next occasion. The educational programs should design feedback processes by appropriately planning subsequent tasks and activities. More insight is needed in designing a full-loop feedback process, in which specific attention is needed in effective feedforward practices.

"Everyone who wants to can practice on me"- a qualitative study of patients' view on health profession students' learning in an interprofessional clinical placement.

INTRODUCTION: Healthcare services face significant challenges due to the aging population, increasing complexity of health issues, and a global shortage of health professionals. Health professions education needs to adapt and develop with healthcare services' needs. Interprofessional education and patient partnership are two trends that are increasingly being reinforced. Health professions students worldwide are expected to acquire competencies in interprofessional collaboration through undergraduate and postgraduate studies. Developing interprofessional collaborative skills in clinical placements is crucial. This study aims to explore two patients' meetings with an interprofessional student team and better understand how the patient can participate actively in the students´ learning processes. METHODS: This is a small single-case study. Two patients participated. Data was generated through participant observation and qualitative interviews. A practical iterative framework for qualitative data analysis inspired the analysis. RESULTS: The patients observed and reflected on the interprofessional students' learning process and felt responsible for contributing to their learning. The patients contributed to students' learning by making themselves available for practicing and sometimes giving feedback. They considered it a win-win situation to be involved in the interprofessional learning activity as they perceived being taken seriously by the students when addressing their problems and experienced positive outcomes for their situation, such as better physical functioning and adjustments to assistive devices. Patients emphasized the importance of learning collaboration between health professionals and how this could contribute to them feeling safer as patients. DISCUSSION: This study highlights the importance of including patients in interprofessional students' learning processes. Patients' active participation in interprofessional clinical placements can empower them, improve their self-efficacy, and potentially shift the power dynamic between patients and healthcare professionals. The study emphasizes the importance of the patient perspective in future research on interprofessional education in clinical settings. The study also highlights the need for clinical supervisors to facilitate patient involvement in interprofessional clinical placements and reinforce patients' feedback for the student team. CONCLUDING COMMENTS: Overall, this study contributes to the growing body of research on interprofessional education and patient partnership and emphasizes the importance of including patients in health professions education.

Taxonomy of teaching methods and their use in health professions education: a scoping review protocol.

INTRODUCTION: Applying the lens of social constructivist theory, teaching methods facilitate the process of learning and may be used differently across settings to align learning goals. Teaching methods are used across disciplines, occupations and learning settings, yet terminology, descriptions and application for use vary widely. This scoping review will identify eligible literature of reported teaching methods with documented descriptions across disciplines with a focus of how teaching methods are applied to health professions education. A literary description of a teaching method was used as a basis from which to select eligible articles based on two criteria, a specified method and delivery of that teaching by a teacher figure. METHODS AND ANALYSIS: Using the extension of the Joanna Briggs Institute methodology aligned to Arksey and O'Malley's six-stage framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, this scoping review will systematically search ERIC, Embase, Web of Science and PubMed databases. The search strategy was supported by an information specialist. Eligible studies will be identified in a two-stage screening process with four researchers. To complement eligible peer-reviewed literature, we will also search out relevant grey literature including University Websites, Conference Programmes and handsearched reference lists. Data extraction will be performed using a developed data extraction tool. A narrative summary will accompany charted results and describe the results aligned to the study objectives. ETHICS AND DISSEMINATION: As no intervention or patient recruitment is required for this research, ethics board approval is not required. Results will be disseminated via publication in a peer-reviewed journal, conference presentations and where feasible reaching out to those organisations and universities with published glossaries of terms for teaching.

Demonstrating causality, bestowing honours, and contributing to the arms race: Threats to the sustainability of HPE research.

As the field of health professions education (HPE) continues to evolve, it is necessary to occasionally pause and reflect on the potential effects and outcomes of our research practices. While future-casting does not guarantee that impending negative consequences will be evaded, the exercise can help us avoid pitfalls. In this paper, we reflect on two terms that have taken hold as powerful idols in HPE research that stand above questioning and apart from critique: patient outcomes and productivity. We argue that these terms, and the ways of thinking they uphold, threaten the sustainability of HPE research-one at the level of the community and one at the level of the scholar. First, we suggest that HPE research's history of endorsing a linear and causal association ethos has driven its quest to connect education to patient outcomes. To ensure the sustainability of HPE scholarship, we must deconstruct and disempower patient outcomes as one of HPE's god-terms, as the pinnacle goal of educational activities. To be sustained, HPE research needs to value all of its contributions equally. A second god-term is productivity; it impairs the sustainability of the careers of individual researchers. Problems of honorary authorship, research output expectations, and comparisons with other fields have constructed a space where only scholars with sufficient privilege can prevail. If productivity persists as a god-term, the field of HPE research could decay into a space where new scholars are silenced-not because they fail to make important contributions, but because access is restricted by existing research metrics. These are two of many god-terms threatening the sustainability of HPE research. By highlighting patient outcomes and productivity and by acknowledging our own participation in propagating them, we hope to encourage others to recognize how our collective choices threaten the sustainability of our field.

The rapid growth and expansion of Master of health professions education (MHPE) programs: A mixed-methods study of international curricular trends and guidelines for programs.

PURPOSE: This study explores international trends and standards of Master's degree programs through a comprehensive environmental scan and focus group interviews to understand curricular structure, content, program director expectations, educational context, and future directions. METHOD: Authors conducted a two-phase mixed-methods sequential explanatory design to conduct the environmental scan (phase 1), and subsequently conducting focus groups (phase 2) with program directors. A population list of Master's programs was used to generate a sampling frame, considering the geographic region (continent) and institution type (university, organization, public institution). Qualitative data were coded to analyze the breadth and depth of courses. Three one-hour virtual focus group interviews were conducted with ten program directors. RESULTS: The population list of 159 Masters programs worldwide was used to create a sample for analysis in the environmental scan (n = 46 Masters programs), representing programs from North America, Europe, Australia, and South Africa. Most programs (39%) delivered their courses online, with 20% exclusively offering an in-person program. Focus group participants indicated expectations of graduates, context in which they learn, as well as future directions for improving health professions education graduate programs. CONCLUSION: Program directors should consider programmatic aims, localized needs, and quality/standard of the program in designing Masters programs, with individualized growth opportunities for learners.

Learning technology in health professions education: Realising an (un)imagined future.

CONTEXT: Technology is being introduced, used and studied in almost all areas of health professions education (HPE), often with a claim of making HPE better in one way or another. However, it remains unclear if technology has driven real change in HPE. In this article, we seek to develop an understanding of the transformative capacity of learning technology in HPE. METHODS AND OUTCOMES: We first consider the wider scholarship highlighting the intersection between technology and pedagogy, articulating what is meant by transformation and the role of learning technology in driving educational transformation. We then undertake a synthesis of the current high visibility HPE-focused research. We sampled the literature in two ways-for the five highest impact factor health professional education journals over the past decade and for all PubMed indexed journals for the last 3 years-and categorised the extant research against the Substitution, Augmentation, Modification, Redefinition model. We found that the majority of research we sampled focussed on substituting or augmenting learning through technology, with relatively few studies using technology to modify or redefine what HPE is through the use of technology. Of more concern was the lack of theoretical justification for pedagogical improvement, including transformation, underpinning the majority of studies. CONCLUSIONS: While all kinds of technology use in learning have their place, the next step for HPE is the robust use of technology aiming to lead transformation. This should be guided by transformational educational theory and aligned with pedagogical context. We challenge HPE practitioners and scholars to work thoughtfully and with intent to enable transformation in education for future health professionals.

Researching models of innovation and adoption in health professions education.

BACKGROUND: Despite the constant presence of change and innovation in health professions education (HPE), there has been relatively little theoretical modelling of such change, the experiences of change, the ideology associated with change or the unexpected consequences of change. In this paper, the authors explore theoretical approaches to the adoption of innovations in HPE as a way of mapping a broader theoretical landscape of change. METHOD: The authors, HPE researchers with an interest in technology adoption and systemic change, present a narrative review of the literature based on a series of thought experiments regarding how communities and individuals respond to the introduction of new ideas or methods. This research investigates the stages of innovation adoption, from the emergence and hype around new ideas to the concrete experiences of early adopters. RESULTS: When an innovation first emerges, there is often little concrete information available to inform potential adopters, leaving it susceptible to hype, both positive and negative. This can be described using the Gartner Hype Cycle model, albeit with important caveats. Once the adoption of an innovation gets underway, early adopter user experiences can inform those that follow. This can be described using Rogers' diffusion of innovation model, again with caveats. Notably, neither model goes beyond the point of single point-in-time, yes/no, individual adoption. Other approaches, such as learning curve theory, are needed to track uptake and maintenance by individuals over time. SIGNIFICANCE: This expanded theoretical base, while still somewhat instrumentalist, combined with complementary theoretical perspectives can afford opportunities to better explore reasons for variance, volunteerism and resistance to change. In summary, change is complicated and nuanced, and better models and theories are needed to understand and work meaningfully with change in HPE. To that end, the authors seek to encourage richer and more thoughtful research and scholarly thinking about change and a more nuanced approach to the pursuit of change in HPE as a whole.

Exploring differences in and factors influencing self-efficacy for competence in interprofessional collaborative practice among health professions students.

The value of health care delivered via effective interprofessional teams has created an imperative for interprofessional education (IPE) and interprofessional collaborative practice (ICP). To inform IPE strategies, we investigated differences in perceived self-efficacy (SE) for competence in ICP among health professions students. The study data were collected between 2015 and 2019 from students from 13 different health professions programmes (N = 3,497) before an annual institutional interprofessional programme. Students completed the IPECC-SET-27, a validated instrument evaluating perceived SE for competence in ICP, and rated their 1) amount of previous contact with, and 2) perceived understanding of, the role of different health professions. Students in different health professions education programmes were compared using parametric statistics. Regression analyses explored factors influencing SE for competence in ICP. Findings revealed significant differences in perceived SE for competence in ICP between programmes (p < .05). Specifically, health information management/health informatics, dentistry, medicine, and nursing students expressed relatively higher SE, whereas physical therapy and occupational therapy students expressed relatively lower SE. Perceived understanding of the role of health professions (p < .01) and gender (p < .01) contributed significantly to predicting perceived SE for competence in ICP, while the amount of previous contact with other health professions did not (p = .42). The findings highlight the value of designing IPE with consideration of specific learner needs.

Educational game improves systems thinking, socialization, and teamwork among students of 13 health professions programs.

Systems thinking and interprofessional collaborative practice competencies are critical to inculcate in students of health professions programs. The purpose of this study was to evaluate the impact that an interprofessional education (IPE) experience consisting of an educational game, Friday Night at the ER (FNER), and structured debriefing had on students' systems thinking and self-assessed interprofessional socialization and teamwork skills. Systems thinking was evaluated using the Systems Thinking Scale (STS), and interprofessional socialization and teamwork were evaluated using a modified Interprofessional Socialization and Valuing Scale-9 (ISVS-9) and Interprofessional Collaboration Competency Attainment Scale (ICCAS) question #21. This single-center study targeted students in 13 health professions programs. In the cohort (N of 626), Systems thinking increased significantly. Interprofessional socialization increased significantly, with a large effect size, and 485 (78%) students indicated their interprofessional collaborative practice competencies improved. Program evaluation data revealed students highly valued the experience and would recommend it to their peers. Based on our findings, an IPE experience consisting of FNER gameplay and structured debriefing can improve systems thinking and interprofessional socialization and teamwork in a large, diverse group of students of health professions programs.

German translation and validation of the Interprofessional Facilitation Scale.

We identified evidence from item response theory (IRT) to examine a German translation of the Interprofessional Facilitation Scale (IPFS). The IPFS was administered to n = 130 mixed-health profession participants in a post-interprofessional education practicum questionnaire. We used IRT analyses to examine the following three aspects of the IPFS: (a) general factor strength, (b) subscale usability, and (c) item bias. First, findings indicate a strong, general factor underlying the IPFS that supports unidimensional interpretations. Second, findings supported IPFS overall reliability, but failed to support subscale reliabilities. Third, item bias assessment using a comparator-French sample (n = 89) indicated insubstantial differences across German and French samples. Taken together, we find sufficient evidence to support the IPFS-German translation's application in IPE contexts and unidimensional interpretations. Subscores are not advisable for interpretation, and future researchers should aim to further inspect potential item bias.

Interprofessional Simulation Learning Game Increases Socialization and Teamwork Among Students of Health Professions Programs.

BACKGROUND: Interprofessional (IP) socialization is important to develop early in the training of health professions students. PURPOSE: This study compared changes in health professions students' IP socialization and readiness to function in IP teams and sought to understand students' participation experiences using a simulation learning game ( Friday Night at the ER [FNER]). METHODS: The single-center study targeted students in 13 health professions programs using a mixed-methods design. Student teams engaged in open discussion, played the game, and participated in team debriefing. RESULTS: IP socialization increased from fairly great to great extent among all students. Qualitative analyses revealed 3 overarching themes supporting the development of IP communication and systems-based thinking. Program evaluation data revealed that students highly valued this experience as being effective and important to their professional development. CONCLUSIONS: An IP experience consisting of FNER gameplay and structured debriefing can improve IP socialization and lay the foundation for the development of IP skills among early health professions students.

Profissão e vocação: a enfermagem em questão / Profession and vocation: nursing in question / Profesión y vocación: la enfermería en cuestión

Objetivo: Identificar os motivos pelos quais levaram os estudantes a escolherem a formação universitário em Enfermagem. Metodologia: Estudo exploratório- descritivo, sob abordagem qualitativa, desenvolvido com 276 acadêmicos de Enfermagem de uma universidade pública do Noroeste do estado do Ceará, Brasil. As informações foram coletadas por meio de um questionário eletrônico, aplicado por meio da plataforma Google Forms®. Essas por sua vez, foram analisadas a partir de análise de conteúdo proposto por Minayo, com o suporte do software N VIVO 11®. Resultados: As palavras mais referidas pelos estudantes ao serem questionados acerca dos motivos na escolha do curso de Enfermagem, foram: "Área", "Saúde", "Curso" e "Profissão", as quais suscitam que em algumas situações a escolha do curso aconteceu pela área da Saúde e não pelo curso em específico. Entretanto, outras palavras com maior quantitativo de repetição foram identificadas: "Sempre", "Gosto" e "Enfermagem", que por sua vez, demonstram a identificação com o curso de Enfermagem em específico e com o fazer da profissão. A partir de então, foram definidas seis categorias de análise, a saber "Identificar-se com a profissão", "Determinação Social e Mercado de Trabalho", "Enfermagem como segunda ou única opção", "Influências externas", "Permanência na área da Saúde" e "Vocação e visão solidária-romântica". Considerações finais: A partir dos discursos dos participantes em estudo, evidenciou-se que os motivos pelos quais levaram esses a ingressarem no curso universitário em Enfermagem estão associados ao imaginário da vocação, da concepção da Enfermagem enquanto profissão voltada para o cuidar/cuidado, bem como pelo o interesse de atuação na área da saúde.

Objective: To identify the reasons why students chose a university degree in Nursing. Methodology: Exploratory-descriptive study, under a qualitative approach, developed with 276 Nursing students from a public university in the Northwest of the state of Ceará, Brazil. Information was collected through an electronic questionnaire, applied through the Google Forms® platform. These, in turn, were analyzed based on the content analysis proposed by Minayo, with the support of the N VIVO 11® software. Results: The words most mentioned by students when asked about the reasons for choosing the Nursing course were: "Area", "Health", "Course" and "Profession", which suggest that in some situations the choice of course happened by the Health area and not by the specific course. However, other words with a higher number of repetitions were identified: "Always", "I like" and "Nursing", which, in turn, demonstrate identification with the Nursing course in particular and with the profession. From then on, six categories of analysis were defined, namely "Identifying with the profession", "Social Determination and the Labor Market", "Nursing as a second or only option", "External influences", "Permanence in the area of Health" and "Vocation and solidarity-romantic vision". Final considerations: From the speeches of the participants in the study, it was evident that the reasons why they entered the university course in Nursing are associated with the imaginary of the vocation, of the conception of Nursing as a profession focused on care/care, as well as as well as the interest in acting in the health area.

Objetivo: Identificar las razones por las cuales los estudiantes eligieron la carrera universitaria de Enfermería. Metodología: Estudio exploratorio-descriptivo, con abordaje cualitativo, desarrollado con 276 estudiantes de Enfermería de una universidad pública del Noroeste del estado de Ceará, Brasil. La información se recolectó a través de un cuestionario electrónico, aplicado a través de la plataforma Google Forms®. Estos, a su vez, fueron analizados con base en el análisis de contenido propuesto por Minayo, con el apoyo del software N VIVO 11®. Resultados: Las palabras más mencionadas por los estudiantes cuando se les preguntó acerca de los motivos de la elección de la carrera de Enfermería fueron: "Área", "Salud", "Curso" y "Profesión", lo que sugiere que en algunas situaciones la elección de la carrera pasó por la carrera de Enfermería. área y no por el curso específico. Sin embargo, fueron identificadas otras palabras con mayor número de repeticiones: "Siempre", "Me gusta" y "Enfermería", que, a su vez, demuestran identificación con la carrera de Enfermería en particular y con la profesión. A partir de ahí, se definieron seis categorías de análisis, a saber, "Identificación con la profesión", "Determinación social y mercado de trabajo", "Enfermería como segunda o única opción", "Influencias externas", "Permanencia en el área de la Salud". " y "Vocación y visión solidaria-romántica". Consideraciones finales: A partir de los discursos de los participantes en el estudio, se evidenció que las razones por las cuales ingresaron a la carrera universitaria en Enfermería están asociadas al imaginario de la vocación, de la concepción de la Enfermería como profesión enfocada en el cuidado, así como el interés por actuar en el área de la salud.

Health Profession Students' Interprofessional Socialization and Values Toward a College-Based Virtual Interprofessional Education Activity.

PURPOSE: The inclusion of interprofessional education (IPE) is essential for the health professions curricula and establishes the expectation of collaborative patient-centered care. The COVID-19 pandemic has required educators to develop innovative methods for IPE student engagement. The purpose of this study was to evaluate a college-based virtual IPE activity for first-year health profession students and measure their interprofessional socialization and values (ISVS) toward IPE teams. The validated interprofessional socialization and valuing scales (ISVS-9A/9B) were used. METHODS: A one-group pre-post-test design examined health profession students' ISVS from seven health programs before and after a virtual IPE activity. The IPE activity was a case-study grounded in the Interprofessional Education Collaborative (IPEC) core competencies that addressed each of the student learners' professional roles. RESULTS: A total of 244 students and 122 students completed the ISVS-9A/9B, respectively. A significant increase in the average total ISVS-9A/9B scores was observed among all student learners for 85 matched pairs (5.27 ± 1.11 vs 5.56 ± 1.02, p=0.01). Participating students generally found the activity valuable to their learning. CONCLUSIONS: The virtual composition of the IPE activity reduced logistical barriers and allowed for collaboration and awareness among students. Virtual IPE activities may be the cornerstone for interdisciplinary student engagement.

Representation in Health Professions Education: Striving for an Inclusive Health Professions Education Community.

Author representation and inclusivity in health professions education (HPE) scholarship is receiving increasing attention in academic medicine, with multiple articles calling for greater equity related to gender, geographic, and institutional affiliations. Despite journal efforts to seek diversity, authors from high-income English-speaking countries are the most highly represented in HPE scholarship. Less attention, however, has been focused on the openness of medical education scholars, themselves, to engaging in international collaborations with authors and institutions from low-and-middle income countries. This eye-opener is inspired by the authors' personal experiences in HPE scholarship from an international medical educator perspective and advocates for the creation of an open and inclusive multinational medical education community. We offer suggestions that can help create opportunities for networking, collaboration, and promoting a sense of belonging among HPE scholars worldwide. As researchers, journal editors and associate editors, and faculty in HPE programs, we can work together to create a welcoming and accommodating environment that embraces non-dominant voices and perspectives, with the ultimate goal of achieving diversity and equity in HPE scholarship.