Developing a programmatic approach to faculty development and scholarship using the ASPIRE criteria: AMEE Guide No. 165.

Faculty Development (FD) has become essential in shaping design, delivery and quality assurance of health professions education. The growth of FD worldwide has led to a heightened expectation for quality and organizational integrity in the delivery of FD programmes. To address this, AMEE, An International Association for Health Professions Education, developed quality standards for FD through the development of the AMEE ASPIRE to Excellence criteria. This guide uses the ASPIRE criteria as a framework for health professions educators who wish to establish or expand approaches to FD delivery and scholarship within their institutions.

The social construction of teacher and learner identities in medicine and surgery.

INTRODUCTION: There are growing concerns about the quality and consistency of postgraduate clinical education. In response, faculty development for clinical teachers has improved formal aspects such as the assessment of performance, but informal work-based teaching and learning have proved intractable. This problem has exposed a lack of research into how clinical teaching and learning are shaped by their cultural contexts. This paper explores the relationship between teacher-learner identity, educational practice and the workplace educational cultures of two major specialties: internal medicine and surgery. METHODS: This was a secondary analysis of a large dataset, comprising field notes, participant interviews, images and video-recordings gathered in an ethnographic study. The lead author embedded himself in four clinical teams (two surgical and two medical) in two different hospitals. The authors undertook a critical reanalysis of the observational dataset, using Dialogism and Figured Worlds theory to identify how teachers and postgraduate learners figured and authored their professional identities in the specialty-specific cultural worlds of surgery and internal medicine. RESULTS: Surgery and internal medicine privileged different ways of being, knowing and talking in formal and informal settings, where trainees authored themselves as capable practitioners. The discourse of surgical education constructed proximal coaching relationships in which trainees placed themselves at reputational risk in a closely observed, embodied practice. Internal medicine constructed more distal educational relationships, in which trainees negotiated abstract representations of patients' presentations, which aligned to a greater or lesser degree with supervisors' representations. CONCLUSIONS: Our research suggests that clinical education and the identity positions available to teachers and learners were strongly influenced by the cultural worlds of individual specialties. Attempts to change work-based learning should be founded on situated knowledge of specialty-specific clinical workplace cultures and should be done in collaboration with the people who work there, the clinicians.

Peer feedback in graduate training: A phenomenological investigation of possibilities.

BACKGROUND: Whilst feedback is an essential component of clinical education, it is often lacking in clinical workplaces due to competing priorities. Peer feedback has been proposed as a potential solution but remains underexplored in terms of practicality and effects. We aimed to examine the experiences of peer feedback among paediatric trainees, and the associated feedback culture. METHODS: Following an Interpretative Phenomenological Analysis approach, the personal experiences of 12 paediatric trainees were explored using semi-structured interviews. Interpretive themes were developed between the transcripts using processes of abstraction, subsumption, contextualisation, and cross-case analysis. Themes were subsequently subjected to member checking and peer debriefing processes. RESULTS: We found that peer feedback was influenced by three contextual factors, namely, prevalent feedback culture, interpersonal consent, and the quality of relationships. Peer feedback culture was lacking in clinical workplaces. Feedback between peers was constrained by avoiding criticism and maintaining work relationships. Social and cultural norms inhibited constructive peer feedback without explicit consent. CONCLUSIONS: Enabling peer feedback in clinical settings requires attention to cultural, relational, and consent barriers. Potential approaches should include helping clinicians to develop greater cultural reflexivity, resident training in how to be peer educators, and enhancing institutional supports for peer feedback.

Uncovering the ecology of clinical education: a dramaturgical study of informal learning in clinical teams.

Off-the-job faculty development for clinical teachers has been blighted by poor attendance, unsatisfactory sustainability, and weak impact. The faculty development literature has attributed these problems to the marginalisation of the clinical teacher role in host institutions. By focusing on macro-organisational factors, faculty development is ignoring the how clinical teachers are shaped by their everyday participation in micro-organisations such as clinical teams. We set out to explore how the roles of clinical teacher and graduate learner are co-constructed in the context of everyday work in clinical teams. Using an ethnographic study design we carried out marginal participant observation of four different hospital clinical teams. We assembled a dataset comprising field notes, participant interviews, images, and video, which captured day-to-day working and learning encounters between team members. We applied the dramaturgical sensitising concepts of impression management and face work to a thematic analysis of the dataset. We found that learning in clinical teams was largely informal. Clinical teachers modelled, but rarely articulated, an implicit curriculum of norms, standards and expectations. Trainees sought to establish legitimacy and credibility for themselves by creating impressions of being able to recognise and reproduce lead clinicians' standards. Teachers and trainees colluded in using face work strategies to sustain favourable impressions but, in so doing, diminished learning opportunities and undermined educational dialogue. These finding suggest that there is a complex interrelationship between membership of clinical teams and clinical learning. The implication for faculty development is that it needs to move beyond its current emphasis on the structuring effects of institutional context to a deeper consideration of how teacher and learner roles are co-constructed in clinical teams.

Supporting a teacher identity in health professions education: AMEE Guide No. 132.

This guide provides an understanding of what teacher identity is and how it can be developed and supported. Developing a strong teacher identity in the context of health professions education is challenging, because teachers combine multiple roles and the environment usually is more supportive to the identity of health practitioner or researcher than to that of teacher. This causes tensions for those with a teaching role. However, a strong teacher identity is important because it enhances teachers' intention to stay in health professions education, their willingness to invest in faculty development, and their enjoyment of the teaching role. The guide offers recommendations on how to establish workplace environments that support teacher identity rather than marginalise it. Additionally, the guide offers recommendations for establishing faculty development approaches that are sensitive to teacher identity issues. Finally, the guide provides suggestions for individual teachers in relation to what they can do themselves to nurture it.

Why shouldn't we do that on placement if we're doing it in the real world? Differences between undergraduate and graduate identities in speech and language therapy.

Healthcare graduates are often characterised as ill-prepared for workplace entry. Historically, research on health professional's work preparedness has focused on the quality of graduates' clinical knowledge, skills and problem-solving. This ignores the role of professional identity formation in determining readiness for clinical practice. Yet, professional identity defines graduate self-perception, how others perceive them and informs clinical behaviour. The scholarship of identity formation at the transition from undergraduate to graduate is characterised by individual (cognitive) rather than relational (sociocultural) perspectives. Yet there is growing recognition that identity formation is not just individually mediated, but is also constructed between individuals and social context. The aim of this study was to explore professional identity formation among undergraduates and graduates from one healthcare profession (speech and language therapy-SLT) using a sociocultural theoretical standpoint. A qualitative descriptive methodology was used. Final (4th) year SLT undergraduate students and graduate SLTs with less than 2 years' clinical experience participated in individual semi-structured interviews. Thematic analysis was used to describe patterns in the data, which were subsequently subjected to interpretation informed by the constructs of Figured Worlds. Data analysis revealed that undergraduate professional identity was characterised by dependency, self-centredness (as opposed to patient-centredness), and a naïve role concept. Graduate identity on the other hand included expectations of self-sufficiency, patient-centredness and a more nuanced perception of the professional role. Undergraduates have naïve, prototypical understandings of what it is to be a graduate practitioner. The nature of undergraduate clinical placement hinders meaningful identity development. This suggests that curriculums should facilitate undergraduates to act with meaningful autonomy and to be positioned in more patient-centred roles, e.g. involvement in the decision-making process for patients. Graduates may then feel more authentic as autonomous professionals in their early graduate posts. This leads to better graduate, patient and service outcomes.

Journal club: old tricks and fresh approaches.

Journal club is a long-standing pedagogy within clinical practice and education. While journal clubs throughout the world traditionally follow an established format, new approaches have emerged in recent times, including learner-centred and digital approaches. Key factors to journal club success include an awareness of the learning goals of the target audience, judicious article selection and emphasis on promoting the engagement of participant learners. This article reviews the role that journal club plays in modern clinical education and considers how to optimise its benefit for contemporary learners.

Navigating the system: Physiotherapy student perceptions of performance-based assessment.

BACKGROUND: Performance-based assessment (PBA) is an integral component of health professional education as it determines students' readiness for independent practice. Stakeholder input can provide valuable insight regarding its challenges, facilitators, and impact on student learning, which may further its evolution. Currently, evidence of stakeholder opinion is limited. Thus, we aimed to explore physiotherapy students' perceptions of performance-based assessment in their capacity as its central stakeholders. METHODS: A qualitative interpretive constructivist approach was employed using focus group interviews for data collection. Six focus groups were completed (n = 33). Inductive thematic analysis was used to explore the data. RESULTS: Two themes were identified. The first outlined perceived inconsistencies within the process, and how these impacted on student learning. The second described how students used their experiential knowledge to identify strategies to manage these challenges thus identifying key areas for improvement. CONCLUSION: Inconsistencies outlined within the current physiotherapy performance-based assessment process encourage an emphasis on grades rather than on learning. It is timely that the physiotherapy academic and clinical communities consider these findings alongside evidence from other health professions to improve assessment procedures and assure public confidence and patient safety.

Old practices, new windows: reflections on a communications skills innovation.

Most of the great innovations in communication skills education, from Balint's concept of the 'doctor as drug' to the Calgary Cambridge conceptualisation of the consultation, were founded in general practice. It can be argued however, that there has been a hiatus in the development of new approaches to analysing the consultation since the mid-1990s. It is most welcome therefore that in this issue of the journal two papers are presented that describe and evaluate a novel approach to consultation analysis entitled 'the windows method'. Building on the more structured approaches that preceded it, the windows method offers some genuine innovations in terms of its emphasis on emotional knowledge and the manner in which it addresses many of the potential deficiencies in feedback practice associated with older methods. The new approach is very much in step with current thinking about emotional development and the establishment of appropriate environments for feedback. The windows method has the potential to breathe fresh life into old and well-established communication skills education practices.

Training socially responsive health care graduates: is service learning an effective educational approach?

BACKGROUND: Health care educators strive to train graduates who are socially responsive and can act as "change agents" for communities they serve. Service learning (SL) is increasingly being used to teach the social aspects of health care and develop students' social responsiveness. However, the effectiveness of SL as an educational intervention has not been established. AIM: To assess the evidence for the effectiveness of SL. METHOD: Seven electronic databases were searched up to 2012 and included all articles on SL for pre-professional health care students. Hand searching was also conducted. RESULTS: A total of 1485 articles were identified, 53 fulfilled the search and quality appraisal criteria and were reviewed across six domains of potential SL effects: (i) personal and interpersonal development; (ii) understanding and applying knowledge; (iii) engagement, curiosity and reflective practice; (iv) critical thinking; (v) perspective transformation and (vi) citizenship. CONCLUSION: While SL experiences appear highly valued by educators and students the effectiveness of SL remains unclear. SL is different from other forms of experiential learning because it explicitly aims to establish reciprocity between all partners and increase students' social responsiveness. Impact studies based on the interpretative paradigm, aligned with the principles of social accountability and including all stakeholder perspectives are necessary.

Exploration of a possible relationship between examiner stringency and personality factors in clinical assessments: a pilot study.

BACKGROUND: The reliability of clinical examinations is known to vary considerably. Inter-examiner variability is a key source of this variability. Some examiners consistently give lower scores to some candidates compared to other examiners and vice versa - the 'hawk- dove' effect. Stable examiner characteristics, such as personality factors, may influence examiner stringency. We investigated whether examiner stringency is related to personality factors. METHODS: We recruited 12 examiners to view and score a video-recorded five station OSCE of six Year 1 undergraduate medical students at our institution. In addition examiners completed a validated personality questionnaire. Examiners' markings were tested for statistically significant differences using non-parametric one way analysis of variance. The relationship between examiners' markings and examiner personality factors was investigated using Spearman correlation coefficient. RESULTS: At each station there was a statistically significant difference between examiners markings, confirming the presence of inter-examiner variability. Correlation analysis showed no association between stringency and any of the five major personality factors. When we omitted an outlier examiner we found a statistically significant negative correlation between examiner stringency and openness to experience with a correlation coefficients (rho) of - 0.66 (p = 0.03). Conversely there was a moderate positive correlation between examiner stringency and neuroticism with a correlation coefficient (rho) of 0.73 (p = 0.01). CONCLUSIONS: In this study we did not find any relationship between examiner stringency and examiner personality factors. However, following the elimination of an outlier examiner from the analysis, we found a significant relationship between examiner stringency and two of the big five personality factors (neuroticism and openness to experience). The significance of this outlier is not known. As this was a small pilot study we recommend further studies in this field to investigate if there is a relationship between examiner stringency in clinical assessments and personality factors.

Uncertainty and ambiguity and their association with psychological distress in medical students.

OBJECTIVE: The practice of medicine is inherently uncertain. We sought to measure the level of psychological distress among medical students and to ascertain if an intolerance of uncertainty and ambiguity were associated with distress. METHOD: The authors conducted a cross-sectional study with a population consisting of 4th year undergraduate medical students at an Irish university. Psychological distress was measured with the GHQ-12 scale. The "tolerance of ambiguity" scale and the "Intolerance of Uncertainty Scale (IUS)-12" were used to measure the respective variables. RESULTS: One hundred students (class size of 123) participated in this study giving a response rate of 81 %. A total of 27 % of the students met the criteria for psychological distress. Student psychological distress, as measured by GHQ-12 caseness, was associated with a higher intolerance of uncertainty (mean 31.70 (6.18)) compared with those who were not distressed (mean IUS score 26.66 (6.58)) (t (98) = -5.52, p < 0.001). CONCLUSION: A relative lack of tolerance for uncertainty may prove to be an important predictor of psychological distress in undergraduates. There is an argument for designing appropriate interventions so that learners can come to recognize and embrace uncertainty rather than its remaining unacknowledged and potentially contributing to psychological morbidity.

Preparedness for the transition to medical registrar from senior house officer-What's the problem?

INTRODUCTION: Transitions in clinical training are a hallmark in medical trainee's careers. The transition from senior house officer (SHO) to the role of medical registrar is often viewed as one of the most challenging, but to date, there is little research exploring why the transition is proving problematic for so many learners. The aim of this study was to explore the experiences of trainees preparing to make this transition. METHODS: Using an interpretative phenomenological analysis (IPA) approach, this qualitative study employed semi-structured interviews to explore the lived experiences of transition in a purposive sample of trainees on the cusp of transition from SHO to registrar or who were in their first year of being a medical registrar. Interviews were recorded, transcribed verbatim and analysed using an IPA approach. RESULTS: Six trainees participated in this study, four of whom were currently in SHO positions, with the remaining two in their first year of medical registrar. Two main themes emerged from data-perception of the medical registrar and barriers in transition. The role of the medical registrar was perceived to represent a strong leadership role, with barriers created due to increasing expectations, lack of support and uncertainties regarding the job. CONCLUSION: The role of the medical registrar is a challenging one, representing periods of uncertainty, increased expectations and reduced supports. Within this, there is potential to further support SHOs in transitioning to the role of medical registrar.

Exemplar or facilitator: An exploration of the lived experience of nurse mentors supporting the adaptation of internationally educated nurses.

INTRODUCTION: Deficits in nursing workforces have led to major increases in overseas recruitment in many countries. Internationally educated nurses recruited within Ireland must complete an adaptation programme before they can practice nursing, a process contingent on the support from nurse mentors. However, it is becoming progressively difficult to identify nurses willing to act as mentors, threatening viability of overseas nurse recruitment. This research set out to address this problem by exploring the lived experiences of nurse mentors during the adaptation programme. METHODS: An interpretative phenomenological analysis research design was utilised to explore the experiences of nurse mentors. Semi-structured interviews were conducted with a maximum variance sample of 11 nurse mentors. The data were subjected to an Interpretive Phenomenological Analysis (IPA) sequential analytical approach yielding integrative themes. RESULTS: The lived experiences of participants coalesced into three conceptual themes, mentor identity, sustainability, and learner socialisation. Participants who self-identified as 'mentor exemplars' expressed more negative perceptions of the role when compared with nurses who positioned themselves as 'mentor facilitators'. Nurse mentors were challenged by the complexities of intercultural dissonance and insufficient time and training for their mentoring role because of the pressures of clinical service. CONCLUSION: Although mentorship is essential for the integration of internationally educated nurses, the sustainability of the mentorship role is contingent on how it is supported through training and protected within busy clinical environments. Critically, nurse mentors need to learn how to conceptualise their role as one of facilitating the development of others rather than presenting themselves as exemplary role models.

Reflective practice in medicine: The hidden curriculum challenge.

BACKGROUND: Despite the known benefits of reflection in various health care professions, it is still not a thriving practice in medical education. The literature suggests that this may be due to tensions between epistemological tenets of reflection and biomedicine. Further research is needed into experiences of doctors as they implement reflection in medical education settings. We set out to explore how these experiences were influenced by hidden curricula to provide insights into personal and contextual features of medical settings influencing engagement in reflection. METHODS: Using an interpretative phenomenological analysis (IPA) approach, four semi-structured qualitative interviews were conducted virtually. Participants were doctors who graduated from a postgraduate diploma in clinical education with core reflective practice components. Interviews were recorded, transcribed, coded and analysed using IPA. Opportunities to review and amend transcriptions were provided. FINDINGS: Three superordinate themes were identified including epistemological divergence, fear of showing vulnerability and reflection volte-face. Challenges in engaging in practices epistemologically different to predominant discourses in medicine were compounded by fears of vulnerability and a common antipathy towards reflection. All developed more accommodating perspectives towards reflection with shared experiences of a programme incorporating reflective practice. CONCLUSION: The hidden curriculum can have positive and negative impacts on doctors' engagement in reflection. In facilitating reflective practice for this group, we recommend assisting with awareness of ways of thinking and being in medicine, offering reassurance that reflection may initially feel like running contrary to predominant discourses and finally, role modelling openness to vulnerability to better integrate and promote meaningful engagement in reflection.

A corporeal conundrum: Challenges posed by remote consultation for postgraduate medical education.

BACKGROUND: The COVID-19 pandemic accelerated the use of remote consultation in hospital outpatient clinics. Remote consultation alters the clinical environment and the learning environment in ways that are incompletely understood. This research sought to explore how trainees negotiate training and learning in such an environment when it is novel to them. METHODS: Purposive sampling was used to recruit eight doctors from the gastroenterology department of an academic teaching hospital. Four consultants and four trainees participated in individual, semi-structured interviews. Interpretative phenomenological analysis of interview transcripts was employed and themes developed from the analysis, to characterise the experience of learning and teaching in remote consultation clinics, as described by participants. RESULTS: Participants described how they try to create mental representations of each patient they review by remote consultation. Whilst consultants found this task relatively easy, trainee physicians found remote consultation more challenging and highlighted the importance of the physical presence of the patient to help them form a holistic sense of the patient's condition. Doctors in training also struggled to develop a workable mental model of the patient's condition when physical examination was precluded by remote consultation. CONCLUSIONS: This study highlights the place of the patient's physical presence as an essential educational stimulus to facilitate teaching and learning. Further research is needed to characterise the processes clinicians use to formulate mental models of patients who are physically absent from the consultation room.

The hidden benefits of patient encounters.

BACKGROUND: Whilst it is widely acknowledged that health care professionals (HCPs) learn from patient encounters, research exploring what HCPs learn from their meetings with patients is relatively sparse, particularly in the context of postgraduate training. Moreover, there are few research studies that examine the contribution of patient encounters to HCP education from both HCP and patient perspectives. This study set out to explore HCPs learning from patient encounters from both HCP and patient perspectives. METHODS: Qualitative descriptive design was used to conduct this study. Using purposive sampling, we recruited participants from three different groups in a single department of paediatrics in a teaching hospital. Data was collected through interviews, which were transcribed and analysed for key themes. FINDINGS: Patients felt that they played a central role in clinical education and highlighted their ability to educate postgraduate HCPs about their lived experiences of disease. HCPs highlighted the unique insight into a chronic illness gained from patient accounts, essential to developing patient and family orientated approaches to care. HCPs reported that they developed professionally, learning to adapt their negotiation and educational strategies. CONCLUSIONS: This study highlights the importance of patient encounters as critical contributors to HCPs understanding of the lived experiences of patients with chronic disease, and offers insights into how parents view their contribution to clinical education. Much of this learning is embedded and implicit, which suggests that HCP trainees need to develop better in the moment awareness of what they are learning from their meetings with patients and their families.