Balancing Service and Education in Residency Training

Turner, Teri L.; Fielder, Elaine; Ward, Mark A.

doi:10.1001/jamapediatrics.2015.3816

Cited by 20 publications

(18 citation statements)

References 13 publications

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“…This is consistent with Turner et al. 's encouragement of a ‘shared mental model’ of service and training. The authors in this issue are quite correct that resolution is not achievable in this situation; one could argue that it is not desirable, because prioritising one side will, inevitably, have a negative impact upon the other…”

supporting

confidence: 87%

Balance or tension? Walking the tightrope between training and patient care

Sholl¹

2018

Med Educ

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supporting

confidence: 87%

Balance or tension? Walking the tightrope between training and patient care

Sholl¹

2018

Med Educ

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“…planned or structured) rather than informal (e.g. unplanned or unstructured) learning opportunities and conceptualisations of education and service that understand them as separate activities rather than as deeply intertwined activities, such as viewing service as education and vice versa …”

Section: Discussionmentioning

confidence: 99%

“…In common with health care services elsewhere in the world, such as the USA, the UK National Health Service (NHS) faces unprecedented financial and workforce challenges as a result of rising demand for services and constrained resources . There are particular pressures in specialty areas such as accident and emergency, general practice and mental health because of insufficient funding and a shortage of staff to fill vacant posts .…”

Section: Introductionmentioning

confidence: 99%

Balancing health care education and patient care in the UK workplace: a realist synthesis

et al. 2017

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CONTEXT Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. METHODSWe conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. RESULTSThe most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support.CONCLUSION Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery.

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“…Service and training compete for limited time and resources in this pressured environment . Less time is available for faculty members to teach, and residents also have less time to achieve their competencies .…”

Section: Introductionmentioning

confidence: 99%

Using paradox theory to understand responses to tensions between service and training in general surgery

et al. 2017

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Stakeholder responses to the tensions provided temporary relief but were unlikely to lead to real change if the tension between service and training was considered to be an interdependent and persistent paradox. Reframing the service-training paradox in this way may encourage adjusting responses to create effective working partnerships. Our findings add to the body of knowledge on this topic, and will resonate with all those engaged in surgical and other postgraduate training.

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Balancing Service and Education in Residency Training

Cited by 20 publications

References 13 publications

Balance or tension? Walking the tightrope between training and patient care

Balance or tension? Walking the tightrope between training and patient care

Balancing health care education and patient care in the UK workplace: a realist synthesis

Using paradox theory to understand responses to tensions between service and training in general surgery

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