Can the tools of activity theory help us in advancing understanding and organisational change in undergraduate medical education?

Abstract

Continued changes to healthcare delivery in the UK, and an increasing focus on patient safety and quality improvement, require a radical rethink on how we enable graduates to begin work in challenging, complex environments. Professional regulatory bodies now require undergraduate medical schools to implement an 'assistantship' period in the final year of study, where senior medical students 'shadow' the work of junior doctors, with an expectation that they will be better 'prepared' for work. However, there is little guidance about what an 'assistantship' entails and the current emphasis on preparedness of students arguably underplays the importance of contextualised learning within the workplace environment. This paper will describe a modified Development Work Research (DWR) (Engeström in Developmental work research: activity theory in practice. Lehmanns Media, Berlin, 2005) approach to organisational change, enabling academic, clinical and administrative partners to develop assistantship placements in different hospitals. Our findings indicate that a modified DWR approach can reveal factors indicating organisational readiness to support change within a locally contextualised framework. The process has significant practical applications across a range of healthcare disciplines, as all professions seek to engage with the challenge of enabling successful transitions of graduates to the workplace.

Boosting clinical performance: The impact of enhanced final year placements

“…This study follows on from the Reid et al (2014) study, where a pilot educational intervention study to enhance assistantship experience was undertaken in Leeds medical school. The research team worked intensively in partnership with multidisciplinary teams in three final year placement sites to assess and support their readiness to provide enhanced assistantship placements.…”

“…In the UK context, the transition from final year medical student to Foundation 1 (F1) doctor has frequently been identified as challenging, with concerns over how well medical schools prepare graduates for practice (Reid et al, 2014). As a result, the perceptions of new doctors' 'preparedness' for clinical practice have been extensively studied in recent years; with the principal explanation for problems with clinical performance being that graduates are not fully 'prepared' for starting work.…”

“…However, individual perceptions of preparedness are no guarantee of actual practice performance (Monrouxe et al, 2014) and, as argued by Kilminster et al (2011), the focus on individual skills and knowledge, rather than the individual in the context of the 'placement environment' is of concern. The latter point is taken up by both Reid et al (2014) and Burford et al (2015) who independently investigated how learning opportunities were likely to be affected by the placement learning environment and the learning culture of the multi-disciplinary team.…”

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Background: This study follows on from a Reid et al (2014) study that investigated how to develop effective final year medical student assistantship placements, using multi-disciplinary clinical teams in planning and delivery.Aims: This study assessed the effects on OSCE performance of the in-course enhanced 'super-assistantship' placement introduced to a randomly selected sample of 2013-14 final year medical students at Leeds medical school.Methods: This study used quantitative data analysis to compare the global grades of OSCE stations between students who undertook this placement against those who did not.Results: There was a small overall improvement in the 'super-assistantship' student scores across the whole assessment (effect size = 0.085). 'Pre-op Capacity', 'Admissions Prescribing' and 'Hip Pain' stations had small-medium effect sizes (0.226, 0.215 and 0.214) in favour of the intervention group.

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“…Background: This study follows on from a Reid et al (2014) study that investigated how to develop effective final year medical student assistantship placements, using multi-disciplinary clinical teams in planning and delivery.…”