The influence of structural and institutional change on teaching and culture in clinical settings: An exploratory study

Goldie, John; Dowie, Al; Goldie, Anne; Cotton, Philip; Morrison, Jillian

doi:10.3109/0142159x.2014.947943

Cited by 4 publications

(3 citation statements)

References 20 publications

(16 reference statements)

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“…While there are many papers published on how to change organisational culture in health care, there is very little research on organisational or systems approaches to health service interventions to improve student clinical placements such as the one described in this paper. Reports of the success or otherwise of student clinical placements typically describe activities and interventions by educational institutions, individual supervisors or preceptors, or students rather than the health services themselves [9, 32–35]. As such they are focused on how work based learning occurs rather than on system level changes within health services.…”

Section: Discussionmentioning

confidence: 99%

Improving management of student clinical placements: insights from activity theory

et al. 2016

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BackgroundAn approach to improve management of student clinical placements, the Building Teams for Quality Learning project, was trialed in three different health services. In a previous paper the authors explored in some detail the factors associated with considerable success of this approach at one of these services. In this paper, the authors extend this work with further analysis to determine if the more limited outcomes observed with participants at the other two services could be explained by application of activity theory and in particular the expansive learning cycle.MethodsStaff at three health services participated in the Building Teams for Quality Learning project: a dental clinic, a community aged care facility and a rural hospital. At each site a team of seven multi-disciplinary staff completed the project over 9 to 12 months (total 21 participants). Evaluation data were collected through interviews, focus groups and direct observation of staff and students. Following initial thematic analysis, further analysis was conducted to compare the processes and outcomes at each participating health service drawing on activity theory and the expansive learning cycle.ResultsFifty-one interview transcripts, 33 h of workplace observation and 31 sets of workshop field notes (from 36 h of workshops) were generated. All participants were individually supportive of, and committed to, high quality student learning experiences. As was observed with staff at the dental clinic, a number of potentially effective strategies were discussed at the aged care facility and the rural hospital workshops. However, participants in these two health services could not develop a successful implementation plan. The expansive learning cycle element of modeling and testing new solutions was not achieved and participants were unable, collectively to reassess and reinterpret the object of their activities.ConclusionThe application of activity theory and the expansive learning cycle assisted a deeper understanding of the differences in outcomes observed across the three groups of participants. This included identifying specific points in the expansive learning cycle at which the three groups diverged. These findings support some practical recommendations for health services that host student clinical placements.

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Section: Discussionmentioning

confidence: 99%

Improving management of student clinical placements: insights from activity theory

et al. 2016

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“…There are many factors influencing patient care and feedback to learners in the workplace [34,35], foremost among those being the pressure of service delivery versus the educational need of the learner [1]. Some behavior's that affect seeking feedback cannot be altered like 'time in post' and youth but this can be balanced by providing 'frequent positive feedback' and developing high-quality professional relationships [36].…”

Section: Background Literature Clinicalmentioning

confidence: 99%

Managing the Quality of Ward Based Training in Surgery in UK- A Critical Review

2017

Anesth Med Pract J

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Junior doctors alerted the Director of Medical Education (D.M.E.) to a lack of training by senior colleagues on ward rounds in surgery. At the same time surgical training was rated poorly on the General Medical Council (G.M.C.) Trainees Survey. The West Midlands Deanery threatened to withdraw posts recommending that at least 40% of trainee time be dedicated to training. Trainers reported a lack of time to train and poor engagement by trainees. This review examines the merits of different quality improvement initiatives to patient care through programmed ward round training. Context of the Problem Poor feedback from trainees within the trust at the 'Junior Doctors Forum (J.D.F.)' had suggested a lack of ward based training opportunities due to unstructured ward rounds poorly led by the senior doctors within surgery. The Medical Director (M.D.) tasked the Royal College of Surgeons Tutor for the trust with changing the learning environment on ward rounds to improve care and training.

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“…Socialisation is an interpretive process where individuals make sense of culture through the lens of their own unique backgrounds and the current context of the field. Meaning is created rather than transmitted, and culture is constantly being recreated . Behaviours and practices such as disclosing or not disclosing conflicts of interests are socially constructed in interaction and sustained through institutional structures.…”

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confidence: 99%

Resolving conflicts of interests: the need for reflection

Goldie

2017

Med Educ

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The influence of structural and institutional change on teaching and culture in clinical settings: An exploratory study

Abstract: The apprenticeship model was still felt to be relevant in clinical settings. This has to be balanced against the need for systematic teaching. Structural and institutional change affects learning. Faculty needs to be aware of the socio-historical context of their institutions.

Cited by 4 publications

References 20 publications

Improving management of student clinical placements: insights from activity theory

Improving management of student clinical placements: insights from activity theory

Managing the Quality of Ward Based Training in Surgery in UK- A Critical Review

Resolving conflicts of interests: the need for reflection

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