e-Editor Intern’s note: The following is a scholarly review of several articles found in our Really Good Stuff section of this month’s edition. We thank Carey & Megan for their thoughtful review. – TC
By Carey Mather & Megan Quentin-Baxter
Four short papers appearing in the May issue of Medical Education focus on a constructivist learning approach and personal accountability to develop appropriate professional behaviours and identity. The first three are relatively low cost interventions using existing tools or infrastructure in new, authentic ways, minimising the impact on staff, and explicitly recognising the challenges of an overcrowded curricula. The fourth builds on establishing a safe environment for ‘raising concerns’. The tools provide students with mechanisms for bridging between theory and experiential learning environments, and promoting the development of ‘agency’.(1)
‘Off to a good start’(2) describes medical student orientation to “highlight the central role of physician-patient relationship on the first morning of the first day” and teasing out the reasons why students chose this profession. This sharing forms a platform for an on-going relationship with the programme educators and peers and promotes “facilitating transition into the medical profession”. The researchers claimed that the “profoundly moving stories that emerge not only help each student calibrate their individual moral compass … also serve as an important team building experience”. One student said that it “set an inspirational tone” and the researchers found “professional identity that embraces inquisitive and altruistic professional behaviour” consistent with theories elsewhere.(3)
‘Using Twitter to teach problem based learning’(4) harnessed an emerging social media technology as a useful adjunct for a crowded curricula to “use an innovative approach to optimise the method in which we delivered PBL tutorials.” This innovation minimised impact on student and staff time because participants could post or review the microblogs asynchronously outside scheduled tutorials. It enabled connectivity within the group even though they only met intermittently.(5) Identifying the learning objectives and answering simple questions as they arose enabled more complex interactions during tutorials. Despite staff using the same ‘tutor’ account students indicated they developed rapport with staff members. This strategy also promoted a learner-centred approach that is reshaping pedagogy.(6)
The ‘Professional competencies toolkit: Teaching reflection with flash cards’(7) project sent students into clinical experience every two weeks with at least one of 28 flash cards defining a topic (such as ‘the invisible patient’) and tasks and tips for dealing with it to promote concepts that define habitual professionalism. The flash card/aide memoire provided a specific hook to remind students to collect evidence to facilitate subsequent reflection. This process encouraged to students to bring “their story back to the group” for further discussion in small group settings. The authors claim that encouraging students to focus on “manageable learning “bites” or ”one or two basic elements” promoted a level of reflection leading to “deep understanding of the importance and complexity of the broader issue.” reflecting the early stages of theoretical concepts of Fink’s ‘significant learning’.(8)
‘Concerns about raising concerns’(9) described an environment based on (10) responding to the UK’s Francis Report (11) where dental students were encouraged to “explore their understanding and beliefs regarding professional behaviours” in workshops, annual learning agreements, lectures and final year seminars. New policies and practices (many escalating externally to the school) were put in place to ensure “visibly fair and effective” actions arising from student’s views. The authors observed that students raised “significantly” far more concerns about “themselves, colleagues and staff” than were expected.
In all the use of narrative and communication inform professional identity and promote rapport development with teachers, students or patients. Collaborative, interactive team-building strategies were used to model and explore the central themes, with a common outcome of increased collaboration or connectivity between students, staff or patients. Communication processes were orientated towards relationship-building and increase of rapport to support patient-centred care and habituate professional behaviours.
These approaches give students an opportunity to contribute through articulation of self and their experiences. The student role is elevated to co-creator of knowledge, co-owner of responsibility, and students provided with real opportunities to contribute to patient safety and care.
Collectively these novel approaches could be tailored to other healthcare programmes to foster professional behaviours and student accountability. It would be interesting to hear from institutions using similar or a mixture of methods to promote professional identity development of students.
- Billett S. Relational interdependence between social and individual agency in work and working life. Mind, Culture, and Activity 2006;13(1):53-69.
- Danoff A, Garabedian M, Harnik V, Rosenthal M. Off to a good start. Medical Education 2015;49(5):514.
- Stern DT. Measuring Medical Professionalism. New York: Oxford University Press 2006.
- Lasker R, Vicneswararajah N.. Using Twitter to teach problem-based learning. Medical Education 2015;49(5):531.
- Kamel Boulos MN, Wheeler S. The emerging Web 2.0 social software: an enabling suite of sociable technologies in health and healthcare education. Health Information and Libraries Journal 2007;24(1):2-23.
- Caplan W, Myrick F, Smitten J, Kelly W. What a tangled web we weave: How technology is reshaping pedagogy. Nurse Education Today 2014;34(8):1172-4.
- Seymour P, Watt M. The professional competencies toolkit: teaching reflection with flash cards. Medical Education 2015;49(5):518.
- Fink LD. Creating Significant Learning Experiences: An Integrated Approach to Designing College Courses. Jossey-Bass 2003.
- Ellis JS, Bateman H, Thomason JM, Whitworth J. Concerns about raising concerns. Medical Education 2015;49(5):514-5.
- Kelly M, O’Flynn S, McLachlan JC, Sawdon MA. The clinical conscientiousness index: a valid tool for exploring professionalism in the clinical undergraduate setting. Academic Medicine 2012;87(9):1218-24.
- The Mid Staffordshire NHS Foundation Trust. Public Inquiry Chaired by Robert Francis QC. Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. 3 vols. London: Stationery Office 2013.