Learning in Health and Social Care最新文献

There is increasing interest in the theoretical underpinning of interprofessional education (IPE) and writers in this field are drawing on a wide range of disciplines for theories that have utility in IPE. While this has undoubtedly enriched the research literature, for the educational practitioner, whose aim is to develop and deliver an IPE curriculum that has sound theoretical underpinnings, this plethora of theories has become a confusing, and un-navigable quagmire. This article aims to provide a compass for those educational practitioners by presenting a framework that summarizes key learning theories used in IPE and the relationship between them. The study reviews key contemporary learning theories from the wider field of education used in IPE and the explicit applications of these theories in the IPE literature to either curriculum design or programme evaluation. Through presenting a broad overview and summary framework, the study clarifies the way in which learning theories can aid IPE curriculum development and evaluation. It also highlights areas where future theoretical development in the IPE field is required.

The study described in this paper focuses on an interprofessional learning (IPL) in practice project. The project entailed appointing a number of IPL in practice facilitators whose task it was to assist clinical teams to develop opportunities for students to engage in IPL. The evaluation described focuses on one of the initial project sites, a rehabilitation ward in a community hospital. The evaluation aimed to establish a range of differing perspectives on the project including service users, steering group members, the clinical team and participating students. Narrative data were collected using focus groups, one-to-one interviews, documentary analysis and postal and electronic questionnaires. Triangulation approaches were used to analyse data and the findings were largely positive. Lessons learnt included such things as practical difficulties of introducing IPL in practice, effective use of lay persons in professional education and the difficulties of engaging medical staff in such initiatives. Limitations of the study include difficulties in getting students to participate in either focus group discussions or one-to-one interviews; therefore, alternative data sources had to be deployed, such as e-mail contact. Conclusions are that even when an experienced IPL facilitator is in post there is a need to foster practice staffs’ commitment to IPL.

The aim of this study was to investigate the experiences of physiotherapists engaged in clinical supervision. It aimed to indicate whether physiotherapists understood the purpose of clinical supervision and whether the term affected their understanding and use of the process. The study is set in a physiotherapy department in an acute District General Hospital. Sixteen potential participants were contacted, eight qualified physiotherapists consented to take part. The study adopted a qualitative approach using semi-structured audio-taped interviews which were transcribed prior to content analysis.

A key finding was that the physiotherapists did not have a clear understanding of the purpose of clinical supervision in relation to other support available, for example annual appraisal and rotational reviews. Tensions arose for those who associated clinical supervision with line management and appraisal. Clinical supervision was most effective for physiotherapists who had selected their own supervisor, who were clear about its purpose and who were able to make the link between clinical supervision, continuing professional development and reflective practice.

The study concludes that the purpose of clinical supervision in relation to other support needs to be clarified to help physiotherapists use the process more effectively and that clinical supervisors should receive support and training in this important role. Clinical supervision is used for different purposes at different stages of a career and can enhance the development of confident practitioners. The term ‘clinical supervision’ is inappropriate for physiotherapists due to its lack of clarity. ‘Peer Support and Development’ is an example of an alternative title that may better describe the purpose of the activity.

A study of professional socialization in a medical education programme in Sweden is presented. The aim of the study was to explore ideals held within the educational practice concerning what constitutes an effective professional practitioner. Sixteen respondents from educational practice, eight teachers and eight students, were interviewed regarding their views on what constitutes ‘the ideal physician’, i.e. the desirable end product of medical education. Their responses were classified into six virtues: wisdom, discipline, humility, empathy, maturity and strength, each with corresponding vices. These virtues and vices reflect a desired direction for professional socialization during medical training and the professional performance of physicians. They also provide useful indicators of what has been described as medicine’s hidden curriculum. Implications for curriculum planning and the organization of learning in medical education are discussed.

The perennial debate concerning the so-called ‘theory-practice gap’ pervades health professional education. It is uncertain whether this gap – the notion that knowledge gained in university does not translate well into the workplace – is unavoidable or if it is a manifestation of the learning approaches used and the cultures operative in the two locations. This paper examines how nursing students’ knowledge and skills gained within university clinical laboratories transfer into the reality of the clinical environment. A series of one-on-one interviews were conducted over a two year period with second and third year nursing students (n = 28) participating in a preceptorship clinical placement model at one healthcare organisation. This paper focuses on data from the students' first interview. Data were transcribed and imported into NVivo 8 for thematic analysis. Four key themes emerged, including: ‘How I learn’ which focuses on students’ perceptions of their learning preferences; ‘Lack of engagement – it’s not real’ which concerns a perceived lack of authenticity of clinical laboratories; ‘Lack of affordances’ relating to the learning opportunities available in the clinical setting; and ‘Teacher Impact’ which focuses on the influence of individual teachers on student learning. The ‘parallel universes’ of academia and the workplace create dissonance for students as they juxtapose the authenticity of the clinical laboratories with the reality of professional healthcare practice. Transfer is inextricably linked with the individuals’ learning preferences, the affordances the workplace offers to students, and the willingness of staff to provide exciting, engaging learning opportunities. The challenge for health professional education is to provide a model of clinical education that meets not only the needs of university and clinical staff, but most importantly, the needs of students.

Reflection is a cognitive process for organizing ideas and building theory from observations and experiences. Learning within work-integrated and clinical placements is increasingly required for professional accreditation approval of allied health and other university programmes. Through clinical placements students can develop the knowledge and the practical skills and personal attributes needed for entry into their professions. Relevant to communities of practice, in experiential placements learners actively build on their own life experiences within realistic work-oriented contexts. Supervising practitioner feedback and guidance potentially accelerate the learning through a process of feedback and skilful questioning to encourage deep reflection. However, there has been little research into the role of reflection within experiential placements, particularly with respect to the preparation of students for the Australian pharmacy profession.

A 2007 Australian Learning and Teaching Council-funded research study was conducted regarding pharmacy experiential placements. The purpose was to map Australian university programmes, analyse handbooks and also consult with about 250 stakeholders from a range of backgrounds in relation to issues and quality indicators.

This paper focuses on reflection as one aspect of the Australian pharmacy experiential placement research. It highlights the importance of more comprehensively planned approaches to learning and reflection within experiential placements. This includes university and clinical educator scaffolding and feedback at the pre-placement, during placement and post-placement stages.

This study was set within the UK inter-professional multi-centre randomized controlled PACE Trial of manual-based therapy (BMC Neurology, 2007, 7: 6). The aim of supervision within ‘the trial’ was to maintain specificity of manual-based therapy, sustain retention of therapists, manage quality control and assurance of the therapy, monitor competence in delivering therapy and enhance professional development. The rationale for the study was that the approach to supervision within the trial appeared to be different from the previous experience of supervision for many of the therapists, especially occupational therapists and physiotherapists. A self-report questionnaire utilizing survey methodology identified differences in therapists’ previous clinical supervision and current supervision experience within the trial. All respondents (n = 14) indicated that they liked and preferred supervision that was agenda structured, one to one and regular (at least once a month), interspersed with group (team supervision), peer support meetings, review of taped therapy sessions by supervisor and/or peer for feedback and competency rating. In the main this combination of supervision methods had not been previously experienced. This has implications for practice and future therapy research that both therapists and managers will need to consider. In particular the implementation of group supervision and review of audio taped therapy sessions for analysis, review and feedback in practice to enhance learning and client care.

This project investigates the experiences of nurses who have been recently appointed as lecturers in higher education. Successful nurses and clinical experts suddenly find themselves to be ‘newcomers’ in many aspects of their role when they are appointed to a lecturer post in higher education. The project uses a work-place learning theoretical framework and builds on previous work on becoming an academic. The continuing professional development and contribution of this group of staff have significant impact on the effectiveness of nursing education. The key data source for this small-scale qualitative enquiry is semi-structured interviews with nine nurse lecturers within their first four years of appointment to a case study higher education institution. Additional data on the work-place context are provided by interviews with three line managers and analysis of institutional documents related to the appointment, induction and continuing professional development of academic staff.

The new nurse lecturers generally find their transition to higher education challenging and confusing because of the tensions in their subject, their department and their original practitioner profession, over what a lecturer should be. Their work-place includes a complexity of overlapping communities of practice including subject groups, teaching teams, and clinical placement networks. The different communities require them to emphasize different elements of their identity. The experiences of the new nurse lecturers tend to encourage them to hold on to existing identities as clinical practitioners rather than embrace new identities as academics.

The study has implications for all of those concerned with enhancing the academic work-place as a learning environment for lecturers in professional education fields such as nursing. These include the need to recognize and respond to tensions within the work-place and to nurture non-formal collaborative learning.

Cancer Care Nova Scotia developed an Interprofessional Core Curriculum for Nova Scotia health professionals, using a provincial educational needs assessment of health professionals caring for patients with cancer. This paper reports on the educational outcomes of the Interprofessional Core Curriculum programme, particularly the translation of learning into changes in practice and interprofessional interaction, and factors influencing change. The evaluation was guided by Kirkpatrick's model for assessing educational outcomes and Green and Kreuter's PRECEDE model of factors promoting and impeding change. In total, 411 participants attended the sessions, including nurses (54%), pharmacists (23%), and physicians (11%). We used self-report questionnaires to assess the transfer of learning into changes in practice and interprofessional interactions. High percentages of participants reported changes in both clinical practice and interprofessional interactions 3 months after the sessions. Frequently reported changes to interprofessional interactions were improved communication, increased confidence and assertiveness in interactions with other health professionals and being more respectful of other professions. Participants identified time and work-load as major barriers to change as well as lack of micro- and macro-system level support. The most common reported enabler of change was having attended the educational session. Overall, participants were highly supportive of interprofessional education, although when compared to nurses and pharmacists, physicians were less supportive and had proportionately lower attendance.