Medical Education最新文献

Background: In the English National Health Service, and other health care systems internationally, there have been growing numbers of doctors working on a short- or long-term temporary basis as 'locums'. Social environments and professional relationships are fundamental to learning in clinical contexts; however, locums are often positioned at the periphery of the organisation and the clinical team. An examination of locum learning and continuing professional development is vital to understanding the implications of temporary working for the growing numbers of mobile doctors, often working at the margins of the medical workforce, and whose career trajectories may diverge from traditional models.

Methods: Qualitative interview and focus group data were collected from 130 participants, including 88 professionals and 42 patients, between March 2021 and April 2022 in primary and secondary health care organisations in the English NHS. Participants included locums, patients, permanently employed doctors, nurses and other health care professionals with governance and recruitment responsibilities for locums. Data were analysed using reflexive thematic analysis and abductive analysis.

Results: Four themes were developed from the data: (1) exclusion from formal and informal learning opportunities; (2) self-directed learning and workarounds; (3) decline in knowledge and clinical skills; (4) effects on the professional development of the wider team. Locums were frequently excluded from feedback and learning opportunities because they were considered expensive and not the responsibility of the organisation and there to work, not to train. This meant that professional development was often the responsibility of the locum, self-directed and divorced from context. Locums often did not take on educational supervision roles for the wider team, meaning wider learning and development were disrupted or paused.

Conclusion: To address the challenges locum working might bring for learning and professional development, professional bodies should provide guidance for locum doctors highlighting the risks associated with taking on locum work before medical knowledge and experience are established. To improve quality and safety, organisational leaders should include locums in developmental opportunities. Finally, policy makers need to strike a balance between using locums to address short-term workforce quotas and the long-term impact on the knowledge and development of the workforce and patient safety.

Reid et al. respond to recent challenges to reliability norms in assessment by reinforcing the primacy of validity and reflecting on test length, assessment burden and implications for culture change.

Introduction: Acute care paediatric teams face ambiguous, dynamic patient care situations that demand adaptability to avoid patient harm. Team huddles and adaptation processes have shown promise in mitigating risk and reducing harm. One team process that may occur in huddles is team reflection (TR), defined as a team's capacity to consciously reflect on the group objectives or strategies to adapt to dynamic circumstances. Prior research on in-action TR during patient care episodes demonstrated improved team performance and learning. This study explored how interprofessional teams experience pre-action TR through a simulated huddle before patient arrival. A better understanding of pre-action TR behaviours may reveal an underutilized strategy for improving team function and patient outcomes.

Methods: The authors used simulation-primed qualitative inquiry to examine pre-action TR. Eleven multidisciplinary, interprofessional paediatric critical care teams (four to six members) participated in a simulation in which they were handed off a critically ill patient with imminent arrival time and instructed to plan care, immediately followed by focus groups to explore their experience of pre-action TR. A deductive then inductive approach to thematic analysis was applied using the TuRBO framework: (a) seeking information, (b) evaluating information, and (c) planning.

Results: Teams reported that pre-action TR behaviours fostered psychological safety, reduced barriers for sharing input, supported inclusive leadership, and enhanced shared mental model generation. These behaviours also enabled more effective and efficient planning. Importantly, participants described how pre-action TR behaviours both relied on and reinforced team dynamics such as team familiarity, trust, and psychological safety-highlighting their self-amplifying nature.

Conclusion: Pre-action TR behaviours promote team engagement and coordination, serving as a powerful tool in both training and practice. Integrating TR behaviours into huddles is a feasible strategy to strengthen team training, team dynamics and readiness. Future research should quantify its impact on team performance and patient outcomes.

Background: Like other Canadian specialty postgraduate training programmes, paediatrics recently transitioned to a competency-based medical education (CBME) platform. This programme, the Royal College of Physicians and Surgeons of Canada's Competence By Design (CBD), is espoused as learner-centered. However, resident voices were underrepresented in CBD's creation, and there are emerging concerns that its practical implementation may have unintended effects on this population. We sought to understand how CBD has affected the educational experiences of paediatric residents, with the goal of leveraging their insights to further strengthen this training model.

Methods: Our qualitative instrumental single case study explored the perspectives of paediatric residents who began training in the inaugural CBD cohort in 2021. We conducted semi-structured interviews with fourteen residents during their third year (August 2023-February 2024) in two Canadian programmes. We constructed themes from this data set using reflexive, inductive thematic analysis, looking for regularities that transcended the particularities of the training context.

Results: Our results suggest that residents agree with CBD's espoused purpose, yet feel that its day-to-day implementation has impacted them in four key ways: 1) the onus of responsibility and administrative burden falls to residents; 2) entrustable professional activities generate variable feedback; 3) CBD is less assessment for learning more assessment of learning; and 4) staff physicians have struggled to embrace CBD.

Discussion: Our findings align with concerns raised in other specialties, opening up questions as to why a learner-centered system may be having deleterious effects on its residents. We suggest that if the field is to fully unlock the potential that CBME systems hold, it is necessary to engage productively with resident critiques and to more deeply consider the effects that its historical and ideological aspects-such as its desire to materially demonstrate the acquisition of learner competence as well as a neoliberal orientation-have on CBME's contemporary design and delivery.