Anne Mette Mørcke

Complex perspectives on learning objectives: stakeholders' beliefs about core objectives based on focus group interviews

Objective  To understand core curriculum design and involvement of stakeholders.

The self-efficacy in patient-centeredness questionnaire – a new measure of medical student and physician confidence in exhibiting patient-centered behaviors

BackgroundPatient-centered communication is a core competency in modern health care and associated with higher levels of patient satisfaction, improved patient health outcomes, and lower levels of burnout among physicians. The objective of the present study was to develop a questionnaire assessing medical student and physician self-efficacy in patient-centeredness (SEPCQ) and explore its psychometric properties.MethodsA preliminary 88-item questionnaire (SEPCQ-88) was developed based on a review of the literature and medical student portfolios and completed by 448 medical students from Aarhus University. Exploratory Principal Component analysis resulted in a 27-item version (SEPCQ-27) with three underlying self-efficacy factors: 1) Exploring the patient perspective, 2) Sharing information and power, and 3) Dealing with communicative challenges. The SEPCQ-27 was completed by an independent sample of 291 medical students from 2 medical schools and 101 hospital physicians.ResultsInternal consistencies of total and subscales were acceptable for both students and physicians (Cronbach’s alpha (range): 0.74–0.95). There were no overall indications of gender-related differential item function (DIF), and a Confirmatory Factor Analysis (CFA) indicated good fit (CFI = 0.98; NNFI = 0.98; RMSEA = 0.05; SRMR = 0.07). Responsiveness was indicated by increases in SEPCQ scores after a course in communication and peer-supervision (Cohen’s d (range): 0.21 to 0.73; p: 0.053 to 0.001). Furthermore, positive associations were found between increases in SEPCQ-scores and course-related motivation to learn (medical students) and between SEPCQ scores and years of clinical experience (physicians).ConclusionsThe final SEPCQ-27 showed satisfactory psychometric properties, and preliminary support was found for its construct validity, indicating that the SEPCQ-27 may be a valuable measure in future patient centered communication training and research.

Medical faculty and curriculum design1? ‘No, no, it's like this: You give your lectures …’

Background and aims: The purpose of this study was to understand more completely the (tacit) curriculum design models of medical faculty. We report on two research questions: (1) Can medical faculty give an account of their curriculum design assumptions? and (2) What are their assumptions concerning curriculum design? Method: We conducted an explorative, qualitative case study. We interviewed educational decision makers at the three Danish medical schools and associate professors from different courses concerning curriculum design. We carried out four individual, in-depth interviews and four focus groups with 20 participants in all. Results and conclusions: Only one decision maker had an explicit curriculum design model. However, all participants had assumptions concerning curriculum design. We displayed their assumptions as five essentially different and increasingly complex models: the method-driven, pragmatically driven content-driven, outcome-driven and vision-driven curriculum design models. In the five models, the role of learning outcomes differs. The differences range from a belief that learning outcomes are essential, to a belief that learning outcomes are unimportant, to a belief that learning outcomes are incompatible with higher education. Finally, we found that teachers do not necessarily play a clear, central role in curriculum design.

Searching the core of emergency medicine

Background:  The purpose of this study was to test whether focus groups involving medical students, house officers, senior doctors, and nurses could identify an undergraduate emergency medicine core curriculum.

A validation study of the psychometric properties of the Groningen Reflection Ability Scale

BackgroundReflection, the ability to examine critically one’s own learning and functioning, is considered important for ‘the good doctor’. The Groningen Reflection Ability Scale (GRAS) is an instrument measuring student reflection, which has not yet been validated beyond the original Dutch study. The aim of this study was to adapt GRAS for use in a Danish setting and to investigate the psychometric properties of GRAS-DK.MethodsWe performed a cross-cultural adaptation of GRAS from Dutch to Danish. Next, we collected primary data online, performed a retest, analysed data descriptively, estimated measurement error, performed an exploratory and a confirmatory factor analysis to test the proposed three-factor structure.Results361 (69%) of 523 invited students completed GRAS-DK. Their mean score was 88 (SD = 11.42; scale maximum 115). Scores were approximately normally distributed. Measurement error and test-retest score differences were acceptable, apart from a few extreme outliers. However, the confirmatory factor analysis did not replicate the original three-factor model and neither could a one-dimensional structure be confirmed.ConclusionsGRAS is already in use, however we advise that use of GRAS-DK for effect measurements and group comparison awaits further review and validation studies. Our negative finding might be explained by a weak conceptualisation of personal reflection.

The interprofessional learning experience: Findings from a qualitative study based in an outpatient setting

ABSTRACT Clinical interprofessional education has traditionally taken place in hospital wards, but much diagnosis and treatment have shifted to the outpatient setting. The logical consequence is to shift more students’ clinical placements from the “bedside” to outpatient settings. However, it is unclear how we ensure that this shift maximises learning. The purpose of this article is to understand the authentic learning experience in an interprofessional outpatient clinic setting. We performed an exploratory case study with interviews of four nursing students, 13 medical students, and six staff members who worked in an interprofessional outpatient orthopaedic clinic from March 2015 to January 2016. The interviews were transcribed and analysed using systematic text condensation. The students’ self-reported learning experience in this outpatient clinic was characterised by direct patient contact and by authentic, interprofessional, task-based learning, and a preference for indirect supervision when conducting uncomplicated patient consultations. The supervisors intended to create this interprofessional outpatient clinic experience by having a clear teaching approach based on adult learning principles in a safe and challenging learning environment. The shift to the outpatient setting was strongly and practically supported by the management. This study indicates that student learning can be shifted to the outpatient clinic setting if there is supportive management and dedicated supervisors who establish a challenging yet safe interprofessional learning environment.

Positioning health professional identity: on-campus training and work-based learning

Purpose Drawing on positioning theory, the purpose of this paper is to characterize the activities and positions of students and supervisors at workplaces and on-campus skills training sites across the higher health professional educations of medicine, sports science, and nursing. Furthermore, the study explored the impact of work-based learning (WBL) and skills training on students’ personal professional identity development. Design/methodology/approach A qualitative case study was conducted across six workplace sites and three on-campus skills training sites with 20 days of observation and 21 in-depth interviews. The data were inductively analyzed resulting in the identification of 12 characteristic narratives. This was followed by abductive analysis using Harre’s concept of positioning as the theoretical framework. Findings Across the three higher health professional educations, work-based and on-campus skills training sites were characterized by two learning spaces with distinct positions, rights, and duties. The WBL sites gave the students rich opportunities to position themselves, act independently, and behave as professionals seriously striving for mastery. On the on-campus sites, the students behaved less seriously, and were conscious of their rights to try out things, get support, and have fun. Research limitations/implications The authors recommend that future studies explore aspects of professional identity formation due to its consequences for curriculum design, including the distribution of simulated spaces and professional spaces in students’ learning environments. Originality/value This study adds to the empirical evidence and conceptual frameworks of personal and shared professional identity development in the field of skills and WBL, and it underlines the ongoing value of Harre’s positioning theory in educational research.

Measures of educational effort: what is essential to clinical faculty?

Purpose To enhance the recognition of educational effort and thereby support faculty vitality, the authors aimed to identify essential categories of educational effort from the perspective of clinical faculty and determine whether the emerging categories were in concordance with an organizational perspective. Method The authors performed nominal group processes in four groups in 2008, with the participation of 24 clinical faculty members, 6 in each group, representing 18 (medical, surgical, paraclinical, and psychiatric) specialties at 14 hospitals in Denmark. Subsequently, the authors performed a comparative analysis of the emerging essential categories and the organizational work by the national panel on medical education, appointed by the Association of American Medical Colleges (AAMC). Results The four groups of clinical faculty members agreed on categories of educational effort. This quantitative consistency in prioritization was supported by qualitative consistency, as the authors observed similar uses of words and phrases among all four groups. The top priority in essential categories of educational effort was “Visibility of planned educational activities on the work schedule,” which received 39% of all votes. The comparative analysis showed that the essential categories of educational effort suggested by clinical faculty were in concordance with the steps developed by the AAMC. Conclusions The high degree of consistency among clinical faculty from different locations and specialties and the high concordance with the organizational work of the AAMC suggest that it is possible to develop standardized measurements of educational effort. Clinical faculty emphasized that a good starting point for educational measurements is the work schedule.

Students’ Learning Experiences from Didactic Teaching Sessions Including Patient Case Examples as Either Text or Video: A Qualitative Study

ObjectivesThe aim of this study was to explore medical students’ learning experiences from the didactic teaching formats using either text-based patient cases or video-based patient cases with similar content. The authors explored how the two different patient case formats influenced students’ perceptions of psychiatric patients and students’ reflections on meeting and communicating with psychiatric patients.MethodsThe authors conducted group interviews with 30 medical students who volunteered to participate in interviews and applied inductive thematic content analysis to the transcribed interviews.ResultsStudents taught with text-based patient cases emphasized excitement and drama towards the personal clinical narratives presented by the teachers during the course, but never referred to the patient cases. Authority and boundary setting were regarded as important in managing patients. Students taught with video-based patient cases, in contrast, often referred to the patient cases when highlighting new insights, including the importance of patient perspectives when communicating with patients.ConclusionThe format of patient cases included in teaching may have a substantial impact on students’ patient-centeredness. Video-based patient cases are probably more effective than text-based patient cases in fostering patient-centered perspectives in medical students. Teachers sharing stories from their own clinical experiences stimulates both engagement and excitement, but may also provoke unintended stigma and influence an authoritative approach in medical students towards managing patients in clinical psychiatry.

The validity of student tutors' judgments in early detection of struggling in medical school. A prospective cohort study.

AbstractEarly identification and support of strugglers in medical education is generally recommended in the research literature, though very little evidence of the diagnostic qualities of early teacher judgments in medical education currently exists. The aim of this study was to examine the validity of early diagnosis of struggling in medical school based on informal teacher judgements of in-class behavior. The study design was a prospective cohort study and the outcomes/truth criteria were anatomy failure and medical school drop out. Six weeks into an anatomy course, student tutors attempted to identify medical students, who they reckoned would fail the anatomy course or drop out, based on their everyday experiences with students in a large group educational setting. In addition, they were asked to describe the indicators of struggling they observed. Sixteen student tutors evaluated 429 medical students for signs of struggling. By week six, the student tutors were able to detect approximately 1/4–1/3 of the students who eventually failed or dropped out, and for ¾ of the strugglers they identified, they were correct in their judgments. Informal student tutor’s judgements showed incremental validity for both outcomes when controlling for grades obtained in preceeding exams. Lack of participation, lack of commitment, poor academic performance, poor social interactions and general signs of distress were the main indicators of struggling identified. Teachers’ informal judgements of in-class behavior may be an untapped source of information in the early identification of struggling medical students with added value above and beyond formal testing.