Esther de Groot

Critically reflective dialogues in learning communities of professionals

Communities in which professionals share and create knowledge potentially support their continued learning. To realise this potential more fully, members are required to reflect critically. For learning at work such behaviour has been described as critically reflective work behaviour, consisting of six aspects: challenging groupthink, critical opinion sharing, an openness about mistakes, asking for and giving feedback, experimentation and research utilisation. We studied whether and how these aspects can be distinguished in dialogues of seven different communities of veterinary professionals (critically reflective dialogues). Our exploration of the nature of critically reflective dialogues resulted in an analytical framework. Within each aspect four different modes of communication were identified: interactive, on an individual basis, non-reflective and restricted. We assume that professionals use learning opportunities most in the interactive mode of communication. The framework was employed to study the extent to which dialogues showed these modes of critically reflective dialogues. The results demonstrate that in these communities the modes of communication within aspects were largely non-interactive (i.e., individual, non-reflective). The developed framework discriminates between communities in terms of their critically reflective dialogues. Interventions to improve the effectiveness of learning communities should focus on enhancement of members addressing each others reasons and reflections.

Critically reflective work behavior of health care professionals

Introduction: Better understanding of critically reflective work behavior (CRWB), an approach for work‐related informal learning, is important in order to gain more profound insight in the continuing development of health care professionals. Methods: A survey, developed to measure CRWB and its predictors, was distributed to veterinary professionals. The authors specified a model relating CRWB to a Perceived Need for Lifelong Learning, Perceived Workload, and Opportunities for Feedback. Furthermore, research utilization was added to the concept of CRWB. The model was tested against the data, using structural equation modeling (SEM). Results: The model was well represented by the data. Four factors that reflect aspects of CRWB were distinguished: (1) individual CRWB; (2) being critical in interactions with others; (3) cross‐checking of information; and (4) openness to new findings. The latter 2 originated from the factor research utilization in CRWB. The Perceived Need for Lifelong Learning predicts CRWB. Neither Perceived Workload nor Opportunities for Feedback of other practitioners was related to CRWB. Discussion: The results suggest that research utilization, such as cross‐checking information and openness to new findings, is essential for CRWB. Furthermore, perceptions of the need for lifelong learning are more relevant for CRWB of health care professionals than qualities of the workplace.

Development of critically reflective dialogues in communities of health professionals

Critically reflective dialogues (CRD) are important for knowledge sharing and creating meaning in communities. CRD includes different aspects: being open about mistakes, critical opinion sharing, asking for and giving feedback, experimentation, challenging groupthink and research utilisation. In this article we explore whether CRD aspects change over time, through a study of two dialogues each from six different communities of veterinary health professionals. Change was studied from the perspective of observations, through analysing transcripts of dialogues, and from the perspective of community members’ perceptions, through an evaluative discussion with members. The results showed that some communities became more open about mistakes, a finding that is related to an increase in trust. Other observed aspects of CRD seemed to be fairly stable over time. Community members perceived research utilisation and asking for and giving feedback to have been increased. From an analysis of perceptions of the community members it emerged that limited interaction could be associated with the epistemological conceptions of community members.

Developing an Online Professional Network for Veterinary Education: The NOVICE Project

An online professional network for veterinarians, veterinary students, veterinary educationalists, and ICT (Information and Communication Technology) educationalists is being developed under the EU (European Union) Lifelong Learning Programme. The network uses Web 2.0, a term used to describe the new, more interactive version of the Internet, and includes tools such as wikis, blogs, and discussion boards. Focus groups conducted with qualified and student veterinarians within the projects five founding countries (The Netherlands, Germany, United Kingdom, Hungary, Romania) demonstrated that online professional communities can be valuable for accessing information and establishing contacts. Online networks have the potential to overcome common challenges to face-to-face communities-such as distance, cost, and timing-but they have their own drawbacks, such as security and professionalism issues. The Network Of Veterinary ICt in Education (NOVICE) was developed using Elgg, an open-source, free social networking platform, after several software options had been considered. NOVICE aims to promote the understanding of Web 2.0, confidence to use social software tools, and participation in an online community. Therefore, the Web site contains help sections, Frequently Asked Questions, and access to support from ICT experts. Five months after the networks launch (and just over one year into the project) 515 members from 28 countries had registered. Further research will include analysis of a core groups activities, which will inform ongoing support for and development of informal, lifelong learning in a veterinary context.

Informal and formal learning of general practitioners

Purpose The purpose of this study is to understand the influence of formal learning from a web-based training and informal (workplace) learning afterwards on the behaviour of general practitioners (GPs) with respect to prescription of antibiotics. Design/methodology/approach To obtain insight in various learning processes, semi-structured interviews were conducted with 19 GPs. These interviews were transcribed and analysed with a theory-based template, that had been defined beforehand, but with an open mind for emerging themes. Findings The web-based training was perceived by GPs to change their prescription behaviour, mostly as a result of informal learning processes. Being a research participant and being a supervisor appeared to create most opportunities for informal learning. Practical implications The current research shows that being a research participant and/or a supervisor enhance informal learning activities, for example, reflection and social interaction, and thereby formal training becomes more effective. It is recommended to remind GPs regularly to reflect on their prescribing behaviour and to stimulate them to reflect and seek social interaction besides participating in formal training. Originality/value Our study adds to the existing literature by considering informal learning processes in an evaluation of the perceived effects of formal training. Our findings have implications for the design and evaluation of formal trainings with the purpose of behavioural change of doctors.

Factors Related to Physician Clinical Decision-Making for African-American and Hispanic Patients: a Qualitative Meta-Synthesis

Clinical decision-making may have a role in racial and ethnic disparities in healthcare but has not been evaluated systematically. The purpose of this study was to synthesize qualitative studies that explore various aspects of how a patient’s African-American race or Hispanic ethnicity may factor into physician clinical decision-making. Using Ovid MEDLINE, Embase, and Cochrane Library, we identified 13 manuscripts that met inclusion criteria of usage of qualitative methods; addressed US physician clinical decision-making factors when caring for African-American, Hispanic, or Caucasian patients; and published between 2000 and 2017. We derived six fundamental themes that detail the role of patient race and ethnicity on physician decision-making, including importance of race, patient-level issues, system-level issues, bias and racism, patient values, and communication. In conclusion, a non-hierarchical system of intertwining themes influenced clinical decision-making among racial and ethnic minority patients. Future study should systematically intervene upon each theme in order to promote equitable clinical decision-making among diverse racial/ethnic patients.

Intraprofessional collaboration and learning between specialists and general practitioners during postgraduate training: a qualitative study

BackgroundDuring postgraduate training, general practitioners and other specialists must learn how to deliver shared care to patients; however, the development of formal intraprofessional education is often hampered by curricular constraints. Delivering shared care in everyday work provides trainees with opportunities for informal learning from, about and with one another.MethodsTwelve semi-structured interviews were undertaken with trainee general practitioners and specialists (internal medicine or surgery). A thematic analysis of the input was undertaken and a qualitative description developed.ResultsTrainees from different disciplines frequently interact, often by telephone, but generally they learn in a reactive manner. All trainees are highly motivated by the desire to provide good patient care. Specialist trainees learn about the importance of understanding the background of the patient from GPs, while GP trainees gain medical knowledge from the interaction. Trainees from different disciplines are not very motivated to build relationships with each other and have fewer opportunities to do so. Supervisors can play an important role in providing intraprofessional learning opportunities for trainees.ConclusionsDuring postgraduate training, opportunities for intraprofessional learning occur, but there is much room for improvement. For example, supervisors could increase the involvement of trainees in collaborative tasks and create more awareness of informal learning opportunities. This could assist trainees to learn collaborative skills that will enhance patient care.

Parents’ attitudes and views regarding antibiotics in the management of respiratory tract infections in children: a qualitative study of the influence of an information booklet

Background Respiratory tract infection (RTI) is the most common reason to consult a GP during childhood, and often results in unnecessary prescribing of antibiotics. Using an information booklet during the consultation has been shown to be a promising tool to reduce antibiotic prescribing. The influence of such information on parents’ views, knowledge, and expectations has not been investigated yet. Aim To explore the reported attitude and knowledge of parents towards antibiotics and management of childhood RTI, as well as the added influence of an information booklet, as perceived by parents. Design & setting Qualitative interviews were conducted with Dutch parents who consulted the GP with their child for RTI symptoms and received an information booklet. Method Semi-structured interviews were audio-recorded, transcribed, coded, and analysed using framework analysis by open-axial coding and describing themes. Results Eighteen parents were interviewed. Four themes were identified: prior reticence towards antibiotics; expectations of the consultation and trust in the GPs’ treatment decision; confirmation and reassurance by the booklet; self-management and future consultation intentions. Dutch parents felt reassured and more confident about their pre-existing reticent attitude towards antibiotic treatment; therefore, they thought their opinion and attitude had not really been changed by the booklet. Conclusion In a low-prescribing country like the Netherlands, information should focus on enhancing self-efficacy and providing concrete safety-netting advice. For other countries with less reticence towards antibiotics, it is recommended that the knowledge, attitude, and perceptions of the population is studied, in order to be able to tailor interventions.

Learning of veterinary professionals in communities: a thesis report.

Veterinary professionals can improve on how they continue learning through critically reflective work behaviour in communities. In this way participation in communities might support the transition to evidence-based practice.

Een conversatieanalyse van triagegesprekken

SamenvattingInleiding Triagisten op huisartsenposten voeren triagegesprekken met behulp van de Nederlandse Triage Standaard (NTS), die hen helpt vast te stellen wat de medische urgentie van de hulpvraag van de beller is. In de praktijk heerst het idee dat de NTS over- en ondertriage in de hand werkt. Afhankelijk van de manier waarop de gebruiker met de NTS omgaat kan de vraagstellingstructuur leiden tot een defensieve urgentiebepaling of tot het missen van relevante informatie.Methode Conversatieanalyse is een methode waarmee vanuit talig perspectief de effectiviteit van triagegesprekken kan worden onderzocht. Uit deze vorm van analyse blijkt dat de veiligheid en doelmatigheid van triage niet alleen worden bepaald door de vragen die triagisten stellen, maar ook door de manier waarop zij dit doen en hoe deze vraagstelling van invloed is op de reactie van de beller. De NTS spoort triagisten aan om de beller voortdurend te vragen een keuze te maken tussen opties, waarbij de ene optie leidt tot een hogere urgentie dan de andere. Triagisten formuleren deze opties door middel van een ‘of-vraag’: ‘Is de pijn drukkend, of stekend, of heel scherp?’Resultaten Uit de analyse blijkt dat bepaalde ‘of-vragen’ effectiever zijn dan andere. Een conversatieanalyse van de effectiviteit van de communicatie tijdens triagegesprekken levert kennis op waarmee we de kwaliteit van de triagegesprekken kunnen vergroten.Conclusie Op grond van ons onderzoek bevelen we triagisten aan aanvullende communicatietrainingen te volgen.