Håkan Hult

From Senior Student to Novice Worker : Learning Trajectories in Political Science, Psychology and Mechanical Engineering

This longitudinal study focuses on the transition from higher education to working life. Research has hitherto described the transition in rather general terms, and there is still only limited knowledge about how graduates construe themselves as professionals, or how they experience the transition to the sociocultural contexts of working life. In this study, the transition is viewed as a trajectory between different communities of practice. Three different Master’s programmes at Linköping University are focused on and compared: political science, psychology and mechanical engineering. The specific aims are to: (i) identify aspects of identity and knowledge formation as reported by informants, both as senior students and later as novice workers with 18 months of work experience; (ii) identify features of discourses of knowledge and competence operating in the programmes and working life; and (iii) to relate the results to differences in the way the programmes are designed. The results indicate that the psychology programme prepares for working life in a rational way, that is, the generic skills and substantive knowledge acquired seem to correspond to the demands of professional work. The other programmes stand out as preparing for working life either by providing generic skills that need to be transformed in professional work, or by containing elements that mainly play a ritual role rather than corresponding to the demands of working life.

A phenomenographic approach to research in medical education.

Context  Phenomenography is a qualitative approach to research which has revolutionised the way that researchers and teachers think about the processes and outcomes of learning in higher education. Phenomenography has also been used successfully in medical and health care research for the last 20 years. Phenomenography provides a lens through which to view certain types of research question. It also provides direction for how to empirically carry out the research.

Virtual patient simulation for learning and assessment: Superior results in comparison with regular course exams

Background: Our study aimed to observe the differences in assessment results between virtual patient simulation (VPS) and regular course exams in an Internal Medicine course for undergraduate medical students. Methods: Four cohorts of students (n = 216) used: a VPS or lectures for learning (terms 1 and 2); VPS and lectures or only lectures (term 3); and a paired set-up with both VPS and lectures (term 4). The assessment results, measured with both a VPS-based exam and a paper-based exam, were compared. A scoring rubric (0–6), developed and validated for the purpose of the trial, was applied to both types of assessment. Mean score differences of the results were compared for the four cohorts. Results: Both VPS and regular examination results were significantly higher in the VPS group compared to regular exam group (p < 0.001) in terms 1, 2 and 3. The paired mean difference in term 4 was 0.66 (95% confidence interval (CI) 0.50, 0.83; p < 0.001) for haematology and 0.57 (95% CI 0.45, 0.69; p < 0.001) for cardiology. Conclusion: Our findings suggest that using VPS both for learning and for assessment supports learning. VPS are better than traditional assessment methods when the virtual application is used for both learning and evaluation.

Exploring formative assessment as a tool for learning: students’ experiences of different methods of formative assessment

This study aims to provide a greater insight into how formative assessments are experienced and understood by students. Two different formative assessment methods, an individual, written assessment and an oral group assessment, were components of a pathology course within a medical curriculum. In a cohort of 70 students, written accounts were collected from 17 students and group interviews were carried out to explore the students’ experiences of these two forms of assessment. All students were engaged in both assessment methods, which were conducted a few weeks apart, and data were collected soon after each assessment. Our findings suggest that formative assessments motivate students to study, make them aware of what they have learned and where they need to study more. Thus, formative assessment can act as a tool for learning, contributing to the process and outcomes of learning. A closer look at students’ experiences of each form of assessment reveals interesting differences.

The anatomy of learning anatomy

The experience of clinical teachers as well as research results about senior medical students’ understanding of basic science concepts has much been debated. To gain a better understanding about how this knowledge-transformation is managed by medical students, this work aims at investigating their ways of setting about learning anatomy. Second-year medical students were interviewed with a focus on their approach to learning and their way of organizing their studies in anatomy. Phenomenographic analysis of the interviews was performed in 2007 to explore the complex field of learning anatomy. Subjects were found to hold conceptions of a dual notion of the field of anatomy and the interplay between details and wholes permeated their ways of studying with an obvious endeavor of understanding anatomy in terms of connectedness and meaning. The students’ ways of approaching the learning task was characterized by three categories of description; the subjects experienced their anatomy studies as memorizing, contextualizing or experiencing. The study reveals aspects of learning anatomy indicating a deficit in meaningfulness. Variation in approach to learning and contextualization of anatomy are suggested as key-elements in how the students arrive at understanding. This should be acknowledged through careful variation of the integration of anatomy in future design of medical curricula.

Virtual patient simulation: Knowledge gain or knowledge loss?

Background: Virtual patients (VPs), high-fidelity simulators and standardized patients are powerful educational interventions leading to effective learning and supporting knowledge retention. Aim: This study explored the variations in retention with VP versus regular learning activities. Method: We conducted a randomized controlled study on early and delayed assessment results of 49 students using VP for learning and examination of haematology and cardiology topics in an Internal Medicine course, by means of a 0–10 scoring rubric. Results: The mean difference for early assessment with VP (study – control mean score) was 1.43 (95% confidence interval (CI) 0.96, 1.91; p < 0.001) for haematology and 1.34 (95% CI 0.93, 1.76; p < 0.001) for cardiology. In regular exams, the mean score difference was 2.21 (95% CI 1.3, 3.1; p < 0.001) and 1.52 (95% CI 0.76, 2.28; p < 0.001), respectively. With delayed assessments, the difference in mean score for Web-SP was 1.48 (95% CI 1.09, 1.86; p < 0.001), haematology and 1.16 (95% CI 0.74, 1.58; p < 0.001), cardiology; for regular exams the figures were 1.96 (95% CI 0.93, 2.98; p < 0.001) and 1.74 (95% CI 0.89, 2.58; p < 0.001). The effect size ranged from 0.5 to 0.8. Conclusion: Our results indicate better retention with VP than with traditional learning methods.

What does it mean to be a good teacher and clinical supervisor in medical education

The aim of this study was to describe the different ways medical teachers understand what constitutes a good teacher and a good clinical supervisor and what similarities and differences they report between them. Data was gathered through interviews with 39 undergraduate teachers at a medical university. The transcripts were analysed using a phenomenographic approach. Three categories regarding what it means to be a good teacher and clinical supervisor respectively were identified. Similarities between the two hierarchies were seen with the most inclusive categories of understanding what it means to be a good teacher or supervisor focuses on students’ learning or growth. In the third category a good teacher and supervisor is seen as someone who conveys knowledge or shows how things are done. However, the role of being a clinical supervisor was perceived as containing a clearer focus on professional development and role modelling than the teacher role did. This is shown in the middle category where a good clinical supervisor is understood as a role model and someone who shares what it is like to be a doctor. The middle category of understanding what it means to be a good teacher instead focussing on the teacher as someone who responds to students’ content requests in a partially student-centred perspective. In comparing the ways individual respondents understood the two roles, this study also implies that teachers appear to compartmentalise their roles as teachers and clinical supervisors respectively.

Being a mentor for undergraduate medical students enhances personal and professional development

Background: There is increasing evidence of the positive effects of mentoring in medical undergraduate programmes, but as far as we know, no studies on the effects for the mentors have yet been described in the field of medicine. Aim: This study aims to evaluate an undergraduate mentor programme from the mentors’ perspective, focusing particularly on the effect of mentorship, the relationships between mentoring and teaching and the mentors’ perceived professional and personal development. Methods: Data was gathered through a questionnaire to all 83 mentors (response rate 75%) and semi-structured interviews with a representative sample of 10 mentors. Results: Findings show, for example, that a majority of respondents developed their teaching as a result of their mentorship and improved their relations with students. Most respondents also claimed that being a mentor led to an increased interest in teaching and increased reflections regarding their own values and work practices. Conclusion: Being a mentor was perceived as rewarding and may lead to both personal and professional development.

Clinical reasoning in nursing, a think-aloud study using virtual patients - A base for an innovative assessment

In health-care education, it is important to assess the competencies that are essential for the professional role. To develop clinical reasoning skills is crucial for nursing practice and therefore an important learning outcome in nursing education programmes. Virtual patients (VPs) are interactive computer simulations of real-life clinical scenarios and have been suggested for use not only for learning, but also for assessment of clinical reasoning. The aim of this study was to investigate how experienced paediatric nurses reason regarding complex VP cases and how they make clinical decisions. The study was also aimed to give information about possible issues that should be assessed in clinical reasoning exams for post-graduate students in diploma specialist paediatric nursing education. The information from this study is believed to be of high value when developing scoring and grading models for a VP-based examination for the specialist diploma in paediatric nursing education. Using the think-aloud method, data were collected from 30 RNs working in Swedish paediatric departments, and child or school health-care centres. Content analysis was used to analyse the data. The results indicate that experienced nurses try to consolidate their hypotheses by seeing a pattern and judging the value of signs, symptoms, physical examinations, laboratory tests and radiology. They show high specific competence but earlier experience of similar cases was also of importance for the decision making. The nurses thought it was an innovative assessment focusing on clinical reasoning and clinical decision making. They thought it was an enjoyable way to be assessed and that all three main issues could be assessed using VPs. In conclusion, VPs seem to be a possible model for assessing the clinical reasoning process and clinical decision making, but how to score and grade such exams needs further research.

Students' experiences of learning manual clinical skills through simulation.

Learning manual skills is a fundamental part of health care education, and motor, sensory and cognitive learning processes are essential aspects of professional development. Simulator training has been shown to enhance factors that facilitate motor and cognitive learning. The present study aimed to investigate the students’ experiences and thoughts about their learning through simulation skills training. The study was designed for an educational setting at a clinical skills centre. Ten third-year undergraduate nursing students performed urethral catheterisation, using the virtual reality simulator UrecathVision™, which has haptic properties. The students practised in pairs. Each session was videotaped and the video was used to stimulate recall in subsequent interviews. The interviews were analysed using qualitative content analysis. The analysis from interviews resulted in three themes: what the students learn, how the students learn, and the simulator’s contribution to the students’ learning. Students learned manual skills, how to perform the procedure, and professional behaviour. They learned by preparing, watching, practising and reflecting. The simulator contributed by providing opportunities for students to prepare for the skills training, to see anatomical structures, to feel resistance, and to become aware of their own performance ability. The findings show that the students related the task to previous experiences, used sensory information, tested themselves and practised techniques in a hands-on fashion, and reflected in and on action. The simulator was seen as a facilitator to learning the manual skills. The study design, with students working in pairs combined with video recording, was found to enhance opportunities for reflection.