Peter Musaeus

The semiosis of family conflict: A case study of home-based psychotherapy

This is a case study of a blended family undergoing home-based psychotherapy. The study uses sociocultural theory (Vygotsky) and semiotic cultural psychology (Valsiner) in order to understand the appropriation and usage of signs as regulators of behavior. Furthermore, the article draws upon Foucault’s genealogical approach and Rose’s notion of Psydiscourse. It is argued that this approach is fruitful for understanding psychotherapy as a governing discourse that influences contemporary families. Technologies of the self, such as psychotherapy and signs like ‘time-out’ and ‘stop,’ are used by family members in attempts to break a cycle of conflict—violence but they also exacerbate negative emotions, which we see in the case of conflict. The article develops a critique of the practice of punishment and reward. By analyzing psychotherapy as signs and technologies of the self impacting family life, we start understanding the barriers to well-being in families and individual lives.

The paediatric change laboratory: optimising postgraduate learning in the outpatient clinic

BackgroundThis study aimed to analyse and redesign the outpatient clinic in a paediatric department. The study was a joint collaboration with the doctors of the department (paediatric residents and specialists) using the Change Laboratory intervention method as a means to model and implement change in the outpatient clinic. This study was motivated by a perceived failure to integrate the activities of the outpatient clinic, patient care and training of residents. The ultimate goal of the intervention was to create improved care for patients through resident learning and development.MethodsWe combined the Change Laboratory intervention with an already established innovative process for residents, 3-h meetings. The Change Laboratory intervention method consists of a well-defined theory (Cultural-historical activity theory) and concrete actions where participants construct a new theoretical model of the activity, which in this case was paediatric doctors’ workplace learning modelled in order to improve medical social practice. The notion of expansive learning was used during the intervention in conjunction with thematic analysis of data in order to fuel the process of analysis and intervention.ResultsThe activity system of the outpatient clinic can meaningfully be analysed in terms of the objects of patient care and training residents. The Change Laboratory sessions resulted in a joint action plan for the outpatient clinic structured around three themes: (1) Before: Preparation, expectations, and introduction; (2) During: Structural context and resources; (3) After: Follow-up and feedback. The participants found the Change Laboratory method to be a successful way of sharing reflections on how to optimise the organisation of work and training with patient care in mind.ConclusionsThe Change Laboratory approach outlined in this study succeeded to change practices and to help medical doctors redesigning their work. Participating doctors must be motivated to uncover inherent contradictions in their medical activity systems of which care and learning are both part. Facilitators must be willing to spend time analysing both historical paediatric practice, current data on practice, and steer clear of organisational issues that might hamper a transformative learning environment. To ensure long-term success, economical and organisational resources, participant buy-in and department leadership support play a major role.

Clinical Positioning Space Residents’ Clinical Experiences in the Outpatient Oncology Clinic

In this article, we present a case study of residents’ clinical experiences and communication in outpatient oncology consultations. We apply positioning theory, a dynamic alternative to role theory, to investigate how oncology residents and patients situate themselves as persons with rights and duties. Drawing from seven qualitative interviews and six days of observation, we investigate the residents’ social positioning and their conversations with patients or supervisors. Our focus is on how (a) relational shifts in authority depend on each situation and its participants; (b) storylines establish acts and positions and narratively frame what participants can expect from a medical consultation viewed as a social episode; and (c) the positioning of rights and duties can lead to misunderstandings and frustrations. We conclude that residents and patients locate themselves in outpatient conversations as participants who jointly produce and are produced by patients’ and nurses’ storylines about who should take responsibility for treatment.

Building an environmentally accountable medical curriculum through international collaboration

Abstract Background: Global environmental change is associated with significant health threats. The medical profession can address this challenge through advocacy, health system adaptation and workforce preparedness. Stewardship of health systems with attention to their environmental impacts can contribute to mitigation of and adaptation to negative health impacts of environmental change. Medical schools have an integral role in training doctors who understand the interdependence of ecosystems and human health. Yet integrating environmental perspectives into busy medical curricula is not a simple task. Content: At the 2016 Association for Medical Education in Europe conference, medical educators, students and clinicians from six continents discussed these challenges in a participatory workshop. Here we reflect on emerging themes from the workshop and how to plan for curricular change. Firstly, we outline recent developments in environmental health and associated medical education. Secondly, we reflect on our process and outcomes during this innovative approach to international collaboration. Thirdly, we present learning objectives which cover core content for environmentally accountable medical curricula, developed through a reflective process of international collaboration integrating current literature and the workshop outcomes. Conclusions: International collaboration can bring together diverse perspectives and provide critical insights for the inclusion of environmental health into basic education for medical practitioners.

Proto-computational Thinking: The Uncomfortable Underpinnings

The idea of computational thinking (CT) has resulted in widespread action at all levels of the American educational system. Some action focuses on programming, some on cognition, and some on physical action that is seen as embodying computational thinking concepts. In a K–12 educational context, the observation that computing is usually about some non-computational thing can lead to an approach that integrates computational thinking instruction with existing core curricular classes. A social justice argument can be made for this approach, because all students take courses in the core curriculum.

Designing in situ simulation in the emergency department: evaluating safety attitudes amongst physicians and nurses

BackgroundThis intervention study aimed to enhance patient safety attitudes through the design of an in situ simulation program based on a needs analysis involving thematic analysis of patient safety data and short-term ethnography. The study took place at an Emergency Department (ED) in the Central Region of Denmark. Research suggests that poor handover communication can increase the likelihood of critical incidents and adverse events in the ED. Furthermore, simulation is an effective strategy for training handover communication skills. Research is lacking, however, on how to use patient safety data and a needs analysis to the design of in situ simulation communication training.MethodsThis is a prospective pre-post study investigating the interventional effects of in situ simulation. It used a three-pronged strategy: (1) thematic analysis of patient safety data consisting of reported critical incidents and adverse events, (2) a needs analysis based on short-term ethnography in the ED, and (3) pre-post evaluation using the validated Safety Attitudes Questionnaire (SAQ) and the Trainee Reactions Score.ResultsSixteen different healthcare teams participated composed by 9 physicians and 30 nurses. In the SAQ, participating staff scored their safety attitudes in six categories (n = 39). Two measures where significantly higher for the post-SAQ than those for the pre-SAQ: teamwork climate (p < 0.001) and safety climate (p < 0.05). The Trainee Reactions Score showed that the training was positively evaluated.ConclusionsThis study designed a feasible strategy for implementing in situ simulation based on a needs analysis of critical incidents and adverse events and short-term ethnography.

A mixed methods observational simulation-based study of interprofessional team communication

Background Interprofessional team communication has been identified as an important focus for safety in medical emergency care. However, in-depth insight into the complexity of team communication is limited. Video observational studies might fill a gap in terms of understanding the meaning of specific communication interactions and link team performance to patient outcome. This study had two aims. First, to develop a theorybased evaluation instrument that measures and qualifies team communication. And second, to investigate the quality and content of summaries and re-evaluations evolving step wise and progressively when treating the critically ill patient.

E-collaborating for Environmentally Sustainable Health Curricula

Purpose This chapter aims to demonstrate how medical educators can use e-collaborative tools to collaborating internationally and cross-institutionally towards designing environmental sustainability and health (ESH) education. The main focus of the chapter is on sustainable medical curricula.

Emotions and clinical learning in an interprofessional outpatient clinic: a focused ethnographic study

ABSTRACT During the last decade, there has been a growing recognition that emotions can be of critical importance for students’ learning and cognitive development. The aim of this study was to investigate the self-reported and the observed relationship of: activity-, outcome-, epistemic-, and social emotions’ role in students’ learning in a clinical interprofessional context. We conducted a focused ethnography study of medical and nursing students’ clinical placement in an interprofessional orthopaedic outpatient clinic where the students performed consultations with patients, together. We used content analysis to analyse observational notes and interviews. Two themes were identified. First self-regulated learning with two sub-themes: unexpected incident and reflection. The second theme was cooperative learning with three sub-themes: equality, communication, and role distribution. Participants only reported activating emotions. Negative emotions often occurred when the students together experienced an incongruity between their cognitive capability and the type of task. However, because of the possibility for students to call for a supervisor, the negative activating emotions often, in connection with reflection on the incident, resulted in a positive emotion due to the students’ awareness of having acquired new knowledge and capability, and thereby, learning. It is important to be aware of the close interplay between emotions and clinical learning in an interprofessional context. The learning environment must include easy access for supervision.

The effects of graduate competency-based education and mastery learning on patient care and return on investment: a narrative review of basic anesthetic procedures

BackgroundDespite the widespread implementation of competency-based education, evidence of ensuing enhanced patient care and cost-benefit remains scarce. This narrative review uses the Kirkpatrick/Phillips model to investigate the patient-related and organizational effects of graduate competency-based medical education for five basic anesthetic procedures.MethodsThe MEDLINE, ERIC, CINAHL, and Embase databases were searched for papers reporting results in Kirkpatrick/Phillips levels 3–5 from graduate competency-based education for five basic anesthetic procedures. A gray literature search was conducted by reference search in Google Scholar.ResultsIn all, 38 studies were included, predominantly concerning central venous catheterization. Three studies reported significant cost-effectiveness by reducing infection rates for central venous catheterization. Furthermore, the procedural competency, retention of skills and patient care as evaluated by fewer complications improved in 20 of the reported studies.ConclusionEvidence suggests that competency-based education with procedural central venous catheterization courses have positive effects on patient care and are both cost-effective. However, more rigorously controlled and reproducible studies are needed. Specifically, future studies could focus on organizational effects and the possibility of transferability to other medical specialties and the broader healthcare system.