Terese Stenfors-Hayes

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.

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.

Developing Medical Teachers' Thinking and Practice: Impact of a Staff Development Course.

This paper explores the impact of a staff development course on medical teachers’ thinking and practice. Data have been gathered through 19 semi‐structured interviews with participants on the course one year after their participation. The analysis of the data shows that the course seems to have contributed to changes in the participants’ approaches to teaching and learning, as well as their practice. The changes reported range from using new teaching techniques or tools, to fundamentally transformed views on learning and, thereby, on being a teacher. The findings are compared to previous studies in the field, and the strategic function of staff development courses as a means to support educational development is discussed.

How clinical supervisors develop trust in their trainees: a qualitative study

Clinical supervisors oversee trainees’ performance while granting them increasing opportunities to work independently. Although the factors contributing to supervisors’ trust in their trainees to conduct clinical work have been identified, how the development of trust is shaped by these factors remains less clear.

Mentoring medical students during clinical courses: a way to enhance professional development.

Background: Mentoring is known to develop professional attributes and facilitate socialization into a profession. Only a few structured mentoring programmes for medical students have been reported in the literature. Aim: The objective of this study was to investigate undergraduate medical students’ experiences and perceptions of one-to-one mentoring and whether they felt that the mentorship promoted their personal and professional development. Methods: Medical students (n = 118) during their third and fourth years of their studies were offered a personal mentor for 2 years and followed up via a questionnaire when the mentoring programme was completed. Statistical software was used to compute data. Open-ended questions were analyzed by content analysis. Results: Most of the respondents experienced that the mentoring programme had facilitated their professional and personal development. The role of the mentor was experienced as being more supportive than supplying knowledge. The students appreciated talking to a faculty not connected with their courses. The few barriers to a successful mentorship were mainly related to timing logistics and ‘personal chemistry’. Conclusions: One-to-one mentoring during clinical courses seems to enhance the medical students professional and personal development. Future studies are needed to get a deeper understanding and knowledge about factors of importance for successful mentorship.

Lifelong learning for all? Policies, barriers and practical reality for a socially excluded group

Lifelong learning is recognized as an important tool to reduce social exclusion, but out of the many investigations into the provision of lifelong learning in Europe none has yet sought to examine the specific situation of mental health care service users. This study examines the provision of lifelong learning for this disadvantaged group; it identifies current policies and explores the access to, and nature of, lifelong learning practices for mental health care service users in eight European countries. Data have been collected through a literature and policy review and through questionnaires completed by mental health practitioners in the eight countries. The study found broad compliance amongst the eight countries with the Lisbon policy goals on lifelong learning, but evidence of specific lifelong learning provision for mental health care service users is patchy and sporadic. The study identified the main benefits of, and the barriers to, the participation in lifelong learning for mental health care service users from the viewpoint of mental health professionals and practitioners. The implications for practice were described, and suggestions for actions were made for improving the lifelong learning provision for the target group.

Development of a framework of medical undergraduate teaching activities.

Context  The need for a comprehensive framework of teaching activities in undergraduate medical education was identified by colleagues involved in teacher training at the University of Edinburgh, UK and Karolinska Institutet, Sweden. Such a framework could be used to develop training programmes for medical teachers, to help experienced teachers to reflect upon and communicate with others about their practice, and as a focus for further research on medical teaching.

What does it mean to be a mentor in medical education

Background: Mentor programmes are becoming increasingly common in undergraduate education. However, the meaning attached to being a mentor varies significantly. Aim: The aim of this study is to explore how teachers in medical and dental education understand their role as mentors. Method: Twenty mentors in two different mentor programmes for undergraduate medical and dental students were interviewed. The transcripts were analysed using a phenomenographic approach. Results: The findings comprise three qualitatively different ways of understanding what it means to be a mentor, which are described as: (1) a mentor is someone who can answer questions and give advice, (2) a mentor is someone who shares what it means to be a doctor/dentist, and (3) a mentor is someone who listens and stimulates reflection. The way the mentors understood their role also affected what they did as mentors, their relationships with their mentees and their perceived benefits as mentors. Conclusions: Being a mentor can be perceived in qualitatively different ways also within the same mentor programme. This understanding affects the mentors’ actions, their relationships with their mentees and their perceived benefits of being a mentor. Awareness of ones own understanding is important in improving practices and the findings of this study can be used by mentors, teachers and educational developers to facilitate improved effectiveness in mentor programmes, both for mentors and mentees.

The “Handling” of power in the physician-patient encounter: perceptions from experienced physicians

BackgroundModern healthcare is burgeoning with patient centered rhetoric where physicians “share power” equally in their interactions with patients. However, how physicians actually conceptualize and manage their power when interacting with patients remains unexamined in the literature. This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians. It is necessary to examine physicians’ awareness of power in the context of modern healthcare that espouses values of dialogic, egalitarian, patient centered care.MethodsThirty physicians with a minimum five years’ experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul’s three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu’s social theory served as analytic tools for achieving an understanding of physicians’ perceptions of power in their interactions with patients.ResultsThe analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians’ responses fell under three broad categories: (1) Perceptions of holding and managing power, (2) Perceptions of power as waning, and (3) Perceptions of power as non-existent or irrelevant.ConclusionsAlthough the “sharing of power” is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.