Search

Background: In addition to providing patient care, interprofessional health care teams work collaboratively on a variety of projects. These projects often benefit from using facilitated small group project discussion sessions, such as the Harvard Macy Institute's (HMI) Step Back Process (SBP). Although having a trained facilitator is an important component of the SBP, only a limited number of health care professionals can attend HMI courses in person or virtually, limiting its impact., Approach: We developed three video-based education (VBE) modules to deliver facilitator training on the SBP, informed by principles of Mayer's cognitive theory of multimedia learning. For module development, we used a five-step approach. We evaluated effectiveness of the modules as a self-directed method to enhance SBP facilitator training. An initial survey collected demographic data and module feedback, a follow-up survey collected feedback on the modules' impact on facilitation and interviews focused on the participants' overall experience., Evaluation: Survey results indicated that the modules were positively received and helped to improve participant confidence in facilitating. We identified four themes from the interviews: challenges of facilitating, value of group feedback, value of modules for experienced facilitators and the modules as part of a multi-modal approach to train new facilitators., Implications: This innovation provides insight on delivering facilitator training on the SBP using VBE. Health professions educators developing online facilitator training could adapt our development process and modify implementation guided by our results. Future work should evaluate the best methods to integrate VBE modules into a longitudinal virtual community and assess facilitation techniques., (© 2024 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Purpose: Although most teaching around feedback focuses on the delivery, one must consider that the word 'feedback' is not a neutral word. It inflicts a range of emotions that, when used, may influence the effectiveness of the feedback process. A more profound understanding of health professions educators' perceptions regarding the word 'feedback' can help explain discrepancies between the provision, reception and acceptance of feedback., Methods: This is a qualitative inductive, reflective thematic analysis study. The authors interviewed 22 health professions educators participating in an online workshop to develop their feedback giving skills on their initial perspectives of the word 'feedback'., Results: We found four major themes: (1) Can I tell you a little story about my feedback experience? (2) It is probably going to be negative. (3) There is always something to learn if you are willing to hear the message. (4) It is like getting a report card. From the data, we suggest one key antecedent and two practical approaches one could take when giving feedback., Conclusion: In this article, the authors highlight barriers during the feedback process due to the mere perception of the nature of feedback and the connotations associated with the term itself and suggest approaches that can refocus conversations towards a shared meaning and purpose of improvement, despite the preconceptions of the word 'feedback'., (© 2023 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Background: Teaching hospitals are fast-paced health care environments where clinical supervisors constantly balance teaching and patient care. Although hospital-based clinicians in acute care settings regularly teach trainees, views regarding their teaching roles and how this relates to professional satisfaction are less well studied. We explored perspectives of physicians who teach trainees in medical intensive care units (MICUs), to understand whether their engagement in teaching has any impact on professional (job) satisfaction., Methods: This qualitative study used focus groups of MICU fellows (postgraduate clinical trainees) and attending physicians (consultants) to explore participants' perceptions of their teaching roles. Focus groups were audiotaped and transcribed; thematic analysis was conducted on de-identified transcripts., Findings: Four focus groups were held; two with MICU attendings (n = 13) and two with MICU fellows (n = 12). We identified four key themes: two challenges of teaching (being a chameleon; calibrating learner abilities), one benefit of teaching (facilitating learners' eureka moments) and a call for professional development (peer coaching to enhance teaching skills)., Discussion: Although teaching in acute clinical environments requires balancing dynamic learner needs and complex patient care needs, participants found it highly rewarding. They called for peer coaching initiatives to enhance professional development as teachers and demonstrate departmental commitment to teaching., Conclusion: While teaching in acute clinical settings is challenging for many reasons, clinical teachers emphasise that it is very satisfying when learners see the 'light'. Overt institutional support and recognition for clinical teachers along with peer coaching and debriefing may tilt the balance towards the rewards side of the equation and foster professional satisfaction., (© 2023 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Clinical trainees experience several professional transitions throughout their career, which can be exciting, anxiety-provoking or both. The first to second post-graduate year (PGY) transition for residents (junior doctors) in North America involves assuming new roles such as team leader, clinical supervisor, and teacher, often with minimal preparation. We explored resident experiences and emotions during this transition, and obtained their strategies for navigating this transition, through the lens of Bridges' transition model. This model has three stages: (1) ending, losing and letting go, (2) the neutral zone and (3) the new beginning., Methods: We conducted one in-person focus group and subsequent one-on-one virtual semistructured interviews (due to COVID-19) of PGY-2 and PGY-3 residents who had previously undergone the transition. These sessions were recorded and transcribed, and thematic analysis was performed., Findings: Four residents participated in the focus group, and 14 participated in one-on-one interviews. We identified five key themes: (1) not just a cog in the wheel, (2) contributing to growth of near-peers, (3) being flexible and adaptive, (4) emulating resident role models and (5) relationships with attendings. Residents suggested a transitions-focused retreat, simulation training to lead clinical emergencies, supervised opportunities for PGY-1s to act as PGY-2s coached by senior residents, and pairing PGY-1s with senior residents to help prepare for the transition., Conclusion: Professional transitions are both anxiety-provoking and exciting. Clinical trainees need preparation to successfully navigate multiple transitions. The Bridges' transition model could be useful in conceptualising transitions and planning curricula., (© 2022 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Nurse-doctor collaborations are essential for team-based patient care. Although there are increasing calls for interprofessional education, teaching and learning together is rare. In 2019, we designed a Nurse-Doctor Co-Teaching pilot programme to provide an opportunity for nurses and doctors to co-teach junior doctors and nurses. We aimed to explore the experiences of the co-teachers and understand their perceptions of teaching together. The study was conducted through the lens of positioning theory., Methods: We held an hour-long focus group discussion and follow-up one-on-one interviews with nurses and doctors who participated as co-teachers. Conversations were audio-video recorded, transcribed, and thematically analysed. The Partners Institutional Review Board approved this study., Results: Three nurses and four doctors participated in the focus group conversation, and four nurses and two doctors participated in individual interviews. Participant narratives provided insight into shifts in hospital culture that would be necessary to promote effective interprofessional learning and collaboration: (1) break down professional silos, (2) invite the nursing perspective, (3) flatten professional hierarchies, and (4) recognise nurses as clinical teachers., Conclusion: Nurses and doctors felt they shared a collegial and equal partnership as co-teachers. But this relationship was not typical of their daily clinical roles. Institutional barriers presented challenges to collaboration on the hospital floor and nursing participation in teaching. Successful interprofessional education may require culture and policy shifts that formally recognise nurses as valuable clinical teachers., (© 2022 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Navigating serious illness conversations is a critical competency for clinical trainees in any discipline, yet many feel underprepared to engage in such conversations. This study explored the challenges and emotions experienced by residents (junior doctors) when approaching serious illness conversations and how their perceptions might inform the development of effective communication skills curricula., Methods: Using qualitative methodology, we explored the prior experience of Internal Medicine residents who attended communication skills workshops at Brigham and Women's Hospital between January and May 2020. Using an open-ended questionnaire, we solicited participants' reflections on conducting serious illness conversations. Narratives were de-identified and analysed for key themes. The Mass General Brigham Institutional Review Board approved the study., Findings: Fifty-one out of 70 eligible residents (72.8%) completed the questionnaire. Qualitative analysis identified five key themes: (a) finding the time to do it right, (b) fear of using the wrong words, (c) managing the patient's response and emotion, (d) not knowing how much they can say and (e) finding meaning and fulfilment. Residents also proposed several practical strategies to enhance their communication training., Discussion and Conclusion: Though serious illness conversations were reported as stressful, study participants emphasised that the experiences enabled them to forge meaningful therapeutic relationships and led to a sense of fulfilment. The strategies recommended by our residents offer valuable insights to improve communication training, including through increased simulated and real-time skills practice. Cocreation of curricula by trainees and faculty could potentially address trainees' challenges, promote essential skills, and foster professional identity formation., (© 2022 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Communities of practice foster knowledge sharing, scholarly collaboration, mentoring and professional identify formation. Easier access to technology overall and the desire to engage with peers during the pandemic have increased opportunities to engage in virtual global conversations., Approach: The Brigham Education Institute designed and implemented a series of six bimonthly, 1-hour 'Global Medical Education Cafés' between September 2020 and June 2021. They were offered on the Zoom platform and featured a core educational topic led by one or two discussants, followed by small group interactions surrounding specific questions or challenges. Discussants were selected based on their international reputation and recognition as health professions education scholars and leaders with expertise in specific areas. Each café was advertised through newsletters, social media, educational email lists and open to educators from any healthcare discipline or geographical region., Evaluation: Between 26 and 41 participants attended each session from 12 countries representing five continents. Content analysis of preliminary education evaluation data from chats and reflective narratives identified four key themes: (1) exciting interactive format; (2) sense of worldwide community; (3) safe space for conversations; and (4) strong moderators facilitating engaging peer conversations., Implications: The series leaders aimed to emphasise inclusive, non-hierarchical and cross-cultural conversations. Preliminary evaluation suggests that this goal was achieved; these will remain priorities in future series. Educators worldwide can organise similar events with minimal resources. A safe space for conversations and open-mindedness to learning from a variety of learning and societal cultures are likely essential elements for success., (© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Background: Transitions during medical training are a significant source of stress, and junior doctors (residents) primarily learn new skills through on-the-job training. As residents transition from postgraduate year (PGY) 1 to 2, they take on new responsibilities, including the management of clinically unstable patients in rapid response (RR) scenarios., Approach: In 2018, the internal medicine training programme at Brigham and Women's Hospital implemented a 'Transitions Retreat' to prepare PGY-1s for Year 2. In an informal survey, residents endorsed feeling underprepared to lead RRs. We designed a simulation-based curriculum to teach these skills. Participants completed a questionnaire pre-simulation and post-simulation exploring their perceived preparedness. Volunteer residents assessed performance on the simulation using skills checklists and led structured debriefing sessions. We audiotaped, transcribed and thematically analysed these sessions., Evaluation: Forty-eight of 58 (82%) PGY-1s participated. Pre-intervention, 12.5% felt 'well-prepared' or 'very well-prepared' to lead RRs, compared with 33% post-intervention. Through qualitative analysis, we identified four key themes in our post-simulation debriefing conversations: (1) the chaos of RRs, (2) emotional reactions during RRs, (3) challenges and goals of task management and (4) value of interdisciplinary collaboration., Implications: Though the majority of residents indicated that the curriculum enabled their preparedness to lead RRs and allowed them to process complex emotions in a safe space, we do not know how well this experience translates to the clinical setting. Therefore, we aim to collect follow-up data 6 months into the PGY-2 to explore residents' reflections on real-life experiences as well as whether the simulation impacted their preparedness to lead real-life RRs., (© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Background: Communities of practice (CoPs) are integral to professional identify formation (PIF) of educators. However, it can be challenging to identify and engage with such communities. Social media (SoMe) can facilitate formation of virtual CoPs, support PIF and increase visibility and recognition among peers. Yet, privacy concerns, lack of skills, time constraints and value doubts are reported barriers. The purpose of this study was to explore perceived benefits, challenges and suggested strategies to promote SoMe engagement from a group of health professions educators (HPEs)., Methods: Using qualitative methodology, we explored opinions of educators participating in Harvard Macy Institute courses regarding professional SoMe use through focus group discussions. Discussions were audiotaped and transcribed, and thematic analysis was performed. Brief questionnaires were distributed to collect frequency of and confidence in SoMe use; these data were analysed descriptively. The Partners Healthcare Institutional Review Board approved the study., Results: Forty-eight educators participated in six focus groups. About 93.8% had at least one professional SoMe account, although engagement frequency varied. Qualitative analysis revealed three themes: (1) challenges to engagement, including juggling commitments and feeling overwhelmed; (2) benefits to joining a community, including staying informed and sharing scholarship; and (3) strategies to encourage inclusion, including tailored training and institutional champions., Conclusion: Though challenges to engagement were reported, participants noted multiple benefits. SoMe engagement can foster virtual CoPs among HPEs and potentially contribute to PIF. Subsequently, we offer five recommendations for efficient and impactful social media engagement for healthcare professionals., (© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Clinical educators who wish to engage in scholarship in health professions' education (HPE), are ideally poised at the intersection of educational theories and their application to educational practice. However, the burden of clinical practice does not often allow the time and space for scholarly writing. Being part of a collaborative writing team, incorporating members with varying levels of expertise, from different health care professions, and at different stages of their career, can provide valuable opportunities for clinicians to contribute to scholarship. Such collaborations can also bridge the gap between scholarship and educational practice in clinical settings. In this paper, we emphasise the benefits of collaborative writing, describe challenges for clinical educators in starting writing projects, and identify potential solutions. We outline a systematic approach to collaborative writing grounded in literature and our own experiences. Three key concepts underpin the provided recommendations: types and standards for scholarship, leadership and followership and communities of practice. Psychological safety, mentoring and a growth mindset are emphasised as integral to successful team projects. Finally, we argue that collaborative writing groups in clinical education can be powerful communities of practice where the overall contribution to the field can be greater than the sum of its parts., (© 2021 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Background: Bedside teaching (BST), a time-honoured tradition of clinical teaching which integrates theoretical knowledge and clinical practice, has declined steeply over the last decade. Moreover, many clinician teachers today are not specifically trained in and/or comfortable in delivering effective BST. Resucitating this valuable educational format may require a new approach to preparing teachers and setting the stage for effective BST. Framing BST as an entrustable professional activity (EPA) for teachers may be one strategy to enhance its application and quality., Methods: We aimed to redefine, describe essential features and effective practices for high-quality BST, based on clinical teacher participant perspectives through a focus group discussion and open-ended questionnaires via e-mail, supplemented by insights from literature., Results: Based on data collected, we generated a definition of BST and a list of suggested strategies to optimise BST, for example, preparation, safe learning environment, flexible teaching and patient's benefits. A structured EPA description was created based on this definition., Conclusion: Effective BST requires skilled clinical teachers who are comfortable and confident in this mode of teaching; framing BST as a teaching EPA could guide faculty development and clinical teacher certification., (© 2021 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Background: Mastery of the physical exam (PE), and the ability to teach it to peers and medical students, are important milestones for residents (junior doctors); however, several reports indicate that PE skills are in decline. To address this need, we explored the use of peer observation of teaching (POT) as a conceptual framework to develop an innovative approach to PE teaching at the postgraduate medical education level., Innovation: We designed a PE POT session to be conducted at the patient bedside, and piloted four sessions in April 2014. Sessions involved a senior medicine resident teaching a focused PE to their team (consisting of two postgraduate first-year residents), while being observed by a peer, followed by feedback anchored in 11 validated measures of clinical teaching. The sessions were completed in 30-35 minutes and were enthusiastically received by residents. Participants valued the interactive approach and the opportunity to exchange feedback with a peer on their PE teaching skills., Implications: This pilot using POT methodology to teach the PE addressed mandatory core competencies related to patient care and practice-based learning and improvement. Residents gained insights on their PE teaching skills while interacting with their peers in a novel and reciprocal learning opportunity. This experience helped participants to value their role as PE teachers and generate strategies to change their teaching behaviours. Despite this being a small study, POT offers an innovative approach to teach the PE at the postgraduate level, with the potential to address the gap of PE teaching and learning. Several reports indicate that physical exam skills are in decline., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)