ExBL is applicable to both succeeding and failing students.
Moreover, it differs from interventions that are focused primarily on success in summative assessments. Rather, it addresses the learning skills needed to be effective workplace learners and practitioners. Teaching rather than learning strategies were dominant.
Those initiatives that did set out to make students more independent learners were focused on project or non-experiential components of undergraduate medical curricula. They highlighted the importance of contextualizing learner development to clinical workplace learning, but the means of doing so was beyond the scope of their review. Particularly relevant to this paper were a number of interventions that used education technology [ 28 , 29 ], learning logs or encounter cards [ 30 , 31 ], proformas to structure patient assessments [ 32 , 33 ], and the establishment of clinical teaching wards [ 34 ] to foster favourable interactions between learners and learning environments.
A limitation of many interventions was that they were contextually bound or addressed only very limited learning skills. What the present research adds to them is a generic and comprehensive model of workplace learning that could help make such interventions broader in their scope and provide a framework for evaluating them. This research indicates that ExBL has face validity in the eyes of students and provides a rich set of instances of various components of the model.
What it does not do is move beyond opening the black box of clerkship learning to show how to train faculty and students, or show how ExBL can contribute to curriculum design.
It can, however, help researchers develop testable hypotheses. ExBL is a complex model, according to which learning outcomes are caused by multiple interacting factors. Randomized controlled trials are of limited value in education research because they test simple rather than complex interventions so we favour using design-based or action research methodology to explore the application of ExBL. The focus of ExBL on learning emphasizes whole learning environments of which clinicians are part, rather than just doctors as teachers.
ExBL emphasizes the importance of formally welcoming students to learning environments and introducing them to staff. It emphasizes educational support, particularly when it addresses the affective as well as the cognitive dimension of learning. It argues for students to be treated respectfully as young professionals, rather than ignored or humiliated as was too often the case. It highlights the importance of clinical teachers acting as positive role models, who inspire students towards achieving excellence rather than just doing well enough to pass examinations.
The research also argues for the importance of good organization of placements with clear timetables and scheduled opportunities for students to participate in clinical practice, appropriate to their stage of development. To achieve and maintain high standards of clinical placements, a quality development strategy is also required.
In parallel with the research reported here, we have validated a measure of the quality of clinical learning environments [ 21 ], which makes it possible to measure how well they measure up to the criteria we have proposed and obtain formative, textual feedback for continuing quality development.
Medical students learn by supported participation in the activities of clinical workplaces. Positive emotions towards students and their learning are an important dimension of support. Learning theory can be used to help students and teachers understand how they learn in clinical workplaces. Her experiences as an undergraduate have stimulated her interest in medical teaching and learning and the role they play in shaping medical students.
Her research interests include transitions in medical education and community-based clinical learning. Her research interests include self-assessment and feedback, learning and learning theory. He is an education researcher specialising in the application of learning theory, qualitative methodology and systematic review to clinical workplace learning. Alexandra Hay, Email: ku.
Sarah Smithson, Email: ku. Karen Mann, Email: aC. National Center for Biotechnology Information , U. Journal List Perspect Med Educ v. Perspect Med Educ. Published online May 3. Author information Copyright and License information Disclaimer. Corresponding author. Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author s and the source are credited.
This article has been cited by other articles in PMC. Keywords: Clerkship education, Experience based learning, Qualitative analysis. Open in a separate window. Participants Third-year students, who are at the end of their first year of whole-time workplace learning, were chosen for the study because they have some clerkship experience but still need to develop their workplace learning skills, having only recently transitioned from the pre-clinical to the clinical phase of the programme.
Recruitment of student volunteers An announcement was posted on the medical undergraduate learning management system summarizing the study. Study design The study had two stages. Data analysis All researchers independently read all transcripts and reflective pieces, exchanged interpretations verbally and by email, and met repeatedly to discuss and synthesize the evolving interpretation.
Other affective outcomes Twelve reported outcomes were increased confidence and three were reduced confidence. Pedagogic support There were 44 positive and 15 negative statements about pedagogic support.
Strengths and limitations The preceding paragraph has highlighted the main threat to the validity of our findings. Relation to other publications In addition to the theories quoted earlier, our findings are consistent with the work of Illeris [ 23 ]. Implications for research This research indicates that ExBL has face validity in the eyes of students and provides a rich set of instances of various components of the model. Sarah Smithson is a general practitioner and clinical senior lecturer.
Contributor Information Alexandra Hay, Email: ku.
References 1. Educating physicians: a call for reform of medical school and residency.
San Francisco: Jossey Bass; Morris C, Blaney D. Work-based learning, Chapter 5. In: Swanwick T, editor. Understanding medical education: evidence, theory and practice.
Oxford: Wiley-Blackwell; London: General Medical Council; Frank JR, Danoff D. The bright, well-read, talented medical students who may lack humility are not uncommon. As such, healthcare institutions are strongly focusing on the patient-physician relationship and the patient experience. The editor-in-chief of Medscape, Dr. Eric Topol, visited Stanford to sit down and do an interview with our Dr. Vergese for the Medscape One-on-One online video series. Peter Conrad, a sociologist at Brandeis University, spoke of the rise and fall of the medical authority in the doctor patient office encounter in his many scholarly articles.
Abraham Verghese Interviews Dr. Jerome Kassirer on New Book Signs of Scleroderma can-improv-help-doctors conversation-about-bedside-medicine-gains-momentum. Stanford 25 Skills Symposium Announced! What will bedside manner look like for new data-driven physicians? What is Plummer-Vinson syndrome? What is the Sister Mary Joseph nodule?
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You can find out more about training pathways, medical specialties and foundation programmes on our sister site, The Medic Portal Professional! Providing experiences beyond hospital or clinic walls : Challenging students or residents to work with stakeholders outside of hospital or clinic-based health services could enhance understanding of the patient and consumer experience. Technology has uses in other arenas as well. Even if medical school curricula changed overnight, it would only be one step toward addressing the skills needed by all the practicing doctors. Individual Visits While we encourage everyone to come to one of our organised visits, we recognise that this is not always possible.
What is the ugly duckling sign? Diagnose this skin lesion with newest Stanford 25 video and topic. In particular, the study sought to gain an understanding of how junior doctors experienced the transition from the role of student to that of practising doctor and how well their medical school education had prepared them for this. All 31 participants were interviewed once and 17 were interviewed twice during the year. Ten of the participants also kept audio diaries. Interview and audio diary data were transcribed verbatim and thematically analysed with the aid of a qualitative data analysis software package.
Results The findings show that, despite recent curriculum reforms, most participants still found the transition stressful. However, the stress of transition was reduced by the level of clinical experience gained in the undergraduate years.
Patient safety guidelines present a major challenge to achieving this, although with adequate supervision the two aims are not mutually exclusive. Further support and supervision should be made available to junior doctors in situations where they are dealing with the death of a patient and on surgical placements. The transition from medical student to junior doctor has long been considered a significant rite of passage. Since the Flexner Report 5 first highlighted the need for change in medical education, reform to medical curricula has been ongoing.
During the past two decades in particular, in response to the fast pace of scientific developments and changing societal expectations and values, some radical reforms in education and training have taken place across the globe. An update of the guidelines in placed increasing emphasis on learning about the clinical realities faced by new doctors by stipulating the provision of opportunities for students to shadow junior doctors.
Reforms have also taken place in postgraduate training in the UK and have been introduced as a result of the new Modernising Medical Careers agenda. To this end, formal assessments to determine a range of skills competencies in the workplace have been introduced.
Our study shares some similarities in that it is also a qualitative study conducted in , but it differs in that we interviewed at different times during the year and also used an audio diary method. The latter provided our participants with the opportunity to tell of their experiences soon after they occurred and produced accounts that were immediate and captured the emotional ups and downs of clinical experiences. This study sought to uncover the experiences of these newly qualified doctors and to assess whether the changes to undergraduate and postgraduate education and training have resulted in a smoother transition from the role of medical student to that of trainee doctor.
Specifically, it sought to address the following questions. How are medical graduates experiencing the transition? How well prepared do they perceive themselves to be for their new role and the tasks involved? A stratified, purposive sampling strategy was adopted. The sample was stratified by medical school Peninsula Medical School graduates and graduates from other medical schools, although this aspect is not reported in this paper and by hospital site. The lead researcher travelled to each of the five hospital sites to recruit participants via study briefings in educational sessions.
Of the F1 doctors in the five hospitals, 31 participants 17 men and 14 women volunteered to participate. A minimum of four and a maximum of nine participants came forward at each of the five sites. Participants opting into the study gave their informed consent to participate in two rounds of interviews and to record audio diary entries for the length of the study. Interviews were subsequently arranged by members of the research team. We conducted 28 interviews during Round 1 and 20 in Round 2; 17 participants took part in both rounds of interviews.
Seven participated in both rounds of interviews and provided audio diary recordings. Ten audio diary recordings were collected in total. The purpose of the second interview was to identify any changes in experiences and attitudes. The same interview schedule was utilised on both occasions and interviews were conducted as guided conversations. This approach to interviewing encourages participants to speak on a limited number of topics on a focused, deep level whilst maintaining a conversational flow from one topic to another.
Participants were asked to record audio diary entries throughout the year to recount their experiences of the transition from student to junior doctor and to document any aspects of the programme that were going particularly well or not well and anything else they felt was relevant. Not all participants took part in both rounds of interviews; most apologised for this, stating that shift patterns and time constraints rather than disinterest had prevented their participation. Given their busy schedules, we were pleased that during the first round of interviews 28 of the 31 recruited participants were available for interview, as were 20 for the second round three participants were interviewed for the first time in Round 2.
The number of entries and length of recording varied considerably. Despite the low number of completed diaries, many of the data were extremely rich, providing detailed accounts of experiences that had occurred and describing scenarios that had gone badly as well as more positive experiences. The diarists also vividly described their emotional responses to these events. Written and verbal information was provided to all participants and written consent was obtained before commencement of the study.
Following data collection, the interview and audio diary entries were transcribed verbatim by professional transcribers who specialise in medical interviews. A thematic index was then developed to which the entire dataset could be coded. A final overall indexing system was discussed and agreed by all parties in a collaborative research meeting prior to the first stage of formal analysis. The interview and audio diary data were given equal importance in the coding. Interviews with participants were categorised by the two leads NB and OC.
One of the main findings to emerge from the data is that the transition from medical student to junior doctor is often extremely stressful. One participant expressed this dramatically:. Most of the participants experienced times when they felt burdened and sometimes fearful about taking responsibility for decisions. The pressure of actually dealing with clinical realities and deciding on how to prioritise tasks was often one that they initially found extremely challenging:.