Background: During postgraduate training, considerable efforts for intraprofessional education are in place to prepare primary care residents (PC residents) and medical specialty residents (MS residents) for intraprofessional collaboration (intraPC). Power dynamics are inherently present in such hierarchical medical contexts. This affects intraPC (learning). Yet little attention has been paid to factors that impact power dynamics. This study aims to explore power dynamics and their impact on intraPC learning between PC residents and MS residents during hospital placements.Methods: This study expands on previously published ethnographic research investigating opportunities and barriers for intraPC learning among residents in five Dutch hospitals. We analysed transcripts of observations and in-depth interviews using template analysis. A critical theory paradigm was employed. Discourse analysis additionally informed the data. Results:We defined five interrelated themes that describe characteristics of power dynamics in intraPC learning during hospital placements: beliefs; power distribution; interaction style; subjection; and fearless learning. Power dynamics operate both within and between the themes: power distribution between PC residents, MS residents and MS supervisors seemed to be an attribution affected by underlying beliefs about professional norms or about other professions; beliefs influenced the way PC residents, MS residents and MS supervisors interacted; power distribution based on inequity could lead to subjection of PC residents; power distribution based on equity could lead to fearless learning; and open interactions enabled fearless intraPC learning.Conclusions: Power dynamics have an impact on intraPC learning among residents in hospitals. Constructive power dynamics occur when power distribution is based on equity, combined with sincere open interactions, actively inviting each other into discussions and enlisting the support of MS supervisors to foster fearless learning. This can be achieved by creating awareness of implicit beliefs and making them explicit, recognising interaction that encourages intraPC learning and creating policies that support fearless intraPC learning.

No abstract

No abstract

To foster lifelong learning skills, we need new didactic approaches with aligned assessment methods. Therefore, we investigated whether the outcomes of a project assignment show a different relation to learning strategies than a longitudinal knowledge-based assessment. We studied learning strategies of first year students of medicine and biomedical sciences (n ¼ 248) and performed hierarchical regression analyses for the learning strategies and grades of the longitudinal knowledge-based test and project assignment. Scores of students, measured with the Motivated Strategies for Learning Questionnaire (Likert scale 1-7), were relatively low for critical thinking (3.53), compared to rehearsal (4.40), elaboration (4.82), organisation (4.69) and metacognitive self-regulation (4.33). Knowledge based tests showed a significant relation to elaboration (p < 0.01). For the project-based assessment, we did not find a significant relation to any learning strategy (p ¼ 0.074). Explained variance of the grades was low for all learning strategies (R 2 < 0.043). Different types of assessment did not discriminate between students with high or low scores on learning strategies associated with lifelong learning. An explanation is that the curriculum is not aligned with assessment, or students do not benefit in terms of grades. We conclude that, if assessment is to drive lifelong learning skills, this is not self-evident.

Objectives To evaluate a practice-based, self-directed EBM-course in an undergraduate medical curriculum in terms of EBM attitude and motivation beliefs. Methods This study was conducted in a 4-week course of the first-year undergraduate medical curriculum, which takes place twice in an academic year. One group of students (n=210) received a normal EBM-module in November. A practice-based EBM-module was implemented in January for another group of students (n=130). We approached all students following the courses for participation in our research project. In a quasi-experimental design, a validated survey was used to assess students' EBM task value and self-efficacy on a 7-point Likert-scale. In the experimental group, complementary qualitative data were gathered on attitude and motivation by open evaluative questions. Results Overall response rate was 93,5%, resulting in 191 students in the control group and 127 students in the experimental group. We did not find differences between the groups in terms of EBM task value and self-efficacy. However, the experimental group showed a higher increased perception of the importance of EBM in decision making in clinical practice (60.0% vs 77.2%; χ 2 (1, N=318) = 8.432, p=0.004). These students obtained a better understanding of the complexities and time-consuming nature of EBM in medical practice. Conclusions The practice-based EBM-course helps students to reflect on practice and knowledge critically. Our findings indicate that integrating clinical practice in the undergraduate learning environment fosters attitude and motivation, suggesting that practice-based learning in EBM education may advance student development as a critically reflective practitioner.

Background Engaging with the arts can enrich medical education by fostering transformative learning, reflection, and a holistic view of the patient. Objective To explore the development of professional competence of residents in prolonged arts-based medical education. Methods We followed residents (n=99) of various specialties as they engaged in arts-based learning through creative and reflective assignments such as painting, sculpting, and formal analysis. Participants were interviewed about their learning process and experiences, one-on-one and in small groups, by independent researchers using short, semistructured interviews. We used grounded theory to inform an iterative process for data collection and analysis over the course of 3 years (2016-2018). Results Seven themes were constructed, which showed that (1) slowing down education provides room for reflection; (2) absence of judgment and rules sparks experimentation; (3) engaging with emotions fostered reflection and motivation; (4) the artists' methods provided a perspective change; (5) a holistic view on the patient emerged; (6) residents understood the need to take control over their professional development; and (7) there were barriers to overcome in terms of hierarchy and expectations. Our investigation shows that interns and residents undergo a perspective transformation. Key to the development of the physicians in training is the open and affective nature of the arts in education. Conclusions Arts-based learning results in a new perspective for physicians in training in line with patient-centered health care and self-directed learning.

MBBS students, enrolled for Community Medicine Clerkship Programme at one of the private tertiary health care teaching facilities, participated in developing four health training modules for CHWs, namely, diarrhoeal diseases, typhoid fever, vector-borne diseases and acute respiratory tract infections (ARTIs) during 1-month period. All students were divided into small groups and were asked to formulate modules through various engagement triggers like drama, games, quotes, media clips, puppetries and debates. During the second phase, the same groups of medical students utilised these emerged modules to train 130 field-based CHWs (Anganwadi Workers and Accredited Social Health Activists [ASHAs]) regarding targeted health problems. The final phase of the study commenced with educating 550 general community people in field practice areas (urban and rural) of the institute about identified health problems by trained CHWs. Engagement strategies like street plays, quizzes and puppet shows were used during training programmes of CHWs and general community people. At each phase, pre-and post-intervention scores of participants were evaluated, and the study revealed statistically significant (p < 0.05) knowledge gain about targeted diseases as well as positive attitudes towards an intervention among medical students, CHWs and local community people. | WHAT LESSONS WERE LEARNED?Engaging students at an early stage of medical training in communitybased education facilitated their contextual learning. Modular training was found to be beneficial to build up the capacity and motivation of CHWs towards reducing the burden of targeted diseases in communities. Trained general community people can incorporate this knowledge for prevention and control of these four health problems. However, the long-term impact of current study needs to be assessed to find out significant decline in incidence and prevalence of targeted diseases in the Indian communities. This study has wider implications in expanding it into other communities with similar objectives.