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.

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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.