7. The Competent Mind

Leung, Annie; Epstein, Ronald M.; Moulton, Carol‐Anne

doi:10.7591/9780801465802-011

Cited by 7 publications

(5 citation statements)

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“…Residents do not deliver patient care on their own, or in isolation. Delivering patient care is team work [ 49 ]. Therefore, it might be difficult for PDs to discern residents’ individual contributions from the team effort [ 49 ].…”

Section: Discussionmentioning

confidence: 99%

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Learning the ropes: strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study

et al. 2022

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Background Many residents experience their transitions, such as from medical student to resident, as demanding and stressful. The challenges they face are twofold: coping with changes in tasks or responsibilities and performing (new) social roles. This process of ‘learning the ropes’ is known as Organizational Socialization (OS). Although there is substantial literature on transitions from the perspective of residents, the voices of program directors (PDs) who facilitate and guide residents through the organizational socialization process have not yet been explored. PDs’ perspectives are important, since PDs are formally responsible for Postgraduate Medical Education (PGME) and contribute, directly or indirectly, to residents’ socialization process. Using the lens of OS, we explored what strategies PDs use to facilitate organizational socialization of newcomer residents. Methods We conducted semi-structured interviews with 17 PDs of different specialties. We used a theory-informing inductive data analysis study design, comprising an inductive thematic analysis, a deductive interpretation of the results through the lens of OS and, subsequently, an inductive analysis to identify overarching insights. Results We identified six strategies PDs used to facilitate organizational socialization of newcomer residents and uncovered two overarching insights. First, PDs varied in the extent to which they planned their guidance. Some PDs planned socialization as an explicit learning objective and assigned residents’ tasks and responsibilities accordingly, making it an intended program outcome. However, socialization was also facilitated by social interactions in the workplace, making it an unintended program outcome. Second, PDs varied in the extent to which they adapted their strategies to the newcomer residents. Some PDs used individualized strategies tailored to individual residents’ needs and skills, particularly in cases of poor performance, by broaching and discussing the issue or adjusting tasks and responsibilities. However, PDs also used workplace strategies requiring residents to adjust to the workplace without much intervention, which was often viewed as an implicit expectation. Conclusions PDs’ used both intentional and unintentional strategies to facilitate socialization in residents, which may imply that socialization can occur irrespective of the PD’s strategy. PDs’ strategies varied from an individual-centered to a workplace-centered approach to socialization. Further research is needed to gain a deeper understanding of residents’ perceptions of PD’s efforts to facilitate their socialization process during transitions.

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Section: Discussionmentioning

confidence: 99%

“…Delivering patient care is team work [ 49 ]. Therefore, it might be difficult for PDs to discern residents’ individual contributions from the team effort [ 49 ]. Moreover, it is not only important that every team member knows how to apply professional standards, it is also important that they are able to function in a team.…”

Section: Discussionmentioning

confidence: 99%

Learning the ropes: strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study

et al. 2022

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“…Once repeated, deliberate practice allows for such automaticity, cognitive resources may become available for a more personal approach to professional practice. 54 In technical terms, when germane load needed for learning decreases, intrinsic load for performance has more space. 55 The third layer of competence also relates to motivation, satisfaction and enjoyment.…”

Section: Competence At Layer 3: Personalised Knowledge Skills Interes...mentioning

confidence: 99%

“…Newly licensed physicians and junior specialist attendings are known to experience heavy workloads, 53 because they lack the automaticity of thinking and doing to allow for efficient performance. Once repeated, deliberate practice allows for such automaticity, cognitive resources may become available for a more personal approach to professional practice 54 . In technical terms, when germane load needed for learning decreases, intrinsic load for performance has more space 55 …”

Section: Competence At Layer 3: Personalised Knowledge Skills Interes...mentioning

confidence: 99%

Medical competence as a multilayered construct

ten Cate,

Khursigara‐Slattery,

Cruess

et al. 2023

Medical Education

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BackgroundThe conceptualisation of medical competence is central to its use in competency‐based medical education. Calls for ‘fixed standards’ with ‘flexible pathways’, recommended in recent reports, require competence to be well defined. Making competence explicit and measurable has, however, been difficult, in part due to a tension between the need for standardisation and the acknowledgment that medical professionals must also be valued as unique individuals. To address these conflicting demands, a multilayered conceptualisation of competence is proposed, with implications for the definition of standards and approaches to assessment.The modelThree layers are elaborated. This first is a core layer of canonical knowledge and skill, ‘that, which every professional should possess’, independent of the context of practice. The second layer is context‐dependent knowledge, skill, and attitude, visible through practice in health care. The third layer of personalised competence includes personal skills, interests, habits and convictions, integrated with one's personality. This layer, discussed with reference to Vygotsky's concept of Perezhivanie, cognitive load theory, self‐determination theory and Maslow's ‘self‐actualisation’, may be regarded as the art of medicine.We propose that fully matured professional competence requires all three layers, but that the assessment of each layer is different.ImplicationsThe assessment of canonical knowledge and skills (Layer 1) can be approached with classical psychometric conditions, that is, similar tests, circumstances and criteria for all. Context‐dependent medical competence (Layer 2) must be assessed differently, because conditions of assessment across candidates cannot be standardised. Here, multiple sources of information must be merged and intersubjective expert agreement should ground decisions about progression and level of clinical autonomy of trainees. Competence as the art of medicine (Layer 3) cannot be standardised and should not be assessed with the purpose of permission to practice. The pursuit of personal excellence in this level, however, can be recognised and rewarded.

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“…4,6 However, the workplace can still be di cult to understand for residents due to informal, unmentioned and hidden social forces. [20][21][22] Program directors, supervisors and nurses play a critical role in navigating residents through their socialization process by employing different strategies. [23][24][25] These strategies range from introducing residents to the departments' processes (nurses) 24 and organizing formal and informal orientation programs (supervisors) 25 to paying attention to the socialization processes and expectations which, in turn, ranges from tailoring approaches to address individual residents needs to expecting residents to adapt to the implicit norms of the workplace.…”

Section: Introductionmentioning

confidence: 99%

Transitioning to residency: a qualitative study exploring residents' perspectives on strategies for adapting to residency

Galema

Brouwer

Bouwkamp-Timmer

et al. 2023

Preprint

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Background Despite the widespread use of preparation courses, residents still experience the transition from student to resident as problematic and stressful. Although this transition highly depends on the organization residents work for, only a few studies address individual and organizational strategies that help them adapt. We need this information to optimize transitions and improve onboarding programs and faculty development initiatives. This study explores residents’ experiences with their own and other health care professionals’ strategies to help them adapt to residency, and residents’ perceptions of the impact of other health care professionals’ strategies on their own adaptation efforts.Methods We conducted a qualitative interview study with 16 residents from different hospital-based specialties in the Netherlands. To identify residents’ perceptions of their own and other healthcare professionals’ strategies, we used a template analysis based on the individual and organizational tactics originating from the theory of Organizational Socialization. In this study, we defined other healthcare professionals as residents, supervisors, nurses and advanced practice providers.Results Residents experienced five individual and six organizational strategies. When engaging in social interaction with other healthcare professionals, residents used individual strategies such as asking questions and establishing social relationships to learn how to behave in their roles as doctors and members of the healthcare team. They experienced different strategies from other healthcare professionals, which we clustered into interactional (between healthcare professionals and residents) and systemic strategies (functioning of the system around residents’ training program). These strategies facilitated or hindered residents’ own adaptation efforts. We found differences in perceptions of whether a specific strategy was facilitating or hindering. Some residents, for example, perceived the lack of a role model as facilitating, while others perceived it as hindering.Conclusion Residents felt that smooth transitions require strategic approaches from both residents and other healthcare professionals. They used individual strategies to learn how to perform new tasks, behave appropriately and understand their roles in relation to those of other healthcare professionals. We distinguished interactive and systemic organizational strategies. Organizational strategies positively or negatively affected residents’ own adaptation efforts. We found differences in perceptions of whether specific organizational strategies worked, depending on residents’ individual needs.

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7. The Competent Mind

Cited by 7 publications

References 0 publications

Learning the ropes: strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study

Learning the ropes: strategies program directors use to facilitate organizational socialization of newcomer residents, a qualitative study

Medical competence as a multilayered construct

Transitioning to residency: a qualitative study exploring residents' perspectives on strategies for adapting to residency

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