Dealing with the tension: how residents seek autonomy and participation in the workplace

Olmos-Vega, Francisco M.; Dolmans, Diana; Vargas-Castro, Nicolas; Stalmeijer, Renée E.

doi:10.1111/medu.13326

Cited by 40 publications

(50 citation statements)

References 30 publications

(67 reference statements)

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“…This is not surprising, as residents or interns learn, similar to medical students in clinical environments, through work‐related activities and through interpretation of experiences and social interaction . Multiple studies on residents' active learning in clinical contexts have highlighted the importance of scaffolding their learning opportunities to foster their feelings of competence and autonomy, similar to medical students . Other studies have shown additional similarities, such as how residents' active learning in clinical contexts also varies to include both planned and reactive learning, how questions of others (such as the patient) may be strong motivators for goal setting in active learning, and how individualised learning plans may be helpful to support active learning …”

Section: Self‐regulated Lifelong Learning In Medical Educationmentioning

confidence: 99%

Context matters when striving to promote active and lifelong learning in medical education

et al. 2017

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Where do we stand now? In the 30 years that have passed since The Edinburgh Declaration on Medical Education, we have made tremendous progress in research on fostering ‘self‐directed and independent study’ as propagated in this declaration, of which one prime example is research carried out on problem‐based learning. However, a large portion of medical education happens outside of classrooms, in authentic clinical contexts. Therefore, this article discusses recent developments in research regarding fostering active learning in clinical contexts. Self‐regulated, lifelong learning in medical education Clinical contexts are much more complex and flexible than classrooms, and therefore require a modified approach when fostering active learning. Recent efforts have been increasingly focused on understanding the more complex subject of supporting active learning in clinical contexts. One way of doing this is by using theory regarding self‐regulated learning (SRL), as well as situated learning, workplace affordances, self‐determination theory and achievement goal theory. Combining these different perspectives provides a holistic view of active learning in clinical contexts. Entry to practice, vocational training and continuing professional development Research on SRL in clinical contexts has mostly focused on the undergraduate setting, showing that active learning in clinical contexts requires not only proficiency in metacognition and SRL, but also in reactive, opportunistic learning. These studies have also made us aware of the large influence one's social environment has on SRL, the importance of professional relationships for learners, and the role of identity development in learning in clinical contexts. Additionally, research regarding postgraduate lifelong learning also highlights the importance of learners interacting about learning in clinical contexts, as well as the difficulties that clinical contexts may pose for lifelong learning. However, stimulating self‐regulated learning in undergraduate medical education may also make postgraduate lifelong learning easier for learners in clinical contexts.

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Section: Self‐regulated Lifelong Learning In Medical Educationmentioning

confidence: 99%

Context matters when striving to promote active and lifelong learning in medical education

et al. 2017

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“…Billett used the term ‘affordances’ to highlight the fact that such situations could be both enabling or restricting in terms of learners’ participation. As a result, engagement in workplace affordances is complex and unpredictable . So much so, that learners that share the same training could end up having completely different learning trajectories, as the experiences they accumulate could vary both in quality and quantity …”

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confidence: 99%

Expanding our understanding regarding residents’ participation in the workplace

et al. 2018

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“…Specific modification of clinical complexity by modifying different dimensions of the environment may generate valuable insights into learning environments that are motivating. Previous studies indicated a mismatch between trainees’ and supervisors’ perceptions of and preferences for trainees’ autonomous practice . In addition, trainees’ preferences for supervisory style seem to change over time, which implies that the relation between supervisory style and trainees’ preferences should be taken into account.…”

Section: Discussionmentioning

confidence: 98%

Trainee‐environment interactions that stimulate motivation: A rich pictures study

et al. 2019

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Context Staying motivated when working and learning in complex workplaces can be challenging. When complex environments exceed trainees’ aptitude, this may reduce feelings of competence, which can hamper motivation. Motivation theories explain how intrapersonal and interpersonal aspects influence motivation. Clinical environments include additional aspects that may not fit into these theories. We used a systems approach to explore how the clinical environment influences trainees’ motivation and how they are intertwined. Methods We employed the rich pictures drawing method as a visual tool to capture the complexities of the clinical environment. A total of 15 trainees drew a rich picture representing a motivating situation in the workplace and were interviewed afterwards. Data collection and analysis were performed iteratively, following a constructivist grounded theory approach, using open, focused and selective coding strategies as well as memo writing. Both drawings and the interviews were used to reach our results. Results Trainees drew situations pertaining to tasks they enjoyed doing and that mattered for their learning or patient care. Four dimensions of the environment were identified that supported trainees’ motivation. First, social interactions, including interpersonal relationships, supported motivation through close collaboration between health care professionals and trainees. Second, organisational features, including processes and procedures, supported motivation when learning opportunities were provided or trainees were able to influence their work schedule. Third, technical possibilities, including tools and artefacts, supported motivation when tools were used to provide trainees with feedback or trainees used specific instruments in their training. Finally, physical space supported motivation when the actual setting improved the atmosphere or trainees were able to modify the environment to help them focus. Conclusions Different clinical environment dimensions can support motivation and be modified to create optimal motivating situations. To understand motivational dynamics and support trainees to navigate through postgraduate medical education, we need to take all clinical environment dimensions into account.

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Dealing with the tension: how residents seek autonomy and participation in the workplace

Cited by 40 publications

References 30 publications

Context matters when striving to promote active and lifelong learning in medical education

Context matters when striving to promote active and lifelong learning in medical education

Expanding our understanding regarding residents’ participation in the workplace

Trainee‐environment interactions that stimulate motivation: A rich pictures study

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