Protocol for a realist review of workplace learning in postgraduate medical education and training

Abstract

BackgroundPostgraduate medical education and training (PGMET) is a complex social process which happens predominantly during the delivery of patient care. The clinical learning environment (CLE), the context for PGMET, shapes the development of the doctors who learn and work within it, ultimately impacting the quality and safety of patient care. Clinical workplaces are complex, dynamic systems in which learning emerges from non-linear interactions within a network of related factors and activities. Those tasked with the design and delivery of postgraduate medical education and training need to understand the relationship between the processes of medical workplace learning and these contextual elements in order to optimise conditions for learning. We propose to conduct a realist synthesis of the literature to address the overarching questions; how, why and in what circumstances do doctors learn in clinical environments? This review is part of a funded projected with the overall aim of producing guidelines and recommendations for the design of high quality clinical learning environments for postgraduate medical education and training.MethodsWe have chosen realist synthesis as a methodology because of its suitability for researching complexity and producing answers useful to policymakers and practitioners. This realist synthesis will follow the steps and procedures outlined by Wong et al. in the RAMESES Publication Standards for Realist Synthesis and the Realist Synthesis RAMESES Training Materials. The core research team is a multi-disciplinary group of researchers, clinicians and health professions educators. The wider research group includes experts in organisational behaviour and human resources management as well as the key stakeholders; doctors in training, patient representatives and providers of PGMET.DiscussionThis study will draw from the published literature and programme, and substantive, theories of workplace learning, to describe context, mechanism and outcome configurations for PGMET. This information will be useful to policymakers and practitioners in PGMET, who will be able to apply our findings within their own contexts. Improving the quality of clinical learning environments can improve the performance, humanism and wellbeing of learners and improve the quality and safety of patient care.Systematic review registrationThe review is not registered with the PROSPERO International Prospective Register of Systematic Reviews as the review objectives relate solely to education outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0415-9) contains supplementary material, which is available to authorized users.

A standstill continuing medical education in Serbia 2011-2017

“…The analysis of the period 2011-2017 and the published literature during the last five years [22,23,24,26,[28][29][30][31][32][33] confirm the recommendations published in 2015 [14]:…”

“…With the same intention Whitehurst [32] asks for a "Continuing Medical Education Partnership". A related model to involve practice experience as an essential element in CME has been proposed by Wiese et al [33].…”

Supervised workplace learning in postgraduate training: a realist synthesis

“…We chose a realist approach because it can capture both context and complexity, producing findings that are useful to policymakers and practitioners. The protocol for our realist synthesis initially posed the question: How, why and in what circumstances do doctors learn in clinical environments? Consistent with realist synthesis methodology, the focus of the review narrowed as it progressed through an iterative process of exploration of the literature and consultation with experts and stakeholders.…”

Exploring the knowledge translation of domestic violence research: A literature review

“…Thus, a realist review is not just about the replication of outcomes, but understanding why those outcomes succeed or fail, the influences on those outcomes and the theory of change regarding the intervention (Pawson & Tilley, 2004). It is especially well suited to areas of complexity with variable outcomes (Berg & Nanavati, 2016; Wiese et al., 2017), exploration of mixed data (Kastner et al., 2011) and enables in‐depth analysis (Pawson et al., 2005). Realist reviews have an impact in a wide range of settings including health (Brennan et al, 2017), community mental health (Gee, Bhanbhro, Cook, & Killaspy, 2016), offender mental health (Pearson et al., 2015), domestic violence screening (O'Campo, Kirst, Tsamis, Chambers, & Ahmad, 2011) and advocacy (Rivas, Vigurs, Cameron, & Yeo, 2019).…”