Definitions and Conceptualizations of the Practice Context in the Health Professions: A Scoping Review

Thomas, Aliki; Rochette, Annie; George, Christian; Iqbal, Muhammad Zafar; Ataman, Rebecca; St‐Onge, Christina; Renaud, Jean‐Sébastien

doi:10.1097/ceh.0000000000000490

Cited by 15 publications

(15 citation statements)

References 128 publications

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“…84 Our findings help address the absence of literature accounting for and theorizing the dynamic relationships between contextual factors in CPD. 85 Although the writings of Foucault and governmentality authors such as Dean 72 do not necessarily prescribe solutions for designing better interventions or refining implementation frameworks, they provide theoretical insight into the dynamic interactions and relationships between individual clinicians and the ideologies, meanings, and social structures in health care settings. In doing so, it helps shift consideration of context from "structured lists of disconnected items" 86 that should be accounted for in intervention design and evaluation toward a more reflexive understanding of the rationales and assumptions inherent within the construction of CPD, how it has been shaped by macrosocial forces and through power relations, and to what effect.…”

Section: Discussionmentioning

confidence: 99%

Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics

Wong,

Kitto

2023

J Contin Educ Health Prof

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Introduction: For continuing professional development (CPD) to reach its potential to improve outcomes requires an understanding of the role of context and the influencing conditions that enable interventions to succeed. We argue that the heuristic use of frameworks to design and implement interventions tends to conceptualize context as defined lists of barriers, which may obscure consideration of how different contextual factors interact with and intersect with each other. Methods: We suggest a framework approach that would benefit from postmodernist theory that explores how ideologies, meanings, and social structures in health care settings shape social practices. As an illustrative example, we conducted a Foucauldian discourse analysis of diabetes care to make visible how the social, historical, and political conditions in which clinicians experience, practice, and shape possibilities for behavior change. Results: The discursive construction of continuing education as a knowledge translation mechanism assumes and is contingent on family physicians to implement guidelines. However, they enact other discursively constituted roles that may run in opposition. This paradoxical position creates a tension that must be navigated by family physicians, who may perceive it possible to provide good care without necessarily implementing guidelines. Discussion: We suggest marrying “framework” thinking with postmodernist theory that explores how ideologies, meanings, and social structures shape practice behavior change. Such a proposed reconceptualization of context in the design of continuing professional development interventions could provide a more robust and nuanced understanding of how the dynamic relationships and interactions between clinicians, patients, and their work environments shape educational effectiveness.

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Section: Discussionmentioning

confidence: 99%

Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics

Wong,

Kitto

2023

J Contin Educ Health Prof

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“…Please read about the importance of context in the health professions; a scoping review in this journal issue. 22…”

Section: Innovation Rationalementioning

confidence: 99%

Recommendations for Publishing Innovation Reports in JCEHP

Archibald¹

2023

J Contin Educ Health Prof

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“…Professionals, therefore, operate within a community of peers and complex contexts, and as such, the enactment of their professional competencies is afforded and/or constrained by the practice context. 17…”

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confidence: 99%

Measuring Health Care Work–Related Contextual Factors: Development of the McGill Context Tool

Thomas

St‐Onge

Renaud

et al. 2023

J Contin Educ Health Prof

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Introduction: Contextual factors can influence healthcare professionals' (HCPs) competencies, yet there is a scarcity of research on how to optimally measure these factors. The aim of this study was to develop and validate a comprehensive tool for HCPs to document the contextual factors likely to influence the maintenance, development, and deployment of professional competencies. Methods: We used DeVellis' 8-step process for scale development and Messick's unified theory of validity to inform the development and validation of the context tool. Building on results from a scoping review, we generated an item pool of contextual factors articulated around five themes: Leadership and Agency, Values, Policies, Supports, and Demands. A first version of the tool was pilot tested with 127 HCPs and analyzed using the classical test theory. A second version was tested on a larger sample (n = 581) and analyzed using the Rasch rating scale model. Results: First version of the tool: we piloted 117 items that were grouped as per the themes related to contextual factors and rated on a 5-point Likert scale. Cronbach alpha for the set of 12 retained items per scale ranged from 0.75 to 0.94. Second version of the tool included 60 items: Rasch analysis showed that four of the five scales (ie, Leadership and Agency, Values, Policies, Supports) can be used as unidimensional scales, whereas the fifth scale (Demands) had to be split into two unidimensional scales (Demands and Overdemands). Discussion: Validity evidence documented for content and internal structure is encouraging and supports the use of the McGill context tool. Future research will provide additional validity evidence and cross-cultural translation.

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Definitions and Conceptualizations of the Practice Context in the Health Professions: A Scoping Review

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 15 publications

References 128 publications

Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics

Rethinking Context in Continuing Professional Development: From Identifying Barriers to Understanding Social Dynamics

Recommendations for Publishing Innovation Reports in JCEHP

Measuring Health Care Work–Related Contextual Factors: Development of the McGill Context Tool

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