Transfer of training from an internal medicine boot camp to the workplace: enhancing and hindering factors

Abstract

Background The transfer of training to the workplace is the aim of training interventions. Three primary factors influence transfer: trainee characteristics, training design and work environment influences. Within medical education, the work environment factors influencing transfer of training remain underexplored. Burke and Hutchins’ review of training transfer outlined five work environment influences: opportunity to perform, supervisor/peer support, strategic link, transfer climate and accountability. This study aimed to explore the ways in which work environment factors influence the transfer of training for medical trainees. Methods Internal Medicine Training in Scotland includes a three-day boot camp involving simulation-based mastery learning of procedural skills, immersive simulation scenarios and communication workshops. Following ethical approval, trainees were invited to take part in interviews at least three months after following their boot camp. Interviews were semi-structured, anonymised, transcribed verbatim and analysed using template analysis. Member checking interviews were performed to verify findings. Results A total of 26 trainees took part in interviews between January 2020 and January 2021. Trainees reported a lack of opportunities to perform procedures in the workplace and challenges relating to the transfer climate, including a lack of appropriate equipment and resistance to change in the workplace. Trainees described a strong sense of personal responsibility to transfer and they felt empowered to change practice in response to the challenges faced. Conclusions This study highlights barriers to transfer of training within the clinical workplace including procedural opportunities, a transfer climate with challenging equipment availability and, at times, an unsupportive workplace culture. Trainees are driven by their own sense of personal responsibility; medical educators and healthcare leaders must harness this enthusiasm and take heed of the barriers to assist in the development of strategies to overcome them.

Ensino do Raciocínio Clínico Orientado pela Teoria dos Scripts de Doenças

“…O debate sobre a TA de um contexto a outro não é novo. 16 Por TA entende-se o uso das habilidades aprendidas a uma nova situação, que necessita da recontextualização do conhecimento, um dos últimos estágios do aprendizado. 17 Como mencionando, o RC ocorre pelo reconhecimento dos SD, que contêm as CC discriminatórias das doenças.…”

The impact of simulation-based mastery learning, booster session timing and clinical exposure on confidence in intercostal drain insertion: a survey of internal medicine trainees in Scotland

“…The ultimate aim of training interventions is to transfer skills to the workplace and trainees’ confidence in their own abilities to do so is a key factor in the transfer of skills being successful [ 21 ]. Although trainees may be deemed competent to perform procedures on a manikin in a skills lab, there are numerous factors in the work environment that can influence skill transfer [ 39 ]. If trainees have persistent low self-efficacy for skills they feel they should be confident and competent to perform in their role, then this could lead to discomfort or anxiety [ 40 ].…”

“…Trainees must have access to clinical opportunities to perform in order to transfer skills to the workplace which, as exemplified in this study, is challenging, particularly for the skill of ICD insertion [ 39 ]. This study found significant mitigation of confidence decay for trainees with higher numbers of successful attempts in clinical practice during the intervening period, in keeping with other studies finding that clinical practice increases confidence in ICD insertion [ 2 , 6 , 42 , 43 ].…”

“…However, given all trainees achieved competence during the assessed session, individual self-reported confidence was deemed an important indicator of their self-efficacy in transferring skills to the workplace. It must also be recognised that there are other factors which could influence confidence in performing ICD insertion, such as the precise timing of clinical experience between sessions and supervisor support during such experience, that have not been addressed in this study [ 39 ].…”

“…Future work could explore the barriers to transfer of procedural skills to the workplace, including opportunities to perform from trainee, supervisor and organisational perspectives. Recent work has identified factors such as opportunities to perform the procedure clinically and support from supervisors as crucial to facilitating successful transfer [ 39 , 46 ]. While our results indicate that intervals of 7–20 months between sessions have little impact on trainee confidence, further work is needed to evaluate if shorter intervals of a few months between SBML training interventions maintain confidence or indeed promote transfer to clinical practice.…”