Understanding students’ and clinicians’ experiences of informal interprofessional workplace learning: an Australian qualitative study

Rees, Charlotte E.; Crampton, Paul; Kent, Fiona; Brown, Ted; Hood, Kerry; Leech, Michelle; Newton, Jennifer Margaret; Storr, Michael; Williams, Brett

doi:10.1136/bmjopen-2017-021238

Cited by 29 publications

(56 citation statements)

References 34 publications

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“…This balance develops with supervisory experience and can benefit from appropriate training 56. Additionally, our findings suggest numerous GMC outcomes for which medical graduates are thought to be less well prepared, largely because, we would argue, they lack sufficient informal workplace learning opportunities during their undergraduate education to develop these capabilities 44. Indeed, we believe that PGY1s’ ability to manage complex and challenging situations will only develop through increased informal workplace learning opportunities.…”

Section: Discussionmentioning

confidence: 80%

New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study

et al. 2018

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ObjectiveWhile previous studies have begun to explore newly graduated junior doctors’ preparedness for practice, findings are largely based on simplistic survey data or perceptions of newly graduated junior doctors and their clinical supervisors alone. This study explores, in a deeper manner, multiple stakeholders’ conceptualisations of what it means to be prepared for practice and their perceptions about newly graduated junior doctors’ preparedness (or unpreparedness) using innovative qualitative methods.DesignA multistakeholder, multicentre qualitative study including narrative interviews and longitudinal audio diaries.SettingFour UK settings: England, Northern Ireland, Scotland and Wales.ParticipantsEight stakeholder groups comprising n=185 participants engaged in 101 narrative interviews (27 group and 84 individual). Twenty-six junior doctors in their first year postgraduation also provided audio diaries over a 3-month period.ResultsWe identified 2186 narratives across all participants (506 classified as ‘prepared’, 663 as ‘unprepared’, 951 as ‘general’). Seven themes were identified; this paper focuses on two themes pertinent to our research questions: (1) explicit conceptualisations of preparedness for practice; and (2) newly graduated junior doctors’ preparedness for the General Medical Council’s (GMC) outcomes for graduates. Stakeholders’ conceptualisations of preparedness for practice included short-term (hitting the ground running) and long-term preparedness, alongside being prepared for practical and emotional aspects. Stakeholders’ perceptions of medical graduates’ preparedness for practice varied across different GMC outcomes for graduates (eg, Doctor as Scholar and Scientist, as Practitioner, as Professional) and across stakeholders (eg, newly graduated doctors sometimes perceived themselves as prepared but others did not).ConclusionOur narrative findings highlight the complexities and nuances surrounding new medical graduates’ preparedness for practice. We encourage stakeholders to develop a shared understanding (and realistic expectations) of new medical graduates’ preparedness. We invite medical school leaders to increase the proportion of time that medical students spend participating meaningfully in multiprofessional teams during workplace learning.

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Section: Discussionmentioning

confidence: 80%

New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study

et al. 2018

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“…This paper presents a secondary analysis of qualitative data collected for a study exploring student and clinician experiences of IPSC interactions . The study is underpinned by social constructionism, which highlights that meaning is constructed through social interaction .…”

Section: Methodsmentioning

confidence: 99%

“…We employed narrative methods to understand how students and clinicians made sense of their experiences, including how they constructed identities within those narratives. Although we employed group interviews to collect narratives wherever possible, because a story from one participant may stimulate a story from another, we also employed individual interviews in order to maximise student and clinician participation …”

Section: Methodsmentioning

confidence: 99%

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Student and clinician identities: how are identities constructed in interprofessional narratives?

2019

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CONTEXT Although the literature on professional identity formation in medical education is increasing, it is scant by comparison on student and clinician identities within interprofessional contexts. We therefore adopt a novel discursive approach to identities to explore how soon-to-become graduates and workplacebased clinicians construct their own and others' identities in interprofessional student-clinician (IPSC) interaction narratives. METHODS We conducted a qualitative narrativeinterview study with 38 students and 23 clinicians representing the fields of medicine, midwifery, nursing, occupational therapy, paramedicine and physiotherapy. Through framework analysis, we identified the breadth of student and clinician identity constructions across 208 IPSC interaction narratives, and explored how common constructions differed by narrative and narrator. Through in-depth positioning analysis, we explored how student and clinician identities are discursively positioned within two selected IPSC interaction narratives. RESULTSWe identified 11 common constructions of student identities and eight common constructions of clinician identities across all 208 narratives. We found differences in identity constructions across positively versus negatively evaluated narratives, and student versus clinician narrators, highlighting the rhetorical nature of narratives. Our in-depth positioning analysis of two narratives illustrates how one student and one clinician discursively positioned theirs and others' identities during interprofessional interactions, and how identities vary depending on narrators' evaluations of their stories. Although both positioning analyses illustrate how the narrators' language serves to reproduce the common societal discourse of interprofessional conflict, the clinician narrative also draws on the competing discourse of interprofessional collaboration.CONCLUSIONS Although some of the identities support previous uniprofessional research, our findings illustrate greater breadth and depth in terms of student and clinician identities within interprofessional contexts. We encourage educators to embed identities curricula into existing workplace learning for students and clinicians to help them make sense of their developing professional and interprofessional identities. Workplace educators should facilitate meaningful IPSC interactions to promote interprofessional learning and collaboration.

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“…Although we have considered formal IPPs in this review, there is a body of research highlighting the potential of opportunistic interprofessional workplace learning. 87,88 Interprofessional learning in this context may be less cost-and resourceintensive. 73 However, even within this opportunistic model, dedicated time and resources are needed to facilitate learning.…”

Section: Comparisons With the Existing Literaturementioning

confidence: 99%

‘Bumping along’: a qualitative metasynthesis of challenges to interprofessional placements

et al. 2019

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Context Interprofessional practice is required to manage complex health care needs globally. It is well established that interprofessional placements (IPP) prepare students to work collaboratively, yet IPP implementation remains limited and disjointed. Objectives This review synthesised student, educator and service user perspectives in order to better understand challenges of IPP and provide recommendations for sustainable IPP implementation. Methods A systematic metasynthesis of qualitative literature sourced from databases including CINAHL, Embase and PsycINFO was completed. Studies that incorporated student, educator and/or service user perspectives on IPP experiences were included. We focused specifically on factors limiting implementation of IPP. The presage‐process‐product (3P) theory provided the theoretical framework for inductive synthesis of 41 empirical studies. A confidence rating for findings was formulated using CERQual (confidence in evidence from reviews of qualitative research). Results We developed three themes, which represent key challenges to IPP becoming embedded in placement culture: (i) thin theoretical foundations underpinned IPP, limiting understanding of the learning processes involved; (ii) implementation relied heavily on individual champions, which curtails investment and sustainability when personnel change, and (iii) students, educators and service users were unsure of the function of IPP and their respective roles, leading to uncertainty along with some negative perceptions of this placement approach. Conclusions In line with the 3P theoretical framework, IPP would benefit from explicit connections with educational and change management theories during presage stage IPP requires coordinated leadership and resource investment, and during product stage clear integration of interprofessional learning outcomes in curricula is advised. Addressing the identified challenges across the stages of IPP will support further development of IPP, firmly establishing this approach within placement culture. IPP can them make a significant contribution to the development of a collaborative practice‐ready workforce. This in turn will enhance service user outcomes and safety.

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Understanding students’ and clinicians’ experiences of informal interprofessional workplace learning: an Australian qualitative study

Cited by 29 publications

References 34 publications

New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study

New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study

Student and clinician identities: how are identities constructed in interprofessional narratives?

‘Bumping along’: a qualitative metasynthesis of challenges to interprofessional placements

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