Embracing the tension between vulnerability and credibility: ‘intellectual candour’ in health professions education

The tension between expressing vulnerability and seeking credibility creates challenges for learning and teaching. This is particularly true in health care, in which practitioners are regarded as highly credible and making errors can often lead to dire consequences and blame. From a transformative learning perspective, expressing vulnerability may help individuals to access different ways of knowing. By contrast, from a sociological perspective, seeking to maintain credibility results in ritualised interactions and these ritualised encounters can reinforce credibility. One means of embracing this tension between expressing vulnerability and appearing credible is ‘intellectual candour’, an improvisational expression of doubts, thoughts and problems with the dual purpose of learning and promoting others’ learning. Educators’ revelations of inner struggles are proposed as a means of inviting reciprocal vulnerability. This builds trust and a platform for learning, particularly of the transformative nature. It also allows modelling of how to balance the vulnerability–credibility tension, which may provide a template for professional practice.     

Can positive inquiry strengthen obstetric referral systems in Cambodia?

Maternal death remains high in low resource settings. Current literature on obstetric referral that sets out to tackle maternal death tends to focus on problematization. We took an alternative approach and rather asked what works in contemporary obstetric referral in a low income setting to find out if positive inquiry could generate original insights on referral that could be transformative. We documented and analysed instances of successful referral in a rural province of Cambodia that took place within the last year. Thirty women, their families, healthcare staff and community volunteers were purposively sampled for in‐depth interviews, conducted using an appreciative inquiry lens. We found that referral at its best is an active partnership between families, community and clinicians that co‐constructs care for labouring women during referral and delivery. Given the short time frame of the project we cannot conclude if this new understanding was transformative. However, we can show that acknowledging positive resources within contemporary referral systems enables health system stakeholders to widen their understanding of the kinds of resources that are available to them to direct and implement constructive change for maternal health. Copyright © 2016 John Wiley & Sons, Ltd.     

‘I now have a visual image in my mind and it is something I will never forget’: an analysis of an arts-informed approach to health professions ethics education

This paper reports on a study of an arts informed approach to ethics education in a health professions education context. The purpose of this study was to investigate students’ reported learning experiences as a result of engagement with an arts-informed project in a health professions’ ethics course. A hermeneutic phenomenological methodological approach was adopted for the study. The data were collected over 5 years, and involved analysis of 234 occupational therapy students’ written reflections on learning. Phenomenological methods were used. Five key themes were identified with respect to students’ reported learning including: becoming aware of values, (re) discovering creativity, coming to value reflection in professional life, deepening self-awareness, and developing capacities to imagine future practices. There appear to be a number of unique ways in which arts-informed approaches can contribute to health professions education including: activating imaginative engagement, fostering interpretive capacity, inspiring transformative understandings, offering new ways of knowing, deepening reflection, and heightening consciousness, while also enriching the inner life of practitioners. Innovative approaches are being used to introduce arts-informed practices in health professions curricula programs. The findings point to the promise of arts-informed approaches for advancing health sciences education.     

Commentary: Realizing the Vision Through Fieldwork Education

A systematic process for students to actively direct their own professional competence is needed with careful realignment of fieldwork placements to ensure acquisition of future professional competencies. This transformative habit should begin in the academic portion of their learning and further developed during field-work.     

Religious Faith and Transformational Processes in Marriage

Leading scholars of marital processes strongly recommend supplementing the current focus on marital conflict to include research on transformative processes. This qualitative study examines the connection between religion and the transformative processes of commitment and coping in marriage. The sample for this study includes 184 married couples (N = 368 individuals), making it far larger than most in‐depth, qualitative interview‐based studies. Participants included Christians, Jews, and Muslims with an over sampling of minorities and immigrant families living in all eight regions of the United States. For several decades studies have shown a largely positive correlation between (a) religiosity and marital commitment and (b) religiosity and (generally) positive coping, but with little explanation regarding how and why. Findings of this study indicate that there are specific religious beliefs and practices related to how these couples approach their marriages—including several that relate to the two transformative processes of commitment and coping.     

Learning for real life: patient-focused interprofessional workshops offer added value

Objectives This paper reports relevant findings of a pilot interprofessional education (IPE) project in the Schools of Medicine and Healthcare Studies at the University of Leeds. The purpose of the paper is to make a contribution towards answering 2 questions of fundamental importance to the development of IPE. Is there a demonstrable value to learning together? What types of IPE, under what circumstances, produce what type of outcomes? Design Pre‐registration house officers (PRHOs), student nurses and pre‐registration pharmacists attended a series of 3 workshops intended to develop participants' understanding about each other's professional roles, to enhance teamworking and to develop communication skills. Evaluation covered the process of development of the workshops, the delivery of the workshops and their effects on both facilitators and participants. Results The course was well received by the participants. The learning reported by the participants reflected 2 project objectives. Participants emphasised communication skills – both with other professionals and patients ? and the development of increased awareness of others' roles. These 2 aspects were interlinked. Conclusions The project aims and 2 of the learning outcomes were achieved. There was a demonstrable value to learning together, particularly with regard to interprofessional communications. This project was effective and can make a contribution towards answering the question ‘What types of IPE, under what circumstances, produce what type of outcomes?’     

The PROCESS Project

This article presents an evaluation of a particular approach to observation and assessment. It was developed within a project known as PROCESS which was undertaken in collaboration between Roehampton Institute and the London Borough of Merton. It was piloted, and subsequently used widely within this local education authority, alongside in‐service sessions and project evaluation. It has now gained wider recognition through publication. Initially aimed at the production of a baseline assessment procedure which was consistent with principles embodying holistic learning, the project developed to encompass a range of related issues. Above all it generated inquiry and insights into provision for learning and classroom management which became interwoven with strategies for observation and reflection.     

Processes of Change in Self‐Directed Couple Relationship Education

Abstract: The current study examined the learning processes involved in professionally supported self‐directed couple relationship education (CRE). Fifty‐nine couples completed Couple CARE, a systematic, self‐directed CRE program designed in flexible delivery mode to be completed at home. Couples watched a DVD introducing key relationship ideas and skills and then completed a structured guidebook. The learning process was supported by telephone‐based coaching sessions from a professional relationship educator. Couples completed the learning tasks associated with the programe and successfully implemented a wide range of relationship self‐change, and most reported continuing implementation of program learning at 6 months follow‐up. These findings suggest that Couple CARE is readily accessible and results in effective skill acquisition for couples.     

‘What works here doesn’t work there’: The significance of local context for a sustainable and replicable asset‐based community intervention aimed at promoting social interaction in later life

Interventions that harness local assets to benefit a community are increasingly being promoted to improve health and well‐being. In practice, we know little about how local contexts or reliance on local resources affect the sustainability and scalability of asset‐based community developments. This qualitative case study documents the development and implementation of a novel asset‐based community development project. Based in a large mainly rural county in North East England with relatively high levels of socioeconomic deprivation, the project aimed to prevent social isolation among older people, using a range of food‐related activities. Twenty‐one semi‐structured interviews were conducted with service users, volunteers, project partners, project development workers and senior staff. Interviews explored the project's design and implementation process, outcomes for participants and the wider community, and project sustainability and scalability. Thematic analysis of the data identified four factors likely to be important for creating sustainable and replicable asset‐based community projects. These factors are (a) recognising and harnessing assets among local people who may be otherwise marginalised due to age, geographical isolation and/or socioeconomic deprivation; (b) identifying assets that can be provided by local businesses; (c) genuine project co‐production to develop activities that meet local needs and inspire enthusiasm among all stakeholders; and (d) ongoing organisational support to meet the challenges to sustainability that exist in socioeconomically deprived areas. We conclude that successful asset‐based community projects require extensive community input and learning captured from existing programmes can facilitate the replicability of programmes in other community contexts.     

An overview of the SATIN project

SATIN, or SATiety INnovation, is a 5‐year European‐funded research project to develop and test new food products with satiating qualities to help control appetite, manage weight and combat obesity. It is a €6 million Framework 7 project funded by the European Commission, designed to develop foods that regulate appetite by reducing hunger, accelerating within‐meal satiation and enhancing between meal satiety. The SATIN project employs novel food processing methods to modify food structure to produce functional foods for weight management. This article provides a useful summary of the work plans and describes how industry and academia will work together to produce products ready to commercialise and with proven consumer benefits. The SATIN project involves seven small‐ to medium‐sized enterprises, four industry and seven academic partners. SATIN will also seek to educate consumers and other stakeholders about satiety to optimise the impact of weight management outcomes.     

Preparedness is not enough: understanding transitions as critically intensive learning periods

Medical Education 2011: 45 : 1006–1015 Objectives Doctors make many transitions whilst they are training and throughout their ensuing careers. Despite studies showing that transitions in other high‐risk professions such as aviation have been linked to increased risk in the form of adverse outcomes, the effects of changes on doctors’ performance and consequent implications for patient safety have been under‐researched. The purpose of this project was to investigate the effects of transitions upon medical performance. Methods The project sought to focus on the inter‐relationships between doctors and the complex work settings into which they transition. To this end, a ‘collective’ case study of doctors was designed. Key transitions for foundation year and specialist trainee doctors were studied. Four levels of the case were examined, pertaining to: the regulatory and policy context; employer requirements; the clinical teams in which doctors worked, and the doctors themselves. Data collection methods included interviews, observations and desk‐based research. Results A number of problems with doctors’ transitions that can all adversely affect performance were identified. (i) Transitions are regulated but not systematically monitored. (ii) Actual practice (as observed and reported) was determined much more by situational and contextual factors than by the formal (regulatory and management) frameworks. (iii) Trainees’ and health professionals’ accounts of their actual experiences of work showed how performance is dependent on the local learning environment. (iv) The increased regulation of clinical activity through protocols and care pathways helps to improve trainees’ performance, whereas the less regulated aspects of work, such as rotas, induction and the making of multiple transitions within rotations, can impede performance during a period of transition. Conclusions Transitions may be reframed as critically intensive learning periods (CILPs) in which doctors engage with the particularities of the setting and establish working relationships with other doctors and other professionals. Institutions and wards have their own learning cultures which may or may not recognise that transitions are CILPS. The extent to which these cultures take account of transitions as CILPs will contribute to the performance of new doctors. Thus, these findings have implications for practice and for policy, regulation and research.     

Transitioning to a new era: Future directions for staff development during COVID‐19

The COVID‐19 pandemic created an urgent need for staff development. However, COVID‐19 has created many challenges, including the inability to meet in‐person, travel restrictions to conferences, overwhelming clinical demands on already overextended faculty members and the increased need to focus on personal health and safety. Although current challenges were immediately met with solutions borne out of an emergency, questions remain on how to identify and sustain best practices and further evolve staff development beyond the immediate crisis. Reviewing the Medical Adaptations series revealed several lessons. Several authors used cognitive apprenticeship to provide scaffolding upon which learners can build skills, knowledge and attitudes. Additionally, moderators were recommended during live educational sessions in order to manage the chat box and engage the audience. Comprehensive IT support was key. A post‐session debrief helped deepen understanding and provided a space for peer support and community building. Building a repository for educational materials was recommended. Although we made significant gains in the ability to offer staff development, we must consider potential and unintended consequences and explore how we can use transformative learning theory to capitalize on what we have gained. Utilizing technology can potentially increase access to online learning; however, when not implemented carefully, it can magnify inequities. While providing IT support can serve to mitigate some inequities borne by socioeconomic and generational differences, additional strategies should be implemented to account for English as a second‐language learners; those with disabilities who do not have access to adaptive technology; and other marginalized groups who may already feel vulnerable to presenting arguments in oppositions of authority or the majority. Crafting online education experiences to allow for small group, peer‐to‐peer and social interactions is vital to continued professional and identity development. Now that the urgency has lessened, taking time to ensure what is being offered follows best practices in developing and disseminating quality online education is paramount for broad acceptance.     

Wise owls and professors: the role of older researchers in the review of the National Service Framework for Older People

Aim This article explores the involvement of older people in research and inspection, reflecting on the learning from the recent ‘joint review’ of the National Service Framework for Older People in England. Methodological context Working in 10 different localities, the ‘joint review’ comprised a formal inspection of health and local council services (carried out by the Healthcare Commission, Commission for Social Care Inspection and the Audit Commission) and an externally commissioned university‐led research project designed to ascertain the views and experiences of older people living in the 10 inspection sites. In total, 1839 older people were interviewed individually and through focus groups and an additional 4200 older people completed questionnaires. A distinctive feature of the research was the inclusion of a team of older researchers who had undertaken training in research methods in later life. Reflections of the older researchers and other members of the research team on undertaking this large‐scale user involvement project were ascertained via a day‐long seminar which was tape recorded and transcribed. Learning While many espouse the principle of ‘service user involvement’ in research, there is a need to move beyond the rhetoric of participation and any blanket assumptions about what it means to be an ‘older researcher’, a ‘service user researcher’ or indeed, a ‘professional researcher’. This means ensuring that within any given team (user‐controlled or collaborative) there are clear lines of accountability and equal opportunities for individual appraisal, support, and personal or professional development. Such considerations are key to working with ‘older researchers’ and encouraging diversity in the research workforce more generally.     

A model for evaluating the sustainability of community-directed treatment with ivermectin in the African Program for Onchocerciasis Control

Onchocerciasis is controlled by mass treatment of at‐risk populations with ivermectin. Ivermectin is delivered through community‐directed treatment (CDTI) approach. A model has been developed to evaluate the sustainability of the approach and has been tested at 35 projects in 10 countries of the African Program for Onchocerciasis Control (APOC). It incorporates quantitative and qualitative data collection and analysis, taking account of two factors identified as crucial to project sustainability. These are (i) the provision of project performance information to partners, and (ii) evidence‐based support for project implementation. The model is designed to provide critical indicators of project performance of the model to implementing, coordinating, and funding partners. The model's participatory and flexible nature makes it culturally sensitive and usable by project management. This model is able to analyze the different levels involved in project implementation and arrive at a judgment for the whole project. It has inbuilt mechanisms for ensuring data reliability and validity. The model addresses the complex issue of sustainability with a cross‐sectional design focusing on how and at which operational level of implementation to strengthen a CDTI project. The unique attributes and limitations of the model for evaluating the sustainability of projects were described. Copyright © 2012 John Wiley & Sons, Ltd.     

SnapAnatomy,a Computer‐Based Interactive Tool for Independent Learning of Human Anatomy

Computer‐aided instruction materials are becoming increasing popular in medical education and particularly in the teaching of human anatomy. This paper describes SnapAnatomy, a new interactive program that the authors designed for independent learning of anatomy. SnapAnatomy is primarily tailored for the beginner student to encourage the learning of anatomy by developing a three‐dimensional visualization of human structure that is essential to applications in clinical practice and the understanding of function. The program allows the student to take apart and to accurately put together body components in an interactive, self‐paced and variable manner to achieve the learning outcome.     

Neonatal health program management in a resource‐constrained setting in rural Uttar Pradesh,India

This analysis identifies salient features of team management that were critical to the efficiency of program implementation and the effectiveness of behavior change management to promote essential newborn care practices in Uttar Pradesh, India. In May 2003, the Johns Hopkins Bloomberg School of Public Health and King George Medical University initiated a cluster‐randomized, controlled neonatal health research program. In less than 2 years, the trial demonstrated rapid adoption of several evidence‐based newborn care practices and a substantial reduction in neonatal mortality in intervention clusters. Existing literature involving research program management in resource‐constrained areas of developing countries is limited and fails to provide models for team organization and empowerment. The neonatal research project examined in this paper developed a unique management strategy that provides an effective blueprint for future projects. Transferable learning points from the project include emphasizing a common vision, utilizing a live‐in field site office, prioritizing character and potential in the hiring process, implementing a learning‐by‐doing training program, creating tiers of staff recognition, encouraging staff autonomy, ensuring a broad staff knowledge base to seamlessly handle absences, and maintaining the flexibility to change partnerships or strategies. Copyright © 2009 John Wiley & Sons, Ltd.     

Support at Home for Early Language and Literacies (SHELLS): Collaboration and Challenge

The project, “Support at Home for Early Language and Literacies (SHELLS)”, is an early literacy intervention designed to empower the families of young children between birth and three years of age in their role as their children's first literacy teachers. SHELLS' content is based on participant interests, current knowledge about children's literacy learning in the years prior to school entry, and growing acceptance of the importance of learning in the first three years of life. SHELLS began in 1997 and currently operates with both Indigenous and non-Indigenous families in rural and regional areas of New South Wales, Australia. In this paper, the project and some of the future challenges are discussed. It is suggested that the collaborative and flexible model that has been developed for SHELLS has the potential to assist families from a range of social, cultural, economic and geographical settings in supporting their children's early literacy learning.     

A generative response to palliative service capacity in Canada

PURPOSE: This paper situates a large-scale learning and service development capacity-building initiative for hospice palliative care services within the current Canadian policy context for use by international readers. DESIGN/METHODOLOGY/APPROACH: In 2000 a national initiative using action research as its design was crafted to support continuing professional development and knowledge management in primary-health care environments. FINDINGS: The Canadian health policy context is complex and requires innovative solutions to achieve desired changes in response to emerging population health demands for quality end-of-life care. Employment of educational and social science constructs, including complexity theory, communities of practice, transformative learning theory, and workplace learning methods, has proven helpful in supporting the creation of national capacity for hospice palliative care. RESEARCH LIMITATIONS/IMPLICATIONS: There is a significant contribution for social scientists to make in aiding a better understanding of the complexity in health systems. At the same time, an aging population in industrial countries demands more active engagement of legal and bioethical scholars in a range of emerging policy and legislative questions about quality end-of-life care. Educational research is also required to understand better and reform curricula to prepare an emerging generation of health science practitioners for the demands of an aging population. PRACTICAL IMPLICATIONS: Changing health service delivery environments demand rethinking of the knowledge and skills leaders require to influence desired change. A broader understanding of where and how learning takes place is essential for enhancing the quality of patient care. ORIGINALITY/VALUE: The Pallium Project represents a generative response to facilitating learning and building longer-term system capacity. The journey of project development to date illustrates some important lessons that can be adopted from hospice palliative care to inform other primary-health care initiatives, including, potentially, mental health, cardiology, diabetes, geriatrics, where productive change can result from productively linking specialists and primary-care colleagues.     

‘I could never have learned this in a lecture’: transformative learning in rural health education

Health indicators for rural populations in Australia continue to lag behind those of urban populations and particularly for Indigenous populations who make up a large proportion of people living in rural and remote Australia. Preparation of health practitioners who are adequately prepared to face the ‘messy swamps’ of rural health practice is a growing challenge. This paper examines the process of learning among health science students from several health disciplines from five Western Australian universities during ‘Country Week’: a one-week intensive experiential interprofessional education program in rural Western Australia. The paper weaves together strands of transformative theory of learning with findings from staff and student reflections from Country Week to explore how facilitated learning in situ can work to produce practitioners better prepared for rural health practice.