Paula Rowland is championing: ‘Nurses whisper.’ Identities in nurses’ patient safety narratives of nurse-trainee doctors’ interactions.
Nurses whisper. How to resist the title that draws you in. Whispering can be conspiratorial, of course. But whispering can also be intimate, encouraging, a quiet expression of amazement. With this simple phrase – ‘nurses whisper’- we are drawn into questions of voice, of power, of frontstages and backstages where the identities of healthcare providers are constructed. This qualitative study by Ray Samuirwo, Allison Bullock, Katie Webb and Lynn V. Monrouxe draws out this identity construction. Interviewing nurses about their experiences in dyadic interactions with trainee doctors in relation to patient safety, the authors shift our gaze to the ways learning and identity are always relational, always in context. No one profession learns alone. And no one identity is constructed in isolation from others. Using a combination of inductive and deductive analytical strategies, the authors classify seven different nurse identities and the corresponding narrative constructions of medical trainees in relation to patient safety. Drawing conclusions and implications with particular relevance to clinical learning environments, these insights are essential for health professions education. But what are nurses whispering? You are going to have to read this paper to find out.
Ivan Silver is championing: The Butterfly Effect in Clinical Supervision
In my youth I was a dancer in a performance dance group called “Haparparim” (The Butterflies). It was a seminal learning experience that led me to associate the flight of butterflies, the joy of dance and curiosity about why this wonderful learning experience was so impactful.
This elegant and succinct paper has illuminated my understanding of these associations. The paper was written for both clinical supervisors and for researchers studying clinical supervision. It’s basic premise is that clinical supervision is a complex matrix of activities that may be partially understood using logical linear models of communication but is best understood by applying complexity theory and non-linearity models to the multiple variables that could be influencing the quality of learning and ultimately patient care and safety. The authors introduce the metaphor of the “butterfly effect” that was coined by a meteorologist, Edward Lorenz to account for the phenomenon that a small change in a dynamic system (a flapping butterfly wing) can have profound and unpredictable effects due to the profound influence of tiny variations.
Applied to supervision and related scholarship, this metaphor raises the challenges for supervisors and researchers of fully understanding what is actually happening in supervision, the timing of supervisor interventions, the responses of supervisees and the subsequent multiple and subtle outcomes that occur after each supervision session. The authors cite evidence from several studies that highlight consistent features of the rationale for decision making of supervisors – that it is often intuitive, not easily enunciated, and not always replicable from student to student. Supervisors when asked for their rationale for the decisions they make, may often respond, “it depends”. How do we understand the “it depends” situations? The authors respond by issuing a challenge to supervisors and researchers to try and make the effect of butterfly wings more visible and audible.
Malika Sharma is championing: Symbolic Solidarity or Virtue Signaling? A Critical Discourse Analysis of the Public Statements Released by Academic Medical Organizations in the Wake of the Killing of George Floyd
Black lives matter. In the wake of the murder of George Floyd in 2020, many medical schools responded with “statements of solidarity.” Scholars Brown, Auguste, Omobhude, Bakana, and Sukhera use critical discourse analysis to explore these statements to explore issues of power and identify areas of tension. They ask incisive questions around the ways in which so-called solidarity statements can further entrench a problematic status quo by individualizing responsibility, absolving institutions of accountability, and erasing the specificity of anti-Black racism. Words matter – both in what is said, and what is left unsaid. Words do matter – but to actually work in solidarity, the authors demonstrate that we must move beyond words, and into action.
Kathryn Parker is championing: ‘Making room for student autonomy’ – an ethnographic study of student participation in clinical work
Participation in clinical work is important for medical students’ professional development. However, students often report that they experience a passive observer role, and further research on contextual factors that infuence student participation is needed. The theory of practice architectures contributes a new perspective to this challenge by elucidating how cultural-discursive, material-economic, and social-political arrangements enable and constrain student participation in clinical work. The aim of this study was to explore how practice architectures in clinical learning environments enable and constrain medical students’ participation. The study was designed as an ethnographic feld study in three student clinics: 106 h of observation. Analysis comprised ethnographic analysis followed by application of the theory of practice architectures. The ethnographic analysis resulted in six themes: setting the scene, when to call for help, my room – my patient, getting in a routine, I know something you don’t, and my work is needed. Applying the theory of practice architectures showed that material-economic arrangements, such as control of the consultation room and essential artefacts, were crucial to student participation and position in the clinical workplace. Furthermore, co-production of a student mandate to independently perform certain parts of a consultation enabled a co-productive student position in the hierarchy of care-producers. The findings offer a conceptually generalisable model for the study of material and social dimensions of clinical learning environments. Although not all clinical learning environments may wish to or have the resources to implement a student clinic, the findings offer insights into general issues about the arrangements of student participation relevant to most clinical teaching contexts.
Why this article is important….
1. This grounds the practice of student-led services in a theoretical model.
2. It approaches student-led learning opportunities from a cultural perspective.
3. Grounded in theory and with a cultural perspective, the article provides practical tips on how to best support student-led learning.
Quantitative research is commonplace in health professions education (HPE). One of the most recurrent questions answered through quantitative methods is whether a new educational intervention (e.g., a new way of providing feedback) is more effective than the established way of doing things. Imagine you are an educator, reading an article describing the effects of an intervention. How would you decide whether the intervention is effective, and potentially worth implementing? Educators may often rely on p-values to make such decisions, due in part to researchers’ reliance on this statistic. However, p-values are often misinterpreted, even by researchers.
The article I have chosen assesses how often researchers misinterpret their own non-statistically significant results (i.e., when p ≥ 0.05). Although this article is not published in an HPE-related journal, it reviews articles published in four high impact journals that do publish HPE-related research. The authors found that, in more than half of cases, researchers interpreted a non-statistically significant result as evidence of no differences between conditions. In many cases, however, there may be educationally meaningful differences that are compatible with the data, even when p ≥ 0.05. Accordingly, when researchers frame non-statistically significant results as evidence of no effect, educators may be less likely to attend to interventions whose potential for benefit, given the possibility of an educationally meaningful effect, may outweigh their costs of implementation.
This is, in my opinion, the most important HPE-related article of the year, because it reveals a reliance on a statistical paradigm that may limit the progress of quantitative research in our field, especially in how it is interpreted and applied by educators. It motivated me to reflect on how I frame my findings for both researchers and educators, and inspired my adoption of Bayesian methods, as is recommended by the authors.
6FebThis virtual community event is for CFD members to come together to during a lunch and learn to discuss emerging curiosities, questions and tensions within health professions education on the topic of the month.
7FebAre you someone who is in a leadership role or responsible influencing people/change and looking to enhance the performance or support the development of another in the areas of teaching, leadership, scholarship and advocacy? In this applied workshop, we will explore how you can enhance your skills as a coach through Brief Solution Focused Coaching to support a colleague develop themselves at work or in the clinical academic environment.
14FebPlease join us for BPER Reads, our annual "Battle of the Papers" where Ivan Silver and Paula Rowland will battle it out to convince us which paper of 2022 is the one paper all health professional educators must read.
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