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Medical and nurse students’ perspective on learning in acute care
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Medical and nurse students’ professional training takes place in a complex and rapidly changing health care setting. Workplace learning in this context have a considerable potential to contribute to the development of professional competence. However, the complexity of the acute care context can also hinder such an advancement.

Aim: To explore medical and nurse students’ perspective on how and what they learn during acute care placements, and how aspects of such a milieu could influence learning.

Method: A qualitative design was chosen. In study I free text answers and interview data from medical and nurse students were collected and a content analysis was conducted. In study II & III ethnographic observations and informal conversations were collected in an acute medical ward. Medical and nurse students, staff and supervisors were observed and an inductive analysis was performed. In study IV interview data was collected from graduated nurses on their learning experiences as students in acute care. An inductive comparative analysis was performed on these interview data together with data from ethnographic observations of nurse students’ interactions and learning in the acute health care ward.

Results: In study I we identified three themes that influenced students’ progress towards professional competence: Management, planning and organisation for learning; Workplace culture and Learning a profession. In study II we identified four characteristics that formed how students adapted and interacted in the community of practice: Complex and stressful situations; Variable composition and roles of community members; Transitions through community boundaries and Levels of importance and priority. In study III we identified two themes that influenced medical students’ opportunities to participate and learn in an acute internal medicine ward: Nervousness and curiosity and Invited and involved. Finally, in study IV three themes described long-term outcomes of workplace learning for nurse students: To handle shifting situations; To build relationships and To act independently.

Conclusion: The workplace culture in an acute care ward formed the conditions in which students learn and interact. Students have at arrival to enter a community of practice, adapt to its culture and to be accepted. If students were given opportunities to participate actively in the real patient care, they successively developed a professional identity.

Medical and nurse students achieved differing competences and interacted in dissimilar ways during workplace learning. Medical students’ interactions and learning were dominated by queries and responses. However, the potential to develop competence to judge and approach complex patient cases was underutilised. Learning at the ward provided nurse students with understanding of their future profession as nurses, and they learnt how to handle stress and variable situations.

We found that the stressful, ever-changing, demanding, but also considerably structured and organised acute care ward offered abundant learning opportunities that could be used. Therefore, it is maybe not necessary to create and structure new learning situations. But rather to use real care situations and patient cases, and to form conditions and attitudes that make learning in this real world situation inspiring and valuable. However, the full potential of this is as yet not fully utilized.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2016. , 70 p.
National Category
Nursing
Identifiers
URN: urn:nbn:se:rkh:diva-2439ISBN: 978-91-7676-351-3 (print)OAI: oai:DiVA.org:rkh-2439DiVA: diva2:1137746
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
List of papers
1. Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community
Open this publication in new window or tab >>Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community
2014 (English)In: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 27, no 1, 15-23 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The healthcare system is complex and the education of medical and nursing students is not always a priority within it. However, education offered at the point of care provides students with opportunities to apply knowledge, and to develop the necessary skills and attitudes needed to practice their future profession. The major objective of this study was to identify students' views of generic aspects of the healthcare environment that influences their progress towards professional competence.

METHODS: We collected free text answers of 75 medical students and 23 nursing students who had completed an extensive questionnaire concerning their learning in clinical wards. In order to obtain richer data and a deeper understanding, we also interviewed a purposive sample of students. Qualitative content analysis was conducted.

RESULTS: We identified three themes: (1) How management, planning and organising for learning enabled content and learning activities to relate to the syllabus and workplace, and how this management influenced space and resources for supervision and learning; (2) Workplace culture elucidated how hierarchies and communication affected student learning and influenced their professional development and (3) Learning a profession illustrated the importance of supervisors' approaches to students, their enthusiasm and ability to build relationships, and their feedback to students on performance.

DISCUSSION: From a student perspective, a valuable learning environment is characterised as one where management, planning and organising are aligned and support learning. Students experience a professional growth when the community of practice accepts them, and competent and enthusiastic supervisors give them opportunities to interact with patients and to develop their own responsibilities.

National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2440 (URN)10.4103/1357-6283.134296 (DOI)24934938 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
2. Community of practice and student interaction at an acute medical ward: An ethnographic study
Open this publication in new window or tab >>Community of practice and student interaction at an acute medical ward: An ethnographic study
2016 (English)In: Medical teacher, ISSN 0142-159X, E-ISSN 1466-187X, Vol. 38, no 8, 793-800 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A deeper understanding is needed of the acute medical care setting as a learning environment for students.

AIM: To explore workplace culture of an acute medical ward and students' interactions within this community.

METHOD: An ethnographic design was applied. Medical and nurse students' interactions were observed and informal questioning performed. Field notes were transcribed and analysed qualitatively, inspired by Wengers' "Community of practice" theory.

RESULTS: We identified four characteristics that regulated how students adapt and interact in the community of practice. Complex and stressful situations were stabilized by routines and carriers of culture. Variable composition and roles of community members were a part of the daily routine but did not seam obvious to students. Transitions through community boundaries were confusing especially for new students. Levels of importance and priority: Hierarchies and orders of priority were present as regulators of roles, routines and interactions, and of how staff approach different patient groups.

CONCLUSION: The culture shaped a pattern for, and created prerequisites that challenged students' adaptation and created a space for learning. Students' task on arrival was to enter the semipermeable membrane of the community of practice and to understand and adapt to its culture, and try to become accepted.

National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2441 (URN)10.3109/0142159X.2015.1104411 (DOI)26573137 (PubMedID)
Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
3. Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study
Open this publication in new window or tab >>Medical students' opportunities to participate and learn from activities at an internal medicine ward: an ethnographic study
2017 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, e013046Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To optimise medical students' early clerkship is a complex task since it is conducted in a context primarily organised to take care of patients. Previous studies have explored medical students' perceptions of facilitation and hindrance of learning. However, the opportunities for medical student to learn within the culture of acute medicine care have not been fully investigated. This study aimed to explore how medical students approach, interact and socialise in an acute internal medicine ward context, and how spaces for learning are created and used in such a culture.

DESIGN AND SETTING: Ethnographic observations were performed of medical students' interactions and learning during early clerkship at an acute internal medicine care ward. Field notes were taken, transcribed and analysed qualitatively. Data analysis was guided by Wenger's theory of communities of practice.

PARTICIPANTS: 21 medical students and 30 supervisors participated.

RESULTS: Two themes were identified: Nervousness and curiosity-students acted nervously and stressed, especially when they could not answer questions. Over time curiosity could evolve. Unexplored opportunities to support students in developing competence to judge and approach more complex patient-related problems were identified. Invited and involved-students were exposed to a huge variation of opportunities to learn, and to interact and to be involved. Short placements seemed to disrupt the learning process. If and how students became involved also depended on supervisors' activities and students' initiatives.

CONCLUSIONS: This study shed light on how an acute internal medicine ward culture can facilitate medical students' possibilities to participate and learn. Medical students' learning situations were characterised by questions and answers rather than challenging dialogues related to the complexity of presented patient cases. Further, students experienced continuous transfers between learning situations where the potential to be involved differed in a wide variety of ways.

Keyword
ethnography, internal medical ward, learning, medical students, undergraduate
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2443 (URN)10.1136/bmjopen-2016-013046 (DOI)28196948 (PubMedID)
Note

As manuscript in dissertation with title:

Activities at an internal medicine ward -medical students’ opportunities to participate and learn

Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved
4. Nurses' perspective on their undergraduate professional learning in acute care
Open this publication in new window or tab >>Nurses' perspective on their undergraduate professional learning in acute care
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:rkh:diva-2444 (URN)
Note

As manuscript in dissertation

Available from: 2017-09-01 Created: 2017-09-01 Last updated: 2017-09-01Bibliographically approved

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