Self-Directed Learning, A Guide for Learners and Teachers

3. Do I use effective communication strategies? Is there always “time just to talk”? Do I seek family observations/information in assessment? In monitoring? Do family members have opportunities to ask questions or seek clarification? Do I present information at a time and in a format preferred by the family members? Do I keep my work with family members respectful, yet informal, and free of professionally precious jargon?

The adult learner.

The care of the patient.

Hermeneutic phenomenology, as a methodology, is not fixed. Inherent in its enactment are contested areas of practice such as how interview data are used and reported. Using philosophical notions drawn from hermeneutic phenomenological literature, we argue that working with crafted stories is congruent with the philosophical underpinnings of this methodology. We consider how the practical ontic undertaking of story crafting from verbatim transcripts is integral with the interpretive process. We show how verbatim transcripts can be crafted into stories through examples taken from interview data. Our aim is to open dialogue with other hermeneutic phenomenological researchers and offer alternate possibilities to conventional ways of work with qualitative data. We argue that crafted stories can provide glimpses of phenomena that other forms of data analysis and presentation may leave hidden. We contend that crafted stories are an acceptable and trustworthy methodological device.

Crafting Stories in Hermeneutic Phenomenology Research: A Methodological Device

Book Review: Conducting hermeneutic research: From philosophy to practice:

The problem: Clinical practice commonly presents new doctors with situations that they are incapable of managing safely. This harms patients and stresses the new doctors and other clinicians. Unpreparedness for practice remains a problem despite changes in curricula from apprenticeship to outcome-based designs. This is unsurprising because capability depends on learning from practical experience in supportive learning environments. To assure the care of patients and well-being of residents, the pedagogy of medical students' practice-based education is in urgent need of an overhaul. This Guide: Experience based learning (ExBL) is a 21st century pedagogy of practice-based learning, derived from best current theory and evidence. ExBL specifies capabilities that medical students need to acquire from practical experience. It exemplifies how clinicians' behavior can help students gain experience. It explains how reflection converts real patient learning into capability and identity. It identifies desirable features of learning environments. This Guide advises clinicians, students, placement leads, faculty developers, and other stakeholders how to make new doctors as capable as possible. ExBL is a comprehensive model of medical students' practice-based learning, which complements competency-based education to prepare new doctors to deliver safe, effective, and compassionate care.

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Experience based learning (ExBL): Clinical teaching for the twenty-first century

https://pureadmin.qub.ac.uk/ws/files/127140732/Gillespie_2017.pdf

How do patients experience caring? Scoping review

CONTEXT Peabody's maxim 'the secret of the care of the patient is in caring for the patient' inspired generations of doctors to relate humanely to patients. Since then, phrases such as 'managed care' have impersonalised caring. The term 'patient-centred' was introduced to re-personalise caring. Ironically, however, such terms have been defined by professionals' preconceptions rather than patients' experiences. Using patients' experiences of doctors being (un)caring to guide doctors' learning could reinvigorate caring. Interpretive phenomenology provides qualitative research tools with which to do this. METHODS Ten patients, purposively selected to have broad experiences of primary, secondary and tertiary health care, consented to participate. To stay close to their lived experiences, participants first drew 'Pictor' diagrams to represent relationships between themselves and professionals during remembered experiences of (un)caring. A researcher then used the depictions to structure in-depth, one-to-one explorations of the lived experience of caring. Verbatim transcripts were analysed using template analysis. To remain very close to patients' experiences, the researchers assembled a narrative description of the phenomenon of caring using participants' own words. RESULTS Caring doctors were genuine. They allowed their own individuality to interact with patients' individuality. This made participants feel recognised as individuals, not just diseases. Caring doctors listened and spoke carefully, encouraged expressions of emotion, were accessible and responsive, and formed relationships. These factors empowered participants to be actively involved in their own care. Little things like smiling, shaking hands, admitting uncertainty, asking a colleague for advice and calling a participant unexpectedly at home showed that doctors were prepared to 'go above and beyond'. This was caring. CONCLUSIONS These findings provide medical educators with an interpretation of caring that is truly patient-centred. Coupling technical proficiency with human qualities - being genuinely empathic and respectful - within doctor-patient relationships is the essence of caring.

/pdf/how-can-tomorrow-s-doctors-be-more-caring-a-phenomenological-47h6wyfmay.pdf

How can tomorrow's doctors be more caring? A phenomenological investigation

Competent but unprepared new graduates are sitting ducks for psychosocial harm

/pdf/medical-students-need-experience-not-just-competence-1xi2cj0mvs.pdf

Medical students need experience not just competence

Prescribing (writing medication orders) is one of residents' commonest tasks. Superficially, all they have to do is complete a form. Below this apparent simplicity, though, lies the complex task of framing patients' needs and navigating relationships with them and other clinicians. Mistakes, which compromise patient safety, commonly result. There is no evidence that competence-based education is preventing harm. We found a profound contradiction between medical students becoming competent, as defined by passing competence assessments, and becoming capable of safely caring for patients. We reinstated patients as the object of learning by allowing students to 'pre-prescribe' (complete, but not authorise prescriptions). This turned a disabling tension into a driver of curriculum improvement. Students 'knotworked' within interprofessional teams to the benefit of patients as well as themselves. Refocusing undergraduate medical education on patient care showed promise as a way of improving patient safety.

/pdf/the-pen-is-mightier-than-the-sword-reinstating-patient-care-wvnukyhicc.pdf

Hannah Gillespie

Papers

Experience based learning (ExBL): Clinical teaching for the twenty-first century

How do patients experience caring? Scoping review

How can tomorrow's doctors be more caring? A phenomenological investigation

Medical students need experience not just competence

The pen is mightier than the sword. Reinstating patient care as the object of prescribing education.