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:

Taking responsibility for prescribing is one of newly qualified doctors’ greatest stressors.1 Despite being a routine task, prescribing insulin is particularly stress‐inducing. The global pandemic has made it more important to minimise transitioning students’ stress; yet there are fewer clinicians to support their accelerated transitions.We had planned an intervention during 9‐week ‘Clinical Assistantships’ immediately before qualifying. Students would write insulin ‘pre‐prescriptions’, which supervisors would endorse as prescriptions that were appropriate to dispense. A trained healthcare professional or person with diabetes (‘debriefer’) would conduct one‐to‐one Case Based discussions (CBDs) to help students learn reflectively from experience.

Enhancing workplace learning at the transition into practice: Lessons from a pandemic.

Purpose The hope that reliably testing clinicians' competencies would improve patient safety is unfulfilled and clinicians' psychosocial safety is deteriorating. Our purpose was to conceptualise 'mutual safety', which could increase benefit as well as reduce harm. Methods A cultural-historical analysis of how medical education has positioned the patient as an object of benefit guided implementation research into how mutual safety could be achieved. Results Educating doctors to abide by moral principles and use rigorous habits of mind and scientific technologies made medicine a profession. Doctors' complex attributes addressed patients' complex diseases and personal circumstances, from which doctors benefited too. The patient safety movement drove reforms, which reorientated medical education from complexity to simplicity: clinicians' competencies should be standardised and measurable, and clinicians whose 'incompetence' caused harm remediated. Applying simple standards to an increasingly complex, and therefore inescapably risky, practice could, however, explain clinicians' declining psychosocial health. We conducted a formative intervention to examine how 'acting wisely' could help clinicians benefit patients amidst complexity. We chose the everyday task of insulin therapy, where benefit and harm are precariously balanced. 247 students, doctors, and pharmacists used a thought tool to plan how best to perform this risky task, given their current clinical capabilities, and in the sometimes-hostile clinical milieus where they practised. Analysis of 1000 commitments to behaviour change and 600 learning points showed that addressing complexity called for a skills-set that defied standardisation. Clinicians gained confidence, intrinsic motivation, satisfaction, capability, and a sense of legitimacy from finding new ways of benefiting patients. Conclusion Medical education needs urgently to acknowledge the complexity of practice and synergise doctors' and patients' safety. We have shown how this is possible.

Acting wisely in complex clinical situations: 'Mutual safety' for clinicians as well as patients.

The wolf shall dwell with the lamb: the power dynamics of interprofessional education

Prescribing is a common task, often performed by junior clinicians, with potential for significant harm. Despite this, it is common for medical students to qualify having only prescribed in simulated scenarios or assessments. We implemented an alternative: students were given pens with purple ink, which permitted them to write prescriptions for real patients. We set out to understand how this intervention, pre-prescribing, created a zone of proximal development (ZPD) for learners.An anonymous, mixed methods, evaluation questionnaire was distributed to all final-year medical students at one university in the United Kingdom. Analysis was guided by Experience Based Learning theory.Two hundred and eighteen students made 386 free-text comments. Most participants reported that pre- helped them become capable doctors (Strongly Agree n = 96, 45%; Agree: n = 110, 50%). Pre-prescribing created a ZPD in which participants could use the tools of practice in authentic contexts under conditions that made it safe to fail.This research shows how a theoretically informed intervention can create conditions to enhance learning. It encourages educators to identify aspects of routine practice that could be delegated, or co-performed, by learners. With appropriate support, educators can create 'safe-fails' which allow learners to participate safely in authentic, risky, and indeterminate situations they will be expected to navigate as newly qualified clinicians. 

Pre-prescribing: Creating a zone of proximal development where medical students can safely fail

Abstract Purpose Prescribing is a common task, often performed by junior clinicians, with potential for significant harm. Despite this, it is common for medical students to qualify having only prescribed in simulated scenarios or assessments. We implemented an alternative: students were given pens with purple ink, which permitted them to write prescriptions for real patients. We set out to understand how this intervention, pre-prescribing, created a zone of proximal development (ZPD) for learners. Methods An anonymous, mixed methods, evaluation questionnaire was distributed to all final-year medical students at one university in the United Kingdom. Analysis was guided by Experience Based Learning theory. Results Two hundred and eighteen students made 386 free-text comments. Most participants reported that pre- helped them become capable doctors (Strongly Agree n = 96, 45%; Agree: n = 110, 50%). Pre-prescribing created a ZPD in which participants could use the tools of practice in authentic contexts under conditions that made it safe to fail. Conclusions This research shows how a theoretically informed intervention can create conditions to enhance learning. It encourages educators to identify aspects of routine practice that could be delegated, or co-performed, by learners. With appropriate support, educators can create ‘safe-fails’ which allow learners to participate safely in authentic, risky, and indeterminate situations they will be expected to navigate as newly qualified clinicians.

Hannah Gillespie

Papers

Enhancing workplace learning at the transition into practice: Lessons from a pandemic.

Acting wisely in complex clinical situations: 'Mutual safety' for clinicians as well as patients.

The wolf shall dwell with the lamb: the power dynamics of interprofessional education

Pre-prescribing: Creating a zone of proximal development where medical students can safely fail

Pre-prescribing: Creating a zone of proximal development where medical students can safely fail