How rural immersion training influences rural work orientation of medical students: Theory building through realist evaluation

IntroductionThe assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021.Methods and analysisThe intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might ‘work’ to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders.Ethics and disseminationEthics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences.

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Active learning of medical students in Taiwan: A realist evaluation

10.21203/rs.3.rs-34476/v2 ◽

2020 ◽

Author(s):

Chien-Da Huang ◽

Hsu-Min Tseng ◽

Chang-Chyi Jenq ◽

Liang-Shiou Ou

Keyword(s):

Medical Students ◽

Active Learning ◽

Professional Identity ◽

Learning Outcomes ◽

Cultural Context ◽

Early Stage ◽

Self Regulation ◽

Realist Evaluation ◽

Evaluation Framework ◽

Process Models

Abstract Background: Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why. Methods: Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the ‘context-mechanism-outcome’ (CMO) configurations. Results: Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers’ guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes). Conclusions: We identified three CMO configurations of Taiwanese medical students’ active learning. The connections among hierarchical culture, fear, teachers’ guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.

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Rural Undergraduate Support and Coordination, Rural Clinical School, and Rural Australian Medical Undergraduate Scholarship: rural undergraduate initiatives and subsequent rural medical workforce

Australian Health Review ◽

10.1071/ah11072 ◽

2012 ◽

Vol 36 (3) ◽

pp. 301 ◽

Cited By ~ 9

Author(s):

Denese E. Playford ◽

Edwina Cheong

Keyword(s):

Medical Students ◽

Western Australia ◽

Medical Practitioners ◽

Rural Background ◽

Rural Workforce ◽

Medical Undergraduate ◽

Undergraduate Experience ◽

History Of ◽

Rural Work ◽

Educational Placements

Background. This study examined postgraduate work after an undergraduate clinical year spent in the Rural Clinical School of Western Australia (RCSWA), compared with 6 weeks Rural Undergraduate Support and Coordination (RUSC)-funded rural experience in a 6-year undergraduate medical course. Rural background, sex and Rural Australian Medical Undergraduate Scholarship (RAMUS)-holding were taken into account. Methods. University of Western Australia undergraduate data were linked by hand with postgraduate placements to provide a comprehensive dataset on the rural exposure history of junior medical practitioners working in Western Australia between 2004 and 2007. Results. Participation in the RCSWA program was associated with significantly more postgraduate year one rural work than RUSC placement alone (OR = 1.5, CI 0.97–2.38). The RCSWA workforce effect increased at postgraduate year two (OR = 3.0, CI 1.6484 to 5.5935 relative to RUSC). Rural-origin practitioners who chose the RCSWA program were more likely than other rural-origin practitioners to take rural rotations in both postgraduate years. RAMUS holders’ choice in relation to the RCSWA program predicted later rural work. There were no effects of sex. Conclusions. Rural initiatives, in particular the Rural Clinical School program, are associated with postgraduate rural choices. The real impact of these data rely on the translation of early postgraduate choices into long-term work commitments. What is known about the topic? Specific training of rural graduates is strongly related to subsequent rural workforce. In addition, rural educational placements affect medical students’ intentions to practise rurally. Retrospective data from rural relative to urban general practitioners link rural background, rural undergraduate experience and rural postgraduate experience with rural work. What does this paper add? Much of the Australian prospective outcomes research has looked at workforce intentions of graduates, or the workforce outcomes of small graduate cohorts of Rural Clinical Schools. This paper followed nearly 500 graduates by name through to their PGY1 and PGY2 workforce decisions. As this cohort comprised 80% of three completely graduated MBBS years, these data validly represent the outcome of a medical school which is comparable to all Australian medical schools in its RUSC, Rural Clinical School and RAMUS recipients. The paper provides the first peer-reviewed outcomes data for the RAMUS scholarship program. What are the implications for practitioners? Rural supervision of medical students is an effective way to recruit new workforce. The longer students are supervised in rural settings, the better. But undergraduate programs need to be linked with postgraduate initiatives that take graduates of medical student initiatives into vocational programs able to deliver a trained rural workforce.

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Rural work outcomes of medical students participating in a contracted Extended Rural Cohort (ERC) program by course-entry preference

Medical Teacher ◽

10.1080/0142159x.2019.1569755 ◽

2019 ◽

Vol 41 (6) ◽

pp. 703-710 ◽

Cited By ~ 1

Author(s):

Belinda O’Sullivan ◽

Matthew McGrail ◽

Laura Major ◽

Mark Woodfield ◽

Christian Holmes

Keyword(s):

Medical Students ◽

Work Outcomes ◽

Rural Work

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Using the realist interview approach to maintain theoretical awareness in realist studies

Qualitative Research ◽

10.1177/1468794119881985 ◽

2019 ◽

Vol 20 (4) ◽

pp. 485-515 ◽

Cited By ~ 4

Author(s):

Ferdinand C Mukumbang ◽

Bruno Marchal ◽

Sara Van Belle ◽

Brian van Wyk

Keyword(s):

Evaluation Studies ◽

Explanatory Power ◽

Realist Evaluation ◽

Theory Building ◽

Qualitative And Quantitative ◽

Interview Technique ◽

Data Collection And Analysis ◽

Relevant Context ◽

Generative Mechanisms ◽

Interviewing Technique

Realist evaluation submits that theories and models of how, why, for whom and under what circumstances programs work could be formulated by conceptualizing the relational links between the context within which programs are implemented, the generative mechanisms the programs trigger, and the outcomes of interest. Qualitative and quantitative data collection and analysis allow for the description of the relevant context, the generative mechanisms, and the emergent outcomes of programs and provide explanatory power to link these elements. The ‘realist interviewing technique’, whereby interviewees comment on a suggested ‘program theory’ to provide refinement, is proposed as a distinctive approach for conducting interviews in a realist-informed inquiry. However, the application of this interviewing strategy within the realist evaluation studies is underutilized. In this study, we demonstrate how the realist interview technique reinforces and maintains theoretical awareness and contributes to trustworthiness through three theory-building phases: theory gleaning, theory refining, and theory consolidation.

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A Realist Evaluation of Senior Medical Students' Perspective of a One-Week A Residential Aged Care Facility Clerkship

10.21203/rs.3.rs-127873/v1 ◽

2020 ◽

Author(s):

Janette Christine Radford ◽

Marguerite Bramble ◽

Anne Todd

Keyword(s):

Medical Students ◽

Care Facility ◽

Aged Care ◽

Realist Evaluation ◽

Residential Aged Care ◽

Previous Theory ◽

Experience Based Learning ◽

Focus Group Data ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

Abstract Background: Residential aged care facilities (RACFs), also known as nursing or aged care homes are infrequently used to deliver experience-based learning to medical students. Methods: This is a realist evaluation of senior medical students’ perspective of a one-week clerkship delivered in RACFs seeking to find what aspects of their clerkship worked for whom and why as part of the evaluation of the clerkship. This is a qualitative study using written and focus group data.Results: The highly structured curriculum delivered many positive learning outcomes for students such as practice in improving management of end-of-life and dementia care, an understanding of how RACFs functioned, and a chance to participate in interprofessional practice. The context also challenged some students who struggled to see the relevance of the clerkship in relation to their personal and/or professional identities.Conclusions: The realist evaluation builds on a previous theory of experience-based learning adding a student intraindividual aspect to the theory to better define the mechanisms involved. The resulting realist theory of experience-based learning may prove useful to other studies of experience-based learning.

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Active learning of medical students in Taiwan: a realist evaluation

BMC Medical Education ◽

10.1186/s12909-020-02392-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chien-Da Huang ◽

Hsu-Min Tseng ◽

Chang-Chyi Jenq ◽

Liang-Shiou Ou

Keyword(s):

Medical Students ◽

Active Learning ◽

Professional Identity ◽

Learning Outcomes ◽

Cultural Context ◽

Early Stage ◽

Self Regulation ◽

Realist Evaluation ◽

Evaluation Framework ◽

Process Models

Abstract Background Active learning is defined as any instructional method that engages students in the learning process. Cultural differences in learning patterns can play an important role in engagement with active learning. We aimed to examine process models of active learning to understand what works, for whom and why. Methods Forty-eight sixth- and seventh-year medical students with experience of active learning methods were purposively selected to participate in ten group interviews. Interactions around active learning were analysed using a realist evaluation framework to unpack the ‘context-mechanism-outcome’ (CMO) configurations. Results Three core CMO configurations, including cultural, training and individual domains, were identified. In the cultural context of a strong hierarchical culture, the mechanisms of fear prompted students to be silent (outcome) and dare not give their opinions. In the training context of teacher-student familiarity alongside teachers’ guidance, the mechanisms of learning motivation, self-regulation and enthusiasm were triggered, prompting positive learning outcomes and competencies (outcome). In the individual context of learning how to learn actively at an early stage within the medical learning environment, the mechanisms of internalisation, professional identity and stress resulted in recognising active learning and advanced preparation (outcomes). Conclusions We identified three CMO configurations of Taiwanese medical students’ active learning. The connections among hierarchical culture, fear, teachers’ guidance, motivation, the medical environment and professional identity have been shown to affect the complex interactions of learning outcomes. Fear derived from a hierarchical culture is a concern as it is a significant and specific contextual factor, often sparking fear with negative outcomes.

Download Full-text