Understanding of healthcare professionals towards the roles and competencies of clinical pharmacists in South Africa.

BACKGROUND: Incorporating clinical pharmacists in collaborative medical teams results in better patient treatment and health outcomes. In addition, the understanding of other healthcare professionals (HCPs) towards the role of clinical pharmacists can either facilitate or hinder the implementation and expansion of these services. The main distinction between pharmacists and clinical pharmacists lie in their different scope of duties. This study set out to explore other HCPs' understanding towards the role of the clinical pharmacists in South Africa, and to identify associated factors. METHODS: An exploratory, survey-based, quantitative study was conducted. A survey assessing HCPs' understanding based on the competencies and role of a clinical pharmacist was distributed to 300 doctors, nurses, pharmacists and clinical pharmacists. An exploratory factor analysis was carried out to determine the construct validity of the measurement. Items were analysed for grouping into subscales through principal components analysis. Differences in the variable scores for gender, age, work experience and previous experience working with a clinical pharmacist were analyzed using independent t-tests. Analysis of variance was used to analyze differences in the variable scores for the different HCPs and the different departments of work in the hospital. RESULTS: The factor analysis yielded two separate subscales, measuring HCPs' (n = 188) understanding towards the role of a clinical pharmacist, as well as the competencies of a clinical pharmacist. Doctors (85, n = 188) (p = 0.004) and nurses (76, n = 188) (p = 0.022), working in both surgical and non-surgical units, had significantly poorer understanding of the role of clinical pharmacists than clinical pharmacists (8, n = 188) and pharmacists (19, n = 188) (p = 0.028). Where specific clinical pharmacist activities were described, 5-16% of pharmacists were unsure whether an activity forms part of a clinical pharmacist's role. Over 50% of the clinical pharmacists disagreed that their role also includes pharmacist's activities, like stock procurement and control, pharmacy and administrative work, and hospital pharmacy-medication dispensing activities. CONCLUSION: The findings highlighted the possible impact of role expectations and lack of understanding among HCPs. A standard job description with recognition from statutory bodies could promote other HCPs, as well as clinical pharmacists' understanding of their roles. Findings further suggested the need for interventions like interprofessional education opportunities, staff induction programmes and regular interprofessional meetings to foster acknowledgement of clinical pharmacy services, promoting the acceptance and growth of the profession.

How progress evaluations are used in postgraduate education with longitudinal supervisor-trainee relationships: a mixed method study.

The combination of measuring performance and giving feedback creates tension between formative and summative purposes of progress evaluations and can be challenging for supervisors. There are conflicting perspectives and evidence on the effects supervisor-trainee relationships have on assessing performance. The aim of this study was to learn how progress evaluations are used in postgraduate education with longitudinal supervisor-trainee relationships. Progress evaluations in a two-year community-pharmacy specialization program were studied with a mixed-method approach. An adapted version of the Canadian Medical Education Directives for Specialists (CanMEDS) framework was used. Validity of the performance evaluation scores of 342 trainees was analyzed using repeated measures ANOVA. Semi-structured interviews were held with fifteen supervisors to investigate their response processes, the utility of the progress evaluations, and the influence of supervisor-trainee relationships. Time and CanMEDS roles affected the three-monthly progress evaluation scores. Interviews revealed that supervisors varied in their response processes. They were more committed to stimulating development than to scoring actual performance. Progress evaluations were utilized to discuss and give feedback on trainee development and to add structure to the learning process. A positive supervisor-trainee relationship was seen as the foundation for feedback and supervisors preferred the roles of educator, mentor, and coach over the role of assessor. We found that progress evaluations are a good method for directing feedback in longitudinal supervisor-trainee relationships. The reliability of scoring performance was low. We recommend progress evaluations to be independent of formal assessments in order to minimize roles-conflicts of supervisors.

Appreciating small-group active learning: What do medical students want, and why? A Q-methodology study.

INTRODUCTION: For Small-Group Active Learning (SMAL) to be effective, students need to engage meaningfully in learning activities to construct their knowledge. Teachers can have difficulty engaging their students in this process. To improve engagement, we aimed to identify the diversity in medical students' appreciation of SMAL, using the concepts of epistemic beliefs and approaches to learning. METHOD: Q-methodology is a mixed-method research design used for the systematic study of subjectivity. We developed a set of 54 statements on active learning methods. In individual interviews, first-year medical students rank ordered their agreement with these statements and explained their reasons. Data were analyzed using a by-person factor analysis to group participants with shared viewpoints. RESULTS: A four-factor solution (i.e. profiles) fit the data collected from 52 students best and explained 52% of the variance. Each profile describes a shared viewpoint on SMAL. We characterized the profiles as 'understanding-oriented', 'assessment-oriented', 'group-oriented', and 'practice-oriented'. DISCUSSION: The four profiles describe how and why students differ in their appreciation of SMAL. Teachers can use the profiles to make better-informed decisions when designing and teaching their SMAL classes, by relating to students' epistemic beliefs, and approaches to learning. This may improve student motivation and engagement for SMAL.

Measurement invariance of the strength of motivation for medical school: a multi-group confirmatory factor analysis.

BACKGROUND: The Strength of Motivation for Medical School-Revised (SMMS-R) questionnaire measures students' motivation for studying medicine. It includes three subscales: 'willingness to sacrifice', 'readiness to start', and 'persistence'. Measurement invariance is a prerequisite for group comparisons. The objectives of this study were to verify the factorial structure of the SMMS-R questionnaire and to investigate it's measurement invariance. METHODS: A total of 989 medical students were approached, 930 cases were kept for data analysis. Factorial structure of and measurement invariance of the SMMS-R were tested using single and multiple group confirmatory factor analyses with Mplus. Trational Cronbach's α along with McDonald's ω and glb were used to measure internal consistency for each subscale. RESULTS: Internal consistency for subscales and the full instrument were within the acceptable range. A 3-factor structure of the Chinese version of the SMMS-R was supported. Full configural, metric and partial scalar invariance were obtained. CONCLUSIONS: The SMMS-R showed measurement invariance across gender and two independent samples. So it can be used for group and cross-cultural comparisons.

A multi-site study on medical school selection, performance, motivation and engagement.

Medical schools seek ways to improve their admissions strategies, since the available methods prove to be suboptimal for selecting the best and most motivated students. In this multi-site cross-sectional questionnaire study, we examined the value of (different) selection procedures compared to a weighted lottery procedure, which includes direct admission based on top pre-university grade point averages (≥8 out of 10; top-pu-GPA). We also considered whether students had participated in selection, prior to being admitted through weighted lottery. Year-1 (pre-clinical) and Year-4 (clinical) students completed standard validated questionnaires measuring quality of motivation (Academic Self-regulation Questionnaire), strength of motivation (Strength of Motivation for Medical School-Revised) and engagement (Utrecht Work Engagement Scale-Student). Performance data comprised GPA and course credits in Year-1 and clerkship performance in Year-4. Regression analyses were performed. The response rate was 35% (387 Year-1 and 273 Year-4 students). Top-pu-GPA students outperformed selected students. Selected Year-1 students reported higher strength of motivation than top-pu-GPA students. Selected students did not outperform or show better quality of motivation and engagement than lottery-admitted students. Participation in selection was associated with higher engagement and better clerkship performance in Year-4. GPA, course credits and strength of motivation in Year-1 differed between students admitted through different selection procedures. Top-pu-GPA students perform best in the medical study. The few and small differences found raise questions about the added value of an extensive selection procedure compared to a weighted lottery procedure. Findings have to be interpreted with caution because of a low response rate and small group sizes.

Integrating the teaching role into one's identity: a qualitative study of beginning undergraduate medical teachers.

Beginning medical teachers often see themselves as doctors or researchers rather than as teachers. Using both figured worlds theory and dialogical self theory, this study explores how beginning teachers in the field of undergraduate medical education integrate the teacher role into their identity. A qualitative study was performed, involving 18 beginning medical teachers at a Dutch medical school. The teachers were interviewed twice and kept a logbook over a period of 7 months. The study shows that the integration of the teacher role into the teachers' identity was hampered by the idea that teaching is perceived by others as a low status occupation. Some teachers experienced significant tension because of this, while others showed resilience in resisting the negative associations that were thought to exist regarding teaching. The teachers used five different identity narratives in order to integrate the teacher role into their identity, in which the positions of teacher and doctor or researcher were found to be combined, adopted or rejected in diverse ways. The five identity narratives were: (1) coalition between the I-position of teacher and other I-positions; (2) no integration of the I-position of teacher: holding on to other I-positions; (3) construction of the I-position of teacher and other I-positions as opposites; (4) coalition between the I-position of teacher and a third position of coordinator; and (5) meta-position: trivialising the importance of status. These identity narratives offer starting points for supporting undergraduate teachers during their early professional years.

How motivation affects academic performance: a structural equation modelling analysis.

Few studies in medical education have studied effect of quality of motivation on performance. Self-Determination Theory based on quality of motivation differentiates between Autonomous Motivation (AM) that originates within an individual and Controlled Motivation (CM) that originates from external sources. To determine whether Relative Autonomous Motivation (RAM, a measure of the balance between AM and CM) affects academic performance through good study strategy and higher study effort and compare this model between subgroups: males and females; students selected via two different systems namely qualitative and weighted lottery selection. Data on motivation, study strategy and effort was collected from 383 medical students of VU University Medical Center Amsterdam and their academic performance results were obtained from the student administration. Structural Equation Modelling analysis technique was used to test a hypothesized model in which high RAM would positively affect Good Study Strategy (GSS) and study effort, which in turn would positively affect academic performance in the form of grade point averages. This model fit well with the data, Chi square = 1.095, df = 3, p = 0.778, RMSEA model fit = 0.000. This model also fitted well for all tested subgroups of students. Differences were found in the strength of relationships between the variables for the different subgroups as expected. In conclusion, RAM positively correlated with academic performance through deep strategy towards study and higher study effort. This model seems valid in medical education in subgroups such as males, females, students selected by qualitative and weighted lottery selection.

Motivation as an independent and a dependent variable in medical education: a review of the literature.

BACKGROUND: Motivation in learning behaviour and education is well-researched in general education, but less in medical education. AIM: To answer two research questions, 'How has the literature studied motivation as either an independent or dependent variable? How is motivation useful in predicting and understanding processes and outcomes in medical education?' in the light of the Self-determination Theory (SDT) of motivation. METHODS: A literature search performed using the PubMed, PsycINFO and ERIC databases resulted in 460 articles. The inclusion criteria were empirical research, specific measurement of motivation and qualitative research studies which had well-designed methodology. Only studies related to medical students/school were included. RESULTS: Findings of 56 articles were included in the review. Motivation as an independent variable appears to affect learning and study behaviour, academic performance, choice of medicine and specialty within medicine and intention to continue medical study. Motivation as a dependent variable appears to be affected by age, gender, ethnicity, socioeconomic status, personality, year of medical curriculum and teacher and peer support, all of which cannot be manipulated by medical educators. Motivation is also affected by factors that can be influenced, among which are, autonomy, competence and relatedness, which have been described as the basic psychological needs important for intrinsic motivation according to SDT. CONCLUSION: Motivation is an independent variable in medical education influencing important outcomes and is also a dependent variable influenced by autonomy, competence and relatedness. This review finds some evidence in support of the validity of SDT in medical education.

Twelve tips to stimulate intrinsic motivation in students through autonomy-supportive classroom teaching derived from self-determination theory.

BACKGROUND: Self-determination theory (SDT) of motivations distinguishes between intrinsic and extrinsic motivations. Intrinsic motivation is observed when one engages in an activity out of genuine interest and is truly self-determined. Intrinsic motivation is the desired type of motivation for study as it is associated with deep learning, better performance and positive well-being in comparison to extrinsic motivation. It is dependent on the fulfilment of three basic psychological needs described by SDT. These are the needs for autonomy, competence and relatedness. According to SDT, autonomy-supportive teaching is important, because it makes students feel autonomous and competent in their learning and also supported (relatedness) by their teachers. AIM: The concept of autonomy-supportive teaching is relevant to medical education, but less known. Through this article, we aim to make this concept understood and practically used by medical teachers. METHODS: We used SDT literature as a basis to formulate these 12 tips. RESULTS: We present 12 practical tips derived from SDT, for teachers in health professions, on how to engage in autonomy-supportive teaching behaviours in order to stimulate intrinsic motivation in their students. CONCLUSION: These tips demonstrate that it is not difficult to engage in autonomy-supportive teaching behaviour. It can be learned through practice and self-reflection on teaching practices.