Preparing Medical and Nursing Students for Interprofessional Feedback Dialogues.

Background: In healthcare education, preparing students for interprofessional feedback dialogues is vital. However, guidance regarding developing interprofessional feedback training programs is sparse. In response to this gap, the Westerveld framework, which offers principles for interprofessional feedback dialogue, was developed. Approach: Using the Westerveld framework, we developed and implemented an interprofessional feedback intervention for 4th-year nursing and 5th-year medical students. It encompasses two half-day workshops comprising small group sessions, interactive lectures, and a goal-setting assignment for the rotations. This paper describes the intervention and reflects on students' self-reported goals, as learning outcomes, to inform future interprofessional feedback dialogue education. Outcomes: To understand student's learning outcomes, we coded the content and specificity of 288 responses to the goal-setting assignment. Students indicated they mainly aimed to improve their feedback actionability, but contrastingly set - largely unspecific - goals, addressing the initiation of feedback dialogues. To better understand the process of setting these goals, we held three focus groups (N = 11): aside from the Westerveld framework, students used previous experience in rotations, outcome expectations, and personal characteristics as sources in their goal-setting process. Reflection: The contrast between students' aims to improve their actionability and their goals to initiate dialogues, suggests that overcoming practice barriers to initiating dialogues are conditional to developing other feedback dialogue aspects. These and other goal conflicts in the workplace may hinder them setting specific feedback dialogue goals. We recommend explicit discussion of these challenges and conflicts in interprofessional feedback dialogue education.

Vertical integration in medical education: the broader perspective.

Curricular integration represents collaborations between disciplines to establish a coherent curriculum and has become the dominant recommendation for medical education in the second half of the twentieth century. Vertical integration specifically is the integration between the clinical and basic science parts throughout the program. Vertically integrated curricula present basic sciences imbedded in a clinical context from the start of medical school.The authors briefly discuss vertical integration in relationship with context theory, motivation theory, professional identity formation, transition to practice and the continuum of education and practice. They conclude that vertical integration, rather than horizontal integration, extends far beyond curriculum structure. They consider vertical integration a philosophy of education, with impact on students' maturation and engagement with the profession, and which applies not only to undergraduate education but to the lifelong learning of professionals. The definition of vertical integration as "an educational approach that fosters a gradual increase of learner participation in the professional community through a stepwise increase of knowledge-based engagement in practice with graduated responsibilities in patient care" is more comprehensive than its older conceptualization.

Social Identification with the Medical Profession in the Transition from Student to Practitioner.

Phenomenon: This study explores professional identity formation during a final year of medical school designed to ease the transition from student to practitioner. Although still part of the undergraduate curriculum, this "transitional year" gives trainees more clinical responsibilities than in earlier rotations. Trainees are no longer regarded as regular clerks but work in a unique position as "semi-physicians," performing similar tasks as a junior resident during extended rotations. Approach: We analyzed transcripts from interviews with 21 transitional-year medical trainees at University Medical Center Utrecht about workplace experiences that affect the development of professional identity. We used Social Identity Approach as a lens for analysis. This is a theoretical approach from social psychology that explores how group memberships constitute an important component of individual self-concepts in a process called 'social identification.' The transcripts were analyzed using thematic analysis, with a focus on how three dimensions of social identification with the professional group emerge in the context of a transitional year: cognitive centrality (the prominence of the group for self-definition), in-group affect (positivity of feelings associated with group membership) and in-group ties (perception of fit and ties with group members). Findings: Students were very aware of being a practitioner versus a student in the position of semi-physician and performing tasks successfully (i.e., cognitive centrality). Students experienced more continuity in patient care in transitional-year rotations than in previous clerkships and felt increased clinical responsibility. As a semi-physician they felt they could make a significant contribution to patient care. Students experienced a sense of pride and purpose when being more central to their patients' care (i.e., in-group affect). Finally, in extended rotations, the trainees became integrated into daily social routines with colleagues, and they had close contact with their supervisors who could confirm their fit with the group, giving them a sense of belonging (i.e., in-group ties). Insights: Using the three-dimension model of social identification revealed how students come to identify with the social group of practitioners in the context of a transitional year with extended rotations, increased clinical responsibilities, and being in the position of a "semi-physician." These findings shed light on the identity transition from student to practitioner within such a curricular structure.

The Significance of Experiencing Clinical Responsibilities for Specialty Career Choice.

AIM: Medical trainees make career choices in the final year of medical school or after graduation, if they do not continue with residency directly. Most Dutch medical students are trained in vertically integrated (VI) curricula, with early clinical experience and a gradual increase in clinical responsibilities. Students in such curricula have been reported to make career choices at an earlier stage than graduates from more traditionally designed curricula. Many Dutch graduates build further clinical experience after graduation as physicians-not-in-training (PNITs) before beginning residency. We explored how students make career choices and whether pre-residency clinical responsibilities influence this choice. METHOD: A qualitative study with a phenomenology approach was used. The authors conducted a longitudinal interview study of medical students with two intervals over a 2-year period. The interview questions covered how trainees establish career preferences and which factors affect preference and choice over time. RESULTS: Experiencing clinical responsibility was a key factor for career preference during all interview rounds. Being a PNIT who makes diagnostic and therapeutic decisions, have their own patients and have significant patient care responsibilities creates opportunities to build an image of a future context of employment. Some participants mentioned that their experience of having full responsibility as a PNIT was pivotal in a career preference change. CONCLUSION: Clinical responsibility as a student or a PNIT appears to be important for career preference and choice. The experience of responsibility as a medical doctor forces trainees to reflect on personal needs and to consider which career preference fits best.

Factors affecting senior medical students' career choice.

OBJECTIVES: To gain insight into factors affecting career preference and career choice during the final phase of medical school, above and beyond a model that was presented by Bland and colleagues in 1995 (the "Bland model"). METHODS: A qualitative study was conducted. One-hour semi-structured interviews were conducted with final-year medical students about career preference and the factors influencing preference and choice. The interviews were transcribed and a thematic analysis was applied, to identify patterns and interrelationships in the data and to compare and contrast these with the Bland model. RESULTS: Twenty-four students participated. Three critical sets of factors, not present in the Bland model, emerged from the interviews: (a) factors arising from student-initiated information collection, (b) patient population characteristics of a specialty domain, and (c) the characteristics of teams and colleagues within a specialty. CONCLUSIONS: Students appear to actively match and calibrate perceptions of different specialty characteristics with their current personal needs and expected future needs, and to include cues from self-initiated information collection about a speciality. This agency aligns with Billett's workplace learning theory. Next, specialty patient population features appear to be taken into account; this was not unexpected but not included in the Bland model. Finally, the characteristics of teams and colleagues of a specialty were stressed in the interviews. These three components broaden the applicability of the Bland model--originally created for primary-care careers--to medical specialties in general.

Effect of the Bologna bachelor degree on considerations of medical students to interrupt or terminate their medical training.

BACKGROUND: The bachelor-master system potentially enables medical students to stop or temporary interrupt their training after obtaining a bachelor degree. A survey at the time of introduction of this two-cycle model in Dutch medical education showed little interest among students in these possibilities. AIMS: To investigate students' considerations to stop or pause now that this model is well established. METHODS: Questionnaires were sent to 314 second year and 348 third year bachelor students and 256 first year master students at University Medical Center Utrecht. RESULTS: Response rates were 33.4% for the second year and 42.0% for the third year bachelor students and 48.8% for the master students. Of all these students, one to three percent seriously considered a permanent stop. Of the bachelor students, about one quarter seriously considered a temporary stop after finishing the bachelor program. Of the master students, one in seven indicated that they did take a break at that opportunity. CONCLUSIONS: Awarding the bachelor degree does not particularly encourage students to discontinue their medical study. Our results are comparable to the results of the survey at the time of the introduction of the bachelor-master system, which supports our previous conclusion.

Effect of the new Bologna bachelor degree on career considerations of medical students in one medical school.

BACKGROUND: The bachelor-master (BaMa) structure was introduced in medical schools in The Netherlands since 2003 and in Utrecht University in 2006. AIM: The aim of this study was to determine whether conferring a bachelor degree at the end of 3 years of medical school influences the career considerations of the students. METHODS: Two cohorts (BaMa and pre-BaMa) of medical students at Utrecht University were approached to fill out questionnaires in 2008 and 2009, about their career plans and whether a bachelor degree would affect these plans. RESULTS: In 2008, two-thirds of the students in both cohorts indicated that they considered a temporary stop. In 2009, the BaMa cohort showed substantially less interest in such a stop than the pre-BaMa cohort. Very few students considered a permanent stop. Comparison of third year pre-BaMa students (2008 cohort) with third year BaMa students (2009 cohort) revealed adjusted odds ratios of 2.34 (95% CI 1.34-4.09) for a temporary stop and 1.33 (95% CI 0.51-3.42) for a definitive stop. CONCLUSION: Awarding a bachelor degree in the BaMa structure does not encourage students to interrupt or discontinue their medical study, to transfer to another master programme or to transfer to another medical school.