The last decade (2010-2019) has seen calls to action to improve the prescribing practice of junior doctors. An in-depth investigation into the causes of prescribing errors by foundation trainees in relation to their medical education (the EQUIP study) in the UK reported a prescription error rate of 8.9% for all prescribed medicines, and although that is a UK study, there are similarities with New Zealand prevocational training programmes. The EQUIP study revealed that existing teaching strategies are not working. To believe a single intervention will prevent most prescribing errors is simplistic, and for improvement to occur, new prescribers need to learn from their mistakes. Traditionally, the education of junior doctors has focused on their competence and professional registration requirements. Working in healthcare is collective and multidisciplinary, and errors occur through human and system factors.
The basis of knowledge creation is the dynamic relationships that arise from the interaction of people with the environment, generations with each other, and social and physical relationships. (Durie, 2004, p. 1139) Practice-based education (PBE) is a broad term, referring in this book to tertiary education that prepares graduates for their practice occupations, and the work, roles, identities and worlds they will inhabit in these occupations. In practice as in theory, PBE operates at curriculum level and through particular teaching and learning strategies. A PBE curriculum is one that frames goals, strategies and assessment around engagement with and preparation for practice; it values both learning for and learning in practice and occupational contexts.
Aim: This study explores the implementation of a model of clinical learning that encourages full participation and engagement in practice. Supervisors in diverse settings volunteered to trial and implement the model in their practice environments. The initial model was built from the perspective of junior doctors as learners. This study focuses on the experiences of supervisors from medicine and nursing in the workplace and their perspectives on workplace learning both as facilitators of learning and as lifelong learners. Methods: This study fits within a socio‑cultural framework of learning and draws on practice research methodology to reveal and chronicle the experiences of clinical supervisors working across two health disciplines and diverse clinical settings. One working in an emergency medicine environment, the other within a small group of nursing preceptors (supervisors) on medical and surgical wards. Results: Results support the model and identified simple and effective behaviours that encourage participation and learning when learning is recognised as a social activity that occurs within inter-professional clinical teams. These include strategies that are familiar to supervisors but which are not consistently utilised: orientation to the tasks of the placement and to the team, ensuring engagement and involvement in the team and coaching professional skills and problem-solving abilities. The dynamic relationship between supervisor and supervisee evolves over time which can be likened to a dance but which requires someone to make the first move. Conclusion: This paper presents supervisors' and supervisees' reflections on the usefulness of the clinical learning model and builds on it by identifying strategies that supervisors and supervisee can use to enhance learning in clinical settings.
Assessment of health professional students is an important part of learning process. It also helps in ensuring their safety to practice. Recent research suggests that while criteria are useful especially for identifying problems and providing feedback, over-objectification can reduce validity. In order to reduce the discrimination in the assessment process a global rating scale was introduced. This article explains the rating scale and how it is beneficial for the assessment process.
A key goal of Maori health provider development in New Zealand is to establish programs run by Maori for Maori. This goal requires a pool of qualified health professionals who are willing and confident to teach the next generation of practitioners. Within this frame of reference, we adapted a mainstream health education program - the Graduate Certificate in Clinical Teaching - to meet the needs of interdisciplinary groups of Maori health professionals. The content is mainstream, international and interdisciplinary but the pedagogy is Maori, with Maori customs, values and traditions upheld and practised. The Christchurch College of Education and Mauri Ora Associates are jointly involved in the administration, design and delivery of the program, recruitment of guest tutors and ongoing curriculum updates. Hauora.com (a national Maori health workforce development organisation) contracts independently with both organisations and provides an oversight and quality monitoring role. Together the three organisations work with other Maori health professional groups (and receive the support and cultural supervision of the elders of Tangata Marae) to deliver the qualification. This paper describes how this course is designed and maintained and the cooperation between health and education, Maori and Pakeha organisations required for this to have been sustained over four years.
This paper discusses an innovative teaching and learning project (ITLP) introduced in 2004 to the curriculum of a graduate nurse program. The project involved a New Zealand poet working for three months as poet in residence at Capital and Coast District Health Board, Wellington, New Zealand. The purpose of the residency was for the poet to connect with nurses and patients, encourage reading and writing of poetry, hold poetry-reading sessions, and facilitate a reflective poetry-writing forum for graduate nurses. Innovation. Graduate nurses were identified as a significant group already developing reflective practice and critical thinking skills through guided group reflection (Johns, 2005). The aim of the forum was to facilitate the nurses' reflection on their first year of practice by having them write composite poems comprising pairs of lines and with the subject matter grounded in their clinical practice. Evaluation. Verbal and written feedback was collated and emerging themes summarised. Outcomes. Four composite and three individual poems were written. Initially, the nurses did not believe a connected poem would emerge. Relevance to other settings. The introduction of poetry writing into the graduate nurse program curriculum continued into 2005. The initiative used the same structure and resulted in similar outcomes. This simple, innovative teaching and learning strategy is transferable and relevant to other settings and easily implemented by educators where reflection on practice is critical to professional development. Published and online evidence shows that resident poets and poetry writing by health professionals are established phenomena within various international health settings.
A brief note on the model, which has two critical components like attributes, linked to the task of providing patient care, and attributes related to engagement with the team. Factors, which help in promoting involvement in workplace learning by junior doctors, are presented. The original model, outcomes from the multi-site evaluation and feedback from a range of health professional supervisors who have implemented the model in their supervision practice are discussed.
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