#8E Research Papers - Learning Teamwork and Methods - AMEE

#8E Research Papers - Learning Teamwork and Methods

8E1 (43)
Date of Presentation: Tuesday, 27 August 2019
Time of Presentation: 1400-1420
Location of Presentation: Hall M, Level 1

A case study of experiential learning in quality improvement: delving deeper into
assumptions of project-based learning

AUTHOR(S):
        Joanne Goldman, University of Toronto, Toronto, Canada (Presenter)
        Ayelet Kuper, University of Toronto, Toronto, Canada
        Ross Baker, University of Toronto, Toronto, Canada
        Beverly Bulmer, St. Michael's Hospital, Toronto, Canada
        Lianne Jeffs, Sinai Health System, Toronto, Canada
        Trey Coffey, SickKids Hospital, Toronto, Canada
        Christine Shea, University of Toronto, Toronto, Canada
        Cynthia Whitehead, University of Toronto, Toronto, Canada
        Kaveh Shojania, University of Toronto, Toronto, Canada
        Brian Wong, University of Toronto, Toronto, Canada

ABSTRACT

Introduction: The use of an experiential learning approach in quality improvement (QI) education has been strongly
endorsed over the past twenty years and has come to be viewed as the optimal way of teaching QI. Experiential
learning in QI education is widely operationalized by engaging learners in developing and executing a QI project. This
type of learning can result in improvements in knowledge and, at times, care processes. However, QI project-based
learning has been demonstrated to have challenges at the learner, program and organization levels. Uncertainty
remains regarding the optimal ways to deliver training to maximize the learning and project outcomes of experiential
learning in QI. Shifting the focus of QI education research to conceptualize and examine the realities of project-based
learning in complex workplaces would deepen our understanding of the diverse factors that affect experiential
learning processes and outcomes. To address this gap, we conducted a case study of QI education with a focus on
project-based learning across three QI continuing education programs. This study aimed to explore individuals’
experiences of QI project-based learning and professional and organizational factors that influence learning and
project experiences.
Methods: An interpretive qualitative case study methodology (Stake, 2000) was used to examine the experience of
project-based learning in three QI continuing education programs: a university Masters, a university Certificate, and a
hospital Fellowship program. Case study methodology allows for an in-depth exploration of a phenomenon as situated
within a complex social, cultural and political context. In an interpretive approach, researchers are sensitized towards
participants’ perceptions and experiences, including shared and divergent understandings and behaviours (Caronna,
2010; Stake, 2000). Data collection consisted of 58 interviews with participants, course directors, and organizational
stakeholders; 135 hours of in-class observations; and relevant documents. Content and comparative analysis
approaches were used. The evolving coding framework and themes were informed by a conventional approach, being
derived directly from the data, as well as by a directed approach, being informed by relevant health professions
education research (e.g. curriculum development, mentorship and experiential learning).
Results: The findings provide insight to five key factors that influenced participants’ experiences of project-based
learning. These were: 1. Variable emphasis on learning versus project objectives and resulting benefits, tensions and
consequences; 2. Challenges with integrating the QI project into the curriculum timeline; 3. Variability in project
coaching; 4. Participants’ variable access to resources and influence over QI project given their professional roles; 5.
The influence of the workplace environment on project success.
Discussion and Conclusion: The findings from this study point towards two possible future directions. The first
involves commitment to invest in the factors identified in this study that influence experiential learning and to their
complex interactions. The second requires an openness to questioning project-based learning and exploration of
alternative models of QI learning, such as case-based or simulation approaches, when a project-based learning
approach might not be feasible or optimal. Similar to experiential learning in the clinical context, project-based learning
in QI in the health systems context, a relatively young field, will require further research using diverse methodological
and theoretical approaches to learn how best to deliver experiential QI training, and to consider the role of other
approaches to QI education.
References:

Stake R. Case studies. In Denzin NK and Lincoln YS (Eds.) Handbook of Qualitative Research. Thousand Oaks:Sage;
2000. Caronna CA. Why use qualitative methods to study health care organizations? Insights from multi-level case
studies. In Bourgeault I, Dingwall R, and de Vries R (Eds.) The SAGE Handbook of Qualitative Methods in Health
Research. Thousand Oaks: Sage Publications Ltd.; 2010.

#8E Research Papers - Learning Teamwork and Methods

8E2 (102)
Date of Presentation: Tuesday, 27 August 2019
Time of Presentation: 1420-1440
Location of Presentation: Hall M, Level 1

Making a lecture stick: The effects of spaced instruction on knowledge retention in
medical education

AUTHOR(S):
    Marjolein Versteeg, LUMC, Leiden, the Netherlands (Presenter)
         Marnix Timmer, LUMC, Leiden, the Netherlands
         Paul Steendijk, LUMC, Leiden, the Netherlands

ABSTRACT

Introduction: Medical students suffer from the persistent problem of forgetfulness, resulting in poor
retention of medical knowledge and skills needed to become qualified health professionals1. This
challenging issue may be resolved by implementing spaced learning in the medical curriculum. The spacing
effect is one of the most robust phenomena in the science of learning. It establishes increased knowledge
retention by repeating the to-be-learned information using temporal intervals, i.e. spacing the learning
sessions. Spaced learning activities are already finding their way into (online) testing and simulation
training, but the instructional phase seems to be overlooked. This is remarkable as one of the most
commonly used teaching method to transfer knowledge is lecturing, in which a large volume of
information is covered without interruption, resulting in poor retention. Guided by the need for
instructional designs that enhance learners’ knowledge retention, we designed a spaced learning lecture
based on psychological and neuroscientific literature2. Our aim was to investigate the efficacy of spaced
learning in the instructional phase in medical education.
Methods: In this study, second-year medical students (N = 149) were randomly allocated to either the
spaced lecture group or a control group. The spaced lecture consisted of three 15-min instructional
sessions, separated by 5-minute breaks with distractor activities. Repetition of the material was established
by including a summary of the preceding information after each break. The control group received the
exact same lecture, but without the breaks, thereby resembling a traditional lecture. A pre-post design was
used, measuring students’ baseline knowledge prior to the lectures (t = -14 days) and their knowledge
retention one week after the lectures (t = 8 days).
Results: The retention test (α = 0.74) was performed by a total of 107 students (Spaced: n = 61, Control: n =
46). The average score on the retention test was not significantly different between the spaced lecture
group (33.8±13.6%) and the control group (31.8±12.9%) after controlling for students’ baseline-test
performance (F(1,104) = 0.55, p = 0.458). Students’ narrative comments showed that the experimental
lecture format was well-received, and subjectively benefitted students’ attention-span and engagement.
Discussion & Conclusion: This study was the first to implement spaced instruction in a medical lecture
setting. Although, we were unable to show increased knowledge retention after a spaced lecture, we
suggest that future research should focus on the development of instructional designs that contain
elements of spacing and repetition to facilitate learning. Based on our findings combined with existing
psychological theories and neuroscientific hypotheses, we provide recommendations for researchers and
educators regarding the timing of intervening breaks, retrieval gaps and number of repetitions. Ultimately,
we aim for optimized spaced learning designs in the medical curriculum that help to educate health
professionals with a solid knowledge base.
References: Schneid SD, Pashler H, Armour C. How much basic science content do second-year medical students remember from
their first year? Med Teach. 2018:1-3.
Smolen P, Zhang Y, Byrne JH. The right time to learn: mechanisms and optimization of spaced learning. Nat Rev Neurosci.
2016;17(2):77-88.

#8E Research Papers - Learning Teamwork and Methods

8E3 (112)
Date of Presentation: Tuesday, 27 August 2019
Time of Presentation: 1440-1500
Location of Presentation: Hall M, Level 1

Exploring the undergraduate dental students’ views of collaborative learning in the
clinical learning environment

AUTHOR(S):
    Anna Dargue, University Hospitals Bristol NHS Foundation Trust, Bristol, UK (Presenter)

ABSTRACT

Introduction: Undergraduate dental students in the UK work together in pairs when treating patients as part of their
clinical training. Collaborative learning is described as working together with shared effort and responsibility for a
task.1 Very few studies have explored the students’ views of paired collaborative learning for clinical skills in the clinical
setting, and only one study was found that was relevant to Dentistry. This study had limited depth due to its design.2
Across the UK there are increased student numbers and finite resources available for dental clinical teaching. Local
course evaluations over several years had given conflicting results on students’ views of working in pairs. Thus, this
study aimed to explore the dental students’ perspectives of collaborative clinical working and identify whether any
improvements could be made to the clinical learning environment. Ethical approval was obtained.
Methods: I used a constructivist, interpretivist inductive methodology with a phenomenological basis to understand
the students’ experiences and views of working in pairs. I chose stratified purposeful sampling to illustrate
characteristics across the different years. Eight students from three clinical years recorded three audio-diaries using
Gibbs reflective cycle as a guide, reflecting on their experiences of collaborative learning with peers. This was followed
by individual semi-structured interviews. The diary-interview method was chosen to provide greater depth and clarity,
and allowed investigation of individual beliefs. Inductive thematic analysis was performed on the data.
Results: Students had a mostly positive view of working in collaborative partnerships. Three main themes were
identified around the focus of effective collaborative partnerships. These themes related to individual characteristics,
relationships and learning.
Discussion: The students identified that effective collaborative learning partnerships used active, experiential and
observational learning.
Positive aspects of collaborating with a student partner were feeling supported in their relationships, so creating a safe
learning environment where they were comfortable asking questions. They also valued the emotional support that
working with other students gave, and this helped them cope with pressure. They highlighted the development of
friendships in healthy partnerships that made them feel they belonged. This increased trust and familiarity allowed for
more effective feedback.
Working with a variety of partners was seen as positive and contributed to learning non-technical skills. A technique of
‘benchmarking’, comparing their knowledge and skills with those of a peer, was described by students when paired
and was used in a constructive manner.
Negatives of collaborative learning related to interpersonal difficulties and led to students feeling unsupported in the
clinical environment. This created a barrier to learning. Students also highlighted feeling frustrated in the assistant role
and this increased as they become more experienced. Correspondingly they noted that observational learning
provided lesser quality learning than experiential.
Conclusion: The study demonstrated the significance of social interaction and collaboration with peers to be a vital
part of the clinical learning experience. Peers are seen to have an important effect on each other’s learning in positive
and negative ways.
Suggested improvements arising from this study are the use of ground rules for effective student partnerships and to
promote a safe clinical learning environment. Students need to understand the value of the assistant role which staff
can further encourage and support.
References:
1.        Tolsgaard, MG. Kulasegaram, KM. Ringsted, CV. (2016). Collaborative learning of clinical skills in health professions
education: the why, how, when and for whom. Medical Education, 50, pp. 69-78.
2.        Qualtrough, AJE. (2001). Student operator-assistant pairs: an update. British Dental Journal, 190 (11), pp. 614-618.

#8E Research Papers - Learning Teamwork and Methods

8E4 (197)
Date of Presentation: Tuesday, 27 August 2019
Time of Presentation: 1500-1520
Location of Presentation: Hall M, Level 1

On the same page? The relationship between teamwork within clinical teaching teams
and the experienced learning climate of their residents

AUTHOR(S):
         Iris Jansen, Amsterdam UMC, Amsterdam, The Netherlands (Presenter)
         Milou Silkens, Amsterdam UMC, Amsterdam, The Netherlands
         Renée Stalmeijer, Maastricht University, Maastricht, The Netherlands
         Kiki Lombarts, Amsterdam UMC, Amsterdam, The Netherlands

ABSTRACT

Introduction: Supportive learning climates are key to ensure high quality residency training and patient care (Silkens,
et. al., 2016). Clinical teachers play an important role in creating and maintaining these climates. Efforts aimed at
strengthening the role of clinical teachers have mainly focused on their teaching skills and supervisory styles. Recently,
the perspective that clinical teaching is not just an individual effort, but a team effort, has been proposed. As a result,
the concept of clinical teaching teams was introduced and used to describe how teaching teams collaborate to fulfil
educational tasks and activities (Slootweg, et. al., 2014). However, the level of teamwork within these teams varies and
might influence the resulting learning climate within a given department. The learning climate consists of three
discrete facets: affective, cognitive and instrumental. Identifying the association between teamwork quality and
specific learning climate facets could provide more insight into ways in which the postgraduate learning environment
can be improved. Therefore we posed the following research questions: (1) To what extent is teamwork quality within
teaching teams associated with the residents’ experienced learning climate, and more specifically (2) with the
affective, cognitive and instrumental facets of the learning climate?
Methods: This study included clinical departments that used two validated questionnaires in the period from January
2014 through May 2017. The TeamQ questionnaire evaluated teamwork quality of clinical teachers within a teaching
team. The Dutch Residency Educational Climate Test (D-RECT) questionnaire evaluated residents’ experienced learning
climate. Both questionnaires were administered through a web-based system. Associations were analysed using
multilevel models and multivariate general linear models.
Results: In total, evaluations of 47 teaching teams and 400 residents within 16 hospitals were included in this study.
Teamwork quality was positively associated with the overall residents’ learning climate (b = 0.33; 95% CI = 0.06 – 0.60)
as well as with the affective (b = 0.50; 95% CI = 0.06 - 0.94) and instrumental (b = 0.42; 95% CI = 0.11 - 0.74) learning
climate facet. The results on the cognitive domain were non-significant (b = 0.35; 95% CI = -0.07 – 0.77).
Discussion & Conclusions: Teamwork quality of teaching teams was positively associated with residents’ perceptions
of the overall learning climate as well as with the affective and instrumental learning climate facets. This implies that
social relationships between teaching teams and residents (affective facet) as well as structure and hierarchy
(instrumental facet) benefit from the quality of teamwork. The association between teamwork and the cognitive
learning climate facet was not significant which might be explained by this facet’s orientation at the residents’ own
responsibility. Our results suggest improving the postgraduate learning climate can be reached through promotion of
teamwork within clinical teaching teams. This resonates with studies emphasising the importance of creating teaching
communities to enhance residency training. Future research could widen the lens to include the role of other health
professionals on residency training.
References:
Silkens MEWM, Smirnova A, Stalmeijer RE, Arah OA, Scherpbier AJJA, Van der Vleuten CPM, Lombarts KMJMH. 2016. Revisiting the D-
RECT tool: Validation of an instrument measuring residents' learning climate perceptions. Med Teach. 38(5):476-481.
Slootweg IA, Lombarts KM, Boerebach BC, Heineman MJ, Scherpbier AJ, van der Vleuten CP. 2014. Development and validation of an
instrument for measuring the quality of teamwork in teaching teams in postgraduate medical training (TeamQ). PLoS One. 9(11).