Clinical teaching on an expanding training platform : designing a fit-for-purpose faculty development framework for emerging clinical teachers in a resource-constrained environment

Date
2018-12
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: The research presented in this dissertation was catalysed by a preliminary phase of research which described the journey undertaken by specialist clinicians as they took on the role of clinical teacher. This gave rise to the question of how other clinicians might be assisted on a similar journey, particularly in the context of an under-resourced environment and an expanding clinical training platform. Training in the clinical environment forms a crucial part of medical curricula. Particularly in the later years of the curriculum, it is the component in which students may develop their identity as doctor. Clinicians involved in this phase play a crucial role in the training of medical students. Medical schools are needing to expand their clinical training platforms in order to provide opportunities for greater numbers of students, as well as to offer clinical training that covers the full spectrum of healthcare. In this expansion, medical schools have an obligation to maintain the quality of teaching in the clinical context. Faculty development is a means to strengthen such clinical teaching. In a resource-constrained environment, it is incumbent upon us to consider how best to design faculty development offerings for these emerging clinical teachers. This research was approached from an interpretivist stance, therefore qualitative methods were used. Based on Kern’s six step approach to curriculum development, the targeted needs of emerging clinical teachers were identified by using four different data sets to develop an understanding of current clinical teaching and strategies used to strengthen it. Senior medical students, clinical teachers and staff responsible for faculty development were interviewed and clinical teaching episodes were recorded. Each data set was analysed individually and thereafter all four sets of findings were synthesized and presented as the situational analysis. The findings informed the development of a fit-for-purpose faculty development framework for emerging clinical teachers. The outcome of the study is a fit-for-purpose faculty development framework that is based on four constituent elements. The first is that faculty development be situated within the network of clinical practice, involving not only individuals, but also their clinical practice community and their academic discipline. The second addresses clinical teaching as supervision; the offering of affordances. The third emphasises clinical learning as student engagement, with an essential interplay between the offering of affordances, and the development and exercising of student agency for engagement. The fourth is to tailor-make faculty development offerings that are informed by students’ evaluations of clinical teaching effectiveness. Learning in the workplace needs to be mirrored by teaching in the workplace. This fit-forpurpose framework is offered as a means to assist those responsible for faculty development to meaningfully assist clinicians on the journey to becoming confident clinical teachers.
AFRIKAANSE OPSOMMING: Die navorsing vervat in hierdie proefskrif is deur ’n primêre navorsingsfase voorafgegaan wat die pad aangedui het vir kliniese spesialiste wat kliniese onderrig aanbied. Dit het gelei tot die vraag van hoe ander klinici in soortgelyke omstandighede bygestaan kan word, spesifiek binne die konteks van ’n omgewing met beperkte hulpbronne en ’n kliniese opleidingsplatform wat besig is om uit te brei. Opleiding in die kliniese omgewing is van kardinale belang in mediese kurrikula. Veral in die latere jare van die kurrikulum is dit die deel waartydens studente hul identiteit as dokter kan ontwikkel. Klinici wat in hierdie fase betrokke is, speel ’n kritieke rol in die opleiding van mediese studente. Mediese skole moet hul kliniese opleidingsplatforms uitbrei om geleenthede vir meer studente te skep, asook kliniese opleiding te kan gee wat die volle spektrum van gesondheidsorg dek. Hierdie uitbreiding verplig egter mediese skole om die standaard van opleiding in die kliniese konteks te behou. Fakulteitsontwikkeling is ’n manier waarop kliniese onderrig verbeter kan word. In ’n omgewing met beperkte hulpbronne is ons verplig om oorweging te skenk aan die wyse waarop fakulteitsontwikkeling moet plaasvind om die beste bydrae te lewer tot die ontwikkelende kliniese fasiliteerders. Hierdie navorsing was vanuit ’n interpretivistiese perspektief benader; daarom is kwalitatiewe metodes gebruik. Om ’n begrip te ontwikkel van die stand van kliniese onderrig en die strategiee wat gebruik word om dit te versterk, is die geteikende behoeftes van ontwikkelende kliniese fasiliteerders geidentifiseer. Gebruik is gemaak van vier verskillende data-stelle gebaseer op Kern se ses-stap-benadering tot kurrikulum-ontwikkeling. Onderhoude is met senior mediese studente, kliniese fasiliteerders en personeel verantwoordelik vir fakulteitsontwikkeling gevoer. Daarbenewens is klankopnames van kliniese onderrig-episodes gemaak. Elke data-stel se bevindinge is afsonderlik geanaliseer en daarna is al vier stelle saamgevat en as die omstandigheidsanalise aangebied. Die bevindinge het die ontwikkeling van ’n doelmatige fakulteitsontwikkelingsraamwerk vir ontwikkelende kliniese fasiliteerders verskaf. Die uitkoms van hierdie studie is ’n raamwerk gebaseer op vier saamgestelde elemente wat geskik is vir fakulteitsontwikkeling. Die eerste element is naamlik dat fakulteitsontwikkeling binne die netwerk van kliniese praktyk gelee is, en dit betrek nie alleen individue nie, maar ook hul kliniese praktykgemeenskap en akademiese dissipline. Die tweede spreek kliniese onderrig as toesighouding aan; die aanbied van geleenthede. Die derde element beklemtoon kliniese leer as student betrokkenheid, met ’n noodsaaklike wisselwerking tussen die aanbied van geleenthede, en die ontwikkeling van studente-onafhanklikheid deur middel van persoonlike betrokkenheid. Die vierde is om gepaste, doelmatige fakulteitsontwikkeling aan te bied wat gerugsteun word deur studente-evaluasies van die doeltreffendheid van hulle kliniese onderrig. Leer in die werksituasie behoort deur onderrig in die werkplek weerspieël te word. Hierdie raamwerk, ontwerp vir hierdie spesifieke doel, word aangebied om die persone wat verantwoordelik is vir fakulteitsontwikkeling te ondersteun, sodat hulle klinici op ’n betekenisvolle manier kan bystaan om die nodige selfvertroue as kliniese fasiliteerders te ontwikkel.
Description
Thesis (PhD)--Stellenbosch University, 2018.
Keywords
Medicine -- Study and teaching, Clinical teaching, Emerging clinical teachers, UCTD
Citation