This dissertation presents the results of a research project on unraveling the dynamics of facilitating workplace learning through pedagogic practices in healthcare placements. Supervisors are challenged to foster safe learning opportunities and fully utilize the learning potential of placement through stimulating active participation for students while ensuring quality patient care. In healthcare placements, staff shortages and work pressure may lead to stress when facilitating workplace learning. Enhancing pedagogic practices in healthcare placements seems essential to support students in challenging experiences, such as emotional challenges. This dissertation proposes approaches for optimizing learning experiences for students by highlighting the value of day-to-day work activities and interactions in healthcare placements, and shedding light on agency in workplace learning through supervisor- and student-strategies.
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Purpose Supervisors are responsible to train students in healthcare placements. Although there is knowledge about workplace learning and supervision in general, little is known about supervisors’ pedagogic strategies in specific healthcare placements. In this study, we identify how supervisors’ reasoning and interrelated actions manifest in physiotherapy and nursing work settings. Methods Following the stimulating recall approach, we conducted 16 interviews with supervisors at seven work settings. Using a theoretical framework of workplace supervision, we performed a deductive template analysis. Results Four configurations of pedagogic strategies reveal how supervision manifests in healthcare placements. The results provide unique insights into specific supervision moments, and elucidate the situatedness of the supervisors’ strategies. Conclusions The present study illustrates the variation in aims and focus of supervisors in placements. Supervisors’ pedagogic strategies were found to be mainly based on (A) role modelling, (B) overall support, (C) trust, and (D) letting go. Further research is needed to investigate the interplay between supervisors and students in learning situations within work settings.
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Students’ health profession education includes learning at the workplace through placements. For students, participating in daily work activities in interaction with supervisors, co-workers and peers is a valuable practice to learn the expertise that is needed to become a health care professional. To contribute to the understanding of HPE-students’ workplace learning, the focus of this study is to identify affordances and characterise student’s participation during placements. We applied a research design based on observations. Three student-physiotherapists and four student-nurses were shadowed during two of their placement days. A categorisation of affordances is provided, in terms of students’ participation in activities, direct interactions and indirect interactions. Students’ daily participation in placements is discussed through unique combinations and sequences of the identified affordances reflecting changing patterns over time, and differences in the degree of presence or absence of supervisors, co-workers and peers.
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Background: Clinical reasoning skills are considered to be among the key competencies a physiotherapist should possess. Yet, we know little about how physiotherapy students actually learn these skills in the workplace. A better understanding will benefit physiotherapy education.Objectives: To explore how undergraduate physiotherapy students learn clinical reasoning skills during placements.Design: A qualitative research design using focus groups and semi-structured interviews.Setting: European School of Physiotherapy, Amsterdam, the Netherlands.Participants: Twenty-two undergraduate physiotherapy students and eight clinical teachers participated in this study.Main outcome measures: Thematic analysis of focus groups and semi-structured interviews.Results: Three overarching factors appeared to influence the process of learning clinical reasoning skills: the learning environment, the clinical teacher and the student. Preclinical training failed to adequately prepare students for clinical practice, which expected them to integrate physiotherapeutic knowledge and skills into a cyclic reasoning process. Students’ basic knowledge and assessment structure therefore required further development during the placements. Clinical teachers expected a holistic, multifactorial problem-solving approach from their students. Both students and teachers considered feedback and reflection essential to clinical learning. Barriers to learning experienced by students included time constraints, limited patient exposure and patient communication.Conclusions: Undergraduate physiotherapy students develop clinical reasoning skills through comparison of and reflection on different reasoning approaches observed in professional therapists. Over time, students learn to synthesise these different approaches into their own individual approach. Physiotherapy programme developers should aim to include a wide variety of multidisciplinary settings and patient categories in their clinical placements.
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Background: Differences in professional practice might hinder initiation of student participation during international placements, and thereby limit workplace learning. This study explores how healthcare students overcome differences in professional practice during initiation of international placements. Methods: Twelve first-year physiotherapy students recorded individual audio diaries during the first month of international clinical placement. Recordings were transcribed, anonymized, and analyzed following a template analysis approach. Team discussions focused on thematic interpretation of results. Results: Students described tackling differences in professional practice via ongoing negotiations of practice between them, local professionals, and peers. Three themes were identified as the focus of students’ orientation and adjustment efforts: professional practice, educational context, and individual approaches to learning. Healthcare students’ initiation during international placements involved a cyclical process of orientation and adjustment, supported by active participation, professional dialogue, and self-regulated learning strategies.Conclusions: Initiation of student participation during international placements can be supported by establishing a continuous dialogue between student and healthcare professionals. This dialogue helps align mutual expectations regarding scope of practice, and increase understanding of professional and educational practices. Better understanding, in turn, creates trust and favors meaningful students’ contribution to practice and patient care.
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IntroductionInternational placements challenge students to find the right level of participation, as local practices, language and time pressure may affect their engagement in patient-related tasks or team activities. This study sought to unpack the initiation process during international clinical placements with the ultimate aim to achieve active student participation.MethodsFollowing a constructivist grounded theory approach, we conducted two individual interviews with 15 undergraduate healthcare students (before departure and whilst on placement). To identify emerging themes, we applied an iterative process of data collection and constant comparative analysis. Several team discussions informed further analysis, allowing us to reach a more conceptual level of theory.ResultsFrom our findings we constructed a four-phase model of healthcare students’ initiation of international clinical placements, which brings into focus how the phases of ‘orientation’, ‘adjustment’ and ‘contribution to patient care’ build up towards a ‘sense of belonging’. We identified several factors that induced active student participation in practice, such as a favourable workplace setting, opportunities for learning and a local support network.DiscussionActive student participation is aimed at different goals, depending on the four phases of initiation that eventually lead to a sense of belonging and support workplace learning.
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This study investigates whether creative, expressive, and reflective writing contributes to the formation of a narrative career identity that offers students in higher education a sense of meaning and direction. The contents of writing done by students who participated in 2 two-day writing courses before and after work placements and of a control group were compared. Employers were also asked to evaluate students' performance. Writing samples were analyzed using the Linguistic Index Word Count program and an instrument based on Dialogical Self Theory. Work-placement self-reports were gathered, examined, and used as anecdotal evidence presented in the form of case studies. The results show that career writing can promote the development of career identity and holds promise as a narrative career guidance approach.
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This study investigates whether creative, expressive, and reflective writing contributes to the formation of a work-life narrative that offers both meaning and direction among students in higher education. The content of writing done by students who participated in a two-day writing course at the start (or in preparation) of their work placements and of a control group who did not take part in the course were compared. Writing samples were analysed using the Linguistic Index Word Count program (Pennebaker, Booth, & Francis, 2007) and an instrument based on Dialogical Self Theory (Hermans & Hermans-Konopka, 2010). Results show writing promotes the development of career narratives.
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In this article, we examined whether career writing—creative, expressive, and reflective writing—can increase luck readiness, which is the ability to respond and make use of (career) opportunities. Two 2-day writing courses were taught to third-year bachelor students, one before and one after work placements. In this exploratory study, results showed that luck readiness and work competence increased when students engaged in career writing. Specifically, flexibility, risk, and persistence increased among students in the experimental group. They also made jumps in optimism and efficacy, though no statistically significant differences were found in these domains.
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Novice nurses currently feel unprepared for the social dynamics of the workplace, due to a lack of assertiveness. Although clinical placements in nursing curricula should prepare student nurses for the demanding work environment, they do not seem to meet these expectations. Our study looked into Dutch students’ experiences of clinical placements as a learning environment for assertiveness. Twelve semistructured interviews were conducted and thematically analyzed, revealing three themes and four subthemes. Clinical placements varied greatly in their capability to stimulate assertiveness development. The team's supportiveness toward students and the didactical skill of the coach mainly influenced this capability. In general, students lacked a clear professional role with regards to their colleagues, stifling assertive behavior with the fear of failing the clinical placement. Our findings indicate that future-proof nursing curricula should support the development of assertive interprofessional conduct in students both before and during clinical placement.
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