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Together for evident evidence: How GP supervisors and trainees learn informally and collaboratively to consider best evidence, patients’ preferences and clinical expertise, and how to support and enhance this in the GP workplace

Projectomschrijving

Samen leren in de huisartspraktijk

Huisartsen in opleiding (aios) leren het vak door stage te lopen bij een ervaren huisarts, de opleider. Hoe leren de opleider en de aios samen (informeel) om bewijs, voorkeuren van de patiënt en de eigen expertise als clinicus combineren? En hoe kan dit beter?

Doel en werkwijze

Hiervoor doen we onderbouwde voorstellen die helpen om het samen leren van aios en opleiders op de werkplek te verbeteren. Consulten en leergesprekken werden geanalyseerd en besproken met de aios en opleiders in Nederland en België. Daarnaast vonden focusgroepen plaats.

Resultaten

Huisartsen van de toekomst kunnen nu, naast de eerste 3 stappen van Evidence Based Medicine (EBM): vragen, zoeken en beoordelen van literatuur, ook leren om bewijs in de klinische praktijk te gebruiken. Om het leren van EBM op de werkvloer te verbeteren moet gedacht worden aan formeel onderwijs én aan impliciet leren.

Opleiders én aios kunnen goed van elkaar leren tijdens leergesprekken en tijdens observaties van elkaars consulten op de werkplek. Het is aan te bevelen om expliciete leermomenten te creëren waarin EBM beslissingen worden besproken.  Daardoor verkrijgen aios en supervisor gedeelde mentale modellen. Bovendien kunnen dergelijke discussies nuttig zijn om doorgaans onuitgesproken kennis te expliciteren, waar aios en supervisor beiden van profiteren.

Producten

Titel: Educational strategies to enhance EBM teaching and learning in the workplace: A focus group study.
Auteur: Welink, L., De Groot, E., Damoiseaux, R., & Bartelink, M.
Magazine: BMJ Evidence-Based Medicine
Link: https://ebm.bmj.com/content/early/2021/01/28/bmjebm-2020-111383
Titel: Leren van evidence-based besluitvorming
Auteur: Lisanne Welink
Magazine: Huisarts & Wetenschap
Titel: GP trainees' perceptions on learning EBM using conversations in the workplace: A video-stimulated interview study.
Auteur: Welink, L. S., De Groot, E., Pype, P., Van Roy, K., Van Den Wittenboer, I. D., Bartelink, M. -. E. L., & Damoiseaux, R. A. M. J. (2020).
Magazine: BMC Medical Education
Titel: Learning conversations with trainees: An undervalued but useful EBM learning opportunity for clinical supervisors.
Auteur: Welink, L. S., de Groot, E., Bartelink, M. -. E. L., Van Roy, K., Damoiseaux, R. A. M. J., & Pype, P.
Magazine: Teaching and Learning in Medicine
Titel: Applying evidence-based medicine in general practice: A video-stimulated interview study on workplace-based observation.
Auteur: Welink, L. S., Van Roy, K., Damoiseaux, R. A. M. J., Suijker, H. A., Pype, P., De Groot, E., & Bartelink, M. -. E. L.
Magazine: BMC Family Practice
Titel: EBM leren toepassen door observatie, werkt dat?
Auteur: Welink, L., Van Roy, K., Damoiseaux, R., Suijker, H., Pype, P., de Groot, E., & Bartelink, M. E. L.
Magazine: Huisarts & Wetenschap
Link: https://link.springer.com/article/10.1007/s12445-020-0907-z

Verslagen


Samenvatting van de aanvraag

Background Practicing evidence-based medicine (EBM) is increasingly important in medical practice. EBM is the combination of best evidence, patients’ preferences and clinical expertise. During medical specialty training and during postgraduate general practice training, education in EBM focusses mainly on the first three steps of EBM (ask, acquire, appraise). General practitioner (GP) trainees will learn the final two steps (apply and evaluate) in the workplace. Presumably GP trainees learn informally how to apply and evaluate in daily clinical practice from their GP supervisors, experienced practitioners who provide role support and learning experiences. GP supervisors, in turn, might also learn from their trainees, for example searching for evidence or appraisal of the literature. It is highly plausible that trainees and supervisors learn EBM collaboratively. However, based on the literature and on our own experiences, we expect this to take place in a suboptimal manner. It is unknown how such learning processes take place in the GP workplace and, when suboptimal, how to support and enhance these. The aim of this study is to understand how GP supervisors and trainees informally and collaboratively learn to apply and evaluate EBM in daily clinical practice (considering the evidence, patients’ preferences and clinical expertise), and how we can support and enhance these learning processes in the GP workplace. Methods We video record consultations of both GP supervisors and trainees, inspect these recordings and interview pairs of supervisors and trainees together (with video stimulated recall methods) to find out their perceptions with regard to applying and evaluating EBM in daily clinical practice. Next, we video record tutorial dialogues between GP supervisors and trainees and interview them separately about these recordings. On the basis of the results of these interviews, we develop design principles that help to define which measures should be taken to support and enhance this EBM informal collaborative learning in the workplace. We prioritize these principles using a Delphi study method with (medical) educationalists as experts. Finally, we discuss the measures in focus groups with relevant medical stakeholders. Topics to be considered are whether measures are acceptable and implementable, and which formal training supervisors and trainees would need to embed these measures in the workplace. Dissemination To disseminate our findings, we will publish about them in the (inter)national scientific literature. We will present our studies to a broad audience of people interested in learning the final two steps of EBM in the workplace. However, we will pay most attention to dissemination within the context of postgraduate GP training. In the Netherlands also in the national EBM curriculum, which we are to implement, for trainers and staff of all academic postgraduate GP and elderly medicine training centres. And in Belgium we will disseminate our findings among all such groups as well.

Kenmerken

Projectnummer:
839130005
Looptijd: 100%
Looptijd: 100 %
2016
2022
Gerelateerde subsidieronde:
Projectleider en penvoerder:
dr. M.E.L. Bartelink
Verantwoordelijke organisatie:
Universitair Medisch Centrum Utrecht
Afbeelding

Onderzoek van onderwijs

Om de kwaliteit van de opleidingen tot huisarts en specialist ouderengeneeskunde te verbeteren, financieren we onderzoek van onderwijs. Dit project is één van die onderzoeken. Bekijk de andere projecten.