In deze tweede rapportageperiode heeft de op dit project aangestelde aiotho 6 maanden besteed aan onderzoek en 6 maanden aan de opleiding tot huisarts.
In de onderzoeksperiode zijn de eerste twee studies verder afgerond (systematic review over opleiding van excellente professionals en interviewstudie met docenten en opleiders)/ uitgewerkt en is de dataverzameling onder de aios uitgevoerd en zijn die data geanalyseerd.
De voorbereidingen voor het vervolg zijn in gang gezet.
Tot op heden hebben de benoemde studies bij de samenvatting de volgende resultaten opgeleverd:
• Het systematische literatuuroverzicht laat zien dat veel verschillende (persoonlijke) karakteristieken invloed hebben op de identificatie van een excellente medische professional. De 20 geincludeerde artikelen hadden communicatie en (sociaal)gedrag met elkaar gemeen. Slechts zes artikelen bediscussieerden leren, waarin ‘geïnteresseerd zijn in leren’ en ‘proactief zijn
in leren’ de gemeenschappelijke thema’s waren.
• De interviewstudie laat zien dat de supervisors talentvolle aios identificeren aan de hand van hun persoonlijke karakteristieken en verwachtingen voor de toekomst. De talentvolle aios is de aios die over het algemeen het ‘hele’ palet bezit, leergierig is, nieuwsgierig is en bewust is van zijn rol als aios. Verscheidene leerstrategieën worden beschreven. Daarnaast
hebben zowel de werkcontext als de persoonlijke karakteristieken van de supervisors invloed op de identificatie van de talentvolle aios. Dit laatste heeft vervolgens weer invloed op de begeleiding van deze aios.
Training of medical professionals mostly takes place in the clinical workplace (workplace-based learning), which is different from formal (classroom) education as it is more informal and dependent on the learning opportunities as offered by the patient mix presenting to the practice (de Jong, 2013-2) and thereby more dependent on active organization of the learning process by the trainee. For optimal learning and training, trainees are required to actively steer their own learning.
In our experience some trainees take more advantage of this workplace-based learning environment than others, and are identified as high-achieving by their peers, trainers and teachers based on their performance in clinical practice. These high-achieving trainees may be more adapted to workplace-based learning than their peers, specifically when looking at their self-regulation, in terms of adjusting their behavior, their environment and their cognitive and affective states to optimally benefit from the workplace as learning environment (Zimmerman, 2000) and also by deliberately training for practice (Myolopolous, 2012). Additionally, their quality of social and work relations might be better (Mahant, 2012). Although our insight into the characteristics of self-regulated learning in the workplace gained a significant amount of attention in the last years (Berkhout 2015, 2016-1 & 2016-2; Saggaser 2012, 2015 & 2016) the relationship with the performance of high-achievers in the workplace is unknown. In addition, methods for stimulating trainees in using a more effective learning approach in the workplace are currently unavailable.
Knowledge on the manners in which high-achievers optimize their learning in the workplace is important firstly because by identifying the specific ways of learning that high-achieving trainees adopt, workplace-based learning of all postgraduate trainees might be enhanced. Secondly, these insights may help to support high-achieving trainees in optimally benefiting from their training program.
With the theory of Self-Regulated Learning as described by Zimmerman (Zimmerman, 2000) as starting point, in this study, we therefore aim to gain insight into the differences in workplace-based learning between high-achieving trainees and their peers and develop programs to enhance workplace-based learning accordingly.
Working within a contructicist research paradigm and by using qualitative methodology we aim to answer the following research questions:
1. What are the differences in approaches to learning between high-achieving postgraduate medical trainees and their peers in workplace-based learning?
2. What adaptations can be made to the workplace (including organization and trainer) and (how) can we influence self-regulated learning strategies in the workplace of all trainees, to enhance workplace-based learning?
3. How can we support high-achieving trainees in making optimal use of their training program?
This study will take place in the General Practice (GP) and Elderly Care Medicine (ECM) Specialty Training Programs. Both programs are competency-based, using the 7 roles as described in the CanMeds model and have a similar setup.
As hardly any empirical research has been performed on high-achieving learners in the workplace, it is useful to first perform qualitative studies further exploring the issue. Based on the results of these studies and the literature on this subject, possible interventions for all trainees and for high-achieving trainees be developed.
Three different – but connected - approaches will be used to explore the differences in learning approaches between
high-achieving trainees and their peers. These will consist of: a) a realist review of the literature, b) interviews with trainers, teachers and trainees on identification of high-achieving trainees, c) Interviews with high-achieving trainees and Ecological Momentary Assessment of learning in the workplace. Based on the data collected using the above methods we will – using triangulation - develop a general view on the learning of high-achieving trainees in the workplace.
Based on the outcomes of the studies in high-achieving trainees and literature, interventions for all trainees to enhance workplace-based learning will be developed and pilot-tested, according to the steps of complex intervention as described by the Medical Research Council (Craig, 2008).
In addition we aim to identify measures that support high-achieving trainees in making optimal use of their learning environment. This study will be performed using focus groups with high-achieving trainees, educationalists, trainers and teachers from both training programs.