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In this article we aim to elucidate some pedagogical aspects of interprofessional workplace learning, using the learning strategies of the Centre for Interprofessional Workplace Learning, Norway (TVEPS) as a case. We find the Expansive Learning Theory well suited for a creative interaction with the learning strategies at our interprofessional training centre. The Expansive Learning Theory focuses on learning over a substantial time horizon, but also opens for micro-cycles of learning over a shorter time of hours or days, which mirrors the learning system of TVEPS. As the social premises for learning are both situated and in change, human learning as a social process is diverse and in continuous change. Expansive Learning Theory focuses the interprofessional team learning at the workplace rather than on individual learning. Thereby such team learning is regarded as situated at the workplace premises physically, interpersonally, administratively and social-historically. The interprofessional student team’s learning process creates an object, a construct within the physical, ethical, social, administrative, or theoretical domain. In the TVEPS learning system, the object is the patient care plan which the student team produces, by working on resolving contradictions in the zone of proximal development. By debriefing the object (the care plan) with the staff, the object is developed further in creative interplay. New objects may be developed, as changed care or change in administrative systems at the workplace. By linking these concepts, Expansive Learning Theory can function as an analytical tool for understanding interprofessional learning activity at the workplace. © 2019, © 2019 Taylor & Francis Group, LLC.

Objective: Despite concern regarding high rates of mental illness and suicide amongst the medical profession, the link between working hours and doctors' mental health remains unclear. This study examines the relationship between average weekly working hours and junior doctors' (JDs') mental health in Australia. Design and participants: A randomly selected sample of 42 942 Australian doctors were invited to take part in an anonymous Beyondblue National Mental Health Survey in 2013, of whom 12 252 doctors provided valid data (response rate approximately 27%). The sample of interest comprised 2706 full-time graduate medical trainees in various specialties, at either intern, prevocational or vocational training stage. Consultants and retired doctors were excluded. Outcome measures: Main outcomes of interest were caseness of common mental disorder (CMD) (assessed using a cut-off of 4 as a threshold on total General Health Questionnaire-28 score), presence of suicidal ideation (SI) (assessed with a single item) and average weekly working hours. Logistic regression modelling was used to account for the impact of age, gender, stage of training, location of work, specialty, marital status and whether JDs had trained outside Australia. Results: JDs reported working an average of 50.1 hours per week (SD=13.4). JDs who worked over 55 hours a week were more than twice as likely to report CMD (adjusted OR=2.05; 95% CI 1.62 to 2.59, p<0.001) and SI (adjusted OR=2.00; 95% CI 1.42 to 2.81, p<0.001) compared to those working 40-44 hours per week. Conclusions Our results show that around one in four JDs are currently working hours that are associated with a doubling of their risk of common mental health problems and SI. These findings suggest that management of working hours represents an important focus for workplaces to improve the mental health of medical trainees. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

[No abstract available]

Introduction: Employer led apprenticeship trailblazer groups develop the occupational standard and end point assessment associated with a particular job or occupation. All degree apprenticeship programmes within England must align to these and for allied health professions, this is a new concept. Exploring stakeholder motivations for being part of the trailblazer groups is essential to inform subsequent curriculum design and implementation for this new model of education. Methods: Eighteen semi-structured interviews were undertaken across the three radiography related (diagnostic, therapeutic and sonography) trailblazer groups using a pragmatic constructivist approach. Results: Strong themes emerged around professional recognition, and conflicts between being ‘educated’ or ‘trained’, and between vocational and academic components of radiography training. Even within these pioneer groups there was a lack of understanding around degree apprenticeship programmes and their potential impact upon the workforce. Whilst the benefits on recruitment and retention of staff through widening participation were acknowledged, there were concerns around apprentice pay and mentorship. Evidence of professional protectionism was uncovered, balanced by professional pride and a strong desire for team working within and between institutions. Conclusion: The study highlighted an urgent need for further research and awareness raising for employers and practitioners, prior to implementation of radiography-related degree apprenticeships. Implications for practice: This is the first evaluation of stakeholder motivations related to the development of degree apprenticeships within the allied health professions. The results and recommendations for practise will inform the imminent implementation of degree apprenticeships for the three radiography related professions, facilitating a smooth transition to apprenticeships for clinical and education departments. © 2019 The College of Radiographers

Background: As prescribing skills are a prerequisite for rational use of medicines, and education and training are important in acquiring these skills, we aimed to explore what aspects junior physicians find important when being taught the art of prescribing. Methods: Written feedback from 34 interns after participating in an educational session as part of a randomized controlled study at a university hospital formed the qualitative data in this study. Manifest content analysis was performed, guided by the research question “Educating junior physicians in the art of prescribing: what aspects do they find important?” Meaning units were extracted and categorized, and emergent themes were identified. Results: Five themes emerged. The first, clinical relevance, was exemplified by the categories valuable for health care; perceived relevance for one’s own work; and translating theory into practice while the second, applicable content, included categories such as clinical advice; practical tips on using the electronic medical record system; and tools that facilitate. The third and fourth themes, reality-based teaching and creative discussions, were exemplified by the categories patient cases and feedback; and discussion-based teaching; wide-ranging discussions and a permissive and open atmosphere, respectively. In the last theme, effective structure, we identified the categories clear structure; small group teaching; allocated time for discussion; well-organized administration; and home assignment for practice. Conclusion: Creative discussions, effectively structured in small group sessions, with clinically relevant, reality-based content built on case studies and feedback, are aspects which junior physicians find important when educated in the art of prescribing. © 2019, The Author(s).

Background: In Taiwan's hospitals, English medical discourse underpins nursing and medical practice. Much patient care work is done through language work, by both text and talk. This means that when nurses start their nursing careers in the hospital context, where English medical discourse is shared to produce knowledge and engage in practice, knowledge of medical discourse and the ability to use it are prerequisites. In the process of learning and using such specialist language, the formation of professional identities is assumed. Objectives: This study aimed to explore nurses' learning journeys relating to medical discourse and the development of their professional identities. Methods: This research adopted a qualitative approach, using data from 10 nurses working in different hospitals in Taiwan. Results: The findings revealed that English medical discourse was employed in Taiwan's hospitals not only for fulfilling professional purposes but also for socialising nurses into the healthcare community. Nurses acquired it through interactions, small talk, relationships, discussions, and nursing tasks. Their professional identities were formed through engaging in meaningful nursing practice based on English medical discourse. However, in the learning process, they encountered difficulties in the areas of listening, speaking, and reading, which raised concerns about patient safety. Conclusion: Sufficient support is needed to ease nurses' difficulties in learning. We propose having primary and secondary preceptors, establishing a mentorship policy, and creating a learning environment that is supportive of nurses' learning experiences. © 2019 Elsevier Ltd

Objective: We aimed to investigate registrar, practice and consultation characteristics associated with varying degrees of GP registrars’ practice rurality. Design: A cross-sectional analysis of 12 rounds of data collection (2010-2015) from the longitudinal Registrar Clinical Encounters in Training study, an ongoing, cohort study of Australian GP registrars. The principal analysis used was a generalised ordered logistic regression. Setting/Participants: GP registrars in training practices within five of 17 GP regional training providers in five Australian states. Main outcome measure: Degree of rurality of the practice in which the registrar undertook training terms was calculated from the practice postcode using the Australian Standard Classification-Remoteness Area classification. Results: A total of 1161 registrars contributed data for 166 998 patient consultations (response rate 95.5%). Of these, 56.9% were in major city practices (ASGC-RA1), 25.7% were in inner-regional practices (ASGC-RA2) and 17.4% were in outer-regional/rural practices (ASGC-RA3-5). Several statistically significant associations (P = <.001) were found within regional/rural practices (ASGC-RA2-5), when compared with major city practices (ASGC-RA1). These included registrar characteristics such as being in Term 1, being medically trained overseas, and having worked at the practice previously; patient characteristics such as the patient being an existing patient, being older and being Aboriginal or Torres Strait Islander; and consultation characteristics such as performance of procedures. Conclusion: Our findings suggest that registrars are undertaking rural practice early in their GP training and are being exposed to a rich and challenging mix of clinical and educational practice. © 2020 National Rural Health Alliance Ltd.

Apprentices in the area of nursing care and automotive mechatronics are exposed to increased health risks. In this context, the promotion of physical activity (PA) is considered an effective strategy for the assurance of work ability. The goal of the PArC-AVE study was therefore to better understand the role of PA for apprentices employed in these two sectors. In an exploratory study, 55 apprentices wore an ActiGraph accelerometer over seven consecutive days and were subject to activity analysis. The objective accelerometer data (18,979 ± 3780 steps/day; 471.00 ± 159.75 min of moderate-to-vigorous PA/week), complemented by questionnaire data, indicated that most met the volume-based PA recommendations. Subsequently, we conducted a multicenter study comprising 745 apprentices from six vocational education institutions. Path analyses showed that competencies for health-enhancing PA were significantly related to indicators of work ability (0.180 ≤ b ≤ 0.452) and psychophysical health (0.139 ≤ b ≤ 0.347), whereas mere volume of PA was not (−0.048 ≤ b ≤ 0.080). In summary, apprentices of nursing care and automotive mechatronics showed high levels of PA. However, the results highlight the importance of competencies for health-enhancing PA. The PAHCO model could provide a useful framework for the conceptualization of effective interventions. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation. © 2019 American Association of Anatomists

Rheumatic and musculoskeletal diseases (RMDs) encompass a spectrum of degenerative, inflammatory conditions predominantly affecting the joints. They are a leading cause of disability worldwide and an enormous socioeconomic burden. However, worldwide deficiencies in adult and paediatric RMD knowledge among medical school graduates and primary care physicians (PCPs) persist. In October 2017, the World Forum on Rheumatic and Musculoskeletal Diseases (WFRMD), an international think tank of RMD and related experts, met to discuss key challenges and opportunities in undergraduate RMD education. Topics included needs analysis, curriculum content, interprofessional education, teaching and learning methods, implementation, assessment and course evaluation and professional formation/career development, which formed a framework for this white paper. We highlight a need for all medical graduates to attain a basic level of RMD knowledge and competency to enable them to confidently diagnose, treat/manage or refer patients. The importance of attracting more medical students to a career in rheumatology, and the indisputable value of integrated, multidisciplinary and multiprofessional care are also discussed. We conclude that RMD teaching for the future will need to address what is being taught, but also where, why and to whom, to ensure that healthcare providers deliver the best patient care possible in their local setting. © 2019, The Author(s).