Sarah Sholl1, Rola Ajjawi2, Helen Allbutt3, Jane Butler4, Divya Jindal-Snape5, Jill Morrison6, Charlotte Rees7. 1. Business School, Edinburgh Napier University, Edinburgh, UK. 2. Centre for Research in Assessment and Digital Learning, Deakin University, Burwood, Vic., Australia. 3. Planning and Corporate Governance, NHS Education for Scotland, Edinburgh, UK. 4. Health Education England - Kent, Surrey and Sussex, Crawley, UK. 5. School of Education and Social Work, University of Dundee, Dundee, UK. 6. Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. 7. Faculty of Medicine, Nursing and Health Sciences, HealthPEER (Health Professions Education and Education Research), Monash University, Clayton, Vic., Australia.
Abstract
CONTEXT: Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. METHODS: We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. RESULTS: The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. CONCLUSION: Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery.
CONTEXT: Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. METHODS: We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. RESULTS: The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. CONCLUSION: Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery.
Authors: Charlotte E Rees; Paul Crampton; Fiona Kent; Ted Brown; Kerry Hood; Michelle Leech; Jennifer Newton; Michael Storr; Brett Williams Journal: BMJ Open Date: 2018-04-17 Impact factor: 2.692
Authors: Charlotte E Rees; Sarah L Lee; Eve Huang; Charlotte Denniston; Vicki Edouard; Kirsty Pope; Keith Sutton; Susan Waller; Bernadette Ward; Claire Palermo Journal: Adv Health Sci Educ Theory Pract Date: 2019-11-05 Impact factor: 3.853
Authors: Sarah Lee; Charlotte Denniston; Vicki Edouard; Claire Palermo; Kirsty Pope; Keith Sutton; Susan Waller; Bernadette Ward; Charlotte Rees Journal: BMJ Open Date: 2019-06-01 Impact factor: 2.692
Authors: Lillian Gelberg; Samuel T Edwards; Elizabeth R Hooker; Meike Niederhausen; Andrew Shaner; Brianna J Cowan; Carole M Warde Journal: J Gen Intern Med Date: 2021-09-30 Impact factor: 5.128