"It's Always There, Right?" Exploring Internal Medicine Teams' Use of Basic Science Knowledge on Inpatient Rounds.

IF 4.8 2区 医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES
Perspectives on Medical Education Pub Date : 2025-06-06 eCollection Date: 2025-01-01 DOI:10.5334/pme.1766
Tracy B Fulton, John C Penner, Sally A Collins, Marieke van der Schaaf, Bridget C O'Brien
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引用次数: 0

Abstract

Purpose: Attendings and trainees are expected to use basic science knowledge (BSK) in clinical practice and learning. Evidence of how is scant, and more research situated in clinical learning environments (CLEs) is needed. Our study aimed to characterize use of BSK during patient care in a CLE and the actions, interactions, materials, and beliefs that influence its use, to inform efforts to connect BSK education to clinical workplace learning and patient care.

Method: We conducted a constructivist grounded theory study, collecting data from eight inpatient Internal Medicine (IM) teams at one US institution from October 2022 to January 2023. Data included field notes from 27 hours observing inpatient rounds and 24 team member interviews. Iterative data analysis involved coding, memo writing, and constant comparison to develop a theory of BSK use on IM inpatient rounds.

Results: We found that BSK can be activated on rounds through social interactions (among team members, with patients), and in contact with materials (e.g. the electronic health record). Our findings describe BSK as activated when team members connect to and test BSK or when they explore uncertainty; and that activation is supported by beliefs that BSK use brings value to patient care. However, team members often left BSK not activated, accompanied by beliefs about it not being a good fit for patient care activities. Actions associated with leaving BSK not activated included delegating responsibility for using it, deferring discussion, or curtailing conversations about it.

Discussion: Much of the literature describes BSK use in the clinical setting as the product of individual cognition. Our findings extend this characterization, illustrating how social and material elements of the inpatient CLE influence BSK use on rounds. These elements can be leveraged to activate BSK to support integration of learning with patient care in the workplace.

“它总是在那里,对吧?”探索内科团队在查房过程中对基础科学知识的使用。
目的:期望主治医生和学员在临床实践和学习中使用基础科学知识(BSK)。如何做到这一点的证据很少,需要在临床学习环境中进行更多的研究。本研究旨在描述CLE患者护理期间BSK使用的特征,以及影响其使用的行为、互动、材料和信念,以告知将BSK教育与临床工作场所学习和患者护理联系起来的努力。方法:我们进行了一项基于建构主义的理论研究,收集了2022年10月至2023年1月期间美国一家机构8个住院内科(IM)团队的数据。数据包括27小时观察住院病人查房和24个团队成员访谈的现场记录。迭代数据分析包括编码、备忘录撰写和不断的比较,以开发BSK在IM住院查房中的使用理论。结果:我们发现BSK可以在查房时通过社会互动(团队成员之间,与患者之间)和接触材料(例如电子健康记录)来激活。我们的研究结果表明,当团队成员连接并测试BSK或探索不确定性时,BSK被激活;这种激活是由BSK的使用为病人护理带来价值的信念所支持的。然而,团队成员往往没有激活BSK,并认为它不适合患者护理活动。与不激活BSK相关的行为包括委派使用它的责任、推迟讨论或减少关于它的对话。讨论:许多文献将临床环境中BSK的使用描述为个体认知的产物。我们的研究结果扩展了这一特征,说明了住院CLE的社会和物质因素如何影响查房时BSK的使用。可以利用这些元素来激活BSK,以支持工作场所中学习与患者护理的整合。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.70
自引率
8.30%
发文量
31
审稿时长
28 weeks
期刊介绍: Perspectives on Medical Education mission is support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Official journal of the The Netherlands Association of Medical Education (NVMO). Perspectives on Medical Education is a non-profit Open Access journal with no charges for authors to submit or publish an article, and the full text of all articles is freely available immediately upon publication, thanks to the sponsorship of The Netherlands Association for Medical Education. Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary. The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members. The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief. Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission. Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary. The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members. The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief. Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
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