严重安全事件作为临床学习环境动态的窗口:定性情境分析。

IF 5.2 1区 教育学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES
Paula Rowland, Maria Athina Tina Martimianakis, Glen Bandiera, Walter Tavares
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引用次数: 0

摘要

临床学习环境(CLE)是复杂的,并没有从推进其独特动态的概念理解的角度进行彻底的探索。促进这种理解的一个机会在于检查具体情况,例如当学生/培训生卷入严重的患者安全事件时会发生什么。方法:在协商命令和话语概念的影响下,我们在加拿大一所大型城市大学及其附属卫生科学中心进行了一项定性的解释性研究,采用文献分析和半结构化访谈。使用阿黛尔·克拉克情景分析的概念和工具分析了文件和采访记录。结果:在2022年3月至2023年4月期间,我们对工作人员医师(n = 6)、住院医师(n = 2)、安全负责人和/或大学管理人员(n = 9)进行了17次访谈。分析显示,参与者必须不断地解释、谈判和重新谈判反补贴力量,以实现CLE的愿望。此外,分析揭示了关于CLE学习性质的潜在竞争话语,激发了CLE在发展临床专业知识和职业认同方面的长期紧张关系。讨论:我们的研究揭示了反补贴力量,相互作用的政策和潜在的分歧,关于学习的必要性和重点CLE。这些反补贴压力塑造了对患者安全的了解。除了学习内容或过程,被投资团体还必须学会协商分布在多个社会领域的风险和责任。这些分布正在发生变化。了解这些动态对于寻求积极影响CLE的教育者和研究人员至关重要。未来的CLE研究应考虑到对卫生服务组织施加的各种压力,以及对这些空间的教育任务可能产生的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Serious safety events as a window into clinical learning environment dynamics: A qualitative situational analysis.

Introduction: Clinical learning environments (CLE) are complex and have not been thoroughly explored from the perspective of advancing conceptual understanding of their unique dynamics. An opportunity to advance this understanding rests in examining specific situations, such as what happens when a student/trainee has been involved in a serious patient safety event.

Methods: Shaped by concepts of negotiated orders and discourses, we conducted a qualitative, interpretive study in a large urban university and affiliated health science centre in Canada using document analysis and semi-structured interviews. Documents and interview transcripts were analysed using concepts and tools from Adele Clarke's situational analysis.

Results: Between March 2022 and April 2023, we conducted 17 interviews with staff physicians (n = 6), medical residents (n = 2), safety leaders and/or university administrators (n = 9). Analysis revealed counter-vailing forces that must be constantly interpreted, negotiated and re-negotiated by participants attempting to deliver on the aspirations of the CLE. Furthermore, analysis revealed potentially competing discourses about the nature of learning in the CLE, animating long-standing tensions about the role of the CLE in developing clinical expertise and professional identity.

Discussion: Our study reveals counter-vailing forces, interacting policies and potential disagreements about the learning imperatives and priorities of the CLE. These counter-vailing pressures shape learning about patient safety. More than learning content or process, invested groups must also learn to negotiate risks and responsibilities distributed across multiple social arenas. These distributions are changing. Understanding these dynamics is essential for educators and researchers seeking to positively influence the CLE. Future CLE research should account for the various pressures acting on health service organizations and the possible implications for educational mandates in these spaces.

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来源期刊
Medical Education
Medical Education 医学-卫生保健
CiteScore
8.40
自引率
10.00%
发文量
279
审稿时长
4-8 weeks
期刊介绍: Medical Education seeks to be the pre-eminent journal in the field of education for health care professionals, and publishes material of the highest quality, reflecting world wide or provocative issues and perspectives. The journal welcomes high quality papers on all aspects of health professional education including; -undergraduate education -postgraduate training -continuing professional development -interprofessional education
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