Reflexiones sobre el refinamiento modular y el
aprendizaje interprofesional en la educación clínica
Reflections on modular refinement and
inter-professional learning in clinical education
Recibido: diciembre 12 de 2017 | Revisado: febrero 26 de 2018 |
Aceptado: mayo 26 de 2018
John Tredinnick-rowe1
1 University of Plymouth
john.tredinnick-rowe@plymouth.c.uk
ab st r aCt
Modular refinement of courses in clinical education is essential to im-
prove the quality of tuition that students receive. This study looks at
stu-dent feedback scores to determine if changes to group work and the
in-troduction of interprofessional teaching staff improved the quality of
the student experience. A mixed group of professionals taught three
differ-ent cohorts of post-graduate clinical students. Prior to this, non-
clinical staff, rather than a mix of medical educators, and clinical
professionals taught the same course. Students’ feedback about the class
used four cat-egories: for relevance, for style/ mode of delivery, for
organisation, and for enjoyment. We compared the scores before after
the intervention. Student feedback ranged from 9 -14 participants for
each category. Following the module-redesign students’ feedback
scores increased in each category, with the largest increases coming in
relevance. Matching the professional characteristics of the teachers to
students can have a beneficial effect in terms of the relevance of clinical
courses, as well as style, mode of delivery, and organisation. Student
feedback can be used to determine the success of modular reforms if the
correct psychometric measure are used in the feedback paperwork.
Key words: education, sociology, reform
re sum e n
El refinamiento modular de los cursos en educación clínica es esencial para
mejorar la calidad de la matrícula que reciben los estudiantes. Este estudio
analiza los puntajes de los comentarios de los estudiantes para determinar
si los cambios en el trabajo en grupo y la introducción del personal docente
interprofesional mejoraron la calidad de la experiencia del estudiante. Un
grupo mixto de profesionales enseñó a tres cohortes diferentes de
estudiantes clínicos de posgrado. Antes de esto, el personal no clínico, en
lugar de una combinación de educadores médicos y profe-sionales clínicos,
enseñaba el mismo curso. Los comentarios de los estu-diantes sobre la
clase utilizaron cuatro categorías: por relevancia, estilo/ modo de entrega,
organización y disfrute. Comparamos los puntajes antes de la intervención.
Las opiniones de los estudiantes variaron de 9 a 14 par-ticipantes para cada
categoría. Tras el rediseño del módulo, los puntajes de los comentarios de
los estudiantes aumentaron en cada categoría, y los mayores aumentos se
volvieron relevantes. La coincidencia de las carac-terísticas profesionales
de los profesores con los alumnos puede tener un efecto beneficioso en
términos de la relevancia de los cursos clínicos, así como del estilo, modo
de entrega y organización. Las observaciones de los estudiantes se pueden
utilizar para determinar el éxito de las reformas modulares si se utilizan las
medidas psicométricas correctas en los docu-mentos de retroalimentación.
Palabras clave: educación, sociología, reforma
DOI: http://dx.doi.org/10.24039/cv201861250
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John Tredinnick-rowe
Introduction
We teach on a module called Assessment
in Clinical Education; this is a master’s level
course and part of the masters in clinical
education. The course typically has cohorts of
15 -25 students and will run between 2-3
times per year. The course is designed for
clinical professionals and caters for doctors,
dentists, nurses, paramedics, and other
healthcare professionals.
The course comprises of study days and
tutorial sessions with lecturers. For the purpose
of this text, we shall focus on the day-session
entitled: Assessment and Remediation. Where
medical remediation is “the process through
which doctors’ performance concerns can be
addressed to facilitate a return to safe practice”
(Swanwick and Whiteman, 2013, p. 1). In this
short communication, we will discuss the
process of modular reform and group work. The
learning outcomes for the day-session are to:
• Identify contemporary assessment
methodologies.
• Understand the rationale for
selection of methodologies.
• To be able to critically review the
validity evidence for the methodologies.
• Understand how to synthesise key
findings of the strengths and
weaknesses of the evidence.
• Draw conclusions about the validity
of assessment methodologies.
The day-session explores how validity in the
assessment of remediation can or cannot be
constructed, psychological theories of learning
and an expert presentation by an employee of
the National Clinical Assessment Service
(NCAS). NCAS is the NHS organisation that
conducts psychometric evaluations of clinical
professionals that undergo remediation.
Module Design Theory
The module is taught in an interprofession-
al learning style, something which as an ap-
proach has been gaining ground in medical
education (Curran, Sharpe, and Forristall,
2007). The sociological basis of such an ap-
proach being predicated on ideas close to
what Bourdieu (2005) described as
structural homology – Figure 1.
Figure 1. The nature of exchange in Bourdieusian
terms - matching capital leads to interaction
Where the forms of capital that two groups
possess (tutors and tutees), be they linguistics,
social, economic etc. have structural affini-ties
that lead to increased interaction. Conse-quently,
it was predicted that such an approach would
facilitate teaching that is more effective.
Methods - Modular Refinement
The module learning outcomes are inti-
mately connected the students’ first piece of
summative coursework, entitled: A critical re-
flective analysis of an assessment methodology
against the APA validity framework (Downing
2003). As such, the masters level teaching is
designed to help promote skills of critical re-
flexive analysis in the students (White, Fook,
and Gardner 2006).
Using what Kolb termed as an Experien-
tial Learning Cycle (Kolb 1984), the
modules undergo a continual review
process of reflec-tive post-course meetings
between lecturers to help improve the
transfer of learning, and so improve the
content (Leberman and Martin 2004).
To assess the impact upon student learning
of modular reforms we measured four areas in
their feedback forms: relevance, enjoyment,
style and organisation. To provide some his-
torical data and context to the module, we
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synthesised the student feedback scores for
the last four iterations. The session in Feb-
15 did not use an interprofessional learning
ap-proach, all the three subsequent ones did,
and this is shown in Figure 1.
Results
The scoring system works in the follow-
ing way, students were asked how they would
rate the teaching for the aspects described, on
a scale of 1-5 (with one being poor and five
being excellent). Despite its limitations, the
data gives an approximation of the progress
that has been made in relation to our reforms.
Student feedback ranged from 9 -14 partic-
ipants for each category. We have collapsed
the scores into a single info graphic for each
category, by cohort for the period 2015 –
2016 in Figure 2.
Figure 2. Module feedback 2015-16
Since we have introduced the interprofes-
sional learning approach to our teaching, we
have seen increases in all for four score areas,
with the largest increases coming in relevance.
This increased score may have been related to
a discourse analysis of key remediation poli-
cy documents from the Academy of Medical
Royal College (AoMRC 2009, 2012, 2013),
and associated authors (Mascie-Taylor 2010,
Foley 2014). We interrogated the texts from
the position of a medical student looking for
information on remediation. From this, we
created a series of PowerPoint slides on the se-
mantic context of remediation. It was felt that
this would also create the basis of a good
dis-cussion with the students.
In addition, it was important that we un-
derstood all the UK guidance that exists for
doctors who are going through remediation.
i.e. understanding the students perspective (J.
Brooks and M. Brooks , 2000). This modular
reform process indicated that collecting data
on the relevance of the teaching was a useful
indicator. More widely each time the course
has been modified in accordance to the stu-
dents’ feedback it has become more enjoyable,
more relevant, better organised and delivered
in a more appreciable manner (Hattie and
Timperley, 2007).
Interprofessional Group Work
Interprofessional group work in clin-ical
education focuses on the social inte-gration
of differing groups, in the hope that such
skills can be utilised in their own work
practice (Reeves, Perrier, Goldman, Freeth
and Zwarenstein, 2013). One group exercise
that we introduced as part of the reform in-
volved using four different vignettes of
clinical malpractice adapted from real world
cases in AoMRC documents. One vignette
was about a doctor, the other three a nurse,
dentists and physiotherapist. The students
were put into groups of four and told which
vignette they were to discuss, and we
deliberately ensured that the doctors on the
course did not get the vignette about doctors
and so forth for the nursing students. i.e. we
avoided putting clin-ical students into silos,
as Nasca , Weiss , and Bagian (2014)
highlighted as an issue. The students had 10
minutes to address specific questions, which
we set them about the case, after which in
their groups they debated the issue in class.
The fact that the scores (given in Figure 2)
for relevance and enjoyment remained high for
the sessions indicated that our attempts to
provide students with more relevant literature
worked. As a first attempt to address this issue,
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John Tredinnick-rowe
the scores seemed to suggest it was
effective, or at least was an improvement.
As with the group work, and modular re-
finement, although the data is limited it does
give us an approximation of the changes be-
tween students overtime due to the interven-
tions that we introduced into the classroom.
Conclusion
In conclusion, we hope to continue using
student-feedback data to determine the success
of our modular reform in the future. It seems
that careful matching the professional charac-
teristics of the staff to students can have a ben-
eficial effect in terms of the relevance of clinical
courses. Collecting this data is imperative to
determine if the interventions we make work,
and to improve the quality of the education.
Disclosure Statement
The authors report no conflicts of
interest. The authors alone are responsible
for the con-tent and writing of this article.
Funding
None to declare
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