Download - Qualitative Research in Simulation
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A Model for Qualitative Research
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Conceptual Framework and Purpose
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Methods and Validity
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Implicit vs. Explicit Curricula in General Pediatric Education: Is There a Convergence?
Dorene Balmer, Christina Master, Boyd Richards, and Angelo Giardino Pediatrics, 2008
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Explicit Curriculum
• Medical knowledge• Patient care• Professionalism• Interpersonal communication
• Practice-based learning
• Systems-based practice
Background
Implicit Curriculum
Opportunities to learn when residents are doing their everyday work
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Background (conceptual framework)Hidden vs Formal Curriculum ◦Rituals, beliefs, practices that function at the level of the organizational structure and culture
◦Single competency: Professionalism
Implicit vs Explicit curriculum ◦“Unadvertised”, informal and often ad hoc teaching
◦Spans the six competencies
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Purpose (purpose)
• To study what pediatric residents have the opportunity to learn implicitly as they do their everyday work
• To understand how this learning maps on to goals and objectives in a competency-based explicit curriculum for a General Pediatrics rotation
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Operational DefinitionsExplicit Curriculum ◦Competency based goals and objectives for one inpatient General Pediatric rotation
Implicit Curriculum: ◦Observed and reported events, activities and conversations that occurred as part of everyday life on a General Pediatric floor
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Data Collection: ObservationObservation(Methods)(Methods)One General Pediatrics floor143 hours of observation ◦ 2/3s between 8:00 a.m. and Noon
◦ January to AugustMedical team:◦ Attendings, senior residents and interns
Observer-participant stance
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Data Collection: Interviews((MethodsMethods))Overlapped with observation14/18 attendings, 16/22 interns and 9/11 senior residents
Audio-taped and transcribedGeneral questions◦What surprised you?◦What would you change?◦No competency specific probes
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Data Analysis ((MethodsMethods)) Data source
interview transcripts and notes from observation
Inductive analysis • Inductively derived codes
• Codes: “labels” for key concepts
• Iterative revision of code list
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Data Analysis
Final phase: Identification of themes pertaining to curricular convergence
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Trustworthiness Trustworthiness (Validity)(Validity)Single observer and interviewer
Prolonged observation, allowing for check on preliminary findings
Independent coding of 30% of notes from observation
Created audit trail
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Theme 1: Overall Curricular Convergence
• Residents had frequent opportunities to address 29/32 more granular objectives in the explicit curriculum
• Example: • [objective for Patient Care] Develop an appropriate diagnostic and therapeutic plan for patients requiring hospitalization
• [observation on rounds] “… so the plan for this 6 month old with retropharyngeal abscess is to continue the clinda …”
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… but some divergence
Example ◦Converged around communication and teamwork
◦Diverged around systems-based practice and health care costs
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Theme 2: Messiness of the Implicit Curriculum
Difficult to predict• Directed by patients illnesses and social situations
Difficult to compartmentalize• Lack of boundaries between competency domains
• Example: • Discharging patients: interconnection between patient care and systems based practice
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Theme 2: Messiness of the Implicit CurriculumDifficult to balance
• Dominated by patient care• Learning by doing
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Theme 3: Lack of formal recognition of the explicit curriculum• No direct reference to the explicit curriculum or the AGCME competencies throughout the study
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Discussion
How the PARTS
Contribute to the WHOLE
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Take away message:• Recognize competency-based education as inherent to the learning that occurs in today’s clinical context