Identifying Factors that Influence Workplace Learning

Identifying Factors that Influence Workplace Learning in Postgraduate Medical Education

1.       Abstract

a.       Context

                                                               i.      Post graduate educational programs immersed in a complex workplace.

                                                             ii.      Necessary to gain insight into the factors that influence the process of learning in the workplace.

b.      Methods

                                                               i.      Semi-structured group interviews.

c.       Results

                                                               i.      A framework consisting of 56 factors was identified. These were grouped into 10 categories, which in turn were grouped into four domains: the working environment, educational factors in the workplace, NHPT (Nursing Home Physician Trainees) characteristics, and supervisor characteristics. Of the factors that influence workplace learning, social integration was cited most often. Supervisors more often reported educational factors and NHPTs more frequently reported impediments.

d.      Conclusion

                                                               i.      When supervisors explicitly discuss the learning process and learning conditions within the workplace. Special attention should be paid to the aspects of social integration. A good start could be to answer the question regarding how to establish a basic feeling of “knowing where you are” and “how to go about things” to make residents feel comfortable enough to focus on the learning process

2.       Introduction

a.       Knowledge about the factors that influence workplace-learning is important for curriculum designers and all those involved in postgraduate medical training.

b.      Various research has pointed to the importance of workplace-learning through participation in social practices.

c.       Van Woerkom (2003) describes aspects of the working environment such as workload, task autonomy and defines motivational factors, such as experience of social integration and balance between security and challenge. High need also for critically reflective work behavior, including reflection and asking for feedback.

d.      Boendermaker (2003) found that feedback skills, a critical attitude towards the postgraduate student, communication skills, and an attitude of respect towards the student are all important. Study stresses the importance of equipping students with survival skills in order to help them integrate into a community of practice. The transition to the hospital environment is difficult for students who feel that they are in the way and are unsure of what is expected of them.

3.       Context

a.       Pay more structured attention to supervision during workplace learning. Organizations can provide an educator preparation course and classes on teaching for all supervising physicians.

b.      The study addresses the following questions:

                                                               i.      Which factors influence workplace learning of NHPTs as perceived by them and their supervisors?

                                                             ii.      Which factors are perceived as an impediment to the workplace learning of NHPTs?

                                                            iii.      Is there a difference between NHPTs and their supervisors with regard to these factors?

4.       Methods

a.       Desgin

                                                               i.      Each group discusses the following questions in semi-structured group interviews:

1.       What can be instructive to NHPTs in the teaching nursing home?

2.       Who do postgraduate physicians learn from in the teaching nursing home?

3.       What is experienced as stimulating and what as restricting for the learning process?

4.       What makes a teaching nursing home a good educational environment?

                                                             ii.      The aim of the assignment was to report as many factors as they could in as much detail as possible.

                                                            iii.      Firstly, exploratory research benefits most from interviews when the respondents are considered to be experts on the subject of the study.

b.      Analysis

                                                               i.      Task variation, task autonomy, task clarity

                                                             ii.      Categories were grouped into domains and the definitions of the factors, categories, and domains. The last step consisted of filing the interview data for each of the groups into the framework of factors, categories, and domains

5.       Results

a.       Which factors do participants to influence workplace learning of NHPTs

                                                               i.      The first domain, “the working environment” was defined as a collection of all the factors regarding medical practice within a health care organization. Where the provision of care is organized in an interdisciplinary fasion.

                                                             ii.      The second domain “educational factors in the workplace” was defined as being all of the factors involving the organization of learning activities and educational conditions.

                                                            iii.      The definition of the third domain “NHPT characteristics” was composed of the personal aspects of the NHPT and learning activities by NHPTs.

                                                           iv.      Finally, the domain of the “supervisor characteristics” was defined as the aspects regarding the qualities of supervisors and supervising skills.

                                                             v.      This framework proved to be appropriate for the following positively formulated questions: “What can be instructive?”, “From whom do NHPTs learn?” and “What is experienced as restrictive for workplace learning?”

                                                           vi.      Comparing the domains, the “workplace” is mentioned most often (39%) and the domain “supervisor” the least (12%). 83% of the groups reported emotional experiences as an influence on workplace learning. 64% cited material experiences of social integration – defined as a sense of belonging in the workplace or a good atmosphere in which students felt integrated. 53% factors regarding working in an organization. Interdisciplinary team meeting, workload, access to the Internet or library, and learning from successes and mistakes were each reported by 77% of the groups. Finally, 66% reported task variation as a characteristic of workplace learning and 60% reported a good supervisor.

b.      Which factors impede the workplace learning of NHPTs?

                                                               i.      Only two characteristics were reported by half of the groups or more: 77% reported that a high workload impedes the learning process and 50% reported an unstable organization as an impediment.

c.       Differences between NHPTs and their supervisors

                                                               i.      Significantly more often than their NHPT groups, the supervisor groups reported that “practicing with the supervisor” and “the supervisor being a good role model” are important factors of workplace learning. Nearly 70% o0f supervisors also reported a NHPT characteristic “reflection on experiences” as important.

6.       Discussion

a.       Only two characteristics that impede workplace learning were reported by 50% of the groups or more: too high a workload and an unstable organization. This result seems consistent with other finding s that demonstrate a reversed U-shaped curve of what is experience as an optimal workload.

b.      It could be argued that supervisors tend to overestimate their role in the learning process. The teacher-curriculum, in which the supervisors participate, focuses explicitly on teaching skills, such as being a role mode and practicing together. Therefore, it could be argued that the supervisors’ answers were based on what they learn in the teacher-curriculum and the NHPT answers are based on their actual experiences.

c.       “How are postgraduate learned introduced into the workplace?” “What has been done to equip them with the skills, and the information they need in order to co-operate and to integrate successfully, while being allowed to learn?” They may improve their educational relationship if they explicitly discuss the learning process and learning conditions within the workplace.