Situating Faculty Development in the Clinical Workplace

Sammanfattning: Medical students’ access to clinical supervision when rotating through hospital workplaces and the quality of that supervision are and have been an area of growing professional and societal concern. Increased training measures targeted at supervising physicians have been suggested to address this issue. Traditionally, such training has focused on offering physicians opportunities to develop as supervisors in off-site courses. This thesis applies the insights of social practice theory to investigate and discuss the implications of adopting a practice-centred, workplace learning approach to faculty development among clinical supervisors in a Swedish medical education and healthcare context. In cycles of mixed methods and action research, I construct a model for faculty development and implement it in collaboration with physicians and students in different hospital settings. Workplace learning (practice) theory is applied to analyse and frame the findings from investigations of different stakeholders’ experiences of the model. This includes an analysis of the environmental and individual factors that influence the learning- and implementation process. Assessment instruments are developed and incorporated into the model to trigger collective analyses of the students’ learning climate and supervision approaches. The validity and reliability of instruments scores are examined. The educational developer’s experiences are documented and critically reflected on. Based on the findings, I propose a model for faculty development– the On-Site Model. The model is underpinned by principles that place value on learning that is: workplace-situated; practice-based; collaborative & co-regulated; student-focused; and autonomy-conducive (guided by appreciative inquiry). The model centers on collaborative development of the learning environment and supervision practice. Together and with the help of students, supervisors analyse the possibilities and barriers for a desired state (an ideal student learning environment) and determine their own intermediate steps and means to develop in this direction. The analysis of factors influencing the model shows that interrelated structural and sociocultural variables and variables related to individual and relational agency define the workplace learning environment and condition the type of developmental learning afforded by the principles. For instance, segmented care processes, the organizational logic of production, and the length and structure of student rotations influence opportunities for continuity of relationships and collaborations. At the same time, clinical department managers and faculty members challenged structural impediments and supported the creation of infrastructures to enable collaborations, developmental learning and innovations. A salient finding was how clinical supervisors developed a sense of togetherness that empowered them to challenge cultures and structural barriers and achieve desired changes in practice. The instruments proved to have a high degree of construct validity. However, the thesis problematises how methods are used to evaluate construct validity and the usability of instrument scores. It suggests the use of instruments as part of an open, multidirectional feedback system. In conclusion, the thesis findings indicate that attention to students’ perceptions of the learning environment can contribute to an increased focus on the workplace as a learning environment for physician learners at all levels. It illuminates several strategic implications of an On-Site model. Among other things, I suggest further exploration of the ways in which the model may be integrated as one of many activities into a system for continuing professional development constructed in cooperation between the higher education and the healthcare organizations. I argue that the On-Site model is an important supplement to continuing professional development based on individual physicians’ needs for competencies, as it focuses on collaborative practice development and collective competence-building. In extension, this may include the interprofessional collaborative learning and building of collective competence necessary to address current and future needs of healthcare.