Department of Education, St Lucas Andreas Hospital, Amsterdam, the Netherlands.
Med Educ. 2013 Mar;47(3):271-81. doi: 10.1111/medu.12081.
Many studies have examined how educational innovations in postgraduate medical education (PGME) impact on teaching and learning, but little is known about effects in the clinical workplace outside the strictly education-related domain. Insights into the full scope of effects may facilitate the implementation and acceptance of innovations because expectations can be made more realistic, and difficulties and pitfalls anticipated. Using workplace-based assessment (WBA) as a reference case, this study aimed to determine which types of effect are perceived by users of innovations in PGME.
Focusing on WBA as a recent instance of innovation in PGME, we conducted semi-structured interviews to explore perceptions of the effects of WBA in a purposive sample of Dutch trainees and (lead) consultants in surgical and non-surgical specialties. Interviews conducted in 2011 with 17 participants were analysed thematically using template analysis. To support the exploration of effects outside the domain of education, the study design was informed by theory on the diffusion of innovations.
Six domains of effects of WBA were identified: sentiments (affinity with the innovation and emotions); dealing with the innovation; specialty training; teaching and learning; workload and tasks, and patient care. Users' affinity with WBA partly determined its effects on teaching and learning. Organisational support and the match between the innovation and routine practice were considered important to minimise additional workload and ensure that WBA was used for relevant rather than easily assessable training activities. Dealing with WBA stimulated attention for specialty training and placed specialty training on the agenda of clinical departments.
These outcomes are in line with theoretical notions regarding innovations in general and may be helpful in the implementation of other innovations in PGME. Given the substantial effects of innovations outside the strictly education-related domain, individuals designing and implementing innovations should consider all potential effects, including those identified in this study.
许多研究考察了研究生医学教育（PGME）中的教育创新如何影响教学，但对于教育相关领域之外的临床工作场所的影响知之甚少。全面了解影响可能会促进创新的实施和接受，因为可以使期望更加现实，并预见困难和陷阱。本研究以基于工作场所的评估（WBA）为参考案例，旨在确定 PGME 中创新的使用者感知到哪些类型的效果。
专注于 WBA 作为 PGME 中的一项新创新，我们对荷兰外科和非外科专业的受训者和（首席）顾问进行了有针对性的样本，使用半结构化访谈来探讨 WBA 的效果。2011 年对 17 名参与者进行了访谈，并使用模板分析进行了主题分析。为了支持对教育领域之外的效果进行探索，研究设计受到创新扩散理论的启发。
确定了 WBA 的六个效果领域：情感（对创新的亲和力和情绪）；处理创新；专业培训；教学和学习；工作量和任务以及患者护理。用户对 WBA 的亲和力部分决定了其对教学的影响。组织支持和创新与常规实践之间的匹配被认为对于最小化额外工作量和确保 WBA 用于相关而不是易于评估的培训活动很重要。处理 WBA 引起了对专业培训的关注，并将专业培训列入临床部门的议程。
这些结果与一般创新的理论概念一致，可能有助于在 PGME 中实施其他创新。鉴于教育相关领域之外的创新具有重大影响，设计和实施创新的个人应考虑所有潜在影响，包括本研究中确定的影响。
