Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
Barts and The London School of Medicine, Queen Mary University of London, London, UK.
Med Educ. 2021 Jan;55(1):45-54. doi: 10.1111/medu.14345. Epub 2020 Sep 13.
Clinical placements are central to the process of preparing future health professionals for practice. Health care environments are increasingly complex and demanding with clinical placements often being perceived as a burden on busy health professionals giving rise to a service-education tension. This tension creates a situation ripe for simplistic solutionist approaches. For example, characterising the problem of clinical placements as students negatively impacting on service productivity results in a reductionist solution such as universities compensating health services for student education. Challenges faced by placement seekers and placement providers are multifaceted and complex requiring a more sophisticated understanding and response to the challenges of involving students in the workplace to prepare them for the future workforce.
RE-CONCEPTUALISATION: We argue that the health and education systems have become de-coupled. Learning and working are seen as distinct activities that are at odds with one another. Re-imagining the purposes and practices of clinical placements for the mutual benefit of patients, health services and students may fruitfully address this disconnect.
We present a worked example using the conceptual and analytical tools of cultural-historical activity theory to articulate what we have learnt about this health-education disconnect. Our worked example draws on research involving a series of clinical education case studies within acute care contexts.
Through the lens of cultural-historical activity theory, we highlight that solutionist approaches are entrenched in a de-coupling of health from education where the shared object of preparing the future workforce is fragmented. Successful re-coupling requires a partnership that is founded on a shared commitment to preparing the future workforce; recognises that learning and practice are inseparable; and understands that both activity systems are fluid and that collaboration to stay focused on the shared object of preparing the future workforce is complex, challenging and ongoing work.
临床实习对于培养未来医疗专业人员的实践能力至关重要。医疗保健环境日益复杂和苛刻，临床实习通常被视为对忙碌的医疗专业人员的负担，导致服务与教育之间的紧张关系。这种紧张关系为简单的解决方案主义方法创造了条件。例如，将临床实习的问题描述为学生对服务生产力产生负面影响，导致了一种简化的解决方案，例如大学为医疗服务补偿学生教育。实习寻求者和实习提供者所面临的挑战是多方面的和复杂的，需要更深入地理解和应对让学生参与工作场所以培养他们为未来劳动力做准备的挑战。
我们认为，卫生和教育系统已经脱节。学习和工作被视为截然不同的活动，彼此不协调。重新构想临床实习的目的和实践，以实现患者、医疗服务和学生的共同利益，可能会有效地解决这种脱节。
我们提出了一个实例分析，使用文化历史活动理论的概念和分析工具来阐明我们对这种卫生与教育脱节的理解。我们的实例分析借鉴了在急性护理背景下进行的一系列临床教育案例研究。
通过文化历史活动理论的视角，我们强调解决方案主义方法根深蒂固地存在于卫生与教育的脱节之中，即准备未来劳动力的共同目标被碎片化。成功的重新结合需要建立在共同承诺的基础上，即准备未来的劳动力；认识到学习和实践是不可分割的；并理解这两个活动系统都是流动的，并且保持对准备未来劳动力的共同目标的关注的合作是复杂、具有挑战性和持续的工作。
