Department of Pediatrics, Radboudumc Amalia Children's Hospital, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Research on Learning and Education, Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands.
BMC Med Educ. 2021 Sep 7;21(1):479. doi: 10.1186/s12909-021-02910-6.
Residents need to be trained across the boundaries of their own specialty to prepare them for collaborative practice. Intraprofessional learning (i.e. between individuals of different disciplines within the same profession) has received little attention in the postgraduate medical education literature, in contrast to the extensive literature on interprofessional learning between individuals of different professions. To address this gap, we performed a scoping review to investigate what and how residents learn from workplace-related intraprofessional activities, and what factors influence learning.
The PRISMA guidelines were used to conduct a scoping review of empirical studies on intraprofessional workplace learning in postgraduate medical education published between 1 January 2000 to 16 April 2020 in Pubmed, Embase, PsycINFO, ERIC and Web of Science. This study applied 'best fit' framework-based synthesis to map the existing evidence, using the presage-process-product (3P) model developed by Tynjälä (2013).
Four thousand three hundred thirty records were screened, and 37 articles were included. This review identified influencing (presage) factors that derived from the sociocultural environment, learner and learning context. Studies described that complexity of care can both facilitate and hinder learning. Furthermore, intraprofessional learning is threatened by professional stereotyping and negative perceptions, and awareness of learning opportunities and explicit reflection are critical in intraprofessional workplace learning. Studies described a range of informal and formal intraprofessional activities (process) under the headings of collaboration in clinical practice, rotations or placements, formal educational sessions and simulated workplace training. In general, learners responded well and their attitudes and perceptions improved, learners reported increased knowledge and skills and positive behavioural changes (product). Learning outcomes were reported in the domains of patient-centred care, collaborative attitudes and respect, mutual knowledge and understanding, collaborative decision making, communication, leadership, teamwork and reflexivity.
This review gives insight into the high learning potential of intraprofessional activities. Many of the included studies relied on self-reported perceptions of change, therefore, future research should focus on generating more robust evidence including objectively examined outcome measures. This review offers a comprehensive overview of the factors that influence intraprofessional workplace learning in postgraduate medical education. Finally, we provide recommendations for enhancing intraprofessional learning in clinical practice.
为了使住院医师能够为协作实践做好准备，需要跨专业界限对其进行培训。在研究生医学教育文献中，很少关注专业内学习（即同一专业内不同学科的个体之间），而广泛关注不同专业的个体之间的跨专业学习。为了解决这一差距，我们进行了范围界定审查，以调查住院医师从与工作场所相关的专业内活动中学习了什么以及如何学习，以及影响学习的因素。
本研究使用 PRISMA 指南对 2000 年 1 月 1 日至 2020 年 4 月 16 日期间在 Pubmed、Embase、PsycINFO、ERIC 和 Web of Science 上发表的研究生医学教育中与工作场所相关的专业内学习的实证研究进行了范围界定审查。本研究应用 Tynjälä（2013 年）开发的预-过程-结果（3P）模型，基于“最佳拟合”框架综合现有证据。
筛选出 4330 条记录，纳入 37 篇文章。该综述确定了源自社会文化环境、学习者和学习环境的影响（预）因素。研究表明，医疗复杂性既可以促进也可以阻碍学习。此外，专业定型和负面看法威胁着专业内学习，对学习机会的认识和明确的反思在专业内工作场所学习中至关重要。研究描述了在临床实践协作、轮岗或实习、正式教育课程和模拟工作场所培训下的一系列非正式和正式的专业内活动（过程）。一般来说，学习者反应良好，态度和看法有所改善，学习者报告了知识和技能的增加以及积极的行为变化（结果）。学习成果在以患者为中心的护理、协作态度和尊重、相互了解、协作决策、沟通、领导力、团队合作和反思等领域报告。
本综述深入了解了专业内活动的高学习潜力。许多纳入的研究都依赖于对变化的自我报告感知，因此，未来的研究应侧重于生成更具说服力的证据，包括客观检查的结果衡量标准。本综述全面概述了影响研究生医学教育中专业内工作场所学习的因素。最后，我们为提高临床实践中的专业内学习提供了建议。
