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是否条条大路通罗马?运用情境学习理论考察医学研究生教育中临床教育者的发展轨迹。

Do All Roads Lead to Full Participation? Examining Trajectories of Clinical Educators in Graduate Medical Education through Situated Learning Theory.

机构信息

Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.

Department of Medical Education, Dartmouth School of Medicine, Hannover, New Hampshire, USA.

出版信息

Teach Learn Med. 2024 Oct-Dec;36(5):613-623. doi: 10.1080/10401334.2023.2230188. Epub 2023 Aug 7.

Abstract

: As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described. We explore these three questions here. : Communities of Practice, a component of Situated Learning Theory, serves as a helpful framework to explore trajectories of educator identity development among Graduate Medical Educators. We used a inductive and deductive approach to Thematic Analysis, with Situated Learning Theory as our interpretive frame. Semi-structured interviews of faculty members of GME programs matriculating into a Health Professions Education Program were conducted, focusing on participants' lived experiences in medical education and how these experiences shaped their Professional Identity Formation. : Participants noted peripheral, inbound, boundary, and outbound trajectories, but not an insider trajectory. Trajectory derailment was attributed to competing demands, imposter syndrome and gendered marginality. Modes of belonging were critical tools participants used to shape PIF, not only with educator roles but disengagement with other roles; of future roles with the support of mentors; and fluid with multiple mutually reinforcing identities. Participants identified like resumes and formal roles that helped them negotiate across Community of Practice boundaries. : Despite a desire for full participation, some clinical educators remain marginal, struggling along a peripheral trajectory. Further research exploring this struggle and potential interventions to strengthen modes of belonging and boundary objects is critical to create equitable access to the inbound trajectory for all of our colleagues, leaving the choice of trajectories up to them.

摘要

: 当新的教员在研究生医学教育领域开始他们的职业生涯时,他们每个人都从教育社区的边缘开始了专业身份形成的旅程。所经历的轨迹差异很大,并且不能保证完全参与给定的教育社区。虽然一些医学院和研究生培训计划可能会培养专业身份的形成,但对教员的支持却很少。迄今为止,研究生医学教育教员所经历的轨迹、可能使入轨轨迹脱轨的因素以及研究生医学教育教员用来驾驭这些轨迹的工具尚未明确描述。我们在这里探讨这三个问题。: 实践社区是情境学习理论的一个组成部分,是探索研究生医学教育者教育者身份发展轨迹的有用框架。我们采用归纳和演绎的方法进行主题分析,并以情境学习理论为解释框架。对进入健康专业教育计划的研究生医学教育计划的教员进行了半结构化访谈,重点关注参与者在医学教育中的生活经历以及这些经历如何塑造他们的专业身份形成。: 参与者注意到外围、入轨、边界和出站轨迹,但没有内部轨迹。轨迹脱轨归因于竞争需求、冒名顶替综合征和性别边缘化。归属模式是参与者用来塑造 PIF 的关键工具,不仅与教育者角色有关,而且与其他角色的脱节有关;在导师的支持下获得未来角色的归属;以及与多种相互强化的身份的灵活归属。参与者确定了类似简历和正式角色的工具,这些工具帮助他们在实践社区边界内进行协商。: 尽管渴望充分参与,但一些临床教育者仍然处于边缘地位,沿着外围轨迹苦苦挣扎。进一步探索这种挣扎以及潜在干预措施以加强归属模式和边界对象的研究对于为我们所有的同事创造公平获得入轨的机会至关重要,让他们自己选择轨迹。

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