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"Humans"

Purpose Error is inevitable in medicine, given its inherent uncertainty and complexity. Errors can teach powerful lessons; however, because of physicians’ self-imposed silence and the intricacies of responsibility and blame, learning from medical error has been underexplored. The purpose of this study was to understand how physicians perceived learning from medical errors by exploring the tension between responsibility and blame and factors that affected physicians’ learning. Method Nineteen physicians participated in semistructured interviews, conducted in 2016–2017 at Western University in Canada, that probed their experiences in learning from medical errors. Data collection and analysis were conducted iteratively, with themes identified through constant comparative analysis. Results Participants felt personal responsibility and blame for their errors. Residency produced particularly salient memories of errors. Participants identified interconnecting cultural factors (normalizing error, peer support and mentorship, formal rounds) and individual factors (emotional response, confidence and experience), which either helped or hindered their perceived learning. Conclusions Learning from medical error requires navigation through blame and responsibility. The keen responsibility felt by physicians must be acknowledged when enacting a system-based approach to medical error. Adopting a learning culture perspective suggests opportunities to enable and disable features of the learning environment to optimize learning from error as residents learn to become the most responsible physician for all outcomes. A better understanding of the factors that shape learning from error can help make the transition from error to learning more explicit, thereby increasing the opportunity to learn and teach from errors that permeate the practice of medicine. © © 2019 by the Association of American Medical Colleges.

Background and Aims: In educational measurement, performance assessments occupy a niche for offering a true-to-life format that affords the measurement of high-level cognitive competencies and the evidence to draw inferences about intellectual capital. However, true-to-life formats also introduce myriad complexities and can skew if not outright distort the accuracy of inferences. For validating claims about test-takers from performance assessments, the collection of evidence about response processes is a necessity of sufficient import that the validation process needs to be labelled a cognitive validation to ensure that the cognitive is not forgotten in the logic of the validation process. Analysis and Example: Cognitive validation is described as a three-pronged process of (1) identifying the knowledge, skills, and attributes associated with the intellectual capital of interest, (2) selecting and/or developing tasks to elicit intellectual capital, and (3) collecting substantive empirical evidence of examinee response processes as part of the overall validity argument. This three-pronged process is illustrated using the American Institute of CPA's (2018) practice analysis, task-based simulations (TBSs), and use of think-aloud interviews to evaluate claims. Conclusions: Although cognitive laboratories and think alouds are used to measure distinct types of response processes as test-takers interact with performance assessments, both methods are among the best for obtaining direct but differential evidence from test-takers. The labour and cost of collecting this evidence are often not done or not done well by many testing programmes. However, for performance assessments to succeed in measuring what they purport to measure, the investment of cognitive validation must be made. © 2019 The British Psychological Society

The aim of this study is to identify the influence of social dimensions of the work environment and the employees' felt responsibility on the transfer of safety training. We tested a model in which responses and reactions from safety players such as coworkers, supervisors, and safety professionals are positively related to the transfer of training (TT), through the mediating effect of the employees' felt responsibility and the moderating influence of supervisor support and sanctions. A two-time data collection was implemented among blue-collar employees, all low qualified, from four city councils who attended a fundamental safety training program delivered by in-house safety trainers, all safety professionals (n = 203). Data analysis revealed that (a) supervisors' safety responses, coworkers' safety responses, and safety professionals' reactions positively influenced the TT, an effect (b) mediated by employees' felt responsibility and (c) moderated by supervisor sanctions, but not by supervisor support. The results suggest that high sanctions enhance the positive effect of high self-responsibility on TT, and, importantly, aggravate the negative effect of low self-responsibility on TT. This is the first study to empirically test both the influence of felt responsibility and the safety professionals' reactions in the transfer process. Research should continue to examine the former construct's influence on the transfer process including, for example, its effect on supervisor support, and the latter as a safety-related social dimension variable of the work environment. © 2019 APA, all rights reserved.

[No abstract available]

Personality development in emerging adults who do not attend college after high school has been largely overlooked so far. In this study, we investigated personality development in emerging German adults (N T 1  = 1,886, M ageT1  = 18.01 years, 29% female) undergoing vocational education and training (VET). The trainees were assessed at the start of VET, 1.5 years later, and another 1.5 years after that, just before graduation. Longitudinal latent change score analyses were applied. Bivariate analyses investigated life satisfaction and job strain as social and work-related aspects that are potentially reciprocally related to personality development. Mean-level personality changes included increases in neuroticism and decreases in agreeableness and conscientiousness in the first interval. In the second interval, neuroticism decreased and conscientiousness increased. Simultaneously, trainees reported a gradual decrease in extraversion and openness across the 3-year time span. Personality, especially agreeableness and conscientiousness, emerged as a stronger predictor of changes in job strain and life satisfaction than vice versa. For example, more agreeable and more conscientious trainees subsequently showed increases in life satisfaction. Trainees reporting higher job strain subsequently showed decreases in agreeableness. Trajectories of personality development partly support the maturity principle that has been established in many college student samples. © 2018 The British Psychological Society

The purpose of this case study was to examine how students with severe disabilities participated in service-learning at a food pantry and the curricular goals they addressed. Service-learning is a form of experiential learning that blends classroom instruction with community service. Participants included 3 high school students with severe disabilities enrolled in a private faithbased school, 5 school staff, and the food pantry coordinator. Data were collected over a 6-month period from observations, interviews, and a focus group. Findings indicate students partially participated in service-learning with supports using a strengths-based approach. Barriers to participation included unclear paraprofessionals' roles, uncertain project priorities, and insufficient supports for communication and behavior. Curricular goals addressed emphasized Jewish values and functional skills. An extension of Furco's service-learning theoretical model is proposed to conceptualize service-learning as being situated along a continuum from supported volunteering to vocational training.; L'objectif de cette étude de cas était d'examiner la participation d'élèves ayant un handicap sévère au programme d'apprentissage par stage de travail dans une banque alimentaire ainsi que les objectifs d'apprentissage qui y ont adressés. L'apprentissage par stage de travail est une forme d'apprentissage expérientiel qui inclut des instructions en classe et un apprentissage par stage de travail. Les participants incluaient des élèves présentant un handicap sévère provenant de trois écoles secondaires confessionnelles privées, cinq membres des équipese coles ainsi que le coordonnateur de la banque alimentaire. Les données ont été collectées durant une période de six mois à partir d'observations, d'entrevues et d'un groupe de discussion. Les résultats indiquent que les élèves ont partiellement participé au programme d'apprentissage par stage de travail avec une aide issue d'une approche basée sur les forces. Les obstacles à la participation ont été les rôles paraprofessionnels flous, les priorités incertaines du projet ainsi que l'aide insuffisante à la communication et au comportement. Les objectifs d'apprentissage visés mettaient l'accent sur les valeurs juives ainsi que sur les habiletés fonctionnelles. Une extension du modèle théorique de l'apprentissage par stage de travail de Furco est proposée afin de permettre de conceptualiser le service communautaire dans un continuum allant du bénévolat avec aide jusqu'à la formation professionnelle.; El propósito de este estudio de caso fue examinar cómo los estudiantes con discapacidades severas participaron en el servicio de aprendizaje en una despensa de alimentos y las metas curriculares que abordaron. El aprendizaje por servicio es una forma de aprendizaje experiencial que combina la instruccio n en el aula con el servicio a la comunidad. Los participantes incluyeron 3 estudiantes de secundaria con discapacidades severas inscritos en una escuela privada basada en la fe, 5 empleados de la escuela y el coordinador de la despensa de alimentos. Los datos se recopilaron durante un período de 6 meses a partir de observaciones, entrevistas y un grupo focal. Los hallazgos indican que los estudiantes participaron parcialmente en aprendizaje-servicio con apoyos utilizando un enfoque basado en fortalezas. Las barreras a la participación incluían roles de paraprofesionales poco claros, prioridades inciertas del proyecto y apoyos insuficientes para la comunicación y el comportamiento. Las metas curriculares abordadas enfatizaron los valores de la religion judía y las habilidades funcionales. Se propone una extensión del modelo teórico de aprendizaje-servicio de Furco para conceptualizar el aprendizaje-servicio como si estuviera situado a lo largo de un continuo desde el apoyo voluntario hasta la formación profesional. © AAIDD.; © AAIDD.; © AAIDD.

Aim: Against the background of an impending shortage of family practitioners, it is important to investigate the factors influencing the choice to become one. The aim of this study was to identify factors that encourage medical students to choose to practice family medicine. Method: Using a questionnaire, students in the fourth and fifth years of their studies in the Federal State of Hesse were asked about the factors that had influenced their choice of medical specialty and their experience of courses in family medicine. Predictors of an interest in practicing family medicine were calculated using multiple logistic regression. Results: 361 questionnaires were returned, representing a response rate of 70.9%. Confirmation of personal strengths, an interest in the field, and practical experience of the subject generally turned out to be important factors influencing the choice of medical specialty. 49.3% of students expressed an interest in practicing family medicine. A link existed between an interest in working as a family doctor and the opportunity to take over an existing practice, experience of medicine in rural areas, and an appreciation of the conditions of work. With regard to education at medical school, positive experiences during a clinical traineeship in family medicine and positive role models among teachers of general practice were identified as predictors. Conclusion: Almost half the medical students were open to the idea of practicing family medicine. Experience of medicine in rural areas and positive experiences of courses in general practice were linked to an increased interest in working as a family doctor. To promote this interest, it may be a promising approach to increase opportunities to collect experience of medicine in rural areas, and to encourage highly motivated teaching practices. © 2019 Bien et al.

Purpose: Longitudinal integrated clerkships (LICs) are innovative educational models that emphasize medical student continuity with patients, preceptors, peers, and health systems. We characterize LIC growth in the US and interpret the growth using Rogers’ Diffusion of Innovation Theory. Methods: In 2015, we surveyed 123 US allopathic medical schools affiliated with Clerkship Directors in Internal Medicine (CDIM). The organization’s annual survey was supplemented with questions aimed to quantify the number of current and planned LICs and to determine the intended purpose of starting LICs. Results: Of the 94 (out of 123 possible) schools which were responding, 35 (37%) have at least one LIC of six months or greater; of these 20 are year-long. Nineteen schools are engaged in planning a new LIC or increasing the number of students in an LIC. At least 45 (48%) responding schools will have LICs in future years. Respondents report implementing LICs to foster continuity of care, support patient-centeredness, advance inter-professional education, and address workforce shortages. Conclusions: The number of LICs is increasing across the US. We considered the data through the lens of Diffusion of Innovation Theory, speculated that LIC growth has reached “critical mass,” and considered why the LIC innovation may be self-sustaining. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

Objectives: This study aimed to elucidate graduate perceptions of how fellowship training impacted their post-training professional and personal lives. Methods: Interviews were conducted with 13 graduates of a hybrid (e.g. blended-learning) fellowship program. All participants were at least 1 year post completion of fellowship to limit recall bias and allow for post-training personal and professional development. Qualitative analysis was performed on interview transcriptions using directed content analysis with two coders other than the interviewers, followed by discussion until agreement was reached if there were disputes related to coding analysis. If needed, arbitration was provided from one of two interviewers. Results: Analysis revealed three primary constructs of post-fellowship impact: practical, social, and personal. Practical subthemes were centric to care delivery. Social subthemes extended to intra, inter, and non-professional connections. Personal subthemes noted professional and cognitive evolution. Discussion: Participants clearly described impact extending well beyond day-to-day practice suggesting that fellowship impacted the whole person versus sole practitioner. This study may impact program structure and content inclusion for fellowship programs as well as providing support for fellows in training. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.

Background: For 4 years, the profession of critical care paramedic has been established in Germany. As a result, nonmedical rescue service personnel receive a 3-year apprenticeship for the first time. This also led to a revaluation of functions and responsibilities within this occupational field. Objectives: Which medical and social processes contributed to the establishment of the occupational profile of a critical care paramedic? How did training methods change over the last 50 years and which debates helped to shape the development of the occupational field? Materials and methods: The article at hand is based on an interpretation of archival primary sources of the parties observed. Moreover, it is also predicated on a qualitative content analyses of the secondary literature focusing on the subject area of nonmedical rescue service personnel. Results: In the 1960s, a professionalisation process for paramedics was initiated after realising that rapid medical treatment on location can have a positive impact on the healing process. The debate on the training for paramedics has been influenced by longstanding negotiations between different parties about the question of which tasks could be ascribed to nonmedical rescue service personnel. Conclusions: In the larger context, the discussions about the tasks of critical care paramedics are centered around the question of delegation and, respectively, the substitution of medical tasks usually assigned to physicians. The academization of the profession that is currently emerging will continue to lead to conflicts with the medical profession. © 2018, Springer Medizin Verlag GmbH, ein Teil von Springer Nature.