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At Universitat Politècnica de València, Meridies, an internship programme that places engineering students in countries of Latin America, is one of the few opportunities the students have to explore the implications of being a professional in society in a different cultural and social context. This programme was analyzed using the capabilities approach as a frame of reference for examining the effects of the programme on eight student participants. The eight pro-public-good capabilities proposed by Melanie Walker were investigated through semi-structured interviews. The internship is an environment in which students can put into practice the knowledge they have acquired in undergraduate studies and to find practical relevance in what they studied. Occasionally, this also entails a critical questioning of what they have learned, a greater awareness of the limits of the contents of their studies and of the way things were taught, and interest in less explored issues that are closely linked to social justice. However, tensions can arise between the pro-public-good oriented perspectives of this programme, and a more instrumental vision. One way to overcome these tensions is to foster consideration of reflexivity, that is, the dynamic relationship between technology and society. To do so, the programme must create space before and during the internship, and upon the return of the students, to discuss and collectively reflect upon their lived experience. Additionally, it ought to engage supervisors in this educational journey, both at the university and in the host institutions, and also involve socially committed organisations in this task. © 2015, Springer Science+Business Media Dordrecht.

In the seemingly routine and the everyday, lie layers of cultural and social symbolism. So it is with dirt. This article examines the social and cultural roles of dirt within socialization practices in working-class industrial and ex-industrial communities. Drawn from oral history accounts with 46 former and current engineering apprentices, the discussion demonstrates dirt as a concept and a practicality, and how the idea of ‘getting dirty’ provided a cultural imagery used to renegotiate moral boundaries that devalue working class, masculine experiences and identities. Building on from the work of Skeggs (1997, 2004, 2011), it demonstrates the lived experience of value within the industrial workplace past and present. Through dirt, the role of cultural artefacts and iconography within working-class experience and workplace training is explored. Additionally, the role of a cultural icon like dirt in the intergenerational dialogues of workplace communities is given new attention. In doing so the article argues that while after decades of underinvestment in apprenticeships as a model for training in the UK, a recent resurgence in interest can go some way in overcoming the long-term effects of the loss of large-scale industrial work. However, the cultures of work attached to the apprenticeships of the past are, within deindustrialization, much more complicated to develop or recreate. © London School of Economics and Political Science 2019

[No abstract available]

Background: Globally, burnout is an increasingly prevalent problem amongst young medical professionals. This review aims to understand the factors related to burnout in the early-career stage of medicine. Drawing on the widely used Job Demands-Resources Model, the antecedents of burnout were distinguished from its outcomes. Methods: The review adopted the PRISMA guidelines. Using specific search terms, peer-reviewed articles were obtained from a range of databases and assessed against selection criteria. To meet inclusion requirements, the study had to be published between 2000 and 2018, include a validated measure of burnout, and undertake empirical assessment of factors related to burnout in medical students and/or junior medical officers/residents. Additional studies were obtained and reviewed from the reference lists of selected articles. Results: Out of the 3796 studies that were initially found, 585 were assessed against the eligibility criteria leaving 113 studies for review. These studies highlighted the negative consequences of burnout in the early medical career. Also identified were work-specific and person-specific demands that likely lead to burnout and, work and person resources that appear to reduce burnout. Conclusion: This review provides a framework to explain the growing problem of burnout amongst early-career medical professionals. However, further research is necessary to overcome the current reliance on cross-sectional designs and small sample sizes. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Objectives Although clinical learning is pivotal for nursing education, the learning process itself and the terminology to address this topic remain underexposed in the literature. This study aimed to examine how concepts equivalent to 'learning in practice' are used and operationalised and which learning activities are reported in the nursing education literature. The final aim was to propose terminology for future studies. Design The scoping framework proposed by Arksey and O'Malley was used to answer the research questions and address gaps in the literature. Two systematic searches were conducted in PubMed, EBSCO/ERIC and EBSCO/CINAHL between May and September 2018: first, to identify concepts equivalent to 'learning in practice' and, second, to find studies operationalising these concepts. Eligible articles were studies that examined the regular learning of undergraduate nursing students in the hospital setting. Conceptualisations, theoretical frameworks and operationalisations were mapped descriptively. Results relating to how students learn were synthesised using thematic analysis. Quality assessment was performed using the Critical Appraisal Skills Programme checklist. Results From 9360 abstracts, 17 articles were included. Five studies adopted a general, yet not explained, synonym for learning in practice, and the other approaches focused on the social, unplanned or active nature of learning. All studies used a qualitative approach. The small number of studies and medium study quality hampered a thorough comparison of concepts. The synthesis of results revealed five types of learning activities, acknowledged by an expert panel, in which autonomy, interactions and cognitive processing were central themes. Conclusions Both theoretical approaches and learning activities of the current body of research fit into experiential learning theories, which can be used to guide and improve future studies. Gaps in the literature include formal and informal components of learning, the relation between learning and learning outcomes and the interplay between behaviour and cognitive processing. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Introduction Seeing and treating patients in daily practice forms the basis of general practitioner (GP) training. However, the types of patients seen by GP trainees do not always match trainees' educational needs. Knowledge about factors that shape the mix of patient types is limited, especially with regard to the role of the professionals who work in the GP practice. Aim We investigated factors affecting the mix of patients seen by GP trainees from the perspective of professionals. Design and setting This qualitative study involved GP trainees, GP supervisors, medical receptionists and nurse practitioners affiliated with a GP Specialty Training Institute in the Netherlands. Methods Twelve focus groups and seven interviews with 73 participants were held. Data collection and analysis were iterative, using thematic analysis with a constant comparison methodology. Results The characteristics of patients' health problems and the bond between the doctor and patient are important determinants of GP trainees' patient mix. Because trainees have not yet developed bonds with patients, they are less likely to see patients with complex health problems. However, trainees can deliberately influence their patient mix by paying purposeful attention to bonding with patients and by gaining professional trust through focused engagement with their colleagues. Conclusion Trainees' patient mix is affected by various factors. Trainees and team members can take steps to ensure that this mix matches trainees' educational needs, but their success depends on the interaction between trainees' behaviour, the attitudes of team members and the context. The findings show how the mix of patients seen by trainees can be influenced to become more trainee centred and learning oriented. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

Contemporary medical school evaluations are narrow in focus and often do not consider the wider systems implications of the relationship between learning and teaching, research, clinical care, and community engagement. The result is graduates who lack the necessary knowledge and skills for the modern health care system and an educational system that is limited in its ability to learn and change. To address this issue, the authors apply complexity theory to medical school evaluation, using four key factors-nesting, diversity, self-organization, and emergent outcomes. To help medical educators apply this evaluation approach in their own settings, the authors offer two tools-a modified program logic model and sensemaking. In sensemaking, they use the organic metaphor of the medical school as a neuron situated within a complex neural network to enable medical educators to reframe the way they think about program evaluation. The authors then offer practical guidance for applying this model, including describing the example of addressing graduates' engagement in the health care system. The authors consider the input of teachers, the role of culture and curriculum, and the clinical care system in this example. Medical school evaluation is reframed as an improvement science for complex social interventions (medical school is such an intervention) in this model. With complexity theory's focus on emergent outcomes, evaluation takes on a new focus, reimagining medical students as reaching their future potential as change agents, who transform health systems and the lives of patients. © 2017 by the Association of American Medical Colleges.

Objective Skills to address different health literacy problems are lacking among health professionals. We sought to develop and pilot test a comprehensive health literacy communication training for various health professionals in Ireland, Italy and the Netherlands. Methods Thirty health professionals participated in the study. A literature review focused on evidence-informed training-components. Focus group discussions (FGDs) explored perspectives from seventeen professionals on a prototype-program, and feedback from thirteen professionals following pilot-training. Pre-post questionnaires assessed self-rated health literacy communication skills. Results The literature review yielded five training-components to address functional, interactive and critical health literacy: health literacy education, gathering and providing information, shared decision-making, enabling self-management, and supporting behaviour change. In FGDs, professionals endorsed the prototype-program and reported that the pilot-training increased knowledge and patient-centred communication skills in addressing health literacy, as shown by self-rated pre-post questionnaires. Conclusion A comprehensive training for health professionals in three European countries enhances perceived skills to address functional, interactive and critical health literacy. Practice implications This training has potential for wider application in education and practice in Europe. © 2017 Elsevier B.V.

Background: Over the last two decades, competency-based frameworks have been internationally adopted as the primary educational approach in medicine. Yet competency-based medical education (CBME) remains contested in the academic literature. We look broadly at the nature of this debate to explore how it may shape scholars’ understanding of CBME, and its implications for medical education research and practice. In doing so, we deconstruct unarticulated discourses and assumptions embedded in the CBME literature. Methods: We assembled an archive of literature focused on CBME. The archive dates from 1996, the publication year of the first CanMEDS Physician Competency Framework. We then conducted a Foucauldian critical discourse analysis (CDA) to delineate the dominant discourses underpinning the literature. CDA examines the intersections of language, social practices, knowledge and power relations to highlight how entrenched ways of thinking influence what can or cannot be said about a topic. Findings: Detractors of CBME have advanced an array of conceptual critiques. Proponents have often responded with a recurring discursive strategy that minimises these critiques and deflects attention from the underlying concept of the competency-based approach. As part of this process, conceptual concerns are reframed as two practical problems: implementation and interpretation. Yet the assertion that these are the construct's primary concerns was often unsupported by empirical evidence. These practices contribute to a discourse of infallibility of CBME. Discussion: In uncovering the discourse of infallibility, we explore how it can silence critical voices and hinder a rigorous examination of the competency-based approach. These discursive practices strengthen CBME by constructing it as infallible in the literature. We propose re-approaching the dialogue surrounding CBME as a starting point for empirical investigation, driven by the aim to broaden scholars’ understanding of its design, development and implementation in medical education. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education

Purpose To examine the literature documenting successes in recruiting and retaining rural primary care physicians. Method The authors conducted a narrative review of literature on individual, educational, and professional characteristics and experiences that lead to recruitment and retention of rural primary care physicians. In May 2016, they searched MEDLINE, PubMed, CINAHL, ERIC, Web of Science, Google Scholar, the Grey Literature Report, and reference lists of included studies for literature published in or after 1990 in the United States, Canada, or Australia. The authors identified 83 articles meeting inclusion criteria. They synthesized results and developed a theoretical model that proposes how the findings interact and influence rural recruitment and retention. Results The authors' proposed theoretical model suggests factors interact across multiple dimensions to facilitate the development of a rural physician identity. Rural upbringing, personal attributes, positive rural exposure, preparation for rural life and medicine, partner receptivity to rural living, financial incentives, integration into rural communities, and good work-life balance influence recruitment and retention. However, attending medical schools and/or residencies with a rural emphasis and participating in rural training may reflect, rather than produce, intention for rural practice. Conclusions Many factors enhance rural physician identity development and influence whether physicians enter, remain in, and thrive in rural practice. To help trainees and young physicians develop the professional identity of a rural physician, multifactorial medical training approaches aimed at encouraging long-term rural practice should focus on rural-specific clinical and nonclinical competencies while providing trainees with positive rural experiences. © © by the Association of American Medical Colleges.