In 2015 the Review of Medical Intern Training Report, which was commissioned by the Australian Health Ministers’ Advisory Council had the following to say about the current state of medical internship in Australia.
[Internship in Australia] “should have entry requirements that reflect agreed and defined expectations of work-readiness that [medical] graduates must meet before commencing [their internship]”…Final Report Independent Review of Medical Intern Training
…“there is scope to better facilitate the transition from university to practice by ensuring graduates are more consistently work-ready.”Final Report Independent Review of Medical Intern Training
All well and good.
But what is exactly meant by work readiness?
Medical Education is unfortunately burdened oftentimes with a definitional problem. By which I mean if we have not established our terms and the majority are in agreement we have hobbled our chances of implementing an evidence-based approach from the get-go. Or as Dr Jason Frank puts it:
“Despite recent proposals to enhance the evidence base of medical education in general, progress is suboptimal. Without a common language in the medical education enterprise, educators and policy-makers are hampered in their attempts to pursue quality, ensure outcomes, evaluate policies, and further innovation”
Toward a definition of competency-based education in medicine: a systematic review of published definitions.
Jason R. Frank, Rani Mungroo, Yasmine Ahmad, Mimi Wang, Stefanie De Rossi &Tanya Horsley
Pages 631-637 | Published online: 27 Jul 2010 https://doi.org/10.3109/0142159X.2010.500898
So what is the definition of work readiness for interns (medical graduates)? Well, it turns out that there is none. Or at least not in the 1500 medical articles that I searched through to find one. Even the more researched and similar concept of preparedness seems to lack a framework or definition according to Monrouxe et al (2017) .
No wonder then that various stakeholders might have differing opinions on what constitutes a work ready graduate. From the graduate themselves who, if we translate the research in preparedness, we might expect around 2 to 3 out of ten to feel non-work ready. To the supervisors and directors of training who might in turn worry about whether 1 or 2 out of a hundred might have some deficits in work readiness. To the employer who sees the extreme cases of non-work readiness and is then at risk of attributional bias in suggesting that there is a more global problem. To the regularity authorities who see even fewer cases.
But we are of course talking binary concepts above. We are suggesting that a medical graduate is either work ready or not. Of course this is unlikely to be the case. From the research in nursing of Walker building on the work of Caballero we are told that
Work readiness is the degree to which graduates possess the characteristics and attributes that prepare them for success in the workplace…the consensus is that it is multifactorial [with the following dimensions identified] work competence… social intelligence… organisational acumen… personal work characteristicsWalker et al
In my own institution we are currently facing a challenge in endeavouring to implement a new medical degree with a stronger emphasis on a work ready graduate (in the absence of a definition of what one is). We know from talking to our current final year students and well as from external groups such as the Australian Medical Council that we could be doing better to prepare our students for the transition to internship.
But with an already crowded curriculum and teaching program delivered across a footprint the size of England with variable quality and reliability of technology what is the solution?
Well it turned out our medical students were keen to engage themselves in the problem and it also turned out that many of the intern and resident doctors working in our region were keen to pass on their knowledge and wisdom in a near to peer fashion. This resonated with the students. They wanted some practical advice for preparing for internship.
But how to connect the two? We had pockets were various face to face “Intern 101” programs were occurring amongst students and graduates but access was not consistent and as mentioned getting everyone together (even using University video technology) was not easy.
The solution was a personalised approach. Most medical students and graduate doctors use facebook as a form for connecting and sharing of ideas. Facebook is one of many applications that helps people establish personalised learning environments (PLEs). PLEs are now old concepts in education land but are still reasonably foreign in medical education. Milligan defines PLEs as thus
Systems that help learners take control of and manage their own learning. PLEs support learners to: set their own learning goals (possibly with the support of teachers) manage their learning, both content and process communicate with others in the process of learningMilligan 2006
Most of what has been written about PLESs is in relation to digital technology and in particular dynamic web applications, other wise known as Web 2.0. PLEs are in fact a learning concept or approach and they don’t necessarily require digital technologies to exist. But there is no doubt that recent changes in the internet such as search and social networks has greatly expanded the ability of learners to engage in personalised learning (even if they are unaware that this is what they are in fact doing).
What We Did
We used a closed group on facebook to invite all current final year medical students as well as intern and resident teachers. We fielded suggested topics from both students and teachers. Once a month an hour long webinar occurred during the evening using Zoom webinar and Facebook Livestream to the group. Students could attend and ask questions in real time as well as share their own resources with others. If students did not wish to attend live or were unable to they could watch the webinar later and ask questions at this point. If students preferred not to use facebook we posted the webinars to the student group on their University Learning Management System as well.
By making the sessions relevant to the student we were able to have strong participation in the group and the webinars (98% of the cohort joined and some of the videos were seen by 85% plus of the group). The interns and residents were more available during the evening and were able to bring their own approach (i.e. some used PCs, some used tablets, some used power points, some had physical resources to display). Students and teachers connected independently of the university videoconferencing infrastructure and the system “just worked” like all systems should.
Even two years ago we could not have done this in such a fashion as whilst the technology existed the integration of a closed facebook group with livestream did not.
What Are the Implications for Faculty?
Harden and Lilley have suggested 8 Roles for the modern the Medical Teacher:
- Scholar and Teacher
- Manager and Leader
- Assessor and Diagnostician
- Curriculum Developer and Planner
- Role Model as Teacher and Practitioner
- Information Provider and Coach
- Facilitator and Mentor
That’s a long list. But a couple of things I don’t see on this list are “Curator” and “Marketer”. Let me explain further. If we are to accept that learning in medical education is to progress down a path where the learner is more in control and has more options about what they learn, then being fixed in one’s personal teaching delivery is likely to lead to stagnation.
In recent days if a new teacher was asked to take on a particular lecture topic they would often ask the old teacher for their slides. Nowadays you can hop on to YouTube and quickly realise that for most topics someone has already covered it usually in a better and more entertaining way. For example, Osmosis has over 800 explainer videos on a range of common medical school topics with over 800,000 subscribers!
Find Your Niche
This is not to say that there is not a role for new content. The trick will be for us as Medical Educators to avoid producing content that has already been well covered. To collect for our students (curate) content to make their task in finding useful resources easier. To create useful new content in our niche and to ensure that our students are aware of our efforts (marketing).
In my own personal example. I have noticed that doctors are poorly prepared for career transitions, for example putting together resumes and preparing for job interviews. Its an area I have knowledge about and interest in. So I have started a “niche” YouTube channel called Career Doctor with the Value Proposition of helping other doctors to manage their own medical careers.
Many of my most succesful videos to date have been what’s called “How To” videos. For example the How to Make a Stand Out Medical CV (Resume) video as of publishing this article has 1.1k views in less than 12 months.
I’ve been careful to ensure that my efforts to provide free teaching resources are not wasted by adopting best YouTube practices (good titles, good thumbnails, tagging etc..) as well as promoting broadly on social media, using email marketing and of course setting up this particular website as a presence on the web to blog about these efforts.
Interestingly along the way I have found that some learners quite quickly adopt the ideas that I suggest in my videos, whereas others contact me after with questions as if they have not really watched the videos.
In many ways this is an example of the “curse of the expert”. Putting in too much content or learning based on your own knowledge of the subject.
In other cases its possibly an example that some learners want to learn independently (learn from you), others want some form of coaching or interaction (learn with you) and finally some just want you to solve the problem for them (get it done by you).