Optimising workplace learning in postgraduate medical education : towards supporting residents and supervisors in clinical practice
Authors:   , Robbrecht Marieke 
Published: November 2024

The training of medical specialists, also known as postgraduate medical education (PGME), primarily entails workplace learning. Workplace learning (WPL) refers to the acquisition of professional skills while actively engaging in the authentic work environment. In recent years, significant advancements have occurred in this WPL framework for residents specialising in various fields. These developments stem from the exponential growth of medical knowledge and technologies, coupled with substantial progress in educational research focused on medical training and the education of medical specialists.10,11 In Chapter 1, the introduction, these developments are thoroughly discussed, along with key determinants of the quality of resident training, namely the workplace, the intended learning outcomes, and the learning process. Chapter 2 outlines the various research objectives. In Chapter 3, the first research objective is discussed. There is much literature detailing the facilitators and challenges encountered during residents' WPL. However, there was no such study specifically within the context of Flanders, where the specialist training uniquely integrates WPL with the Master in Specialist Medicine (MSM) program. Therefore, focus groups were conducted, inviting both residents and supervisors to share their perspectives on what worked well and what did not during WPL. Three themes emerged: dual learning path, feedback, and supporting the learning process. Within each theme, facilitators and challenges were identified. This dissertation primarily focuses on addressing the identified challenges to enhance WPL. Within the theme of the dual learning path, one issue discussed was the lack of clarity regarding the competencies to be attained. Either the residents did not know an established competency framework, or multiple frameworks were in use which led to confusion. Specifically within paediatric residency, two frameworks were currently employed: the framework of the MSM, which is integrated into the electronic portfolio, and the framework for general training paediatrics established by the European Union of Medical Specialists. Additionally, the CanMEDS competency framework is predominantly used in undergraduate medical education. In Chapter 4, these three frameworks were systematically scrutinised and merged. Subsequently, this framework was validated through a Delphi study. Five groups of experts iteratively provided their opinions on the relevance and formulation of the competencies. Ultimately, a set of 95 competencies was validated after three rounds of the Delphi process. Building upon the findings of the focus group discussions outlined in Chapter 3, it was identified within the theme of learning support that there were insufficient opportunities for direct observation, as well as challenges in fostering thorough self-reflection due to limited input. The use of video recordings could offer a potential solution to address these issues. Consequently, Chapter 5 presents a systematic review which assessed the various ways in which video could be employed, as well as the learning effects described in current literature regarding its use during WPL of residents. The recording needed to take place within an environment where cameras are not typically integrated into routine clinical practice. Eleven studies met the inclusion criteria; all demonstrated a positive impact, yet they showed considerable heterogeneity in their designs, making it challenging to formulate general recommendations regarding the use of video in residency training solely based on this review. Chapter 6 presents the pilot study in which paediatric residents, working in the neonatal intensive care unit (NICU), recorded a video of themselves during a clinical activity. Subsequently, these trainees engaged in self-reflection before and after watching the video using a structured self-reflection form. A comparison of these self-reflections before and after video review revealed a significant increase in the number of areas for improvement identified by the residents. However, their self-satisfaction levels remained unaffected. Additionally, residents noted proportionally more strengths than areas for improvement both before and after video review. They also found integration of video review into their training feasible. Subsequently, the general discussion in Chapter 7 presented several recommendations based on the findings of the preceding studies and the current knowledge available in the literature. This was followed by the limitations of this dissertation, which were critically examined and reflected upon. Finally, there remains the reflection on whether this thesis has indeed investigated how WPL in PGME can be optimised, providing support not only to the residents but to their supervisors and supervising colleagues as well. The recommendations formulated are a step in the right direction, but further research is necessary to support this advice. Moreover, there is ample work ahead for residents, supervisors, educationalists, hospital managers, researchers and policymakers to collaboratively support the translation of theory in medical education research into practice. Only through collaboration among all stakeholders can an optimal residency training program be achieved.