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      Learning relationships in community-based service-learning: a social network analysis

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          Abstract

          Background

          Little is known about the social learning of students within community-based clinical placements and ways in which it can be supported. In an allied health service-learning program, we analysed students’ learning relationships to quantify what, and from whom students learnt.

          Methods

          We conducted a social learning network survey in four domains of learning (clinical knowledge, procedural skills, professional development, and complex determinants of health) to explore learning relationships ( ties) with other people ( alters) that students ( egos) formed during their placement. We quantified how different roles (supervisors, health professionals, administrators, peers, schoolteachers, and clients) contributed to the students’ learning in each of the four domains. We used exponential random graph models (ERGMs) to test which relational processes contributed to the structure of the observed learning networks.

          Results

          Data was available from a complete cohort of 10 students on placement in a network of 69 members, thus providing information on 680 potential learning relations. Students engaged in similar ways in the domains of clinical knowledge, procedural skills, and professional development. Learning relations with academic supervisors were significantly more likely. Also students reported reciprocal learning relations with peers – i.e. they formed learning pairs. This effect was absent in learning networks about complex determinants of health (including socio-economic and cultural factors). Instead, local administrative staff were significantly more often the source of learning about the local contextual factors.

          Conclusions

          Understanding the structure of student learning networks through social network analysis helps identify targeted strategies to enhance learning in community-based service-learning programs. Our findings suggest students recognised important learning from each other and from administrative personnel that is unrelated to the content of their placement. Based on this insight clinical educators could prepare students to become agentic learners, learning with each other and from sources outside their program.

          Electronic supplementary material

          The online version of this article (10.1186/s12909-019-1522-1) contains supplementary material, which is available to authorized users.

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          Most cited references62

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          An introduction to exponential random graph (p*) models for social networks

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            Understanding the barriers to setting up a healthcare quality improvement process in resource-limited settings: a situational analysis at the Medical Department of Kamuzu Central Hospital in Lilongwe, Malawi

            Background Knowledge regarding the best approaches to improving the quality of healthcare and their implementation is lacking in many resource-limited settings. The Medical Department of Kamuzu Central Hospital in Malawi set out to improve the quality of care provided to its patients and establish itself as a recognized centre in teaching, operations research and supervision of district hospitals. Efforts in the past to achieve these objectives were short-lived, and largely unsuccessful. Against this background, a situational analysis was performed to aid the Medical Department to define and prioritize its quality improvement activities. Methods A mix of quantitative and qualitative methods was applied using checklists for observed practice, review of registers, key informant interviews and structured patient interviews. The mixed methods comprised triangulation by including the perspectives of the clients, healthcare providers from within and outside the department, and the field researcher’s perspectives by means of document review and participatory observation. Results Human resource shortages, staff attitudes and shortage of equipment were identified as major constraints to patient care, and the running of the Medical Department. Processes, including documentation in registers and files and communication within and across cadres of staff were also found to be insufficient and thus undermining the effort of staff and management in establishing a sustained high quality culture. Depending on their past experience and knowledge, the stakeholder interviewees revealed different perspectives and expectations of quality healthcare and the intended quality improvement process. Conclusions Establishing a quality improvement process in resource-limited settings is an enormous task, considering the host of challenges that these facilities face. The steps towards changing the status quo for improved quality care require critical self-assessment, the willingness to change as well as determined commitment and contributions from clients, staff and management.
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              Agency as a fourth aspect of students’ engagement during learning activities

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                Author and article information

                Contributors
                fabian.held@sydney.edu.au
                christopher.roberts@sydney.edu.au
                michele.daly@sydney.edu.au
                claire.brunero@health.nsw.gov.au
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                25 April 2019
                25 April 2019
                2019
                : 19
                : 113
                Affiliations
                [1 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Office of the Deputy Vice-Chancellor (Education), , University of Sydney, ; Sydney, Australia
                [2 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Faculty of Medicine and Health, , University of Sydney, ; Sydney, Australia
                [3 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, University of Sydney, Rural Clinical School (Broken Hill), ; Sydney, Australia
                [4 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, University of Sydney, Rural Clinical School (Broken Hill), ; Broken Hill, Australia
                Author information
                http://orcid.org/0000-0002-5260-5576
                Article
                1522
                10.1186/s12909-019-1522-1
                6482529
                31023298
                995137f0-449a-424c-b215-368e83be2bba
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 14 September 2017
                : 17 March 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Education
                social networks,peer learning,service-learning,supervision,clinical education,allied health students

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