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Exploring teams of learners becoming “WE” in the Intensive Care Unit – a focused ethnographic study

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      Abstract

      Background

      Research about collaboration within teams of learners in intensive care is sparse, as is research on how the learners in a group develop into a team. The aim of this study was to explore the collaboration in teams of learners during a rotation in an interprofessional education unit in intensive care from a sociocultural learning perspective.

      Methods

      Focused Ethnographic methods were used to collect data following eight teams of learners in 2009 and 2010. Each team consisted of one resident, one specialist nurse student and their supervisors (n = 28). The material consisted of 100 hours of observations, interviews, and four hours of sound recordings. A qualitative analysis explored changing patterns of interplay through a constant comparative approach.

      Results

      The learners’ collaboration progressed along a pattern of participation common to all eight groups with a chronological starting point and an end point. The progress consisted of three main steps where the learners’ groups developed into teams during a week’s training. The supervisors’ guided the progress by gradually stepping back to provide latitude for critical reflection and action.

      Conclusion

      Our main conclusion in training teams of learners how to collaborate in the intensive care is the crucial understanding of how to guide them to act like a team, feel like a team and having the authority to act as a team.

      Related collections

      Most cited references 28

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      On Two Metaphors for Learning and the Dangers of Choosing Just One

       A. Sfard (1998)
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        The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks.

        Interprofessional collaboration is a key factor in initiatives designed to increase the effectiveness of health services currently offered to the public. It is important that the concept of collaboration be well understood, because although the increasingly complex health problems faced by health professionals are creating more interdependencies among them, we still have limited knowledge of the complexity of interprofessional relationships. The goal of this literature review was to identify conceptual frameworks that could improve our understanding of this important aspect of health organizations. To this end, we have identified and taken into consideration: (A) the various definitions proposed in the literature and the various concepts associated with collaboration, and (B) the various theoretical frameworks of collaboration. Our results demonstrate that: (1) the concept of collaboration is commonly defined through five underlying concepts: sharing, partnership, power, interdependency and process; (2) the most complete models of collaboration seem to be those based on a strong theoretical background, either in organizational theory or in organizational sociology and on empirical data; (3) there is a significant amount of diversity in the way the various authors conceptualized collaboration and in the factors influencing collaboration; (4) these frameworks do not establish clear links between the elements in the models and the outputs; and (5) the literature does not provide a serious attempt to determine how patients could be integrated into the health care team, despite the fact that patients are recognized as the ultimate justification for providing collaborative care.
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          Learning from clinical work: the roles of learning cues and credibility judgements.

          How learners interpret their clinical experiences to create meaningful learning has not been well studied. We explored experiences considered by doctors to be influential in their learning in order to better understand this process. Using a grounded theory approach, we interviewed 22 academic doctors who had been in practice for ≤ 5 years. Participants were asked to reflect on experiences they considered to have been influential during their training. Constant comparative analysis for emerging themes was conducted iteratively with data collection. A model of clinical learning emerged in which the clinical work itself is central. As they observe and participate in clinical work, learners can attend to a variety of sources of information that facilitate the interpretation of the experience and the construction of knowledge from it. These 'learning cues' include feedback, role models, clinical outcomes, patient or family responses, and comparisons with peers. The integration of a cue depends on the learner's judgement of its credibility. Certain cues, such as clinical outcomes or feedback from patients, are seen as innately credible, whereas other cues, particularly feedback from supervisors, are subjected to critical judgement. Learners make complex judgements regarding the credibility of information about clinical performance. Credibility judgements influence the learning that arises from the clinical experience. Further understanding of how such judgements are made could guide educators in providing credible information to learners. © Blackwell Publishing Ltd 2012.
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            Author and article information

            Affiliations
            [ ]Department of Anaesthesiology and Intensive Care, Karolinska University Hospital, Huddinge, Sweden
            [ ]Karolinska Institutet, Department of Clinical Science Intervention and Technology, Stockholm, Sweden
            [ ]Department of Education, Stockholm University, Stockholm, Sweden
            [ ]Karolinska Institutet, Department of Neurobiology, Care Science and Society, Division of Nursing, Stockholm, Sweden
            Contributors
            helen.conte@ki.se
            max.scheja@edu.su.se
            hans.hjelmqvist@ki.se
            maria.jirwe@ki.se
            Journal
            BMC Med Educ
            BMC Med Educ
            BMC Medical Education
            BioMed Central (London )
            1472-6920
            16 August 2015
            16 August 2015
            2015
            : 15
            4537779 414 10.1186/s12909-015-0414-2
            © Conte et al. 2015

            Open Access This 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.

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            © The Author(s) 2015

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