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      What motivates young physicians? – a qualitative analysis of the learning climate in specialist medical training

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          Abstract

          Background

          Not least the much-invoked shortage of physicians in the current and the next generation has resulted in a wide range of efforts to improve postgraduate medical training. This is also in the focus of the current healthcare policy debate. Furthermore, quality and scope of available postgraduate training are important locational advantages in the competition for medical doctors. This study investigates the preferences and concerns that German house officers (HOs) have about their current postgraduate training. It also highlights how HOs evaluate the quality of their current postgraduate training and the learning environment.

          Methods

          HOs were asked to answer the question: “Which things are of capital importance to you personally in your medical training?”, using a free text format. The survey was conducted web based (Lime survey) and all data was anonymized. Summarizing qualitative analyses were performed using the software tool MaxQDA.

          Results

          A total of 255 HOs participated in this study (female: n = 129/50.6 %; male: n = 126/49.4 %; age: 32 + 6 years) associated with 17 different German hospitals and from four medical specialties. Ten categories were generated from a total of 366 free text answers: 1. methodology of learning ( n = 66), 2. supervision ( n = 66), 3. learning structure ( n = 61), 4. teaching competence ( n = 37), 5. dedication ( n = 34), 6. work climate ( n = 29), 7. feedback/communication ( n = 22), 8. challenge/patient safety ( n = 21), 9. time/resources ( n = 17), 10. personal security/safety ( n = 13).

          Conclusions

          HOs want a reliable and curriculum-guided learning structure. Different studying techniques should be used with sufficient (time) resources available in a trusting and communicative learning environment. Competent and dedicated instructors are expected to give individual and specific feedback to the HOs on individual strengths and deficits. Instructors should develop educational concepts in cooperation with the HOs and at the same time avoid excessive demands on HOs or hazards to patients.

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          Most cited references13

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          The assessment of clinical skills/competence/performance.

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            Assessment of clinical competence.

            Tests of clinical competence, which allow decisions to be made about medical qualification and fitness to practise, must be designed with respect to key issues including blueprinting, validity, reliability, and standard setting, as well as clarity about their formative or summative function. Multiple choice questions, essays, and oral examinations could be used to test factual recall and applied knowledge, but more sophisticated methods are needed to assess clincial performance, including directly observed long and short cases, objective structured clinical examinations, and the use of standardised patients. The goal of assessment in medical education remains the development of reliable measurements of student performance which, as well as having predictive value for subsequent clinical competence, also have a formative, educational role.
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              AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education - a unifying perspective.

              J M Genn (2001)
              This paper looks at five focal terms in education - curriculum, environment, climate, quality and change - and the interrelationships and dynamics bemeen and among them. It emphasizes the power and utility of the concept of climate as an operationalization or manifetation of the curriculum and the other three concepts. Ideas pertaining w the theory of climate and its measurement can provide a greater understanding of the medical cumadurn. The environment is an impoltant detemzinant of behaviour. Environment is perceived by students and it is perceptions of environment that are related w behaviour. The environment, as perceived, may be designated as climate. It is argued that the climate is the soul and spirit of the medical school environment and curriculum. Students' experiences of the climate of their medical education environment are related w their achievements, sangaction and success. Measures of educational climate are reviewed and the possibilities of new climate measures for medical education are discussed. These should take account of current trends in medical education and curricula. Measures of the climate may subdivide it inw dzfferent components giving, for example, separate assessment of so-called Faculty Press, Student Press, Administration Press and Physical or Material Environmental Press. Climate measures can be used in different modes with the same stakeholders. For example, students may be asked to report, first, their perceptions of the actual environment they have experienced and, second, w report on their ideal or preferred environment. The same climate index can be used with different stakeholders giving, for example, staff and student comparisons. The climate is important for staff as well as for students. The organizational climate that teaching staff experience in the work environment that they inhabit is important for their well-being, and that of their students. The medical school is a learning organization evolving and changing in the illuminative evaluation it makes of its environment and its curriculum through the action research studies of its climate. Consderations of climate in the medical school along the lines of continuous quality improvement and innovation are likely to further the medical school as a learning organization with the attendant benefits. Unless medical schools become such learning organizations their quality of health and their longevity may be threatened.
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                Author and article information

                Contributors
                +49-451-500 2766 , peter.iblher@uksh.de
                Marzellus.Hofmann@uni-wh.de
                Michaela.Zupanic@uni-wh.de
                georg.breuer@kfa.imed.uni-erlangen.de
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                15 October 2015
                15 October 2015
                2015
                : 15
                : 176
                Affiliations
                [ ]Institute for Teaching and Educational Research in Health Sciences, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
                [ ]University of Lübeck Clinic for Anaesthesiology and Intensive Care Medicine, Ratzeburger Allee 160, 23538 Lübeck, Germany
                [ ]Student Dean’s Office, School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
                [ ]Erlangen-Nürnberg University Clinic for Anaesthesiology, Krankenhausstr. 12, 91054 Erlangen, Germany
                Article
                461
                10.1186/s12909-015-0461-8
                4608325
                bfafa42c-57b7-403e-901a-951a239f3713
                © Iblher et al. 2015

                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
                : 15 April 2015
                : 9 October 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Education
                postgraduate medical training,learning climate,assessment,feedback,curriculum
                Education
                postgraduate medical training, learning climate, assessment, feedback, curriculum

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