Uddannelse og arbejdstilrettelæggelseDet Regionale Råd for Lægers Videreuddannelse, Region Nord
23.09.14
Mads Skipper
Ph.d.-studerende, 1.reservelæge
Oversigt
• Bekymringer
• Det kliniske læringsmiljø
• Ph.d.-studie
Bekymringer
• For mange uddannelsesmæssige uproduktive opgaver
• Risiko for ”fluebens”-mentalitet til uddannelse
• Uforholdsmæssig stor og koncentreret arbejdsbyrde
• Utilstrækkelig tid til rådighed til refleksion
• Utilstrækkelig klinisk supervision
• Intensiteten af arbejdet
• Transition og introduktion
Portræt af det kliniske læringsmiljø
• Det er en overforenkling at se hospitalsmiljøet som en enkelt enhed.
• Der er forskelle i dynamikken og intensiteten i
• menneskernes relationer til hinanden,
• typen af adfærd som tilskyndes,
• vigtigheden tillagt forskellige aktiviteter og
• allokationen af indsatser og ressourcer.
Rotem et.al., 1996
Ph.d.-projekt – uddannelse og arbejdstilrettelæggelse
• Feltstudie (observationer) inkl. fokusgruppe interview
• 3-timersmøder – tekstanalyse og outcome (initiativer) over tid
• Interventionsstudie – Change Lab
Residents create educational and organisational change – in a paediatric department
Skipper, M & Nøhr, SB: Three-hour meetings – junior doctors creating educational and organisational changes in a paediatric department in DK, AMEE 2014
Quantitative inventory of initiatives for change with follow up on initiatives
Skipper, M & Nøhr, SB: Three-hour meetings – junior doctors creating educational and organisational changes in a paediatric department in DK, AMEE 2014
”…it is crucial that the junior and
the senior doctor both have time
– for supervision” (Resident)
”…it is crucial that the junior and
the senior doctor both have time
– for supervision” (Resident)
”…it is easier to recall
something you’ve had in
your own hands”
(Resident)
”…it is easier to recall
something you’ve had in
your own hands”
(Resident)
”…and insist that the foremost learning
situation is bed-side, the next best thing is
reading charts and then down at a fifth,
sixth, seventh place comes sitting around a
desk and being taught, going to lectures
and the like” (Consultant)
”…and insist that the foremost learning
situation is bed-side, the next best thing is
reading charts and then down at a fifth,
sixth, seventh place comes sitting around a
desk and being taught, going to lectures
and the like” (Consultant)
“I think… well… you can’t
think of training without
thinking about service, and
vice versa you can’t think of
service without thinking
about training” (Consultant)
“I think… well… you can’t
think of training without
thinking about service, and
vice versa you can’t think of
service without thinking
about training” (Consultant)
Photo courtesy of Thomas Balslev, MD, PhD.
Skipper M., Musaeus P. & Nøhr SB. What links the hospital Work organization with postgraduate workplace learning? A pilot case study of a university hospital paediatric department in Denmark. CCME 2014
”In medical education, there will always be a tension between education and service. However, to frame it as a question of balance or trade-off is to miss the underlying premise of this perspective: education and service are
the same thing. There is no separation between the ”pedagogic curriculum” of education and the ”work curriculum” of service. In this way, it would be wrong to ”stop and teach”. Instead, the teaching should be a part
of the work as it is happening”
Pratt et al. (2001) Spørgsmål?
