BackgroundAcademics aim to understand the experiences of people living with cognitive and/or language impairment in their search for epistemic justice. Methods that do not rely solely on verbal... Show moreBackgroundAcademics aim to understand the experiences of people living with cognitive and/or language impairment in their search for epistemic justice. Methods that do not rely solely on verbal information (e.g., interviews, focus groups) but also employ an attunement to the non-verbal - such as participant observation and creative methods, are seen as a suitable way to do justice to people's non-verbal interactions. However, in practice, researchers still experience ethical issues in everyday encounters with participants with cognitive and/or language impairment even when trying to address epistemic issues while employing such methods. This article aims to demonstrate 1) the importance of attending to the non-verbal in order to prevent epistemic injustice in research and 2) how a case-study approach and discussing ethical dilemmas with peers may help to unpack some of the ethical tensions that the researchers experience.Aim and methodsThis article focuses on ethical dilemmas the authors encountered during their research projects in the past. Three cases chosen by the authors illustrate these dilemmas. Dilemmas are presented as auto-ethnographical written accounts, which were discussed during ten retrospective dialogical sessions (60–90 min) organized by the research group consisting of six academic researchers.ResultsEthically sound research, in which older people living with cognitive and/or language impairment are engaged, entails much more than following procedures about informed consent, privacy, submitting a proposal to an ethics committee, and using suitable methods and techniques. Ethical issues in these studies relate to everyday situations in which researchers tried to do justice to the knowledge of people who have difficulties expressing themselves verbally, but were challenged by what they have initially experienced as ‘having it wrong,’ ‘not knowing,’ and ‘losing something in translation’ in their practice. Finally, we learned that the interactions the researchers encountered were complex. They had to constantly evaluate the appropriateness of their approach, balance rational and intuitive forms of interaction and interpretation, and consider ways of communicating the research findings.Discussion and conclusionApproximating epistemic justice in research with people with cognitive and/or language impairment requires extra effort in daily research routines. Sharing everyday ethical issues via case stories and reflecting on these issues encourages moral learning and brings new knowledge about the craftsmanship of researchers. Especially the collaborative and dialogical reflection helped the researchers to dig deeper and find words for intangible processes that often remain unaddressed. However, sharing stories about ethical issues requires mutual trust and safety because sharing and reflecting may bring discomfort, messiness, and uncertainty. Show less
Kunneman, M.; Hargraves, I.G.; Sivly, A.L.; Branda, M.E.; LaVecchia, C.M.; Labrie, N.H.M.; ... ; Montori, V. 2022
Objective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation... Show moreObjective: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. Methods: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. Results: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p = .8), significantly and weakly correlated to decisional conflict (rho = -0.28, p = .002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. Conclusion: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. Practice Implications: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options. Show less
The number of transnational students is quite substantial in Oman. In the Gulf Region, it is common to recruit non-Anglophone expatriate staff to teach on these programmes while they rarely have... Show moreThe number of transnational students is quite substantial in Oman. In the Gulf Region, it is common to recruit non-Anglophone expatriate staff to teach on these programmes while they rarely have prior experience in a Western university. In Oman, expatriate academics form a considerable majority of the teaching staff in transnational education (TNE). This means that for practically all of them the environment in which they teach is academically, culturally and sometimes also linguistically new to them. The same holds for the students as the vast majority come from the local government schools where Arabic is the medium of instruction in both primary and secondary school, and the British academic system is new to them.This raises the questions of how a TNE teaching and learning environment can be created that is in line with the expectations of the British programmes so that students can succeed academically, and secondly, how academics who teach on these programmes can be supported in their professional practice towards creating such an environment. The study took a holistic approach by investigating this environment from the points of view of an observer, the teachers and the students, and considered how these different perspectives informed a long-term continuing professional development (CPD) programme. Show less
Gulden, R. van der; Heeneman, S.; Kramer, A.W.M.; Laan, R.F.J.M.; Scherpbier-de Haan, N.D.; Thoonen, B.P.A. 2020
Background It is assumed that portfolios contribute to self-regulated learning (SRL). Presence of these SRL processes within the documentation kept in portfolios is presupposed in common... Show moreBackground It is assumed that portfolios contribute to self-regulated learning (SRL). Presence of these SRL processes within the documentation kept in portfolios is presupposed in common educational practices, such as the assessment of reflective entries. However, questions can be asked considering the presence of SRL within portfolios. The aim of this study was to gain insight into the documentation of SRL processes within the electronic (e)-portfolio content of medical trainees. SRL consists of numerous processes, for this study the focus was on self-assessment via reflection and feedback, goal-setting and planning, and monitoring, as these are the processes that health professions education research mentions to be supported by portfolios. Methods A database containing 1022 anonymous e-portfolios from General Practitioner trainees was used to provide descriptive statistics of the various available e-portfolio forms. This was followed by a quantitative content analysis of 90 e-portfolios, for which, a codebook was constructed to rate the documentation of the included SRL processes. Results The numbers of forms in the e-portfolios varied to a great extent. Content analysis showed a limited documentation of reflective entries, and available entries mainly described events and experiences without explanations and context. Feedback was generally limited to comments on what went well and lacked specificity, context and suggestions for future action. Learning goals and plans were short of specificity, but did contain challenging topics and different goals were compatible with each other. 75% of the e-portfolios showed (limited) signs of monitoring. Conclusions The e-portfolio content showed limited documentation of SRL processes. As documentation of SRL requires time and asks for a high level of introspection and writing skills, one cannot expect documentation of SRL processes to appear in e-portfolio content without efforts. Show less
Background: For the purpose of continuous performance improvement, physicians are expected to reflect on their practice. While many reflection studies are theoretically oriented and often... Show moreBackground: For the purpose of continuous performance improvement, physicians are expected to reflect on their practice. While many reflection studies are theoretically oriented and often prescriptive in the sense that they conceptualize what reflection should look like, the current study starts with practicing physicians themselves and maps how these physicians conceptualize and experience reflection in daily professional practice. Methods: We conducted a qualitative study using in-depth interviews with 13 hospital-based physicians from various specialties and institutions. The interviews were transcribed verbatim and were analyzed iteratively, following the interpretative phenomenological analysis approach. Results: Data analysis resulted in the identification of three main topics: fuzziness, domain specificity and dialogical dynamics of reflection in professional practice. Reflection was conceptualized as a fuzzy process of contemplation and action, leading to change and hopefully improvement of personal performance and health care in general. Physicians’ experiences with reflection were different for the patient domain and the team domain. Whereas experiences in the patient domain were recalled first and discussed in relatively clear terms, those in the team domain came second and were discussed in more ambiguous terms. In order to achieve improvement in daily practice, honest and open dialogues were perceived as necessary. These dialogues were regarded as the result of an interplay between an internal and an external dialogue. The internal dialogue required sensitivity and courage of the individual; the external dialogue required psychological safety and encouragement of the environment. Within the team domain however, handling the external dialogue effectively was not self-evident, underlining the importance of psychological safety. Conclusions: This study draws attention to the interdependence between the individual and the collective contributions to reflective activity in professional practice. Apart from its importance to physicians’ individual medical performance, reflective activity is also important to the functioning of a team of physicians. To allow reflection to rise from an individual activity to a team activity, it is necessary to invest in a safe environment in which people are encouraged to think, act, and be engaged. Keywords: Reflection, Reflective practice, Continuing medical education, Professional development, Qualitative research methods Show less
The literature indicates that teacher professional development and learning may be improved by using formative assessment procedures. This thesis focuses on a specific form of formative assessment,... Show moreThe literature indicates that teacher professional development and learning may be improved by using formative assessment procedures. This thesis focuses on a specific form of formative assessment, negotiated assessment, which is characterised by the exchange of views between assessor and assessee and the extensive involvement of the participants (assessees) in their own assessment procedure. The participants negotiate with their assessor about several aspects of the negotiated assessment procedure. Assumptions in negotiated teacher assessment are that the opportunities for negotiation might promote the development of a sense of agency in terms of teachers feeling in control of their learning and assessment processes and feeling able to pursue their learning objectives. This thesis covers four studies in which different aspects of negotiated assessment were examined. Its aim was to gain more knowledge about a negotiated assessment procedure to promote teacher learning in the area of stimulating students__ reflections. The results show that very little negotiation took place during the dialogues. Despite the lack of negotiation during the assessment meetings, the teachers reported a strong sense of agency. Overall, the teachers__ opinions indicated that the elements of the negotiated assessment procedure facilitated their professional learning. The contribution was particularly seen in change in their knowledge, beliefs, attitudes and practice. Teacher professional development; Teacher learning; Formative assessment; Negotiated assessment; Negotiation; Feedback; Agency; Reflection Show less
The topic of this study is the portfolio that is being used in a teacher education institute as an instrument for stimulating reflection on their development as teachers by student teachers. This... Show moreThe topic of this study is the portfolio that is being used in a teacher education institute as an instrument for stimulating reflection on their development as teachers by student teachers. This reflection can be seen in the themes student teachers have written in their portfolios. The nature of reflection has been described by means of content analysis. The student teachers in this study mainly used their portfolios for examing what they had done and learned and much less for learning from these experiences. The results show that teacher education institutes must be very clear about what they aim at with reflection. Subsequently portfolio supervision and the use of the portfolio should be much better geared to this. Whether the portfolio is a suitable instrument for using in educating teachers should also be discussed. Show less
