Postgraduate blended learning for NHS Educational Supervisors: A realist evaluation of impact on professional practice.

This thesis aims to explain the multiple, socially situated influences that shape formal continuing professional development’s (CPD) impact on practice for consultant doctors and dentists holding the role of Educational Supervisor. It does so to better enable CPD curriculum designers, tutors, and students to critically examine these influences on their practice. Since 2015, in the UK, postgraduate medical educators holding the formal, nationally defined role of Educational Supervisor must engage annually in CPD to remain in role. This is known as educational revalidation. Moreover, role holders must demonstrate how their educational practice meets the Academy of Medical Educators’ formal, national standards. Together revalidation and standardisation have created an ongoing need for formal CPD courses. Given the resource-intense nature of formal CPD, stakeholders are keen to understand if and how CPD has an impact on learners’ practice. However, the literature to date has largely explained formal learning for postgraduate medical educators in psychological terms and practice change as the unproblematic uptake of course content. Causal explanations of formal CPD’s impact on professional practice largely focus on teaching techniques, course content and learners’ reactions. Staff and students’ epistemological assumptions about the nature and goals of formal CPD are mostly overlooked. This leaves learners’ manner of engagement with CPD techniques and content under-explored. Such explanations also overlook the influence of socio-professional influences in the wider practice domain that may shape CPD design, delivery, experiences, and outcomes. Furthermore, at the time of this study, there was no ethnographic research into CPD’s impact on practice taking place in Educational Supervisors’ workplaces. Therefore, little is known about the influence of the practice context on medical educators’ learning processes and any subsequent impact on their teaching or supervisory practice. In this study, I therefore ask what enablements and constraints in the professional domain influence CPD staff and students before, during and after the CPD and how these shape CPD’s impact on practice. Bhaskarian critical realism, particularly as conceptualised by Elder-Vass, underpins this project. And this permits me to offer a unique conceptualisation of CPD programmes as instances of causally efficacious social structures from which emerge impact on practice. That is, I view the nature of teaching and learning relations between students, tutors, and materials as one key part of the explanation for any impact on learners’ practice. Equally key, this conceptualisation also enables me to socially situate CPD programmes in the wider professional context. This permits me to examine the causal influences of formal and cultural social structures in the practice domain on CPD staff and students. As a result, this thesis offers a complex explanation of CPD’s impact on practice as multiply shaped by structures and agency and as contextually contingent. This project was conducted across northwest England and involved 16 participants. I used a two-stage, qualitative, realist evaluation research design to evaluate a university accredited, blended learning module for Educational Supervisors. The first stage of the project involved semi structured interviews with four members of module staff and analysis of the module’s six-page formal curriculum document. From this stage, I set out the curriculum design and tutoring team’s beliefs about how and why the CPD module could impact on students’ practice. In the second stage of the research, I interviewed 12 module students who worked as Educational Supervisors in the NHS, analysed a Learning Agreement they wrote for their module studies and observed their supervision of junior doctors in the workplace. This second stage therefore explored the professional students’ experience of CPD and workplace supervision to explain the nature, extent, and reasons for any impact on their practice or barriers thereto. I conducted template analysis of curriculum and student documents, of interview and observations transcripts and of field notes taken during observations. Although the template evolved as data analysis progressed, I used the same template for the curriculum and student documents as well as for staff and student interviews. However, I developed a separate template for coding observations of practice. I engaged in abductive and retroductive reasoning to ask why the data might be as they were. This permitted socially situated explanations of formal CPD’s impact on Educational Supervisors’ practice which are largely absent from the postgraduate medical education literature. This research found that the affordances and normative expectations surrounding the role of consultant clinician and Educational Supervisor positively and negatively influence both CPD learning and its impact on practice. In particular, I suggest the notion of ‘role salience’ to explain how the CPD context may foreground widely held beliefs about learners’ other professional roles. This study found that during group work, on and off campus, role salience prevented learners from engaging actively or meaningfully in CPD. Also, I posit the notion of a role-based ‘sphere of influence’ to explain why some practitioners may be able to implement changes to practice where others cannot. These are social-relational explanations of learning and its impact on practice. They involve the causal influence of the regulatory body, as well as staffing and training structures and enculturated beliefs about supervision in the NHS workplace. This thesis therefore enhances our theoretical understanding of the reasons for and nature of formal CPD’s impact on practice.

Name dc:type.qualificationname

Doctor of Philosophy (PhD)

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

University of Cambridge

Year dc:date.issued

2021

Author dc:creator

• Wells, Alison

Advisor dc:contributor.advisor

• Liu, Yongcan

• blended learning
• postgraduate medical education
• realist evaluation
• impact on practice
• NHS Educational Supervisors
• Educational Supervision

Licence

• https://www.repository.cam.ac.uk/bitstreams/279cab98-a227-4641-a6f9-3098534172d5/download
• https://www.rioxx.net/licenses/all-rights-reserved/

Language dc:language

eng

DOI dc:identifier.doi

https://doi.org/10.17863/CAM.99109

OAI identifier oai:identifier

oai:www.repository.cam.ac.uk:1810/352958