Table 2 Identified themes (deductive analysis)
Locus of uncertainty: Alice | Locus of uncertainty: Dena | ||
|---|---|---|---|
Theme | Sub-theme | ||
Sources of uncertainty for the student | Probability | • This patient interview may, or may not, have an impact on Alice’s academic progress • Alice may, or may not, learn from this situation | • Dena’s learning around the problem-based learning (PBL) topic may, or may not, be compromised • Dena may, or may not, miss out on an opportunity to learn from her colleagues in a team setting |
Ambiguity | • Alice isn’t able to fully engage with the patient meaning that the patient history is incomplete • There is a specific lack of details around psychosocial information concerning the patient • It is not clear whether or not the patient’s response is a symptom of a psychiatric disorder • There is a lack of trust in information related to consent, i.e., “Is this the right patient?”; “Is consent in place?” • Alice lacks clear options on how best to proceed, i.e., stay with patient or exit? which communication skills to use? • Alice lacks clear information on how she will be assessed on this interview | PBL is a teaching and learning strategy which naturally incorporates elements of ambiguity • There is a lack of induction to PBL and why it is used • There is a lack of instructions as to the specific task, e.g., details around goals, student roles, learning outcomes • There is a lack of clear guidance as to how assessment will take place | |
Complexity | • The patient’s situation and presentation are inherently complex • Consent and capacity to consent are complex concepts • There appears to be a rapid change in the patient’s condition which culminates in withdrawal of consent • Alice experiences tension between two roles: a student who will be assessed and a healthcare professional, i.e., “How will this reflect on me?” versus “How am I to proceed in managing this patient?” • Alice’s apparent lack of experience and/or training adds difficulty to the situation | • PBL is an inherently complex teaching and learning strategy • The students are in their first year and lack experience with PBL • The environment, e.g., room set up, was not conducive to a successful PBL session • Key people, e.g., the facilitator and other group members, are absent from the session • Dena is balancing the priorities of different tasks, i.e., engaging with the PBL session or studying for an anatomy test | |
Issues of uncertainty for the student | Scientific | • Alice is not sure if this is the right patient • She is not sure if consent is in place • She cannot fully interpret the patient’s narrative or presentation • She is not sure how to approach the patient, or what to do or say; she is “bogged down in uncertainty” • She lacks clarity on whether to proceed with the interview or to exit • She struggles with how to apply her communication skills training in this particular setting • She is not sure how to change course when things don’t go to plan | • Dena is disoriented by the teaching approach overall • She lacks information about the benefits of PBL • She is not sure how to proceed with the task • She is not sure why she would engage with the task, or why it is important • She lacks clarity on how to gain reputable information to complete the task • She lacks a clear connection between this task and how it links back to the end goal of her education |
Practical | • She does not trust that the system around consent has been followed correctly • She not sure which role is most important within this educational setting, her role as a student or her role as a healthcare professional • She is unsure of the role of the healthcare team, and how to interact with them, in the care of this patient • She doubts the relevance or effectiveness of the communication training she has received to-date • She is not sure if, or how much, she should disclose about the situation to her tutor • She is unsure about how the assessment process works here | • She is unclear of the role of the facilitator and who is “in charge” • She is unclear of the role of the other group members and what to expect of them • She doesn’t know when, or if, the tutor is coming back • She doesn’t know her group, or where they are • She is unsure about how this group task will be assessed • She is unsure which task to prioritise: engage with the PBL session or study for the anatomy test • She lacks clarity about the attendance policy for this session, and she doesn’t know whether to stay or leave • Her efforts to engage with the task are hindered by lack of access to resources, e.g., effective Wi-Fi | |
Personal | • She is not sure if she has the knowledge that she needs to handle this situation • She wonders why the communication skills that she has learned aren’t working for her • She has concerns around the consequences for her (“How will this reflect on me?”; “Am I going to get in trouble?”) • She has specific concerns around the consequences of this situation on her grades • She doubts herself with regards to how her approach with the patient (“Have I made a mistake?”) • She experiences upset, anger and/or frustration as a result of the situation | • She is not sure what her responsibilities are in this situation • She is confused as to why she’s not getting more support from the teaching staff • She feels a lack of trust in the facilitator and other group members • She is not sure if she wants to do this task; she experiences a lack of motivation • She experiences anxiety and a lack of confidence in her ability to retrieve solid information • She has concerns about how she is going to be marked • She has concerns about the fairness of the assessment process | |
What knowledge/skills/ attitudes might help the student to manage this uncertainty? | Knowledge | • More knowledge of this specific patient’s medical history • Boundaries (i.e., knowing when to stay and when to go, knowing what to put up with) • Help-seeking (i.e., knowing when/how to ask for help, knowing your team and who to call, knowing limits of capabilities) • Consent and capacity • The importance of the patient (i.e., knowing to place the patient at the centre of the learning) • The nature of uncertainty: “It’s not personal” | • More knowledge about PBL, its purpose and value • Uncertainty is part of the process in PBL • More knowledge about the specific session (e.g., the outcomes required, the specific assessment methods) • More knowledge about her classmates and the facilitator, and their roles and potential issues affecting them • More knowledge about the PBL topic and its importance • How group work takes place • How the session fits with the end goals of Dena’s profession • The nature of uncertainty: “It’s okay to not know”; “Sometimes the answers aren’t going to be perfect”; “Sometimes there is uncertainty and it’s just part of the process and you just have to go with a path”) |
Skills | • Communication skills (e.g., recognising psychosocial issues, attending to nonverbal skills, giving patients space to tell their story) • Managing difficult interactions • Empathy • Assertiveness • Emotional regulation (e.g., meditative strategies) • Self-awareness • Resilience • Reflective processes • Cooperation • Teamwork • Problem solving • Insight • Taking initiative | • Communication skills • Self-directed learning • Teamwork • Research skills • Problem solving skills • Information retrieval skills • Project management skills • Decision making despite incomplete knowledge | |
Attitudes | • Openness • Adaptability/Capacity to change course • Collaborative attitude • Professionalism • Acceptance of patient difficulties • Showing an interest in learning • Growth mindset • Positivity • Confidence/Experience | • Openness to new ideas and processes • Motivation • Respect for others • Value learning from others • Growth mindset • Positive outlook | |