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In postgraduate medical education, required competencies are described in detail in existing competency frameworks. This study proposes an alternative strategy for competency-based medical education design, which is supported by change management theories. We demonstrate the value of allowing room for re-invention and creative adaptation of innovations. This new strategy was explored for the development of a new generic competency framework for a harmonised European curriculum in Obstetrics and Gynaecology. The generic competency framework was developed through action research. Data were collected by four European stakeholder groups (patients, nurses, midwives and hospital boards), using a variety of methods. Subsequently, the data were analysed further in consensus discussions with European specialists and trainees in Obstetrics and Gynaecology. These discussions ensured that the framework provides guidance, is specialty-specific, and that implementation in all European countries could be feasible. The presented generic competency framework identifies four domains: 'Patient-centred care', 'Teamwork', 'System-based practice' and 'Personal and professional development'. For each of these four domains, guiding competencies were defined. The new generic competency framework is supported by European specialists and trainees in Obstetrics and Gynaecology, as well as by their European stakeholders. According to change management theories, it seems vital to allow room for re-invention and creative adaptation of the competency framework by medical professionals. Therefore, the generic competency framework offers guidance rather than prescription. The presented strategy for competency framework development offers leads for implementation of competency-based medical education as well as for development of innovations in postgraduate medical education in general.

Improving collaboration in Dutch maternity care is seen as essential to improve continuity of care and thereby safety, client satisfaction, and health outcomes. This study aims to monitor and evaluate whether the regional Maternity Care Network Northwest Netherlands (MCNNN) and its local multidisciplinary obstetric partnerships contributed to collaboration. This mixed-method study followed the methodology of reflexive monitoring in action. Data were collected from 2014 to 2016 through interviews (n=73), questionnaires (n=430), and reflection sessions (n=4) and analyzed inductively and deductively based on a model for interprofessional and interorganizational collaboration. The findings outline (1) MCNNN-activities, (2) experienced collaboration within obstetric partnerships, and (3) MCNNN as supporting structure. The findings showed improvements on both the relational and organizational level of interprofessional and interorganizational collaboration. The MCNNN’s meetings, products, and research projects facilitated knowledge development and dissemination and its obstetric partnerships fostered contact and deliberation among maternity care professionals. However, collaborative challenges were also experienced, including mistrust and difficulties in information sharing, influenced by lacking financial and organizational facilitation. The MCNNN could improve its supporting role in the system innovation toward integration in maternity care by means of a further transformation to a knowledge network that is focused on reflexively overcoming collaborative challenges at all levels in the maternity care system.

Emerging research on implicit bias recognition and management within health professions describes individually focused educational interventions without considering workplace influences. Workplace learning theories highlight how individual agency and workplace structures dynamically interact to produce change within individuals and learning environments. Promoting awareness of individual biases shaped by clinical learning environments may therefore represent a unique type of workplace learning. We sought to explore how individuals and the workplace learning environment interact once awareness of implicit biases are triggered within learners. In accordance with longitudinal case study methodology and informed by constructivist grounded theory, we conducted multiple longitudinal interviews with physician and nurse participants over 12 months. Our results suggest that implicit bias recognition provokes dissonance among participants leading to frustration, and critical questioning of workplace constraints. Once awareness is triggered, participants began reflecting on their biases and engaging in explicit behavioural changes that influenced the perception of structural changes within the learning environment itself. Collaboration, communication and role modeling within teams appeared to facilitate the process as individual and workplace affordances were gradually transformed. Our findings suggest a potential model for understanding how individual learners adaptively reinvent their role in response to disruptions in their learning environment.

Introduction: Identity threats, such as stereotype threat and microaggressions, impair learning and erode well‐being. In contrast to identity threat, less is known about how learners experience feelings of safety regarding their identity. This exploratory study aims to develop a theory of identity safety in the clinical learning environment. Methods: This multi‐institutional, qualitative interview study was informed by constructivist grounded theory and critical pedagogy. Participants were clinical students at three public medical schools in the United States in 2022. Investigators purposively sampled participants for interviews based on their responses to an 11‐item survey with an open‐ended question soliciting students' personal identities and responses to both the racial/ethnic and gender Stereotype Vulnerability Scales. The investigators interviewed, coded, constantly compared and continued sampling until the codes could be developed into categories, then concepts and finally into a theory. The team engaged in critical reflexivity throughout the analytic process to enrich data interpretations. Results: Sixteen diverse students were interviewed. We organised their identity‐salient experiences into identity threat, threat mitigation and identity safety. Participants experienced identity threat through unwelcoming learning environments, feeling compelled to change their behaviour in inauthentic ways or sociopolitical threat. Threat mitigation occurred when a participant or supervisor intervened against an identity threat, dampening but not eliminating the threat impact. Participants characterised identity safety as the ability to exist as their authentic selves without feeling the need to monitor how others perceive their identities. Identity safety manifested when participants demonstrated agency to leverage their identities for patient care, when others upheld their personhood and saw them as unique individuals and when they felt they belonged in the learning environment. Discussion Attending to identity safety may lead to educational practices that sustain and leverage team members' diverse identities. Identity safety and threat mitigation may work together to combat identity threats in the learning environment. In this edition of @medEd_journal, @jbullockruns et al. describe identity safety, where learning environments allow learners to exist as their authentic selves. The figure is worth 1000 words. [ABSTRACT FROM AUTHOR]

Students feel insufficiently supported in clinical environments to engage in active learning and achieve a high level of self-regulation. As a result clinical learning is highly demanding for students. Because of large differences between students, supervisors may not know how to support them in their learning process. We explored patterns in undergraduate students' self-regulated learning behavior in the clinical environment, to improve tailored supervision, using Q-methodology. Q-methodology uses features of both qualitative and quantitative methods for the systematic investigation of subjective issues by having participants sort statements along a continuum to represent their opinion. We enrolled 74 students between December 2014 and April 2015 and had them characterize their learning behavior by sorting 52 statements about self-regulated learning behavior and explaining their response. The statements used for the sorting were extracted from a previous study. The data was analyzed using by-person factor analysis to identify clusters of individuals with similar sorts of the statements. The resulting factors and qualitative data were used to interpret and describe the patterns that emerged. Five resulting patterns were identified in students' self-regulated learning behavior in the clinical environment, which we labelled: Engaged, Critically opportunistic, Uncertain, Restrained and Effortful. The five patterns varied mostly regarding goals, metacognition, communication, effort, and dependence on external regulation for learning. These discrete patterns in students' self-regulated learning behavior in the clinical environment are part of a complex interaction between student and learning context. The results suggest that developing self-regulated learning behavior might best be supported regarding individual students' needs.

Learning by working is omnipresent in healthcare education. It enables people to learn how to perform, think, and interact in ways that work for their specific context. In this paper, I review my approach to studying this process. It centers on the question why healthcare professionals do what they do and how their actions and learning are intertwined. The aim of this paper is to illustrate what I have learned from the research I have been involved in, in such a way that it enables other researchers, educators, and clinicians to understand and study practice-based learning in healthcare workplaces. Therefore, I build on a programmatic line of research to present a framework of practice-based learning consisting of three inextricably linked levels of analysis. The first level focuses on how situations lead to personal experiences, the second level looks at strings of experiences that lead to multiple trajectories, and the third level deals with reifications arising from recurrent activities. This framework, and its interrelations and inherent tensions, helps to understand why healthcare workplaces can be both a powerful learning environment and a frustratingly hard place to change.