#KeyLIMEPodcast 311: Preparedness for practice – P4P 4U & Me

Reference

Ottrey et. al., Exploring health care graduates’ conceptualisations of preparedness for practice: A longitudinal qualitative research study Med Educ. 2021 Feb 22 Online ahead of print.

Reviewer

Jason R. Frank (@drjfrank)

Background

Forget your health professional background for a minute. Think about a job you had earlier in life that did not go so well…Perhaps something you bombed. Now think of another job that you really did well in the past. What was the difference? Why were you more prepared to do one job over another? Furthermore, what kinds of words would you use to explain your understanding “preparedness for practice”?

The “P4P” literature is an established genre of #meded/HPE papers, often driven by assessment for competence of graduates. However, there are many interchangeable terms used for P4P beyond “competence”. Consider this list:

• Preparedness
• Competence
• Readiness
• Responsibility
• Suitability
• Fitness
• Skills
• Confidence
• Knowledge
• Experience
• Employability
• Autonomy
• Independence
• Resilience
• Short-term
• Long-term

Once again, our field suffers from no lingua franca, making it harder to build on previous work.

Purpose

Enter Ella Ottrey, Charlotte Rees et al from Down Under (Monash & USydney). As part of a program of research exploring P4P in the health professions, this study explored how learners from multiple health professions conceptualized P4P. They had 3 research questions:

1. How do health care learners across the final-year student to new graduate transition conceptualize P4P?
2. What (if any) differences exist in their solicited versus unsolicited P4P conceptualisations?
3. What (if any) longitudinal patterns exist in conceptualisations across the final-year student to new graduate transition?

Key Points on the Methods

This a special study: both Herculean in effort and beautifully executed and described. The authors endear themselves by their comprehensive, yet elegant description of their methods. They define their terms, they make their philosophical stance explicit (social constructivism), they make it easy to follow their reasoning and steps.

The authors used longitudinal qualitative research (LQR) in 3 phases:

1. Entrance interviews (individual and group face to face) (n=18; 35 people)
2. Longitudinal audio diaries (LADs) of relevant experience stories via smartphone (n=183; 30 participants)
3. Exit interviews (individual and group virtually during COVID). (n=12; 22 participants)

All participants were in a transition-to-practice phase of training. Participants were from 4 different health professions (dietetics, nursing, pharmacy, and medicine) from one Australian university. Maximum variation sampling guided selection.

Interviews were well described using standard methods. Data were solicited initially by asking for conceptualizations of P4P and memorable relevant stories. Unsolicited content came from the audio diaries. Before the final exit interviews, participants were asked to listen to their own audiotapes again to allow for recursive interviewing (brilliant!).

They did this for $10 each.

Data analysis of transcripts followed framework analysis, which involves familiarization, thematic framework identification, coding, preliminary analyses, indexing, charting patterns, and finally mapping and interpretation. Data was considered longitudinally, by case, and collectively as a population.

A team reflexivity exercise was done at the start and elegantly described.

Key Outcomes

The majority of participants were single, white, English-speaking women. There was a 63% retention rate from beginning to end of the study.

Overall, the authors found 13 different P4P conceptualizations (from 300 quotations) that were consistent with the published literature. These were stable over time and across all 4 professions, with a little variability. Experience, knowledge, and confidence were most commonly found, resilience and short-term the least. Of the 300 quotations, only 69 were directly solicited in interviews, whereas the rest were identified in unsolicited talk. This is consistent with previously published similar literature on conceptualizations.

Conceptualizations were relatively stable over time. Competence and independence dominated later study phases closer to graduation.

Key Conclusions

The authors conclude…

1. This is the first paper to uniquely explore graduating health professionals’ conceptualization of P4P over time and across multiple professions.
2. This study once again demonstrates a phenomenon in which health professionals have difficulty describing a concept explicitly but can elaborate extensive understanding via experiences.
3. Explicit articulations of P4P should perhaps be part of HPE design.

Spare Keys – Other take home points for Clinician Educators

• This is an amazing study in its scope, level of effort and beautifully articulated description.
• This is a model paper for the use of LQR & framework analysis.
• Once again, this paper shows a cacophony of conceptualizations in our field of #meded/HPE. I wonder if that holds back the advancement of our thinking.
• Identity formation is another key concept in theories of P4P, and it is missing
• Are the elaborate unsolicited conceptualizations a reflect of the hidden curriculum?
• Should these findings give us pause about the data we obtain from interviews? Perhaps we should switch to asking for relevant stories and experiences.

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