The relationship between preceptor power use and learner sense of empowerment: A study of social power in clinical learning environments

Transcription

1 The relationship between preceptor power use and learner sense of empowerment: A study of social power in clinical learning environments Judy Baird, Keyna Bracken, Lawrence Grierson

2 I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d appareils médicaux ou un cabinet de communication. Author: Judy Baird Date: Oct Delete this box before presenting: Please keep only the applicable statement, shown above is Option 1 with Option 2 to follow on next slide. Note: Speakers who have no involvement with industry should inform the audience that they cannot identify any conflict of interest. Supprimez cette boîte avant de faire votre présentation : Veuillez conserver uniquement l énoncé pertinent; ci-dessus se trouve l option 1, l option 2 paraissant à la diapo suivante. Note: Les conférenciers qui n ont aucun lien avec l industrie doivent aviser leur auditoire qu ils n ont aucun conflit d intérêts à déclarer.

3 Hidden Curriculum the set of influences that function at the structural and cultural levels of an educational organization to impact the nature of the values, attitudes, and behaviours that are transmitted to learners (Hafferty, 1998)

4 The Hidden Curriculum in Clerkship Clerkship students: fail to develop their moral reasoning, and even showed signs of deterioration (Patenaude, Niyonsenga & Fafard, 2003) use inappropriate humor, making derogatory comments about patients (Reddy et al., 2007) failing to follow what has been taught as the correct course of action (Wear, Aultman, Varley & Zarconi, 2006)

5 Hidden Curriculum Influences on Students Psychological/Developmental Social Interactions Learning Environment

6 Obedience (Milgram, 1963) (Image, Vanderbilt University)

7 Power in Learning Relationships Often unaware of the power we have as teachers, especially in small group and individual settings Social Power French and Raven (1959) 5 bases of social power: coercive, reward, referent, legitimate and expert

8 Empowerment Concept of empowerment has been applied in management literature as well as health care settings Impact on job performance and satisfaction In education-applied to adult learners Dimensions of empowerment: impact, meaningfulness and competence (Frymier 1996)

9 Learning Environment Clinical learning Environments tightly rule bound and often hierarchical (Lemp 2004) Learners can act in accordance with the implicit rules rather than based on values or ethics (Feudtner and Christakis 1994, Rees and Montrouxe 2011)

10 Study Design Objective: To determine if clerks perception of their individual empowerment correlates with the types of social power employed by their preceptor. Three clerkship cohorts, 6 disciplines, Class of 2013 and 2014 at MDG School of Medicine

11 Surveys Surveys Teacher Power Use Scale (TPUS) Learner Empowerment Scale (LEM) Analysis TPUS, LEM correlational analysis ANOVA Preceptor involvement n=217, response rate=43%

12 Perceived Power Use 6 5 Perceived Preceptor Power Use Coercive Legitimate Reward Referrant Expert

13 The Relationship Between Perceived Power Use and Empowerment Importance (r 2 ) Meaningfulness (r 2 ) Competence (r 2 ) Coercive Legitimate Reward Referent Expert p <.05

14 Perception of Coercive Power Use

15 Rotation by Preceptor 100 % reported time spent with Staff Physician Family Medicine Psychiatry Internal Medicine Surgery OBGYN Pediatrics

16 Coercive Power Use by Supervisor Involvement

17 Conclusions Positive Correlation between Power Use and Empowerment Higher Coercive Power Use in clerkship rotations with greater resident involvement Because of residents? Because of multiple preceptors?

18 Next Steps Objectify the hidden organizational hierarchy of core clerkship rotations Better understand the learner experience of power and the influence on learning and behaviour Qualitative Study: ethnography and grounded theory-stay tuned Implications for residency training