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Supervisors' intention to observe clinical task performance: an exploratory study using the theory of planned behaviour during postgraduate medical training.

ABSTRACT: BACKGROUND:Direct observation of clinical task performance plays a pivotal role in competency-based medical education. Although formal guidelines require supervisors to engage in direct observations, research demonstrates that trainees are infrequently observed. Supervisors may not only experience practical and socio-cultural barriers to direct observations in healthcare settings, they may also question usefulness or have low perceived self-efficacy in performing direct observations. A better understanding of how these multiple factors interact to influence supervisors' intention to perform direct observations may help us to more effectively implement the aforementioned guidelines and increase the frequency of direct observations. METHODS:We conducted an exploratory quantitative study, using the Theory of Planned Behaviour (TPB) as our theoretical framework. In applying the TPB, we transfer a psychological theory to medical education to get insight in the influence of cognitive and emotional processes on intentions to use direct observations in workplace based learning and assessment. We developed an instrument to investigate supervisors intention to perform direct observations. The relationships between the TPB measures of our questionnaire were explored by computing bivariate correlations using Pearson's R tests. Hierarchical regression analysis was performed in order to assess the impact of the respective TPB measures as predictors on the intention to perform direct observations. RESULTS:In our study 82 GP supervisors completed our TPB questionnaire. We found that supervisors had a positive attitude towards direct observations. Our TPB model explained 45% of the variance in supervisors' intentions to perform them. Normative beliefs and past behaviour were significant determinants of this intention. CONCLUSION:Our study suggests that supervisors use their past experiences to form intentions to perform direct observations in a careful, thoughtful manner and, in doing so, also take the preferences of the learner and other stakeholders potentially engaged in direct observations into consideration. These findings have potential implications for research into work-based assessments and the development of training interventions to foster a shared mental model on the use of direct observations.

SUBMITTER: de Jonge LPJWM

PROVIDER: S-EPMC7193388 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Supervisors' intention to observe clinical task performance: an exploratory study using the theory of planned behaviour during postgraduate medical training.

de Jonge Laury P J W M LPJWM Mesters Ilse I Govaerts Marjan J B MJB Timmerman Angelique A AA Muris Jean W M JWM Kramer Anneke W M AWM van der Vleuten Cees P M CPM

BMC medical education 20200430 1

<h4>Background</h4>Direct observation of clinical task performance plays a pivotal role in competency-based medical education. Although formal guidelines require supervisors to engage in direct observations, research demonstrates that trainees are infrequently observed. Supervisors may not only experience practical and socio-cultural barriers to direct observations in healthcare settings, they may also question usefulness or have low perceived self-efficacy in performing direct observations. A b ...[more]

PMID: 32354331

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Project description:BACKGROUND:Providing sickness certification is a decision that primary care physicians make on a daily basis. The majority of sickness certification studies in the literature involve a general assessment of physician or patient behaviour without the use of a robust psychological framework to guide research accuracy. To address this deficiency, this study utilized the Theory of Planned Behaviour (TPB) to specifically gauge the intention and other salient predictors related to sickness certification prescribing behaviour amongst primary care physicians. METHODS:A cross-sectional study was conducted among N = 271 primary care physicians from 86 primary care practices throughout two states in Malaysia. Questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to the provision of sickness leave. Questionnaire validity was established through factor analysis and the determination of internal consistency between theoretically related constructs. The temporal stability of the indirect measures was determined via the test-retest correlation analysis. Structural equation modelling was conducted to determine the strength of predictors related to intentions. RESULTS:The mean scores for intention to provide patients with sickness was low. The Cronbach α value for the direct measures was good: overall physician intent to provide sick leave (0.77), physician attitude towards prescribing sick leave for patients (0.77) and physician attitude in trusting the intention of patients seeking sick leave (0.83). The temporal stability of the indirect measures of the questionnaire was satisfactory with significant correlation between constructs separated by an interval of two weeks (p < 0.05). Attitudes and subjective norms were identified as important predictors in physician intention to provide sick leave to patients. CONCLUSION:An integrated behavioural model utilizing the TPB could help fully explain the complex act of providing sickness leave to patients. Findings from this study could assist relevant agencies to facilitate the creation of policies that may help regulate the provision of sickness leave and alleviate the work burden of sickness leave tasks faced by physicians in Malaysia.

Project description:Introduction To promote patients’ referral across healthcare institutions and integrated care delivery, we identified predictors of physicians’ behaviour and intention to refer patients in a county medical consortium in China on the basis of the theory of planned behaviour (TPB). Methods This census-based cross-sectional study was conducted in Yangxi Hospital Group (YHG). All physicians in county hospitals and township health centres were invited to participate. Structural equation modelling was employed to analyse the relationships between referral intention and behaviour and other TPB variables in the group of whole participants and in sub-groups. Results In total, 330 physicians participated in this study. One-third of participants were general practitioners, and half of them were from county hospitals. Referral behaviour of females (χ2 = 20.372, p < 0.001), who had lower education levels (χ2 = 17.859, p = 0.001), lower professional title (χ2 = 14.963, p = 0.005), and lower monthly salary (χ2 = 33.753, p < 0.001) were less frequent than the others. Among them, 116 (35.2%), 108 (32.7%), and 106 (32.1%) respondents reported that they had never referred patients, had referred patients 1–9 times, and had referred patients over 10 times during the past 3 months, respectively. The mean score of referral intention was 4.23/5 (SD = 0.71). In the model with all participants, a stronger referral intention (β = 0.218, 95% CI = 0.080–0.356) was associated with more frequent referral behaviour. The subjective norm (β = 0.703, 95% CI = 0.590–0.817) was the strongest predictor of physicians’ referral intention, followed by perceived behavioural control (β = 0.234, 95% CI = 0.090–0.378). Mediated by referral intention, subjective norms (β = 0.153, p < 0.01) and perceived behavioural control (β = 0.190, p < 0.01) had significant indirect effects on physicians’ referral behaviour. The model with participants in county hospitals showed similar results to the model with all participants. Meanwhile, in the model with participants in township health centres, there were no significant associations between referral behaviour and other TPB constructs. Conclusion Physicians’ referral behaviour was influenced by intention, subjective norms, and perceived behavioural control in Chinese county hospitals.

Project description:Aims and objectivesTo assess nursing and allied health students' demographics, knowledge and intentions to care for patients with an infectious disease, COVID-19.BackgroundCOVID-19 has caused a public health crisis and worldwide panic. Little is known about students' knowledge levels and intentions to care for infected patients during pandemics.DesignA quantitative, cross-sectional study.MethodA cross-sectional study with a convenience sample (N = 480) of nursing and allied health students was analysed using the Mann-Whitney and Spearman's correlation tests.ResultsAt least 60% of the participants attained high scores for 16 of the 22 items on the knowledge scale. Knowledge was positively associated with attitude (rs = .19, p < .01) and perceived behavioural control (rs = .38, p < .01) and negatively associated with subjective norms (rs = -.11, p < .05). Senior students had higher scores (p = .024) in knowledge. Intention was negatively correlated with knowledge (rs = -.24, p < .01) and perceived behavioural control (rs = -.16, p < .01). Male students (p = .031) and younger students had higher scores in intention (p = .040). Males had higher scores in subjective norms (p < .001), and older and senior students had higher scores in perceived behavioural control (p < .001).ConclusionsDespite the current knowledge on COVID-19 available through multimedia-communication channels, students had negative perceived behavioural controls and intentions to care for COVID-19 patients. Formal education and training are required to enhance students' intentions to care for patients with infectious diseases. Additionally, demographics and belief variables influence students' intentions to care, and further in-depth analysis is required. Relevance to Clinical Practice This study suggests the importance of updating and contextualizing nursing and allied health curricula to meet global infectious disease guidelines and, ultimately, to support the healthcare system with efficient practitioners in future pandemics.

Project description:ObjectiveStudies indicate that initial career intentions and personal characteristics (eg, gender) can influence medical career decision-making. However, little is known about how personal characteristics and intention interact with career decision-making. To address this gap, we examined the link between career intention at the start of the 2-year UK Foundation Programme (FP) and career intentions on its completion.MethodsData came from the 2017 UK National Career Destination Survey, a cross-sectional study completed by all second year foundation doctors. We included respondents' demographics (gender, graduate status on entry to medical school, career intention on starting the FP) and career intention as an outcome measure (eg, specialty (residency) training (UK), NHS non-training posts/further study, career break, working abroad). Multinomial regression was used to assess the independent relationship between background characteristics and career intention.ResultsThere were 6890 participants and 5570 usable responses. 55.9% of respondents were female and 43.1% were male, 77.1% were non-graduates and 22.9% were graduate entrants to medical school. Approximately two-thirds (62.3%, n=2170) of doctors who had an original intention to pursue specialty training after F2, still intended to do so on completion. Most of those who stated at the start of F2 that they did not want to pursue specialty indicated at the end of F2 they would be undertaking other employment opportunities outwith formal training. However, 37.7% of respondents who originally intended to pursue specialty training on FP completion did something different. Graduate entrants to medicine were more likely to immediately progress into specialty training compared with their peers who did medicine as a primary first degree.ConclusionOriginal intention is a strong predictor of career intentions at the end of the FP. However, a considerable proportion of doctors changed their mind during the FP. Further research is needed to understand this behaviour.

Project description:BackgroundEven though evolution is the overarching principle that connects all areas of biology, a significant proportion of pre-service teachers do not intend to teach evolution, minimize the teaching of evolution, or teach alternative ideas in biology classes. To prevent adverse teaching practices and promote effective pre-service teacher education, we aimed to identify and analyze variables that foster or hinder their behavioral intentions to teach evolution.MethodWe adopted a behavioral psychology research perspective and developed a research model based on the theory of planned behavior to examine behavioral intentions for teaching evolution in biology classrooms. We extended the model with additional variables that have been delineated by teacher education research as essential determinants for the behavioral intention to teach evolution. We proposed several hypotheses suggesting that the attitude toward teaching evolution, subjective norms, perceived behavioral control, personal religious faith, perceived usefulness, and knowledge about evolution determine a person's behavioral intention. We conducted a quantitative cross-sectional study in teacher education to test the hypotheses and surveyed N = 339 pre-service biology teachers using an online questionnaire. We analyzed the data using a two-stage structural equation model.ResultsWe were able to confirm all proposed hypotheses. The most important results revealed that pre-service teachers' knowledge about and perceived usefulness of evolution are only moderately pronounced. Moreover, the subjective norm is a predictor not only of behavioral intention but also of the attitude toward teaching evolution. The variable of perceived behavior control partly moderates the relationship between knowledge about evolution and behavioral intention. Additionally, perceived usefulness is an important and marginally stronger predictor of a person's attitude than personal religious faith.ConclusionThe extended model of the theory of planned behavior has highlighted the need for educational programs to increase knowledge about and the perceived usefulness of evolution even stronger. The findings delineated the effects of essential determinants on behavioral intentions and provided information about the necessary levers of teacher education.Supplementary informationThe online version contains supplementary material available at 10.1186/s12052-022-00175-1.

Project description:BackgroundBlood shortage is a persistent problem affecting Taiwan's health-care system. The theory of planned behavior (TPB) has been commonly used in studies of health advocacy. The purpose of this study was to develop a questionnaire measuring clinicians' intention to prescribe transfusion based on the TPB.MethodA questionnaire comprising 15 items for assessing clinicians' intention to prescribe blood transfusion was developed, and it collected demographic characteristics, tested patient blood management (PBM) and perceived knowledge of PBM. Furthermore, the questionnaire contained four subscales related to the TPB. A total of 129 clinicians participated in this pilot study between July and December2020. Item analysis and exploratory factor analysis were conducted to examine the validity and reliability of this measurement instrument.ResultsThe results indicated no statistically significant correlations between the demographic characteristics and PBM test scores. Regarding perceived knowledge, the results of a one-way analysis of variance revealed that the effect of age, hierarchy of doctors, and education level were significant. In terms of subjective norms, a significant effect on education level was noted [t (129) = 2.28, p < 0.05], with graduate school graduates receiving higher scores than college graduates. An analysis of variance demonstrated the effects of hierarchy, education level, and medical specialty on perceived behavioral control. The results of the regression analyses revealed that perceived knowledge (β = 0.32, p < 0.01) and subjective norms (β = 0.22, p < 0.05) were significantly related to clinicians' behavioral intentions.ConclusionsThis study revealed that factors affecting clinicians' blood transfusion management can be explained using the TPB-based questionnaire. This study demonstrated that physicians' perceptions of whether most people approve of PBM and their self-assessment of their PBM knowledge affect their intentions to proceed with PBM. According to this finding, a support system among physicians must be established and maintained to increase physicians' confidence in promoting PBM.

Dataset Information

Supervisors' intention to observe clinical task performance: an exploratory study using the theory of planned behaviour during postgraduate medical training.

Publications

Supervisors' intention to observe clinical task performance: an exploratory study using the theory of planned behaviour during postgraduate medical training.

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