Open Learning Culture Research Articles

In-situ obstetric simulation – ticking all the boxes

Simulation is increasingly valued as a versatile and effective tool for medical education [1]. This is even timelier with the recent release of the Ockenden Report which recommends in-situ simulation in obstetric units to promote safety [2]. With the recent change of speciality training curricula, especially in anaesthetics, there has been an increased requirement for simulation-based training. However, the COVID-19 pandemic has had a significant negative impact on medical training, both in terms of clinical breadth and opportunities for educational activities [3]. In order to tackle all these requirements, we developed an in-situ multidisciplinary obstetric simulation programme. This was supported by the anaesthetic simulation fellow, obstetric anaesthetic lead and fellow and obstetric safety fellow, together with senior midwifery input. This allowed simulation development, running and debriefing to benefit from the skill and experience of a multidisciplinary team. The local simulation centre provided technical support which allowed us to take the simulation to multiple locations on the labour ward. Learners were from anaesthetic, midwifery, theatre, and operating department practitioner backgrounds and we conducted this simulation programme as three-monthly sessions corresponding with trainees’ rotations. The scenarios were based around previous critical incidents while ensuring the psychological safety of the candidates. This demonstrates an open learning culture where lessons learnt can be shared and patient safety prioritised. It was also be useful in applying a systems approach to understanding how errors occurred. Feedback confirmed the in-situ aspect of this session provided experiential learning and improved familiarity of the environment. This was especially pertinent as the sessions were conducted with trainees new to the department. It also allowed midwifery and theatre staff to take part in the session who otherwise may not have. A multidisciplinary approach allowed flattening of team hierarchy as shown by feedback. We ensured challenges associated with in-situ simulation were met with the team ready to respond to clinical needs in the department. No simulated equipment or medication was used and all documentation was labelled appropriately. Obstetric emergencies can be life changing and can significantly affect those involved. This simulation session addressed several learning needs while rising to the challenges of in-situ simulations. We hope to continue developing this programme with more specialities represented and integrating learning from critical incidents while ensuring psychological safety. 1. Higham H, Baxendale B. To err is human: use of simulation to enhance training and patient safety in anaesthesia. BJA: British Journal of Anaesthesia. 2017;119(suppl_1):i106–14. 2. Ockenden D. Emerging findings and recommendations from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust. House of Commons. 2020 Dec 10. 3. Seifman MA, Fuzzard SK, To H, Nestel D. COVID-19 impact on junior doctor education and training: a scoping review. Postgraduate medical journal. 2022;98(1160):466–76.

GENESISS 1—Generating Standards for In-Situ Simulation project: a scoping review and conceptual model

BackgroundIn-Situ Simulation (ISS) enables teams to rehearse and review practice in the clinical environment to facilitate knowledge transition, reflection and safe learning. There is increasing use of ISS in healthcare organisations for which patient safety and quality improvement are key drivers. However, the effectiveness of ISS interventions has not yet been fully demonstrated and requires further study to maximise impact. Cohesive programmatic implementation is lacking and efforts to standardise ISS terms and concepts, strengthen the evidence base and develop an integrated model of learning is required. The aim of this study was to explore the current evidence, theories and concepts associated with ISS across all areas of healthcare and develop a conceptual model to inform future ISS research and best practice guidance.MethodsA scoping review was undertaken with stakeholder feedback to develop a conceptual model for ISS. Medline, OpenGrey and Web of Science were searched in September 2018 and updated in December 2020. Data from the included scoping review studies were analysed descriptively and organised into categories based on the different motivations, concepts and theoretical approaches for ISS. Categories and concepts were further refined through accessing stakeholder feedback.ResultsThirty-eight papers were included in the scoping review. Papers reported the development and evaluation of ISS interventions. Stakeholder groups highlighted situations where ISS could be suitable to improve care and outcomes and identified contextual and practical factors for implementation. A conceptual model of ISS was developed which was organised into four themes: 1. To understand and explore why systematic events occur in complex settings; 2.To design and test new clinical spaces, equipment, information technologies and procedures; 3. To practice and develop capability in individual and team performance; 4. To assess competency in complex clinical settings.ConclusionsISS presents a promising approach to improve individual and team capabilities and system performance and address the ‘practice-theory gap’. However, there are limitations associated with ISS such as the impact on the clinical setting and service provision, the reliance of having an open learning culture and availability of relevant expertise. ISS should be introduced with due consideration of the specific objectives and learning needs it is proposed to address. Effectiveness of ISS has not yet been established and further research is required to evaluate and disseminate the findings of ISS interventions.

Ordinary extraordinary: the para/pata:institutionalism of Critical Practice

ABSTRACTThis paper considers Critical Practice, the London-based cluster of artists, designers, curators, academics and other researchers who share a commitment to the critical practice of art, its organisation and its education as public goods. I discuss Critical Practice as an open learning culture, contextualising it with reference to institutional critique and the discursive practice of peer-to-peer exchange as general social technique. This leads me to consider ways this exchange can confound elitism and conservatism when conscientiously organised through sensitive formats. I consider two that feature in the repertoire of Critical Practice: un-conferences and future archiving. These formats and the Cluster's relation to its host (Chelsea College of Arts, University of the Arts London) are respectively probed using parainstituting (i.e. self-organisation as social reproduction) and patainstituting (i.e. the self-organisation of aspiration). After discussing each in turn, I propose a nascent framework of pata/para:instituting. I have written this account of Critical Practice as a long-standing member. My interest in better understanding the Cluster's ways of doing and being is not an end in itself, but rather to more effectively grasp the qualities of self-organised practice and/as education in art and design more generally.

Interdisciplinary and transdisciplinary research and practice: Balancing expectations of the ‘old’ academy with the future model of universities as ‘problem solvers’

AbstractAcademics are increasingly required to balance the expectations of the ‘old’ academy with a future model of universities as interdisciplinary and transdisciplinary ‘problem solvers’. This paper highlights changing expectations of academics in producing alternative research outcomes in collaborative, practice‐based research. Through a series of workshops with 20 researchers, preferred research outcomes and tensions in achieving these outcomes were identified. The tensions identified are presented as three dichotomies comprising the tension between: (a) ‘I versus We’ ‐ individual versus team expectations & outcomes. (b) Disciplinary outcomes versus inter‐/transdisciplinary outcomes. (c) Learning versus research objectives for the students and academics involved. These tensions reflect the authors' experiences of working in three international sustainability projects, drawing on lessons learned from these projects, with recommendations for universities seeking to implement interdisciplinary and transdisciplinary doctoral and postdoctoral programmes. Recommendations include the need for formal and informal leadership models, strong communication skills, empathy and willingness to learn from each other. A need for more systemic changes within university administration to better reward and value the breadth and depth of collaborative work, while facilitating open learning cultures and practice‐oriented learning opportunities and curricula across faculties was also identified.

Open Learning Cultures. A guide to Quality, Evaluation and Assessment for Future Learning

Open Learning Cultures. A guide to Quality, Evaluation and Assessment for Future Learning

The first lecture: Playing upon identities and modeling academic roles

In this paper we investigate the discursive practices that contextualize active student participation in a formal ‘first lecture’ situation. The observation that some experienced lecturers consistently generate high levels of student involvement, regardless of the specific student populations they are faced with, provided the starting-point for this enquiry. We zoom in on student speaker roles that are scaffolded in embedded and hypothetical interactional domains that often ‘pass under the radar’ (Erickson, 2004) of what counts as data in educational research. Attention to interactional detail in the multimodal performance of participant roles reveals how emergent open learning cultures might be bootstrapped on hybrid and complex discourse practices.