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Modern Healthcare. August 14, IGI Global Snippet. ISBN Vault Inc. Archived from the original on Healthcare Information and Management Systems, August 4, IHealthBeat, May 8, January 26, Retrieved April 19, Nashville Business Journal, January 26, Bloomberg Businessweek, March 16, Archived from the original on 14 July Retrieved 19 April Retrieved Archived from the original on 25 October Bloomberg, May 3, August 4, Archived from the original on September 11, The New York Times.

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Views Read Edit View history. Help Learn to edit Community portal Recent changes Upload file. Download as PDF Printable version. Add links. Nasdaq : CHNG. Nashville, Tennessee , U. A conception, or a way of experiencing a specific phenomenon, is perceived as a relation between the person and the phenomenon.

Thus, the object of phenomenographic research is the phenomenon as experienced by individuals rather than the phenomenon itself. Phenomenography is grounded on the premise that there is a limited number of ways of experiencing a particular phenomenon and that they are logically related.

The primary outcome of phenomenographic analysis is a structured set of logically related categories describing qualitative variations in ways of experiencing or understanding the phenomenon in question at a collective level [ 34 ]. Phenomenography is a viable qualitative approach to educational research in HE [ 27 ]. It fits within the interpretivism paradigm, which acknowledges that there are multiple, diverse interpretations of reality [ 27 ].

The context of this study is Finnish undergraduate medical and dental education offered by five universities. In , the intake of new students was , and the number of working age physicians in Finland [ 35 ] was 21, Basic medical education lasts for six years and confers a licentiate degree in medicine ECTS credits , and dental programmes last five and a half years ECTS credits.

The basis for the educational and practice standards developing undergraduate medical education in Finland was recently updated [ 36 ]. The competence objectives are divided into three main categories: professional values and activities, professional skills, and professional knowledge. The teaching of clinical skills is integrated into all activities of the discipline-specific clinical period three to six academic years. Students participate in the work of various hospital departments and health centres, where they learn the necessary medical skills.

All medical schools have research programmes for students who wish to undertake scientific work. Student-centred learning methods, such as problem-based learning PBL , have been introduced [ 37 ]. The current development efforts emphasise a competence orientation in medical education and national, discipline-specific collaboration in reaching a consensus on the core content of undergraduate education in medicine and dentistry [ 38 ].

Participants represented various employment backgrounds as medical doctors and as teachers. One was a specialising dentist, and the rest of the doctors were licensed medical specialists, eight specialised in dentistry. The majority of the respondents 11 had participated in some pedagogical short-term training during their careers, however only six of the teachers were involved in continuous pedagogical training within the last three years.

The data were collected in from three group interviews [ 39 ]. Interviews are the most common method used to obtain phenomenographic data, although there are other methods used [ 30 , 40 , 41 ].

Because the aim of this study was to investigate the range of different ways of experiencing the same phenomenon, we considered conducting group interviews an effective method to encourage the participants to express their thoughts, views, and experiences by interacting with one another. One group interview was conducted in the spring of , and two online group interviews were conducted in the fall of Interviews were transcribed verbatim. The transcription of min of interviews provided 80 pages for analysis.

Although group dynamics provide advantages during data collection, challenges may also arise, including an expectation of consensus rather than diversity, for which stronger members take the lead while others follow rather than expressing their own opinions and understandings [ 42 ]. In general, despite these limitations, the researcher plays a critical role in steering the conversation, involving the silent participants, and inviting participants to specify their views [ 44 ].

In the present study, smaller meetings were organised to promote equal opportunities to speak and to be heard. By having everyone participate from the beginning, the interviewer encouraged participants to speak and to feel confident in voicing their opinions. The interview questions were semi-structured [ 34 ]. The framework of themes to be explored were addressed by the following broadly structured questions:.

What kind of pedagogical models have you personally applied? Which models do you know that are commonly used in medical and dental education? New ideas were discussed during the interviews by the participants, and the questions were asked as part of the discussion in the order in which the topics emerged. Follow-up questions or reformulated questions were asked when necessary to uncover underlying meanings [ 34 ].

Set of quantitative multiple-choice questions were used to map explanatory background variables, such as teaching experience and the field of specialisation. Transcripts were considered as a whole and were repeatedly re-read to obtain and identify the underlying foci and intentions expressed in them.

No predetermined categories or theories were used, but they were constituted in relation to the data. A draft set of descriptive categories for collective meaning was developed by comparing and contrasting the identified similarities and differences in expressed sentiments.

The second phase of the analysis sought to delineate the logical relationships among the various categories. The aim was to reveal one way of seeing a phenomenon in comparison to another, more complex one [ 28 , 30 ]. To ensure a robust analysis, the data were initially analysed by the first author, and a second opinion was then sought from research colleagues, with whom she met several times.

Discussing and revising the categories and their structures in this way confirmed the valid interpretation of the data [ 40 ]. The final phase of the analysis focused on ensuring that the categories of description met the three quality criteria defined by Marton and Booth [ 30 ]: a each category describes a distinctly different way of experiencing the phenomenon; b a logical relationship between the different categories is hierarchically represented; and c a limited number of categories describing variation are presented.

In the first category, medical teachers experienced the undergraduate medical and dental education practices as an established situation to which they were accustomed.

The competence orientation was based on local competence needs and related implications. The professional needs for competence were determined by teachers as individuals.

Targeted learning outcomes are listed there [in the curriculum], but how they are actually implemented in teaching is up to the university.

The targeted learning outcomes guide teaching, but how they are achieved is for the teacher to decide. Participants expressed insecurity in teacherhood, and employed a variety of metrics to describe their credibility as teachers, no matter how experienced they were in the field of medicine itself.

Medical teachers were familiar and confident with a variety of digital learning solutions that they considered essential instructional scaffolds. In the second category, medical teachers experienced the educational practices as fragmented requiring reassembly. The competence orientation was regional , reflecting multifaceted healthcare needs in particular areas, such as sparsely populated area of Lapland.

Teachers deliberately interpreted the curriculum, referring to the actual curricular content they had been engaged with during their studies years ago. But, if I think of myself as a student, I think it would be easier and maybe better to [teach] one thing at a time. Teacherhood was based on appreciation of competence , and expertise in pedagogy and medicine were genuinely respected.

Even if there is research-based teaching, it should be well-linked to clinical, practical work, which is of course the highest level of competence. The competence to be achieved was described through learning objectives defined based on a core content analysis. Core content analysis was preferred instructional scaffold for both teachers and students to prioritise the extensive medical education objectives. It is probably easier for the student to concretely understand the targeted learning outcomes.

A core content analysis is a good tool for teachers and for curriculum work, evaluation and…planning teaching methods. Students [use] the core content for exams in such a way that some only focus on those subjects because you should get through the exam if you know those things.

The third category describes medical teachers' experiences of the educational practices as accelerators of change. Participants expressed that a national consensus on competence orientation is a crucial precondition for development. The curriculum was co-created and experienced as a change agent.

The significance of nationwide collaboration and commitment to high-quality medical education were emphasised. Targeted learning outcomes and a core content analysis are done, and they are the same nationally, and we acknowledge that they exist. Teacherhood was experienced as promoting professional empowerment. Learning was based on practical applications , and the goal was to equip students with competence to conduct self-assessment in medical practice.

Instructional scaffolds to support this provided students with authentic learning opportunities. I got stuck reading those evaluations made by students about the emergency situation. Systematic clinical work where the student can start small and then progress and develop and receive feedback on that. Then, when the skills have developed, they can do more. This process would naturally include the competence-based approach and targeted learning outcomes. The fourth category represents medical teachers' experiences of the educational practices through a future orientation.

Competence orientation was growing in line with European guidelines and frameworks and curricular development efforts were based on an assessed curriculum. The realization that has come to me is that basically, I start teaching them, the students, in the style in which I myself learn, and then you notice that not everyone learns well the way I learn.

Teacherhood was believed to provide a decent chance of continuous development. Teachers who had participated in pedagogical training were interested in the new visions, pedagogical models, and tools. They were eager to apply what they learned immediately in their teaching. Learning was based on interprofessional interaction and seen in line with the requirement of professional growth.

We should focus on what is essential and important in terms of working life and studying and growing up to be a physician. The instructional scaffolds that could have supported all previous efforts were assessment criteria. However, all forms, levels, and objectives of assessment were deemed to require considerable improvement. But, there is a need for development.

I recognize that, for example, the assessment criteria are not transparent at all. I would like more tools for the evaluation of clinical work so that the competences could be assessed. In the first category, the educational practices were considered in relation to an established situation that offered little to no potential for change. The position of a teacher was not considered influential. The second category describes the fragmented educational practices and unique individual efforts to reassemble fragments.

The third category describes the accelerators of change through current development efforts. The factors considered crucial for nation-level upheaval, harmonisation, and digitisation were collaboration and co-creation. The fourth category raises practical implications based on the current understanding of the future.

Phenomenographic results reveal different ways of experiencing undergraduate medical and dental education practices. The present situation does not appear to be optimal for the development of teaching and learning practices, given that teachers feel insecure about their pedagogical competence as they do not possess common metrics to describe their abilities or performance in a classroom. Our findings are in line with their results: the method of implementing intended planned curricula seems to position teachers as passive co-operators and thus represents a top-down curriculum design process.

EPAs have the potential to be employed in the evaluation of diverse curriculum models or in identifying curriculum gaps [ 16 ]. The role of pedagogical experts in the process of defining the core curriculum needs to be discussed further. Medical teachers have a strong sense of competence and a profound inner drive to review and improve current practices. Medical schools have well-established pedagogical practices worth developing into the digital era.

Reactive strategies have been successful during COVID pandemic [ 45 , 46 ], and our results confirm that teachers are confident and comfortable facilitating already applied pedagogical choices online. However, they are not always able to rationalise their choices as their actions are based on individual experiences as a learner or teacher instead of conscious pedagogical consideration. Our findings indicate that medical teachers are future orientated and have interest in developing teaching practices and the profession.

They thrive as developers when collaboration and co-creation is supported. National interdisciplinary co-operation accelerates their impact. A lack of instructional scaffolds, such as assessment criteria, discourages many of these efforts, from planning to classroom actions. Core content analysis is perceived as an appropriate tool to allocate resources and focus actions as current medical education requires students to master extensive amounts of information.

Biesta and van Braak [ 25 ] propose a triad of professional qualification, professional socialisation, and professional subjectification to reorient curriculum design, pedagogy, assessment, and evaluation in educational practice.

Rotthoff et al. Still, EPAs have been reported to improve student assessment and are well accepted in workplace assessment [ 16 ]. Ruhalahti [ 20 ] and Alkhowailed et al. Our results confirm that practices of authentic assessment have not yet been established [ 45 , 46 ].

Re-evaluation and empirical substantiation of competence-based assessment is required. The results reflect doctors' perceptions of the changing educational paradigm in medical schools, suggesting practical implications for the further development of medical and dental education and training.

Biesta and van Braak [ 25 ] emphasise that aims and actions should always be considered in relation to context. A competence-based approach should enhance accuracy in different forms of assessment as success is always measured as advancement in practice [ 21 , 22 ].

This paradigmatic change requires the reconstruction of teacherhood and medical education research, both in classrooms and clinical practice. Our results emphasise that a medical teacher's role reflects the diverse expectations of students, academia, and medical practice. This reinforces the notion that systematic teacher research can improve the practice of education [ 25 , 26 ]. The results of this study cannot be generalised, but they may be transferable to similar situations or applicable in another context.

The sample was not completely random in that we selected active teachers as respondents. We cannot exclude the possibility that our findings could be an expression of other latent or unexplored dimensions related to the phenomenon.

There is a need to enrich the content of the curriculum with national guidelines aiming at congruence between assessment and objectives. Our results suggest an assessment application of the theoretical concepts delivered and promote the competence orientation at different depths and breadths in medical and dental undergraduate education curricula. Development of assessment criteria is crucial.

A holistic view of competence oriented HE should be emphasised. Up-to-date pedagogical faculty development programme [ 49 ] is a key prerequisite for teacher empowerment and a future orientation in teaching and learning for healthcare professions. Transforming educational beliefs and reconceptualising teacherhood in medical and dental education could increase the prestige of the teaching profession both at the level of society and within the scientific community. Due to confidentiality agreements, supporting data can only be made available to bona fide researchers subject to a non-disclosure agreement.

The anonymized datasets of the current study in Finnish are available from the corresponding author on reasonable request. Developing medical professionalism in future doctors: a systematic review. Int J Med Educ. Article Google Scholar. Managing tensions in assessment: moving beyond either—or thinking. Med Educ. European Union. Recommendation on key competences for lifelong learning. Off J Eur Union.

Google Scholar. Davies H. Competence-based curricula in the context of Bologna and EU higher education policy. Ipperciel D, ElAtia S. Assessing graduate attributes: building a criteria-based competency model. Int J High Educ. BMC Med Educ. New ways of seeing: supplementing existing competency framework development guidelines with systems thinking. Adv in Health Sci Educ.

Niemi-Murola L, Merenmies J. Educational objectives of basic medical education as basis for reforming specialist training. CanMEDS physician competency framework. General Medical Council. Outcomes for graduates. Accessed 7 Jul It does not have to be either or! Assessing competence in medicine should be a continuum between an analytic and a holistic approach. Carraccio CL, Englander R. From Flexner to competencies: reflections on a decade and the journey ahead.

Acad Medicine. Building a framework of entrustable professional activities, supported by competencies and milestones, to bridge the educational continuum. Acad Med. Moercke AM, Eika B. What are the clinical skills levels of newly graduated physicians? Self-assessment study of an intended curriculum identified by a Delphi process.

Mapping and assessment of personal and professional development skills in a pharmacy curriculum. Entrustable professional activities in entry-level health professional education: a scoping review. Med Teach. Toward a shared language for competency-based medical education. High Educ. Ruhalahti S. Redesigning a pedagogical model for scaffolding dialogical, digital and deep learning in vocational teacher education. Acta Electronica Universitatis Lapponiensis.

Self-assessment in medical practice. J R Soc Med. Gordon MJ. A review of the validity and accuracy of self-assessments in health professions training. Trends in study methods used in undergraduate medical education research, — J Am Med Assoc.

Beyond the medical model: thinking differently about medical education and medical education research. Teach Learn Med. Xerri D. The use of interviews and focus groups in teacher research. A phenomenographic approach to research in medical education.

Variation and commonality in phenomenographic research methods. High Educ Res Dev. Marton F. Phenomenography —describing conceptions of the world around us. Instr Sci. Marton F, Booth S. Learning and awareness. New York: Lawrence Erlbaum Associates;

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WebJan 15,  · If you’re enrolled in a health plan with dental coverage: You can't remove dental coverage from your Marketplace health plan. But, you can change health plans . WebJan 15,  · If you’re enrolled in a health plan with dental coverage: You can't remove dental coverage from your Marketplace health plan. But, you can change health plans . Apr 5,  · EDEN PRAIRIE, Minn. & NASHVILLE, Tenn. -- (BUSINESS WIRE)--Apr. 5, Optum, a diversified health services company, and Change Healthcare (NASDAQ: CHNG), a health care technology leader, have agreed to extend their merger agreement to December 31, In a joint statement, the companies said: “The extended agreement reflects our firm.