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Type: Theses
Title: Developing clinical teacher’s self-efficacy in Australian general practice
Author: McArthur, Lawrence Andrew
Issue Date: 2016
School/Discipline: Adelaide Medical School
Abstract: The Australian health system, including general practice as the main primary health care provider, faces many challenges. This includes a rapidly ageing population, the increasing burden of chronic disease and co-morbidities, increased community expectations, technological advances and balancing a burgeoning evidence base with holistic, patient centred care. Concurrent changes include the shift from apprenticeship to competency-based education, competitive tender processes for general practitioner (GP) training with increased accountability for government funding and workforce distribution. Though high professional standards of general practice in Australia provide a strong foundation for a mature GP training program, in addition to the clinical and financial, there are wider educational challenges. There is an increased expectation that a GP clinically supervises and teaches undergraduate and postgraduate medical and allied health students. The GP supervisor role is pivotal, underpins all the learning, yet is complex, demanding and at times, potentially conflicting. Ageing GP supervisors, the lack of recognised qualifications, limited clinical teaching professional development and training capacity saturation, especially in rural and remote areas, are impacting on the quality of clinical teaching. Beyond being the medical expert, GPs have other important roles in the Australian health system and are uniquely placed to lead and respond to these challenges and changes. An important pillar underpinning quality primary health care is high quality training. For the GP supervisor to function effectively in primary health care provision and be the cornerstone of GP training, there needs to be an evidence based understanding of their roles, competencies and professional development. A consensus-developed national competency based framework provides the foundation to align clinical practice, accreditation, clinical teaching, student training, quality assurance and ongoing professional development. Articulating the GP role as a scholar, recognises the essential clinical teaching domains and defines the knowledge, skills, attitudes and attributes of a clinical teacher. Identifying these competencies informed descriptors of quality, required training, professional development and potential assessment approaches. A new unified conceptual construct of clinical teacher self-efficacy provides a new dimension for medical education research. Clinical teacher self-efficacy is the confidence and belief that their teaching will positively influence and impact on the learner in the clinical medical environment. Knowledge translation from fields of psychology and education show that self- efficacy is a key factor in influencing the teacher’s professional behaviour, motivation and persistence. It also influences performance and student learning outcomes. A systematic review on the effectiveness of interventions on the self-efficacy of clinical teachers identified a paucity of research. In the few published studies the interventions that positively impacted on self-efficacy in the clinical teacher included: focussed clinical teaching courses, interactivity using clinical scenarios, communication skills and teaching prompts, with peer learning, review and mentoring. There is an international absence of a measurement tool to evaluate self-efficacy in clinical teaching. Consequently a second objective of this thesis was to develop and validate a new Self-Efficacy in Clinical Teaching (SECT) tool. A two-stage evaluation showed SECT to be an authentic and reliable measurement with good content, construct and dimensional validity. The innovation of a low technological intervention using mental imagery and visualisation provided an interactive clinical teacher professional development, and demonstrated the development of self-efficacy in the clinical teacher. Although secondary outcomes showed no impact on indirect performance indicators (supervisor qualities or quality of clinical teaching), further research is indicated. Self-efficacy development can form an effective and integral part of the professional development of clinical teachers and medical educators. The duality of competency and self-efficacy can provide the arms for excellence in Australian general practice and clinical teaching. An increased recognition and support for the clinical teaching roles of the GP will provide community benefits by fostering high quality training, excellent patient care, patient safety, and cost-effectiveness.
Advisor: Stocks, Nigel
Beilby, Justin
Gonzalez, David
Dissertation Note: Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 2016.
Keywords: general practice training
clinical teacher
mental imagery
self-efficacy in clinical teaching (SECT) measurement
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
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