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Cited by 27Innovations in Medical EducationInnovative Education and Learning PracticesAppreciative Inquiry and Organizational Change

The paediatric change laboratory: optimising postgraduate learning in the outpatient clinic

Open access
Skipper, Mads, Musaeus, Peter, Nøhr, Susanne Backman·2016·BMC Medical Education
DOI 10.1186/s12909-016-0563-yPMC PMC4736176
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Abstract

BACKGROUND: This study aimed to analyse and redesign the outpatient clinic in a paediatric department. The study was a joint collaboration with the doctors of the department (paediatric residents and specialists) using the Change Laboratory intervention method as a means to model and implement change in the outpatient clinic. This study was motivated by a perceived failure to integrate the activities of the outpatient clinic, patient care and training of residents. The ultimate goal of the intervention was to create improved care for patients through resident learning and development. METHODS: We combined the Change Laboratory intervention with an already established innovative process for residents, 3-h meetings. The Change Laboratory intervention method consists of a well-defined theory (Cultural-historical activity theory) and concrete actions where participants construct a new theoretical model of the activity, which in this case was paediatric doctors' workplace learning modelled in order to improve medical social practice. The notion of expansive learning was used during the intervention in conjunction with thematic analysis of data in order to fuel the process of analysis and intervention. RESULTS: The activity system of the outpatient clinic can meaningfully be analysed in terms of the objects of patient care and training residents. The Change Laboratory sessions resulted in a joint action plan for the outpatient clinic structured around three themes: (1) Before: Preparation, expectations, and introduction; (2) During: Structural context and resources; (3) After: Follow-up and feedback. The participants found the Change Laboratory method to be a successful way of sharing reflections on how to optimise the organisation of work and training with patient care in mind. CONCLUSIONS: The Change Laboratory approach outlined in this study succeeded to change practices and to help medical doctors redesigning their work. Participating doctors must be motivated to uncover inherent contradictions in their medical activity systems of which care and learning are both part. Facilitators must be willing to spend time analysing both historical paediatric practice, current data on practice, and steer clear of organisational issues that might hamper a transformative learning environment. To ensure long-term success, economical and organisational resources, participant buy-in and department leadership support play a major role.

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  • Change Laboratory interventions have been carried out and reported in various medical settings in Finland, Denmark, Brazil, and the United Kingdom.

    “Change Laboratory interventions have been carried out and reported in various medical settings in Finland (Engeström 2018), Denmark (Skipper et al. 2016), Brazil (Vilela et al. 2020;Grilo Diniz et al. 2020, in press) and the United Kingdom (Reid et al. 2015;Morris et al. 2020, in press).”

    From Using activity theory to transform medical work and learning (2021) · cites this paper as Skipper et al. 2016

  • The Change Laboratory has been shown to be of use in medical education contexts.

    “The Change Laboratory has been shown to be of use in medical education contexts.”

    From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [38]

  • In Denmark, researchers used the Change Laboratory to develop innovative change in a pediatric department and new ways of learning and practice, conceptualizing the conflict between learning and patient care as two contradicting activity systems.

    “In Denmark, researchers utilized the Change Laboratory to develop innovative change in a pediatric department and develop new ways of learning and practice. The conflict between learning and patient care were conceptualized as two activity systems contradicting each other.”

    From Cultural Historical Activity Theory for Studying Practice-Based Learning and Change in Medical Education (2021) · cites this paper as [38]

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Authors
Skipper, M., Musaeus, P., & Nøhr, S. B.
Affiliations
Aarhus University (DK)
Corresponding author
Skipper, Mads
ORCID
Venue
BMC Medical Education
Publisher
Springer Science and Business Media LLC
Published
2016-02-02
Volume
16
Issue
1
Pages
42-42
ISSN
1472-6920 (ISSN-L)
DOI
10.1186/s12909-016-0563-y
PMC
PMC4736176
OpenAlex
W2263177611
Cited by
27
References
41
Citations by year
2026: 3 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 3 · 2019: 5 · 2018: 3 · 2017: 1
FWCI
2.98
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMC Medical Education (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • VBN Forskningsportal (Aalborg Universitet) (submittedVersion, other-oa)
Funders
Doctor Inger Goldmanns Fund
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
  • Social Sciences › Human Factors and Ergonomics › Innovative Education and Learning Practices
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Appreciative Inquiry and Organizational Change
Keywords
Change Laboratory, pediatric outpatient clinic, graduate medical education, residency training, workplace learning, activity theory, expansive learning, organizational restructuring
MeSH terms
Continuity of Patient Care, Denmark, Education, Medical, Graduate, Hospitals, University, Humans, Internship and Residency, Organizational Innovation, Outpatient Clinics, Hospital, Pediatrics, Pilot Projects, Organizational Culture, Models, Educational, Patient-Centered Care, Organizational Case Studies

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