Patience, Persistence and Pragmatism: Experiences and Lessons Learnt from the Implementation of Clinically Integrated Teaching and Learning of Evidence-Based Health Care - A Qualitative Study

Background

Clinically integrated teaching and learning are regarded as the best options for improving evidence-based healthcare (EBHC) knowledge, skills and attitudes. To inform implementation of such strategies, we assessed experiences and opinions on lessons learnt of those involved in such programmes.

Methods and Findings

We conducted semi-structured interviews with 24 EBHC programme coordinators from around the world, selected through purposive sampling. Following data transcription, a multidisciplinary group of investigators carried out analysis and data interpretation, using thematic content analysis. Successful implementation of clinically integrated teaching and learning of EBHC takes much time. Student learning needs to start in pre-clinical years with consolidation, application and assessment following in clinical years. Learning is supported through partnerships between various types of staff including the core EBHC team, clinical lecturers and clinicians working in the clinical setting. While full integration of EBHC learning into all clinical rotations is considered necessary, this was not always achieved. Critical success factors were pragmatism and readiness to use opportunities for engagement and including EBHC learning in the curriculum; patience; and a critical mass of the right teachers who have EBHC knowledge and skills and are confident in facilitating learning. Role modelling of EBHC within the clinical setting emerged as an important facilitator. The institutional context exerts an important influence; with faculty buy-in, endorsement by institutional leaders, and an EBHC-friendly culture, together with a supportive community of practice, all acting as key enablers. The most common challenges identified were lack of teaching time within the clinical curriculum, misconceptions about EBHC, resistance of staff, lack of confidence of tutors, lack of time, and negative role modelling.

Conclusions

Implementing clinically integrated EBHC curricula requires institutional support, a critical mass of the right teachers and role models in the clinical setting combined with patience, persistence and pragmatism on the part of teachers.

Benevolent Patriotism: Art, Dissent and the American Effect

This article examines the role of contemporary art in a post-9/11 context through The American Effect exhibition at the Whitney Museum of American Art in New York in 2003. This exhibition displayed a range of artworks from around the world that specifically engaged with, commented upon and interrogated the USA's pre-eminent position as a global superpower. In the politically charged climate after 9/11, the exhibition offered itself as a critical voice amid the more obvious patriotic clamour: it was one of the places where Americans could ask (and answer) the question, `Why do they hate us so much?' Although The American Effect claimed to be a space of dissent, it ultimately failed to question, let alone challenge, US global hegemony. Instead, the exhibition articulated a benevolent patriotism that forced artwork from other nations into supplicating and abject positions, and it obscured the complex discursive networks that connect artists, curators, critics, audiences and art museums.