Healthcare Student Well-Being within Informal Learning Spaces
Caroline Mozo Prospectus Defense 11.23.20
Introduction
18 Million healthcare workers in the USA
Introduction
(CDC, 2017)
18 Million healthcare workers in the USA
Medical Doctor (MD)
Introduction
Physician Assistant (PA)
(CDC, 2017)
Registered Nurse (RN)
High demand as the USA experiences a growing Healthcare Shortage
(AAMC, 2019; Gdiesing, 2019; Mercer, 2020)
Medical Doctor (MD)
Introduction
Physician Assistant (PA)
Registered Nurse (RN)
Introduction
High attrition rates of healthcare students could contribute to this Growing shortage (Hamshire et al., 2019; Hamshire et al., 2013)
Introduction
Student Well-being is critical to student success + elements of the built environment within
Introduction
Student Well-being is critical to student success + elements of the built environment within
Informal learning spaces can positively influence student well-being (Ashwood et al., 2013; Mokgele & Rothmann, 2014; Tackett et al., 2016)
Introduction
This presentation will review... The Current State of the Healthcare Profession Healthcare Providers Roles + Responsibilities Healthcare Instruction Educational Environments
This presentation will review... The Current State of the Healthcare Profession Healthcare Providers Roles + Responsibilities Healthcare Instruction Educational Environments Student Well-Being Well-Being Well-Being + the Built Environment Methodology
The Current State of the Healthcare Profession
3.65 Trillion American dollars spent on healthcare in 2018
(Herman, 2019)
The Current state of the healthcare Profession
3.65 Trillion American dollars spent on healthcare in 2018
(Herman, 2019)
Projected to continue growing at a rate of annually + represent
5.5 percent
19.4 percent of the nation’s GDP by 2027
(Sisko et al., 2019)
The Current state of the healthcare Profession
3.65 Trillion American dollars spent on healthcare in 2018
(Herman, 2019)
Projected to continue growing at a rate of annually + represent
5.5 percent
19.4 percent of the nation’s GDP by 2027
(Sisko et al., 2019) 7% = 55,400 MDs
31% = 37,000 PAs
The Current state of the healthcare Profession
12% = 371,500 RNs
Estimated that by 2025, the USA can expect a workforce gap of approximately
-680,430 workers
(Mercer, 2020)
The Current state of the healthcare Profession
Estimated that by 2025, the USA can expect a workforce gap of
-680,430
approximately workers (Mercer, 2020) This mounting shortage stems from several contributing factors including:
The Current state of the healthcare Profession
Estimated that by 2025, the USA can expect a workforce gap of
-680,430
approximately workers (Mercer, 2020) This mounting shortage stems from several contributing factors including:
aging + retirement of practitioners
practitioner burnout + fatigue
lack of emerging graduates
The Current state of the healthcare Profession
COVID-19
Healthcare Providers Roles and Responsibilities
primary healthcare team
A is typically comprised of physicians, PAs, + RNs (AAFP, 2017; Denver Health, 2011)
Physician (Medical Doctor)
Physician Assistant (PA)
Registered Nurse (RN)
Healthcare Providers Roles and Responsibilities
Physicians, also referred to as doctors, are primary healthcare providers + key members of the team
- approximately 595,491 active MDs (AAMC, 2017) - 4 years towards bachelor’s degree - 4 years towards MD - 3 - 8 years of internship + residency (Denver Health, 2011) - clinicians practice within clinical settings - 3 part United States Medical Licensing Examination (USMLE) aka “the Boards” (AMA, 2020; USMLE, 2020) - pathophysiological perspective - diagnosis + treatment driven - focus on the signs + symptoms (Pangaro & Romano, 2014) Medical Doctor (MD)
Healthcare Providers Roles and Responsibilities
Physician assistants are emerging primary
healthcare providers that work alongside other members of the healthcare team
Physician Assistant (PA)
- relatively new discipline - profession is rapidly growing (AAMC, 2017) - approximately 130,620 certified PAs in the USA - 4 years towards bachelor’s degree - 2-3 years towards master’s degree in Physician Assistant Studies - Physician Assistant National Certifying Examination (PANCE) (AAPA, 2020; Mayo Clinic, 2020; University of Kentucky, 2020) - mid-level practitioner under the supervision of physicians (Kartha, 2014; Shiel, 2018) - provide many of the same services as their supervising physicians
Healthcare Providers Roles and Responsibilities
Registered nurses are critical members of the healthcare team and play a unique and expansive role (Gwynedd Mercy University, 2020)
- estimated 2,951,960 active practitioners (BLS, 2018) - spend the most time engaging with and providing face-to-face care to patients (Pangaro & Romano, 2014) - either a 2 year associate degree in nursing or a 4 year bachelor’s degree in nursing - state-required National Council Licensure Examination for Registered Nurses (NCLEX-RN) (Gwynedd Mercy University, 2020; Mayo Clinic, 2020; NCSBN, 2020)
- RNs deliver direct patient care while also serving as health educators + advocates (ANA, 2020; Davoodvand et al., 2016;
Gerber, 2018)
Registered Nurse (RN)
- sociological perspective (Pangaro & Romano, 2014)
Healthcare Providers Roles and Responsibilities
Healthcare Instruction
Doctor of Medicine (MD) - 19,936 graduates for 2018-2019 (AAMC, 2019) - 4 year curriculum - lecture, laboratory, simulation, + clinicals (AAMC, 2020; The Princeton Review, 2020)
Future MD
Healthcare instruction
- years 1 + 2 involve preclinical education, which focuses on science, physiology, disease processes, + treatment - 4 - 8 hours of class, 5 days a week - years 3 + 4 involve clinical education, including clerkships + clinical rotations at affliliated hospitals or clinics - students typically work 12 hour shifts in clerkships + clinical rotations (AAMC, 2020) - students also begin the process of completing “the Boards� ((AAMC, 2020; BLS, 2017; The Princeton Review, 2020; USMLE, 2020)
Master in Physician assistant studies (MPAS/MS-PAS) - over 9,000 graduates each year (AAPA, 2019) - most programs are approximately 3 years (AAPA, 2020; ARCPA, 2020; PAEA, 2020)
- year 1 focuses on the foundations of medical science, medical therapeutics, + pathophysiology (AAPA, 2020; Tufts University, 2020)
- 6 - 8 hours of class, 5 days a week (Tufts University, 2020) - years 2 + 3 students will complete upwards of 2,000 clinical hours in clinical disciplines (AAPA, 2020; Tufts University, 2020) Future PA
Healthcare Instruction
Bachelor of Science In Nursing (BSN)
- 4 year BSN program - many job opportunities require a BSN - BSN required to attain graduate level nursing degrees - combination of in-class learning and clinical rotations - typical ratio of 3 clinical learning hours per every 1 hour of classroom instruction (Nurse Journal, 2014)
Future RN
Healthcare Instruction
Typical course And Clinical offerings aCross Disciplines Course/Clinical
MD
MPAS/MS-PAS
BSN
x x x x x x x x x
x x x x x x x x x
x x x x x x x x
Anatomy Physiology Microbiology Pharmacology Reproductive Health Psychology Pediatrics Family Medicine Clinical Medicine
Healthcare Instruction
educational Environments
formal learning spaces
In , instructors lead students in dedicated educational spaces (Dowling, 2020)
Educational environments
formal learning spaces
In , instructors lead students in dedicated educational spaces (Dowling, 2020)
Lecture Halls
Classrooms
Educational environments
Laboratories
Clinical Settings
Lecture Halls are large formal learning
environments that can accommodate upwards of 500 occupants (Hanley, 2017)
Learning - passive, active, auditory, + visual
Features
- instructor lead - delineated instructor + student zones
Technology
- microphones - projectors - document cameras - computers Educational environments
Courses
- Anatomy - Physiology - Biology
- Chemistry - Psychology - Nutrition
Classrooms function similarly to lecture halls; however, they are smaller in scale Learning - passive, active, auditory, kinesthetic, + visual
Features
- instructor lead - distinct instructor + student zones - flexible seating
Technology
- smartboards - projectors - document cameras - computers Educational environments
Courses
- Communication - Substance in Health Abuse + Effects - Multicultural on Health Factors + Health
Laboratories (labs) are designed + equipped with specialty equipment to accommodate learning Learning
- passive, active, auditory, kinesthetic, visual, hands-on, + experiment-driven
Features
- instructor lead - teaching, research, wet, dry, + simulation labs
Technology
- specialty equipment - smartboards - projectors - document cameras - computers Educational environments
Courses
- Anatomy Lab - Clinical Lab - Chemistry Lab Science - Biology Lab
Clinical Settings Learning
- passive, active, auditory, kinesthetic, visual, hands-on, + experiential
Features
- variety of healthcare settings (hospitals, outpatient clinics, medical offices)
Technology - specialty medical equipment
Educational environments
Clinicals
- Pediatric - Surgery - Geriatric - Urology - Family Medicine - Emergency Medicine
Distance Learning Learning - passive, active, auditory, + visual
Features
- may be conducted either synchronously or asynchronously
Technology
- websites - web conferences - online textbooks -instructional videos Educational environments
Courses - program offerings vary
Informal learning spaces refer to a variety of spaces that accommodate student-led learning (Smith & Costello, 2018)
ownership of learning belongs to the student
Gathering Spaces
Library Spaces
Corridor Spaces
student centers, student unions, + outdoor spaces
alcoves, lobbies, computer stations, + other unassigned spaces
courtyards, plazas, + transitional spaces
Educational environments
Research has suggested that
built environment elements can support student learning + engagement
(Fisher, 2015; Laage et al., 2019; Lanteigne, 2017)
setting
lighting
noise Educational environments
crowding, personal space, territoriality, + privacy color
environmental competence
S
Student Well-Being
rigor and expectations
Given the of healthcare curriculums, many students struggle to succeed + complete their programs of study (Boylan & Fowler, 2010)
Student Well-being
rigor and expectations
Given the of healthcare curriculums, many students struggle to succeed and complete their programs of study (Boylan & Fowler, 2010)
Stressors
Common involve academic, interpersonal, intrapersonal, or environmental factors (Bulo & Sanchez, 2014)
Student Well-being
rigor and expectations
Given the of healthcare curriculums, many students struggle to succeed and complete their programs of study (Boylan & Fowler, 2010)
Stressors
Common involve academic, interpersonal, intrapersonal, or environmental factors (Bulo & Sanchez, 2014)
1/3 of undergrads
experience mental health issues
Student Well-being
rigor and expectations
Given the of healthcare curriculums, many students struggle to succeed and complete their programs of study (Boylan & Fowler, 2010)
Stressors
Common involve academic, interpersonal, intrapersonal, or environmental factors (Bulo & Sanchez, 2014)
1/3 of undergrads 3rd leading cause experience mental health issues
Student Well-being
of death among young adults is suicide
rigor and expectations
Given the of healthcare curriculums, many students struggle to succeed and complete their programs of study (Boylan & Fowler, 2010)
Stressors
Common involve academic, interpersonal, intrapersonal, or environmental factors (Bulo & Sanchez, 2014)
1/3 of undergrads 3rd leading cause experience mental health issues
Student Well-being
of death among young adults is suicide
1/5 of students
had thought about suicide
rigor and expectations
Given the of healthcare curriculums, many students struggle to succeed and complete their programs of study (Boylan & Fowler, 2010)
Stressors
Common involve academic, interpersonal, intrapersonal, or environmental factors (Bulo & Sanchez, 2014)
1/3 of undergrads 3rd leading cause experience mental health issues
of death among young adults is suicide
1/5 of students
had thought about suicide
Students who do experience mental health issues are especially at risk for reduced (Ashwood et al., 2015)
educational outcomes
Student Well-being
Studies have linked several factors to students’ overall sense of
well-being
course study demands
study resources
burnout and fatigue
general health
alcohol use
satisfaction with life
traumatic experiences
engagement
behavioral issues
sense of control mental health support sense of community
Student Well-being
at risk for reduced well-being Healthcare students may be especially
Student Well-being
at risk for reduced well-being Healthcare students may be especially
Reduced Well-Being = absenteeism, presenteeism, suicide, poor retention, + reduced patient care
Student Well-being
at risk for reduced well-being Healthcare students may be especially
Reduced Well-Being = absenteeism, presenteeism, suicide, poor retention, + reduced patient care
Student Well-being
Healthcare students self-reported lower levels of well-being compared to students of other disciplines at the end of their programs
at risk for reduced well-being Healthcare students may be especially
Reduced Well-Being = absenteeism, presenteeism, suicide, poor retention, + reduced patient care
Student Well-being
Healthcare students self-reported lower levels of well-being compared to students of other disciplines at the end of their programs
Physician suicide rates are reportedly higher than those of the general population
Well-being
Defining well-being A Timeline 1948
“a state of complete physical, mental and social well-being + not merely the absence of disease or infirmity”
WHO
1969
“the degree to which he has an excess of positive over negative affect”
Bradburn
1978
“a global assessment of a person’s quality of life according to his own chosen criteria”
Shin + Johnson
1989
identified its antecedents, including positive interrelationships, self-acceptance, purpose in life, environmental mastery, a realization of potential, + autonomy “pleasant and unpleasant moods and emotions, whereas life satisfaction refers to a cognitive sense of satisfaction with life”
1997 well-being
Ryff Diener + Suh
Current Constructs:
Objective well-being
Objective well-being refers to the external and universal, meaning outside of one’s individualized, personal experience, and is often thought of as meeting basic needs; often associated with quality of life and financial/economic well-being
well-being
Current Constructs:
Subjective well-being
Subjective well-being is associated with the internal, personalized experience of each unique individual, often compared to happiness as it focuses on the perspective of the individual and their feelings; most often measured via self-reported scales related to individual’s perceptions of themselves and the world around them
well-being
Current Constructs of
Well-being
Well-Being
Objective
Eudaimonic
x
Physical
x
Financial/Economic
x
Subjective x
Hedonic
x
Social
x
Emotional
x
Psychological
well-being
x
x
Well-being and the built environment
Roger Ulrich further asserts this relationship
between well-being + the built environment in his theory of supportive design
A Sense of Control
Access to Social Support
Well-being and the built environment
Access to Positive Distractions
Research has suggested that the following
Interior Elements have the greatest potential to support user well-being
circulation + sightlines
lighting
acoustics
Well-being and the built environment
access to natural views + biophilic elements
color
furniture arrangement, choice, + ergonomics
S
Methodology
purpose
This research study aims to investigate the relationship between healthcare student well-being + the built environment within informal learning spaces The goal is to develop design considerations for healthcare informal learning spaces that support student well-being + add to the growing body of knowledge related to well-being + the built environment
Methodology
Research Questions How do informal learning spaces within healthcare instruction facilities affect healthcare student well-being? a. Which elements of the built environment support student well-being? b. Which elements of the built environment negatively impact student well-being? c. How can informal learning spaces be designed to foster community, encourage engagement, + reduce fatigue + burnout in healthcare students?
Methodology
Target Sample Population - university students in MD (medical doctor) degree program, master’s degree in physician assistant studies program, or bachelor’s degree in nursing program - purposive sampling - participants will be recruited from a Carnegie R1 University located in the American Southeast as well as student members of 3 healthcare professional organizations - focus group participants will be a sub-set of approximately 30 survey participants enrolled in the selected university, selected based upon their stated interested in the survey, + qualifying survey responses to inclusion criteria
Methodology
Instruments - Survey - built in Qualtrics - comprised of 4 parts - 73 questions related either to well-being, the assessment of the built environment, + participant demographics - estimated time of completion is 15 minutes - “Ryff Scales of Psychological Well-Being” has been chosen for its reliability + theoretical grounding (Burns & Machin, 2008; Kállay & Rus, 2014; Ryff & Keyes, 1995) - at the completion of the survey, students will be asked if they would be interested/willing to participate in a focus group with offer of an incentive
Methodology
Instruments - Focus Group - remote online focus groups using Zoom - multiple focus groups will be conducted with students recruited from the online survey - each focus group will comprised of 6 students - last between 30 + 60 minutes - all participants will be given basic rules + guidelines at the start - each participant will be given numbers to match them to their survey responses - format will be conversational with high moderator involvement via guided, verbal questions to allow students to expand on the survey topics - questions will focus on the stressors (curriculum-based + environmental), how time is spent, + supports + hinderances in these spaces
Methodology
In conclusion This study serves to investigate the relationship between healthcare students’ perceptions of their own well-being and their informal learning environments. The goal is to develop design considerations that will help support student well-being in order to support their academic and professional development. One of the interior design profession’s central goals is to enhance the human experience through the design and manipulation of the built environment, ultimately impacting the health and well-being of users (ASID, 2020; NCIDQ, 2020). Healthcare designers have been and continue to be leaders in evidence-based design (EBD) practices that inform their designs (Hamilton, 2016; Peavey & Wyst, 2017; Stichler, 2016). Through continued research and investigation, the interior design profession will continue providing new insights related to the built environment’s impact on the American healthcare industry.
Methodology