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PURPOSE: This study was done to establish a clinical ladder system for nurses in a small and medium-sized hospital in Korea. METHODS: The study was carried from July, 2016 to May, 2018. Data collection was done in a general hospital with 250 beds located in Gyeonggi Province. The clinical ladder system was developed and operated according to the value system of small and medium-sized hospital. Focus group interviews and a satisfaction survey were conducted for evaluation. Collected quantitative data were analyzed using the SPSS/WIN 22.0 program and qualitative data underwent content analysis. RESULTS: The clinical ladder system is a 5-step ladder that includes 3 domains, 5 nursing competencies and 25 nursing behavioral indicators related to core values of the hospital. The operating system were promotion review system, education system and support/reward system. After conducting a pilot clinical ladder system, satisfaction of nurses was 2.86, out of a possible 4. Nurses who participated in the clinical ladder system experienced improvement in motivation, job performance, self-esteem, professionalism, recognition and were able to develop a goal in their minds. CONCLUSION: The results indicate that the clinical ladder system can be used as a strategy for professional development for nurses in small and medium-sized hospitals.
Career Mobility ; Data Collection ; Education ; Focus Groups ; Gyeonggi-do ; Hospitals, General ; Korea ; Motivation ; Nursing ; Professionalism ; Work Performance

PURPOSE: This study was done to explore the relationship between expectations of the clinical ladder system (CLS), career commitment and turnover intention in nurses employed in small-medium sized hospitals. METHODS: Participants were 154 nurses from 3 small-medium sized hospitals in Gyeonggi Province and Gwangju City. From February, 8 to April, 14, 2017, self-report questionnaires were collected and analyzed using frequency, t-test, ANOVA, Scheffé test, and Person correlation coefficients. RESULTS: Of the participant nurses, 61% perceived the CLS as needed. The mean score for expectation of CLS, career commitment, and turnover intention on 5-point scale were 3.38, 3.17, 3.21, respectively. There were no significant differences in expectation of CLS according to general characteristics, but career commitment and turnover intention did show significant differences depending on age, position, type of work shift. Expectation of CLS correlated positively with career commitment (r=.23, p=.005), and career commitment correlated negatively with turnover intention (r=−.49, p < .001). CONCLUSION: The results of this study show that there is a need to adopt the clinical ladder system to improve career commitment.
Career Mobility ; Gwangju ; Gyeonggi-do ; Humans ; Intention

Medical schools have been slowly adopting online learning into pedagogical methods for more than a decade. While some medical educators are reluctant to accept these changes, the ongoing coronavirus disease 2019 (COVID-19) pandemic poses a threat to the delivery of traditional medical education, which has accelerated the inevitable implementation of online learning. This sudden change may be a new challenge to medical educators who are new to this territory. Therefore, this review aims to provide foundational concepts of online learning and practical guidelines in the context of medical education. The authors first identify three foundational concepts, which are transactional distance, presence, and independent learners. In online learning, transactional distance, determined by dialogue and structure, becomes more important than physical distance. Furthermore, effective and successful online learning requires the achievement and accommodation of cognitive, social, and teaching presences. It is also crucial to recognize learners not as passive recipients of information predefined by a teacher, but as active, capable, and independent individuals. The authors, then, discuss the practical guidelines for designing an effective online curriculum. Five online pedagogical guidelines are laid out in this review: design structures and flows to embrace experiential learning, accommodate both synchronous and asynchronous learning, design/facilitate interactions, promote practice opportunities, and promote a learning community. By understanding the foundational concepts and applying these guidelines, the adoption of online learning in the medical school may supplement the traditional medical education or even provide additional benefits in the new normal after the COVID-19 pandemic.

For the last half-century, interprofessional education (IPE) has been identified and discussed as a critical educational process to facilitate collaboration in order to improve healthcare outcomes for healthcare participants. While the concept is not new, outcome-based research has provided few valid and reliable explanations of whether and how IPE can be effective in healthcare quality improvement. This challenge stems from the struggle to understand the epistemological meaning of IPE. The purpose of this literature review paper is to provide a synthesized understanding of IPE, its meaning, and to provide practical guidance for medical educators. The paper reviewed several key aspects of IPE. Professionalility was discussed to understand the historical background of IPE, followed by an explanation of the international trend of embracing the complexity of health care practice and the need for interprofessional collaboration. Additionally, several theoretical perspectives, such as general systems theory, social identity theory, and community of practice were reviewed to pinpoint what constitutes IPE. Several existing definitions were discussed with similar concepts (i.e., disciplinary vs. professional, and multi-, inter-, vs. trans-) to clarify the nature of knowledge and collaboration in IPE. Three concepts, including practice, authenticity of context, and socialization were proposed as key constructs of IPE, followed by appropriate timing of IPE, outcome research, directions for future research, and guidance for implementation. Community-based medical education practice, professional socialization within a community, and longitudinal system-based outcome research are recommended as future directions for research and practice.
Cooperative Behavior ; Delivery of Health Care ; Education ; Education, Medical ; Education, Professional ; Interprofessional Relations ; Professional Practice ; Quality of Health Care ; Social Identification ; Socialization ; Systems Theory

Professional identity formation (PIF) is an essential concept in professional education. Many scholars have explored conceptual frameworks of PIF and conducted empirical studies to advance an understanding of the construct in medical education. Despite its importance, it is unclear what educational approaches and assessment practices are actually implemented in medical education settings. Therefore, we conducted a literature review of empirical studies reporting educational practices for medical learners’ PIF. We searched the Web of Science database using keywords and chose 37 papers for analysis based on inclusion and exclusion criteria. Thematic analysis was conducted. Most empirical papers (92%) were from North America and Western Europe and used qualitative research methods, including mixed methods (99%). The papers reported the use of reflection activities and elective courses for specific purposes, such as art as an educational activity. Patient and healthcare experiences were also found to be a central theme in medical learners’ PIF. Through an iterative analysis of the key themes that emerged from the PIF studies, we derived the following key concepts and implications: (1) the importance of creating informal and incidental learning environments, (2) ordinary yet authentic patient experiences, (3) a climate of psychosocial safety in a learning environment embracing individual learners’ background and emotional development, and (4) the reconceptualization of PIF education and assessment. In conclusion, research on PIF should be diversified to include various cultural and social contexts. Theoretical frameworks should also be diversified and developed beyond Kegan’s developmental framework to accommodate the nonlinear and dynamic nature of PIF.