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Articles

Students’ ways of experiencing writing a bachelor’s thesis: a phenomenographic interview study

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Pages 1640-1653 | Received 15 Apr 2022, Accepted 02 Dec 2022, Published online: 20 Feb 2023

ABSTRACT

A bachelor’s thesis can be characterized as a proof of basic research and a trajectory of academic writing. This study addresses students’ ways of experiencing the writing process at the halfway stage, a stage that has been ignored in research. In a phenomenographic interview-study design, semi-structured interviews with 15 nursing students were carried out. A phenomenographic analysis of the data represents an outcome space with four categories of ways of experiencing writing: A. Structure, B. Comparison, C. Shift, and D. Relation. The categories of ways of experiencing the writing of a bachelor’s thesis constitute a range of foci, from solitary writing and assurance of the textual structure to a shared understanding, discussion, and transformation. This study confirms that sharing the preparation of texts in groups at the halfway stage can promote academic and relational skills. Conclusions address the nature of academic writing at the halfway stage and discuss potential pedagogical implications of the transformation from writing for oneself to writing for others, across disciplines and beyond academic levels.

Introduction

Bachelor’s theses (BT) are acknowledged as the written proof of acquired basic research skills and understanding of theory in the core subject of study at university (Ashwin et al., Citation2017). Furthermore, the writing of academic theses is often described as a continuum of growth and development. However, the particular steps students experience in the pursuit have largely been ignored in research, and especially so when it comes to nursing education, which is the educational domain of this study.

As with other practice-based professions, over the past few decades, nursing education has become gradually integrated into higher education (HE) (EHEA, Citation1999). This transformation has prompted a rapid academization and a continuous launch of novel designs to stimulate learning activities involving academic writing and student research (Bailey et al., Citation2015; Jordal et al., Citation2021).

This development has also raised the expectations regarding academic writing which, in turn, has impacted how the task is carried out and experienced by students. Therefore, this study attempts to provide insights into students’ experiences of writing a BT in nursing education. In particular, the results bring to the fore aspects of educational relevance at the halfway stage of the process of writing.

Academic writing in higher education

Delahunt et al. (Citation2012) summarize three learning purposes for academic writing at university: study skills purpose, academic integration and disciplinary identity-building. While the study skills discourse stresses students’ compliance with academic standards of writing, students’ academic integration and disciplinary identity-building are seen as demanding challenges both by students and educators (Hamilton et al., Citation2010).

Generally, students’ carrying out of independent theses depicts a trajectory of struggling and increasing awareness of the complexities of the task (Altınmakas & Bayyurt, Citation2019; Roderick, Citation2019). Students’ ways of working with theses have also been described as representing qualitatively different processing in terms of deep and surface approaches to thesis writing (Lavelle & Guarino, Citation2003; Lundgren & Halvarsson, Citation2009). Characteristic of a deep approach is a focus on the topic of writing which is experienced as interesting and meaningful. A deep approach typically involves an intention to search for meaning and engage in a creative writing process. Experiencing a lack of meaning in the task, on the other hand, can lead to a surface approach where writing merely becomes a process of compiling and presenting unrelated facts (Lavelle et al., Citation2013).

Arguably, in their efforts to write academic theses, students are found to deploy various attitudes and beliefs (Lavelle et al., Citation2013). According to Greenbank and Penketh (Citation2009), students may rely on experiential intuition about meeting scores and less on the formal supervision provided through textbooks and written feedback. Mitchell et al. (Citation2019) showed that low self-efficacy in academic writing can hamper students’ understanding and integration of supervision feedback into their theses. Another aspect of importance for academic writing relates to the context in which such writing can be practised. Spaces that facilitate dialogue and active student engagement in topics studied can promote students’ sense of competency in relation to tasks confronting them in various settings (Dysthe et al., Citation2006; Nicol, Citation2010). Although academic writing constitutes a situated and contextual task (Kember et al., Citation2020), research also shows different levels of transitions taking place. As Prosser and Webb (Citation1994) showed, students can be well aware of their own shortcomings after the writing work is completed. This points towards a potential to students’ own reassessing of their texts at a later phase, and independent of immediate feedback. Lundgren and Robertsson (Citation2013) showed how former students experience skills and knowledge acquired from thesis writing as useful in health care work.

One of the most established frameworks of academic writing, often used in relation to teaching and supervision is the process-product theory (Dovey, Citation2010). The thesis work as a product represents a focus on an efficient and accurate final academic product, while the process view denotes the process of textual maturation and the writer’s own investigative writing path (Ajjawi et al., Citation2021). Research that builds on this framework shows that before the start of writing, students expect to get support with problem-solving (process) whereas methodological knowledge (product) is deemed as less important at this point (Henricson et al., Citation2018). While there is a good deal of research that confirms students’ feelings of reward when the task is completed, we still know rather little about the halfway stage of writing. What we do know is that issues such as time management and the increasing workload seriously challenge students’ sense of control of the task at this point (Donnelly et al., Citation2013; Negretti, Citation2012). Furthermore, since the outcome of success or a failure is not yet known to the students, the halfway situation can be said to constitute a space of liminality in learning (Meyer & Land, Citation2003).

This study brings to the fore experiential and in-depth aspects of the halfway stage of learning and writing a BT. We argue that if educators can have a deeper knowledge about students’ various ways of experiencing the writing at this point, much can be achieved in targeting support and curriculum adequately. Thus, this paper reports results from a study with the aim of describing nursing students’ ways of experiencing the process of writing a bachelor’s thesis at the halfway stage.

Phenomenography as research approach, methodology and theory

Phenomenography as a research approach aims to observe and describe students’ studying, learning, and understanding of subject matter and to describe the phenomena being learnt. It is an explorative approach relying on the notion that empirical observation and theory should meet halfway, so that a theory can be put to the test and developed, instead of being taken for granted. Phenomenography is not based on phenomenology or any other specific philosophy but on empirical research of descriptions of qualitatively different ways of experiencing different aspects of a subject matter (Svensson, Citation1997). So, phenomenography as an approach enables the investigation of critical aspects that can influence learners’ conceptions of learning material and thus has the potential to identify important drivers of students’ learning processes (Marton & Booth, Citation1997). This approach takes its point of departure in a non-dualist ontology where an individual, and what is learnt, denotes an internal relationship of meaning between the individual and the world. This second-order perspective can reveal critical aspects of learning and understanding. Conceptions and understandings are the epistemological manifestations of an individual’s awareness of aspects of particular phenomena (Marton, Citation1981). Phenomenographic research has shown that the awareness is connected to what it is possible to experience, conceive and understand on that particular occasion and thus, can be transformed through learning and teaching (Marton, Citation1997). In other words, the aim of a phenomenographic study is not to reveal what learning is, but rather to find out how learning can be brought about (Runesson Kempe, Citation2022). Phenomenographic research within nursing education has yielded information about students’ challenges in conceptualizing critical topics which can be used to inform teaching (Barry et al., Citation2017).

The present study

Practically, in the context of this study which concerns nursing education, writing of a BT involves a 10-week full-time module including an instruction lesson, independent writing, and five sessions of group supervision with six to eight students and a teacher. Students use digital and printed resources supporting organization of the structure in the work and with academic writing style. Furthermore, students access library tutoring to perform structured searches in selected databases. The BT is written as a literature review, as promoted especially in health and social professions courses for their alignment to evidence-based practices (EBP), which are required in these professional fields (Aglen, Citation2016). A BT is individually graded but may be written with a peer from the same course year. A formal defence seminar with another peer group acting as opponents finalizes the module. The examiners of BTs have a PhD, and supervisors are teachers with a minimum qualification at masters’ level.

Thus, in the context of this study, the students are at a halfway stage of their writing and about to receive, or have just received, midpoint assessments from an examiner that are formative for further revisions of the work.

Method

Participants

A purposive sample of 15 nursing students, undergoing their final year of the nursing education programme at a Swedish university, was recruited in two steps. Two of the authors were involved in the first step, presenting the study in connection with a lecture that starts the module of writing a BT. All students who took part on that occasion were shown a 5-min PowerPoint presentation at the end of the lecture, informing them that voluntary interviews would take place at the halfway stage of writing a BT. Thereafter, a consent was collected for possible participation in the study five weeks after the students’ commencement of writing. In the second stage of recruitment, the first author contacted students (n = 22), who initially had volunteered to participate, by email. A total of 15 students confirmed their participation in interviews. In phenomenography, a purposive sample of 15–20 participants is regarded enough to ensure sufficient variation (Tight, Citation2016). shows demographics of the interviewed students.

Table 1. Presentation of demography of the participants.

Data collection

The semi-structured interviews were carried out 2019–2020 at a location and time chosen by the participants. Accordingly, two of the interviews were held in cafes, and 10 were carried out in a meeting room at the university. Due to the restrictions of the COVID-19 pandemic in spring 2020, three of the interviews were held through a digital conversation platform, Zoom. The interviews lasted between 20 and 90 min and were audio recorded with a separate digital audio recorder (not by Zoom). The starting question framed the focus of the question on the process of writing: ‘Could you please tell me about your writing of a BT at this point?’. Furthermore, probing questions were posed to capture the students’ own elaborations on working with the BT (Ashworth & Lucas, Citation2000; Bruce, Citation1994). After completing data collection, the interviews were transcribed verbatim.

Ethical considerations

Following the declaration for Good Research Practices (Swedish Research Council, Citation2017), an informed written consent to the data collection was obtained from all participants. Information about voluntariness and right to withdraw participation without consequences was conveyed to every participant. To protect the participants’ confidentiality, the transcripts were anonymized by the first author. That is, other authors in the research group had access to anonymized material only. Original tapes were kept digitally secured by the first author in a personal USB with a two-step authentication code. Approval from the Regional Ethics Review Board in Stockholm is registered with number 2017/639–31/5.

Analysis

Data were analysed using phenomenography, a qualitative research approach to capture variation in peoples’ different ways of experiencing phenomena in the world – in this case, the writing of a BT (Marton & Booth, Citation1997).

In detail, a seven-step analysis including familiarization, condensation, comparison, grouping, articulating, labelling, and contrasting was conducted, with a focus on students’ different ways of experiencing the writing of a BT (Sjöström & Dahlgren, Citation2002; Stenfors-Hayes et al., Citation2013).

  1. In the first step, to familiarize with the whole of the material, reflective notes were taken along with reading the transcripts.

  2. The second step involved further reading of the whole material in parallel with identifying and condensing purposeful sentences in the transcripts into manageable meaning units.

  3. In the third step, the meaning units were collected separately, allowing for comparison of their similarities and differences.

  4. The fourth step involved grouping of meaning units that indicated resemblance, also regrouping due to differences interpreted in the ways of experiencing the writing of BT.

  5. The fifth step involved a preliminary articulation of the meaning embedded into preliminary categories, and relations between the categories. In this phase, an independent assessor appraised the preliminary categories several times by comparing them with longer excerpts from the transcripts.

  6. In the sixth step, each category was established based on its coherence and distinctiveness by mapping the meaning of ways to experience the writing of a BT.

  7. The final, seventh step involved a comparison of the whole material, i.e., the range of meaning and completeness covered in the categories and the relationships amongst them. According to conventions in the research field, this phase was performed collectively, both by all the authors and externally with a collegium for phenomenography and variation theory.

Results

Four hierarchically inclusive categories of qualitatively different ways of experiencing the writing of a BT at the halfway stage constitute the following outcome space of variation:

  1. Structure

  2. Comparison

  3. Shift

  4. Relation.

In the following, each category is described in more detail together with key excerpts highlighting each particular way to experience the process of writing a BT. Each excerpt is attributed to a study participant, noted as Student 1–15.

A. Structure

This category describes the way of experiencing the writing of a BT by focusing on its structural visual properties at this point. Typically, working on a visual layout of the different sections, such as putting in references, were described. Focusing on the structure of the BT requires careful, piece-by-piece working. Hence, unclarity of instructions, templates and digital writing tools were emphasized as problems. Accounts in this category describe a stylistically and aesthetically correctly structured BT as a label for meticulous care, regarding the appeal of the text. At this point, the way of experiencing represents the writing as assuring an individual BT, rather than a linking to the peer group or an academic community of reference.

It feels a little like expressing myself in writing is my strength. I think that words are a lot of fun. I like to formulate myself and see how a small word can make a difference, or a sentence construction. I think it is fun formatting texts because it becomes neat and structured, and it feels good when it’s structured. (Student 4)

It is nice when one knows how it should be, that one can make it look consistent throughout – in running text, seeing the references, and how one references the sources in the text – so one sees that it all hangs together and it looks clean and tidy. It is something one must work on now. (Student 15)

B. Comparison

Over and above a focus on textual production, as in category A, this category describes that standards communicated by the examiner, supervisor, peers and guidelines were seen as means in continuous comparisons of differences and similarities to the structure of one’s own text. Linking to established standards of textual quality, comparison could be justified as the writer often ‘becomes blinded by one’s own writings’ (Student 8). In order ‘to do it right’ (Student 3), comparison also relates to use of correct format of academic language in the text. Here, the focus is dynamic where understanding of differences and similarities is shared with others. Thus, this category shows an opening for academic cooperation in activities to assure validity in the production of texts.

… we were supposed to do a quality appraisal according to the school’s template … and when we had to look into another group’s work, I checked their chosen articles, looked them up and checked if the group had written correctly. I found some mistakes and omissions. (Student 1)

‘I am not sure, but it is scientific, I suppose, that one must write in a certain way and not use colloquial language, and that one must not have own views and such but instead write based on facts and science and such … ’ ‘Yes, we check each other’s texts. One learns then a great deal about others’ work. One learns things that one maybe wouldn’t have done otherwise’. (Student 3)

I can then look at text or clips we must not write. It becomes somewhat this methodology of presentation that is about the same for everyone. We are not allowed to copy of course but write in one’s own words – but it will be somewhat the same context in any case. Then one can use the trick of copying a text and rewriting it when you have it in one’s paper. I read books and then I try to reformulate what I think is important and the sentences and get it into the text. One notices what one does – one marks what one thinks is important and then one lifts it in and moves it around until it is right. So, one starts a little broader and then narrows down, and then one changes and reformulates and after that also writes about something extra. I try to define as much as possible and write as clearly as possible. I don’t know if it is with the idea that it should really be so that anyone can read and understand. (Student 6)

C. Shift

This category holds ways, over and above writing as Structure (A) and as Comparison (B), of experiencing the contents in the BT from other perspectives than one’s own. The way of experiencing writing as shift entails a focus on decisions for inclusion of material in the BT. Typically, shifts entail extensive writing and rewriting. To come to terms with changes and improvements and to write anew, to see the work from others’ point of view is thus seen as necessary. However, feedback from others could be either rejected or accepted due to unclarities and misunderstanding of the text being discussed. This category points towards an awareness of shifts in terms of experiencing the arguments in the text becoming collectively proven. Thus, the category describes a notion of assuring, adjusting, and changing ones’ text in a scholarly dialogue with others in the same context.

That is probably what is the hard part – being able always to stand on as good ground as possible before the coming opposition, that one has as concrete and good facts as possible … So, it is difficult because it is never possible to predict what another person will think when they read one’s work. It is very, very difficult. The only thing one can really do is to read and critically examine oneself and just try, try to see what it is that another person could actually pick up on, what they could find that they may be a bit critical of. Critical facts, or if one has chosen a category in the result that they may think does not really answer the research purpose. ‘Why have you chosen this and not this?’ for example. So, we have a separate document where we write where we have filled in that this is okay, but someone could take this up at the opposition. We can make any changes there and then at once – that, okay, if we write like this, we will support ourselves with four sources instead of one source – but we still say the same thing in context. (Student 5)

I think one does things for their own sake so that it becomes a good work. So, I have never taken on personally something someone else says. So, it is more my own choice whether I want to change something due to what they have said. I don’t have to change it just because they say so. (Student 9)

D. Relation

In addition to Structure, Comparison and Shift as ways of experiencing the writing of a BT, as described in previous categories, the writing of a BT is described here as Relation. In contrast to previous categories, experiencing the writing is here related to communication and dialogue with other health professionals, patients, and society, that is, outside the university context. Consistent with iterative and comprehensive reading and writing relating to other studies in the field, one’s own critical voice and analytical skills as a writer are acknowledged and assured. Textually, the writing of a BT is experienced as the discovery of relationships between parts and whole. The writer is freely altering the focus from parts to the whole, and back, as well as from the text to real life, and back. This way of experiencing points towards reflective thinking and transformation as functions of writing.

I think that it develops in some form of reflection about how others have written, because we have to do a literature review – we may not use any other method or design or work. It must also develop a kind of helicopter perspective or macro perspective of what the research world looks like in this subject. I have anyway learnt to browse through a lot – I don’t know how many articles I have read. Then one can quickly extract the key points. (Student 10)

I do not want to do what politicians do. I do not want to work with health care development. But I wanted to get a word in because I actually want to work clinically as a nurse. I think it is dead exciting and I cannot let go of these other issues. So, I do not know how to use it (the BT) but it’s a bit like my DNA, I think they are fun questions to think about – what I do and work with, really no matter what it is. It can apply equally to a football team or in a constellation in group work or anywhere. But there a little that is passion driven as well, and I probably actually think in a way that stimulates my writing partner to engage. Then it is fun and gets done. (Student 2)

Hierarchy of dimensions of meaning and structure of different ways of experiencing writing of a BT

According to classical phenomenographic studies in education, an outcome space provides categories that describe qualitatively different ways of experiencing a phenomenon (Marton & Booth, Citation1997). In an outcome space, the categories are inclusive and display a hierarchy of variation and complementarity (Mimirinis & Ahlberg, Citation2021; Stenfors-Hayes et al., Citation2013). In this way, the categories of description from A to D also relate to each other. Through further analysis of the relationships of the categories, as well as contrasting them, a structural dimension was generated and compared with the data. In this way, the global meaning of data is clarified and supported by two dimensions characterizing a level of awareness among a group of students (Marton & Pong, Citation2005), that is, a logical hierarchy that illustrates the potential for learning (Straub & Maynes, Citation2021). A logical hierarchy of the dimensions of meaning and structure of ways of experiencing the writing of a BT is presented in .

Table 2. Meaning and structural dimensions of ways of experiencing writing of a BT.

Trustworthiness

The findings report on conceptualizations of lived experience, rather than just enactment of skills and knowledge (Ashworth & Lucas, Citation2000). In fact, many of the students expressed that being interviewed allowed them to reflect deeper on their learning process at this point. Furthermore, a halfway stage means that the BT was started but not yet completed, which gives a situated student perspective. The interviews generated rich data, and so the sample of 15 nursing students was seen as sufficient. Through the processes of analysis, the individual participants’ accounts were transformed to a communal outcome space with four categories of description. According to Booth (Citation1997), fewer inclusive categories arrived at is regarded to indicate analytical precision and credibility in phenomenographic studies. In line with a dialogic reliability check (Åkerlind, Citation2012), the meaning and structure of categories () were appraised by an independent assessor and discussed by experts in a research collegium specialized in phenomenography and variation theory. As no further categories were found, and mismatches were considered and resolved, the final interrater reliability was estimated to be 94% and regarded as methodologically sufficient. However, as educational interventions in learning and teaching may alter ways of experiencing phenomena, transferability of results needs careful judgment (Barry et al., Citation2017; Straub & Maynes, Citation2021).

Discussion

The students in this interview study were asked to describe their writing of a BT at the halfway stage. The findings highlight that being in the same phase of writing a BT is experiential and can be conceptualized in qualitatively different ways. Ideally, scientific work is an opportunity for autonomous and independent learning on a topic of choice (Jordal et al., Citation2021; Lundgren & Halvarsson, Citation2009). However, this study highlights that in an investigation of a topic at this point, a disciplinary group of peers may be an important foundation against which a student can conceptualize the structure of the work (A), compare and share texts (B), shift perspectives (C) and relate aspects (D). A writing period in academia tends to involve the scattered organization of library and literacy services and limited resources of supervision and time (Hallett, Citation2013). Thus, the meaning and structure identified in the resulting categories contributes to the body of knowledge in learning and teaching at universities in this regard.

To bring out pedagogical implications worth considering in the context of writing academic theses the following discussion centres on, and clarifies, the structural dimensions found in the categories of description in terms of potential for learning.

Firstly, students can have their focus on the structure of writing, as indicated by the category A. Next, ‘writing-technical truths’ has previously only been found to promote relating facts (Jordal et al., Citation2021). However, this focus on structure should not be rejected as it can provide a functional strategy in solving the task (Donnelly et al., Citation2013). Nevertheless, what this category highlights is that the students working in a solitary manner. Experiencing the writing as a way to work alone points to a tension between the peer and group-models of education as an established way of working within the module. Group tutoring models require active participation in discussions with peers and the academic group. So, working alone potentially impacts students’ ways of seeing their academic identity and role of a colloquial group in conceptualizing topics (Kember et al., Citation2020). This way of experiencing being engaged in a solitary manner could benefit from an earlier, portion-wise support to enable a shared discovery in building connecting threads in the work.

Category B shows the students’ ways of experiencing making comparisons, and the key concept in this description is sharing. In order to compare, students share their material and familiarize themselves with contrasting formulations and argumentations. An analysis and synthesis of difficult scientific texts can be experienced as being too far from the world of a student (Coleman & Tuck, Citation2020). Therefore, a fruitful sharing and comparison of texts prerequisites a group that works well together and has an atmosphere of tolerance and respect. Mitchell et al. (Citation2021) found that supervision and feedback for students’ BTs apply a hidden curriculum which students actively tried to ‘figure out’ in order to ‘do it right’. Given the opportunity of community and sharing time and space, we propose that in designing supervision, students’ use of the strategy of comparison could be considered as a way to learn different ways of academic discourse rather than a hidden form of plagiarism. Training in academic writing in small groups prior to the BT module could function as a safe space for learning. This, since writing exercises in groups, where texts are shared other early on, entail giving and receiving feedback, which has been proven sensitive and difficult for students (McCune, Citation2004).

The results described in category C suggest a change of focus towards an awareness that shifts can take place. Furthermore, shifts presuppose interaction and change of perspective. Seeing something from others’ perspectives is eye-opening and dynamic learning (Guerra & Zuccoli, Citation2014). One interesting aspect is the students valuing the impression and understanding their BT would encounter in the final defence seminar. This result underlines the purpose and meaning of the academic group for relatively safe growth of identity as academics, as well as supporting critical thinking and intersubjectivity confirmed in several studies on academic thesis writing at different levels (Akister et al., Citation2009; Delahunt et al., Citation2012; Samara, Citation2006; Utriainen et al., Citation2011).

Category D describes the most comprehensive way of experiencing the writing as an awareness of relationships between parts and whole in the thesis topic, as well as its broader relation to the audience and real-life contexts beyond academia. In other words, the writing of a BT is a way to relate to the world. This way of experiencing is ‘passion driven’ and transformative since it is focused on dialogue beyond the immediate writing phase. For this, a peer group can function as a foundation from which to reach out and connect to the outside world.

This also conforms to the idea of preparing to consolidate scientific discourse and expose language-bound practices in that specific field of knowledge, i.e., life-long learning (Meyer & Land, Citation2003). Writing within research projects may foster this kind of experiencing. In line with work by Van de Poel and Gasiorek (Citation2012), writing a BT can create a communicative currency in society and thus empower students to continue further with taking part in scientific activities involving writing.

Even though issues relating to assessments of students’ texts were beyond the scope of this study, students’ accounts show an awareness of quality being put into place. Therefore, students’ own accounts of their ways of experiencing engagement with the texts can inform developments of supervision within all kinds of modules involving academic writing.

In this study, we cannot verify any malfunction of groups. However, the results indicate that shared working is one of the prerequisites for quality work with BT.

A BT is often questioned in relation to whether it really promotes development of transformative skills in students. However, skills embedded in writing, especially information literacy, are a vital part of the work of various professions, since they connect to communication and several strategies for evidence-based practices (Forster, Citation2015).

So, this study, while largely confirming others in the field of academic writing, also shows the pedagogical potential of the writing of a BT at the halfway stage. Over and above the students’ struggle with addressing their research problems, our resulting categories A and B also point to experiencing the writing as engaging with construction and a general fit of the work. Categories C and D, on the other hand, are connected to the writing as a way to communicate.

Conclusion

At the halfway stage of writing an academic thesis, students can have a primary focus on the structure of the work which entails working alone. Other students can experience the writing as an opportunity to face and share different understandings of the work and the topic, which can reach beyond the academic context of writing. Educators and supervisors of academic thesis writing may benefit from a deeper knowing whether students view the writing as a solitary work or as a shared process. This, because solitary writing is also writing for oneself, and a shared writing process involves writing for others and for audiences outside the HE programme.

These results are potentially relevant to curriculum designers, educators and supervisors in various HE programmes, that have the intention to foster high quality learning. The next step of research would therefore be to test these results and tailor targeted interventions to enhance shared academic debate and knowledge dissemination among various academic professions, a transformative skill much needed in today’s society.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Red Cross Research Foundation.

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