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Wang YP, Zhao CX, Zhang SE, Li QL, Tian J, Yang ML, Guo HC, Yuan J, Zhou SY, Wang M, Cao DP. Proactive personality and critical thinking in Chinese medical students: The moderating effects of psychological safety and academic self-efficacy. Front Psychol 2022; 13:1003536. [PMID: 36324776 PMCID: PMC9621085 DOI: 10.3389/fpsyg.2022.1003536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/03/2022] [Indexed: 10/12/2023] Open
Abstract
Objectives This study aimed to identify the relationship among proactive personality, psychological safety, academic self-efficacy and critical thinking, and to further explore whether psychological safety and academic self-efficacy could be a moderator in the association between proactive personality and critical thinking among Chinese medical students. Materials and methods The cross-sectional study was carried out from October to December 2020 in China. Totally, 5,920 valid responses were collected at four Chinese medical universities. Critical thinking, proactive personality, psychological safety, academic self-efficacy and demographic factors were assessed through questionnaires. Hierarchical multiple regression was used to identify interrelationship clusters among variables. Simple slope analyses were performed to explore the moderating effects of psychological safety and academic self-efficacy. Results The mean score of critical thinking among medical students was 3.85 ± 0.61. Proactive personality, psychological safety, and academic self-efficacy were shown to be important factors for critical thinking. Psychological safety and academic self-efficacy moderated the association between proactive personality and critical thinking. A simple slope analysis showed that high psychological safety and academic self-efficacy weakened the impact of proactive personality on critical thinking. Conclusion Most medical students surveyed in China might have relatively high levels of critical thinking. Psychological safety and academic self-efficacy moderated the association between proactive personality and critical thinking. More interventions related to psychological safety and academic self-efficacy will be helpful to improve critical thinking among Chinese medical students.
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Affiliation(s)
- Yan-ping Wang
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Chen-xi Zhao
- Academic Affairs Office, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shu-e Zhang
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Qing-lin Li
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Jing Tian
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Mao-ling Yang
- Department of Obstetrics, Women and Children’s Hospital Affiliated to Chengdu Medical College, Chengdu, China
| | - Hai-chen Guo
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Jia Yuan
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Sheng-yan Zhou
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - Min Wang
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
| | - De-pin Cao
- Department of Health Management, School of Health Management, Harbin Medical University, Harbin, China
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Roh YS, Jang KI, Issenberg SB. Gender Differences in Psychological Safety, Academic Safety, Cognitive Load, and Debriefing Satisfaction in Simulation-Based Learning. Nurse Educ 2022; 47:E109-E113. [PMID: 35324496 DOI: 10.1097/nne.0000000000001179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As there is an increasing trend in the number of male-identifying learners in undergraduate nursing education, a need exists to identify the gender differences in learners' perceptions regarding simulation-based learning. PURPOSE This study aimed to identify the gender differences in psychological safety, academic safety, cognitive load, and debriefing satisfaction in simulation-based nursing education. METHODS A cross-sectional descriptive survey was implemented with 97 female and 95 male nursing students. Data were analyzed using Mann-Whitney U tests or independent-samples t tests. RESULTS Female nursing students reported a lower academic safety and higher intrinsic load than male nursing students. Male nursing students perceived a higher germane load than female nursing students. CONCLUSIONS The significance of the present study was the identification of gender differences in participant perception of the simulation learning experience for effective simulation design.
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Affiliation(s)
- Young Sook Roh
- Professor (Roh), Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea; Professor (Jang), College of Nursing, The Kyungbok University, Namyangju-si, Gyeonggi-do, Republic of Korea; and Professor (Issenberg), University of Miami Miller School of Medicine, Miami, Florida
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Williamson AJH, Jensen RM, Smith BK. Educational Safety for the Surgical Learner. JOURNAL OF SURGICAL EDUCATION 2022; 79:1083-1087. [PMID: 35525777 DOI: 10.1016/j.jsurg.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
Psychological safety is known to improve team performance and organizational learning. The related concept of "educational safety" has recently emerged to describe an environment in which learners can unreservedly focus on learning and professional growth, without worrying about the potential repercussions of interpersonal risk-taking. Educational safety is crucial for optimal learning in clinical environments, and yet is difficult to establish due to constant performance assessment, fear of failure, and pervasive hierarchies. In this perspective, we propose a framework for conceptualizing educational safety in surgical learning environments, and explore current threats to educational safety. We also discuss strategies for combating these threats, as well as the importance of further research to evaluate the impact of educational safety on surgical learning outcomes.
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Affiliation(s)
| | - Rachel M Jensen
- Department of Surgery, Stanford University, Stanford, California
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Ten-year mixed-method evaluation of prelicensure health professional student self-reported learning in an interfaculty pain curriculum. Pain Rep 2022; 7:e1030. [PMID: 36128043 PMCID: PMC9478270 DOI: 10.1097/pr9.0000000000001030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/21/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction: Student perspectives on interprofessional pain education are lacking. Objectives: The purpose of this study was to evaluate ratings of knowledge acquisition and effective presentation methods for prelicensure health professional students attending the University of Toronto Centre for the Study of Pain Interfaculty Pain Curriculum (Canada). Methods: A 10-year (2009–2019) retrospective longitudinal mixed-methods approach comprising analysis and integration of quantitative and qualitative data sets was used to evaluate 5 core University of Toronto Centre for the Study of Pain Interfaculty Pain Curriculum learning sessions. Results: A total of 10, 693 students were enrolled (2009–2019) with a mean annual attendance of 972 students (±SD:102). The mean proportion of students rating “agree/strongly agree” for knowledge acquisition and effective presentation methods across sessions was 79.3% (±SD:3.4) and 76.7% (±SD:6.0), respectively. Knowledge acquisition or presentation effectiveness scores increased, respectively, over time for 4 core sessions: online self-study pain mechanisms module (P = 0.03/P < 0.001), online self-study opioids module (P = 0.04/P = 0.019), individually selected in-person topical pain sessions (P = 0.03/P < 0.001), and in-person patient or interprofessional panel session (P = 0.03). Qualitative data corroborated rating scores and expanded insight into student expectations for knowledge acquisition to inform real-world clinical practice and interprofessional collaboration; presentation effectiveness corresponded with smaller session size, individually selected sessions, case-based scenarios, embedded knowledge appraisal, and opportunities to meaningfully interact with presenters and peers. Conclusion: This study demonstrated positive and increasing prelicensure student ratings of knowledge acquisition and effective presentation methods across multifaceted learning sessions in an interfaculty pain curriculum. This study has implications for pain curriculum design aimed at promoting students' collaborative, patient-centered working skills. See commentary: Trouvin A-P. “Ten-year mixed method evaluation of prelicensure health professional student self-reported learning in an interfaculty pain curriculum”: a view on pain education. PAIN Rep 2022;7:e1031. Students attending learning sessions at the University of Toronto Interfaculty Pain Curriculum (2009–2019) in Toronto, Canada, self-report high ratings of knowledge acquisition and effective presentation methods.
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Daly Guris RJ, Toy S, Bruins BB, Hu P, Laverriere EK, Oke A, Sequera-Ramos L, Struyk BP, Ward CG, Fiadjoe JE, Garcia-Marcinkiewicz AG. Practice what you teach: An approach to integrate airway education for experienced anesthesia clinicians. Paediatr Anaesth 2022; 32:1024-1030. [PMID: 35603427 DOI: 10.1111/pan.14495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/03/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disrupted clinician education. To address this challenge, our divisional difficult airway program (AirEquip) designed and implemented small-group educational workshops for experienced clinicians. Our primary aim was to test the feasibility and acceptability of a small-group, flexible-curriculum skills workshop conducted during the clinical workday. Secondary objectives were to evaluate whether our workshop increased confidence in performing relevant skills and to assess the work-effort required for the new program. METHODS We implemented a 1:1 and 2:1 (participant to facilitator ratio) airway skills workshop for experienced clinicians during the workday. A member of the AirEquip team temporarily relieved the attendee of clinical duties to facilitate participation. Attendance was encouraged but not required. Feasibility was assessed by clinician attendance, and acceptability was assessed using three Likert scale questions and derived from free-response feedback. Participants completed pre and postworkshop surveys to assess familiarity and comfort with various aspects of airway management. A work-effort analysis was conducted and compared to the effort to run a previously held larger-format difficult airway conference. RESULTS Fifteen workshops were conducted over 7 weeks; members of AirEquip were able to temporarily assume participants' clinical duties. Forty-seven attending anesthesiologists and 17 CRNAs attended the workshops, compared with six attending anesthesiologists and five CRNAs who attended the most recent larger-format conference. There was no change in confidence after workshop participation, but participants overwhelmingly expressed enthusiasm and satisfaction with the workshops. The number of facilitator person-hours required to operate the workshops (105 h) was similar to that required to run a single all-day larger-format conference (104.5 h). CONCLUSION It is feasible and acceptable to incorporate expert-led skills training into the clinical workday. Alongside conferences and large-format instruction, this modality enhances the way we are able to share knowledge with our colleagues. This concept can likely be applied to other skills in various clinical settings.
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Affiliation(s)
- Rodrigo J Daly Guris
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Serkan Toy
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Benjamin B Bruins
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Paula Hu
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth K Laverriere
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Ayodele Oke
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Luis Sequera-Ramos
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brian P Struyk
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christopher G Ward
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John E Fiadjoe
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Annery G Garcia-Marcinkiewicz
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Lin C, Han C, Huang Y, Chen L, Su CC. Effectiveness of the use of concept maps and simulated cases as a teaching-learning strategy in enhancing the learning confidence of baccalaureate nursing students: A qualitative approach. NURSE EDUCATION TODAY 2022; 115:105418. [PMID: 35636244 DOI: 10.1016/j.nedt.2022.105418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 05/02/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Didactic lectures and exam-oriented learning can lead to students becoming passive learners who rely on rote memory. This learning style negatively impacts their ability to cultivate the core nursing values and critical thinking. OBJECTIVES This study aimed to investigate the impact of a concept mapping teaching-learning strategy on undergraduate nursing students' ability to integrate theoretical biosciences knowledge into care practice and on their skills in critical thinking and teamwork. METHODS A qualitative research design was adopted. A course entitled Evaluation and Analysis of Adult Nursing Cases was developed based on a concept mapping strategy involving 24 simulated cases relevant to medical and surgical nursing. The participants were students from the two-year undergraduate nursing programme at a university in Taiwan. Data were collected from September 2020 to February 2021. Qualitative data were collected from semi-structured face-to-face interviews with 20 students and from 100 reflective reports on students' learning journeys. The data were analysed using qualitative content analysis. RESULTS Two major themes were identified: (1) changes in learning style and thinking and (2) rewards from learning. The participants reported that their learning style had changed from reliance on rote learning to image memory, and their thinking process from linear (cause-effect) to multifaceted thinking at different levels. The teaching and learning strategies contributed to feelings of ability advancement and psychological safety, which led to learning achievement and confidence. CONCLUSION The use of a concept mapping strategy and simulated cases enhanced students' learning by enabling them to integrate theoretical knowledge and improve their thinking abilities. The teaching and learning strategies helped participants in learning about psychological safety and increased their learning confidence.
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Affiliation(s)
- ChunChih Lin
- Department of Nursing, Chang Gung University of Science and Technology, 2, Jiapu Rd, West Sec. Pu-tz, ChiaYi 613, Taiwan; Chang Gung Memorial Hospital at Linkou, 2, Jiapu Rd, West Sec. Pu-tz, ChiaYi 613, Taiwan.
| | - ChinYen Han
- Department of Nursing and Clinical Competency Center, Chang Gung University of Science and Technology, 261 Wenhua 1 st Rd., Guishan Dist., Tauyuan 333, Taiwan; Chang Gung Memorial Hospital at Linkou, 261 Wenhua 1 st Rd., Guishan Dist., Tauyuan 333, Taiwan.
| | - YaLing Huang
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, Queensland, Australia Gold Coast Campus B7.47, Locked Mail Bag 4, Coolangatta (Southern Cross University) QLD 4225; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia, Gold Coast Campus B7.47, Locked Mail Bag 4, Coolangatta (Southern Cross University) QLD 4225.
| | - LiChin Chen
- Department of Nursing, New Taipei Municipal TuCheng Hospital, No.6, Sec.2, Jincheng Rd., Tucheng Dist., New Taipei City 236, Taiwan.
| | - Ching-Ching Su
- Department of Nursing, Chang Gung University of Science and Technology, 2, Jiapu Rd, West Sec. Pu-tz, ChiaYi 613, Taiwan.
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Pincavage AT, Osman NY, Alexandraki I, Ismail NJ, Levine DL, Onumah CM, Lai CJ. AAIM Recommendations to Promote Equity in the Clerkship Clinical Learning Environment. Am J Med 2022; 135:1021-1028. [PMID: 35504324 DOI: 10.1016/j.amjmed.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nora Y Osman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Irene Alexandraki
- Texas Tech University Health Sciences Center Paul L. Foster School of Medicine, El Paso
| | - Nadia J Ismail
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Diane L Levine
- Department of Medicine, Wayne State University School of Medicine, Detroit, Mich
| | - Chavon M Onumah
- Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Cindy J Lai
- Department of Medicine, University of California, San Francisco, School of Medicine
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58
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Pham TV, Kim HH, Kritzer MD, Mankad M, Gagliardi JP. Perceived Stalking by a Patient: An Educational Case Report. J Grad Med Educ 2022; 14:394-397. [PMID: 35991111 PMCID: PMC9380637 DOI: 10.4300/jgme-d-21-01201.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tony V. Pham
- Tony V. Pham, MD, MScGH, is Instructor, Massachusetts General Hospital
| | - Hyun-Hee Kim
- Hyun-Hee Kim, MD, is Instructor, Massachusetts General Hospital
| | - Michael D. Kritzer
- Michael D. Kritzer, MD, PhD, is Instructor, Massachusetts General Hospital
| | - Mehul Mankad
- Mehul Mankad, MD, is Adjunct Assistant Professor, Duke University Medical Center
| | - Jane P. Gagliardi
- Jane P. Gagliardi, MD, MHS, is Director, Medicine-Psychiatry Residency Training Program, Duke University Medical Center
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Lawton AJ, Rosenberg LB. Carpe Communication: Seizing the Small Moments to Teach Interpersonal and Communication Skills on Inpatient Services. J Grad Med Educ 2022; 14:386-389. [PMID: 35991098 PMCID: PMC9380627 DOI: 10.4300/jgme-d-21-01135.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Andrew J. Lawton
- Andrew J. Lawton, MD, is Instructor in Medicine and Assistant Program Director, Department of Medicine, Brigham and Women's Hospital/Dana-Farber Cancer Institute and Harvard Medical School
| | - Leah B. Rosenberg
- Leah B. Rosenberg, MD, is Assistant Professor of Medicine and Attending Physician, Department of Medicine, Massachusetts General Hospital and Harvard Medical School
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McClintock AH, Fainstad T. Growth, Engagement, and Belonging in the Clinical Learning Environment: the Role of Psychological Safety and the Work Ahead. J Gen Intern Med 2022; 37:2291-2296. [PMID: 35710656 PMCID: PMC9296742 DOI: 10.1007/s11606-022-07493-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
Psychological safety is the perception that an environment is safe for interpersonal risk taking, exposing vulnerability, and contributing perspectives without fear of being shamed, blamed, or ignored. The presence of psychological safety has been associated with improved team learning and innovation, leader inclusivity, and team members' sense of belonging. In medical education, psychological safety has additional benefits: it allows learners to be present in the moment and to focus on the tasks at hand, and reduces trainee focus on image. Several key features of psychologically safe environments have already been described, including the presence of high-quality relationships, the absence of social positioning, a learner-driven and flexible learning agenda, the lack of formal assessment, and time for debriefing. However, many of the structures and cultural traditions in medical education are in clear opposition to these features. This paper describes the current barriers to psychological safety in medical education, and sets out an agenda for change. In accordance with benefits seen in other sectors, we anticipate that an emphasis on relationships and psychological safety will support the learning, inclusion, and success of medical trainees.
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Affiliation(s)
- Adelaide H McClintock
- Department of Medicine, Division of General Internal Medicine, University of Washington School of Medicine, 4245 Roosevelt Way NE, Box 354765, Seattle, WA, 98107, USA.
| | - Tyra Fainstad
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Hovlid E, Husabø G, Valestrand EA, Hartveit M. Learning team-based quality improvement in a virtual setting: a qualitative study. BMJ Open 2022; 12:e061390. [PMID: 35728894 PMCID: PMC9214407 DOI: 10.1136/bmjopen-2022-061390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The objective was to explore students' perceptions of learning quality improvement (QI) in a virtual setting and identify factors that promote or inhibit virtual learning. DESIGN We used an exploratory case study design with focus group interviews. The data were analysed using a thematic analysis approach, with an analytical framework derived from activity theory and Bloom's revised taxonomy of six categories of cognitive processes of learning. SETTING Postgraduate students participating in a virtual 1-day simulation module to learn QI at two universities in Norway. PARTICIPANTS Four focus groups with a total of 12 participants. RESULTS The students' descriptions of learning outcomes indicate that the learning activity involved a variety of cognitive activities, including higher-order cognitive processes. We identified three themes pertaining to the students' experiences of the virtual learning activity: learning through active participation, constructing a virtual learning opportunity and creating a virtual learning environment. The students described that participation and active engagement led to a greater understanding and an integration of theory and practical improvement skills. They reported that to engage in the virtual learning opportunity, it was necessary to create a learning environment where they felt psychologically safe. CONCLUSION Our findings indicate that it is possible to facilitate collaborative learning integrating theoretical knowledge and practical skills in a virtual setting. Students experienced that engaging in the virtual learning activity contributed to the integration of theoretical knowledge and practical skills. Psychological safety seems to be important for students' engagement in the virtual learning activity. A virtual learning environment alters prior common norms for interaction based on physical presence, which in turn affect students feeling of psychological safety. Educators need to be aware of this and facilitate a virtual learning environment where students feel comfortable to engage.
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Affiliation(s)
- Einar Hovlid
- Department of Social Science, Western Norway University of Applied Sciences - Sogndal Campus, Sogndal, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Gunnar Husabø
- Department of Social Science, Western Norway University of Applied Sciences - Sogndal Campus, Sogndal, Norway
| | - Eivind Alexander Valestrand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Medical Education, University of Bergen, Bergen, Norway
| | - Miriam Hartveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Helse Fonna HF, Haugesund, Norway
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Kinnear B, DeCoursey B, Caya T, Baez J, Warm EJ. Things We Do for No Reason™: Toxic quizzing in medical education. J Hosp Med 2022; 17:481-484. [PMID: 35642103 PMCID: PMC9328362 DOI: 10.1002/jhm.12846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Benjamin Kinnear
- Department of Pediatrics, Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Bailey DeCoursey
- Department of Pediatrics, Cincinnati Children's Hospital Medical CenterUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Teresa Caya
- Resident (PGY‐4), Internal Medicine and Pediatrics, Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Javier Baez
- Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Eric J. Warm
- Program Director, Internal Medicine, Department of Internal MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
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Matthiesen M, Kelly MS, Dzara K, Begin AS. Medical residents and attending physicians’ perceptions of feedback and teaching in the United States: a qualitative study. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2022; 19:9. [PMID: 35468668 PMCID: PMC9247714 DOI: 10.3352/jeehp.2022.19.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Residents and attendings agree on the importance of feedback to resident education. However, while faculty report providing frequent feedback, residents often do not perceive receiving it, particularly in the context of teaching. Given the nuanced differences between feedback and teaching, we aimed to explore resident and attending perceptions of feedback and teaching in the clinical setting. METHODS We conducted a qualitative study of internal medicine residents and attendings from December 2018 through March 2019 at the Massachusetts General Hospital to investigate perceptions of feedback in the inpatient clinical setting. Residents and faculty were recruited to participate in focus groups. Data were analyzed using thematic analysis to explore perspectives and barriers to feedback provision and identification. RESULTS Five focus groups included 33 total participants in 3 attending (n=20) and 2 resident (n=13) groups. Thematic analysis of focus group transcripts identified 7 themes which organized into 3 thematic categories: (1) disentangling feedback and teaching, (2) delivering high-quality feedback, and (3) experiencing feedback in the group setting. Residents and attendings highlighted important themes in discriminating feedback from teaching. They indicated that while feedback is reactive in response to an action or behavior, teaching is proactive and oriented toward future endeavors. CONCLUSION Confusion between the critical concepts of teaching and feedback may be minimized by allowing them to each have their intended impact, either in response to prior events or aimed toward those yet to take place.
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Affiliation(s)
- Madeleine Matthiesen
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael S. Kelly
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristina Dzara
- Department of Biomedical Informatics and Medical Education and Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine, Seattle, WA, USA
- Department of Medical Education, University of Washington School of Medicine, Seattle, WA, USA
- Center for Leadership and Innovation in Medical Education, University of Washington School of Medicine, Seattle, WA, USA
| | - Arabella Simpkin Begin
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Naser MJ, Hasan NE, Zainaldeen MH, Zaidi A, Mohamed YMAMH, Fredericks S. Impostor Phenomenon and Its Relationship to Self-Esteem Among Students at an International Medical College in the Middle East: A Cross Sectional Study. Front Med (Lausanne) 2022; 9:850434. [PMID: 35445049 PMCID: PMC9013881 DOI: 10.3389/fmed.2022.850434] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
The atmosphere of constant scrutiny of academic ability that prevails in medical colleges may leave some students at risk of expressing feelings of intellectual fraudulence and phoniness. Impostor phenomenon (IP) traits have been associated with anxiety, depression, job dissatisfaction, and poor professional performance. Internationally trained junior doctors exhibit stronger IP feelings than colleagues trained within their own country of citizenship. These feelings may develop during student life. International universities are diverse and complex environments where students may be emersed in a cultural milieu alien to their societies of origin, leading to feelings of isolation. Individuals with IP traits often perceive themselves as the “only one” experiencing this phenomenon, resulting in further isolation and negative self-evaluation, especially among women and underrepresented minorities. IP has also been linked to low self-esteem among students. This study assessed the prevalence of IP and its relationship to self-esteem among students at a campus of a European medical college with a large international student body situated in the Middle East. The self-administered questionnaires: Clance's Impostor Phenomenon Scale (CIPS) and Rosenberg's Self-Esteem Scale (RSES) were completed by 290 medical students (58.3% females). Participants' median (range) age was 19 years (16–35). Students were of 28 different nationalities; the largest proportions were from Gulf Corporation Council (GCC) countries. The prevalence of low self-esteem was 18.6%, while 45.2% of the students demonstrated traits suggestive of IP. There was a strongly negative correlation between CIPS and RSES (r = −0.71). No significant gender differences were found in IP. Similarly, no differences in IP were found when comparing between age groups, previous experience in higher education or year of study. Multivariate analysis showed that students from GCC countries had higher levels of self-esteem relative to students from other regions. Low self-esteem was a strong predictor of IP. Country of origin may influence students' self-esteem studying in international university settings.
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Affiliation(s)
- Maryam Jameel Naser
- School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya, Bahrain
| | - Nebras Ebrahim Hasan
- School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya, Bahrain
| | - Manal Hasan Zainaldeen
- School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya, Bahrain
| | - Ayesha Zaidi
- School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya, Bahrain
| | | | - Salim Fredericks
- School of Medicine, Royal College of Surgeons in Ireland, Medical University of Bahrain, Adliya, Bahrain
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Madsgaard A, Røykenes K, Smith-Strøm H, Kvernenes M. The affective component of learning in simulation-based education - facilitators' strategies to establish psychological safety and accommodate nursing students' emotions. BMC Nurs 2022; 21:91. [PMID: 35443709 PMCID: PMC9019791 DOI: 10.1186/s12912-022-00869-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background Active learning situations such as simulation-based education (SBE) are found to trigger a wide range of emotions among students. Facilitators have an important educational role in SBE which include being attentive and adaptive to students’cognitive and affective responses. Although the importance of emotions in SBE is recognized in facilitator guidelines, little is known about how facilitators accommodate student affect. Hence, this study explores facilitators’ strategies for addressing students’ emotions in SBE. Method Individual interviews with nine facilitators were performed and transcripts were subjected to qualitative analyses in accordance with interpretive description approach. Results Findings show that facilitators are attentive to and continuously assess students’ emotional responses in SBE. Both positive emotions, such as interest and surprise, and negative emotions such as anxiety are cultivated, yet adapted to the perceived needs of the individual student. Psychological safety was seen as a prerequisite for optimal learning, regardless of the students’ previous level of knowledge. Furthermore, significant learning was seen as something that might also arise from uncomfortable experiences, such as students realizing their own mistakes or uncertainty. Hence facilitators were found to balance levels of difficulty, emotional arousal and psychological safety during the various phases of SBE. Conclusion Facilitators recognize the emotional dimension of learning in SBE and have numerous strategies for accommodating students’ emotions. This study highlights the complexity of the facilitator’s role in adapting training to individual cognitive and emotional needs. These findings have implications for facilitator training which should include awareness of the role of emotions in learning and strategies for observing and accommodating training to meet emotional needs.
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Affiliation(s)
- Anine Madsgaard
- VID Specialized University, Ulriksdalen 10, 5009, Bergen, Norway.
| | - Kari Røykenes
- VID Specialized University, Ulriksdalen 10, 5009, Bergen, Norway
| | | | - Monika Kvernenes
- University of Bergen, VID Specialized University, Bergen, Norway
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Thibault LP, Bourque CJ, Luu TM, Huot C, Cardinal G, Carriere B, Dupont-Thibodeau A, Moussa A. Residents as Research Subjects: Balancing Resident Education and Contribution to Advancing Educational Innovations. J Grad Med Educ 2022; 14:191-200. [PMID: 35463172 PMCID: PMC9017267 DOI: 10.4300/jgme-d-21-00530.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/15/2021] [Accepted: 01/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Research in education advances knowledge and improves learning, but the literature does not define how to protect residents' rights as subjects in studies or how to limit the impact of their participation on their clinical training. OBJECTIVE We aimed to develop a consensual framework on how to include residents as participants in education research, with the dual goal of protecting their rights and promoting their contributions to research. METHODS A nominal group technique approach was used to structure 3 iterative meetings held with the pre-existing residency training program committee and 7 invited experts between September 2018 and April 2019. Thematic text analysis was conducted to prepare a final report, including recommendations. RESULTS Five themes, each with recommendations, were identified: (1) Freedom of participation: participation, non-participation, or withdrawal from a study should not interfere with teacher-learner relationship (recommendation: improve recruitment and consent forms); (2) Avoidance of over-solicitation (recommendation: limit the number of ongoing studies); (3) Management of time dedicated to participation in research (recommendations: schedule and proportion of time for study participation); (4) Emotional safety (recommendation: requirement for debriefing and confidential counseling); and (5) Educational safety: data collected during a study should not influence clinical assessment of the resident (recommendation: principal investigator should not be involved in the evaluation process of learners in clinical rotation). CONCLUSIONS Our nominal group technique approach resulted in raising 5 specific issues about freedom of participation of residents in research in medical education, over-solicitation, time dedicated to research, emotional safety, and educational safety.
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Affiliation(s)
- Louis-Philippe Thibault
- Louis-Philippe Thibault, MD, BBA, is a Student, Master's in Medical Education Program, Harvard Medical School, and a Pediatrician, Department of Pediatrics, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Claude Julie Bourque
- Claude Julie Bourque, PhD, is an Assistant Professor and a Researcher, Department of Pediatrics, Centre for Applied Health Sciences Education, Faculty of Medicine, Université de Montréal, Quebec, Canada
| | - Thuy Mai Luu
- Thuy Mai Luu, MD, MSc, is an Associate Clinical Professor, Department of Pediatrics, and Clinician-Scientist, CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Celine Huot
- Celine Huot, MD, MSc, is a Full Clinical Professor and Researcher, Department of Pediatrics and CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Genevieve Cardinal
- Genevieve Cardinal, LLM, is Chair of the Research Ethics Board and Manager, Research Ethics Office, CHU Sainte-Justine
| | - Benoit Carriere
- Benoit Carriere, MD, MHPE, is an Associate Professor and the Director of Medical Education, CHU Sainte-Justine, Department of Pediatrics, Faculty of Medicine, Université de Montréal
| | - Amelie Dupont-Thibodeau
- Amelie Dupont-Thibodeau, MD, PhD, is an Assistant Professor and a Researcher, Department of Pediatrics, CHU Sainte-Justine Research Center, Faculty of Medicine, Université de Montréal
| | - Ahmed Moussa
- Ahmed Moussa, MD, MMEd, is an Associate Professor, Department of Pediatrics, a Clinician-Scientist, CHU Sainte-Justine Research Center, and Director, Center for Applied Health Sciences Education, Faculty of Medicine, Université de Montréal
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67
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A mobile application to facilitate implementation of programmatic assessment in anaesthesia training. Br J Anaesth 2022; 128:990-996. [DOI: 10.1016/j.bja.2022.02.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/22/2022] Open
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Hippolyte-Blake D, Dreschler A, Rose A, Rae P, Archer J, Garrod TJ. A qualitative study of the incentives and barriers that influence preferences for rural placements during surgical training in Australia. ANZ J Surg 2022; 92:341-345. [PMID: 35112443 DOI: 10.1111/ans.17523] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rural exposure of long durations during clinical training is positively associated with rural career uptake and is a central strategy to addressing the geographical maldistribution of Australia's surgical workforce. However, the incentives and barriers to trainees undergoing surgical training preferencing repeated rural placements in Australia are not well understood. This qualitative study explores the incentives and barriers that influence preference for rural placements during surgical training in Australia. METHODS This qualitative study employed online semi-structured in-depth interviews. Participants were recruited using an online survey, and interviews were conducted between October 2020 and November 2020. Transcripts were transcribed and de-identified, and thematically analysed. RESULTS Twenty-nine semi-structured interviews were conducted with trainees and 12 Fellows. Twenty-five participants identified as male, and four identified as female. Four main incentives identified were: (1) broad scope of learning opportunities, (2) quality of supervision, (3) positive work environment and (4) lifestyle. Seven barriers identified were: (1) inadequate preparation for placement, (2) limited case mix to support learning outcomes, (3) lack of formally structured learning opportunities, (4) workload and safe hours concerns, (5) lack of peer support, (6) childcare and educational needs and (7) partner career development. CONCLUSION The strategy of encouraging trainees to undertake rural placements to address the maldistribution of the surgical workforce should include initiatives that support learning outcomes across their training levels. In addition, improving trainees' ability to prepare adequately for placements may also improve the number and duration of rural placements trainees undertake during their training.
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Affiliation(s)
- Dinah Hippolyte-Blake
- Education Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Alison Dreschler
- Fellowships Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Andrew Rose
- Training Services Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Peter Rae
- Education Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Julian Archer
- Education Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tamsin J Garrod
- Education Portfolio, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
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Brennan N. Emotions, psychological safety and recommendations for designing remediation programmes. MEDICAL EDUCATION 2022; 56:141-143. [PMID: 34761423 DOI: 10.1111/medu.14687] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
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Marquardt D, Langdale L, Kim S, Leroux B, Friedrich J, Schreuder AB, Wood DE. Closing the gap: Triangulation of surgeons’ respectful behaviors perceived by medical students, residents, and patients. Surgery 2022; 172:96-101. [DOI: 10.1016/j.surg.2021.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
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71
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McClintock AH, Kim S, Chung EK. Bridging the Gap Between Educator and Learner: The Role of Psychological Safety in Medical Education. Pediatrics 2022; 149:183907. [PMID: 34972228 DOI: 10.1542/peds.2021-055028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Adelaide H McClintock
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Sara Kim
- Academic and Regional Affairs and the Department of Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Esther K Chung
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
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72
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Higham A, Behrman S, Vlachos H, Lightfoot H, Stevens R, Stegen G. Let's embed peer-support groups into the medical curriculum for all. Future Healthc J 2021; 8:e692-e694. [PMID: 34888468 DOI: 10.7861/fhj.2021-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Even before the COVID-19 pandemic, attending to the mental wellbeing of all doctors was high on the political agenda. The quality of patient care is also known to be related to doctors' wellbeing. Now, in the midst of a global pandemic, doctors are having to cope with ever more trauma and moral injury. Group-based peer support and regular reflective practice are interventions known to reduce clinician burnout and optimise wellbeing. Junior doctors are the most likely of all medical groups to be at a high risk of burnout. The NHS Staff and Learners' Mental Wellbeing Commission report advocates establishing explicit peer support mechanisms and the use of peer support as part of the first line of psychological first aid. Peer support is not addressed in the curriculum for the majority of medical specialties. We recommend that regular peer-support reflective groups are provided during protected time for all trainees.
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Affiliation(s)
| | | | | | - Heidi Lightfoot
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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73
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Ross S, Lee AS. Relationships, continuity and time in health professions education. MEDICAL EDUCATION 2021; 55:1344-1346. [PMID: 34612531 DOI: 10.1111/medu.14674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Shelley Ross
- Department of Family Medicine, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ann S Lee
- Department of Family Medicine, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
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74
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Kochis M, Kamin D, Cockrill B, Besche H. Understanding and Optimizing Group Dynamics in Case-Based Collaborative Learning. MEDICAL SCIENCE EDUCATOR 2021; 31:1779-1788. [PMID: 34956697 PMCID: PMC8651884 DOI: 10.1007/s40670-021-01367-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 06/14/2023]
Abstract
Teamwork skills are recognized as a core competency of physicians. To more effectively prepare trainees for the demands of their future work, medical educators are increasingly turning to group-based instructional formats. We employ case-based collaborative learning (CBCL) - a format which requires daily in-class discussion and collaboration in assigned small groups. While students overwhelmingly embraced CBCL as stimulating and thought-provoking, some students reported that social dynamics among group members adversely impacted their experience. Using mixed methods, we demonstrate that a short intervention that asked students to discuss how they can best learn together improved small group dynamics, and promoted psychological safety among peers. Importantly, no specific instruction in team work was required, students overall had a clear understanding how they could improve, but they did not know how to start this conversation with each other. To promote team learning, we propose that educators emphasize students' accountability to their peers' learning in addition to their own, and devote some time in class for teams to reflect and discuss how to improve learning with each other. Our observations are of interest to anyone frequently relying on group work without peer assessment or formal feedback on group performance.
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Affiliation(s)
- Michael Kochis
- Harvard Medical School, Boston, USA
- Department of Surgery, Mass General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Daniel Kamin
- Harvard Medical School, Boston, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115 USA
| | | | - Henrike Besche
- Program in Medical Education, Harvard Medical School, 260 Longwood Ave, Boston, MA 02115 USA
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Peng CR, Schertzer KA, Caretta-Weyer HA, Sebok-Syer SS, Lu W, Tansomboon C, Gisondi MA. Assessment of Entrustable Professional Activities Using a Web-Based Simulation Platform During Transition to Emergency Medicine Residency: Mixed Methods Pilot Study. JMIR MEDICAL EDUCATION 2021; 7:e32356. [PMID: 34787582 PMCID: PMC8663509 DOI: 10.2196/32356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The 13 core entrustable professional activities (EPAs) are key competency-based learning outcomes in the transition from undergraduate to graduate medical education in the United States. Five of these EPAs (EPA2: prioritizing differentials, EPA3: recommending and interpreting tests, EPA4: entering orders and prescriptions, EPA5: documenting clinical encounters, and EPA10: recognizing urgent and emergent conditions) are uniquely suited for web-based assessment. OBJECTIVE In this pilot study, we created cases on a web-based simulation platform for the diagnostic assessment of these EPAs and examined the feasibility and acceptability of the platform. METHODS Four simulation cases underwent 3 rounds of consensus panels and pilot testing. Incoming emergency medicine interns (N=15) completed all cases. A maximum of 4 "look for" statements, which encompassed specific EPAs, were generated for each participant: (1) performing harmful or missing actions, (2) narrowing differential or wrong final diagnosis, (3) errors in documentation, and (4) lack of recognition and stabilization of urgent diagnoses. Finally, we interviewed a sample of interns (n=5) and residency leadership (n=5) and analyzed the responses using thematic analysis. RESULTS All participants had at least one missing critical action, and 40% (6/15) of the participants performed at least one harmful action across all 4 cases. The final diagnosis was not included in the differential diagnosis in more than half of the assessments (8/15, 54%). Other errors included selecting incorrect documentation passages (6/15, 40%) and indiscriminately applying oxygen (9/15, 60%). The interview themes included psychological safety of the interface, ability to assess learning, and fidelity of cases. The most valuable feature cited was the ability to place orders in a realistic electronic medical record interface. CONCLUSIONS This study demonstrates the feasibility and acceptability of a web-based platform for diagnostic assessment of specific EPAs. The approach rapidly identifies potential areas of concern for incoming interns using an asynchronous format, provides feedback in a manner appreciated by residency leadership, and informs individualized learning plans.
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Affiliation(s)
- Cynthia R Peng
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kimberly A Schertzer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Holly A Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Stefanie S Sebok-Syer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - William Lu
- Cornell University College of Engineering, Ithaca, NY, United States
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Bullock JL, O'Brien MT, Minhas PK, Fernandez A, Lupton KL, Hauer KE. No One Size Fits All: A Qualitative Study of Clerkship Medical Students' Perceptions of Ideal Supervisor Responses to Microaggressions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S71-S80. [PMID: 34348373 DOI: 10.1097/acm.0000000000004288] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE This study explores medical students' perspectives on the key features of ideal supervisor responses to microaggressions targeting clerkship medical students. METHOD This single-institution, qualitative focus group study, based in an interpretivist paradigm, explored clerkship medical students' perceptions in the United States, 2020. During semistructured focus groups, participants discussed 4 microaggression scenarios. The authors employed the framework method of thematic analysis to identify considerations and characteristics of ideal supervisor responses and explored differences in ideal response across microaggression types. RESULTS Thirty-nine students participated in 7 focus groups, lasting 80 to 92 minutes per group. Overall, students felt that supervisors' responsibility began before a microaggression occurred, through anticipatory discussions ("pre-brief") with all students to identify preferences. Students felt that effective bystander responses should acknowledge student preferences, patient context, interpersonal dynamics in the room, and the microaggression itself. Microassaults necessitated an immediate response. After a microaggression, students preferred a brief one-on-one check-in with the supervisor to discuss the most supportive next steps including whether further group discussion would be helpful. CONCLUSIONS Students described that an ideal supervisor bystander response incorporates both student preferences and the microaggression context, which are best revealed through advanced discussion. The authors created the Bystander Microaggression Intervention Guide as a visual representation of the preferred bystander microaggression response based on students' discussions. Effective interventions promote educational safety and shift power dynamics to empower the student target.
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Affiliation(s)
- Justin L Bullock
- J.L. Bullock is a second-year resident, internal medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Meghan T O'Brien
- M.T. O'Brien is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Prabhjot K Minhas
- P.K. Minhas is a second-year medical student, University of California, San Francisco School of Medicine, San Francisco, California
| | - Alicia Fernandez
- A. Fernandez is associate dean for population health and health equity and professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Katherine L Lupton
- K.L. Lupton is associate professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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McClintock AH, Fainstad TL, Jauregui J. Creating Psychological Safety in the Learning Environment: Straightforward Answers to a Longstanding Challenge. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:S208-S209. [PMID: 34705709 DOI: 10.1097/acm.0000000000004319] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Tyra L Fainstad
- T.L. Fainstad, University of Colorado Anschutz Medical Campus
| | - Joshua Jauregui
- Author affiliations: A.H. McClintock, J. Jauregui, University of Washington
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Whelan B, Hjörleifsson S, Schei E. Shame in medical clerkship: "You just feel like dirt under someone's shoe". PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:265-271. [PMID: 33950359 PMCID: PMC8505567 DOI: 10.1007/s40037-021-00665-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 05/14/2023]
Abstract
INTRODUCTION This study explores how senior medical students' experience and react to shame during clinical placements by asking them to reflect on (1) manifestations of shame experiences, (2) situations and social interactions that give rise to shame, and (3) perceived effects of shame on learning and professional identity development. METHODS In this interpretive study, the authors recruited 16 senior medical students from two classes at a Norwegian medical school. In three focus group interviews, participants were invited to reflect on their experiences of shame. The data were analyzed using systematic text condensation, producing rich descriptions about students' shame experiences. RESULTS All participants had a range of shame experiences, with strong emotional, physical, and cognitive reactions. Shame was triggered by a range of clinician behaviours interpreted as disinterest, disrespect, humiliation, or breaches of professionalism. Shame during clinical training caused loss of confidence and motivation, worries about professional competence, lack of engagement in learning, and distancing from shame-associated specialties. No positive effects of shame were reported. DISCUSSION Shame reactions in medical students were triggered by clinician behaviour that left students feeling unwanted, rejected, or burdensome, and by humiliating teaching situations. Shame had deleterious effects on motivation, learning, and professional identity development. This study has implications for learners, educators, and clinicians, and it may contribute to increased understanding of the importance of supportive learning environments and supervisors' social skills within the context of medical education.
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Affiliation(s)
- Beth Whelan
- Student Health and Wellness Center, Memorial University, St. John's, NL, Canada.
| | - Stefan Hjörleifsson
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Edvin Schei
- Centre for Medical Education and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Heeneman S, de Jong LH, Dawson LJ, Wilkinson TJ, Ryan A, Tait GR, Rice N, Torre D, Freeman A, van der Vleuten CPM. Ottawa 2020 consensus statement for programmatic assessment - 1. Agreement on the principles. MEDICAL TEACHER 2021; 43:1139-1148. [PMID: 34344274 DOI: 10.1080/0142159x.2021.1957088] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In the Ottawa 2018 Consensus framework for good assessment, a set of criteria was presented for systems of assessment. Currently, programmatic assessment is being established in an increasing number of programmes. In this Ottawa 2020 consensus statement for programmatic assessment insights from practice and research are used to define the principles of programmatic assessment. METHODS For fifteen programmes in health professions education affiliated with members of an expert group (n = 20), an inventory was completed for the perceived components, rationale, and importance of a programmatic assessment design. Input from attendees of a programmatic assessment workshop and symposium at the 2020 Ottawa conference was included. The outcome is discussed in concurrence with current theory and research. RESULTS AND DISCUSSION Twelve principles are presented that are considered as important and recognisable facets of programmatic assessment. Overall these principles were used in the curriculum and assessment design, albeit with a range of approaches and rigor, suggesting that programmatic assessment is an achievable education and assessment model, embedded both in practice and research. Knowledge on and sharing how programmatic assessment is being operationalized may help support educators charting their own implementation journey of programmatic assessment in their respective programmes.
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Affiliation(s)
- Sylvia Heeneman
- Department of Pathology, School of Health Profession Education, Maastricht University, Maastricht, The Netherlands
| | - Lubberta H de Jong
- Department of Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Luke J Dawson
- School of Dentistry, University of Liverpool, Liverpool, UK
| | - Tim J Wilkinson
- Education Unit, University of Otago, Christchurch, New Zealand
| | - Anna Ryan
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Glendon R Tait
- MD Program, Department of Psychiatry, and The Wilson Centre, University of Toronto, Toronto, Canada
| | - Neil Rice
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Dario Torre
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - Adrian Freeman
- College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Cees P M van der Vleuten
- Department of Educational Development and Research, School of Health Profession Education, Maastricht University, Maastricht, The Netherlands
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Ow GM, Shipley LC, Nematollahi S, Stetson GV. Morning report for all: a qualitative study of disseminating case conferences via podcasting. BMC MEDICAL EDUCATION 2021; 21:392. [PMID: 34294060 PMCID: PMC8295545 DOI: 10.1186/s12909-021-02799-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite its long-established importance, diagnostic reasoning (DR) education has suffered uneven implementation in medical education. The Clinical Problem Solvers (CPSolvers) podcast has emerged as a novel strategy to help teach DR through case conferences with expert diagnosticians and trainees. CPSolvers has 25,000 listeners in 147 countries. The aim of this study was to evaluate the podcast by eliciting the developers' goals of the podcast, then determining to what extent they aligned with the listeners' actual usage habits, features they valued, and perceptions of the podcast. METHODS We conducted semi-structured interviews with 3 developers and 8 listeners from April-May 2020, followed by qualitative thematic analysis. RESULTS Three major developer goals with sub-goals resulted: 1. To teach diagnostic reasoning in a case-based format by (1a) teaching schemas, (1b) modeling expert diagnostic reasoning, (1c) teaching clinical knowledge, and (1d) teaching diagnostic reasoning terminology. 2. To change the culture of medicine by (2a) promoting diversity, (2b) modeling humility and promoting psychological safety, and (2c) creating a fun, casual way to learn. 3. To democratize the teaching of diagnostic reasoning by leveraging technology. Listeners' usage habits, valued features, and perceptions overall strongly aligned with all these aspects, except for (1c) clinical knowledge, and (1d) diagnostic reasoning terminology. Listeners identified (1a) schemas, and (2c) promotion of psychological safety as the most valuable features of the podcast. CONCLUSION CPSolvers has been perceived as a highly effective and novel way to disseminate DR education in the form of case conferences, serving as an alternative to traditional in-person case conferences suspended during COVID-19. CPSolvers combines many known benefits of in-person case conferences with a compassionate and entertaining teaching style, plus advantages of the podcasting medium - democratizing morning report for listeners around the world.
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Affiliation(s)
- Gregory M Ow
- University of California, 513 Parnassus, Suite S-245, San Francisco, CA, 94143-0454, USA.
| | | | | | - Geoffrey V Stetson
- University of California, 513 Parnassus, Suite S-245, San Francisco, CA, 94143-0454, USA
- San Francisco VA Medical Center, San Francisco, USA
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Lomis KD, Mejicano GC, Caverzagie KJ, Monrad SU, Pusic M, Hauer KE. The critical role of infrastructure and organizational culture in implementing competency-based education and individualized pathways in undergraduate medical education. MEDICAL TEACHER 2021; 43:S7-S16. [PMID: 34291715 DOI: 10.1080/0142159x.2021.1924364] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In 2010, several key works in medical education predicted the changes necessary to train modern physicians to meet current and future challenges in health care, including the standardization of learning outcomes paired with individualized learning processes. The reframing of a medical expert as a flexible, adaptive team member and change agent, effective within a larger system and responsive to the community's needs, requires a new approach to education: competency-based medical education (CBME). CBME is an outcomes-based developmental approach to ensuring each trainee's readiness to advance through stages of training and continue to grow in unsupervised practice. Implementation of CBME with fidelity is a complex and challenging endeavor, demanding a fundamental shift in organizational culture and investment in appropriate infrastructure. This paper outlines how member schools of the American Medical Association Accelerating Change in Medical Education Consortium developed and implemented CBME, including common challenges and successes. Critical supporting factors include adoption of the master adaptive learner construct, longitudinal views of learner development, coaching, and a supportive learning environment.
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Affiliation(s)
- Kimberly D Lomis
- Medical Education Outcomes, American Medical Association, Chicago, USA
| | - George C Mejicano
- School of Medicine, Oregon Health and Science University, Portland, USA
| | | | | | - Martin Pusic
- Department of Pediatrics, Harvard Medical School, Boston, USA
| | - Karen E Hauer
- School of Medicine, University of California, San Francisco, San Francisco, USA
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82
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Yau BN, Chen AS, Montgomery KB, Dubuque N, McDowelle DM. An Internal Perspective: the Psychological Impact of Mistreatment. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:308-314. [PMID: 33709287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Student mistreatment remains a prominent issue in medical education. Mistreatment has been linked to negative mental health outcomes, including depression, anxiety, and burnout. Continued challenges in this arena include difficulties in identifying mistreatment and underreporting. The objective of this study was to better understand the nuances of individual students' reactions to mistreatment. METHODS Medical students, who had experienced mistreatment, were invited to participate in this study. Individual, semi-structured, peer-to-peer interviews were conducted with 21 students. Interview transcriptions were coded using grounded theory and inductive analysis, and themes were extracted. RESULTS The interviews generated 34 unique mistreatment incidents. Four major themes arose in students' reactions to mistreatment. (1) Descriptions-the student described the incident as inappropriate, unusual, or unnecessary. (2) Recognition-most students did not immediately recognize the incident as mistreatment. (3) Emotions-the student described negative emotions (negative self-views, anger, powerlessness, shock, discomfort) associated with the mistreatment incident. (4) Coping mechanisms-the student utilized avoidance and rationalization to process their mistreatment. CONCLUSIONS Mistreatment generates complex emotions and coping mechanisms that impair the learning process. These complex emotions and coping mechanisms also make it difficult for trainees to identify mistreatment and to feel safe to report. Increasing understanding of the psychological impact of mistreatment can help peers and educators better screen for mistreatment in trainees and guide them in reporting decisions.
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Affiliation(s)
- Bernice N Yau
- University of Texas Southwestern Medical Center, Dallas, TX, USA.
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83
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Farrell LM, Buydens S, Bourgeois-Law G, Regehr G. Experiential learning, collaboration and reflection: key ingredients in longitudinal faculty development. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:82-91. [PMID: 34249193 PMCID: PMC8263038 DOI: 10.36834/cmej.70224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Longitudinal faculty development (LFD) may allow for increased uptake of teaching skills, especially in a forum where teachers can reflect individually and collectively on the new skills. However, the exact processes by which such interventions are effective need further exploration. METHODS This qualitative study examined an LFD initiative teaching a novel feedback approach attended by five family practice physicians. The initiative began with two 1.5-hour workshops: Goal-Oriented Feedback (as the teaching skill to be developed) and Narrative Reflection (as the tool to support personal reflection on the skill being learned). Over the subsequent six-months, the five participants iteratively applied the feedback approach in their teaching and engaged in narrative reflection at four 1-hour group sessions. Transcripts from the group discussions and exit interviews were analyzed using thematic analysis. RESULTS Iteratively trialing, individually reflecting on, and collectively exploring efforts to implement the new feedback approach resulted in the development of a learning community among the group. This sense of community created a safe space for reflection, while motivating ongoing efforts to learn the skill. Individual pre-reflection prepared individuals for group co-reflection; however, written narratives were not essential. CONCLUSION LFD initiatives should include an emphasis on ensuring opportunities for iterative attempts of teaching skills, guided self-reflection, and collaborative group reflection and learning to ensure sustainable change to teaching practices.
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Affiliation(s)
- Laura M Farrell
- Department of Medicine, University of British Columbia, British Columbia, Canada
| | - Sarah Buydens
- Department of Family Medicine, University of British Columbia, British Columbia, Canada
| | - Gisele Bourgeois-Law
- Department of Obstetrics and Gynecology, University of British Columbia, British Columbia, Canada
| | - Glenn Regehr
- Department of Surgery, Faculty of Medicine, University of British Columbia, British Columbia
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84
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Logan AA, Rao M, Cornia PB, Hagan SL, Newman TA, Redinger JW, Woan J, Albert TJ. Virtual Interactive Case-Based Education (VICE): A Conference for Deliberate Practice of Diagnostic Reasoning. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11159. [PMID: 34079908 PMCID: PMC8131415 DOI: 10.15766/mep_2374-8265.11159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/24/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Current approaches to teaching diagnostic reasoning minimally address the need for deliberate practice. We developed an educational conference for internal medicine residents to practice diagnostic reasoning and examine how biases affect their differential diagnoses through cognitive autopsies. METHODS We formatted the Virtual Interactive Case-Based Education (VICE) conference as a clinical problem-solving exercise, in which a facilitator presents a case to a single discussant selected from the audience. We delivered VICE on an internet-based conferencing platform with screen-sharing capability over approximately 30 minutes. To maximize learners' psychological safety, we employed an active facilitation model that normalized uncertainty and prioritized the diagnostic process over arriving at the correct diagnosis. RESULTS Resident attitudes toward VICE were assessed by utilizing a postconference survey and gathering descriptive data for 11 sessions. Ninety-seven percent of respondents (n = 35) felt that VICE was a novel and valuable addition to their curriculum. Qualitative data suggested that positive features of the conference included the opportunity to practice diagnostic reasoning, the single-discussant format, and the supportive learning environment. Discussants reported that holding the conference in person would have negatively impacted their experience. DISCUSSION Internal medicine residents universally valued the opportunity to engage in deliberate practice of case-based reasoning in a psychologically safe environment during the VICE conference. The virtual nature of the conference contributed significantly to discussants' positive experience. This resource includes all materials necessary to implement VICE, as well as an instructional video on facilitation.
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Affiliation(s)
- Alexander A. Logan
- Clinical Instructor, Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco
| | - Mayuree Rao
- Fellow, Department of Medicine, VA Puget Sound Health Care System and University of Washington
| | - Paul B. Cornia
- Associate Professor, Department of Medicine, University of Washington; Section Head for Hospital Medicine, VA Puget Sound Health Care System
| | - Scott L. Hagan
- Acting Assistant Professor, Department of Medicine, University of Washington; Medical Director, Seattle VA Primary Care Clinic, VA Puget Sound Health Care System
| | - Thomas A. Newman
- Clinical Instructor, Department of Medicine, University of Washington; Attending Physician, VA Puget Sound Health Care System
| | - Jeffrey W. Redinger
- Clinical Instructor, Department of Medicine, University of Washington; Attending Physician, VA Puget Sound Health Care System
| | - Jessica Woan
- Clinical Assistant Professor, Department of Medicine, University of Washington; Attending Physician, VA Puget Sound Health Care System
| | - Tyler J. Albert
- Assistant Professor, Department of Medicine, University of Washington; Attending Physician, VA Puget Sound Health Care System
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85
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Amaechi O, Foster KE, Tumin D, Campbell KM. Addressing the gate blocking of minority faculty. J Natl Med Assoc 2021; 113:517-521. [PMID: 33992432 DOI: 10.1016/j.jnma.2021.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/17/2021] [Accepted: 04/05/2021] [Indexed: 11/15/2022]
Abstract
There have been ongoing efforts to increase the presence of underrepresented minorities in medicine (URMM), including faculty development initiatives, mentoring programs and outreach efforts. However, URMM faculty face unique challenges that are crucial for academic institutions and leaders to recognize in order to improve retention of this group and allow for meaningful advancement in the field. This paper introduces the concept of gate blocking, defined as what happens to minority faculty as a result of the consequences of the minority tax and systems designed to advantage some and disadvantage others. In addition to defining gate blocking, the authors make recommendations to address this concern in academic medicine and promote the advancement and retention of URMM faculty.
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Affiliation(s)
- Octavia Amaechi
- Spartanburg Regional Family Medicine Residency Program, Medical University of South Carolina, Charleston, SC, United States
| | - Krys E Foster
- Department of Family and Community Medicine, Thomas Jefferson University at the Sidney Kimmel Medical College, Philadelphia, PA, United States
| | - Dmitry Tumin
- Department of Pediatrics, Educational Research Associate, Division of Academic Affairs, Brody School of Medicine, East Carolina University, 600 Moye Blvd AD-47, Greenville, NC 27834, United States
| | - Kendall M Campbell
- Research Group for Underrepresented Minorities in Academic Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
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Bynum WE, Sukhera J. Perfectionism, Power, and Process: What We Must Address to Dismantle Mental Health Stigma in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:621-623. [PMID: 33885411 DOI: 10.1097/acm.0000000000004008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this commentary, the authors draw on 2 personal accounts of mental illness published by Kirk J. Brower, MD, and Darrell G. Kirch, MD, in this issue to consider how and why mental health stigma is maintained in medical education. In particular, they explore how perfectionism, power differentials, and structural forces drive mental illness stigma in medical education. They argue that mental health stigma in medical education, while deeply embedded in the physician archetype and medical culture, is not inevitable and that dismantling it will require individual courage, interpersonal acceptance, and institutional action.
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Affiliation(s)
- William E Bynum
- W.E. Bynum IV is associate professor, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina
| | - Javeed Sukhera
- J. Sukhera is associate professor, Departments of Psychiatry and Paediatrics and scientist, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J, Bryce M. Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.
Objectives
To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Design
A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.
Review methods
Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.
Results
A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.
Limitations
Limitations were the low quality of included literature and limited number of UK-based studies.
Future work
Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.
Study registration
This study is registered as PROSPERO CRD42018088779.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amanda Wanner
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Medicine, Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, VIC, Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
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Nursing students’ perceptions of simulation design features and learning outcomes: The mediating effect of psychological safety. Collegian 2021. [DOI: 10.1016/j.colegn.2020.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Atherley AEN, Nimmon L, Teunissen PW, Dolmans D, Hegazi I, Hu W. Students' social networks are diverse, dynamic and deliberate when transitioning to clinical training. MEDICAL EDUCATION 2021; 55:376-386. [PMID: 32955741 PMCID: PMC7984257 DOI: 10.1111/medu.14382] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 05/15/2023]
Abstract
CONTEXT Transitions in medical education are dynamic, emotional and complex yet, unavoidable. Relationships matter, especially in times of transition. Using qualitative, social network research methods, we explored social relationships and social support as medical students transitioned from pre-clinical to clinical training. METHODS Eight medical students completed a social network map during a semi-structured interview within two weeks of beginning their clinical clerkships (T0 ) and then again four months later (T1 ). They indicated meaningful interactions that influenced their transition from pre-clinical to clinical training and discussed how these relationshipsimpacted their transition. We conducted mixed-methods analysis on this data. RESULTS At T0 , eight participants described the influence of 128 people in their social support networks; this marginally increased to 134 at T1 . People from within and beyond the clinical space made up participants' social networks. As new relationships were created (eg with peers and doctors), old relationships were kept (eg with doctors and family) or dissolved over time (eg with near-peers and nurses). Participants deliberately created, kept or dissolved relationships over time dependent on whether they provided emotional support (eg they could trust them) or instrumental support (eg they provided academic guidance). CONCLUSIONS This is the first social networks analysis paper to explore social networks in transitioning students in medicine. We found that undergraduate medical students' social support networks were diverse, dynamic and deliberate as they transitioned to clerkships. Participants created and kept relationships with those they trusted and who provided emotional or instrumental support and dissolved relationships that did not provide these functions.
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Affiliation(s)
- Anique E. N. Atherley
- Faculty of Health, Medicine and Life SciencesSchool of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
- School of MedicineUniversity of Western SydneyPenrithNSWAustralia
| | - Laura Nimmon
- Faculty of MedicineCentre for Health Education Scholarship (CHES)University of British ColumbiaVancouverBCCanada
| | - Pim W. Teunissen
- Faculty of Health, Medicine and Life SciencesSchool of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
- Department of Obstetrics and GynaecologyVU University Medical CentreAmsterdamThe Netherlands
| | - Diana Dolmans
- Faculty of Health, Medicine and Life SciencesSchool of Health Professions Education (SHE)Maastricht UniversityMaastrichtThe Netherlands
| | - Iman Hegazi
- School of MedicineUniversity of Western SydneyPenrithNSWAustralia
| | - Wendy Hu
- School of MedicineUniversity of Western SydneyPenrithNSWAustralia
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Bynum WE, Varpio L, Lagoo J, Teunissen PW. 'I'm unworthy of being in this space': The origins of shame in medical students. MEDICAL EDUCATION 2021; 55:185-197. [PMID: 32790934 DOI: 10.1111/medu.14354] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/28/2020] [Accepted: 08/07/2020] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Shame results from a negative global self-evaluation and can have devastating effects. Shame research has focused primarily on graduate medical education, yet medical students are also susceptible to its occurrence and negative effects. This study explores the development of shame in medical students by asking: how does shame originate in medical students? and what events trigger and factors influence the development of shame in medical students? METHODS The study was conducted using hermeneutic phenomenology, which seeks to describe a phenomenon, convey its meaning and examine the contextual factors that influence it. Data were collected via a written reflection, semi-structured interview and debriefing session. It was analysed in accordance with Ajjawi and Higgs' six steps of hermeneutic analysis: immersion, understanding, abstraction, synthesis, illumination and integration. RESULTS Data analysis yielded structural elements of students' shame experiences that were conceptualised through the metaphor of fire. Shame triggers were the specific events that sparked shame reactions, including interpersonal interactions (eg, receiving mistreatment) and learning (eg, low test scores). Shame promoters were the factors and characteristics that fuelled shame reactions, including those related to the individual (eg, underrepresentation), environment (eg, institutional expectations) and person-environment interaction (eg, comparisons to others). The authors present three illustrative narratives to depict how these elements can interact to lead to shame in medical students. CONCLUSIONS This qualitative examination of shame in medical students reveals complex, deep-seated aspects of medical students' emotional reactions as they navigate the learning environment. The authors posit that medical training environments may be combustible, or possessing inherent risk, for shame. Educators, leaders and institutions can mitigate this risk and contain damaging shame reactions by (a) instilling a true sense of belonging and inclusivity in medical learning environments, (b) facilitating growth mindsets in medical trainees and (c) eliminating intentional shaming in medical education.
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Affiliation(s)
- William E Bynum
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Lara Varpio
- Department of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Janaka Lagoo
- Duke Family Medicine Residency Program, Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
| | - Pim W Teunissen
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Khurshid Z, De Brún A, Moore G, McAuliffe E. Virtual adaptation of traditional healthcare quality improvement training in response to COVID-19: a rapid narrative review. HUMAN RESOURCES FOR HEALTH 2020; 18:81. [PMID: 33115494 PMCID: PMC7594275 DOI: 10.1186/s12960-020-00527-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/16/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND Information and communication technology are playing a major role in ensuring continuity of healthcare services during the COVID-19 pandemic. The pandemic has also disrupted healthcare quality improvement (QI) training and education for healthcare professionals and there is a need to rethink the way QI training and education is delivered. The purpose of this rapid evidence review is to quickly, but comprehensively collate studies to identify what works and what does not in delivering QI training and education using distance learning modalities. METHODS Three healthcare databases were searched along with grey literature sources for studies published between 2015 and 2020. Studies with QI training programmes or courses targeting healthcare professionals and students with at least one component of the programme being delivered online were included. RESULTS A total of 19 studies were included in the review. Most studies had a mixed methods design and used blended learning methods, combining online and in-person delivery modes. Most of the included studies reported achieving desired outcomes, including improved QI knowledge, skills and attitudes of participants and improved clinical outcomes for patients. Some benefits of online QI training delivery include fewer required resources, reduced need for on-site instructors, increased programme reach, and more control and flexibility over learning time for participants. Some limitations of online delivery modes include limited learning and networking opportunities, functional and technical problems and long lead time for content adaptation and customisation. DISCUSSION The review highlights that distance learning approaches to QI help in overcoming barriers to traditional QI training. Some important considerations for those looking to adapt traditional programmes to virtual environments include balancing virtual and non-virtual methods, using suitable technological solutions, customising coaching support, and using multiple criteria for programme evaluation. CONCLUSION Virtual QI and training of healthcare professionals and students is a viable, efficient, and effective alternative to traditional QI education that will play a vital role in building their competence and confidence to improve the healthcare system in post-COVID environment.
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Affiliation(s)
- Zuneera Khurshid
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Room B111, Dublin, Ireland
| | - Aoife De Brún
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Gemma Moore
- National Quality Improvement Team, Evidence for Improvement, Health Service Executive, Stewarts Hospital, Mill Lane, Palmerstown, Dublin, D20HY57 Ireland
| | - Eilish McAuliffe
- UCD Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Demystifying research in medical education: a novel framework, resources, and ethical challenges. Int Anesthesiol Clin 2020; 58:46-51. [PMID: 32804874 DOI: 10.1097/aia.0000000000000289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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93
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Martin L, Sibbald M, Brandt Vegas D, Russell D, Govaerts M. The impact of entrustment assessments on feedback and learning: Trainee perspectives. MEDICAL EDUCATION 2020; 54:328-336. [PMID: 31840289 DOI: 10.1111/medu.14047] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 11/01/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Assessment for and of learning in workplace settings is at the heart of competency-based medical education. In postgraduate medical education (PGME), entrustable professional activities (EPAs) and entrustment scales are increasingly used to assess competence. However, the educational impacts of these assessment approaches remain unknown. Therefore, this study aimed to explore trainee perceptions regarding the impacts of EPAs and entrustment scales on feedback and learning processes in the clinical setting. METHODS Four focus groups were conducted with postgraduate trainees in anaesthesia, emergency medicine, general internal medicine and nephrology at McMaster University in Hamilton, Ontario, Canada. Data collection and analysis were informed by principles of constructivist grounded theory. RESULTS Entrustable professional activities representing well-defined tasks are perceived as potentially effective drivers for feedback and learning. Use of EPAs and entrustment scales, however, may augment existing tensions between developmental (for learning) and decision-making (of learning) assessment functions. Three key dilemmas seem to influence the impact of EPA-based assessment approaches on residents' learning: (a) standardisation of outcomes versus flexibility in assessment to align with individual learning experiences; (b) assessment tasks focusing on performance standards versus opportunities for learning, and (c) feedback focusing on numeric entrustment scores versus narrative and dialogue. Use of entrustment as an assessment outcome may impact trainees' motivation and feelings of self-efficacy, further enhancing tensions between learning and performance. CONCLUSIONS Entrustable professional activities and entrustment scales may support assessment for learning in PGME. However, their successful implementation requires the careful management of dilemmas that arise in EPA-based assessment in order to support competence development.
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Affiliation(s)
- Leslie Martin
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthew Sibbald
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Dana Russell
- Postgraduate Medical Education, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Marjan Govaerts
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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94
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McLeod GA, Vaughan B, Carey I, Shannon T, Winn E. Pre-professional reflective practice: Strategies, perspectives and experiences. INT J OSTEOPATH MED 2020. [DOI: 10.1016/j.ijosm.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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95
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Releasing the Net to Promote Minority Faculty Success in Academic Medicine. J Racial Ethn Health Disparities 2020; 7:202-206. [PMID: 31953638 DOI: 10.1007/s40615-020-00703-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
Underrepresented minority faculty in academic medicine continue to be underrepresented in academic health centers across the country. Their underrepresentation impacts advancements in clinical care, education, and discovery and slows our forward progress in the field. Underrepresented in medicine faculty includes people who are black or African American, Hispanic or Latinx, or Native American. Barriers to underrepresented faculty recruitment, retention, and advancement include minority and gratitude taxes, imposter syndrome, and a lack of an appreciation of power distance and distance traveled. This article reviews five barriers to progress in achieving appropriate diversity among faculty and leadership of academic health centers, focusing on the multiplying effects of these barriers and potential steps forward.
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96
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Kivlehan E, Chaviano K, Fetsko L, Javaid S, Chandan P, Rojas AM, Dubon ME. COVID-19 pandemic: Early effects on pediatric rehabilitation medicine training. J Pediatr Rehabil Med 2020; 13:289-299. [PMID: 33164964 DOI: 10.3233/prm-200765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The COVID-19 pandemic hastened the need for graduate medical education (GME) innovation, resulting in the creation of multiple pediatric rehabilitation medicine (PRM) e-learning initiatives. There has been a paucity of data regarding trainee perceptions regarding quickly developed new methods of learning during the pandemic. This study explored PRM trainee perceptions of e-learning and effects of the pandemic on education. METHODS Questionnaire study with data collected via REDCap. RESULTS Greater than half of PRM trainees (56.6%, 30/53) responded. Most respondents reported that the virtual lectures series (79.3%), journal club (78.9%), and virtual arts initiatives (75.0%) were valuable to their education. Common benefits noted included access to subject experts, networking, lecture recording, and location flexibility. Common concerns included lack of protected time, virtual platform fatigue, and decreased engagement. Most respondents were not redeployed. Relative to before the pandemic, less satisfaction with clinical education (70.0%) and greater satisfaction with non-clinical education (60.0%) was reported. The majority of graduating trainees felt positively (83.3%) and 16.7% were neutral regarding confidence to graduate. CONCLUSION Trainees perceived national e-learning as valuable to their education, especially due to the access to expert leaders around the nation. Future work should explore ways to overcome barriers and optimize benefits of GME and PRM e-learning.
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Affiliation(s)
- Emily Kivlehan
- McGaw Medical Center at Northwestern University, Chicago, IL, USA.,Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Kelli Chaviano
- Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, USA
| | - Lauren Fetsko
- Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Simra Javaid
- Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, TX, USA
| | - Priya Chandan
- Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, KY, USA
| | - Ana-Marie Rojas
- Shirley Ryan AbilityLab, Chicago, IL, USA.,Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Mary E Dubon
- Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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97
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Young M, LaDonna K, Varpio L, Balmer DF. Focal Length Fluidity: Research Questions in Medical Education Research and Scholarship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:S1-S4. [PMID: 31365400 DOI: 10.1097/acm.0000000000002913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research and scholarship in health professions education has been shaped by intended audience (i.e., producers vs users) and the purpose of research questions (i.e., curiosity driven or service oriented), but these archetypal dichotomies do not represent the breadth of scholarship in the field. Akin to an array of lenses required by scientists to capture images of a black hole, the authors propose the analogy of lenses with different focal lengths to consider how different kinds of research questions can offer insight into health professions research-a microscope, a magnifying glass, binoculars, and telescopes allow us to ask and answer different kinds of research questions. They argue for the relevance of all of the different kinds of research questions (or focal lengths); each provides important insight into a particular phenomenon and contributes to understanding that phenomenon in a different way. The authors propose that research questions can move fluidly across focal lengths. For example, a theoretical question can be made more pragmatic through asking "how" questions ("How can we observe and measure a phenomenon?"), whereas a pragmatic question can be made more theoretic by asking a series of "why" questions ("Why are these findings relevant to larger issues?"). In summary, only through the combination of lenses with different focal lengths, brought to bear through interdisciplinary work, can we fully comprehend important phenomena in health professions education and scholarship-the same way scientists managed to image a black hole.
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Affiliation(s)
- Meredith Young
- M. Young is associate professor, Department of Medicine and Institute for Health Sciences Education, McGill University, Montreal, Quebec, Canada. K. LaDonna is assistant professor, Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. L. Varpio is professor, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland. D.F. Balmer is associate professor, Department of Pediatrics, The Children's Hospital of Pennsylvania and University of Pennsylvania, Philadelphia, Pennsylvania
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98
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Chan M, Nimmon L. Spinning the lens on physician power: narratives of humanism and healing. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:305-308. [PMID: 31562636 PMCID: PMC6820609 DOI: 10.1007/s40037-019-00537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Divisive, disabling and dangerous power has featured heavily in health professions literature, social media and medical education. Negative accounts of the wielding of power have discoloured the lens through which the public sees medicine and distorted the view of a profession long associated with healing, humanism and heart. What has been buried in the midst of this discourse are positive accounts of power where the yielding of power is encouraging, empathetic and empowering. This article offers three personal vignettes illustrating the ability of power to positively affect lives in the practice of medicine, for patients and doctors alike. More of these stories are needed to uplift and rebalance the conversation on physician power and how it can be used for good. It is necessary to provide a narrative framework of what it looks like to be a healer and a humanistic doctor to satisfy the general public through a commitment to cultivate multidimensional future healthcare providers.
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Affiliation(s)
- Mercedes Chan
- Department of Paediatrics, Division of Paediatric Rheumatology, University of British Columbia, Vancouver, BC, Canada.
- BC Children's Hospital, Vancouver, BC, Canada.
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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99
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Lama A, Hogg J, Olson AP. Perspectives from the other side of the screen: how clinicians and radiologists communicate about diagnostic errors. Diagnosis (Berl) 2019; 7:45-53. [DOI: 10.1515/dx-2019-0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/21/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Miscommunication amongst providers is a major factor contributing to diagnostic errors. There is a need to explore the current state of communications between clinicians and diagnostic radiologists. We compare and contrast the perceptions, experiences, and other factors that influence communication behaviors about diagnostic errors between clinicians and radiologists.
Methods
A survey with questions addressing (1) communication around diagnostic error, (2) types of feedback observed, (3) the manner by which the feedback is reported, and (4) length of time between the discovery of the diagnostic error and disclosing it was created and distributed through two large academic health centers and through listservs of professional societies of radiologists and clinicians.
Results
A total of 240 individuals responded, of whom 58% were clinicians and 42% diagnostic radiologists. Both groups of providers frequently discover diagnostic errors, although radiologists encounter them more frequently. From the qualitative analysis, feedback around diagnostic error included (1) timeliness of error, (2) specificity in description or terminology, (3) collegial in delivery, and (4) of educational value through means such as quality improvement.
Conclusions
Clinicians and radiologists discover diagnostic errors surrounding the interpretation of radiology images, although radiologists discover them more frequently. There is significant opportunity for improvement in education and practice regarding how radiologists and clinicians communicate as a team and, importantly, how feedback is given when an error is discovered. Educators and clinical leaders should consider designing, implementing, and evaluating strategies for improvement.
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Affiliation(s)
- Anna Lama
- Department of Medical Education, West Virginia University School of Medicine , Morgantown, WV , USA
| | - Jeffery Hogg
- West Virginia University School of Medicine , Morgantown, WV , USA
| | - Andrew P.J. Olson
- Department of Medicine , University of Minnesota Medical School , Minneapolis, MN , USA
- Department of Pediatrics , University of Minnesota Medical School , 420 Delaware St SE, MMC 741 , Minneapolis, MN 55455 , USA
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