The influence of postgraduate qualifications on educational identity formation of healthcare professionals

The Value of Master's Degree Programmes in Health Professions Education: A Scoping Review

INTRODUCTION

There are increasing numbers of Master's Degree Programmes in Health Professions Education (MHPE), and the value to their students and graduates is not well understood. We conducted a scoping review to explore what is known about the value of MHPE programmes to their students and graduates.

METHODS

A scoping review was conducted using Arksey and O'Malley's five-stage framework. PubMed, CINAHL, Cochrane, BEI, ERIC and EThOs databases were searched in addition to cited reference searching. Original research with an evaluation and published in the English language were included.

RESULTS

Nineteen studies were included. Studies were based in a variety of locations on five continents, and included in-person, distance and blended learning. Students and graduates of MHPE programmes self-reported development of their pedagogical knowledge, confidence and credibility in their role as an educator, and educational scholarship. Enhanced career opportunities and opportunities for collegial interactions and networks were also reported. Important barriers included struggling with the time and financial commitments required for studying on a MHPE programme.

CONCLUSIONS

There are a variety of dimensions of value of MHPE programmes to their students and graduates. Important practical recommendations for MHPE programme providers and employers include providing opportunities for the development of networks and supporting the time and financial commitments required for studying.

Exploring the current state of clinical and practical teaching in obstetrics and gynecology in the era of competency-based education: a nationwide survey among German teaching coordinators

BACKGROUND

Obstetrics and gynecology (OB/GYN) is an essential medical field that focuses on women's health. Universities aim to provide high-quality healthcare services to women through comprehensive education of medical students. In Germany, medical education is undergoing a phase of restructuring towards the implementation of competency-based learning. The objective of the current survey was to gain insights into the teaching methods, resources, and challenges at German medical universities in the field OB/GYN. This aims to document the current state of medical education and derive potential suggestions for improvements in the era of competency-based learning. The survey was conducted with teaching coordinators from the majority of OB/GYN departments at German universities.

METHODS

A questionnaire was sent to the teaching coordinators in all 41 OB/GYN departments at German university hospitals. The survey was delivered via email with a link to an online survey platform.

RESULTS

The study received 30 responses from 41 universities. Differences were observed in the work environment of teaching coordinators concerning release from clinical duties for teaching purposes and specialized academic training. Overall, medical education and student motivation were perceived positively, with noticeable gaps, particularly in practical gynecological training. Deficiencies in supervision and feedback mechanisms were also evident. Subfields such as urogynecology and reproductive medicine appear to be underrepresented in the curriculum, correlating with poorer student performance. E-learning was widely utilized and considered advantageous.

CONCLUSION

The present study provides valuable insights into the current state of medical education in OB/GYN at German universities from the perspective of teaching experts. We highlight current deficits, discuss approaches to overcome present obstacles, and provide suggestions for improvement.

Observing expert opinion of medical affairs pharmaceutical physicians on the value of their clinical experience to the pharmaceutical industry using the Jandhyala method

BACKGROUND

The pharmaceutical industry requires a highly qualified workforce with diverse skillsets. Medical affairs pharmaceutical physicians (MAPPs) have unique qualifications among pharmaceutical company employees, but the exact contribution of their education and training is unknown. This study aimed to identify the medical education and training competencies MAPPs use in the pharmaceutical industry in relation to the four external stakeholders, regulators, payors, prescribers, and patients.

METHOD

Ten MAPPs were recruited using convenience sampling via professional networks. A systematic literature review and the Jandhyala method, a two-stage qualitative online consensus method, identified which of MAPPs' medical education and training competencies they used in their work with each external stakeholder. Statistical analyses determined heterogeneity in the relevance of competencies and competency categories to each stakeholder.

RESULTS

Nine MAPPs completed the study. Of the 59 competencies identified, 54 were relevant to all external stakeholders. Relevance of competencies varied significantly between external stakeholders (p = .0434). Binary competency scores varied significantly for three pairs of stakeholders, "patient vs. payor" (p = .025), "prescriber vs. regulator" (p = .013) and "prescriber vs. payor" (p = .008). Between-stakeholder overall frequency count varied significantly for two of the nine competency categories.

CONCLUSION

MAPPs develop a highly specialized set of competencies during medical education and training from which they use distinct subsets to meet the needs of external stakeholders in the pharmaceutical industry. Undergraduate and postgraduate competency-based medical education appears to prepare MAPPs for cognitive and technical work. Further exploration may aid understanding of how they develop soft skills.

The Making of an Educator: Professional Identity Formation Among Graduate Medical Education Faculty Through Situated Learning Theory

INTRODUCTION

Professional identity formation (PIF) is a foundational element to professional medical education and training. Given the impact of faculty role models and mentors to student and trainee learning, mapping the landscape of PIF among faculty takes on increased importance. We conducted a scoping review of PIF through the lens of situated learning theory. Our scoping review question was: How is situated learning theory used to understand the process of PIF among graduate medical educators?

METHODS

The scoping review methodology described by Levac et al served as the architecture for this review. Medline, Embase, PubMed, ERIC, CINAHL, PsycINFO, and Web of Science Core Collection were searched (from inception) using a combination of terms that describe PIF among graduate medical educators.

RESULTS

Of the 1434 unique abstracts screened, 129 articles underwent full-text review, with 14 meeting criteria for inclusion and full coding. Significant results organized into three main themes: importance of using common definitions; evolution of theory over time with untapped explanatory power; identity as a dynamic construct.

DISCUSSION

The current body of knowledge leaves many gaps. These include lack of common definitions, need to apply ongoing theoretical insights to research, and exploration of professional identity as an evolving construct. As we come to understand PIF among medical faculty more fully, twin benefits accrue: (1) Community of practices can be designed deliberately to encourage full participation of all graduate medical education faculty who desire it, and (2) Faculty can more effectively lead trainees in negotiating the ongoing process of PIF across the landscape of professional identities.

Do All Roads Lead to Full Participation? Examining Trajectories of Clinical Educators in Graduate Medical Education through Situated Learning Theory

Phenomenon: As new faculty members begin their careers in Graduate Medical Education, each begins a journey of Professional Identity Formation from the periphery of their educational communities. The trajectories traveled vary widely, and full participation in a given educational community is not assured. While some medical school and post-graduate training programs may nurture Professional Identity Formation, there is scant support for faculty. To date, the trajectories that Graduate Medical Education faculty travel, what may derail inbound trajectories, and what tools Graduate Medical Education faculty use to navigate these trajectories have not been explicitly described. We explore these three questions here. Approach: Communities of Practice, a component of Situated Learning Theory, serves as a helpful framework to explore trajectories of educator identity development among Graduate Medical Educators. We used a inductive and deductive approach to Thematic Analysis, with Situated Learning Theory as our interpretive frame. Semi-structured interviews of faculty members of GME programs matriculating into a Health Professions Education Program were conducted, focusing on participants' lived experiences in medical education and how these experiences shaped their Professional Identity Formation. Findings: Participants noted peripheral, inbound, boundary, and outbound trajectories, but not an insider trajectory. Trajectory derailment was attributed to competing demands, imposter syndrome and gendered marginality. Modes of belonging were critical tools participants used to shape PIF, not only engagement with educator roles but disengagement with other roles; imagination of future roles with the support of mentors; and fluid alignment with multiple mutually reinforcing identities. Participants identified boundary objects like resumes and formal roles that helped them negotiate across Community of Practice boundaries. Insights: Despite a desire for full participation, some clinical educators remain marginal, struggling along a peripheral trajectory. Further research exploring this struggle and potential interventions to strengthen modes of belonging and boundary objects is critical to create equitable access to the inbound trajectory for all of our colleagues, leaving the choice of trajectories up to them.

Faculty development strategies to empower university teachers by their educational role: A qualitative study on the faculty members and students' experiences at Iranian universities of medical sciences

BACKGROUND

This study aimed to identify and explain the strategies of faculty development based on their role at Iranian Universities of Medical Sciences.

METHODS

We conducted a qualitative content analysis study in 2021 using purposive, snowball sampling, with a maximum variation in the faculty members' age and experience level. Twenty four participants were enrolled in this study (eighteen faculty members and six medical sciences students); data collection consisted of two phases of semi-structured interviews and a brainstorming group technique. Data were categorized into two themes and six related subthemes, based on their similarities and differences after frequent summarization.

RESULTS

The data analysis yielded two themes and eight categories. The first theme was to explain competencies based on role and task with two sub-themes: Tasks and capabilities and development and excellence of personal qualities. The second theme was the best strategies for empowering the teachers with four sub-themes, including problem-based learning, integration of methods, evaluation-based education, and scholarship in education (PIES), which explains the strategies that can support the development of teachers in medical sciences universities, and all the concepts were interrelated to each other.

CONCLUSION

From the experiences of faculty members, the importance of some strategies in education and empowering the teachers' professional competence dimensions should be emphasized. PIES could explain the practical strategies that can support the development of teachers in medical sciences universities.

Perseverance and consistency of interest in underrepresented post-doctoral fellows and early-career faculty

Introduction

Underrepresented researchers face more challenges than their well-represented counterparts. Perseverance and consistency of interest are associated with career success in well-represented physicians. Therefore, we examined associations of perseverance and consistency of interest with Clinical Research Appraisal Inventory (CRAI), science identity, and other factors related to career success among underrepresented post-doctoral fellows and early-career faculty.

Methods

This is a cross-sectional analysis of data collected from September to October 2020 among 224 underrepresented early-career researchers at 25 academic medical centers in the Building Up Trial. We used linear regression to test associations of perseverance and consistency of interest scores with CRAI, science identity, and effort/reward imbalance (ERI) scores.

Results

The cohort is 80% female, 33% non-Hispanic Black, and 34% Hispanic. The median perseverance and consistency of interest scores were 3.8 (25th-75th percentile: 3.7,4.2) and 3.7 (25th-75th percentile: 3.2, 4.0), respectively. Higher perseverance was associated with a higher CRAI score (β = 0.82; 95% CI = 0.30, 1.33, p = 0.002) and science identity (β = 0.44; 95% CI = 0.19, 0.68, p = 0.001). Higher consistency of interest was associated with a higher CRAI score (β = 0.60; 95% CI = 0.23, 0.96, p = 0.001) and higher science identity score (β = 0.20; 95% CI = 0.03, 0.36, p = 0.02), while lower consistency of interest was associated with imbalance favoring effort (β = -0.22; 95% CI = -0.33, -0.11, p = 0.001).

Conclusions

We found that perseverance and consistency of interest are related to CRAI and science identity, indicating that these factors may positively influence one's decision to stay in research.

What are the Attitudes of Medical Students at Jazan University Toward Professionalism?

PURPOSE

We assessed the attitudes of Jazan University medical students toward professionalism and evaluated the associations of those attitudes with demographic factors.

MATERIALS AND METHODS

Seven hundred ninety-seven respondents (88.85% response rate) out of 898 students who were invited to this study (50.7% were men and 49.3% were women) were studied by their response to the Learner's Attitude of Medical Professionalism Scale (LAMPS) that assess their level of agreement with 28 items, each reflecting a single professionalism competency within the subscales of Altruism, Excellence, Duty/Accountability, Honor/Integrity, and Respect for Others.

RESULTS

Of 797 respondents (88.85% response rate), 50.7% were men and 49.3% were women. Subscales with high agreement scores were Excellence (median, 21.0; range, 6-30) and Duty/Accountability (median, 21.0; range, 7-35). Subscales with slightly lower agreement scores were Respect for Others (median, 15.0; range, 5-25), Altruism (median, 15.0; range, 5-25), and Honor/Integrity (median, 12.0; range, 5-25). No sex differences were observed for most subscales; however, men gave higher agreement scores on the Excellence subscale, and compared with year 3 respondents (preclinical phase), year 6 respondents (clinical phase) gave higher agreement scores on the Excellence, Altruism, and Respect for Others subscales.

CONCLUSION

Overall, medical students at Jazan University indicated high agreement with all attitudes to professionalism subscales on the LAMPS.

Dermatology residents as educators: a qualitative study of identity formation

BACKGROUND

One of the many identities a physician comes to form during their career is their identity as an educator. Exploring formation of this identity may enrich our understanding of how physicians make decisions related to their roles as educators, their behaviors, and how this ultimately influences the educational environment. It is the aim of this study to investigate educator identity formation of dermatology residents while early in their careers.

METHODS

Drawing on a social constructionist paradigm, we conducted a qualitative study, utilizing an interpretative approach. We examined longitudinal data over a 12-month period using dermatology residents' written reflections from their professional portfolios and semi-structured interviews. We collected this data as we progressed through and beyond a 4-month professional development program designed to encourage residents' growth as educators. Sixty residents in their second, third, or final year of residency programs located in Riyadh, Saudi Arabia were invited to take part in this study. Twenty residents participated with sixty written reflections and 20 semi-structured interviews. Qualitative data were analyzed using a thematic analysis approach.

RESULTS

Sixty written reflections and 20 semi-structured interviews were analyzed. Data was categorized according to themes corresponding to the original research questions. For the first research question regarding identity formation, themes included definitions of education, the process of education, and identity development. For the second research question, 1 theme entitled professional development program included, the following sub-themes: individual act, interpersonal activity, and an organizational undertaking, with many believing that residency programs should prepare residents for their educator roles. Participants also described newfound leadership ambitions of creating new dermatology fellowship programs as a result of taking part in the Resident-as-Educator program.

CONCLUSIONS

Our study provides insights on the dynamic formation of educator identities amongst dermatology residents. Investment in developing residents as educators through professional development programs may instigate transformational change on the individual physician level and profession's level.

Professional qualifications of medical affairs pharmaceutical physicians and other internal stakeholders in the pharmaceutical industry

Background: Medical affairs pharmaceutical physicians (MAPPs) have unique value to pharmaceutical companies due to their accountability for activities that benefit regulators, payors, prescribers and patients. This study assessed whether MAPPs' specialist training and education in pharmaceutical medicine could account for this level of value by determining whether there was significant variation in education and training between MAPPs and other internal stakeholders of pharmaceutical companies. Methods: A systematic search of LinkedIn profiles from the 10 pharmaceutical companies by revenue was conducted between June and October 2021. Job title and type and year of undergraduate and postgraduate qualifications were extracted. A one-sided Mann-Whitney test assessed for differences in the total number of qualifications between MAPPs and other internal stakeholders involved in medical affairs using MAPPs as the reference group. Other internal stakeholders included medical affairs pharmacists (MAPharm), other medical affairs professionals (MAOth), and market access (MAcc), commercial (COmm) and sales professionals. Sub-group analysis determined differences in undergraduate and postgraduate education. Results: In total, 524 profiles were included. Compared to all other internal stakeholders, MAPPs had a significantly higher number of undergraduate (p < 0.001) and postgraduate (MAPharm, p = 0.003; MAOth, p = 0.004; MAcc, COmm and Sales, p < 0.001) qualifications. Additionally, MAPPs had a significantly longer time to industry than other internal stakeholders apart from MAPharm. Of those with clinical qualifications, MAPPs were almost twice as likely to have business qualifications. Conclusions: Of all internal stakeholders, MAPPs had the highest number of qualifications and the best match between expertise and the contextual demands of decision-makers in the pharmaceutical industry. Pharmaceutical companies in the UK can use these findings to clarify role boundaries and decision-making power based on the nature and level of expertise of each internal stakeholder.

Structure and impact of longitudinal Graduate Medical Education curricula designed to prepare future clinician-educators: A systematic scoping review: BEME Guide No. 74

BACKGROUND

Many Graduate Medical Education (GME) programs offer clinician-educator curricula. The specific instructional methods employed and current best practices for clinician-educator curricula are unknown. We aimed to characterize the structure, curriculum content, instructional methods, and outcomes of longitudinal GME clinician-educator curricula.

METHODS

We conducted a scoping review, registered with BEME, by comprehensively searching health science databases and related grey literature from January 2008 to January 2021 for studies involving longitudinal GME curricula aimed to train future clinician-educators.

RESULTS

From 9437 articles, 36 unique curricula were included in our review. Most curricula were designed for residents (n = 26) but were heterogeneous in structure, instructional methods, and content. Several curricular themes emerged, including: 1) duration ≥ 12 months, 2) application of theory-based didactics with experiential activities, 3) independent projects, 4) exposure to faculty mentorship and educator communities, 5) strengthening competencies beyond teaching and scholarship, and 6) protected time and funding. Most outcomes were positive and focused on learner satisfaction or behavior change related to scholarly output and career tracking.

CONCLUSIONS

Curricula in our review included important skills including experiential teaching, scholarly projects, and exposure to educator communities. Future curricula should build on these competencies and include more assessment of learner and program outcomes.

I am an Educator: Investigating Professional Identity Formation using Social Cognitive Career Theory

PhenomenonClinician-educators (CE) are physicians who fill a unique role within academic medicine, as they are responsible both for patient care and for training future physicians via teaching, curricular design, and creation of educational scholarship. Development of a strong professional identity as an educator leads to greater career satisfaction and a higher likelihood of staying in academic medicine. However, little is known about how this identity develops, especially in the training environment where there are competing pressures to develop as a clinician and researcher. This study aimed to explore professional identity formation in residents and fellows interested in becoming educators. Approach: We used a longitudinal, qualitative approach to investigate professional identity formation in residents and fellows participating in the Clinician-Educator Training Pathway. The longitudinal nature allowed us to temporally explore which aspects of the program and experiences acted as barriers or facilitators of professional identity formation as a CE. Our study used the social cognitive career theory (SCCT) Career Choice Model, which considers contextual influences in addition to the three variables of self-efficacy beliefs, outcome expectations, and goals. Findings: We found that participants shared a common goal of building self-efficacy as an educator. Participants took actions to engage more deliberately in formal and informal teaching and acting as an educator by giving learner feedback, developing curricula, and consuming and conducting educational research, all of which increased self-efficacy as educators. At the beginning of the program, participants were unclear of the roles and trajectories followed to become CEs. Engaging with a community of CEs clarified pathways and presented role models that could be seen as possible selves. This study also elucidated contextual influences relating to personal factors, career opportunities, and potential for advancement that mediated the goals and actions taken by participants to become educators. Insights: This study demonstrates that the SCCT Career Choice Model provides an excellent framework for understanding professional identity formation in future educators. Our participants built self-efficacy, formed outcome expectations, and set goals and took specific actions toward the goal of becoming an educator. Participants tested the various role model attributes as possible selves to see how those would be effective in their own career. Reflection on expectations, career goals, and self-efficacy as a clinician and an educator can assist in identity formation as a CE and can assist those designing CE training programs to better support identity formation in their participants.

Analysis in the ethical decision-making of dental, nurse and physiotherapist students, through case-based learning

INTRODUCTION

Training in ethical competencies is perceived with special interest among the objectives of health education. The dimensions of the person such as integrity, autonomy and dignity influence the choice of interventions, but the different specialties of the health sciences conceive these dimensions with different perspectives depending on the clinical setting. These divergences can be detected during the first years of undergraduate studies, and it is important to know the professional bias and its possible causes.

MATERIALS AND METHODS

A procedure was developed through case-based learning (CBL) to assess various characteristics of decision-making during the early stages of student training. A semi-quantitative method was designed based on the narrative responses of a case with ethical implications in the field of gender violence. The method was applied to 294 undergraduate students in nursing (95), physiotherapy (109) and dentistry (90) from the Faculty of Health Sciences of a Spanish university. A frequency analysis of the narrative responses of the students to the proposed case was carried out, using the chi-square test to determine any association between the variables studied: gender, specialty and ethical knowledge.

RESULTS

Four types of response categories were detected, as a result of combining the personal conversation, report to legal authority or require assistance of other teams. The most common option in dentists is conversation only, while physical therapists include the assistance of other teams. In nursing, a balance is observed between both possibilities. The results show that student responses differ significantly among specialties and also differ significantly according to test scores on ethical knowledge. However, no significant differences were found between the responses provided by men and women.

CONCLUSION

Most of the health sciences students highly valued their own capacity for dialogue and reflection to approach situations with complex ethical dimensions. We consider that case-based learning (CBL), in combination with narrative analysis is a valid means of evaluating the professional ethical competencies of students in health sciences careers applied to a common goal.

Becoming Agents of Change: Contextual Influences on Medical Educator Professionalization and Practice in a LMIC Context

Medical educators are particularly needed in Low- and Middle-Income Countries (LMIC), where medical schools have grown rapidly in size, number, and global outlook in response to persistent health workforce shortages and increased expectations of quality care. Educator development is thus the focus of many LMIC programs initiated by universities and governments of high income countries. While signs of medical educator professionalization such as postgraduate qualifications, specialized units, and professional associations have emerged in LMIC, whether these relate to programs originating from outside LMIC contexts is unknown. This study investigated the contextual influences on the long-term impact of an international faculty development program a decade after its delivery in a LMIC context - Vietnam. Ten years after an international aid program to develop clinical skills teaching expertise in Vietnam, we conducted in-depth qualitative interviews with eight medical educators from all eight participating medical schools. Selected for their leadership potential, each participant had completed the Maastricht Masters in Health Professions Education during the program. Interview transcripts underwent thematic analysis, using the Theory of Practice Architectures as a conceptual lens to highlight the contextual influences on professional practice. Four themes were identified: Careers and Practices before, during, and after the program, Unrecognized and Unseen practice, Structural Restraints on individual advancement and collective activity, and the Cultivation of Connections through social traditions. Participants reported being in well-established teaching delivery roles. However, the absence of professionalizing discourses and material resources meant that practice was restricted and determined by institutional leadership and individuals' adaptations. Informed by the theory of practice architectures, we found that change in medical education practice will falter in contexts that lack supporting discursive, material-economic, and socio-political arrangements. While there were emerging signs of individual agency, the momentum of change was not sustained and perhaps unapparent to Western framings of educational leadership. Practice architectures offers a framework for identifying the contextual features which influence practice, from which to design and deliver sustainable and impactful interventions, and to advance context-relevant evaluation and research. Our findings suggest that faculty development delivered across diverse contexts, such as in distributed or transnational medical programs, may have more effect if informed by a practice architectures analysis of each context.

A Systematic Review on the Current Trend In Nonsurgical Aesthetic Training for Knowledge, Skill, and Professional Identity Formation

BACKGROUND

Non-surgical aesthetics is a rapidly growing healthcare domain and lacks pedagogically sound education and training programs. The trainee physicians often participate in short courses which are outside of the scope of an existing postgraduate training program to acquire the necessary knowledge and procedural skills. However, such training programs lack values and interests that shape critical thinking and holistic decision-making, often referred to as professional identity.

OBJECTIVES

This systematic review aims to analyse current trends in non-surgical aesthetic clinical education to form knowledge, skills, and professional identity.

METHODS

A detailed literature search was conducted in nine databases; PubMed [United States National Library of Medicine (NLM), Bethesda, MD], Cochrane (Wiley, Hoboken, NJ), Centre for Reviews and Dissemination [(CRD) University of York, York, United Kingdom], and Google Scholar (Google, Mountain View, CA) for relevant studies published between January 2010 and December 2020, with an update in September 2021.

RESULTS

Fifty-five articles were identified through electronic searches, amongst which forty were selected following a review of the abstracts. Sixteen articles were identified as the best evidence for the detailed and iterative review based on their relevance and fit to the inclusion criteria. Unfortunately, none of the included studies designed their questionnaire based on the Kirkpatrick Model, which is best known for analysing and evaluating the results of training and educational programs.

CONCLUSIONS

This systematic review provides valuable insight into graduate professional identity formation and graduates' readiness for independent clinical practice. Therefore, particular consideration should be given to incorporating these triggers when developing evidence-based postgraduate curricula for non-surgical aesthetics.

Navigating landscapes of practice: A longitudinal qualitative study of physicians in medical education

INTRODUCTION

Despite its widespread application in medical education, belonging to a single community of practice does not reflect the overall experience of physician-educators. Knowing how physician-educators find their way among different communities of practice (ie their landscape of practice) has implications for professional development but the limited description in the literature. In this longitudinal qualitative research, we explored how physicians who pursue graduate degrees in medical education navigate their landscape of practice.

METHODS

11/29 physicians in one cohort of a masters in medical education programme were interviewed annually from 2016 (programme start) to 2020 (2 years post-graduation). We iteratively collected and analysed data, creating inductive codes and categorising coded data by mode of identification (engagement, imagination, alignment) and time. We organised narratives into time-ordered data matrices so that final analysis wove together mode, time and participant.

RESULTS

All participants consistently spoke of navigating their landscape of practice, which included the community created in the graduate programme; but that single community 'doesn't define the journey itself'. They shifted engagement from teaching individual learners to translating what they learned in the graduate programme to develop educational projects and produce scholarship. They shifted the imagination from relying on internal and external assessments to experience-inspired versions of their future self. And they shifted alignment from belonging to the graduate programme's community of practice, then belonging to different communities in their landscape of practice and ultimately focussing on communities that mattered most to them.

DISCUSSION

Physicians in a graduate programme in medical education navigated their dynamic landscape of practice by shifting how they engaged in medical education, as well as what they imagined and who they aligned with as physician-educators. Our work offers novel insights into how knowledgeability emerges through time as overlapping modes of identification.

Perception of Saudi Undergraduate Students Towards Professionalism in Medicine

Objectives

Professionalism has garnered immense attention in medical education due to increased societal accountability and focus on excellence in healthcare. However, less attention has been given to identifying attitudes about professionalism in medical students who are the future advocates of the healthcare system. This study aimed to assess perceptions of Saudi undergraduate medical students towards professionalism.

Methods

A cross-sectional survey was carried out among second and sixth year students of the College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia, in September 2018. A self-administered professionalism questionnaire was anonymously completed. Students were asked to provide their level of agreement with 18 survey items using a 5-point Likert scale.

Results

Overall, 288 students participated in the study (males: 49.3% and females: 50.7%), with a response rate of 90%. The median professionalism score was high (71.0; range: 64–76) regardless of age, gender or level of education. Similar high scores were noted in the following subscales: Excellence, 20.0 (range: 18–21); Respect for Others, 17.0 (14–18); Altruism, 12.0 (10–13); Duty, 8.0 (7–9); Accountability, 7.0 (6–8) and Honour and Integrity, 8.0 (7–10). No gender differences were observed in the majority of subscales. However, males demonstrated higher scores in the Duty subscale (males: 9.0 versus females: 8.0; P = 0.026).

Conclusion

Medical students demonstrated high professionalism scores. Future studies are needed to assess the impact of the course curriculum on their level of professionalism over time.

Advancing careers in medical education: 'Practice architectures' for success in a resource-constrained setting

INTRODUCTION

Advancement of careers in medical education remains a challenge around the world and is under-researched in resource-constrained contexts. Using the Theory of Practice Architectures (TPA) as a conceptual lens, we investigated the emergence and subsequent development of medical education careers in a resource-constrained country.

METHODS

Qualitative semi-structured interviews were conducted with a purposive sample of 14 early-career and leading medical educators from all 9 medical schools and the 1 postgraduate institute in Sri Lanka. Thematic analysis was performed, informed by the three conceptual lenses of TPA: discursive-cultural, material-economic, and socio-political.

RESULTS

Three themes were identified: faculty development as a career-building discourse (discursive-cultural); leadership focused on creating a workforce with expertise in medical education, equal to clinical medicine specialties (material-economic); and collaborative professional networks in health professions education originating from faculty development activities (socio-political).

CONCLUSION

Using TPA, our findings highlight that faculty development can foster a powerful discourse for promoting academic careers in medical education. Medical education leaders can also play a critical role by establishing formal training programmes in medical education, and collaborative professional networks can improve visibility of careers in medical education, particularly when participants share expertise and resources between institutions and health professions, across the continuum of undergraduate to postgraduate training. TPA can also be used to better understand how cultural, material-economic and socio-political factors can enhance or hinder career development in different contexts, whether resource-limited or well-resourced.

Setting Agenda for Medical Education Research in Pakistan

Objective:

To justify the allocation of human and financial resources, this study aims to identify multiple stakeholders’ views of medical education research priorities in Pakistan for the next five years.

Methods:

This two-stage exploratory mixed-method study was conducted from Jan 2018 to Jun 2019. A purposively selected sample of 250 faculty members, research supervisors, postgraduate students, undergraduate students and policymakers actively involved in improving Medical Education were included. In Stage-I: An exploratory open-ended questionnaire asking about Medical Education Research (MER) priorities in Pakistan for the next five years was emailed. Data were thematically analyzed to identify MER areas. In Stage-II: Another questionnaire was developed based on MER areas. The participants were asked to rate their importance on a scale of one to five. Descriptive statistics were calculated using SPSS.v.24.

Results:

In Stage-I, 140 participants and in Stage-II, 130 participants from different stakeholder groups responded. We identified 20 research priorities grouped under eight themes: curriculum organization, content, delivery, assessment, workplace, students, faculty and educational management. Top three research priorities were identifying needs and developing effective provisions for continuous professional development of the faculty, improving assessment and communication skills.

Conclusion:

The study identified top MER priority areas as continuous professional development, assessment and communication skills. Some areas unique to the current study include admissions, fostering critical thinking, Islamic values in professionalism and ethics. The study provides evidence-base for decision-making about allocating time and funds for MER in Pakistan.

Supporting a teacher identity in health professions education: AMEE Guide No. 132

This guide provides an understanding of what teacher identity is and how it can be developed and supported. Developing a strong teacher identity in the context of health professions education is challenging, because teachers combine multiple roles and the environment usually is more supportive to the identity of health practitioner or researcher than to that of teacher. This causes tensions for those with a teaching role. However, a strong teacher identity is important because it enhances teachers' intention to stay in health professions education, their willingness to invest in faculty development, and their enjoyment of the teaching role. The guide offers recommendations on how to establish workplace environments that support teacher identity rather than marginalise it. Additionally, the guide offers recommendations for establishing faculty development approaches that are sensitive to teacher identity issues. Finally, the guide provides suggestions for individual teachers in relation to what they can do themselves to nurture it.

World Federation for Medical Education: Appropriateness of Basic Medical Education standards in Pakistan

Objective:

To explore the appropriateness of WFME Basic Medical Education (BME) standards to Pakistani context.

Methods:

A descriptive cross-sectional survey of faculty, graduates and students of five Masters’ in Health Professions Education programmes was carried out from Jul-Dec 2017. Participants were asked to rate the appropriateness of WFME-BME basic standards to Pakistani context on a fourpoint Likert scale (Strongly Disagree through to Strongly Agree). They were also asked for additional comments, if any. Descriptive statistics were carried out for quantitative data, while content analysis for qualitative data.

Results:

A total of 127/200 participants responded (63.5%). For all major areas (106 standards), 97.7% responses (n=13,149) were positive while only 2.3% (n=313) were negative. Ninety-six standards got more than 95% positive response while only 10 standards in three major areas got more than five percent negative response. These include five standards from major area Mission and Outcomes, one from Educational Programme and four from Students.

Conclusions:

This is the first study exploring the appropriateness of WFME-BME standards for accreditation in Pakistan. We found that all the areas, sub-areas and standards are largely appropriate. We recommend further deliberation on 10 standards with more than five percent negative responses, regarding their contextualization to Pakistan and the development of guidelines and possible reconsiderations in WFME future revisions.

Using Bourdieu to explore graduate attributes in two online Master's programmes

Within the expansion of postgraduate educational qualifications for health professionals, graduate attributes have become important markers of outcomes and value. However, it is not clear how or when graduate attributes develop, or how they are applied in professional practice after graduation. We interviewed 17 graduates from two online Master's programmes to explore their perceptions of how postgraduate study had influenced their practice and professional identity. Our thematic analysis produced three main themes (academic voice, infectious curiosity, and expanding worldview) which reflected changes in the participants' confidence, attitude, perspective, and agency across professional and academic settings. We then conducted a secondary phase of analysis using Bourdieu's concepts of 'field', 'capital', and 'habitus'. While graduate attributes have been conceptualised as the context-independent acquisition of traits that can be employed by individuals, Bourdieu's framework highlights their relational qualities: they are caught up in the cultural history and context of the student/professional, the reputation of the awarding institution, and the graduate's location within a network of professional peers.

Stuck in the blend: Challenges faced by students enrolled in blended programs of Masters in Health Professions Education

Objectives:

The advent of computer technology and widespread use of internet has given rise to e-learning and blended programs all over the world. The aim of this study was to explore problems faced by students enrolled in blended program of MHPE in Pakistan.

Methods:

This was a qualitative exploratory study done between October 2017 and February 2018. Data included semi-structured individual interviews of eighteen students and four facilitators involved in blended MHPE programs of three leading Universities of Pakistan. Nine hundred and two students’ reflective essays were also included for data triangulation. Data was organized in Atlas-ti and analyzed through thematic analysis using Revised Community of Inquiry framework.

Results:

Seventy open codes were condensed to fifteen sub-themes and five themes. Learner related problems comprised difficulty in self-regulation and self-directed learning as emphasized by the facilitators whereas students quoted teacher related problems focusing on feedback provision. Cognitive issues included huge cognitive load with engagement issues. Students also highlighted issues with social interaction encompassed difficulties in interacting with facilitators and managing group dynamics. Both students and facilitators agreed on institutional issues focused on limited resource provision, unsatisfactory administrative support and financial issues.

Conclusion:

Students of MHPE are challenged with variety of issues in blended learning program relating to self-regulation, heavy cognitive load with engagement, social interaction especially with facilitators and managing group dynamics Addressing these issues can improve the experience of these students in blended programs.

Along the Axes of Difference: Setting Scholarship and Practice Agendas for Faculty Development

The rise of academic clinical education programs underlines the growing influence of faculty development on how health care is taught and therefore practiced. Research to date has outlined the rapid rise of these postgraduate qualifications and their impact on their graduates' professional identities. Given the scale and nature of the change, it is worth considering these programs from a broader perspective. "Axes of difference" are invoked to chart the tensions and intersections between various social identities that form distinctive features of clinical education. Six axes are described: patients-clinicians, trainees-trainers, classrooms-clinics, uniprofessional-interprofessional, local-global, and teachers-clinicians. These reveal a range of complexities about faculty development, which can inform both practice and scholarship agendas.