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Rees CE, Ottrey E. "Lives and times": The case for qualitative longitudinal research in anatomical sciences education. ANATOMICAL SCIENCES EDUCATION 2024. [PMID: 39354856 DOI: 10.1002/ase.2514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 10/03/2024]
Abstract
Qualitative longitudinal research (QLR) focuses on changes in perceptions, interpretations, or practices through time. Despite longstanding traditions in social science, QLR has only recently appeared in anatomical sciences education (ASE). While some existing methodology papers guide researchers, they take a narrow view of QLR and lack specificity for ASE. This discursive article aims to (1) describe what QLR is and its benefits, its philosophies, methodologies and methods, considerations, and quality indicators, and (2) critically discuss examples of QLR in ASE. Underpinned by relativist ontology and subjectivist epistemology, time can be understood as fluid/subjective or fixed/objective. QLR is a flexible, creative, and exploratory methodology, often associated with other methodologies. Sampling is typically purposive, with repeated and recursive data collection methods, and complex three-strand analyses (themes, cases, and time), enabling cross-sectional and longitudinal analyses. QLR involves ethical, relationship, analytical, dissemination, and funding considerations. Key quality indicators relate to qualitative research as well as temporal aspects. Most of the nine ASE papers reviewed explored changes in anatomy learners, but few labeled their methodology as QLR. Just under half described their sampling as purposive, most employed pre-planned and standardized repeated interviews, analyzed their data cross-sectionally, and utilized qualitative data analysis software. Most cited the confirmability and transferability of their studies, but few cited credibility and dependability elements. Study timeframes and tempos were generally clear, but details of longitudinal retention/attrition were often lacking, and longitudinal data analysis was not often conducted. We therefore provide recommendations for the conduct of QLR in ASE.
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Affiliation(s)
- Charlotte E Rees
- School of Health Sciences, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Ella Ottrey
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
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Kim K, Hornor E, Zarrabi AJ. The Museum as a Shared Space: Developing Contextual and Cross-Disciplinary Approaches to Arts-Based Education. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:761-769. [PMID: 39157535 PMCID: PMC11330253 DOI: 10.2147/amep.s464634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 06/17/2024] [Indexed: 08/20/2024]
Abstract
Introduction Despite the growing evidence favoring use of context-based interdisciplinary pedagogies in medical education, museum learning remains underutilized as a low-cost, replicable tool for introducing such constructs. We describe a novel approach to museum-based education building off the existing pedagogy of Visual Thinking Strategies that heightens the role of context. Methods Outside the Frame, an optional elective at Emory University School of Medicine, was piloted in two iterations for a total of 7 second-year medical students who voluntarily enrolled in the course for the fall 2022 and 2023 semesters. Participating students were transitioning from the preclinical classroom environment to clinical clerkships, a period associated with feelings of personal and professional instability that may particularly benefit from critical reflection. The course included didactic components, hands-on crafting activities, presentations, and discussion groups. Student feedback was collected through anonymous pre- and post-course surveys, as well as written narrative reflections. Results All post-course responses ranked their experience of the course as being "valuable" or "very valuable". Narrative reflections were overall positive and highlighted the role of context and cross-disciplinary input in shaping metacognitive awareness and cultivating comfort with uncertainty. Discussion This pilot innovation demonstrates that a methodical framework to arts-based learning can elevate the role of context in a standardized museum education curriculum. Future visual arts and medicine courses may incorporate this framework to chart more active collaborations with museum educators and humanities faculty, as well as engage a broader range of communities and professional disciplines beyond medicine.
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Affiliation(s)
- Kain Kim
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Ali-John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
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Stephens GC, Lazarus MD. Twelve tips for developing healthcare learners' uncertainty tolerance. MEDICAL TEACHER 2024; 46:1035-1043. [PMID: 38285073 DOI: 10.1080/0142159x.2024.2307500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Uncertainty is pervasive throughout healthcare practice. Uncertainty tolerance (i.e. adaptively responding to perceived uncertainty) is considered to benefit practitioner wellbeing, encourage person-centred care, and support judicious healthcare resource utilisation. Accordingly, uncertainty tolerance development is increasingly referenced within training frameworks. Practical approaches to support healthcare learners' uncertainty tolerance development, however, are lacking. AIMS Drawing on findings across the literature, and the authors' educational experiences, twelve tips for promoting healthcare learners' uncertainty tolerance were developed. RESULTS Tips are divided into 1. Tips for Learners, 2. Tips for Educators and Supervisors, and 3. Tips for Healthcare Education Institutions and Systems. Each tip summarises relevant research findings, alongside applications to educational practice. CONCLUSIONS Approaches to developing uncertainty tolerance balance factors supporting learners through uncertain experiences, with introducing challenges for learners to further develop uncertainty tolerance. These tips can reassure healthcare education stakeholders that developing learner uncertainty tolerance, alongside core knowledge, is achievable.
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education, Monash University, Clayton, Victoria, Australia
- Monash Centre for Scholarship in Health Education, Monash University, Clayton, Victoria, Australia
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Belhomme N, Lescoat A, Launey Y, Robin F, Pottier P. "With Great Responsibility Comes Great Uncertainty". J Gen Intern Med 2024:10.1007/s11606-024-08954-w. [PMID: 39085579 DOI: 10.1007/s11606-024-08954-w] [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: 02/12/2024] [Accepted: 07/12/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Uncertainty is inherent in medicine, and trainees are particularly exposed to the adverse effects of uncertainty. Previous work suggested that junior residents seek to leverage the support of supervisors to regulate the uncertainty encountered in clinical placements. However, a broader conceptual framework addressing uncertainty experience, from the sources of uncertainty to residents' responses, is still needed. OBJECTIVE To capture the spectrum of uncertainty experiences in medical residents, providing an integrative framework that considers the influence of specialties and training stages on their experience with clinical uncertainty. DESIGN We used Hillen's uncertainty tolerance framework to conduct a thematic template analysis of individual and focus group interviews, identifying themes and subthemes reflecting residents' experience of clinical uncertainty. PARTICIPANTS Medical residents from diverse medical specialty training programs, across five French medical schools. APPROACH Qualitative study driven by an interpretivist research paradigm. RESULTS Twenty residents from all years of medical residency and diverse medical specialties were interviewed during three focus groups and five individual interviews. They described managing treatments, making ethical decisions, and communicating uncertainty, as their major sources of uncertainty. We identified residents' delayed response to uncertainty as a key theme, fostering the development of experiential learnings. Prior clinical experience was a key determinant of uncertainty tolerance in medical residents. Entrusting residents with responsibilities in patient management promoted their perception of self-efficacy, although situations of loneliness resulted in stress and anxiety. CONCLUSION Residents face significant uncertainty in managing treatments, ethical decisions, and communication due to limited clinical experience and growing responsibilities. Scaffolding their responsibilities and clearly defining their roles can improve their comfort with uncertainty. To that extent, effective supervision and debriefing are crucial for managing emotional impacts and fostering reflection to learn from their uncertain experiences.
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Affiliation(s)
- Nicolas Belhomme
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Université Rennes, Rennes, France.
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
- LISEC (Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication) - UR_2310, Université de Strasbourg, Strasbourg, France.
| | - Alain Lescoat
- Service de Médecine Interne et Immunologie Clinique, CHU Rennes, Université Rennes, Rennes, France
- Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Yoann Launey
- Réanimation chirurgicale, Département d'Anesthésie-Réanimation-Médecine Périopératoire, CHU Rennes, Université Rennes, Rennes, France
| | - François Robin
- Service de Rhumatologie, CHU Rennes, Université Rennes, INSERM, U 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), Rennes, France
| | - Pierre Pottier
- Service de Médecine Interne et Immunologie Clinique, CHU Nantes, 1 Place Alexis-Ricordeau, 44000, Nantes, France
- Faculté de Médecine-Pôle Santé, Nantes Université, Nantes, France
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Lazarus MD, Gouda-Vossos A, Ziebell A, Parasnis J, Mujumdar S, Brand G. Mapping Educational uncertainty stimuli to support health professions educators' in developing learner uncertainty tolerance. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10345-z. [PMID: 38869782 DOI: 10.1007/s10459-024-10345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 05/19/2024] [Indexed: 06/14/2024]
Abstract
Uncertainty is a feature of healthcare practice. In recognition of this, multiple health profession governing bodies identify uncertainty tolerance as a healthcare graduate attribute and evaluate uncertainty tolerance within new graduate cohorts. While it is clear that uncertainty tolerance development for healthcare learners is valued, gaps remain for practically addressing this within healthcare curricula. Guiding frameworks for practical approaches supporting uncertainty tolerance development in healthcare learners remains sparse, particularly outside of medicine and in certain geographical locations. As uncertainty tolerance is increasingly recognised as being, at least in part, state-based (e.g. contextually changeable)- a broader understanding of teaching practices supporting uncertainty tolerance development in diverse health professions is warranted. This study explored educators' teaching practices for purposefully stimulating learners' uncertainty tolerance. Semi-structured interviews investigated how academics at a single institution, from diverse fields and health professions, stimulate uncertainty across multiple learning contexts. Framework analysis identified three themes for stimulating uncertainty: Purposeful questioning, Forecasting uncertainty, and Placing learners in unfamiliar environments, with characterisation of these themes (and related subthemes) also described. Many of the identified themes align with aspects of existing learning theories suggesting that curricular frameworks supporting learner uncertainty tolerance development may be informed by theories beyond the boundaries of health professions education research.
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Affiliation(s)
- Michelle D Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| | - Amany Gouda-Vossos
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Angela Ziebell
- School of Life and Environmental Science, Deakin University, 221 Burwood Hwy, Burwood, Vic, 3125, Australia
| | - Jaai Parasnis
- Department of Economics, Monash University, Wellington Rd, Clayton, VIC, 3180, Australia
| | - Swati Mujumdar
- School of Psychological Sciences, Monash University, Wellington Road, Clayton, Vic, 3180, Australia
| | - Gabrielle Brand
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, VIC, 3199, Australia
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Lazarus MD, Truong M, Douglas P, Selwyn N. Artificial intelligence and clinical anatomical education: Promises and perils. ANATOMICAL SCIENCES EDUCATION 2024; 17:249-262. [PMID: 36030525 DOI: 10.1002/ase.2221] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/14/2022] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Anatomy educators are often at the forefront of adopting innovative and advanced technologies for teaching, such as artificial intelligence (AI). While AI offers potential new opportunities for anatomical education, hard lessons learned from the deployment of AI tools in other domains (e.g., criminal justice, healthcare, and finance) suggest that these opportunities are likely to be tempered by disadvantages for at least some learners and within certain educational contexts. From the perspectives of an anatomy educator, public health researcher, medical ethicist, and an educational technology expert, this article examines five tensions between the promises and the perils of integrating AI into anatomy education. These tensions highlight the ways in which AI is currently ill-suited for incorporating the uncertainties intrinsic to anatomy education in the areas of (1) human variations, (2) healthcare practice, (3) diversity and social justice, (4) student support, and (5) student learning. Practical recommendations for a considered approach to working alongside AI in the contemporary (and future) anatomy education learning environment are provided, including enhanced transparency about how AI is integrated, AI developer diversity, inclusion of uncertainty and anatomical variations within deployed AI, provisions made for educator awareness of AI benefits and limitations, building in curricular "AI-free" time, and engaging AI to extend human capacities. These recommendations serve as a guiding framework for how the clinical anatomy discipline, and anatomy educators, can work alongside AI, and develop a more nuanced and considered approach to the role of AI in healthcare education.
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Affiliation(s)
- Michelle D Lazarus
- Centre for Human Anatomy Education (CHAE), Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mandy Truong
- Monash Nursing and Midwifery, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Peter Douglas
- Monash Bioethics Centre, Faculty of Arts, Monash University, Clayton, Victoria, Australia
| | - Neil Selwyn
- Monash Data Futures Institute, Monash University, Clayton, Victoria, Australia
- Faculty of Education, Monash University, Clayton, Victoria, Australia
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Robertson KA, Organ JM, Yard M, Byram JN. First patient project: Engaging pathology through the donor dissection experience and its role in professionalism. ANATOMICAL SCIENCES EDUCATION 2024; 17:199-212. [PMID: 37803942 DOI: 10.1002/ase.2341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/03/2023] [Accepted: 09/08/2023] [Indexed: 10/08/2023]
Abstract
The peer-reviewed anatomical education literature thoroughly describes the benefits and drawbacks of donor dissection. Gross anatomy laboratory environments utilizing donor dissection are generally considered to be a premier environment where students foster non-traditional discipline-independent skills (NTDIS), including the acquisition of professionalism, empathy, resilience, emotional intelligence, and situational awareness. Therefore, this IRB-approved study explored the impact of a formal humanism and pathology thread, the first patient project (FPP), on the personal and professional development of pre-professional undergraduate students in a gross anatomy dissection-based course. Five reflections from each student were collected across four cohorts (n = 74 students, 370 reflections). A post-course questionnaire collected data on student perceptions of the project. The framework method was used to analyze reflection and free response data and descriptive statistics were performed on Likert-style items using Excel. Three themes were identified to encompass the impacts of the FPP on professional development and include: Socialization (through collective dissection experience and pathology), Humanistic Qualities (respect for the donor and their history, and introspection), and Content and Skills (technical and NTDIS, anatomical knowledge). The end of course FPP survey was completed by 29 students across three cohorts (65%) and their perspectives were generally favorable regarding the promotion of respect, empathy, and humanization of their donors. This study underscores the value of incorporating humanism, pathology, and reflection, facilitated through formal curriculum for pre-professional undergraduate students. It provides evidence of the positive impact on their personal and professional development, supporting the integration of NTDIS in curricula across various disciplines.
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Affiliation(s)
- Kyle A Robertson
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, West Lafayette, Indiana, USA
| | - Jason M Organ
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael Yard
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Jessica N Byram
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Kruskie ME, Byram JN, Mussell JC. Near-Peer Teaching Opportunities Influence Professional Identity Formation as Educators in Future Clinicians. MEDICAL SCIENCE EDUCATOR 2023; 33:1515-1524. [PMID: 38188376 PMCID: PMC10766879 DOI: 10.1007/s40670-023-01951-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 01/09/2024]
Abstract
Teaching is a key role of a physician. Despite this, medical students are rarely exposed to the necessary skills and techniques throughout the duration of their education to prepare them for this component of their training. The gross anatomy lab provides a safe environment for students serving as near-peer educators to teach and learn to manage unexpected and uncomfortable situations. Students acting in near-peer teaching roles see a range of benefits from addressing personal weaknesses to improving communication skills and enhancing their anatomy and clinical knowledge, but there remains a lack of insight on how these experiences shape students' professional identity. This study examined how the professional identities of second-year medical students are shaped by serving as peer educators (PEs) in a gross anatomy laboratory. Gross anatomy PEs from the 2022 and 2025 cohorts recorded audio diary reflections at the end of each week they served as a PE highlighting how this role impacted how they view themselves as future physicians. Audio diary recordings were transcribed verbatim and analyzed using the framework method which includes familiarization, code application, and interpretation. A total of 26 audio diaries averaging 4 min in length were recorded across 11 PEs. Themes included Balancing Workload, Role of a Near Peer, Learning to Communicate, Learning to Collaborate, and Learning through Teaching. Students recognized that in addition to reinforcing their didactic training, serving as a peer educator in the gross anatomy lab helped them build skills necessary to fulfil their future role as a physician educator.
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Affiliation(s)
- Megan E. Kruskie
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Jessica N. Byram
- Department of Anatomy, Cell Biology, & Physiology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Jason C. Mussell
- 6146 MEB, Department of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, 1901 Perdido St., New Orleans, LA 70112 USA
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Lee C, Hall KH, Anakin M. Finding Themselves, Their Place, Their Way: Uncertainties Identified by Medical Students. TEACHING AND LEARNING IN MEDICINE 2023:1-11. [PMID: 37435723 DOI: 10.1080/10401334.2023.2233003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/19/2023] [Accepted: 06/16/2023] [Indexed: 07/13/2023]
Abstract
Phenomenon: Navigating uncertainty is a core skill when practicing medicine. Increasingly, the need to better prepare medical students for uncertainty has been recognized. Our current understanding of medical students' perspectives on uncertainty is primarily based on quantitative studies with limited qualitative research having been performed to date. We need to know from where and how sources of uncertainty can arise so that educators can better support medical students learning to respond to uncertainty. This research's aim was to describe the sources of uncertainty that medical students identify in their education. Approach: Informed by our previously published framework of clinical uncertainty, we designed and distributed a survey to second, fourth-, and sixth-year medical students at the University of Otago, Aotearoa New Zealand. Between February and May 2019, 716 medical students were invited to identify sources of uncertainty encountered in their education to date. We used reflexive thematic analysis to analyze responses. Findings: Four-hundred-sixty-five participants completed the survey (65% response rate). We identified three major sources of uncertainty: insecurities, role confusion, and navigating learning environments. Insecurities related to students' doubts about knowledge and capabilities, which were magnified by comparing themselves to peers. Role confusion impacted upon students' ability to learn, meet the expectations of others, and contribute to patient care. Navigating the educational, social, and cultural features of clinical and non-clinical learning environments resulted in uncertainty as students faced new environments, hierarchies, and identified challenges with speaking up. Insights: This study provides an in-depth understanding of the wide range of sources of medical students' uncertainties, encompassing how they see themselves, their roles, and their interactions with their learning environments. These results enhance our theoretical understanding of the complexity of uncertainty in medical education. Insights from this research can be applied by educators to better support students develop the skills to respond to a core element of medical practice.
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Affiliation(s)
- Ciara Lee
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Katherine Helen Hall
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Megan Anakin
- Education Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Lee C, Hall K, Anakin M, Pinnock R. Medical students' responses to uncertainty: a cross-sectional study using a new self-efficacy questionnaire in Aotearoa New Zealand. BMJ Open 2023; 13:e066154. [PMID: 37295833 PMCID: PMC10277104 DOI: 10.1136/bmjopen-2022-066154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES Responding well to clinical uncertainty is a crucial skill for any doctor. To better understand how medical students develop this skill, Social Cognitive Theory can be used to explore students' perceived capability to respond to situations of uncertainty. This study aimed to construct a self-efficacy questionnaire and use it to measure medical students' responses to clinical uncertainty. DESIGN A 29-item questionnaire was constructed. For each item, participants rated their confidence in responding to uncertain situations using a scale of 0-100. Data were analysed with descriptive and inferential statistics. SETTING Aotearoa New Zealand. PARTICIPANTS The questionnaire was distributed to 716 of 852 medical students in second, fourth and sixth year, at the three campuses of the Otago Medical School. RESULTS The Self-Efficacy to Respond to Clinical Uncertainty (SERCU) questionnaire was completed by 495 participants (69% response rate) and found to be highly reliable (α=0.93). Exploratory factor analysis confirmed a unidimensional scale. A multiple linear regression model predicted self-efficacy scores from year of study, age, mode of entry, gender and ethnicity, F(11,470) = 4.252, p<0.001 adj. R²=0.069. Male students and those admitted to the programme 3 years postdegree or with significant allied health experience were predicted to have significantly higher self-efficacy scores. Year of study was not a significant predictor of average efficacy scores. CONCLUSIONS Our research contributes a novel, highly reliable questionnaire that uses self-efficacy to measure medical student responses to uncertainty. The questionnaire revealed that students' confidence in responding to uncertainty may be more related to their background and life experience than to progression through the curriculum. Medical educators and researchers can use the SERCU questionnaire to obtain a new perspective on how their students respond to uncertainty, inform future research and tailor teaching about uncertainty.
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Affiliation(s)
- Ciara Lee
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Katherine Hall
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Megan Anakin
- Education Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ralph Pinnock
- Education Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Lazarus MD, Gouda‐Vossos A, Ziebell A, Brand G. Fostering uncertainty tolerance in anatomy education: Lessons learned from how humanities, arts and social science (HASS) educators develop learners' uncertainty tolerance. ANATOMICAL SCIENCES EDUCATION 2023; 16:128-147. [PMID: 35114066 PMCID: PMC10078696 DOI: 10.1002/ase.2174] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/24/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
Uncertainty tolerance, individuals' perceptions/responses to uncertain stimuli, is increasingly recognized as critical to effective healthcare practice. While the Covid-19 pandemic generated collective uncertainty, healthcare-related uncertainty is omnipresent. Correspondingly, there is increasing focus on uncertainty tolerance as a health professional graduate "competency," and a concomitant interest in identifying pedagogy fostering learners' uncertainty tolerance. Despite these calls, practical guidelines for educators are lacking. There is some initial evidence that anatomy education can foster medical students' uncertainty tolerance (e.g., anatomical variation and dissection novelty), however, there remains a knowledge gap regarding robust curriculum-wide uncertainty tolerance teaching strategies. Drawing upon humanities, arts and social sciences (HASS) educators' established uncertainty tolerance pedagogies, this study sought to learn from HASS academics' experiences with, and teaching practices related to, uncertainty pedagogy using a qualitative, exploratory study design. Framework analysis was undertaken using an abductive approach, wherein researchers oscillate between inductive and deductive coding (comparing to the uncertainty tolerance conceptual model). During this analysis, the authors analyzed ~386 min of data from purposively sampled HASS academics' (n = 14) discussions to address the following research questions: (1) What teaching practices do HASS academics' perceive as impacting learners' uncertainty tolerance, and (2) How do HASS academics execute these teaching practices? The results extend current understanding of the moderating effects of education on uncertainty tolerance and supports prior findings that the anatomy learning environment is ripe for supporting learner uncertainty tolerance development. This study adds to growing literature on the powerful moderating effect education has on uncertainty tolerance and proposes translation of HASS uncertainty tolerance teaching practices to enhance anatomy education.
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Affiliation(s)
- Michelle D. Lazarus
- Centre for Human Anatomy EducationDepartment of Anatomy and Developmental BiologyFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Amany Gouda‐Vossos
- Centre for Human Anatomy EducationDepartment of Anatomy and Developmental BiologyFaculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
| | - Angela Ziebell
- School of Life and Environmental SciencesDeakin University Burwood CampusBurwoodVictoriaAustralia
| | - Gabrielle Brand
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonVictoriaAustralia
- School of Nursing and MidwiferyFaculty of Medicine, Nursing and Health SciencesMonash UniversityFrankstonVictoriaAustralia
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Koh ZJ, Yeow M, Srinivasan DK, Ng YK, Ponnamperuma GG, Chong CS. A randomized trial comparing cadaveric dissection and examination of prosections as applied surgical anatomy teaching pedagogies. ANATOMICAL SCIENCES EDUCATION 2023; 16:57-70. [PMID: 34968002 DOI: 10.1002/ase.2166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 06/14/2023]
Abstract
Anatomy is an important component in the vertical integration of basic science and clinical practice. Two common pedagogies are cadaveric dissection and examination of prosected specimens. Comparative studies mostly evaluate their immediate effectiveness. A randomized controlled trial design was employed to compare both the immediate and long-term effectiveness of dissection and prosection. Eighty third-year medical students undergoing their surgical rotation from the Yong Loo Lin School of Medicine were randomized into two groups: dissection and prosection. Each participated in a one-day hands-on course following a similar outline that demonstrated surgical anatomy in the context of its clinical relevance. A pre-course test was conducted to establish baseline knowledge. A post-course test was conducted immediately after and at a one-year interval to evaluate learner outcome and knowledge retention. A post-course survey was conducted to assess participant perception. Thirty-nine and thirty-eight participants for the dissection and prosection groups, respectively, were included for analysis. There was no significant difference between mean pre-course test scores between the dissection and prosection groups [12.6 (3.47) vs. 12.7 (3.16), P > 0.05]. Both the mean immediate [27.9 (4.30) vs. 24.9 (4.25), P < 0.05] and 1 year [23.9 (4.15) vs. 19.9 (4.05), P < 0.05] post-course test scores were significantly higher in the dissection group. However, when adjusted for course duration [dissection group took longer than prosection group (mean 411 vs. 265 min)], these findings were negated. There is no conclusive evidence of either pedagogy being superior in teaching surgical anatomy. Based on learner surveys, dissection provides a greater learner experience.
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Affiliation(s)
- Zong Jie Koh
- Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Marcus Yeow
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Dinesh Kumar Srinivasan
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yee Kong Ng
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Gominda G Ponnamperuma
- Department of Medical Education, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Choon Seng Chong
- Division of Colorectal Surgery, Department of General Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
- Dean's office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Chen J, Zhang L, Qian W. Cognitive differences between readers attentive and inattentive to task-related information: an eye-tracking study. ASLIB J INFORM MANAG 2022. [DOI: 10.1108/ajim-01-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeAttentive to task-related information is the prerequisite for task completion. Comparing the cognition between attentive readers (AR) and inattentive readers (IAR) is of great value for improving reading services which has seldom been studied. To explore their cognitive differences, this study investigates the effectiveness, efficiency and cognitive resource allocation strategy by eye-tracking technology.Design/methodology/approachA controlled user study of two types of task, fact-finding (FF) and content understanding (CU) tasks was conducted to collect data including answer for task, fixation duration (FD), fixation count (FC), fixation duration proportion (FDP), and fixation count proportion (FCP). 24 participants were placed into AR or IAR group according to their fixation duration on paragraphs related to task.FindingsTwo types of cognitive resource allocation strategies, question-oriented (QO) and navigation-assistant (NA) were identified according to the differences in FDP and FCP. In FF task, although QO strategy was applied by the two groups, AR group was significantly more effective and efficient. In CU task, although the two groups were similar in effectiveness and efficiency, AR group promoted their strategies to NA while IAR group sticked to applying QO strategy. Furthermore, an interesting phenomenon “win by uncertainty”, which implies IAR group may get correct answer through uncertain means, such as clue, domain knowledge or guess, rather than task-related information, was observed.Originality/valueThis study takes a deep insight into cognition from the prospect of attentive and inattentive to task-related information. Identifying indicators about cognition helps to distinguish attentive and inattentive readers in various tasks automatically. The cognitive resource allocation strategy applied by readers sheds new light on reading skill training. A typical reading phenomenon “win by uncertainty” was found and defined. Understanding the phenomenon is of great value for satisfying reader information need and enhancing their deep learning.
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14
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Stephens GC, Karim MN, Sarkar M, Wilson AB, Lazarus MD. Reliability of Uncertainty Tolerance Scales Implemented Among Physicians and Medical Students: A Systematic Review and Meta-Analysis. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1413-1422. [PMID: 35234716 DOI: 10.1097/acm.0000000000004641] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Uncertainty tolerance (UT) is a construct describing individuals' perceptions of, and responses to, uncertainty across their cognition, emotion, and behavior. Various UT scales have been designed for physician and medical student populations. However, links between UT and other variables (e.g., training stages) are inconsistent, raising concerns about scale reliability and validity. As reliability is a precondition for validity, a necessary first step in assessing UT scales' efficacy is evaluating their reliability. Accordingly, the authors conducted a meta-analysis of the reliability of UT scales designed for, and implemented among, physician and medical student populations. METHOD In 2020, the authors searched 4 electronic databases alongside a citation search of previously identified UT scales. They included English-language, peer-reviewed studies that implemented UT scales in physician and/or medical student populations and reported reliability evidence. A meta-analysis of studies' Cronbach's alphas evaluated aggregated internal consistency across studies; subgroup analyses evaluated UT scales by named scale, population, and item characteristics. RESULTS Among 4,124 records screened, 35 studies met the inclusion criteria, reporting 75 Cronbach's alphas. Four UT scales appeared in at least 3 included studies: Physicians' Reactions to Uncertainty scale 1990 (PRU1990) and 1995 (PRU1995) versions, Tolerance for Ambiguity scale (TFA), and Tolerance of Ambiguity in Medical Students and Doctors scale (TAMSAD). The scores from these scales ranged in reliability from very good (PRU1990: 0.832, PRU1995: 0.818) to respectable (TFA: 0.761, TAMSAD: 0.711). Aggregated internal consistency was significantly higher ( P < .001) among physicians (0.797) than medical students (0.711). CONCLUSIONS UT scales generally demonstrated respectable internal consistency when administered among physicians and medical students, yet the reliability among medical students was significantly lower. The authors caution against using UT scores for decision-making purposes (e.g., applicant selection, program evaluation), especially among medical student populations. Future research should explore the reasons underlying these observed population differences.
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Affiliation(s)
- Georgina C Stephens
- G.C. Stephens is a PhD student, Centre for Human Anatomy Education, Monash University, Melbourne, Australia; ORCID: https://orcid.org/0000-0001-9695-7592
| | - M Nazmul Karim
- M.N. Karim is a lecturer, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; ORCID: https://orcid.org/0000-0003-2604-9649
| | - Mahbub Sarkar
- M. Sarkar is a lecturer, Monash Centre for Scholarship in Health Education, Monash University, Melbourne, Australia; ORCID: https://orcid.org/0000-0002-6940-3946
| | - Adam B Wilson
- A.B. Wilson is associate professor, Department of Anatomy and Cell Biology, Rush University, Chicago, Illinois; ORCID: https://orcid.org/0000-0002-1221-5602
| | - Michelle D Lazarus
- M.D. Lazarus is associate professor and director, Centre for Human Anatomy Education, and curriculum integration lead, Monash Centre for Scholarship in Health Education, Monash University, Melbourne, Australia; ORCID: https://orcid.org/0000-0003-0996-4386
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15
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Truong M, Lazarus M, Ochoa GG, Brand G. Resisting and unlearning dehumanising language in nursing and healthcare practice, education and research: A call to action. NURSE EDUCATION TODAY 2022; 116:105458. [PMID: 35803047 DOI: 10.1016/j.nedt.2022.105458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/22/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Mandy Truong
- Monash Nursing & Midwifery, Faculty of Medicine Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia.
| | - Michelle Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Biomedical Discovery Institute, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
| | - Gabriel García Ochoa
- School of Languages, Literatures, Cultures and Linguistics, Faculty of Arts, Monash University, Melbourne, Victoria, Australia.
| | - Gabrielle Brand
- Monash Centre for Scholarship in Health Education, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia; Monash Nursing & Midwifery, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia.
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Babenko O, Lee A. Ambiguity and uncertainty tolerance and psychological needs of medical students: A cross-sectional survey. CLINICAL TEACHER 2022; 19:e13523. [PMID: 36000148 DOI: 10.1111/tct.13523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although the ubiquitous presence of ambiguity and uncertainty in medical practice is widely acknowledged, a greater understanding of contextual factors for educators to consider in helping students learn to respond to ambiguity and uncertainty adaptively is needed. Drawing on self-determination theory, the purpose of this study was to explore the unique roles of basic psychological needs-autonomy, competence and relatedness-in medical students' tolerance of ambiguity and uncertainty. METHODS This was a cross-sectional survey study of third-year medical students (n = 70) at a large Canadian university. In regression analysis, the three basic psychological needs were entered as predictors of medical students' tolerance of ambiguity and uncertainty while controlling for students' age and gender. RESULTS Of the three needs, the need for competence was determined to be statistically significant in relation to students' tolerance of ambiguity and uncertainty (β = 0.326; p = 0.038). The needs for autonomy and relatedness were determined to be not statistically significant (β = -0.170; p = 0.274 and β = 0.154; p = 0.218, respectively). DISCUSSION We observed that medical students, who experienced satisfaction of the need for competence in the learning environment, reported greater tolerance of ambiguity and uncertainty. Potential implications for medical education are discussed, based on self-determination theory.
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Affiliation(s)
- Oksana Babenko
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ann Lee
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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17
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Stephens GC, Sarkar M, Lazarus MD. 'A whole lot of uncertainty': A qualitative study exploring clinical medical students' experiences of uncertainty stimuli. MEDICAL EDUCATION 2022; 56:736-746. [PMID: 35130579 PMCID: PMC9306844 DOI: 10.1111/medu.14743] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Uncertainty tolerance (UT) describes how individuals respond to stimuli of uncertainty, with low UT among medical doctors and students linked to negative outcomes such as burnout. UT research in medical education has focused on measuring the construct, with little research seeking to understand how medical students experience uncertainty. Hence, knowledge on how education may shape students' UT development is lacking. As a first step to understanding students' UT, we asked 'How do medical students, in their clinical years, experience uncertainty stimuli?' METHODS Utilising a social constructionist approach, we undertook a qualitative study with 41 clinical years medical students. Data were collected during the 2020 academic year employing in-semester reflective diary entries (n = 230 entries), and semi-structured interviews at the end of semesters (n = 40 interviews). Data were analysed by framework analysis. RESULTS Students described three major themes of uncertainty stimuli: (i) educational uncertainty, (ii) professional uncertainty and (iii) clinical uncertainty. Educational uncertainty was the dominant stimulus described by students and represents unknowns related to what students needed to learn and how to learn within the context of clinical placements. Professional uncertainty encompassed questions about who students are as developing professionals and who they would be as doctors. Clinical uncertainty was the least represented stimulus and concerned aspects of patient care where the body of medical knowledge is unable to provide clear answers. CONCLUSIONS Our findings indicate that clinical learners experience wide reaching uncertainties and suggest that students' stimuli may differ from those of clinicians with more established knowledge and careers. This work now paves the way forward in developing educational interventions to foster UT, such as modifying uncertainties not integral to learning, and purposefully introducing clinical uncertainties relevant to students' learning stage.
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Affiliation(s)
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health EducationMonash UniversityClaytonVictoriaAustralia
| | - Michelle D. Lazarus
- Centre for Human Anatomy Education Director and Monash Centre for Scholarship in Health EducationMonash UniversityClaytonVictoriaAustralia
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18
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Haudek SB, Bahner I, Belovich AN, Bonaminio G, Brenneman A, Brooks WS, Chinn C, El-Sawi N, Habal S, Haight M, Ikonne U, McAuley RJ, McKell D, Rowe R, Taylor TAH, Thesen T, Vari RC. How Science Educators Still Matter: Leveraging the Basic Sciences for Student Success. MEDICAL SCIENCE EDUCATOR 2022; 32:747-753. [PMID: 35531349 PMCID: PMC9066389 DOI: 10.1007/s40670-022-01549-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | - Ingrid Bahner
- Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | | | | | | | - William S. Brooks
- University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL USA
| | - Cassie Chinn
- International Association of Medical Science Educators, Huntington, WV USA
| | - Nehad El-Sawi
- Des Moines University Medicine & Health Sciences, Des Moines, IA USA
| | - Shafik Habal
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA USA
| | - Michele Haight
- Sam Houston State University College of Medicine, Huntsville, TX USA
| | - Uzoma Ikonne
- Eastern Virginia Medical School, Norfolk, VA USA
| | - Robert J. McAuley
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI USA
| | | | - Rebecca Rowe
- University of New England College of Osteopathic Medicine, Biddeford, ME USA
| | - Tracey A. H. Taylor
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI USA
| | - Thomas Thesen
- University of Houston College of Medicine, Houston, TX USA
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19
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Stephens GC, Sarkar M, Lazarus MD. Medical Student Experiences of Uncertainty Tolerance Moderators: A Longitudinal Qualitative Study. Front Med (Lausanne) 2022; 9:864141. [PMID: 35547203 PMCID: PMC9083353 DOI: 10.3389/fmed.2022.864141] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/21/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Uncertainty tolerance (UT), a construct explicating individuals' response to perceived uncertainty, is increasingly considered a competency for effective medical practice. Lower UT among physicians is linked with negative outcomes, including less favorable attitudes toward patient-centered care, and increased burnout risk. Despite decades of research, as yet few have engaged methodological approaches aiming to understand the factors that may influence medical students' UT (so-called moderators). Such knowledge, though, could inform teaching practices for fostering learners' skills for managing uncertainties. Accordingly, we asked “What factors do medical students in their clinical years perceive as moderating their perceptions of, and responses to, uncertainty?” Methods We conducted a qualitative study with forty-one medical students in clinical years at an Australian medical school, with data collected throughout 2020. Participants described their experiences of uncertainty through both in-semester reflective diary entries (n = 230) and end of semester group or individual semi-structured interviews (n = 40). Data were analyzed using a team-based framework analysis approach. Results Four major themes of UT moderators were identified: (1) Individual factors, (2) Sociocultural factors, (3) Academic factors and (4) Reflective learning. Aspects of individual, sociocultural and academic factors were perceived as having either positive or negative influences on students' perceptions of uncertainty. By contrast, reflective learning was described as having a predominantly positive influence on students' perceptions of uncertainty, with students noting learning opportunities and personal growth afforded through uncertain experiences. Conclusions As healthcare becomes increasingly complex, a future challenge is equipping our medical students with strategies and skills to manage uncertainties. Our study identified multiple moderators of medical students' UT, key among them being reflective learning. We also identified UT moderators that contemporary and future medical educators may be able to harness in order to develop learner UT as a healthcare graduate attribute, especially through teaching practices such as intellectual candor. Further research is now required to evaluate the impact of proposed educational interventions, and to develop effective assessments of students' skills for managing clinical uncertainties.
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Affiliation(s)
- Georgina C Stephens
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, Australia
| | - Mahbub Sarkar
- Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Michelle D Lazarus
- Centre for Human Anatomy Education, Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC, Australia.,Monash Centre for Scholarship in Health Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
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20
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Balmer DF, Richards BF. Conducting qualitative research through time: how might theory be useful in longitudinal qualitative research? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:277-288. [PMID: 34460054 DOI: 10.1007/s10459-021-10068-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
This paper explores the use of theory in longitudinal qualitative research, an approach to research which explores lived experiences as they unfold. The authors illustrate how the complexity of conducting qualitative research through time drives an understanding and use of theory that differs from other research approaches. Longitudinal qualitative research considers time as fluid, subjective, and unbounded-in contrast to the more common taken-for-granted understanding of time as fixed, objective, and linear. Furthermore, longitudinal qualitative research is predicated on a premise of trust in the context of enduring research relationships. Therefore, while subject-matter theories used to investigate topics of interest to health professions educators may be useful frameworks for other types of research, longitudinal qualitative research needs theories that accommodate the myriad of changes in lived experiences through time. The authors share their decade-long, longitudinal qualitative research story, highlighting their decision points and insights. In doing so, they foreground issues such as time as fluid as an important contribution to health professions education literature.
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Affiliation(s)
- Dorene F Balmer
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 9NW 72, Philadelphia, PA, 19104, USA.
| | - Boyd F Richards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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21
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Moffett J, Armitage-Chan E, Hammond J, Kelly S, Pawlikowska T. "It's okay to not know …" a qualitative exploration of faculty approaches to working with uncertainty. BMC MEDICAL EDUCATION 2022; 22:135. [PMID: 35232453 PMCID: PMC8887020 DOI: 10.1186/s12909-022-03180-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Whilst it is recognised that a capacity to manage uncertainty is an essential aspect of working as a healthcare professional, there is little clear guidance on how to facilitate student learning in this domain. A lack of faculty development opportunities also suggests that health professions' educators may feel ill-equipped to assist students in developing effective approaches to uncertainty. The purpose of this study was to explore a faculty development intervention designed to help educators unpack students' experiences of uncertainty, and identify attributes which may help students to manage uncertain situations. METHODS This qualitative study was informed by a constructivist methodological approach, where participants were encouraged to share meaning around the nature of uncertainty in health professions' education. Two 90-min faculty development sessions were held. These sessions invited participants to apply Han et al.'s taxonomy of uncertainty to role-played scenarios of student uncertainty within a focus group setting. Focus group data were collected, and examined using a two-stage, hybrid approach of deductive and inductive thematic analysis. RESULTS Han et al.'s taxonomy helped participants to identify multiple sources and issues of uncertainty in the role played scenarios, thus unveiling the extent of uncertainties encountered by health professions' learners. Data analysis revealed four themes overall: "Sources of uncertainty", "Issues of uncertainty", "Uncertainty attributes", and "Learning environment." Participants also contributed to a list of attributes which they considered helpful to undergraduate health professions' students in managing uncertain situations. These included an awareness of the nature of uncertainty within healthcare practice, an ability to recognise uncertainty, and adopting attitudes of adaptability, positivity, and resilience. CONCLUSIONS This study highlights the successful use of Han et al.'s taxonomy of uncertainty within a faculty development setting. Our findings suggest that the taxonomy is a practical and versatile tool that health professions' educators can use in shared reflections and conversations around uncertainty with students or colleagues.
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Affiliation(s)
- Jenny Moffett
- Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin 2, D02 YN77 Ireland
| | | | - Jennifer Hammond
- University of Glasgow, Garscube Estate, 464 Bearsden Road, Glasgow, G61 1QH Scotland
| | - Síle Kelly
- RCSI, Smurfit Building, Beaumont Hospital, Beaumont Road, Dublin 9, D09 YD60 Ireland
| | - Teresa Pawlikowska
- Health Professions’ Education Centre, RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin 2, D02 YN77 Ireland
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Papanagnou D, Ankam N, Ebbott D, Ziring D. Towards a medical school curriculum for uncertainty in clinical practice. MEDICAL EDUCATION ONLINE 2021; 26:1972762. [PMID: 34459363 PMCID: PMC8409968 DOI: 10.1080/10872981.2021.1972762] [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: 04/15/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 05/21/2023]
Abstract
Uncertainty abounds in the clinical environment. Medical students, however, are not explicitly prepared for situations of uncertainty in clinical practice, which can cause anxiety and impact well-being. To address this gap, we sought to capture how students felt in various clinical scenarios and identify programs they found helpful as they worked through uncertainty in their clerkships to better inform curriculum that prepares them to acknowledge and navigate this uncertainty. This is an observational cross-sectional study of third-year medical students surveyed at the end of core clerkships. The survey consisted of the General Self-Efficacy (GSE) Scale and Intolerance of Uncertainty Scale (IUS). Items asked students to rate preparedness, confidence, and comfort with uncertainty in clinical practice. Items on curricular programs asked students to identify training that prepared them for uncertainty in clerkships, and examined correlations with specific clinical practice uncertainty domains (CPUDs). Spearman's rank-order correlation, Chi-Square, and ANOVA were used to analyze quantitative data. Open responses were analyzed using Braun and Clarke's Framework. Response rate was 98.9% (287/290). GSE was inversely correlated with IUS (p < 0.001). GSE was positively correlated with all CPUDs (p < 0.005). IUS had an inverse correlation with all CPUDs (p < 0.005). Pedagogies with statistically-significant relationships with preparing students for uncertainty, communicating and building relationships with patients during times of uncertainty, and overall well-being included: team debriefs, role plays, case- and team-based learning, story slams, and sharing narratives with peers and faculty (p < 0.05). Qualitatively, students appreciated storytelling, role-modeling of communication strategies, debriefing, and simulations. Strategically immersing specific educational formats into formal curriculum may help cultivate skills needed to prepare students for uncertainty. Clinical debriefs, interprofessional role plays, simulations, communications skills training, instructor emotional vulnerability, storytelling, and peer-to-peer conversations may have the most impact. Further study is required to evaluate their longitudinal impact.
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Affiliation(s)
- Dimitrios Papanagnou
- Professor and Vice Chair for Education in the Department of Emergency Medicine and Associate Dean for Faculty Development, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
- CONTACT Dimitrios Papanagnou Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, College Building, Suite 100, Room 101, Philadelphia, PA19107
| | - Nethra Ankam
- Associate Professor in the Department of Rehabilitation Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - David Ebbott
- Third-year medical student, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - Deborah Ziring
- Clinical Associate Professor in the Department of Medicine and Senior Associate Dean for Academic Affairs, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
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Balmer DF, Varpio L, Bennett D, Teunissen PW. Longitudinal qualitative research in medical education: Time to conceptualise time. MEDICAL EDUCATION 2021; 55:1253-1260. [PMID: 33847408 PMCID: PMC8596518 DOI: 10.1111/medu.14542] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/26/2021] [Accepted: 04/09/2021] [Indexed: 05/14/2023]
Abstract
CONTEXT Longitudinal qualitative research is an approach to research that entails generating qualitative data with the same participants over extended periods of time to understand their lived experiences as those experiences unfold. Knowing about dynamic lived experiences in medical education, that is, learning journeys with stops and starts, detours, transitions and reversals, enriches understanding of events and accomplishments along the way. The purpose of this paper is to create access points to longitudinal qualitative research in support of increasing its use in medical education. METHODS The authors explore and argue for different conceptualisations of time: analysing lived experiences through time versus analysing lived experiences cross-sectional or via 2-point follow-up studies and considering time as subjective and fluid as well as objective and fixed. They introduce applications of longitudinal qualitative research from several academic domains: investigating development and formal education; building longitudinal research relationship; and exploring interconnections between individual journeys and social structures. They provide an illustrative overview of longitudinal qualitative research in medical education, and end with practical advice, or pearls, for medical education investigators interested in using this research approach: collecting data recursively; analysing longitudinal data in three strands; addressing mutual reflexivity; using theory to illuminate time; and making a long-term commitment to longitudinal qualitative research. CONCLUSIONS Longitudinal qualitative research stretches investigators to think differently about time and undertake more complex analyses to understand dynamic lived experiences. Research in medical education will likely be impoverished if the focus remains on time as fixed. Seeing things qualitatively through time, where time is fluid and the past, present and future interpenetrate, produces a rich understanding that can move the field forward.
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Affiliation(s)
- Dorene F. Balmer
- Department of PediatricsPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Lara Varpio
- Department of MedicineCenter for Health Professions EducationUniformed Services University of the Health SciencesBethesdaMDUSA
| | - Deirdre Bennett
- Medical Education UnitSchool of MedicineUniversity College CorkCorkIreland
| | - Pim W. Teunissen
- Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
- Department of Obstetrics and GynecologyMaastricht University Medical CenterMaastrichtThe Netherlands
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24
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Palermo C. Leadership and practice in times of complexity and uncertainty. Nutr Diet 2021; 77:487-489. [PMID: 33150690 DOI: 10.1111/1747-0080.12646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Claire Palermo
- Department of Nutrition, Dietetics and Food, Monash University, Clayton, Australia.,Monash Centre for Scholarship in Health Education, Monash University, Clayton, Australia
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Moffett J, Hammond J, Murphy P, Pawlikowska T. The ubiquity of uncertainty: a scoping review on how undergraduate health professions' students engage with uncertainty. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:913-958. [PMID: 33646469 PMCID: PMC7917952 DOI: 10.1007/s10459-021-10028-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/11/2021] [Indexed: 05/30/2023]
Abstract
Although the evidence base around uncertainty and education has expanded in recent years, a lack of clarity around conceptual terms and a heterogeneity of study designs means that this landscape remains indistinct. This scoping review explores how undergraduate health professions' students learn to engage with uncertainty related to their academic practice. To our knowledge, this is the first scoping review which examines teaching and learning related to uncertainty across multiple health professions. The scoping review is underpinned by the five-stage framework of (Arksey and O'Malley in Scoping studies: Towards a methodological framework International Journal of Social Research Methodology 8(1) 19-32, 2005). We searched MEDLINE, Embase, PsychINFO, ISI Web of Science, and CINAHL and hand-searched selected health professions' education journals. The search strategy yielded a total of 5,017 articles, of which 97 were included in the final review. Four major themes were identified: "Learners' interactions with uncertainty"; "Factors that influence learner experiences"; "Educational outcomes"; and, "Teaching and learning approaches". Our findings highlight that uncertainty is a ubiquitous concern in health professions' education, with students experiencing different forms of uncertainty at many stages of their training. These experiences are influenced by both individual and system-related factors. Formal teaching strategies that directly support learning around uncertainty were infrequent, and included arts-based teaching, and clinical case presentations. Students also met with uncertainty indirectly through problem-based learning, clinical teaching, humanities teaching, simulation, team-based learning, small group learning, tactical games, online discussion of anatomy topics, and virtual patients. Reflection and reflective practice are also mentioned as strategies within the literature.
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Affiliation(s)
- Jenny Moffett
- RCSI Health Professions' Education Centre, 123 St Stephen's Green, Dublin, Ireland.
| | - Jennifer Hammond
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Paul Murphy
- RCSI Health Professions' Education Centre, 123 St Stephen's Green, Dublin, Ireland
| | - Teresa Pawlikowska
- RCSI Health Professions' Education Centre, 123 St Stephen's Green, Dublin, Ireland
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Ambiguity tolerance among medical students and its relationship with personality and participation in the mentoring program: A cross-sectional study. Ann Med Surg (Lond) 2021; 62:425-430. [PMID: 33643640 PMCID: PMC7889433 DOI: 10.1016/j.amsu.2021.01.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/12/2021] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Low ambiguity tolerance (AT) can lead to burnout and impact medical students' quality of life. Interventions are effective in increasing tolerance in ambiguous situations. Mentors can be facilitators in ambiguous situations. We aimed to determine the AT among Tehran University of medical sciences (TUMS) medical students and assess its relation with personality traits and mentor-seeking behavior. Methods A cross-sectional study was designed. We used Budner AT questionnaire and the Ten Item Personality Inventory in our study. Questionnaires were sent to 350 randomly selected TUMS medical students in different years of education. Two hundred six students completed the questionnaires. The response rate was 58.85%. Results The mean AT score was 59.77 among TUMS medical students. No significant difference was seen between different genders and students with different marital statuses. Also, AT was constant among students at different years at medical school and at different education levels (P > 0.05). Students who had participated in the mentoring program were significantly more intolerant of novel situations (P = 0.01). However, they did not have significantly different scores in other subscales of AT scale and its total score than those who had not participated in the mentoring program (P > 0.05). Conclusion Medical students are more intolerant of ambiguity at TUMS than medical students abroad, and there should be interventions to help them cope in ambiguous situations. Mentoring programs may also be considered for future interventions as participants who participate in the program are less tolerant of ambiguity in novel situations.
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Babenko O, Linkiewich D, Lodewyk K, Lee A. Ambiguity Tolerance and Prospective Specialty Choice Among Third-Year Medical Students. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2021; 5:2. [PMID: 33860157 DOI: 10.22454/primer.2021.453158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction Poor tolerance of ambiguity is consequential in clinical practice, and has been linked to avoidance of family medicine, in which there is inherently more ambiguity. This study aimed to investigate the relationship between tolerance of ambiguity and prospective specialty choice of medical students in their third year of medical school. This stage of medical training is of particular importance as students develop clinical reasoning skills and encounter clinical ambiguity. Methods This was a cross-sectional study using an online survey. Sixty-one third-year medical students (62% response rate) from a large Canadian university completed the survey with a validated measure of ambiguity tolerance (the 29-item Tolerance of Ambiguity in Medical Students and Doctors scale) and their top three specialty choices. Specialty choices were subsequently grouped into two categories: family medicine (FM) and non-family medicine (non-FM) specialties. Results There was no significant mean difference in tolerance of ambiguity between students who reported interest in FM and students interested in non-FM specialties. Similarly, we observed no significant difference in tolerance of ambiguity between female and male students. Older students reported higher levels of ambiguity tolerance. Older students were also more likely to report FM as one of their top three specialty choices. Conclusion Qualitative studies are needed to explore possible reasons for the observed results, including the effects of digital information resources and clinical decision-making tools on medical students' ambiguity tolerance. Medical educators should be aware that some students may require explicit training in how to respond to ambiguity.
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Affiliation(s)
- Oksana Babenko
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Delane Linkiewich
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kalee Lodewyk
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ann Lee
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
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From Jerseys to Scrubs: Is Sport Background Associated with Medical Students’ Tolerance of Ambiguity and Uncertainty? HEALTH PROFESSIONS EDUCATION 2020. [DOI: 10.1016/j.hpe.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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