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Maggio LA, Costello JA, Artino AR. Describing the Landscape of Medical Education Preprints on MedRxiv: Current Trends and Future Recommendations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:981-986. [PMID: 38619532 DOI: 10.1097/acm.0000000000005742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
PURPOSE A preprint is a version of a research manuscript posted to a preprint server prior to peer review. Preprints enable authors to quickly and openly share research, afford opportunities for expedient feedback, and enable immediate listing of research on grant and promotion applications. In medical education, most journals welcome preprints, which suggests that preprints play a role in the field's discourse. Yet, little is known about medical education preprints, including author characteristics, preprint use, and ultimate publication status. This study provides an overview of preprints in medical education to better understand their role in the field's discourse. METHOD The authors queried medRxiv, a preprint repository, to identify preprints categorized as "medical education" and downloaded related metadata. CrossRef was queried to gather information on preprints later published in journals. Data were analyzed using descriptive statistics. RESULTS Between 2019 and 2022, 204 preprints were classified in medRxiv as "medical education," with most deposited in 2021 (n = 76; 37.3%). On average, preprint full-texts were downloaded 1,875.2 times, and all were promoted on social media. Preprints were authored, on average, by 5.9 authors. Corresponding authors were based in 41 countries, with 45.6% in the United States, the United Kingdom, and Canada. Almost half (n = 101; 49.5%) became published articles in predominantly peer-reviewed journals. Preprints appeared in 65 peer-reviewed journals, with BMC Medical Education (n = 9; 8.9%) most represented. CONCLUSIONS Medical education research is being deposited as preprints, which are promoted, heavily accessed, and subsequently published in peer-reviewed journals, including medical education journals. Considering the benefits of preprints and the slowness of medical education publishing, it is likely that preprint depositing will increase and preprints will be integrated into the field's discourse. The authors propose next steps to facilitate responsible and effective creation and use of preprints.
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Stoltz T, Weger U, da Veiga M. Consciousness and education: contributions by Piaget, Vygotsky and Steiner. Front Psychol 2024; 15:1411415. [PMID: 39161692 PMCID: PMC11330876 DOI: 10.3389/fpsyg.2024.1411415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/05/2024] [Indexed: 08/21/2024] Open
Abstract
The objective of this study is to gain an understanding of the development of consciousness and its relationship with education based on different theoretical models-namely those by Piaget, Vygotsky and Steiner. All three of them focus on different subcomponents of the educational process and there is hence a need for integrative discussion. Piaget and Vygotsky are fundamental references in the understanding of developmental and learning processes. Steiner was a pioneer in proposing a pedagogy that progresses by integrating feeling and wanting alongside thinking in the educational process. Their theories have important similarities but also differences and these will be essential for broadening the understanding of the construction of consciousness and its relationships with education.
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Affiliation(s)
- Tania Stoltz
- Department of Theory and Fundamentals of Education, Federal University of Paraná, Curitiba, Brazil
| | - Ulrich Weger
- Department of Psychology, Witten-Herdecke University, Witten, Germany
- Integrated Curriculum Anthroposophical Psychology, Witten-Herdecke University, Witten, Germany
| | - Marcelo da Veiga
- Department of Philosophy and Aesthetics, Alfter, Germany
- Department of Educational Sciences, Alfter, Germany
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Gondwe KW, Collins K, Hearst MO, Nkhoma-Mussa Y, Wendland CL. Decolonizing study-abroad programs in nursing in low- and middle-income countries. Nurs Outlook 2024; 72:102231. [PMID: 39018779 DOI: 10.1016/j.outlook.2024.102231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 06/03/2024] [Accepted: 06/22/2024] [Indexed: 07/19/2024]
Abstract
Study abroad programs expose scholars, including nursing faculty and students, to different settings and cultures. However, the world of global health is rooted in colonial practices that have the potential to cause harm to communities. In this reflection, we provide lessons we have learned through study abroad that guide strategies for decolonizing our practice while working toward cultural safety and humility. We utilized a qualitative case study method. Authors discussed and reviewed study abroad programs through a series of virtual discussions. Discussions showed that study abroad programs present opportunities for students and faculty to grow and learn. However, unacknowledged privileges among visiting students and faculty, and lack of understanding of the impacts of colonialism, may lead to harm in communities and inequitable relationships with local providers. Understanding the privileges that we hold is important in advancing positive and equitable experiences in study abroad programs.
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Affiliation(s)
- Kaboni Whitney Gondwe
- University of Washington, Department of Child, Family, and Population Health Nursing School of Nursing, Seattle, WA.
| | | | - Mary O Hearst
- University of Minnesota, School of Nursing, Minneapolis, MN
| | | | - Claire L Wendland
- Departments of Anthropology and Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI
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Rashid MA. The emerging multipolar world order: Implications for medical education. MEDICAL TEACHER 2024:1-3. [PMID: 38994843 DOI: 10.1080/0142159x.2024.2377398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/03/2024] [Indexed: 07/13/2024]
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Bansal E, Rice T. Teaching Moral Courage & Rights-Based Leadership in Medicine: A Cross-Disciplinary Exploration. TEACHING AND LEARNING IN MEDICINE 2024:1-11. [PMID: 38956858 DOI: 10.1080/10401334.2024.2369611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/24/2024] [Indexed: 07/04/2024]
Abstract
Clinical medicine's complexities and demands often surpass the scope of formal ethics and leadership training that medical schools and residency programs provide. The discrepancy between medical education and the realities of clinical work may contribute to ethical erosion among learners, namely, medical students and residents. Unlike traditional approaches to teaching professional ethics and leadership in medicine, rights-based (aspirational) pedagogies approach trainees as autonomous moral agents, whose work has moral value to themselves and others, who live with the ethical consequences of their professional choices, and whose work shapes their individual moral character. By incorporating teaching strategies that intentionally build learners' rights-based leadership through the development of moral courage, medical educators may counter important aspects of ethical erosion while promoting learner preparedness, outcomes, and well-being. Military teaching approaches offer a valuable example to medical educators seeking to create structured curricula that foster moral courage to promote rights-based leadership, given the high level of moral and managerial complexity present in both medicine and the military. Through a comparative analysis of professional ethics in the medical and military disciplines, this Observation article explores the validity of applying precedents from military ethics and leadership education to medical training. Through arguments rooted in moral philosophy, military history, and military organizational research, we explore the expansion of rights-based teaching methods within the predominantly traditional and rules-based norms of medical education. In relating these findings to real-life clinical scenarios, we offer six specific, rights-based modifications to medical ethics curricula that have potential to promote morally courageous leadership and counteract the ethical erosion medical students and residents face.
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Affiliation(s)
- Esha Bansal
- Internal Medicine Residency Program, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Timothy Rice
- Departments of Psychiatry and Medical Education, Icahn School of Medicine at Mount Sinai, Gustave L Levy Place, New York, New York, USA
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Arfeen Z, Diaz B, Whitehead CR, Rashid MA. An opportunity to be grateful for? Exploring discourses about international medical graduates from India and Pakistan to the UK between 1960 and 1980. BMJ Glob Health 2024; 9:e014840. [PMID: 38937271 PMCID: PMC11216068 DOI: 10.1136/bmjgh-2023-014840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/21/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Following India and Pakistan gaining independence from British colonial rule, many doctors from these countries migrated to the UK and supported its fledgling National Health Service (NHS). Although this contribution is now widely celebrated, these doctors often faced hardship and hostility at the time and continue to face discrimination and racism in UK medical education. This study sought to examine discursive framings about Indian and Pakistani International Medical Graduates (IPIMGs) in the early period of their migration to the UK, between 1960 and 1980. METHODS We assembled a textual archive of publications relating to IPIMGs in the UK during this time period in The BMJ. We employed critical discourse analysis to examine knowledge and power relations in these texts, drawing on postcolonialism through the contrapuntal approach developed by Edward Said. RESULTS The dominant discourse in this archive was one of opportunity. This included the opportunity for training, which was not available to IPIMGs in an equitable way, the missed opportunity to frame IPIMGs as saviours of the NHS rather than 'cheap labour', and the opportunity these doctors were framed to be held by being in the 'superior' British system, for which they should be grateful. Notably, there was also an opportunity to oppose, as IPIMGs challenged notions of incompetence directed at them. CONCLUSION As IPIMGs in the UK continue to face discrimination, we shed light on how their cultural positioning has been historically founded and engrained in the imagination of the British medical profession by examining discursive trends to uncover historical tensions and contradictions.
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Affiliation(s)
| | - Brett Diaz
- The Wilson Centre, Toronto, Ontario, Canada
| | - Cynthia Ruth Whitehead
- The Wilson Centre, Toronto, Ontario, Canada
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Muchatuta M, Patel S, Gonzalez Marquez C, Thilakasiri K, Manian SV, Chan J, Mssika N, Clark T, Burkholder T, Turgeon N, Kampalath VN, Poola N, Offorjebe OA, Dozois A, Hyuha G, Vaughan‐Ogunlusi O, McCammon C, Wells K, Rybarczk M, Castillo MP, Adeyeye AA, Rees CA, Dutta S, Garbern SC. Building a framework to decolonize global emergency medicine. AEM EDUCATION AND TRAINING 2024; 8:e10982. [PMID: 38765709 PMCID: PMC11099782 DOI: 10.1002/aet2.10982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 05/22/2024]
Abstract
Background Global emergency medicine (GEM) is situated at the intersection of global health and emergency medicine (EM), which is built upon a history of colonial systems and institutions that continue to reinforce inequities between high-income countries (HICs) and low- and middle-income countries (LMICs) today. These power imbalances yield disparities in GEM practice, research, and education. Approach The Global Emergency Medicine Academy (GEMA) of the Society for Academic Emergency Medicine formed the Decolonizing GEM Working Group in 2020, which now includes over 100 worldwide members. The mission is to address colonial legacies in GEM and catalyze sustainable changes and recommendations toward decolonization at individual and institutional levels. To develop recommendations to decolonize GEM, the group conducted a nonsystematic review of existing literature on decolonizing global health, followed by in-depth discussions between academics from LMICs and HICs to explore implications and challenges specific to GEM. We then synthesized actionable solutions to provide recommendations on decolonizing GEM. Results Despite the rapidly expanding body of literature on decolonizing global health, there is little guidance specific to the relatively new field of GEM. By applying decolonizing principles to GEM, we suggest key priorities for improving equity in academic GEM: (1) reframing partnerships to place LMIC academics in positions of expertise and power, (2) redirecting research funding toward LMIC-driven projects and investigators, (3) creating more equitable practices in establishing authorship, and (4) upholding principles of decolonization in the education of EM trainees from LMICs and HICs. Conclusions Understanding the colonial roots of GEM will allow us to look more critically at current health disparities and identify inequitable institutionalized practices within our profession that continue to uphold these misguided concepts. A decolonized future of GEM depends on our recognition and rectification of colonial-era practices that shape structural determinants of health care delivery and scientific advancement.
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Affiliation(s)
- Monalisa Muchatuta
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - Shama Patel
- Department of Emergency MedicineUniversity of FloridaJacksonvilleFloridaUSA
| | | | - Kaushila Thilakasiri
- Ministry of Health Sri LankaOxford University Hospitals NHS TrustColomboSri Lanka
| | | | - Jennifer Chan
- Department of Emergency MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Ngassa Mssika
- Department of Emergency MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Taryn Clark
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - Taylor Burkholder
- Department of Emergency MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Nikkole Turgeon
- Department of Emergency MedicineBoston Medical CenterBostonMassachusettsUSA
| | - Vinay N. Kampalath
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Nivedita Poola
- Department of Emergency MedicineSUNY Downstate Medical CenterBrooklynNew YorkUSA
| | - O. Agatha Offorjebe
- Department of Emergency Medicine, Alpert MedicalSchool of Brown UniversityProvidenceRhode IslandUSA
| | - Adeline Dozois
- Department of Emergency MedicineAtrium Health Carolinas Medical CenterCharlotteNorth CarolinaUSA
| | - Gimbo Hyuha
- Department of Emergency MedicineMuhimbili University of Health And Allied ScienceDar es SalaamTanzania
| | | | - Carol McCammon
- Department of Emergency MedicineEastern Virginia Medical SchoolNorfolkVirginiaUSA
| | - Katie Wells
- Department of Emergency MedicineThe University of VermontBurlingtonVermontUSA
| | - Megan Rybarczk
- Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Maria Paula Castillo
- Department of Emergency MedicineUniversidad de Ciencias MedicasSan JoseCosta RicaUSA
| | | | - Chris A. Rees
- Emory University School of MedicineAtlantaGeorgiaUSA
| | - Sanjukta Dutta
- Department of Emergency MedicineFortis HospitalKolkataIndia
| | - Stephanie Chow Garbern
- Department of Emergency Medicine, Alpert MedicalSchool of Brown UniversityProvidenceRhode IslandUSA
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Sims DA, Lucio-Ramirez CA, Cilliers FJ. Factors influencing clinician-educators' assessment practice in varied Southern contexts: a health behaviour theory perspective. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10341-3. [PMID: 38811446 DOI: 10.1007/s10459-024-10341-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/12/2024] [Indexed: 05/31/2024]
Abstract
In many contexts, responsibility for exit-level assessment design and implementation in undergraduate medical programmes lies with individuals who convene clinical clerkships. Their assessment practice has significant consequences for students' learning and the patients and communities that graduates will serve. Interventions to enhance assessment must involve these assessors, yet little is known about factors influencing their assessment practice. The purpose of this study was to explore factors that influence assessment practice of clerkship convenors in three varied low-and-middle income contexts in the global South. Taking assessment practice as a behaviour, Health Behaviour Theory (HBT) was deployed as a theoretical framework to explore, describe and explain assessor behaviour. Thirty-one clinician-educators responsible for designing and implementing high-stakes clerkship assessment were interviewed in South Africa and Mexico. Interacting personal and contextual factors influencing clinician-educator assessment intention and action were identified. These included attitude, influenced by impact and response appraisal, and perceived self-efficacy; along with interpersonal, physical and organisational, and distal contextual factors. Personal competencies and conducive environments supported intention to action transition. While previous research has typically explored factors in isolation, the HBT framing enabled a systematic and coherent account of assessor behaviour. These findings add a particular contextual perspective to understanding assessment practice, yet also resonate with and extend existing work that predominantly emanates from high-income contexts in the global North. These findings provide a foundation for the planning of assessment change initiatives, such as targeted, multi-factorial faculty development.
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Affiliation(s)
- Danica Anne Sims
- University of Oxford, Oxford, UK.
- University of Johannesburg, Johannesburg, South Africa.
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Mokhachane M, Green-Thompson L, Wyatt TR. Voices of Silence: Experiences in Disseminating Scholarship as a Global South Researcher. TEACHING AND LEARNING IN MEDICINE 2024; 36:235-243. [PMID: 36843331 DOI: 10.1080/10401334.2023.2181815] [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: 06/14/2022] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Issue: There is an unspoken requirement that medical education researchers living in the Global South must disseminate their work using dominant frames constructed by individuals living in the Global North. As such, the published literature in our field is dominated by researchers whose work primarily benefits the Western world, casting the rest of what is published as localized and unhelpful knowledge. In this article, we use Audre Lorde's conception of the Master's house as a metaphor to narrate the experiences of two South African medical education researchers trying to disseminate their work into North American venues. In addition to narrating these stories, we describe the personal and professional consequences they experienced as a result of their efforts. Evidence: For researchers working outside of the Global North, entering the Master's formidable house is daunting, and there is no clear pathway in. These narratives illustrate how reviewers and editorial staff act as gatekeepers, continuously shaping ideas about what it means to do acceptable research, and who is allowed to disseminate it within the field. These narratives also show that those who have been rejected by these gatekeepers are often conflicted about their position within the larger field of medical education. Implications: To begin to address this issue, we have made several suggestions for the research community to consider. First, medical education research journals need to create spaces for researchers publishing from the Global South. One suggestion is for journals to create a submission type that is dedicated to researchers working outside of North America. Second, journals should also include more Global South editors and reviewers to help with knowledge translation when articles are submitted from outside North America. If our collective goal is to improve the training of physicians and the health outcomes of humanity, then we need to renovate the Master's house and begin to break down the barriers that separate us from truly building together.
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Affiliation(s)
- Mantoa Mokhachane
- Unit for Undergraduate Medical Education, University of Witwatersrand, Johannesburg, South Africa
| | | | - Tasha R Wyatt
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Jain NR, Nimmon L, Bulk LY. How to … bring a JEDI (justice, equity, diversity and inclusion) lens to your research. CLINICAL TEACHER 2024; 21:e13660. [PMID: 37874114 DOI: 10.1111/tct.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/31/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Neera R Jain
- Centre for Medical and Health Sciences Education, School of Medicine, Faculty of Medical and Health Sciences, Waipapa Taumata Rau/The University of Auckland, Auckland, New Zealand
| | - Laura Nimmon
- Centre for Health Education Scholarship, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
- Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Laura Y Bulk
- Occupational Science & Occupational Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada
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Manan MR, Nawaz I, Rahman S, Manan H. Diversity, equity, and inclusion in medical education journals: An evaluation of editorial board composition. MEDICAL TEACHER 2024; 46:280-288. [PMID: 37634062 DOI: 10.1080/0142159x.2023.2249212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
PURPOSE OF THE ARTICLE As editorial boards (EBs) of medical education journals (MEJs) hold substantial control over framing current medical education scholarship, we aimed to evaluate representation of women as well as geographic and socioeconomic diversity on EBs of these journals. MATERIALS AND METHODS In our cross-sectional study, Composite Editorial Board Diversity Score (CEBDS) was used to evaluate diversity at gender, geographic region, and country income level. Websites of MEJs were screened for relevant information. Job titles were categorized into 3 editorial roles and data were analyzed using SPSS version 26. RESULTS Out of 42 MEJs, 19 journals (45.2%) were published from the Global South. Among 1219 editors, 57.5% were men. Out of 46 editors in chief (EICs), 34.7% were women, and 60.9% were based in high income countries. No EIC belonged to low-income country. The proportion of female advisory board members was found to be positively correlated with the presence of a female EIC. Moreover, 2 journals achieved the maximum CEBDS. All editors belonged to the same World Bank income group and geographic region for 12 and 8 journals respectively. CONCLUSIONS In order to allow a truly global perspective in medical education to prevail, diversity and inclusivity on these journals become important parameters to address. Thus, promoting policies centered on improving diversity in all aspects should become a top priority.
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Affiliation(s)
| | - Iqra Nawaz
- Faculty of Medicine, Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Sara Rahman
- Faculty of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Hamna Manan
- Department of Medicine, Jinnah Hospital, Lahore, Pakistan
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Taylor JS, Wendland CL, Kulasegaram KM, Hafferty FW. Admitting privileges: A construction ecology perspective on the unintended consequences of medical school admissions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1347-1360. [PMID: 36856902 PMCID: PMC9976670 DOI: 10.1007/s10459-023-10210-5] [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: 11/29/2022] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
Medical-school applicants learn from many sources that they must stand out to fit in. Many construct self-presentations intended to appeal to medical-school admissions committees from the raw materials of work and volunteer experiences, in order to demonstrate that they will succeed in a demanding profession to which access is tightly controlled. Borrowing from the field of architecture the lens of construction ecology, which considers buildings in relation to the global effects of the resources required for their construction, we reframe medical-school admissions as a social phenomenon that has far-reaching harmful unintended consequences, not just for medicine but for the broader world. Illustrating with discussion of three common pathways to experiences that applicants widely believe will help them gain admission, we describe how the construction ecology of medical school admissions can recast privilege as merit, reinforce colonizing narratives, and lead to exploitation of people who are already disadvantaged.
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Affiliation(s)
- Janelle S Taylor
- Department of Anthropology, University of Toronto, Toronto, ON, Canada
| | - Claire L Wendland
- Department of Anthropology, Department of Obstetrics & Gynecology, University of Wisconsin-Madison, 5436 Sewell Social Sciences Building 1180 Observatory Drive, 53708, Madison, WI, USA.
| | - Kulamakan Mahan Kulasegaram
- Department of Family and Community Medicine, Wilson Centre for Research in Education, University of Toronto, Toronto, ON, Canada
| | - Frederic W Hafferty
- Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic, Rochester, MN, USA
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Sims DA, Cilliers FJ. Clinician educators' conceptions of assessment in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1053-1077. [PMID: 36662334 PMCID: PMC10624725 DOI: 10.1007/s10459-022-10197-5] [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: 09/26/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
In pursuing assessment excellence, clinician-educators who design and implement assessment are pivotal. The influence of their assessment practice in university-run licensure exams on student learning has direct implications for future patient care. While teaching practice has been shown to parallel conceptions of teaching, we know too little about conceptions of assessment in medical education to know if this is the case for assessment practice and conceptions of assessment. To explore clinician-educators' conceptions of assessment, a phenomenographic study was undertaken. Phenomenography explores conceptions, the qualitatively different ways of understanding a phenomenon. Data analysis identifies a range of hierarchically inclusive categories of understanding, from simple to more complex, and the dimensions that distinguish each category or conception. Thirty-one clerkship convenors in three diverse Southern settings were interviewed in three cycles of iterative data collection and analysis. Four conceptions of assessment were identified: passive operator, awakening enquirer, active owner and scholarly assessor. Six dimensions were elucidated to describe and distinguish each conception: purpose of assessment; temporal perspective; role and responsibility; accountability; reflexivity and emotional valence. Additionally, three characteristics that appeared to track the progressive nature of the conceptions were identified: professional identity, assessment literacy and self-efficacy. These conceptions encompass and extend previously described conceptions across different educational levels, disciplines and contexts, suggesting applicability to other settings. There is some evidence of a relationship between conceptions and practice, suggesting, together with the hierarchical nature of these conceptions, that targeting conceptions during faculty development may be an effective approach to enhance assessment practice.
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Affiliation(s)
- D A Sims
- University of the Western Cape, 14 Blanckenberg Street, Bellville, South Africa.
| | - F J Cilliers
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Akudinobi EA, Rietmeijer CA, Ndowa FJ, Kilmarx PH. Bibliometric Analysis of Authorship of Publications About Sub-Saharan Africa Published in the Journal Sexually Transmitted Diseases , 2011 to 2020. Sex Transm Dis 2023; 50:555-558. [PMID: 36943809 PMCID: PMC10430671 DOI: 10.1097/olq.0000000000001808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/01/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND As a potential indicator of equity in research partnerships, we conducted a bibliometric analysis of author affiliations and author order in publications about sub-Saharan Africa published in the journal Sexually Transmitted Diseases . METHODS We identified articles in the journal Sexually Transmitted Diseases that were about sub-Saharan Africa and published from 2011 to 2020. Medical Subject Heading terms in PubMed were used to identity articles about sub-Saharan Africa. Authors with at least 1 affiliation in sub-Saharan Africa were characterized as sub-Saharan Africa-affiliated authors. RESULTS Of the 1439 articles that were published in Sexually Transmitted Diseases from 2011 to 2020, 148 (10%) had a Medical Subject Heading term for a sub-Saharan African country. Of the 604 authors of these 148 articles, 53 (36%) of the first authors, 493 (53%) of the middle authors, and 58 (40%) of the last authors had a sub-Saharan African affiliation; 13 (8.8%) of the articles had no authors with a sub-Saharan African affiliation. The proportions of sub-Saharan African-affiliated authors in first and last authorship positions did not change significantly from 2011-2015 (77 articles) to 2016-2020 (71 articles). CONCLUSIONS The underrepresentation of Africans in first and last authorship positions suggests power imbalances in global scientific partnerships. Funders, researchers, editors, publishers, and grant and manuscript reviewers each have roles in promoting equity in global health research. This study may serve as an example for journals to establish benchmarks and monitor progress toward a more equitable research environment.
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Affiliation(s)
- Ezinne A. Akudinobi
- From the Fogarty International Center, US National Institutes of Health, Bethesda, MD
| | | | | | - Peter H. Kilmarx
- From the Fogarty International Center, US National Institutes of Health, Bethesda, MD
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Rashid MA, Griffin A. Is West Really Best? The Discourse of Modernisation in Global Medical School Regulation Policy. TEACHING AND LEARNING IN MEDICINE 2023:1-12. [PMID: 37401838 DOI: 10.1080/10401334.2023.2230586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/21/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
Phenomenon: In 2012, the World Federation for Medical Education (WFME) established a recognition programme to evaluate medical school regulatory agencies across the world, in response to a new U.S. accreditation policy. Given the predominantly Western origins and Eastern impacts of the WFME programme, this article deconstructs tensions in the programme using postcolonial theory. Approach: Critical discourse analysis examines the intersections of language, knowledge, and power relations to highlight what can or cannot be said about a topic. We employed it to delineate the dominant discourse underpinning the WFME recognition programme. We drew on the theoretical devices of Edward Said, whose work is foundational in postcolonial thinking but has not been widely used in medical education scholarship to date. An archive of literature about the WFME recognition programme dating back to 2003, when WFME first released global standards for medical education, was analyzed. Findings: In the globalization of medical school regulation, the discourse of modernization can be conceptualized as a means of holding knowledge and power in the West, and enacting this power on those in the East, playing on fears of marginalization in the event of non-engagement. The discourse allows these practices to be presented in an honorable and heroic way. Insights: By uncovering the representation of the WFME recognition programme as being modern and modernizing, this article explores how such conceptualisations can close off debate and scrutiny, and proposes further examination of this programme through a lens that recognizes the inherent inequities and geopolitical power differentials that it operates within.
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Affiliation(s)
- Mohammed Ahmed Rashid
- UCL Medical School, Faculty of Medical Sciences, University College London, London, UK
| | - Ann Griffin
- UCL Medical School, Faculty of Medical Sciences, University College London, London, UK
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Kuper A, O'Sullivan P, Cleland J. Who should be an author on this paper? ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023:10.1007/s10459-023-10256-5. [PMID: 37349496 DOI: 10.1007/s10459-023-10256-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors address the question of who should be listed as an author on a given publication and provide advice as to how to navigate potential tensions in the authorship decision-making process.
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Affiliation(s)
- Ayelet Kuper
- Wilson Centre for Research in Education, University Health Network/University of Toronto, Toronto, Canada.
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
| | - Patricia O'Sullivan
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Rees CA, Rajesh G, Manji HK, Shari C, Kisenge R, Keating EM, Ogbuanu IU, Igunza KA, Omore R, Manji KP. Has Authorship in the Decolonizing Global Health Movement Been Colonized? Ann Glob Health 2023; 89:42. [PMID: 37362829 PMCID: PMC10289040 DOI: 10.5334/aogh.4146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Background Decolonization in global health is a recent movement aimed at relinquishing remnants of supremacist mindsets, inequitable structures, and power differentials in global health. Objective To determine the author demographics of publications on decolonizing global health and global health partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs). Methods We conducted a cross-sectional analysis of publications related to decolonizing global health and global health partnerships from the inception of the selected journal databases (i.e., Medline, CAB Global Health, EMBASE, CINAHL, and Web of Science) to November 14, 2022. Author country affiliations were assigned as listed in each publication. Author gender was assigned using author first name and the software genderize.io. Descriptive statistics were used for author country income bracket, gender, and distribution. Findings Among 197 publications on decolonizing global health and global health partnerships, there were 691 total authors (median 2 authors per publication, interquartile range 1, 4). Publications with author bylines comprised exclusively of authors affiliated with HICs were most common (70.0%, n = 138) followed by those with authors affiliated both with HICs and LMICs (22.3%, n = 44). Only 7.6% (n = 15) of publications had author bylines comprised exclusively of authors affiliated with LMICs. Over half (54.0%, n = 373) of the included authors had names that were female and female authors affiliated with HICs most commonly occupied first author positions (51.8%, n = 102). Conclusions Authors in publications on decolonizing global health and global health partnerships have largely been comprised of individuals affiliated with HICs. There was a marked paucity of publications with authors affiliated with LMICs, whose voices provide context and crucial insight into the needs of the decolonizing global health movement.
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Affiliation(s)
- Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Emergency Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia, United States of America
| | - Gouri Rajesh
- University of Georgia, Athens, Georgia, United States of America
| | - Hussein K. Manji
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Accident and Emergency Department, The Aga Khan Health Services, Tanzania
| | - Catherine Shari
- Emergency Medicine Department, Muhimbili National Hospital-Mloganzila, Dar es Salaam, United Republic of Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Elizabeth M. Keating
- Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | | | - Kitiezo Aggrey Igunza
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | - Karim P. Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
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Maggio LA, Costello JA, Ninkov AB, Frank JR, Artino AR. The voices of medical education scholarship: Describing the published landscape. MEDICAL EDUCATION 2023; 57:280-289. [PMID: 36282076 PMCID: PMC10098831 DOI: 10.1111/medu.14959] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/15/2022] [Accepted: 10/21/2022] [Indexed: 05/21/2023]
Abstract
INTRODUCTION The voices of authors who publish medical education literature have a powerful impact on the field's discourses. Researchers have identified a lack of author diversity, which suggests potential epistemic injustice. This study investigates author characteristics to provide an evidence-based starting point for communal discussion with the intent to move medical education towards a future that holds space for, and values, diverse ways of knowing. METHOD The authors conducted a bibliometric analysis of all articles published in 24 medical education journals published between 2000 and 2020 to identify author characteristics, with an emphasis on author gender and geographic location and their intersection. Article metadata was downloaded from Web of Science. Genderize.io was used to predict author gender. RESULTS The journals published 37 263 articles authored by 62 708 unique authors. Males were more prevalent across all authorship positions (n = 62 828; 55.7%) than females (n = 49 975; 44.3%). Authors listed affiliations in 146 countries of which 95 were classified as Global South. Few articles were written by multinational teams (n = 3765; 16.2%). Global South authors accounted for 12 007 (11.4%) author positions of which 3594 (3.8%) were female. DISCUSSION This study provides an evidence-based starting point to discuss the imbalance of author voices in medical education, especially when considering the intersection of gender and geographical location, which further suggests epistemic injustice in medical education. If the field values a diversity of perspectives, there is considerable opportunity for improvement by engaging the community in discussions about what knowledge matters in medical education, the role of journals in promoting diversity, how to best use this baseline data and how to continue studying epistemic injustice in medical education.
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Affiliation(s)
- Lauren A. Maggio
- MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
| | - Joseph A. Costello
- Center for Health Professions Education, Henry M. Jackson FoundationBethesdaMarylandUSA
| | - Anton Boudreau Ninkov
- École de bibliothéconomie et des sciences de l'informationUniversité de MontréalMontréalQuébecCanada
| | - Jason R. Frank
- Department of Emergency MedicineUniversity of OttawaOttawaOntarioCanada
| | - Anthony R. Artino
- George Washington University School of Medicine and Health SciencesWashingtonDistrict of ColumbiaUSA
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Soemantri D, Findyartini A, Werdhani RA, Koesnoe S, Dahlia D. Are we ready to collaborate? The interprofessional collaborative competencies of healthcare professionals in the Global South context. Front Med (Lausanne) 2022; 9:904658. [PMID: 36341234 PMCID: PMC9633846 DOI: 10.3389/fmed.2022.904658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Current evidence of interprofessional collaboration suggests the importance of measuring and identifying the current state of the health professions’ interprofessional competencies. Therefore, this study was aimed at measuring the interprofessional competencies of health professionals in the Global South context using the validated CICS29. Materials and methods This was a cross-sectional study involving 300 healthcare professionals of a newly established teaching hospital. Prior to the measurement of interprofessional competencies, the 29-items CICS29, which has been translated into Indonesian language, was revalidated using a confirmatory factor analysis (CFA). The 29 items of CICS29 were grouped into six subscales and each item was measured using a 5-point Likert scale. Data on gender, age, type of profession, and the length of working experience was also collected to identify whether discernible differences between grouping variables exists. Results Prior to measuring the interprofessional competencies, the validity of the instrument was established. Based on the CFA, the same six-factor model was found in the current study. The Indonesian CICS29 was reliable, with Cronbach alpha values of 0.921 for the whole instrument and that of each subscale ranged between 0.656 and 0.726. The mean total score of CICS29 was 128.53 (out of 145), ranged from 123 to 133.40 obtained by pharmacists and dentists respectively. No significant differences of CICS29 scores were found between grouping variables. Conclusion The current study has revealed relatively good interprofessional competencies of healthcare professionals working in a newly established teaching hospital in the Global South healthcare context. Measuring the interprofessional competencies serves as baseline for further intervention to nurture and maintain collaborative practice. In addition, the current study has further proven the cross-cultural validity of CICS29, thus appropriate to be utilized in different setting and context.
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Affiliation(s)
- Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Center for Administration, Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia
- *Correspondence: Diantha Soemantri, ,
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Retno Asti Werdhani
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sukamto Koesnoe
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Debie Dahlia
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Universitas Indonesia Hospital, Depok, Indonesia
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Baldwinson R. Global health wars: a rhetorical review of global health critique. MEDICAL HUMANITIES 2022; 48:medhum-2021-012271. [PMID: 35609969 DOI: 10.1136/medhum-2021-012271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
The critique of global health is a longstanding tradition in the global health humanities (GHH). Typically, this critique takes an expected tack: critics take a slice of global health, identify its rhetoric, expose its power, and elucidate its unanticipated consequences. Here, I subject global health critique to its own approach-conducting a 'rhetorical review' of global health critique in order to ascertain whether it has rhetoric, power and unanticipated consequences of its own. Following this review, I find that global health critique has a rhetoric, and that this rhetoric can be organised into three types: (1) 'global health as mere rhetoric', (2) 'splitting global health', and (3) 'figuring global health war.' Ultimately, I argue that the rhetoric of GHH critique, like the rhetoric of global health, is a rhetoric of consequence-and a rhetoric worth revisiting.
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Affiliation(s)
- Raquel Baldwinson
- English, University of British Columbia, Vancouver, British Columbia, Canada
- History of Science, Harvard University, Cambridge, Massachusetts, USA
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21
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Soklaridis S, Lin E, Black G, Paton M, LeBlanc C, Besa R, MacLeod A, Silver I, Whitehead CR, Kuper A. Moving beyond ‘think leadership, think white male’: the contents and contexts of equity, diversity and inclusion in physician leadership programmes. BMJ LEADER 2022; 6:146-157. [DOI: 10.1136/leader-2021-000542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
The lack of both women and physicians from groups under-represented in medicine (UIM) in leadership has become a growing concern in healthcare. Despite increasing recognition that diversity in physician leadership can lead to reduced health disparities, improved population health and increased innovation and creativity in organisations, progress toward this goal is slow. One strategy for increasing the number of women and UIM physician leaders has been to create professional development opportunities that include leadership training on equity, diversity and inclusivity (EDI). However, the extent to which these concepts are explored in physician leadership programming is not known. It is also not clear whether this EDI content challenges structural barriers that perpetuate the status quo of white male leadership. To explore these issues, we conducted an environmental scan by adapting Arksey and O’Malley’s scoping review methodology to centre on three questions: How is EDI currently presented in physician leadership programming? How have these programmes been evaluated in the peer-reviewed literature? How is EDI presented and discussed by the wider medical community? We scanned institutional websites for physician leadership programmes, analysed peer-reviewed literature and examined material from medical education conferences. Our findings indicate that despite an apparent increase in the discussion of EDI concepts in the medical community, current physician leadership programming is built on theories that fail to move beyond race and gender as explanatory factors for a lack of diversity in physician leadership. To address inequity, physician leadership curricula should aim to equip physicians to identify and address the structural factors that perpetuate disparities.
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Affiliation(s)
- Ahmed Rashid
- UCL Medical School, Royal Free Hospital, London, NW3 2PR, UK
| | - Cynthia Whitehead
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, ON, Canada.,Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street, 1ES-565 Toronto, Ontario, Canada M5G 2C4
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Zaidi Z, Young M, Balmer DF, Park YS. Endarkening the Epistemé: Critical Race Theory and Medical Education Scholarship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:Si-Sv. [PMID: 34432718 DOI: 10.1097/acm.0000000000004373] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Zareen Zaidi
- Z. Zaidi is chair, Research in Medical Education (RIME) Program Planning Committee, and professor, Division of General Internal Medicine, University of Florida College of Medicine, Gainesville, Florida; ORCID: https://orcid.org/0000-0003-4328-5766
| | - Meredith Young
- M. Young is incoming co-chair, RIME Program Planning Committee, and associate professor in the Institute of Health Sciences Education and Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Dorene F Balmer
- D.F. Balmer is incoming co-chair, RIME Program Planning Committee, and associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Yoon Soo Park
- Y.S. Park is immediate past chair, RIME Program Planning Committee, associate professor, Harvard Medical School, and director of health professions education research, Massachusetts General Hospital, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-8583-4335
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Naidu T. Says who? Northern ventriloquism, or epistemic disobedience in global health scholarship. Lancet Glob Health 2021; 9:e1332-e1335. [DOI: 10.1016/s2214-109x(21)00198-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
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Weisz G, Nannestad B. The World Health Organization and the global standardization of medical training, a history. Global Health 2021; 17:96. [PMID: 34454517 PMCID: PMC8397872 DOI: 10.1186/s12992-021-00733-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article presents a history of efforts by the World Health Organization and its most important ally, the World Federation for Medical Education, to strengthen and standardize international medical education. This aspect of WHO activity has been largely ignored in recent historical and sociological work on that organization and on global health generally. METHODS Historical textual analysis is applied to the digitalized archives and publications of the World Health Organization and the World Federation for Medical Education, as well as to publications in the periodic literature commenting on the standardization of international medical training and the problems associated with it. RESULTS Efforts to reform medical training occurred during three distinct chronological periods: the 1950s and 1960s characterized by efforts to disseminate western scientific norms; the 1970s and 1980s dominated by efforts to align medical training with the WHO's Primary Healthcare Policy; and from the late 1980s to the present, the campaign to impose global standards and institutional accreditation on medical schools worldwide. A growing number of publications in the periodic literature comment on the standardization of international medical training and the problems associated with it, notably the difficulty of reconciling global standards with local needs and of demonstrating the effects of curricular change.
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Affiliation(s)
- George Weisz
- Cotton-Hannah Chair in the History of Medicine, Department of Social Studies of Medicine, McGill University, 3647 Peel Street, Montreal, Quebec, Canada.
| | - Beata Nannestad
- Cotton-Hannah Chair in the History of Medicine, Department of Social Studies of Medicine, McGill University, 3647 Peel Street, Montreal, Quebec, Canada
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Zaidi Z, Partman IM, Whitehead CR, Kuper A, Wyatt TR. Contending with Our Racial Past in Medical Education: A Foucauldian Perspective. TEACHING AND LEARNING IN MEDICINE 2021; 33:453-462. [PMID: 34279159 DOI: 10.1080/10401334.2021.1945929] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/27/2021] [Indexed: 06/13/2023]
Abstract
Practices of systemic and structural racism that advantage some groups over others are embedded in American society. Institutions of higher learning are increasingly being pressured to develop strategies that effectively address these inequities. This article examines medical education's diversity reforms and inclusion practices, arguing that many reify preexisting social hierarchies that privilege white individuals over those who are minoritized because of their race/ethnicity. Evidence: Drawing on the work of French theorist Michel Foucault, we argue that medical education's curricular and institutional practices reinforce asymmetrical power differences and authority in ways that disadvantage minoritized individuals. Practices, such as medical education's reliance on biomedical approaches, cultural competency, and standardized testing reinforce a racist system in ways congruent with the Foucauldian concept of "normalization." Through medical education's creation of subjects and its ability to normalize dominant forms of knowledge, trainees are shaped and socialized into ways of thinking, being, and acting that continue to support racial violence against minoritized groups. The systems, structures, and practices of medical education need to change to combat the pervasive forces that continue to shape racist institutional patterns. Individual medical educators will also need to employ critical approaches to their work and develop strategies that counteract institutional systems of racial violence. Implications: A Foucauldian approach that exposes the structural racism inherent in medical education enables both thoughtful criticism of status-quo diversity practices and practical, theory-driven solutions to address racial inequities. Using Foucault's work to interrogate questions of power, knowledge, and subjectivity can expand the horizon of racial justice reforms in medicine by attending to the specific, pervasive ways racial violence is performed, both intra- and extra-institutionally. Such an intervention promises to take seriously the importance of anti-racist methodology in medicine.
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Affiliation(s)
- Zareen Zaidi
- Department of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | | | - Cynthia R Whitehead
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tasha R Wyatt
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA
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Chen AY, Kuper A, Whitehead CR. Competent to provide compassionate care? A critical discourse analysis of accreditation standards. MEDICAL EDUCATION 2021; 55:530-540. [PMID: 33283303 DOI: 10.1111/medu.14428] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/22/2020] [Accepted: 11/27/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Medical school accreditation is recognised internationally as an important quality control process for programmes that lead to the Medical Doctor (MD) degree. Accreditation standards govern the accreditation process which in turn drives educational objectives. Given the power of these standards to shape what becomes valued in the curricula, it is therefore imperative to ensure that core values and ideals of the profession are meaningfully incorporated. As the provision of compassionate care has long been a central medical value, this value should be clearly articulated in MD programme accreditation standards. METHODS We conducted a Critical Discourse Analysis of compassionate care within Undergraduate Medical Education (UME) Accreditation Standards governing North American medical schools since 1957. We explored how and to what extent the written language of the accreditation standards incorporated compassionate care. RESULTS References to compassionate care in the UME Accreditation Standards were few and far between. Historically, a statement of 'The Objectives of Undergraduate Medical Education' published by the Association of American Medical Colleges (AAMC) was referenced for the first and only time in the 1957 standards, describing the development of attributes such as the provision of compassionate care as a basic objective of UME. Thereafter, there was infrequent mention of this value. Terms that could potentially incorporate aspects of compassionate care were identified, yet these were explicated in ways that limited connection to compassion. Instead, the term 'care' has increasingly been used instrumentally (ie acute care, chronic care). CONCLUSION The relative absence of language pertaining to compassionate care in accreditation standards is troubling as compassion is integral to good medical care. This absence is particularly important to attend to in the current era of competency-based training where we must be explicit about all important curricular objectives lest essential values and practices be unintentionally lost.
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Affiliation(s)
- Amanda Y Chen
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cynthia R Whitehead
- Department of Family and Community Medicine, Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Wondimagegn D, Soklaridis S, Yifter H, Cartmill C, Yeshak MY, Whitehead C. Passing the microphone: broadening perspectives by amplifying underrepresented voices. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1139-1147. [PMID: 33175325 PMCID: PMC7656220 DOI: 10.1007/s10459-020-10012-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/30/2020] [Indexed: 05/17/2023]
Affiliation(s)
- Dawit Wondimagegn
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Sophie Soklaridis
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada
- Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
| | - Helen Yifter
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Carrie Cartmill
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada
| | - Mariamawit Yonathan Yeshak
- Department of Pharmaceutical Chemistry and Pharmacognosy, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Cynthia Whitehead
- The Wilson Centre, University Health Network, University of Toronto, 200 Elizabeth Street 1ES-559, Toronto, ON, M5G 2C4, Canada.
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
- Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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Paton M, Naidu T, Wyatt TR, Oni O, Lorello GR, Najeeb U, Feilchenfeld Z, Waterman SJ, Whitehead CR, Kuper A. Dismantling the master's house: new ways of knowing for equity and social justice in health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1107-1126. [PMID: 33136279 PMCID: PMC7605342 DOI: 10.1007/s10459-020-10006-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/21/2020] [Indexed: 05/19/2023]
Abstract
Health professions education (HPE) is built on a structural foundation of modernity based on Eurocentric epistemologies. This foundation privileges certain forms of evidence and ways of knowing and is implicated in how dominant models of HPE curricula and healthcare practice position concepts of knowledge, equity, and social justice. This invited perspectives paper frames this contemporary HPE as the "Master's House", utilizing a term referenced from the writings of Audre Lorde. It examines the theoretical underpinnings of the "Master's House" through the frame of Quijano's concept of the Colonial Matrix of Power (employing examples of coloniality, race, and sex/gender). It concludes by exploring possibilities for how these Eurocentric structures may be dismantled, with reflection and discussion on the implications and opportunities of this work in praxis.
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Affiliation(s)
- Morag Paton
- Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, 6th Floor, Toronto, ON M5G 1V7 Canada
- Department of Leadership, Higher and Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Thirusha Naidu
- Behavioural Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Tasha R. Wyatt
- The Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Oluwasemipe Oni
- MD Program, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Gianni R. Lorello
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital - University Health Network, Toronto, Canada
- The Wilson Centre, University Health Network/University of Toronto, Toronto, Canada
| | - Umberin Najeeb
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Zac Feilchenfeld
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stephanie J. Waterman
- Department of Leadership, Higher, and Adult Education, Centre for the Study of Canadian and International Higher Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Cynthia R. Whitehead
- The Wilson Centre, University Health Network/University of Toronto, Toronto, Canada
- Family and Community Medicine, Women’s College Hospital, Toronto, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Ayelet Kuper
- The Wilson Centre, University Health Network/University of Toronto, Toronto, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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