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Naidoo K, Karim R, Rimmel L, Watkins Liu C, Washington K, Privett R, Godsey K, Rucker-Bussie V, Plummer L. Using Structural Competencies for Faculty and Students to Integrate Principles of Social Justice and Health Equity Into a Doctor of Physical Therapy Program. JOURNAL, PHYSICAL THERAPY EDUCATION 2024:00001416-990000000-00124. [PMID: 39116370 DOI: 10.1097/jte.0000000000000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND AND PURPOSE Integrating principles of social justice and health equity (SJHE) into Doctor of Physical Therapy (DPT) education may be one way to confront the root causes of health inequity. The purpose of this method/model presentation is to highlight structural competencies for faculty and students to integrate SJHE into a 3-year DPT program and a professional development program designed to provide core and clinical faculty with the tools to engage in critical discussions with students and support their development as agents of change. METHOD/MODEL DESCRIPTION AND EVALUATION This presentation highlights how SJHE structural competencies can be integrated into existing course content (as opposed to presented as a standalone course). Researchers interviewed 10 DPT faculty and 10 DPT students about their experience learning about SJHE. Six clinical instructors (CIs) who supervised students during a full-time clinical education experience (CEE) discussed students' ability to apply SJHE concepts during CEEs. OUTCOMES Faculty expressed the need for practice in low-stakes settings such as through simulation. Students valued learning about SJHE over 3 years with the opportunity to integrate content during CEEs but felt that SJHE could be better integrated in classroom content. Some peers were perceived to be resistant to SJHE. Clinical instructors described that although students were prepared to apply foundational SJHE concepts, students were surprised by the complexity of patient need. DISCUSSION AND CONCLUSION Exploratory analysis of faculty, CI, and students' perceptions confirm that SJHE is needed in DPT education but takes time to integrate well with a steep learning curve and additional faculty development needs that must be met.
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Affiliation(s)
- Keshrie Naidoo
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Rania Karim
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Lauren Rimmel
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Callie Watkins Liu
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Kamaria Washington
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Rachel Privett
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Keelin Godsey
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Valerie Rucker-Bussie
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
| | - Laura Plummer
- Keshrie Naidoo is an associate professor in the Department of Physical Therapy at the MGH Institute of Health Professions, 36 First Avenue, Charlestown Navy Yard, Boston, MA 02129 . Please address all correspondence to Keshrie Naidoo
- Rania Karim is an assistant professor in the Department of Physical Therapy at the MGH Institute of Health Professions
- Lauren Rimmel is the physical therapist at the Brigham and Women's Hospital
- Callie Watkins Liu is the director of justice, equity, diversity, and inclusion education and programs at the MGH Institute of Health Professions
- Kamaria Washington is the physical therapist and owner at the Pelvic Noire Physical Therapy & Wellness
- Rachel Privett is an adjunct faculty in the Department of Physical Therapy at the MGH Institute of Health Professions
- Keelin Godsey is the physical therapist at the Johns Hopkins Medicine
- Valerie Rucker-Bussie is the physical therapist and owner at the Priority One Wellness
- Laura Plummer is the dean in the School of Health and Rehabilitation Sciences at the MGH Institute of Health Professions
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Hauer K, Minhas P, McDonald J, Perez S, Phinney L, Lucey C, O'Sullivan P. Inclusive Research in Medical Education: Strategies to Improve Scholarship and Cultivate Scholars. J Gen Intern Med 2024:10.1007/s11606-024-08827-2. [PMID: 39103603 DOI: 10.1007/s11606-024-08827-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/15/2024] [Indexed: 08/07/2024]
Affiliation(s)
- Karen Hauer
- University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA.
- Office of Medical Education, University of California, San Francisco, San Francisco, CA, USA.
| | - Prabhjot Minhas
- Boston Combined Residency Program in Pediatrics, Boston Children's Hospital, Harvard University, Cambridge, MA, USA
| | | | - Sandra Perez
- University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Lauren Phinney
- University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Catherine Lucey
- University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
| | - Patricia O'Sullivan
- University of California, San Francisco (UCSF), School of Medicine, San Francisco, CA, USA
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Ellaway RH, O'Brien BC, Sherbino J, Maggio LA, Artino AR, Nimmon L, Park YS, Young M, Thomas A. Is There a Problem With Evidence in Health Professions Education? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:841-848. [PMID: 38574241 DOI: 10.1097/acm.0000000000005730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT What constitutes evidence, what value evidence has, and how the needs of knowledge producers and those who consume this knowledge might be better aligned are questions that continue to challenge the health sciences. In health professions education (HPE), debates on these questions have ebbed and flowed with little sense of resolution or progress. In this article, the authors explore whether there is a problem with evidence in HPE using thought experiments anchored in Argyris' learning loops framework.From a single-loop perspective ("How are we doing?"), there may be many problems with evidence in HPE, but little is known about how research evidence is being used in practice and policy. A double-loop perspective ("Could we do better?") suggests expectations of knowledge producers and knowledge consumers might be too high, which suggests more system-wide approaches to evidence-informed practice in HPE are needed. A triple-loop perspective ("Are we asking the right questions?") highlights misalignments between the dynamics of research and decision-making, such that scholarly inquiry may be better approached as a way of advancing broader conversations, rather than contributing to specific decision-making processes.The authors ask knowledge producers and consumers to be more attentive to the translation from knowledge to evidence. They also argue for more systematic tracking and audit of how research knowledge is used as evidence. Given that research does not always have to serve practical purposes or address the problems of a particular program or institution, the relationship between knowledge and evidence should be understood in terms of changing conversations and influencing decisions.
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Beagan BL, Sibbald KR, Goree TD, Pride TM. Affirmative action and employment equity in the professions: Backlash fueled by individualism and meritocracy. CANADIAN REVIEW OF SOCIOLOGY = REVUE CANADIENNE DE SOCIOLOGIE 2024; 61:241-261. [PMID: 39095938 DOI: 10.1111/cars.12480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
In the 40 years since federal employment equity initiatives were launched in Canada, they have faced persistent backlash. This backlash is grounded in and fueled by conceptualizations of justice and equality that are rooted in ideologies of individualism and meritocracy. Here we draw on 140 qualitative interviews with members of six professions from across Canada, who self-identify as Indigenous, Black or racialized, ethnic minority, disabled, 2SLGBTQ+, and/or from working-class origins, to explore tensions between concepts of justice grounded in group-based oppressions and those grounded in individual egalitarianism. Though affirmative action and employment equity opened up opportunities, people were still left to fight for individual rights. This push to individualism was intensified by persistent hostile misperceptions that people are less qualified and in receipt of 'unfair advantages.' Through discursive misdirection, potential for transformative institutional change is undermined by liberal discourses of individualism and meritocracy.
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Affiliation(s)
- Brenda L Beagan
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kaitlin R Sibbald
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Toni D Goree
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tara M Pride
- School of Occupational Therapy, Western University, London, Ontario, Canada
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Cahn PS. Accounting for agency in structural competency. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:1059-1066. [PMID: 37910288 DOI: 10.1007/s10459-023-10299-8] [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: 02/27/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
To emphasize to learners how factors outside individual control impact health, scholars introduced the concept of structural competency. Structural competency refers to the development of analytical skills that reveal the larger societal context beyond the patient-clinician interaction that shapes health outcomes. The growing adoption of structural competency curricula, however, has revealed that prelicensure and early career health professionals can feel overwhelmed by the mismatch between the wide scale of entrenched problems and the limited scope of their therapeutic skills. In this Reflections paper, I draw on theories from Giddens, Bourdieu, and Foucault to restore a role for individual agency in promoting health. Conceiving of structure and agency as mutually constituting suggests that structures are human-made and can be vulnerable to challenge. Structures, however, disperse power to such an extent that people internalize their rules and discipline themselves to follow them without explicit enforcement. It is precisely in those local sites of power that health professions learners and educators can intervene to interrupt the reproduction of structures harmful to health. As I demonstrate with an example from a reproductive health emergency, being structurally competent may also include contesting agreed upon norms at the level of the learning and clinical environments rather than only macro-level societal forces. Rewriting norms within health professions education and clinical practice is not necessarily a simpler task, but it provides learners and educators with more accessible targets for action.
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Affiliation(s)
- Peter S Cahn
- Department of Health Professions Education, MGH Institute of Health Professions, 36 First Avenue, Boston, MA, 02129, United States of America.
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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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Hannington M, Govender L. Communities of practice: A decolonial critique. CLINICAL TEACHER 2024; 21:e13699. [PMID: 37953680 DOI: 10.1111/tct.13699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023]
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Naidu T, Gingell G, Zaidi Z. Decolonial framework for applying reflexivity and positionality in global health research. Glob Health Promot 2024; 31:52-58. [PMID: 38566278 PMCID: PMC11363464 DOI: 10.1177/17579759241238016] [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: 11/08/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024]
Abstract
Contemporary research practices link to colonial and imperialist knowledge creation and production and may promote harmful perspectives on marginalized and oppressed groups. We present a framework for a decolonial approach to research in global health and health promotion applicable across research settings. This framework is aimed at anticipating and alleviating potentially harmful practices inherent in dominant research methods. The framework focuses from a macro- and micro-level perspective on three critical dyads: 'context' and 'accountability'; 'researcher identity' and 'positionality'; and 'procedural ethics' and 'ethics in practice' considerations. We present guidance for how to consider reflexivity and positionality as they apply in this framework in global health and health promotion research practice.
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Affiliation(s)
| | | | - Zareen Zaidi
- George Washington University Medical Faculty Associates, Washington, USA
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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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Lingard L, Watling C. The writer's voice repertoire: Exploring how health researchers accomplish a distinctive 'voice' in their writing. MEDICAL EDUCATION 2024; 58:523-534. [PMID: 38233970 DOI: 10.1111/medu.15298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Much published research writing is dull and dry at best, impenetrable and off-putting at worst. This state of affairs both frustrates readers and impedes research uptake. Scientific conventions of objectivity and neutrality contribute to the problem, implying that 'good' research writing should have no discernible authorial 'voice'. Yet some research writers have a distinctive voice in their work that may contribute to their scholarly influence. In this study, we explore this notion of voice, examining what strong research writers aim for with their voice and what strategies they use. METHODS Using a combination of purposive, snowball and theoretical sampling, we recruited 21 scholars working in health professions education or adjacent health research fields, representing varied career stages, research paradigms and geographical locations. We interviewed participants about their approaches to writing and asked each to provide one to three illustrative publications. Iterative data collection and analysis followed constructivist grounded theory principles. We analysed interview transcripts thematically and examined publications for evidence of the writers' described approaches. RESULTS Participants shared goals of a voice that was clear and logical, and that engaged readers and held their attention. They accomplished these goals using approaches both conventional and unconventional. Conventional approaches included attention to coherence through signposting, symmetry and metacommentary. Unconventional approaches included using language that was evocative (metaphor, imagery), provocative (pointed critique), plainspoken ('non-academic' phrasing), playful (including humour) and lyrical (attending to cadence and sound). Unconventional elements were more prominent in non-standard genres (e.g. commentaries), but also appeared in empiric papers. DISCUSSION What readers interpret as 'voice' reflects strategic use of a repertoire of writing techniques. Conventional techniques, used expertly, can make for compelling reading, but strong writers also draw on unconventional strategies. A broadened writing repertoire might assist health professions education research writers in effectively communicating their work.
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Affiliation(s)
- Lorelei Lingard
- Department of Medicine and Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Chris Watling
- Department of Oncology and Centre for Education Research & Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Naidu T, Cartmill C, Swanepoel S, Whitehead CR. Shapeshifters: Global South scholars and their tensions in border-crossing to Global North journals. BMJ Glob Health 2024; 9:e014420. [PMID: 38724078 PMCID: PMC11029397 DOI: 10.1136/bmjgh-2023-014420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/14/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Global South researchers struggle to publish in Global North journals, including journals dedicated to research on health professions education (HPE). As a consequence, Western perspectives and values dominate the international academic landscape of HPE. This study sought to understand Global South researchers' motivations and experiences of publishing in Global North journals. METHODS This study used a hermeneutic phenomenological perspective. Unstructured interviews were conducted with 11 authors from 6 Global South countries. Interview transcripts were analysed through a process of familiarisation, identifying significant statements, formulating meanings, clustering themes, developing exhaustive descriptions, producing a fundamental structure and seeking verification. RESULTS Participants described being motivated by local institutional expectations, to improve reputation, to meet Global North perceptions of quality and to draw attention to their Global South context. Participants described experiences where their work was deemed irrelevant to Global North audiences, they were unable to interpret rejections and had learnt to play the publishing game by attending to both local and global imperatives. These motivations and experiences revealed several practical, academic and transformational tensions that Global South authors faced. CONCLUSION The tensions and negotiations encountered by Global South authors who publish in HPE journals reflect a 'border consciousness' whereby authors must shift consciousness, or become 'shapeshifters', inhabiting two or more worlds as they cross borders between the Global South and Global North conventions. There is an added burden and risk in performing this shapeshifting, as Global South authors stand astride the borders of two worlds without belonging fully to either.
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Affiliation(s)
- Thirusha Naidu
- Behavioural Medicine, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
- Public Health and Primary Care, University of Cambridge, UK
| | - Carrie Cartmill
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Sunitha Swanepoel
- University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Cynthia Ruth Whitehead
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
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Kalocsai C, Agrawal S, de Bie L, Beder M, Bellissimo G, Berkhout S, Johnson A, McNaughton N, Rodak T, McCullough K, Soklaridis S. Power to the people? A co-produced critical review of service user involvement in mental health professions education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:273-300. [PMID: 37247126 DOI: 10.1007/s10459-023-10240-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 05/07/2023] [Indexed: 05/30/2023]
Abstract
Meaningful service user involvement in health professions education requires integrating knowledge held by "lay" people affected by health challenges into professional theories and practices. Involving service users redefines whose knowledge "counts" and implies a shift in power. Such a shift is especially significant in the mental health field, where power imbalances between health professionals and service users are magnified. However, reviews of the literature on service user involvement in mental health professional education do little to explore how power manifests in this work. Meanwhile critical and Mad studies scholars have highlighted that without real shifts in power, inclusion practices can lead to harmful consequences. We conducted a critical review to explore how power is addressed in the literature that describes service user involvement in mental health professions education. Our team used a co-produced approach and critical theories to identify how power implicitly and explicitly operates in this work to unearth the inequities and power structures that service user involvement may inadvertently perpetuate. We demonstrate that power permeates service user involvement in mental health professional education but is rarely made visible. We also argue that by missing the opportunity to locate power, the literature contributes to a series of epistemic injustices that reveal the contours of legitimate knowledge in mental health professions education and its neoliberal underpinnings. Ultimately, we call for a critical turn that foregrounds power relations to unlock the social justice-oriented transformative potential of service user involvement in mental health professions education and health professions education more broadly.
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Affiliation(s)
- Csilla Kalocsai
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Sacha Agrawal
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lee de Bie
- Centre for Clinical Ethics, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michaela Beder
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Gail Bellissimo
- Independent service user educator researcher, Toronto, ON, Canada
| | - Suze Berkhout
- University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Johnson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nancy McNaughton
- Wilson Centre for Research in Education at University Health Network and University of Toronto, Toronto, ON, Canada
- Michener Institute of Education at University Health Network, Toronto, ON, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kim McCullough
- Department of Social Work, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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Beagan BL, Bizzeth SR, Sibbald KR, Etowa JB. Epistemic racism in the health professions: A qualitative study with Black women in Canada. Health (London) 2024; 28:203-215. [PMID: 36475974 PMCID: PMC10900862 DOI: 10.1177/13634593221141605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Systemic racism within health care is increasingly garnering critical attention, but to date attention to the racism experienced by health professionals themselves has been scant. In Canada, anti-Black racism may be embodied in structures, policies, institutional practices and interpersonal interactions. Epistemic racism is an aspect of systemic racism wherein the knowledge claims, ways of knowing and 'knowers' themselves are constructed as invalid, or less credible. This critical interpretive qualitative study examined the experiences of epistemic racism among 13 healthcare professionals across Canada who self-identified as Black women. It explores the ways knowledge claims and expert authority are discredited and undermined, despite the attainment of professional credentials. Three themes were identified: 1. Not being perceived or portrayed as credible health professionals; 2. Requiring invisible labour to counter professional credibility 'deficit'; and 3. Devaluing knowledge while imposing stereotypes. The Black women in our study faced routine epistemic racism. They were not afforded the position of legitimate knower, expert, authority, despite their professional credentials as physicians, nurses and occupational therapists. Their embodied cultural and community knowledges were disregarded in favour of stereotyped assumptions. Adopting the professional comportment of 'Whiteness' was one way these health care providers strived to be perceived as credible professionals. Their experiences are characteristic of 'misogynoir', a particular form of racism directed at Black women. Anti-Black epistemic racism constitutes one way Whiteness is perpetuated in health professions institutions.
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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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Neville P. Decolonising dental educational research: reflections from a white researcher. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1679-1695. [PMID: 37074593 PMCID: PMC10113732 DOI: 10.1007/s10459-023-10228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/26/2023] [Indexed: 05/03/2023]
Abstract
While there is an emerging scholarship on decolonising dentistry, the debate about reflexivity, positionality and white privilege in dental educational research and practice is still at a developmental stage. This article aims to contribute to this nascent debate by contemplating the question- is it appropriate, or possible, for a white researcher to undertake decolonisation work in dental education? If so, what would it entail or 'look' like? To answer this important question, the author offers a reflective account of their ethical and epistemological journey with this very question. This journey begins with how I, a white researcher, first became aware of the everyday racism experienced by my racially and ethnically minoritized students, the whiteness of dental educational spaces and how my white privilege and position as a dental educator consciously and unconsciously implicated me in these processes of exclusion and discrimination. While this revelation led to a personal commitment to do better in my practice, both as an educator and a researcher, I continue to struggle with my white ignorance and white fragility as I strive to make my work more inclusive. To illustrate this, I discuss an ethnodrama project on everyday racism that I lead on and how, despite choosing a more democratic research method, hegemonic whiteness continued to make its presence felt through my 'going it alone' method of work. This reflective account reaffirms that regular and routine self-reflection is key to ensuring that racialised inappropriate and damaging assumptions, frameworks of thinking, and ways of working are checked for. However, my praxis won't evolve through critical introspection alone. I need to be open to making mistakes, educating myself about racism and anti-racist practice, asking for help and guidance from my minoritized colleagues and more importantly, committing to working with people from minoritized communities rather than on them.
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Affiliation(s)
- Patricia Neville
- University of Bristol, Bristol, UK.
- Bristol Dental School, University of Bristol, Lower Maudlin Street, Bristol, BS1 2LY, UK.
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Rispel LC, Ditlopo P, White J, Blaauw D. Perspectives of the cohort of health professionals in the WiSDOM study on the learning environment, transformation, and social accountability at a South African University. MEDICAL EDUCATION ONLINE 2023; 28:2185121. [PMID: 36880804 PMCID: PMC10013394 DOI: 10.1080/10872981.2023.2185121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/01/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The dearth of empirical research on transformative health professions education informed this study to examine the factors that influence the perspectives of the cohort of health professionals in the WiSDOM study on the learning environment, transformation, and social accountability at a South African university. METHODS WiSDOM, a prospective longitudinal cohort study, consists of eight health professional groups: clinical associates, dentists, doctors, nurses, occupational therapists, oral hygienists, pharmacists, and physiotherapists. At study inception in 2017, participants completed a self-administered questionnaire that included four domains of selection criteria (6 items); the learning environment (5 items); redress and transformation (8 items); and social accountability (5 items). In the analysis, we, rescaled the original Likert scoring of 1 (strongly disagree) to 7 (strongly agree) to a new scale ranging from 0-10. We calculated the mean scores for each item and across items for the four domains, with low scores (0.00-1.99) classified as poor and high scores (8.00-10.00) as excellent. We used multiple linear regression analysis to compare the mean scores, while adjusting for different socio-demographiccharacteristics. RESULTS The mean age of the 501 eligible participants was 24.1 years; the majority female (72.9%), 45.3% self-identified as Black African; and 12.2% were born in a rural area. The domains of selection criteria and redress and transformation obtained mean scores of 5.4 and 5.3 out of 10 respectively, while social accountability and the learning environment obtained mean scores of 6.1 and 7.4 out of 10 respectively. Self-identified race influenced the overall mean scores of selection criteria, redress and transformation, and social accountability (p < 0.001). Rural birth influenced the perceptions on selection criteria, redress and transformation (p < 0.01). CONCLUSION The results suggest the need to create inclusive learning environments that foreground redress, transformation, and social accountability, while advancing the discourse on decolonised health sciences education.
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Affiliation(s)
- Laetitia C. Rispel
- Centre for Health Policy & South African Research Chairs Initiative (SARChI), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Prudence Ditlopo
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janine White
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Duane Blaauw
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Naidoo K. Moving Beyond the DEI Mission Statement to Justice, Equity, Diversity, and Inclusion in Action. JOURNAL, PHYSICAL THERAPY EDUCATION 2023; 37:257-258. [PMID: 38478778 DOI: 10.1097/jte.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Affiliation(s)
- Keshrie Naidoo
- Keshrie Naidoo is an associate professor and Interim Chair of Physical Therapy at the MGH Institute of Health Professions, Boston, MA 02129 ( ). Please address all correspondence to Keshrie Naidoo
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18
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Tuitt NR, Wexler LM, Kaufman CE, Whitesell NR, Rink E, Anastario M, Ivanich JD, Belone L, Moore RS, Huh D, Campbell TE, Allen J. Unsettling Settler Colonialism in Research: Strategies Centering Native American Experience and Expertise in Responding to Substance Misuse and Co-occurring Sexual Risk-Taking, Alcohol-Exposed Pregnancy, and Suicide Prevention Among Young People. ADVERSITY AND RESILIENCE SCIENCE 2023; 4:389-400. [PMID: 38045956 PMCID: PMC10688593 DOI: 10.1007/s42844-023-00100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 12/05/2023]
Abstract
Native American (NA) populations in the USA (i.e., those native to the USA which include Alaska Natives, American Indians, and Native Hawaiians) have confronted unique historical, sociopolitical, and environmental stressors born of settler colonialism. Contexts with persistent social and economic disadvantage are critical determinants of substance misuse and co-occurring sexual risk-taking and suicide outcomes, as well as alcohol exposed pregnancy among NA young people (i.e., adolescents and young adults). Despite intergenerational transmission of resistance and resiliencies, NA young people face continued disparities in substance misuse and co-occurring outcomes when compared to other racial and ethnic groups in the USA. The failure in progress to address these inequities is the result of a complex set of factors; many of which are structural and rooted in settler colonialism. One of these structural factors includes barriers evident in health equity research intended to guide solutions to address these disparities yet involving maintenance of a research status quo that has proven ineffective to developing these solutions. Explicitly or implicitly biased values, perspectives, and practices are deeply rooted in current research design, methodology, analysis, and dissemination and implementation efforts. This status quo has been supported, intentionally and unintentionally, by researchers and research institutions with limited experience or knowledge in the historical, social, and cultural contexts of NA communities. We present a conceptual framework illustrating the impact of settler colonialism on current research methods and opportunities to unsettle its influence. Moreover, our framework illustrates opportunities to resist settler colonialism in research. We then focus on case examples of studies from the Intervention Research to Improve Native American Health program, funded by the NIH, that impact substance use and co-occurring health conditions among NA young people.
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Affiliation(s)
- Nicole R. Tuitt
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lisa M. Wexler
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Carol E. Kaufman
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nancy Rumbaugh Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Rink
- Center for American Indian and Rural Health Equity, College of Education, Health, and Human Resources, Montana State University, Bozeman, MT, USA
| | - Michael Anastario
- Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Jerreed D. Ivanich
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lorenda Belone
- Center for Participatory Research, Department of Health, Exercise, and Sports Science, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Roland S. Moore
- Pacific Institute for Research and Evaluation, Albuquerque, NM, USA
| | - David Huh
- School of Social Work, University of Washington, Seattle, WA, USA
| | | | - James Allen
- Department of Family Medicine and Biobehavioral Health, University of Minnesota, Minneapolis, MN, USA
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Essex R, Kennedy J, Miller D, Jameson J. A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations. Nurs Inq 2023; 30:e12571. [PMID: 37338510 DOI: 10.1111/nin.12571] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations defined broadly, to address gaps in macro-level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide-reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well-being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level.
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Affiliation(s)
- Ryan Essex
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Jack Kennedy
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Denise Miller
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Jill Jameson
- Institute for Lifecourse Development, University of Greenwich, London, UK
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20
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Hansen A, Engel-Hills P, Jacobs C, Blitz J, Cooke R, Hess-April L, Leisegang K, Naidoo N, Volschenk M, van Schalkwyk S. Understandings and practices: Towards socially responsive curricula for the health professions. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1131-1149. [PMID: 36732399 PMCID: PMC9894667 DOI: 10.1007/s10459-023-10207-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/03/2023] [Indexed: 05/21/2023]
Abstract
Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.
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Affiliation(s)
- Anthea Hansen
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Penelope Engel-Hills
- Medical Imaging and Therapeutic Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Cecilia Jacobs
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard Cooke
- Department of Family Medicine and Primary Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia Hess-April
- Department of Occupational Therapy, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Niri Naidoo
- Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Mariette Volschenk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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21
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Monnique J, Abigail K, Anna T C. From Stone Tablets to Counternarratives: There is Another Way to Approach Decision Letters in Health Professions Education Publishing. TEACHING AND LEARNING IN MEDICINE 2023; 35:497-501. [PMID: 37941416 DOI: 10.1080/10401334.2023.2276604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Johnson Monnique
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Konopasky Abigail
- Medical Education at Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Cianciolo Anna T
- Medical Education at Southern Illinois University School of Medicine, Springfield, Illinois, USA
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22
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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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Plasse MJ, Peterson KS. Incorporating social justice learning into competency-based graduate nursing: A discussion of integrating pedagogies. J Prof Nurs 2023; 48:119-127. [PMID: 37775226 DOI: 10.1016/j.profnurs.2023.07.004] [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: 10/15/2022] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The impact of social inequity on the collective health of a society is well documented and, despite decades of research, the problem persists on a global scale. Nurse practitioners are competent to treat the downstream health effects of social inequity, but nursing students may lack the structural awareness to accurately target primary prevention efforts. OBJECTIVE The authors discuss faculty preparation and pedagogical considerations when incorporating social justice learning into a graduate and post-graduate psychiatric nurse practitioner course. DESIGN/METHODS Guided by Walter's Emancipatory Nursing Praxis model, several pedagogical strategies were developed to enhance graduate nursing students' awareness of oppressive and unjust realities in the healthcare setting. CONCLUSION Emancipatory pedagogical strategies in competency-based graduate nursing education can enhance the transformative social learning essential for the development of health equity praxis.
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Affiliation(s)
- Mechelle J Plasse
- UMass Chan Medical School Tan Chingfen Graduate School of Nursing, S1-853, UMass Chan Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA.
| | - Kenneth S Peterson
- UMass Chan Medical School Tan Chingfen Graduate School of Nursing, S1-853, UMass Chan Medical School, 55 Lake Avenue, North, Worcester, MA 01655, USA.
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24
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Goldman J, Lo L, Rotteau L, Wong BM, Kuper A, Coffey M, Rawal S, Alfred M, Razack S, Pinard M, Palomo M, Trbovich P. Applying an equity lens to hospital safety monitoring: a critical interpretive synthesis protocol. BMJ Open 2023; 13:e072706. [PMID: 37524554 PMCID: PMC10391806 DOI: 10.1136/bmjopen-2023-072706] [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] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Hospital safety monitoring systems are foundational to how adverse events are identified and addressed. They are well positioned to bring equity-related safety issues to the forefront for action. However, there is uncertainty about how they have been, and can be, used to achieve this goal. We will undertake a critical interpretive synthesis (CIS) to examine how equity is integrated into hospital safety monitoring systems. METHODS AND ANALYSIS This review will follow CIS principles. Our initial compass question is: How is equity integrated into safety monitoring systems? We will begin with a structured search strategy of hospital safety monitoring systems in CINAHL, EMBASE, MEDLINE and PsycINFO for up to May 2023 to identify papers on safety monitoring systems generally and those linked to equity (eg, racism, social determinants of health). We will also review reference lists of selected papers, contact experts and draw on team expertise. For subsequent literature searching stages, we will use team expertise and expert contacts to purposively search the social science, humanities and health services research literature to support the development of a theoretical understanding of our topic. Following data extraction, we will use interpretive processes to develop themes and a critique of the literature. The above processes of question formulation, article search and selection, data extraction, and critique and synthesis will be iterative and interactive with the goal to develop a theoretical understanding of equity in hospital monitoring systems that will have practice-based implications. ETHICS AND DISSEMINATION This review does not require ethical approval because we are reviewing published literature. We aim to publish findings in a peer-reviewed journal and present at conferences.
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Affiliation(s)
- Joanne Goldman
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Wilson Centre, University of Toronto/University Health Network, Toronto, Ontario, Canada
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Leahora Rotteau
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Brian M Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Wilson Centre, University of Toronto/University Health Network, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maitreya Coffey
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Shail Rawal
- Department of Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Myrtede Alfred
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Saleem Razack
- Department of Pediatrics and Centre for Health Education Scholarship, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Research Institute, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Marie Pinard
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Patricia Trbovich
- Centre for Quality Improvement and Patient Safety, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
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Lurch S, Cobbing S, Chetty V, Maddocks S. Challenging power and unearned privilege in physiotherapy: lessons from Africa. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1175531. [PMID: 37521329 PMCID: PMC10381923 DOI: 10.3389/fresc.2023.1175531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/06/2023] [Indexed: 08/01/2023]
Abstract
Power and unearned privilege in the profession of physiotherapy (PT) reside in the white, Western, English-speaking world. Globally, rehabilitation curricula and practices are derived primarily from European epistemologies. African philosophies, thinkers, writers and ways of healing are not practiced widely in healthcare throughout the globe. In this invited perspectives paper, we discuss the philosophies of Ubuntu and Seriti, and describe how these ways of thinking, knowing, and being challenge Western biomedical approaches to healthcare. We believe implementing these philosophies in the West will assist patients in attaining the health outcomes they seek. Further we call for Western professionals and researchers to stand in solidarity with their African counterparts in order to move towards a diversity of practitioners and practices that help to ensure better outcomes for all.
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Affiliation(s)
- Stephanie Lurch
- School of Rehabilitation Science, Physiotherapy Program, McMaster University, Hamilton, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Saul Cobbing
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Department of Physiotherapy, University of KwaZulu-Natal, Durban,South Africa
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Verusia Chetty
- Department of Physiotherapy, University of KwaZulu-Natal, Durban,South Africa
| | - Stacy Maddocks
- Department of Physiotherapy, University of KwaZulu-Natal, Durban,South Africa
- Centre for Heart Lung Innovation, UBC and St. Paul’s Hospital, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
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Wondimagegn D, Whitehead CR, Cartmill C, Rodrigues E, Correia A, Salessi Lins T, Costa MJ. Faster, higher, stronger - together? A bibliometric analysis of author distribution in top medical education journals. BMJ Glob Health 2023; 8:e011656. [PMID: 37321659 PMCID: PMC10367082 DOI: 10.1136/bmjgh-2022-011656] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/11/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION Medical education and medical education research are growing industries that have become increasingly globalised. Recognition of the colonial foundations of medical education has led to a growing focus on issues of equity, absence and marginalisation. One area of absence that has been underexplored is that of published voices from low-income and middle-income countries. We undertook a bibliometric analysis of five top medical education journals to determine which countries were absent and which countries were represented in prestigious first and last authorship positions. METHODS Web of Science was searched for all articles and reviews published between 2012 and 2021 within Academic Medicine, Medical Education, Advances in Health Sciences Education, Medical Teacher, and BMC Medical Education. Country of origin was identified for first and last author of each publication, and the number of publications originating from each country was counted. RESULTS Our analysis revealed a dominance of first and last authors from five countries: USA, Canada, UK, Netherlands and Australia. Authors from these five countries had first or last authored 70% of publications. Of the 195 countries in the world, 43% (approximately 83) were not represented by a single publication. There was an increase in the percentage of publications from outside of these five countries from 23% in 2012 to 40% in 2021. CONCLUSION The dominance of wealthy nations within spaces that claim to be international is a finding that requires attention. We draw on analogies from modern Olympic sport and our own collaborative research process to show how academic publishing continues to be a colonised space that advantages those from wealthy and English-speaking countries.
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Affiliation(s)
- Dawit Wondimagegn
- College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Cynthia Ruth Whitehead
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| | - Carrie Cartmill
- The Wilson Centre, University Health Network and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Eloy Rodrigues
- Documentation and Library Services, University of Minho, Braga, Portugal
| | - Antónia Correia
- Documentation and Library Services, University of Minho, Braga, Portugal
| | - Tiago Salessi Lins
- Department of Health Promotion, Federal University of Paraiba, Paraiba, Brazil
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Kuper A. Reflections on addressing antisemitism in a Canadian faculty of medicine. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:158-170. [PMID: 37304637 PMCID: PMC10254102 DOI: 10.36834/cmej.76086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Ayelet Kuper
- Wilson Centre for Research in Education, University Health Network/University of Toronto, Ontario, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Ontario, Canada
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Kuper A, O'Sullivan P, Cleland J. Questions and Quandaries: How to respond to reviewer comments. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:7-12. [PMID: 36853450 PMCID: PMC9972321 DOI: 10.1007/s10459-023-10213-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 05/21/2023]
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 first article, the authors address the question of how to respond to a request for revisions after review, including the quandary of how best to respond to conflicting feedback.
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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.
| | - Pat O'Sullivan
- San Francisco School of Medicine, University of California, San Francisco, CA, USA
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Smith CS, Stilianoudakis SC, Carrico CK. Professionalism and professional identity formation in dental students: Revisiting the professional role orientation inventory (PROI). J Dent Educ 2022; 87:646-653. [PMID: 36586414 DOI: 10.1002/jdd.13159] [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: 07/10/2022] [Revised: 10/18/2022] [Accepted: 12/06/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Professionalism is a hallmark of health professions education. Professional identity formation is a growing field of exploration in medical education, and the dental literature is sparse on just how professional identity formation is developed and assessed within dental education. METHODS The validated professional role orientation inventory (PROI) was administered to 2nd year dental students during a spring semester ethics course. The PROI includes four 10-item scales representing four attitudinal factors: Authority, Responsibility, Agency, and Autonomy. RESULTS When compared to a historical sample of dental students in the early 1990s, dental students today scored significantly higher on Responsibility (p = 0.0309) and lower on the Agency factor (p = 0.0001). Authority scores in the current sample of dental students were significantly associated with age and race, with an increase in age associated with a decrease in Authority (p = 0.0504) and Caucasian respondents demonstrating significantly higher scores than Asian or Other races. Debt was associated with differences in Autonomy (p = 0.0683) and Agency (p = 0.0106), with those in the 100k-300k anticipated debt range demonstrating lower levels of both Autonomy and Agency. Race was marginally associated with Responsibility with those in the Other race category (Hispanic, Black/African American, Other/Multiracial) demonstrating higher levels than Caucasian (p = 0.0513). CONCLUSION Dental students' scores denote a continued commitment to others yet a feeling of less sense of control as a practicing professional. A redefining of professionalism to include social activism and advancing health equity is required given their altruism and commitment to others, which remains high.
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Affiliation(s)
- Carlos S Smith
- Department of Dental Public Health and Policy, Virginia Commonwealth University, Richmond, Virginia, USA.,Oral Health Equity Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Spiro C Stilianoudakis
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Caroline K Carrico
- Department of Dental Public Health and Policy, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA.,Oral Health Research Group, Virginia Commonwealth University, Richmond, Virginia, USA
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Corbie G, Brandert K, Fernandez CS, Noble CC. Leadership Development to Advance Health Equity: An Equity-Centered Leadership Framework. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1746-1752. [PMID: 35904425 PMCID: PMC9698199 DOI: 10.1097/acm.0000000000004851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Enduring questions about equity are front and center at this watershed moment in health care and public health. Inequities that became evident in the COVID-19 pandemic in 2020 have highlighted long-standing disparities in health by race and ethnicity. Current crises require examining and reorienting the systems that have, for decades, produced these health inequities; yet, public health and health care leaders are inadequately prepared to respond. The authors offer an equity-centered leadership framework to support the development of visionary leaders for tomorrow. This framework for leadership development programs interweaves traditional leadership and equity, diversity, and inclusion domains in both conceptual knowledge and skills-based teaching for health care and public health leaders, grouping competencies and skills into 4 domains: personal, interpersonal, organizational, and community and systems. A framework such as this will equip leaders with the mindset and skill set to challenge the paradigms that lead to inequity and health disparities.
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Affiliation(s)
- Giselle Corbie
- G. Corbie is Kenan Distinguished Professor, Department of Social Medicine and Department of Medicine, and director, Center for Health Equity Research, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen Brandert
- K. Brandert is assistant dean of practice and assistant professor, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Claudia S.P. Fernandez
- C.S.P. Fernandez is professor, Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cheryl C. Noble
- C.C. Noble is an evaluation consultant, Scotts Valley, California
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Maretic S, MacMillan A. Looking beyond the pool: An intersectional feminist perspective on osteopathic education. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wyatt TR, Ho MJ, Teherani A. Centering Criticality in Medical Education Research: A Synthesis of the 2022 RIME Papers. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S11-S14. [PMID: 35947467 DOI: 10.1097/acm.0000000000004903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Tasha R Wyatt
- T.R. Wyatt is associate director/associate professor, Uniformed Services University of the Health Sciences, Center for Health Professions Education, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-0071-5298
| | - Ming-Jung Ho
- M.-J. Ho is professor of family medicine and associate director, Center for Innovation and Leadership in Education (CENTILE), Georgetown University Medicine Center, and director of education research, MedStar Health, Washington, DC; ORCID: https://orcid.org/0000-0003-1415-8282
| | - Arianne Teherani
- A. Teherani is professor of medicine, director of program evaluation and continuous quality improvement, an education scientist, Center for Faculty Educators, and founding codirector, University of California Center for Climate, Health and Equity, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0003-2936-983
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Burns L, Coelho C, Addy A. Ethnic diversity in academic dentistry in the United Kingdom. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022. [PMID: 35978469 DOI: 10.1111/eje.12847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/14/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
Careers in academic dentistry are failing to attract a new generation of academics to steer dental education and research. Dental academia is further limited by inadequacies in levels of ethnic diversity. There is a stark contrast between the diversity of graduates entering the dental profession and those in academic positions, especially in senior ranks. Dentistry is not the only field in academia, which lacks representation and lessons may be drawn from other faculties. This paper focuses on what is known about dental academia in the United Kingdom, where there are formal research training pathways. There is an emerging recognition of the requirement for action, and it is hoped this will stimulate debate and impetus for research across Europe. The terminology used throughout this piece follows the United Kingdom Cabinet Office recommendations for writing about ethnicity (Writing about ethnicity, 2021; https://www.ethnicity-facts-figures.service.gov.uk/style-guide/writing-about-ethnicity). Where cited sources have employed less acceptable terms (Please don't call me BAME or BME!: Civil service, 2019; https://civilservice.blog.gov.uk/2019/07/08/please-dont-call-me-bame-or-bme/), these have been changed.
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Affiliation(s)
- Lorna Burns
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Cathy Coelho
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Amanda Addy
- Peninsula Dental School, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
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Finn GM, Brown MEL. Ova-looking feminist theory: a call for consideration within health professions education and research. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:893-913. [PMID: 35389154 PMCID: PMC8988912 DOI: 10.1007/s10459-022-10108-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
The role of feminist theory in health professions education is often 'ova-looked'. Gender is one cause of healthcare inequalities within contemporary medicine. Shockingly, according to the World Health Organisation, no European member state has achieved full gender equity in regard to health outcomes. Further, contemporary curricula have not evolved to reflect the realities of a diverse society that remains riddled with inequity. This paper outlines the history of feminist theory, and applies it to health professions education research and teaching, in order to advocate for its continued relevance within contemporary healthcare.
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Affiliation(s)
- G M Finn
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - M E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
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Lynch M, Yoo J, Mukami D, Arian W, Bashford T, Hobden P, Luthra P, Patel M, Ralph N, Winters N, McGrath L, Simms B. Principles to guide the effective use of technology to support capacity development in global health partnerships. BMJ Glob Health 2022; 6:bmjgh-2021-006783. [PMID: 35840176 PMCID: PMC9296875 DOI: 10.1136/bmjgh-2021-006783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Jihoon Yoo
- Tropical Health and Education Trust, London, UK
| | - Diana Mukami
- Institute of Local Capacity Development, Amref Health Africa, Nairobi, Kenya
| | | | - Tom Bashford
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK
| | - Paul Hobden
- Chief Executive Office, Gateway, Cape Town, South Africa
| | - Pramod Luthra
- Associate Postgraduate Dean, Health Education England North West, Manchester, UK
| | - Mumtaz Patel
- Postgraduate Associate Dean, Health Education England North West, Manchester, UK
| | - Neil Ralph
- Technology Enhanced Learning, Health Education England, Leeds, UK
| | - Niall Winters
- Department of Education, University of Oxford, Oxford, UK
| | - Louise McGrath
- Programmes, Tropical Health and Education Trust, London, UK
| | - Ben Simms
- Chief Executive, Tropical Health and Education Trust, London, UK
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Hall J, Kroll T, van Wijck F, Bassil-Morozow H. Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:877442. [PMID: 36189023 PMCID: PMC9397888 DOI: 10.3389/fresc.2022.877442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022]
Abstract
Background Stroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals. Methods This study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions. Findings Six online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support. Conclusion Stroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.
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Affiliation(s)
- Joseph Hall
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
- *Correspondence: Joseph Hall
| | - Thilo Kroll
- UCD Centre for Education, Research and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland
| | - Frederike van Wijck
- Research Centre for Health, School for Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Helena Bassil-Morozow
- Department of Media and Journalism, Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, United Kingdom
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Sukhera J, Goez H, Brown A, Haddara W, Razack S. Freedom from discrimination or freedom to discriminate? Discursive tensions within discrimination policies in medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:387-403. [PMID: 35025019 PMCID: PMC8757400 DOI: 10.1007/s10459-022-10090-1] [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: 04/23/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
The importance of advancing equity, diversity, and inclusion for all members of the academic medical community has gained recent attention. Academic medical organizations have attempted to increase broader representation while seeking structural reforms consistent with the goal of enhancing equity and reducing disproportionality. However, efforts remain constrained while minority groups continue to experience discrimination. In this study, the authors sought to identify and understand the discursive effects of discrimination policies within medical education. The authors assembled an archive of 22 texts consisting of publicly available discrimination and harassment policy documents in 13 Canadian medical schools that were active as of November 2019. Each text was analysed to identify themes, rhetorical strategies, problematization, and power relations. Policies described truth statements that appear to idealize equity, yet there were discourses related to professionalism and neutrality that were in tension with these ideals. There was also tension between organizations' framing of a shared responsibility for addressing discrimination and individual responsibility on complainants. Lastly, there were also competing discourses on promoting freedom from discrimination and the concept of academic freedom. Overall, findings reveal several areas of tension that shape how discrimination is addressed in policy versus practice. Existing discourses regarding self-protection and academic freedom suggest equity cannot be advanced through policy discourse alone and more substantive structural transformation may be necessary. Existing approaches may be inadequate to address discrimination unless academic medical organizations interrogate the source of these discursive tensions and consider asymmetries of power.
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Affiliation(s)
- Javeed Sukhera
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA.
| | - Helly Goez
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Pediatrics, Faculty of Medicine and Dentistry, College of Health Sciences University of Alberta, Edmonton, Canada
| | - Allison Brown
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Wael Haddara
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Medicine and Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - Saleem Razack
- Chair/Chief of Psychiatry, Institute of Living, Hartford Hospital, Terry Building, 200 Retreat Avenue, 06102, Hartford, Connecticut, USA
- Department of Paediatrics and Institute for Health Sciences Education, McGill University, Montreal, Canada
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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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Burm S, Luong V, LaDonna K, Bogie B, Cowley L, Klasen JM, MacLeod A. From struggle to opportunity: Reimagining medical education in a pandemic era. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:115-120. [PMID: 35286689 PMCID: PMC8919355 DOI: 10.1007/s40037-022-00702-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 01/24/2022] [Accepted: 02/05/2022] [Indexed: 06/02/2023]
Abstract
The COVID-19 pandemic has disrupted the international medical education community in unprecedented ways. The restrictions imposed to control the spread of the virus have upended our routines and forced us to reimagine our work structures, educational programming and delivery of patient care in ways that will likely continue to change how we live and work for the foreseeable future. Yet, despite these interruptions, the pandemic has additionally sparked a transformative impulse in some to actively engage in critical introspection around the future of their work, compelling us to consider what changes could (and perhaps should) occur after the pandemic is over. Drawing on key concepts associated with scholar Paulo Freire's critical pedagogy, this paper serves as a call to action, illuminating the critical imaginings that have come out of this collective moment of struggle and instability, suggesting that we can perhaps create a more just, compassionate world even in the wake of extraordinary hardship.
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Affiliation(s)
- Sarah Burm
- Continuing Professional Development and Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Victoria Luong
- Continuing Professional Development and Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kori LaDonna
- Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Bryce Bogie
- MD/PhD Program, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsay Cowley
- Ottawa Blood Disease Centre, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jennifer M Klasen
- Clarunis, Department of Visceral Surgery, University Center for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland
| | - Anna MacLeod
- Continuing Professional Development and Division of Medical Education, Dalhousie University, Halifax, Nova Scotia, Canada
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Pérez AE, Agénor M. Racial/Ethnic and Sexual Orientation Identity Differences in the Receipt of a Sexual History Assessment from a Health Care Provider among Women in the United States. Womens Health Issues 2022; 32:156-164. [PMID: 34924267 DOI: 10.1016/j.whi.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differential sexual history assessment, whereby certain groups are more or less likely to be asked questions about their sexual behavior by a health care provider, may lead to differential sexual health care and counseling. METHODS Using nationally representative data from the 2013 through 2019 waves of the National Survey of Family Growth, we examined racial/ethnic and sexual orientation identity differences in receiving a sexual history assessment from a health care provider in the last 12 months among U.S. women aged 15-44 years (N = 14,019). RESULTS Adjusting for survey wave, Black and Latina heterosexual women; White, Black, and Latina bisexual women; and Black or Latina lesbian women had higher odds (odds ratio range, 1.47 [Latina heterosexual] to 2.71 [Black bisexual]) of having received a sexual history assessment in the last 12 months compared with White heterosexual women. All differences except for those among Black or Latina lesbian women persisted after controlling for demographic, socioeconomic, and health care factors (odds ratio range, 1.43 [Latina heterosexual] to 2.14 [Black bisexual]). Of note, Black bisexual women, about whom providers may hold biased assumptions of promiscuity rooted in both racism and biphobia, had the highest predicted probability of being asked about their sexual behavior by a provider. CONCLUSIONS Person-centered, structurally competent, and anti-oppressive practices and programs aimed at combating bias, stigma, and discrimination in the health care system and facilitating an inclusive clinic environment for all patients are needed to address differences in the provision of sexual health services and promote sexual health equity.
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Affiliation(s)
- Ashley E Pérez
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California.
| | - Madina Agénor
- Department of Behavioral and Social Sciences, Brown University, Providence, Rhode Island
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Wyatt TR, Zaidi Z. Bricolage: A tool for race-related, historically situated complex research. MEDICAL EDUCATION 2022; 56:170-175. [PMID: 34514622 DOI: 10.1111/medu.14629] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/04/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND As medical education grapples with larger issues of race and racism, researchers will need new tools to capture society's complex issues. One promising approach is bricolage, a methodological and theoretical approach that allows researchers to bend analytical tools to meet their needs. Bricolage is both a metaphor and an activity to describe the cognitively creative process researchers engage in while conducting interdisciplinary and multidimensional research. PROCESS At the heart of bricolage is the researchers' engagement in critical hermeneutics, which at its basic level recognises that all objects under study are subject to larger social, political, and historical forces that constrain individuals. Researching with bricolage treats objects of inquiry as part of a historically situated complex system. As such, data are interpreted in ways that build conceptual bridges between individuals' concrete experiences and concepts acknowledging larger social, historical, economic, and political forces. PEARLS To engage in bricolage, researchers should begin by reading and comparing ideas across disciplines to expose disciplinary-specific assumptions, as well as learn about new theories, approaches and methods that might be utilised for a bricolage project. Researchers should also ask themselves philosophical questions to identify new readings or their data. And finally, researchers should experiment with analytical metaphors because they help to frame new relationships between seemingly unrelated theories, methods and concepts. As researchers engage in bricolage, they need to sidestep their training and over-reliance on research protocols and checklists and engage in a creative tinkering to interpret the world in new ways. In doing so, scholars will be able to push traditional research boundaries and generate critical dialogue to move the field forward.
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Affiliation(s)
- Tasha R Wyatt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Zareen Zaidi
- College of Medicine, University of Florida, Gainesville, Florida, USA
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Finn GM, Danquah A, Matthan J. Colonization, cadavers, and color: Considering decolonization of anatomy curricula. Anat Rec (Hoboken) 2022; 305:938-951. [PMID: 34989137 PMCID: PMC9304213 DOI: 10.1002/ar.24855] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 12/21/2022]
Abstract
Anatomy is a discipline that, despite its universal nature, offers limited diversity in terms of representation in cadavers, imagery, technology, and models used within teaching. The universal move toward inclusive curricula has put anatomy education under the microscope, particularly with respect to efforts to decolonize curricula. This paper considers the challenges and opportunities to diversify the anatomy curriculum. Decolonizing anatomy education curricula will entail addressing the ingrained cultures within the disciplines, such that produces a number of challenges including: underrepresentation of certain bodies, difficulty talking about difference, and the hidden curriculum in anatomy education. In order to aid educators in achieving inclusive anatomy curricula, a toolkit and considerations are presented, alongside both do's, don'ts and case examples. We highlight the black-or-white dichotomy, and the absence of brown in between. The paper is a conversation starter for what it means to begin the process of decolonizing the curriculum within anatomy education.
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Affiliation(s)
- Gabrielle M Finn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Adam Danquah
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Joanna Matthan
- School of Dental Sciences, Newcastle University, Newcastle, UK
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Fyfe M, Horsburgh J, Blitz J, Chiavaroli N, Kumar S, Cleland J. The do's, don'ts and don't knows of redressing differential attainment related to race/ethnicity in medical schools. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:1-14. [PMID: 34964930 PMCID: PMC8714874 DOI: 10.1007/s40037-021-00696-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Systematic and structural inequities in power and privilege create differential attainment whereby differences in average levels of performance are observed between students from different socio-demographic groups. This paper reviews the international evidence on differential attainment related to ethnicity/race in medical school, drawing together the key messages from research to date to provide guidance for educators to operationalize and enact change and identify areas for further research. METHODS Authors first identified areas of conceptual importance within differential attainment (learning, assessment, and systems/institutional factors) which were then the focus of a targeted review of the literature on differential attainment related to ethnicity/race in medical education and, where available and relevant, literature from higher education more generally. Each author then conducted a review of the literature and proposed guidelines based on their experience and research literature. The guidelines were iteratively reviewed and refined between all authors until we reached consensus on the Do's, Don'ts and Don't Knows. RESULTS We present 13 guidelines with a summary of the research evidence for each. Guidelines address assessment practices (assessment design, assessment formats, use of assessments and post-hoc analysis) and educational systems and cultures (student experience, learning environment, faculty diversity and diversity practices). CONCLUSIONS Differential attainment related to ethnicity/race is a complex, systemic problem reflective of unequal norms and practices within broader society and evident throughout assessment practices, the learning environment and student experiences at medical school. Currently, the strongest empirical evidence is around assessment processes themselves. There is emerging evidence of minoritized students facing discrimination and having different learning experiences in medical school, but more studies are needed. There is a pressing need for research on how to effectively redress systemic issues within our medical schools, particularly related to inequity in teaching and learning.
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Affiliation(s)
- Molly Fyfe
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- Centre for Higher Education Research and Scholarship, Imperial College London, London, UK
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Sonia Kumar
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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Ellaway RH. Patients! ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:1459-1462. [PMID: 34812972 DOI: 10.1007/s10459-021-10084-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 06/13/2023]
Abstract
In this editorial the Editor considers the roles and representations of patients in health professional education and their implications for educational scholarship in this field. She also considers the implications of patient presence and engagement for the social contract and the ways it is being placed under stress and strain.
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Affiliation(s)
- Rachel H Ellaway
- Department of Community Health Sciences and Office of Health and Medical Education Scholarship, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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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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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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Bracken P, Fernando S, Alsaraf S, Creed M, Double D, Gilberthorpe T, Hassan R, Jadhav S, Jeyapaul P, Kopua D, Parsons M, Rodger J, Summerfield D, Thomas P, Timimi S. Decolonising the medical curriculum: psychiatry faces particular challenges. Anthropol Med 2021; 28:420-428. [PMID: 34282672 DOI: 10.1080/13648470.2021.1949892] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Colonial thinking runs deep in psychiatry. Recent anti-racist statements from the APA and RCPsych are to be welcomed. However, we argue that if it is to really tackle deep-seated racism and decolonise its curriculum, the discipline will need to critically interrogate the origins of some of its fundamental assumptions, values and priorities. This will not be an easy task. By its very nature, the quest to decolonise is fraught with contradictions and difficulties. However, we make the case that this moment presents an opportunity for psychiatry to engage positively with other forms of critical reflection on structures of power/knowledge in the field of mental health. We propose a number of paths along which progress might be made.
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Affiliation(s)
| | - Suman Fernando
- The School of Social Sciences, London Metropolitan University, London, UK
| | - Sara Alsaraf
- Institute for Research into Superdiversity, (IRiS), University of Birmingham, Birmingham, UK
| | - Michael Creed
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Tom Gilberthorpe
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Rukyya Hassan
- Greater Manchester Mental health NHS Trust, Edenfield Centre, Manchester, UK
| | | | | | - Diana Kopua
- Te Kurahuna Mahi a Atua Workforce Agency, Gisborne, New Zealand
| | - Megan Parsons
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | | | | | | | - Sami Timimi
- Lincolnshire Partnership NHS FT, Horizon Centre, Lincoln, UK
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Wyatt TR, Rockich-Winston N. Antiracist work in uncharted waters. CLINICAL TEACHER 2021; 18:474-476. [PMID: 33835706 DOI: 10.1111/tct.13352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Tasha R Wyatt
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Osman NY, Hirsh DA. The organizational growth mindset: Animating improvement and innovation in medical education. MEDICAL EDUCATION 2021; 55:416-418. [PMID: 33377544 DOI: 10.1111/medu.14446] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Nora Y Osman
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David A Hirsh
- Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Cambridge, MA, USA
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50
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Zaidi Z, Bush AA, Partman IM, Wyatt TR. From the "top-down" and the "bottom-up": Centering Foucault's notion of biopower and individual accountability within systemic racism. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:73-75. [PMID: 33624231 PMCID: PMC7902089 DOI: 10.1007/s40037-021-00655-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 05/07/2023]
Affiliation(s)
- Zareen Zaidi
- Department of Medicine, University of Florida College of Medicine, 103204, 32610, Gainesville, FL, USA.
| | - Antonio A Bush
- Equity, Diversity, and Inclusion, Association of American Medical Colleges, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Tasha R Wyatt
- Educational Innovation Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
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