1
|
Najeeb U, Kumagai AK. Uprooting the CanMEDS flower? Equity, social justice, and the Medical Expert role. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:104-106. [PMID: 39114781 PMCID: PMC11302753 DOI: 10.36834/cmej.79092] [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: 08/10/2024]
Affiliation(s)
- Umberin Najeeb
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Arno K Kumagai
- Department of Medicine, University of Toronto, Ontario, Canada
| |
Collapse
|
2
|
Guraya SS, Rashid-Doubell F, Harkin DW, Guraya SY. Mission-driven e-professionalism in the medical field: shaping digital identity and virtual engagement. Front Med (Lausanne) 2024; 11:1276839. [PMID: 38585143 PMCID: PMC10996440 DOI: 10.3389/fmed.2024.1276839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Shaista Salman Guraya
- Health Professions Education, Institute of Learning, Mohammad Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | | - Denis W. Harkin
- Faculty of Medicine Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| |
Collapse
|
3
|
Butler K, Vanstone M, Yak A, Veltman A. "Will I be able to be myself? Or will I be forced to lie all the time?": How Trans and Non-Binary Students Balance Professionalism, Authenticity, and Safety in Canadian Medical Programs. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:119-129. [PMID: 38406648 PMCID: PMC10885831 DOI: 10.5334/pme.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
Introduction Promoting the inclusion of trans and non-binary (TNB) medical trainees is a key step in building an inclusive health workforce well-positioned to provide high-quality healthcare to all patients. Existing data on the experiences of TNB physicians and trainees describe widespread challenges related to prejudice and discrimination, with most trainees concealing their gender identity for fear of discrimination. We aimed to understand how TNB medical students have experienced professionalism and professional identity formation. Methods This was a secondary analysis of data gathered in a constructivist grounded theory study. The authors conducted semi-structured qualitative interviews in 2017 with seven current or recently graduated TNB Canadian medical students. Results and Discussion From medical school application to graduation, TNB medical students reported feeling tensions between meeting expectations of professionalism, being their authentic selves, and seeking to avoid conscious and implicit biases. These tensions played out around issues of disclosure, foregrounding identity through impression management, and responding to identity exemplars. The tension between TNB trainees' desire to bring their whole selves to the practice of medicine and feeling pressured to de-emphasize their gender is ironic when considering the increased call for medical trainees from equity-seeking communities. The most commonly used behavioural frameworks of professionalism were inherited from prior generations and restrict students whose experiences and community-based knowledge are most needed. Demands of professionalism that are incompatible with authentic professional identity development place an inordinate burden on trainees whose identities have been excluded from normative concepts of the professional, including TNB trainees.
Collapse
Affiliation(s)
- Kat Butler
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, CA
| | | | | | - Albina Veltman
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, CA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Luong V, Burm S, Bogie BJM, Cowley L, Klasen JM, MacLeod A, LaDonna KA. A phenomenological exploration of the impact of COVID-19 on the medical education community. MEDICAL EDUCATION 2022; 56:815-822. [PMID: 35253255 PMCID: PMC9115140 DOI: 10.1111/medu.14793] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has caused unprecedented stress to the medical education community, potentially worsening problems like burnout and work-life imbalance that its members have long been grappling with. However, the collective struggle sparked by the pandemic could generate the critical reflection necessary for transforming professional values and practices for the better. In this hermeneutic phenomenological study, we explore how the community is adapting-and even reconceptualising-their personal and professional roles amidst the COVID-19 crisis. METHOD Between April and October 2020, we conducted 27 (17F, 10M) semi-structured interviews with medical trainees (8), physicians (8), graduate students (3) and PhD scientists (8) working in medical education in Canada, the United States and Switzerland. Data analysis involved a variety of strategies, including coding for van Manen's four lifeworld existentials, reflexive writing and multiple team meetings. RESULTS Participants experienced grief related to the loss of long-established personal and professional structures and boundaries, relationships and plans for the future. However, experiences of grief were often conflicting. Some participants also experienced moments of relief, perceiving some losses as metaphorical permissions slips to slow down and focus on their well-being. In turn, many reflected on the opportunity they were being offered to re-imagine the nature of their work. DISCUSSION Participants' experiences with grief, relief and opportunity resonate with Ratcliffe's account of grief as a process of relearning the world after a significant loss. The dismantling of prior life structures and possibilities incited in participants critical reflection on the nature of the medical education community's professional practices. Participants demonstrated their desire for more flexibility and autonomy in the workplace and a re-adjustment of the values and expectations inherent to their profession. On both individual and systems levels, the community must ensure that long-standing calls for wellness and work-life integration are realised-and persist-after the pandemic is over.
Collapse
Affiliation(s)
- Victoria Luong
- Continuing Professional Development and Medical EducationDalhousie UniversityHalifaxNova ScotiaCanada
| | - Sarah Burm
- Continuing Professional Development and Medical EducationDalhousie UniversityHalifaxNova ScotiaCanada
| | - Bryce J. M. Bogie
- Mind, Brain Imaging and Neuroethics Research UnitThe RoyalOttawaOntarioCanada
| | - Lindsay Cowley
- Ottawa Blood Disease CentreOttawa Hospital Research InstituteOttawaOntarioCanada
| | - Jennifer M. Klasen
- Clarunis, Center for Abdominal SurgeryUniversity Hospital BaselBaselSwitzerland
| | - Anna MacLeod
- Continuing Professional Development and Medical EducationDalhousie UniversityHalifaxNova ScotiaCanada
| | - Kori A. LaDonna
- Department of Innovation in Medical Education and Department of Medicine, Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| |
Collapse
|
6
|
Coccia C, Veen M. Because We Care: A Philosophical Investigation into the Spirit of Medical Education. TEACHING AND LEARNING IN MEDICINE 2022; 34:341-349. [PMID: 35469534 DOI: 10.1080/10401334.2022.2056744] [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: 10/20/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
Although in health care education we encounter the word care at every turn, the concept is hardly ever defined or subjected to scrutiny. Care is a foundational concept of health care education, and if we do not take control of our basic concepts, their meaning can be subject to other influences. We take a philosophical approach to care and ask what care is, to connect different conceptions of care in health care education to their common root. We do this by first examining how the concept is used in health care education, how it features in Martin Heidegger's Being and Time, and finally, how these philosophical implications may be applied to medical education. The use of care in medical education suggests that it is foundational to understanding health care education. However, presently the concept is ambiguous and risks being a 'container concept' that becomes meaningless because it is used generally. In publications that feature the concept, it is usually in service of another aspect that is under investigation, and not care itself. For instance, publications on teaching patient-centred care focus on the meaning of 'patient-centeredness' rather than care. In 'health care', there are debates about what 'health' means, but not care. The concept is also used in different and sometimes contradictory meanings: care as the organizational structure of health care that safeguards (health care system), care as empathy or careful attention of medical trainees for patients (caring about one's patients, treating them carefully), and, finally, care as motivation and focus toward a goal (caring about graduating, making a contribution). We turn to the philosophy of Heidegger to integrate these different appearances of care into a unified structure. Heidegger's Being and Time describes care as the basic ontological structure of human existence. This turns out to be a structure of time: in the familiar structure of past present and future. Anticipating a future end, which determines our attitude toward the people, objects, and physical structures we are with now, and in the light of which we orient ourselves to what is already there. By describing the ontological (foundational) structure of care, we argue that care is the spirit of health care education. This unifying structure can be used to integrate phenomena that are recognized as important in health care education but are usually seen as separate. We use an example to illustrate how empathy, health protocols, and educational goals can be connected in one situation. Just as health provides a framework for patient management, care can provide this framework for education. This fundamental concept of care can be used in practice for reflection on anticipated ends in situations in which different modes of care seemingly conflict. Beyond our focus on care, we also illustrate how one can take an important concept in health care education and use philosophy to root it in a foundational understanding of that concept.
Collapse
Affiliation(s)
- Camillo Coccia
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mario Veen
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
7
|
Karuppiah A, Zhang E, Daniel R, Prasanna PD. Professionalism: COVID-19 made me do it! Curr Opin Anaesthesiol 2022; 35:195-200. [PMID: 35142728 DOI: 10.1097/aco.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW COVID-19 pandemic has created profound ethical challenges, not only for clinical decision-making but also for defining physician professional conduct. RECENT FINDINGS Multiple ethical questions arose as the COVID-19 pandemic ravaged globally, including physician obligations in a pandemic, allotment of personal protective equipment, care of unvaccinated patients, discern between evidence-based and unreliable information, addressing end-of-life wishes, implications of involving medical students in a public health crisis, and finally physician burnout aggravated by a pandemic. SUMMARY There is a need to redefine existing medical professionalism standards so that future healthcare professionals are well prepared to deal with similar public health crisis.
Collapse
Affiliation(s)
| | - Elizabeth Zhang
- Medical Student, VCU School of Medicine, Richmond, Virginia, USA
| | | | | |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|