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Kulasegaram KM, Grierson L, Barber C, Chahine S, Chou FC, Cleland J, Ellis R, Holmboe ES, Pusic M, Schumacher D, Tolsgaard MG, Tsai CC, Wenghofer E, Touchie C. Data sharing and big data in health professions education: Ottawa consensus statement and recommendations for scholarship. MEDICAL TEACHER 2024; 46:471-485. [PMID: 38306211 DOI: 10.1080/0142159x.2023.2298762] [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: 12/14/2023] [Accepted: 12/20/2023] [Indexed: 02/04/2024]
Abstract
Changes in digital technology, increasing volume of data collection, and advances in methods have the potential to unleash the value of big data generated through the education of health professionals. Coupled with this potential are legitimate concerns about how data can be used or misused in ways that limit autonomy, equity, or harm stakeholders. This consensus statement is intended to address these issues by foregrounding the ethical imperatives for engaging with big data as well as the potential risks and challenges. Recognizing the wide and ever evolving scope of big data scholarship, we focus on foundational issues for framing and engaging in research. We ground our recommendations in the context of big data created through data sharing across and within the stages of the continuum of the education and training of health professionals. Ultimately, the goal of this statement is to support a culture of trust and quality for big data research to deliver on its promises for health professions education (HPE) and the health of society. Based on expert consensus and review of the literature, we report 19 recommendations in (1) framing scholarship and research through research, (2) considering unique ethical practices, (3) governance of data sharing collaborations that engage stakeholders, (4) data sharing processes best practices, (5) the importance of knowledge translation, and (6) advancing the quality of scholarship through multidisciplinary collaboration. The recommendations were modified and refined based on feedback from the 2022 Ottawa Conference attendees and subsequent public engagement. Adoption of these recommendations can help HPE scholars share data ethically and engage in high impact big data scholarship, which in turn can help the field meet the ultimate goal: high-quality education that leads to high-quality healthcare.
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Affiliation(s)
| | - Lawrence Grierson
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Cassandra Barber
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Saad Chahine
- Faculty of Education, Queen's University, Kingston, Canada
| | - Fremen Chichen Chou
- Faculty of Education, Center for Faculty Development, China Medical University Hospital, Taichung City, Taiwan
| | - Jennifer Cleland
- Director of Medical Education Research & Scholarship Unit, Lee Kong Chian School of Medicine, Singapore
| | | | - Eric S Holmboe
- Accreditation Council for Graduate Medical Education, Chicago, IL, USA
| | | | - Daniel Schumacher
- Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martin G Tolsgaard
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen, Copenhagen, Denmark
| | - Chin-Chung Tsai
- Program of Learning Sciences, National Taiwan Normal University, Taipei, Taiwan
| | - Elizabeth Wenghofer
- School of Kinesiology and Health Sciences, Laurentian University, Sudbury, Canada
| | - Claire Touchie
- University of Ottawa/The Ottawa Hospital, Ottawa, Canada
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Iwai Y, Holdren S, Browne AR, Lenze NR, Lopez FG, Randolph AM, Weil AB. By Medical Students, for Medical Students: A Narrative Medicine Antiracism Program. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241261238. [PMID: 38882027 PMCID: PMC11179471 DOI: 10.1177/23821205241261238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/17/2024] [Indexed: 06/18/2024]
Abstract
Objectives Medical schools have sought to incorporate concepts of race and racism in their curricula to facilitate students' abilities to grapple with healthcare disparities in the United States; however, these efforts frequently fail to address implicit bias or equip students with cultural humility, reflective capacity, and interpersonal skills required to navigate racialized systems in healthcare. The purpose of this study was to develop and evaluate an antiracism narrative medicine (NM) program designed by and for preclinical medical students. Method Preclinical medical students at a single center were eligible to participate from June-July 2021. Program evaluation included a postprogram qualitative interview and electronic survey. The semistructured interview included questions about program experience, lessons learned, and perspectives on antiracism curricula in medical education. Interviews were qualitatively analyzed using open and axial coding. Survey data were analyzed with descriptive statistics. Results A total of 30 students registered. All (100%) respondents reported "somewhat true" or "very true" in the postprogram survey when asked about their ability to reflect on their own racial identity, racial identity of others, and influence of their racial identity on their future role as a healthcare worker through the program. Qualitative analysis revealed 3 themes: (1) curricular engagement; (2) racism and antiracism in medicine; and (3) group experience. Subthemes included: meaningful theoretical content; multimodal works and unique perspectives; race, identity, and intersectionality; deeper diversity, equity, and inclusion engagement; reconstructive visions; future oriented work; close reading and writing build confidence in discomfort; community and support system; and authentic space among peer learners. Conclusion This virtual, peer-facilitated antiracism NM program provided an engaging and challenging experience for participants. Postprogram interviews revealed the program deepened students' understanding of racism, promoted self-reflection and community building, and propagated reconstructive visions for continuing antiracism work.
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Affiliation(s)
- Yoshiko Iwai
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Sarah Holdren
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Alyssa R Browne
- Department of Sociology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Nicholas R Lenze
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Felix Gabriel Lopez
- Department of Psychology, The New School for Social Research, New York, NY, USA
| | - Antonia M Randolph
- Department of American Studies, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Amy B Weil
- Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Ikhlaq H, Agarwal S, Kwok C, Golamgouse H, Derby S, McRae N, Brown MEL, Collin V, Parekh R, Kumar S. Medical students impacted by discrimination: a qualitative study into their experiences of belonging and support systems at medical schools in the UK. BMJ Open 2023; 13:e078314. [PMID: 38154907 PMCID: PMC10759082 DOI: 10.1136/bmjopen-2023-078314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE To better understand the broader experience of medical students impacted by discrimination and the support systems they engage with. DESIGN Qualitative study using semi-structured interviews. SETTING Four medical schools based in the UK. PARTICIPANTS 17 medical students were recruited using volunteer and snowball sampling: all students self-identified as being impacted by discrimination. RESULTS 5 themes were identified: feelings of isolation, imposter syndrome and exclusion; a lack of representation and positive role modelling; the importance of peer support; issues relating to the accessibility of support; building support networks through shared experiences and attempts to foster a sense of inclusion through peer and institutionally led initiatives. CONCLUSIONS The findings of this study suggest medical schools could do more to recognise the importance of acknowledging the multiple identities at risk of discrimination held by students, perpetuating feelings of isolation and exclusion. Our research highlights the need for practical systemic initiatives to improve the sense of belonging of medical students who are impacted by discrimination. Medical educators and institutions should consider formal and informal provisions, such as creating time and space for students to meet and share experiences, access support and reporting networks, to foster a greater sense of belonging.
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Affiliation(s)
- Hamza Ikhlaq
- Faculty of Medicine, Imperial College London, London, UK
| | | | | | | | | | | | - Megan E L Brown
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
| | - Victoria Collin
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation & Research Centre, School of Public Health, Imperial College London, London, UK
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Cleland J, Blitz J, Cleutjens KBJM, Oude Egbrink MGA, Schreurs S, Patterson F. Robust, defensible, and fair: The AMEE guide to selection into medical school: AMEE Guide No. 153. MEDICAL TEACHER 2023; 45:1071-1084. [PMID: 36708606 DOI: 10.1080/0142159x.2023.2168529] [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: 05/05/2023]
Abstract
Selection is the first assessment of medical education and training. Medical schools must select from a pool of academically successful applicants and ensure that the way in which they choose future clinicians is robust, defensible, fair to all who apply and cost-effective. However, there is no comprehensive and evidence-informed guide to help those tasked with setting up or rejuvenating their local selection process. To address this gap, our guide draws on the latest research, international case studies and consideration of common dilemmas to provide practical guidance for designing, implementing and evaluating an effective medical school selection system. We draw on a model from the field of instructional design to frame the many different activities involved in doing so: the ADDIE model. ADDIE provides a systematic framework of Analysis (of the outcomes to be achieved by the selection process, and the barriers and facilitators to achieving these), Design (what tools and content are needed so the goals of selection are achieved), Development (what materials and resources are needed and available), Implementation (plan [including piloting], do study and adjust) and Evaluation (quality assurance is embedded throughout but the last step involves extensive evaluation of the entire process and its outcomes).HIGHLIGHTSRobust, defensible and fair selection into medical school is essential. This guide systematically covers the processes required to achieve this, from needs analysis through design, development and implementation, to evaluation of the success of a selection process.
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Affiliation(s)
- J Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - J Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - K B J M Cleutjens
- School of Health Professions Education, Maastricht University, the Netherlands
| | - M G A Oude Egbrink
- School of Health Professions Education, Maastricht University, the Netherlands
| | - S Schreurs
- School of Health Professions Education, Maastricht University, the Netherlands
- Centrum for Evidence Based Education, University of Utrecht, the Netherlands
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Marjadi B, Chiavaroli N, Sorinola O, Milos Nymberg V, Joyce C, Parsons C, Ryan A. Diversity Audit of Medical School Examination Questions. TEACHING AND LEARNING IN MEDICINE 2023:1-9. [PMID: 37553852 DOI: 10.1080/10401334.2023.2240776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/22/2023] [Accepted: 07/14/2023] [Indexed: 08/10/2023]
Abstract
Phenomenon: This article reports the under-researched presentation of demographic, social, and economic diversity in medical school examination questions. Approach: The present study audited 3,566 pre-clinical and clinical multiple-choice and short answer examination questions in the same year (2018) from three medical schools in two continents to review the diversity of patients portrayed. The audit was based on an extension of Critical Race Theory beyond race and ethnicity to include pertinent social determinants of health. Findings: Patients were presented in 1,537 (43.1%) of the audited examination questions. Apart from age (89.4%) and binary genders (93.9%), other diversity characteristics were rarely portrayed (ethnicity 7.2%, relationship status 1.9%, sexual identity 1.1%, socio-economic status 0.5%, geographic residence 0.1%, disability 0.1%), or not at all (non-binary genders; residency status; religion/spirituality). Insights: While presenting excessive and unnecessary patient characteristics in examination questions should be avoided, the absence of many diversity aspects may reduce examination authenticity and defeat the teaching of diversity in medicine. Medical schools should consider a routine audit and reasonable improvement of the diversity features of patients in examination questions to support teaching and learning activities addressing patients' diversity.
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Affiliation(s)
- Brahmaputra Marjadi
- School of Medicine, Western Sydney University, Campbelltown, Australia
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | | | | | | | - Caroline Joyce
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Carl Parsons
- School of Medicine, Western Sydney University, Campbelltown, Australia
| | - Anna Ryan
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
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Hauer KE, Park YS, Bullock JL, Tekian A. "My Assessments Are Biased!" Measurement and Sociocultural Approaches to Achieve Fairness in Assessment in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S16-S27. [PMID: 37094278 DOI: 10.1097/acm.0000000000005245] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Assessing learners is foundational to their training and developmental growth throughout the medical education continuum. However, growing evidence shows the prevalence and impact of harmful bias in assessments in medical education, accelerating the urgency to identify solutions. Assessment bias presents a critical problem for all stages of learning and the broader educational system. Bias poses significant challenges to learners, disrupts the learning environment, and threatens the pathway and transition of learners into health professionals. While the topic of assessment bias has been examined within the context of measurement literature, limited guidance and solutions exist for learners in medical education, particularly in the clinical environment. This article presents an overview of assessment bias, focusing on clinical learners. A definition of bias and its manifestations in assessments are presented. Consequences of assessment bias are discussed within the contexts of validity and fairness and their impact on learners, patients/caregivers, and the broader field of medicine. Messick's unified validity framework is used to contextualize assessment bias; in addition, perspectives from sociocultural contexts are incorporated into the discussion to elaborate the nuanced implications in the clinical training environment. Discussions of these topics are conceptualized within the literature and the interventions used to date. The article concludes with practical recommendations to overcome bias and to develop an ideal assessment system. Recommendations address articulating values to guide assessment, designing assessment to foster learning and outcomes, attending to assessment procedures, promoting continuous quality improvement of assessment, and fostering equitable learning and assessment environments.
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Affiliation(s)
- Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards, and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: http://orcid.org/0000-0002-8812-4045
| | - Yoon Soo Park
- Y.S. Park is associate professor and associate head, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335
| | - Justin L Bullock
- J.L. Bullock is a fellow, Department of Medicine, Division of Nephrology, University of Washington School of Medicine, Seattle, Washington; ORCID: http://orcid.org/0000-0003-4240-9798
| | - Ara Tekian
- A. Tekian is professor and associate dean for international education, Department of Medical Education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-9252-1588
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de Silva D, Roberts R, Nayar V, Rutt G, Gregory S, Khan A. Tackling differential attainment in specialist GP training in England and Scotland. EDUCATION FOR PRIMARY CARE 2023; 34:199-203. [PMID: 37643423 DOI: 10.1080/14739879.2023.2243453] [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: 06/12/2023] [Accepted: 07/29/2023] [Indexed: 08/31/2023]
Abstract
In this article NHS England and NHS Education for Scotland describe practical ways we are tackling differences in the attainment of people training as general practitioners (GPs).Trainees from minority ethnic groups and international medical graduates are less likely than others to qualify as GPs. It is difficult to change systemic inequalities, but over the past five years we have made practical changes to GP speciality training. Educators recognise there is an issue and are trying to tackle it.For example, people who had not successfully qualified had an opportunity to return to GP training. When we provided individualised targeted support, the proportion who completed training significantly increased (76%).This was a catalyst for reviewing unconscious bias in GP training. We implemented a national programme to tackle differential attainment and system-level bias. Educators now work with all GP trainees to identify their individual needs. Supervisors are trained to recognise bias and provide targeted support. There is mental health support and regular reviews to see whether trainees are ready to sit exams. Trainee representatives are championing the learner voice in national committees. Exams are being altered to reduce unconscious bias. We are monitoring attainment over time.The key message is that differential attainment should not be in the 'too hard basket'. The narrative is changing from 'can't do' to 'must do', supported by appropriate leadership, promotion and resourcing. There is much more to do, but we are making changes, evaluating and applying our learning. We have moved from talking to taking action.
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Affiliation(s)
- Debra de Silva
- Department of primary care, The Evidence Centre, London, UK
| | | | - Vijay Nayar
- Department of primary care, NHS England, London, UK
| | - Graham Rutt
- Department of primary care, NHS England, London, UK
| | | | - Amjad Khan
- Department of primary care, NHS Education for Scotland, Edinburgh, UK
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Morrison N, Zaman T, Webster G, Sorinola O, Blackburn C. 'Where are you really from?': a qualitative study of racial microaggressions and the impact on medical students in the UK. BMJ Open 2023; 13:e069009. [PMID: 37147091 PMCID: PMC10163503 DOI: 10.1136/bmjopen-2022-069009] [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: 05/07/2023] Open
Abstract
OBJECTIVE To explore graduate-entry medical students' experiences of racial microaggressions, the impact of these on learning, performance and attainment, and their views on how these can be reduced. DESIGN Qualitative study using semistructured focus groups and group interviews. SETTING UK. PARTICIPANTS 20 graduate-entry medical students were recruited using volunteer and snowball sampling; all students self-identified as being from racially minoritised (RM) backgrounds. RESULTS Participants reported experiencing numerous types of racial microaggressions during their time at medical school. Students' accounts highlighted how these impacted directly and indirectly on their learning, performance and well-being. Students frequently reported feeling uncomfortable and out of place in teaching sessions and clinical placements. Students also reported feeling invisible and ignored in placements and not being offered the same learning opportunities as their white counterparts. This led to lack of access to learning experiences or disengagement from learning. Many participants described how being from an RM background was associated with feelings of apprehension and having their 'guards up', particularly at the start of new clinical placements. This was perceived to be an additional burden that was not experienced by their white counterparts. Students suggested that future interventions should focus on institutional changes to diversify student and staff populations; shifting the culture to build and maintain inclusive environments; encouraging open, transparent conversations around racism and promptly managing any student-reported racial experiences. CONCLUSION RM students in this study reported that their medical school experiences were regularly affected by racial microaggressions. Students believed these microaggressions impeded their learning, performance and well-being. It is imperative that institutions increase their awareness of the difficulties faced by RM students and provide appropriate support in challenging times. Fostering inclusion as well as embedding antiracist pedagogy into medical curricula is likely to be beneficial.
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Affiliation(s)
- Nariell Morrison
- Department of Education, University of Oxford, Oxford, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Tabbasum Zaman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Georgia Webster
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olanrewaju Sorinola
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Clare Blackburn
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Schafer KR, Sood L, King CJ, Alexandraki I, Aronowitz P, Cohen M, Chretien K, Pahwa A, Shen E, Williams D, Hauer KE. The Grade Debate: Evidence, Knowledge Gaps, and Perspectives on Clerkship Assessment Across the UME to GME Continuum. Am J Med 2023; 136:394-398. [PMID: 36632923 DOI: 10.1016/j.amjmed.2023.01.001] [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: 11/22/2022] [Accepted: 01/03/2023] [Indexed: 01/10/2023]
Affiliation(s)
- Katherine R Schafer
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Lonika Sood
- Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Christopher J King
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | | | | | - Margot Cohen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Amit Pahwa
- Johns Hopkins University School of Medicine, Baltimore, Md
| | - E Shen
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Donna Williams
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
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