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Fisher J, Foggin J, Paes P. Provision of early clinical experience in UK medical schools: a cross-sectional survey. EDUCATION FOR PRIMARY CARE 2024:1-9. [PMID: 39391962 DOI: 10.1080/14739879.2024.2412604] [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: 08/13/2024] [Revised: 09/19/2024] [Accepted: 10/01/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND There is an established evidence base to support early clinical experience (ECE) within medical degree programmes. However, increasingly crowded clinical learning environments can make provision challenging. The aim of this research was to develop understanding about how ECE is provided within UK medical schools. METHODS We conducted a cross-sectional study on ECE provision by UK medical schools using an electronic survey containing a mix of question styles. We gathered data on the stage at which ECE featured within curricula, the amount of ECE provided, the setting for ECE, the learning outcomes covered during ECE and whether such content was formally assessed. Support for survey dissemination was obtained from the UK Medical Schools Council (MSC) Education Leads Advisory Group (ELAG). Responses were collected between 10/05/23 and 11/10/23. FINDINGS Of the 43 eligible UK medical schools, responses were received from 28 (65%). The provision of ECE amongst respondent medical schools was ubiquitous. The majority of ECE was provided within general practice and hospital settings, but community and voluntary sector settings were increasingly employed, as was technology enhanced ECE. A significant shift in the nature of the content addressed during ECE, with less focus on implementation of basic science was seen within learning outcomes. The extent to which ECE learning outcomes were formally assessed was variable. CONCLUSION The amount of ECE provided by UK medical schools has fallen. We encourage institutions to reflect on their provision of ECE and to consider how greater diversity of community settings and technology-enhanced learning could be harnessed.
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Affiliation(s)
- James Fisher
- Honorary Clinical Senior Lecturer, School of Medicine, Newcastle upon Tyne, UK
| | - Jonathon Foggin
- Clinical Teaching Fellow, School of Medicine, Newcastle upon Tyne, UK
| | - Paul Paes
- Head of School of Medicine, Newcastle upon Tyne, UK
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McKay J, Williams K, Stewart J. You just want a break from the hatred of failure: the lived experience of being a student physiotherapist perfectionist and considerations for educators. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:893-918. [PMID: 37823973 PMCID: PMC11208254 DOI: 10.1007/s10459-023-10287-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/24/2023] [Indexed: 10/13/2023]
Abstract
Perfectionism is a personality orientation associated with mental health and adjustment problems. Recent evidence demonstrates that perfectionism is widespread among students and on the rise, with recent generations of students placing increasingly more importance on perfection. Whilst the extant literature is vast, it tends to focus on psychopathology and identification of perfectionism correlates rather than the experience of student perfectionism. Furthermore, the education literature is scant and there is a need to understand the deeper processes and nuances of perfectionism, particularly within health professions education where intense study demands, competition to gain entry to educational programmes, and professional cultures may nurture the problem. This phenomenological study explored the lived experiences of ten physiotherapy students as they wrestled with perfectionism in the various facets of their studies. Semi-structured interviews were undertaken, and participants completed log sheets to document perfectionism-related experiences. Idiographic profiles were composed and interview transcripts were analysed, drawing upon features of both phenomenological and thematic analysis. Perfectionism was found to have toxic consequences for the learning experience. Harmful phenomenological experiences included perpetual and excessive achievement striving, punitive self-criticism and health and wellbeing difficulties. A range of sabotaging learning behaviours such as self-handicapping and feedback avoidance was also illuminated, and cultural and organisational influences perceived to foster perfectionism emerged. Findings are discussed in relation to underlying processes and implications for educators. The prospect of findings transferring to other educational contexts is highlighted.
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Affiliation(s)
- Jane McKay
- School of Health and Life Sciences Learning Development Centre, Glasgow Caledonian University, Glasgow, Scotland.
| | - Kim Williams
- School of Health and Life Sciences, Glasgow Caledonian University, Learning Development Centre, Glasgow, Scotland
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Murry LT, Boyer JG, Catledge K, Gettig JP, Travlos DV, Zarembski D, Kiersma ME. The Intersection of Growth Mindset and Accreditation in Pharmacy Education. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100711. [PMID: 38723896 DOI: 10.1016/j.ajpe.2024.100711] [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: 09/19/2023] [Revised: 04/30/2024] [Accepted: 05/02/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES To describe existing growth mindset literature within pharmacy and health care education, describe how a growth mindset can be beneficial in the accreditation process, and propose potential ways to promote a growth mindset in faculty, preceptors, students, and staff within pharmacy education. FINDINGS To help pharmacy learners develop a growth mindset, existing literature emphasizes the need for a shift toward and aligning assessment with a growth mindset, helping to create self-directed adaptive learners, leading to health care providers who can adjust their practice to tackle expected and unexpected challenges throughout their careers. Strategies to create a culture of growth mindset identified include training faculty and learners on growth mindset and developing new assessments that track a learner's growth. Recommendations for pharmacy educators include encouraging educators to assess their own growth mindset and use a variety of teaching methods and provide feedback on learner effort that encourages the process of learning rather than focusing on individual attributes, traits, and results. SUMMARY Growth mindset intersects with accreditation standards for both professional degree programs and providers of continuing pharmacy education. Continuing professional development process is one way to encourage faculty, staff, and students to develop a growth mindset. While a growth mindset can have many positive impacts on pharmacy accreditation, it is essential to recognize that achieving and maintaining accreditation is a multifaceted process involving numerous factors. A growth mindset can positively influence pharmacy education accreditation by fostering a culture of continuous improvement, innovation, resilience, student-centeredness, data-driven decision-making, collaboration, and effective leadership.
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Affiliation(s)
- Logan T Murry
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - J Gregory Boyer
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | | | - Jacob P Gettig
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | | | - Dawn Zarembski
- Accreditation Council for Pharmacy Education, Chicago, IL, USA
| | - Mary E Kiersma
- Accreditation Council for Pharmacy Education, Chicago, IL, USA.
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Kotwal S, Howell M, Zwaan L, Wright SM. Exploring Clinical Lessons Learned by Experienced Hospitalists from Diagnostic Errors and Successes. J Gen Intern Med 2024; 39:1386-1392. [PMID: 38277023 PMCID: PMC11169201 DOI: 10.1007/s11606-024-08625-w] [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: 10/23/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Diagnostic errors cause significant patient harm. The clinician's ultimate goal is to achieve diagnostic excellence in order to serve patients safely. This can be accomplished by learning from both errors and successes in patient care. However, the extent to which clinicians grow and navigate diagnostic errors and successes in patient care is poorly understood. Clinically experienced hospitalists, who have cared for numerous acutely ill patients, should have great insights from their successes and mistakes to inform others striving for excellence in patient care. OBJECTIVE To identify and characterize clinical lessons learned by experienced hospitalists from diagnostic errors and successes. DESIGN A semi-structured interview guide was used to collect qualitative data from hospitalists at five independently administered hospitals in the Mid-Atlantic area from February to June 2022. PARTICIPANTS 12 academic and 12 community-based hospitalists with ≥ 5 years of clinical experience. APPROACH A constructivist qualitative approach was used and "reflexive thematic analysis" of interview transcripts was conducted to identify themes and patterns of meaning across the dataset. RESULTS Five themes were generated from the data based on clinical lessons learned by hospitalists from diagnostic errors and successes. The ideas included appreciating excellence in clinical reasoning as a core skill, connecting with patients and other members of the health care team to be able to tap into their insights, reflecting on the diagnostic process, committing to growth, and prioritizing self-care. CONCLUSIONS The study identifies key lessons learned from the errors and successes encountered in patient care by clinically experienced hospitalists. These findings may prove helpful for individuals and groups that are authentically committed to moving along the continuum from diagnostic competence towards excellence.
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Affiliation(s)
- Susrutha Kotwal
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Mason Howell
- Department of Biosciences, Rice University, Houston, TX, USA
| | - Laura Zwaan
- Erasmus Medical Center, Institute of Medical Education Research Rotterdam, Rotterdam, The Netherlands
| | - Scott M Wright
- Department of Medicine, Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Medicine, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lanting K, Oudbier J, van den Aardwegh C, Arnold J, Ang W, Otto S, Horta TP, Verpooten L, Suurmond J. Community-based learning in medical education: A starting guide and lessons learned. MEDICAL TEACHER 2024:1-4. [PMID: 38733364 DOI: 10.1080/0142159x.2024.2351591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/01/2024] [Indexed: 05/13/2024]
Abstract
Community-based medical education (CBME) addresses real-world health problems and is characterized by its emphasis on reciprocity and collaboration with community stakeholders. Limited evidence shows that CBME is an effective learning strategy to care for underserved communities. However, medical schools and nursing schools struggle to implement CBME in their curriculum. In this article, we present four practical examples of CBME from medical and nursing schools in Belgium and the Netherlands. By taking the lessons learned derived from these practical examples into account, all students can have an authentic learning experience within the community, which empowers community members and increases their health.
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Affiliation(s)
- Katja Lanting
- School of Health, Saxion - Locatie Deventer, Deventer, Netherlands
| | | | | | | | - Winny Ang
- University of Antwerp, Wilrijk, Belgium
| | - Suzie Otto
- Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | | | | | - Jeanine Suurmond
- Public and Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, Netherlands
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Passarelli AM, Gazelle G, Schwab LE, Kramer RF, Moore MA, Subhiyah RG, Deiorio NM, Gautam M, Gill P, Hull SK, King CR, Sikon A. Competencies for Those Who Coach Physicians: A Modified Delphi Study. Mayo Clin Proc 2024; 99:782-794. [PMID: 38702127 DOI: 10.1016/j.mayocp.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/11/2023] [Accepted: 01/11/2024] [Indexed: 05/06/2024]
Abstract
The rapidly evolving coaching profession has permeated the health care industry and is gaining ground as a viable solution for addressing physician burnout, turnover, and leadership crises that plague the industry. Although various coach credentialing bodies are established, the profession has no standardized competencies for physician coaching as a specialty practice area, creating a market of aspiring coaches with varying degrees of expertise. To address this gap, we employed a modified Delphi approach to arrive at expert consensus on competencies necessary for coaching physicians and physician leaders. Informed by the National Board of Medical Examiners' practice of rapid blueprinting, a group of 11 expert physician coaches generated an initial list of key thematic areas and specific competencies within them. The competency document was then distributed for agreement rating and comment to over 100 stakeholders involved in physician coaching. Our consensus threshold was defined at 70% agreement, and actual responses ranged from 80.5% to 95.6% agreement. Comments were discussed and addressed by 3 members of the original group, resulting in a final model of 129 specific competencies in the following areas: (1) physician-specific coaching, (2) understanding physician and health care context, culture, and career span, (3) coaching theory and science, (4) diversity, equity, inclusion, and other social dynamics, (5) well-being and burnout, and (6) physician leadership. This consensus on physician coaching competencies represents a critical step toward establishing standards that inform coach education, training, and certification programs, as well as guide the selection of coaches and evaluation of coaching in health care settings.
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Affiliation(s)
- Angela M Passarelli
- Institute of Coaching, McLean Hospital, Belmont, MA; Fuqua School of Business, Duke University.
| | - Gail Gazelle
- Division of General Internal Medicine and Primary Care, Harvard Medical School, Boston, MA
| | - Leslie E Schwab
- Atrius Health, Leslie Schwab, LLC: Physician Coaching Services, Newton, MA
| | | | - Margaret A Moore
- Institute of Coaching, McLean Hospital, Belmont, MA; Wellcoaches Corporation, Wellesley, MA
| | - Raja G Subhiyah
- Department of Psychometrics and Data Analysis, National Board of Medical Examiners, Philadelphia, PA
| | - Nicole M Deiorio
- Department of Emergency Medicine, Virginia Commonwealth University School of Medicine, Richmond
| | - Mamta Gautam
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Priscilla Gill
- Health Care Administration, Mayo Clinic College of Medicine and Science, and Human Resources, Mayo Clinic, Jacksonville, FL
| | - Sharon K Hull
- Metta Solutions, LLC, Durham, NC, and Department of Family Medicine, University of North Carolina at Chapel Hill School of Medicine
| | - Cara R King
- Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH
| | - Andrea Sikon
- Department of Internal Medicine and Geriatrics, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
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Rehsi AS, McCarthy KE. Twelve tips for recognizing and supporting medical learners experiencing impostorism. MEDICAL TEACHER 2024; 46:489-494. [PMID: 37934695 DOI: 10.1080/0142159x.2023.2276976] [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: 11/09/2023]
Abstract
The resurgence of studies focused on the Impostor Phenomenon (IP) demonstrates a need for greater understanding of the construct as well as strategies to limit the negative conditions that arise from it. To help address this need, the following twelve tips offer perspectives and suggested approaches for educators to assist medical learners with IP during clinical training. A review of the medical literature and the authors' experiences supplies the following information, organized first by etiology and diagnosis followed by management and special considerations. These tips provide insight into the multifaceted aspects of IP and offer suggestions for support at the individual and institutional levels. With proper monitoring and personalized guidance, educators can assist learners in breaking the cycle of negative thoughts and behaviors to achieve confidence in their professional identity and competence in their clinical skills.
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Affiliation(s)
- Anandpall Singh Rehsi
- Morsani College of Medicine, USF Health, University of South Florida, Tampa, FL, USA
| | - Kelly E McCarthy
- Morsani College of Medicine, USF Health, University of South Florida, Tampa, FL, USA
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Memari M, Gavinski K, Norman MK. Beware False Growth Mindset: Building Growth Mindset in Medical Education Is Essential but Complicated. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:261-265. [PMID: 37643577 DOI: 10.1097/acm.0000000000005448] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
ABSTRACT Mindset theory aims to explain how learners' beliefs about intelligence and learning affect how they perceive effort, react to failure, and respond to feedback in challenging learning contexts. Mindset theory distinguishes between growth mindset (the belief that human capacities can be developed over time) and fixed mindset (the belief that human capacities are inherent and unchangeable). Efforts to develop growth mindset in learners have shown a wide range of benefits, including positive effects on students' resilience, commitment to lifelong learning, and persistence in a field of study, with notable impacts on learners who are struggling, learners from minoritized groups, and women in scientific fields. In recent years, mindset theory interventions have caught the interest of medical educators hoping to engage learners as partners in their own learning and progression to competence. Educators hoping to apply this theory to educational programs and learner-teacher interactions in ways that promote growth mindsets would benefit from awareness of the concept of false growth mindset , a term coined by Carol Dweck to refer to common pitfalls in the theory's application. In this article, the authors highlight important findings from mindset interventions in medical education, identify common pitfalls of false growth mindset in the context of medical learners, and offer suggestions for how educators and institutions can better instigate changes to promote growth mindsets within medical education.
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