Teaching professional development in medical schools

Comparisons of Explicit Weight Bias Across Common Clinical Specialties of US Resident Physicians

BACKGROUND

Patients with high body weight are persistently stigmatized in medical settings, with studies demonstrating that providers endorse negative stereotypes of, and have lower regard for, higher-weight patients. Very little is known about how this weight bias varies across specialties.

OBJECTIVE

The purpose of this study is to examine how explicit weight bias varies between resident providers among sixteen of the largest residency specialties in the USA. The identification of these differences will guide the prioritization and targeting of interventions.

DESIGN

The current study utilized cross-sectional, observational data.

PARTICIPANTS

Forty-nine allopathic medical schools were recruited to participate in this national, longitudinal study. The current study utilized data from 3267 trainees in Year 2 of Residency among those who specialized in one of the most common sixteen residency programs in 2016.

MAIN MEASURES

Participants reported demographic information and residency specialties and completed three sets of measures pertaining to explicit weight bias.

KEY RESULTS

A significant minority (13-48%) of residents reported slight-to-strong agreement with each anti-fat statement. There was a significant relationship between residency specialty and anti-fat blame (F(15, 3189 = 12.87, p < .001), η2 = .06), anti-fat dislike (F(15, 3189 = 7.01, p < .001), η2 = .03), and attitudes towards obese patients (F(15, 3208 = 17.78, p < .001), η2 = .08). Primary care residents (e.g., family medicine, pediatrics) consistently reported lower levels of weight bias than those in specialty programs (e.g., orthopedic surgery, anesthesiology).

CONCLUSIONS

This study is the first to report on weight bias in a large, heterogeneous sample of US resident physicians. Problematic levels of weight bias were found in all specialties, with residents in specialty programs generally reporting more bias than those in primary care residencies. Future research should examine which factors contribute to these differences to guide intervention.

The doctor I want to be: professional self-image in Brazil and Portugal

This qualitative study evaluated the perception of academics about their self-image as future doctors and the factors that influenced the construction of their professional identity. Thirty-two sixth-year medical students in Brazil and Portugal were interviewed. Content analysis in the thematic modality and Goffman’s dramaturgy were used for data analysis and interpretation. The idealized self-image was revealed in two themes: the doctor centered on himself and the one who values the interpersonal relationship. A third theme showed the influence of the University and of elements brought a priori in the doctor’s identity. The results indicate the influence of the hidden curriculum in the construction of professional identity and reinforce the importance of social and humanistic aspects in medical education.

O médico que eu quero ser: autoimagem profissional no Brasil e em Portugal

Este estudo qualitativo avaliou a percepção de acadêmicos sobre sua autoimagem como futuros médicos e os fatores que influenciaram a construção da sua identidade profissional. Foram entrevistados 32 estudantes do sexto ano de Medicina no Brasil e em Portugal. Utilizou-se a análise de conteúdo na modalidade temática e a dramaturgia de Goffman para análise e interpretação dos dados. A autoimagem idealizada revelou-se em duas temáticas: o médico centrado em si e aquele que valoriza a relação interpessoal. Uma terceira temática mostrou a influência da universidade e de elementos trazidos a priori na identidade do médico. Os resultados indicam a influência do currículo oculto na construção da identidade profissional e reforçam a importância dos aspectos sociais e humanísticos na formação médica.

Case-Informed Learning in Medical Education: A Call for Ontological Fidelity

Case-informed learning is an umbrella term we use to classify pedagogical approaches that use text-based cases for learning. Examples include Problem-Based, Case-Based, and Team-Based approaches, amongst others. We contend that the cases at the heart of case-informed learning are philosophical artefacts that reveal traditional positivist orientations of medical education and medicine, more broadly, through their centering scientific knowledge and objective fact. This positivist orientation, however, leads to an absence of the human experience of medicine in most cases. One of the rationales for using cases is that they allow for learning in context, representing aspects of real-life medical practice in controlled environments. Cases are, therefore, a form of simulation. Yet issues of fidelity, widely discussed in the broader simulation literature, have yet to enter discussions of case-informed learning. We propose the concept of ontological fidelity as a way to approach ontological questions (i.e., questions regarding what we assume to be real), so that they might centre narrative and experiential elements of medicine. Ontological fidelity can help medical educators grapple with what information should be included in a case by encouraging an exploration of the philosophical questions: What is real? Which (and whose) reality do we want to simulate through cases? What are the essential elements of a case that make it feel real? What is the clinical story we want to reproduce in case format? In this Eye-Opener, we explore what it would mean to create cases from a position of ontological fidelity and provide suggestions for how to do this in everyday medical education.

Application of test-enhanced learning (TEL) in obstetrics and gynecology: a prospective study

OBJECTIVE

Clinical reasoning is an essential skill, the foundations of which should be acquired during medical school. Within the format of test-based learning, such examinations can also be used to support the long-term retention of procedural knowledge necessary for clinical reasoning. The aim was to investigate whether repeated exposure to clinical cases in obstetrics and gynecology (OBGYN) with built-in questions leads to higher learning outcome than pure reading cases and what influence the delay between the intervention and the final test has on the retention of the respective content.

METHODS

In this non-randomised crossover study, 5th-year medical students (duration of the study is 6 years) taking a 1-week clinical attachment in OBGYN participated in computer-based case seminars in winter term 2020/2021, in which different case histories on gynecological-obstetric diseases were presented. Case content was identical for all groups, but the presentation format (cases with key feature questions vs read-only cases) of individual case vignettes changed weekly. The also intervention was repeated after 2 weeks for each group. Knowledge was assessed in an entry and an exit exam consisting of 40 short-answer questions.

RESULTS

A total of 94 out of 118 eligible students participated in the study (response rate: 79.7%). Learning outcome was significantly higher for items presented in the key feature format compared to items presented as read-only cases (74.2 ± 8.6% vs. 71.0 ± 9.2%; p = 0.017). Furthermore, the analysis showed that the temporal distance of the intervention package from the final examination had no influence on retention.

CONCLUSION

This is the first study to demonstrate an effect of test-enhanced learning on clinical reasoning in the subject of OGBYN. In this cross-over study, repeated testing was more effective than repeated case-based learning alone. Curricular implementation of longitudinal key feature testing can thus improve learning outcomes for OBGYN.

An insightful evaluation of professionalism among dentistry students

Purpose

The objective of this study was to explore the ambience of professionalism related to academic integrity among undergraduate dental students.

Methodology

“Dundee Polyprofessionalism Inventory I: Academic Integrity” was used to collect responses from first-year to fifth-year dental students of the College of Dentistry, King Saud University (Response rate = 78%). The participants’ responses (for 34 professionalism lapses) were recorded by using the Dundee Polyprofessionalism Inventory. Statistical analysis included descriptive statistics, Chi-square, and T-tests (P < 0.05).

Results

The “Ignore” sanction was not opted for any of the 34 professionalism behaviors, and there was unanimous agreement between the participants in considering all 34 behavior statements to be “wrong”. Male and female participants were found to opt for a similar sanction as the median for 16 statements (47%), whereas, for 18 statements (53%), their responses differed with a range of levels 0.5 to 1.5. Preclinical- and clinical-year student responses also showed similarities in their 11 statements (32.3%), and they did differ for 20 statements (58.8%). Interestingly, clinical year respondents were overall on the stricter side of recommending sanctions.

Conclusions

For the majority of the dental students tested, there was a good understanding of the significance of some lapses of professionalism associated with academic integrity. Some of the disclosures in this study were substantially appreciable because none of the students selected “ignore” sanction for any of the survey statements. We found that using the Dundee Polyprofessionalism Inventory for learning and understanding academic professionalism among dental students is useful.

COGConnect: A new visual resource for teaching and learning effective consulting

OBJECTIVE

Consultation skills are essential to clinical practice and, when effective, can facilitate diagnoses and improve patient satisfaction. Various models exist to facilitate consultation teaching. These can be prescriptive, a challenge to apply in clinical settings and are often designed for primary care. In redesigning our entire curriculum, we sought to create a new visual, digital, resource for consultation teaching, aligned with statements from the UK Council for Clinical Communication (UKCCC), and suitable for the evolving expectations of patients, clinicians and the UK NHS, in 21st century medicine.

METHODS

We conducted a literature review encompassing teaching methods, NHS Priorities, patients' priorities, lifestyle interventions and practitioner resilience. COGConnect was designed iteratively through consultation with a graphic designer, health psychologists, a range of clinicians, and a consultation expert, and has evolved through extensive use in our new "effective consulting" course in primary and secondary care.

RESULTS

COGConnect is deliberately visual, iterative, bi-directional and multi-phasic. The central image of COGConnect is two persons in connection; the floating cogs suggesting an encounter of different agents who must adapt their cog-connection in terms of speed, direction and dimension. Around this image we place five core values. The consultation phases are represented by ten colourful cogs, with important additions including 'formulating', 'activating' and 'integrating'.

CONCLUSION

COGConnect builds on the strengths of existing frameworks and provides a strong visual resource suitable for digital learning. It offers greater emphasis on explicit clinical reasoning, activation of patient self-care and learning from the interaction. Having become the de facto resource for consultation skills training across primary and secondary care in our institution, the next phase is to develop the COGConnect.info website and a programme of formal evaluation.

Exploration of the changes in the perceptions of medical students about cadaver dissections using metaphors

Objective

This study examines the changes in metaphors used by medical students before and after the dissection of a cadaver. This will help qualitatively understand the meaning of cadaver dissections.

Methods

The metaphorical expressions about the practice of dissection that were used before and after the dissection exercises were collected from 147 Korean medical students. The collected qualitative data were categorised through a repeated comparative analysis.

Results

The results of the analysis identified seven types of metaphors that were used before the dissection practice: ‘rite of passage’, ‘first step’, ‘precious opportunity’, ‘fog’, ‘hell’, ‘thrill’, and ‘double-edged sword’. After the cadaver dissection, nine types of metaphors were used: ‘introspection’, ‘hell’, ‘precious opportunity’, ‘treasure hunt’, ‘turning point’, ‘debt’, ‘mist’, ‘bittersweet candy’, and ‘buzzer beater’. In general, before a cadaver dissection, students recognised the importance of the practice of cadaver dissection as being a ‘gateway’ or a ‘growing pain’. Metaphors such as ‘introspection’ and ‘mirror’ were used with an improved attitude. However, some students continued to use negative metaphors, such as ‘hell’, before and after the cadaver dissection and maintained negative feelings about it.

Conclusions

The results of our study suggest that, for many medical students, cadaver dissection is a crucial stage of self-reflection and for the formation of their identities as doctors. The consideration of students’ perceptions during all cadaver dissections is therefore essential.

A Global Perspective of Mentorship in Medical Schools: Systematic Review from 2014 to 2019

Formal mentorship programs afford medical students research involvement, career guidance, and personal and professional development. We reviewed a total of 36 studies on mentorship in medical schools, 17 of which are from the United States (US) and 19 from outside the US. This descriptive study has determined the most common mentorship models used in medical schools both in the United States and internationally. Despite variance between programs, medical students in the US and worldwide prefer highly invested mentors with strong interpersonal skills. We concluded that both US and international mentorship provide crucial professional development for students; however, US-based mentorship is more focused on providing experience within individual specialties. More studies on current mentorship practices in medical schools are required to ensure that the diverse international medical education community is better represented.

Professional Development Track to Prepare Future Academic Clinicians

Professional development is instrumental in the success of professionals and trainees in academic medicine. In response to medical student feedback requesting additional professional development opportunities, the Foster School of Medicine developed a distinction program, the Pathway for Preparing Academic Clinicians (PPAC), designed to deliver sought-after skill development and foundational knowledge in the three primary activities of academic medicine: medical education, research, and patient care. This distinction program addresses a curricular gap as identified by students and common to many UME curricula and also provides an opportunity for residency programs to identify student achievement within a pass/fail program.

Changing the channel on medical ethics education: systematic review and qualitative analysis of didactic-icebreakers in medical ethics and professionalism teaching

As medical ethics and professionalism education continues to equip medical students and residents with long-lasting tools, educators should continue to supplement proven teaching strategies with engaging, relatable, and generationally appropriate didactic supplements. However, popular teaching aids have recently been criticized in the literature and summative information on alternatives is absent. The purpose of this review is to evaluate and assess the functional use and application of short form audiovisual didactic supplements or "icebreakers" in medical ethics and professionalism teaching. A systematic review of both the medical and humanities literature (i.e., PubMed/MEDLINE, Cochrane Library, and JSTOR) was conducted from inception to August 1, 2019. Final articles were subjected to a qualitative appraisal and thematic analysis. Thirteen articles were included for final analysis. Sixty-nine percent (n = 9) of the studies were published after 2000. Two studies were qualitative, one study was quantitative, and the remaining articles were commentaries. Short form audiovisual media was most popular outside of the United States (n = 10). Sixty-nine percent (n = 9) of articles advocated for self-contained media in the form of trigger films or short films/videos, while the remaining articles (n = 4) discussed the use of TV/film clips. Producibility of media was exclusive to short/trigger films. Nine themes were identified in the content analysis: adaptability, conversation catalyst, effective, engaging, nuance, practice, producibility, real, and subject diversity. The three most common themes in descending order of frequency were: conversation catalyst, realness, and adaptability. Trigger films represent an effective and unique pedagogical strategy in supplementing current medical ethics and professionalism teaching at the medical school level.

Evaluation of a compulsory reflective group for medical students

INTRODUCTION The ability to reflect - reflection - taking time to stop, think and evaluate is an important professional skill to develop. AIM To evaluate a compulsory reflective group activity to determine whether compulsory participation enabled students to constructively share emotional clinical experiences and develop ethical and professional behaviour. METHODS This was a case study with mixed methodology. Participants were Years 5 and 6 medical students at the University of Auckland, New Zealand. Data collection included pre- and post-reflective group questionnaires with Year 5 and 6 students, questionnaires with general practice academic facilitators, and audiotapes of the reflection group discussions. RESULTS Students shared emotional experiences that were organised into three themes: (i) witnessing unprofessional behaviour; (ii) meeting difficult clinical scenarios for the first time; and (iii) the hierarchy of medicine. They reported positive learning experiences relevant to their future practice and valued the opportunity to share their experiences safely. Facilitators thought the groups provided unique educational opportunities that students appreciated. Eighty-two percent of participants would like to repeat the activity during their medical school training. CONCLUSION Self-reflection is an essential condition for professionalism. Use of reflective groups can help students become ethical and professional doctors.

Patient safety in medical residency training: Balancing bravery and checklists

Distributing responsibility for patient safety between individual professionals and organisational systems is a pressing issue in contemporary healthcare. This article draws on Habermas' distinction between 'lifeworld' and 'system' to explore patient-safety culture in medical residency training. Sociological accounts of medical training have indicated that applying systemic solutions in patient-safety training and practice may conflict with residents' needs. Residents would navigate safety systems to get their work done and safeguard learning opportunities, acting 'in between' the system and traditional processes of socialisation and learning on the job. Our ethnographic study reveals how residents seek to connect system and professional-based learning, and do them together in situated manners that evolve in the course of medical training. We reveal three themes that closely align with the residents' developmental process of maturing during training and on the job to become 'real' physicians: (1) coming to grips with the job; (2) working around safety procedures; and (3) moving on to independence. A more explicit focus on learning to deal with uncertainty may enable residents to become more skilled in balancing safety systems.

Is It Time to Be More Explicit About the Purpose of a Hospital Admission?

PURPOSE

Patient care suffers when teaching teams fail to achieve a shared understanding of problems to be addressed during a hospital admission. In academic contexts where attending physicians take turns supervising, practice variability may contribute to undermining this shared understanding. Exploring variability around what constitutes the purpose of the hospital admission was the focus of this study.

METHOD

Constructivist grounded theory was used to inform data collection and analysis of this two-phase study, conducted in London and Hamilton, Ontario, Canada, in 2012. In phase 1, interviews with 24 attending physicians from 2 academic health centers were conducted. Phase 2 involved analyzing 18 audio-recorded admission case review discussions in relation to the emergent theory from phase 1. Participants for phase 2 were 7 different attendings, 7 medical students, and 5 junior residents.

RESULTS

Three dominant perspectives around the purpose of an admission were identified. The most focused perspective characterized the purpose as making patients ready for discharge. By contrast, the most comprehensive perspective characterized admission as an opportunity to identify ways to improve overall patient health status. The third perspective was in-between-treating acute issues while monitoring pertinent chronic conditions. All attendings expressed a sense of discharge pressure but responded with different strategies. Attendings rarely explicitly discussed their perspectives as part of case review.

CONCLUSIONS

These extremes of practice and lack of overt dialogue are concerning. Potential effects include mixed messages to trainees and missed opportunities for dialogue and debate around what can and should be achieved during a hospital admission.

Teaching professionalism: some features in Canadian physiotherapy programs

The role of "professionalism" is core to many health professions including Physical Therapy (PT), and the development of competence in professionalism is a key requirement of entry-to-practice PT programs. However, the actual curriculum, teaching methodologies, and evaluation methods currently used to develop professional competence during PT training programs in Canada are unclear. This study explored current teaching practices, evaluation and curricular content related to professionalism in Canadian entry-to-practice PT programs. Results showed that teaching practices related to professionalism were not necessarily congruent with methods promulgated by educational theory and relied heavily on lecture, while more appropriate strategies such as simulation and role play were under-utilized. The numbers of different teaching methods utilized for specific aspects of professionalism were variable. Emphasis on different curricular areas related to professionalism also varied: communication was given the most emphasis while change management was under-represented. It is posited that teaching methods related to professionalism could be improved and curricular content and emphasis should also be reconsidered.

Randomized controlled trials of simulation-based interventions in Emergency Medicine: a methodological review

The number of trials assessing Simulation-Based Medical Education (SBME) interventions has rapidly expanded. Many studies show that potential flaws in design, conduct and reporting of randomized controlled trials (RCTs) can bias their results. We conducted a methodological review of RCTs assessing a SBME in Emergency Medicine (EM) and examined their methodological characteristics. We searched MEDLINE via PubMed for RCT that assessed a simulation intervention in EM, published in 6 general and internal medicine and in the top 10 EM journals. The Cochrane Collaboration risk of Bias tool was used to assess risk of bias, intervention reporting was evaluated based on the "template for intervention description and replication" checklist, and methodological quality was evaluated by the Medical Education Research Study Quality Instrument. Reports selection and data extraction was done by 2 independents researchers. From 1394 RCTs screened, 68 trials assessed a SBME intervention. They represent one quarter of our sample. Cardiopulmonary resuscitation (CPR) is the most frequent topic (81%). Random sequence generation and allocation concealment were performed correctly in 66 and 49% of trials. Blinding of participants and assessors was performed correctly in 19 and 68%. Risk of attrition bias was low in three-quarters of the studies (n = 51). Risk of selective reporting bias was unclear in nearly all studies. The mean MERQSI score was of 13.4/18.4% of the reports provided a description allowing the intervention replication. Trials assessing simulation represent one quarter of RCTs in EM. Their quality remains unclear, and reproducing the interventions appears challenging due to reporting issues.

Standing out with Professionalism: How do Students and Faculty of two different Medical Schools perceive it?

Background and Objectives

Medical professionalism is an essential aspect of medical education and practice worldwide. Our objective was to explore and compare the perception as recommended sanctions about professionalism lapses, using the "Dundee Polyprofessionalism Inventory I: Academic Integrity", among the faculty and the students' of two different medical schools in Saudi Arabia.

Methods

Respondents from the two medical schools in Saudi Arabia, recommended sanctions for the first time, absolute lapses in academic professionalism were determined by using the "Dundee Polyprofessionalism Inventory 1: Academic Integrity".

Results

On comparing the faculty and students' responses (from College of Medicine, King Saud University) with the published data (from another, unidentified medical school in Saudi Arabia) we found alignments in recommending sanctions for 14 (46.66%) behaviours among faculty and again concerning the11(36.66%) behaviours among the students of both cohorts.

Conclusion

The results can be used to emphasise on the improved teaching and learning strategies in undergraduate medical students' understanding of professionalism.

A preliminary survey of professionalism teaching practices in anatomy education among Indian Medical Colleges

Professionalism and ethics have gained widespread recognition as competencies to be fulfilled, taught, and assessed within medical education. The role of the anatomy course in developed nations has evolved over time and now encompasses multiple domains, including knowledge, skills, and the inculcation of professionalism and ethics. The Medical Council of India recently recommended the integration of professionalism teaching in undergraduate medical curricula. The authors investigated whether the initial orientation lectures and instructions given by faculty at the outset of undergraduate medical anatomy courses throughout India served a "hidden curriculum" regarding professionalism practices, and whether these orientation messages could serve as an early exposure to medical professionalism and ethics for medical students. An online survey was carried out among 102 anatomy faculty members across India requesting details about specific professionalism protocols and instructions regarding behavior in the dissection hall that are routinely given to preclinical students, as well as the importance that they placed on professional behavior. It was found that most faculty members regularly instruct students regarding expected behavior during the anatomy course, including dissection practices. These instructions stress attributes of professionalism like humanism, accountability, and honesty. However, there needs to be a more concentrated effort by educators to prohibit such unprofessional practices like dissection hall photography, and better information is required regarding biomedical waste disposal. Despite the absence of clear guidelines for professionalism teaching in medical education in India, the existing framework of anatomy education provides an opportunity to introduce the concept of professionalism to the first-year medical student. This opportunity may provide an early foundation for designing a professionalism-integrated curriculum. Anat Sci Educ 10: 433-443. © 2017 American Association of Anatomists.

Impact of Anatomy Boot Camp on Students in a Medical Gross Anatomy Course

Lincoln Memorial University-DeBusk College of Osteopathic Medicine (LMU-DCOM) offers an optional three-week summer Anatomy Boot Camp course (ABC) to facilitate students' transition into medical school and promote retention of anatomy subject matter. The pre-matriculation program is a supplemental instruction course that utilizes a small group learning format. Boot camp instruction is led by teaching assistants and two anatomy professors. Enrollees gain early exposure to Medical Gross Anatomy (MGA) course subject matter, which is taught in the fall semester, and learn study skills necessary to excel in medical school. No grade is assigned for the course, therefore participants can study without the fear of potentially affecting grades. This study evaluates the effectiveness of the LMU-DCOM ABC course using data from four consecutive summers. Independent two-sample t-tests were used to compare ABC to non-ABC students for the following variables: incoming grade point average (GPA) and Medical College Admission Test® (MCAT®) scores, MGA written and laboratory practical examination grades, and final MGA course grade. Additionally, a 26-question survey was administered to 2012-2014 boot camp participants. There were no significant differences in incoming GPA and MCAT scores. However, boot campers scored significantly higher on the first two lecture and laboratory examinations (P < 0.05) for each year of the study. Thereafter scores varied less, suggesting a faster head start for boot camp participants. Mean MGA final grade was on average 3% higher for the boot camp cohort. The survey feedback supports that the ABC course assists with the academic and social transition into medical school. Anat Sci Educ 10: 215-223. © 2016 American Association of Anatomists.

Teaching evidence-based synthesis: an examination of the development and delivery of two innovative methodologies used at the University of Portsmouth

Evidence based practice (EBP) is a process that involves making conscientious decisions that take into account the best available information, clinical expertise, and values and experiences of the patient. EBP helps empower health care professionals to establish service provisions that are clinically excellent, cost-effective, and culturally sensitive to the wishes of their patients. With a need for rapid integration of new evidence into EBP, systematic reviews and meta-analyses have become important tools for health care professionals. Systematic reviews and meta-analyses are conducted in a conscientious manner, following an established set of rules where individuals identify studies that address a particular question based on clearly defined inclusion and exclusion criteria along with a predetermined method of analysis. Conducting systematic reviews and meta-analyses isn't easy nor quick and requires knowledge in a particular subject area, research methods, and statistics. Teaching health care professionals, including undergraduate and graduate students, the processes and skills necessary to carry out systematic reviews and meta-analyses is essential, yet few teaching resources exist for academic staff to facilitate this endeavor. The purpose of this article is to present two strategies taken by academic staff in the Faculty of Science at the University of Portsmouth, UK to teach evidence synthesis and processes to enhance EBP. One case involves a pedagogical approach used with exercise science masters students while the other details the work of an on-line postgraduate certificate program that has been developed in collaboration with Cochrane UK.

Preclinical medical student observations associated with later professionalism concerns

PURPOSE

Professionalism is a core physician competency and identifying students at risk for poor professional development early in their careers may allow for mentoring. This study identified indicators in the preclinical years associated with later professionalism concerns.

METHODS

A retrospective analysis of observable indicators in the preclinical and clinical years was conducted using two classes of students (n = 226). Relationships between five potential indicators of poor professionalism in the preclinical years and observations related to professional concerns in the clinical years were analyzed.

RESULTS

Fifty-three medical students were identified with at least one preclinical indicator and one professionalism concern during the clinical years. Two observable preclinical indicators were significantly correlated with unprofessional conduct during the clinical years: Three or more absences from attendance-required sessions (odds ratio 4.47; p=.006) and negative peer assessment (odds ratio 3.35; p=.049).

CONCLUSIONS

We identified two significant observable preclinical indicators associated with later professionalism concerns: excessive absences and negative peer assessments. Early recognition of students at risk for future professionalism struggles would provide an opportunity for proactive professional development prior to the clinical years, when students' permanent records may be affected. Peer assessment, coupled with attention to frequent absences, may be a method to provide early recognition.

The impact of positive doctor role modeling

BACKGROUND

Role modeling has been highlighted as an important teaching and learning strategy. The aim of this research study was to explore the influences and impact of positive doctor role modelling in twenty-first century medical education.

METHODS

This study was part of a larger study investigating the process of positive doctor role modeling in medical education. This study used focus group interviews with 52 medical students, semi-structured interviews with 25 consultants and interviews after clinics with five consultants and five medical students. A qualitative methodology using the grounded theory approach of Strauss and Corbin was then used to explore the impact of modeling in medical education.

RESULTS

Three main outcomes of role modeling were identified - the development of professional behaviors, the development of professional identity, and the shaping of career aspirations.

CONCLUSION

This study illustrates the powerful, often subconscious impact of doctor role modeling in medical education. This research illustrates that role models are critically important in the professional development, character development, and career development of the modelees. In this way, role modeling effectively enhances the transformation of the student to a doctor.

Sex, Bugs, and Rock 'n' Roll: A Service-Learning Innovation to Enhance Medical Student Knowledge and Comfort With Sexual Health

INTRODUCTION

Sexual health is an intrinsic element of overall health; however, opportunities to enhance medical student comfort and knowledge about sexual health vary substantially and receive limited curricular time. Sex, Bugs, and Rock 'n' Roll is a novel service-learning initiative designed to enhance undergraduate medical student knowledge and comfort with sexual health. A total of 80 fifth-year undergraduate medical students researched, designed, and delivered a short sexual health promotion initiative for a population that experiences inequity.

METHODS

This initiative employed active learning tasks including performing a literature review, participating in team learning, facilitating small-group sessions, and providing peer feedback. Ongoing formative feedback from the program leaders, tutors, and members of the target audience contributed to student development. A summative assessment rubric was used by program leaders to evaluate student performance at the end of the module. Anonymized pre- and posttest knowledge questions and module evaluations were used to evaluate the module.

RESULTS

All 80 (100%) students completed randomized pre- and posttest knowledge questions and module evaluations. Student knowledge scores about sexuality and sexual health improved by 17% between pre- and posttest. All students reported increased comfort with and understanding of the clinical relevance of sexual health in the module evaluations.

DISCUSSION

Sex, Bugs, and Rock 'n' Roll is a promising initiative for improving medical student knowledge and comfort with sexual health. This module also offers a novel way for students to experience sexual health, public health, and social accountability in an active and engaging fashion.

Awareness of ethical issues in medical education: an interactive teach-the-teacher course

PURPOSE

We conducted an international, interdisciplinary teach-the-teacher course to sensitize physicians from different countries to ethical issues in medical education. The purpose of this study was to assess the effects of this course.

METHOD

Before and after participating in a short session on ethical issues in medical education, 97 physicians from different countries in Africa, Asia, and Europe completed a self-assessment questionnaire on their competence and interest in this field. The short session consisted of working in small groups to identify, analyze and discuss ethical dilemmas described in case vignettes adapted from published examples or written by medical students. In addition to the questionnaire, we conducted a large-group experience to explore four basic orientations of participants in ethical thinking: relativism, intentionalism, consequentialism, and absolutism.

RESULTS

We found a significant self-perceived increase in the participants' ability to identify and describe ethical issues and students' dilemmas, in their knowledge about these issues and teaching professionalism, and in their ability to describe both students' perspectives and teachers' and students' behaviors. In addition, participants' feeling of understanding their own culturally learned patterns of determining what is right and wrong increased after taking part in the course. The four contrasting basic ethical orientations showed no significant differences between participants regarding nationality, age, or gender.

CONCLUSION

Ethics of education is an important issue for medical teachers. Teachers' self-perceived competence can be increased by working on case vignettes in small groups.

Recognition of Core Elements of Medical Professionalism among Medical Students and Faculty Members

OBJECTIVES

Medical students and future physicians have chosen to pursue a profession that requires personal integrity, compassion and a constant awareness of the commitment made by them. Professionalism includes personal behaviors, knowledge, and competency. It includes the attitudes and values one holds and that run through the profession as a whole. Medical students learn professionalism during the course by either direct teaching or experiential learning. We conducted this study to estimate the self-reported level of practice of the core elements of professionalism by medical students and medical faculty and compared the two groups.

METHODS

One-hundred and nine students and 83 faculty members of Oman Medical College completed a professionalism questionnaire. The survey questions related to core elements of professionalism and were grouped under professional knowledge, professional skills, professional attitude, and qualities essential for professionalism.

RESULTS

The response rate was 65.6% (109 of 166) among students and 75.5% (83 of 110) from faculty members. Response to the questions on professional skills between the student and faculty group was significantly different (p < 0.001). Similarly, there was a significant difference in the responses related to professional attitude between the student and faculty group (p < 0.001). Students and faculty members have a significant difference in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency (p = 0.024). Similarly, significant differences in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency in clinical and basic sciences faculty members (p = 0.001). Students identified good communication skills (82.6%), and faculty staff identified up to date professional knowledge (62.7%) as the most important aspect of professionalism.

CONCLUSIONS

Both students and teaching faculty agreed that the top most professional elements are up to date knowledge, good communication skills, and teamwork. Hence, it is important that faculty members encourage their students to improve their professional skills and attitude.

Medical student mandala making for holistic well-being

The objective of this qualitative research study was to discover how creating mandalas (art made in reference to a circle) might provide medical students with an opportunity for reflection on their current psychological state. As part of their year 3 family medicine rotation, medical students participated in an art-making workshop, during which, they created mandalas based on their current emotional state. Afterwards, they engaged in reflective writing and discussion. The responses of 180 students were analysed and coded according to the mandala classification framework 'Archetypal Stages of The Great Round of Mandala'. The results indicated that students were actively struggling in integrating conflicting perspectives as they were attempting to reconcile their professional identity as doctors. Additional results pertaining to psychosocial characteristics included navigating difficult emotions, requiring nurturance, handling endings, contemplating existential concerns and managing stress. The study has implications for making use of mandala making within a Jungian framework as means for medical students to reflect on their emotional state and achieve psychological balance.

Early Introduction to Professional and Ethical Dilemmas in a Pharmaceutical Care Laboratory Course

OBJECTIVE

To study the effects of an early professional development series in a pharmaceutical care laboratory (PCL) course on first-year pharmacy students' perceptions of the importance of professional attitudes and action.

DESIGN

Three hundred thirty-four first-year students enrolled in a PCL course participated in a new required learning activity centered on development of professional attitudes and behaviors. Students discussed situational dilemmas in pharmacy practice in small groups, highlighting application of the Oath of a Pharmacist and the Pharmacists' Code of Ethics.

ASSESSMENT

Students completed an optional questionnaire at the beginning and end of the semester to assess change in their attitudes and behaviors related to professionalism in pharmacy practice.

CONCLUSION

While students entered their training with a strong appreciation for professionalism, they felt more confident in applying the Oath of a Pharmacist and the Pharmacists Code of Ethics to dilemmas in practice following the new learning activity.

Association between Sick Leave Prescribing Practices and Physician Burnout and Empathy

OBJECTIVES

To investigate the association between sick leave prescription and physician burnout and empathy in a primary care health district in Lleida, Spain.

METHODS

This descriptive study included 108 primary care doctors from 22 primary care centers in Lleida in 2014 (183,600 patients). Burnout was measured with the Maslach Burnout Inventory and empathy with the Jefferson Scale of Physician Empathy. The reliability of the instruments was measured by calculating Cronbach's alpha and normal distribution was analyzed using the Kolmogorov-Smirnov-Lilliefors and χ2 tests. Burnout and empathy scores were analyzed by age, sex, and place of work (urban vs rural). Sick leave data were obtained from the Catalan Health Institute.

RESULTS

High empathy was significantly associated with low burnout. Neither empathy nor burnout were significantly associated with sick leave prescription.

CONCLUSION

Sick leave prescription by physicians is not associated with physicians' empathy or burnout and may mostly depend on prescribing guidelines.

The effects of dissection-room experiences and related coping strategies among Hungarian medical students

BACKGROUND

Students get their first experiences of dissecting human cadavers in the practical classes of anatomy and pathology courses, core components of medical education. These experiences form an important part of the process of becoming a doctor, but bring with them a special set of problems.

METHODS

Quantitative, national survey (n = 733) among medical students, measured reactions to dissection experiences and used a new measuring instrument to determine the possible factors of coping.

RESULTS

Fifty per cent of students stated that the dissection experience does not affect them. Negative effects were significantly more frequently reported by women and students in clinical training (years 3,4,5,6). The predominant factor in the various coping strategies for dissection practicals is cognitive coping (rationalisation, intellectualisation). Physical and emotional coping strategies followed, with similar mean scores. Marked gender differences also showed up in the application of coping strategies: there was a clear dominance of emotional-based coping among women. Among female students, there was a characteristic decrease in the physical repulsion factor in reactions to dissection in the later stages of study.

CONCLUSIONS

The experience of dissection had an emotional impact on about half of the students. In general, students considered these experiences to be an important part of becoming a doctor. Our study found that students chiefly employed cognitive coping strategies to deal with their experiences. Dissection-room sessions are important for learning emotional as well as technical skills. Successful coping is achieved not by repressing emotions but by accepting and understanding the negative emotions caused by the experience and developing effective strategies to deal with them. Medical training could make better use of the learning potential of these experiences.

Investigation of Unethical and Unprofessional Behavior in Korean Residency Training

PHENOMENON: Medical ethics and professionalism are fundamental competencies for all physicians, and resident physicians have to develop these competencies during their training. Although Korea has a reputation for having the highest quality medical practice in East Asia, improvements in the technological aspects of care have outpaced the developments in institutional systems and education needed to fulfill social responsibility. Enhancing professionalism education during postgraduate training requires thorough exposition of this situation.

APPROACH

Twenty residents from 17 clinical departments at 1 Korean tertiary university-affiliated hospital were recruited, and in-depth interviews were conducted in person by an interviewer who was a fellow resident with participants. Interviewees recalled and described personal experiences or observations of misbehaviors that had occurred during their residency training. Researchers recorded and transcribed all interviews, and 4 researchers conducted a thematic analysis.

FINDINGS

Authors extracted 48 descriptors representing 8 categories of unethical and unprofessional behaviors from the transcripts: (a) substandard practice, (b) violation of work ethics, (c) misconduct related to conflict of interest, (d) dishonesty with patients, (e) violation of patient confidentiality, (f) lack of respect for patients, (g) lack of respect for colleagues, and (h) misconduct in research. Each of the interviewees mentioned between 3 and 18 descriptors. "Not fulfilling basic duties for patient care" was the most frequently mentioned misconduct, followed by "fabricating patient medical status or test results to meet preoperative criteria for anesthesia" and "verbal or physical abuse of junior doctors." INSIGHTS: Residents reported a diverse variety of unethical and unprofessional behaviors throughout their training and described the ethical distress they suffered in the real clinical situations. The results of this study support the notion that reinforcing ethics and professionalism education during postgraduate medical training in a practical and authentic way will help trainees manage the ethical conflicts or dilemmas they will inevitably encounter.

Twelve Tips for teaching medical professionalism at all levels of medical education

Review of studies published in medical education journals over the last decade reveals that teaching medical professionalism is essential, yet challenging. According to a recent Best Evidence in Medical Education (BEME) guide, there is no consensus on a theoretical or practical model to integrate the teaching of professionalism into medical education. The aim of this article is to outline a practical manual for teaching professionalism at all levels of medical education. Drawing from research literature and author's experience, Twelve Tips are listed and organised in four clusters with relevance to (1) the context, (2) the teachers, (3) the curriculum, and (4) the networking. With a better understanding of the guiding educational principles for teaching medical professionalism, medical educators will be able to teach one of the most challenging constructs in medical education.

"I am a doctor": negotiating the discourses of standardization and diversity in professional identity construction

PURPOSE

Medical educators have expressed concern that students' professional identities do not always align with their expectations or with professional standards. The authors propose that, in constructing appropriate professional identities, medical students today are affected by the competing discourses of diversity and standardization.

METHOD

Between March and May 2012, the authors conducted a critical review of seminal publications to highlight the discourses of diversity and standardization in the medical education literature. They surveyed the social sciences literature on identity construction and drew examples from medical education to demonstrate how a social constructionist approach could inform the discussion about how medical students' professional identities are affected by these discourses.

RESULTS

The discourse of diversity emphasizes individuality, difference, and a plurality of possibilities and advances the notion that heterogeneity is beneficial to medical education and to patients. In contrast, the discourse of standardization strives for homogeneity, sameness, and a limited range of possibilities and conveys that there is a single way to be a competent, professional physician. Thus, these discourses are in tension, a fact that medical educators largely have ignored. A social constructionist approach to identity suggests that medical students resolve this tension in different ways and construct different identities as a result.

CONCLUSIONS

To influence medical students' professional identity construction, the authors advocate that educators seek change across the profession-faculty must acknowledge and take advantage of the tension between the discourses of standardization and diversity.

The utility of reflective writing after a palliative care experience: can we assess medical students' professionalism?

BACKGROUND

Medical education leaders have called for a curriculum that proactively teaches knowledge, skills, and attitudes required for professional practice and have identified professionalism as a competency domain for medical students. Exposure to palliative care (PC), an often deeply moving clinical experience, is an optimal trigger for rich student reflection, and students' reflective writings can be explored for professional attitudes.

OBJECTIVE

Our aim was to evaluate the merit of using student reflective writing about a PC clinical experience to teach and assess professionalism.

METHODS

After a PC patient visit, students wrote a brief reflective essay. We explored qualitatively if/how evidence of students' professionalism was reflected in their writing. Five essays were randomly chosen to develop a preliminary thematic structure, which then guided analysis of 30 additional, randomly chosen essays. Analysts coded transcripts independently, then collaboratively, developed thematic categories, and selected illustrative quotes for each theme and subtheme.

RESULTS

Essays revealed content reflecting more rich information about students' progress toward achieving two professionalism competencies (demonstrating awareness of one's own perspectives and biases; demonstrating caring, compassion, empathy, and respect) than two others (displaying self-awareness of performance; recognizing and taking actions to correct deficiencies in one's own behavior, knowledge, and skill).

CONCLUSIONS

Professional attitudes were evident in all essays. The essays had limited use for formal summative assessment of professionalism competencies. However, given the increasing presence of PC clinical experiences at medical schools nationwide, we believe this assessment strategy for professionalism has merit and deserves further investigation.

Analysing the hidden curriculum: use of a cultural web

CONTEXT

Major influences on learning about medical professionalism come from the hidden curriculum. These influences can contribute positively or negatively towards the professional enculturation of clinical students. The fact that there is no validated method for identifying the components of the hidden curriculum poses problems for educators considering professionalism. The aim of this study was to analyse whether a cultural web, adapted from a business context, might assist in the identification of elements of the hidden curriculum at a UK veterinary school.

METHODS

A qualitative approach was used. Seven focus groups consisting of three staff groups and four student groups were organised. Questioning was framed using the cultural web, which is a model used by business owners to assess their environment and consider how it affects their employees and customers. The focus group discussions were recorded, transcribed and analysed thematically using a combination of a priori and emergent themes.

RESULTS

The cultural web identified elements of the hidden curriculum for both students and staff. These included: core assumptions; routines; rituals; control systems; organisational factors; power structures, and symbols. Discussions occurred about how and where these issues may affect students' professional identity development.

CONCLUSIONS

The cultural web framework functioned well to help participants identify elements of the hidden curriculum. These aspects aligned broadly with previously described factors such as role models and institutional slang. The influence of these issues on a student's development of a professional identity requires discussion amongst faculty staff, and could be used to develop learning opportunities for students. The framework is promising for the analysis of the hidden curriculum and could be developed as an instrument for implementation in other clinical teaching environments.

Caring, competence and professional identities in medical education

This paper considers the multiple discourses that influence medical education with a focus on the discourses of competence and caring. Discourses of competence are largely constituted through, and related to, biomedical and clinical issues whereas discourses of caring generally focus on social concerns. These discourses are not necessarily equal partners in the enterprise of medical education. Discourses of competence tend to be privileged while those discourses of caring are often marginalised. Medical students learn to be physicians, and develop professional identities, in the context of these competing discourses. This paper documents a qualitative study designed to explore how professional identities are developed in the context of competing discourses. The study included a Foucauldian discourse analysis of medical education curriculum documents (67 problem-based learning cases in total), 26 h of observation of a small group learning experience (a problem-based learning tutorial), and in-depth, open-ended interviews with five medical students and nine medical educators at a Canadian medical school. The paper describes how professional identities are developed in relation to discourses of competence, noting that students displayed what they considered to be desirable professional identities of confidence, capability and suitability. Also explored are the professional identities demonstrated in relation to discourses of caring, including those of benevolence and humbleness. Despite current conceptualisations, medical education is ripe with potential. The data indicate Foucauldian "spaces of freedom"-sites at which the complexity of the practice of medicine and the interwoven natures of the discourses of competence and caring might be taken into account as a means of challenging taken for granted cultural norms and broadening the medical gaze.

Six ways problem-based learning cases can sabotage patient-centered medical education

PURPOSE

Problem-based learning (PBL) cases tell a story of a medical encounter; however, the version of the story is typically very biomedical in focus. The patient and her or his experience of the situation are rarely the focus of the case despite a prevalent discourse of patient-centeredness in contemporary medical education. This report describes a qualitative study that explored the question, "How does PBL teach medical students about what matters in medicine?"

METHOD

The qualitative study, culminating in 2008, involved three data collection strategies: (1) a discourse analysis of a set of PBL cases from 2005 to 2006, (2) observation of a PBL tutorial group, and (3) semistructured, in-depth, open-ended interviews with medical educators and medical students.

RESULTS

In this report, using data gathered from 67 PBL cases, 26 hours of observation, and 14 interviews, the author describes six specific ways in which PBL cases-if not thoughtfully conceptualized and authored-can serve to overlook social considerations, thereby undermining a patient-centered approach. These comprise the detective case, the shape-shifting patient, the voiceless PBL person, the joke name, the disembodied PBL person, and the stereotypical PBL person.

CONCLUSIONS

PBL cases constitute an important component of undergraduate medical education. Thoughtful authoring of PBL cases has the potential to reinforce, rather than undermine, principles of patient-centeredness.

Does the inclusion of 'professional development' teaching improve medical students' communication skills?

BACKGROUND

This study investigated whether the introduction of professional development teaching in the first two years of a medical course improved students' observed communication skills with simulated patients. Students' observed communication skills were related to patient-centred attitudes, confidence in communicating with patients and performance in later clinical examinations.

METHODS

Eighty-two medical students from two consecutive cohorts at a UK medical school completed two videoed consultations with a simulated patient: one at the beginning of year 1 and one at the end of year 2. Group 1 (n = 35) received a traditional pre-clinical curriculum. Group 2 (n = 47) received a curriculum that included communication skills training integrated into a 'professional development' vertical module. Videoed consultations were rated using the Evans Interview Rating Scale by communication skills tutors. A subset of 27% were double-coded. Inter-rater reliability is reported.

RESULTS

Students who had received the professional development teaching achieved higher ratings for use of silence, not interrupting the patient, and keeping the discussion relevant compared to students receiving the traditional curriculum. Patient-centred attitudes were not related to observed communication. Students who were less nervous and felt they knew how to listen were rated as better communicators. Students receiving the traditional curriculum and who had been rated as better communicators when they entered medical school performed less well in the final year clinical examination.

CONCLUSIONS

Students receiving the professional development training showed significant improvements in certain communication skills, but students in both cohorts improved over time. The lack of a relationship between observed communication skills and patient-centred attitudes may be a reflection of students' inexperience in working with patients, resulting in 'patient-centredness' being an abstract concept. Students in the early years of their medical course may benefit from further opportunities to practise basic communication skills on a one-to-one basis with patients.

Teaching social accountability by making the links: qualitative evaluation of student experiences in a service-learning project

BACKGROUND

Many medical students come into medicine with altruistic motives; few carry this altruism into their practice. As a result rural, remote and international areas are underserved by the medical community. Teaching social accountability may help students remain altruistic and encourage work in underserved areas. Making The Links (MTL) is a project designed to teach medical students the social aspects of medicine via service-learning.

AIMS

The purpose of the study was to explore student reflections on their experiences during the MTL program.

METHODS

Qualitative data analysis was conducted using structured open-ended written questionnaires. Fourteen students, representing three student cohorts, participated in the study. Data was collected between 2005 and 2007.

RESULTS

Six themes emerged from qualitative data analysis. (1) relationships, (2) social determinants of health in real life, (3) community development, (4) interdisciplinarity, (5) linking health and communities, and (6) personal learning. Themes reflected the opportunities and challenges experienced by the students during the MTL project. Students reported that MTL was an essential component of their medical training.

CONCLUSIONS

MTL is a promising model for using service-learning to teach social accountability in medical training.

Evidence-based medicine training during residency: a randomized controlled trial of efficacy

BACKGROUND

Evidence-based medicine (EBM) has been widely integrated into residency curricula, although results of randomized controlled trials and long term outcomes of EBM educational interventions are lacking. We sought to determine if an EBM workshop improved internal medicine residents' EBM knowledge and skills and use of secondary evidence resources.

METHODS

This randomized controlled trial included 48 internal medicine residents at an academic medical center. Twenty-three residents were randomized to attend a 4-hour interactive workshop in their PGY-2 year. All residents completed a 25-item EBM knowledge and skills test and a self-reported survey of literature searching and resource usage in their PGY-1, PGY-2, and PGY-3 years.

RESULTS

There was no difference in mean EBM test scores between the workshop and control groups at PGY-2 or PGY-3. However, mean EBM test scores significantly increased over time for both groups in PGY-2 and PGY-3. Literature searches, and resource usage also increased significantly in both groups after the PGY-1 year.

CONCLUSIONS

We were unable to detect a difference in EBM knowledge between residents who did and did not participate in our workshop. Significant improvement over time in EBM scores, however, suggests EBM skills were learned during residency. Future rigorous studies should determine the best methods for improving residents' EBM skills as well as their ability to apply evidence during clinical practice.