Students as catalysts for curricular innovation: A change management framework

Using a boundary crossing lens to understand basic science educator and clinical educator collaboration in instructional design

PURPOSE

Collaborations between basic science educators (BE) and clinical educators (CE) in medical education are common and necessary to create integrated learning materials. However, few studies describe experiences of or processes used by educators engaged in interdisciplinary teamwork. We use the lens of boundary crossing to explore processes described by BE and CE that support the co-creation of integrated learning materials, and the impact that this work has on them.

MATERIALS AND METHODS

We conducted qualitative content analysis on program evaluation data from 27 BE and CE who worked on 12 teams as part of a multi-institutional instructional design project.

RESULTS

BE and CE productively engaged in collaboration using boundary crossing mechanisms. These included respecting diverse perspectives and expertise and finding efficient processes for completing shared work that allow BE and CE to build on each other's contributions. BE and CE developed confidence in connecting clinical concepts with causal explanations, and willingness to engage in and support such collaborations at their own institutions.

CONCLUSIONS

BE and CE report the use of boundary crossing mechanisms that support collaboration in instructional design. Such practices could be harnessed in future collaborations between BE and CE.

Mapping student engagement in health professions education policy and decision-making: a scoping review

BACKGROUND

"Student engagement" (SE) is gaining momentum as an approach to improve the performance of health professions education (HPE). Nevertheless, despite the broad studies about the role of students in various areas, little is known about the role of SE in policy and decision-making activities. This study aimed to map SE in policy and decision-making regarding terms and definitions, engagement models, influencing factors, outcomes and achievements, and the interconnection between the influencing factors.

METHOD

Five databases (PubMed, Scopus, ProQuest, Web of Science, and ERIC) were systematically searched from Jan 1, 1990, to Nov 12, 2022. The review was followed according to the Arksey and O'Malley framework for scoping reviews and reported according to the PRISMA-ScR guidelines. We included articles published in English focusing on HPE policy and decision-making. The authors summarized and synthesized the findings into themes, subthemes, tables, and models.

RESULTS

Of the 22 articles included in the full-text review, terms and definitions were tabled, and three themes were extracted: 1. models of SE, in which 10 studies (45.5%) presented the highly structured formal models as Organizations, 5 studies (22.7%) reported less-structured community and group as Programs, and 7 studies (31.8%) engaged students only in surveys or interviews as Perspective; 2. Factors influencing SE, that were categorized into 7 subthemes: structural, environmental, and motivational factors, member characteristics, training and mentoring, member relationships, valuing and recognizing. 3. Outcomes and achievements of SE related to systems and members. The interconnection between influencing factors is also demonstrated as a conceptual model.

DISCUSSION

There are various SE models in HPE policy and decision-making, which are mapped and categorized depending on the degree of formality, structuredness, and level of engagement. In our study, three more common SE models in HPE policy and decision-making were investigated. Additionally, these collaborative methods emphasized curriculum development and quality assurance and employed students in these activities. It is worth mentioning that to make SE models more efficient and sustainable, several influencing factors and their interconnections should be considered.

Medical Education Electives Can Promote Teaching and Research Interests Among Medical Students

Introduction

Although all residents routinely teach medical students, not all residents are involved in teaching or trained in teaching during undergraduate medical school, as accreditation bodies do not mandate the promotion of teaching skills to undergraduate medical students. With relatively inadequate formal training and residents' intrinsic time constraints, tactically incorporating formal medical education elective experiences in medical school curricula is understandable. This study explores if medical education electives at Avalon University School of Medicine (AUSOM) can enhance medical students' interest in teaching and research.

Methods

The medical education elective at AUSOM was developed to give interested medical students an elective experience. The course modules include accreditation/regulation, curriculum development, learning theories, assessments, and research methodology. Students can choose any one of the modules. We offered the medical education elective to twenty-five students in the year 2021. All of them gave feedback at the end of the elective. The data was analyzed qualitatively through framework analysis, which includes familiarization, generating initial codes, searching for themes, reviewing, and defining and naming themes.

Results

Different themes emerged, enhancing the interest in academic medicine, understanding research methodologies, supporting learners, and awareness of learning theories.

Conclusion

Doing medical education electives at AUSOM enhanced students' interest in teaching, and students reported that they could understand research methodologies, especially those related to medical education. Medical students should have opportunities for electives in medical education, and more research is required to evaluate the effectiveness of medical education electives across medical schools.

Empowerment of Learners through Curriculum Co-Creation: Practical Implications of a Radical Educational Theory

Framing the Issue: Medical education programs in the U.S. rely on the aphorism that faculty own the curriculum; that is, the specialized knowledge, skills, and attitudes of a physician are the province of the faculty to be delivered to tuition-paying students. From this view, the learner's role is one of passivity and deference. A contrasting approach, termed curriculum co-creation, frames education as a bi-lateral partnership. Co-creation results from learners, in collaboration with instructors, taking an active role in creating the goals and processes of an educational program. Such a partnership requires substantial revision of the expectations for both learners and instructors. In this Observations article, the idea of co-creation is applied to medical education and an aspirational vision for the role and value of faculty-student co-creation is advocated. Description and Explication: Co-creation partnerships of faculty and students occur in many forms, varying in degree of departure from traditional educational practice. Co-creation principles and partnerships can be deployed for almost all aspects of training including selection and organization of content, effective methods of instruction, and assessment of student learning. The outcomes of co-creation occur at three levels. The most specific outcome of co-creation is characterized by increased student engagement and enhanced learning. Broader outcomes include improved efficacy and value in the educational program and institution while, at the farthest-reaching level, a co-creative process can modify the medical profession itself. Although some specific instructional techniques to promote student involvement and input have historically been deployed in medical education, there is little evidence that students have ever been permitted to share in ownership. Implications for Medical Education: When fully embraced, curricular co-creation will be recognizable through improved student engagement and learning along with a revised understanding of how faculty-student relationships can foment reform in medical education and the culture of the profession. Further scholarship and research will be indispensable to examine how co-creative partnerships can flatten hierarchies within medical education and inspire the medical profession to be more inclusive and effective. Following the model of co-creation is expected to inspire learners by empowering them to participate fully as co-owners of their own education and prepare them to lead medical education in a different direction for the future.

By Medical Students, for Medical Students: A Narrative Medicine Antiracism Program

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.

Precision Medical Education

Medical schools and residency programs are increasingly incorporating personalization of content, pathways, and assessments to align with a competency-based model. Yet, such efforts face challenges involving large amounts of data, sometimes struggling to deliver insights in a timely fashion for trainees, coaches, and programs. In this article, the authors argue that the emerging paradigm of precision medical education (PME) may ameliorate some of these challenges. However, PME lacks a widely accepted definition and a shared model of guiding principles and capacities, limiting widespread adoption. The authors propose defining PME as a systematic approach that integrates longitudinal data and analytics to drive precise educational interventions that address each individual learner's needs and goals in a continuous, timely, and cyclical fashion, ultimately improving meaningful educational, clinical, or system outcomes. Borrowing from precision medicine, they offer an adapted shared framework. In the P4 medical education framework, PME should (1) take a proactive approach to acquiring and using trainee data; (2) generate timely personalized insights through precision analytics (including artificial intelligence and decision-support tools); (3) design precision educational interventions (learning, assessment, coaching, pathways) in a participatory fashion, with trainees at the center as co-producers; and (4) ensure interventions are predictive of meaningful educational, professional, or clinical outcomes. Implementing PME will require new foundational capacities: flexible educational pathways and programs responsive to PME-guided dynamic and competency-based progression; comprehensive longitudinal data on trainees linked to educational and clinical outcomes; shared development of requisite technologies and analytics to effect educational decision-making; and a culture that embraces a precision approach, with research to gather validity evidence for this approach and development efforts targeting new skills needed by learners, coaches, and educational leaders. Anticipating pitfalls in the use of this approach will be important, as will ensuring it deepens, rather than replaces, the interaction of trainees and their coaches.

Relationship matters: a qualitative study of medical students' experiences in a learner-driven research program in South Korea

BACKGROUND

Although research experience is important for medical students, it is difficult to develop research skills only through a formal curriculum. To develop research programs that address the authentic needs of students and align with the entirety of the medical school curriculum, a learner-centered approach may be more effective than an instructor-centered approach. This study investigates medical student perspectives on factors that help them develop research competency.

METHODS

Hanyang University College of Medicine in South Korea operates the Medical Scientist Training Program (MSTP) as a supplement to its formal curriculum. Semi-structured interviews were held with 18 students (20 cases) in the program, and qualitative content analysis was performed using the software tool MAXQDA20.

RESULTS

The findings are discussed in relation to three domains: learner engagement, instructional design, and program development. The students were more engaged when they perceived the program as a new experience, had prior research experience, wanted to make a good impression, and felt a sense of contribution. In terms of instructional design, they positively participated in research when their supervisors respected them, set clear tasks, provided constructive feedback, and invited them into the research community. In particular, the students highly valued relationships with their professors, and these relationships served not only as a main motivating factor in their research participation but also affected their college lives and careers.

CONCLUSIONS

The longitudinal relationship between students and professors has newly emerged in the Korean context as a factor that strengthens student engagement in research and the complementary relationship between formal curriculum and MSTP was highlighted to encourage student engagement in research.

Reimagining the Transition to Residency: A Trainee Call to Accelerated Action

The transition from medical student to resident is a pivotal step in the medical education continuum. For applicants, successfully obtaining a residency position is the actualization of a dream after years of training and has life-changing professional and financial implications. These high stakes contribute to a residency application and Match process in the United States that is increasingly complex and dysfunctional, and that does not effectively serve applicants, residency programs, or the public good. In July 2020, the Coalition for Physician Accountability (Coalition) formed the Undergraduate Medical Education-Graduate Medical Education Review Committee (UGRC) to critically assess the overall transition to residency and offer recommendations to solve the growing challenges in the system. In this Invited Commentary, the authors reflect on their experience as the trainee representatives on the UGRC. They emphasize the importance of trainee advocacy in medical education change efforts; reflect on opportunities, concerns, and tensions with the final UGRC recommendations (released in August 2021); discuss factors that may constrain implementation; and call for the medical education community-and the Coalition member organizations in particular-to accelerate fully implementing the UGRC recommendations. By seizing the momentum created by the UGRC, the medical education community can create a reimagined transition to residency that reshapes its approach to training a more diverse, competent, and growth-oriented physician workforce.

A Cautionary Tale: Exploring Stakeholder Emotions During Curricular Change Using Group Concept Mapping

PhenomenonCurricular change is essential but challenging. Change efforts often struggle and some fail due to well-articulated challenges as well as other barriers less understood. The curricular change literature characterizes the organizational and operational features of successful change yet virtually ignores stakeholder emotions. A deeper understanding of these emotional responses during the change process could enhance participant and organizational well-being and support change success. Approach In 2019, data were collected at one large North American medical school using group concept mapping methodology, an asynchronous mixed methods approach. We sought to generate themes characterizing the emotional responses of faculty, administrative staff, and students across multiple stakeholder groups participating in the new and traditional (legacy) curricula 27 months after curricular change initiation. Participants brainstormed, sorted, and rated statements on emotional responses. Rating participants rated each statement using a Likert scale from 1 (does not resonate) to 4 (very strongly resonates) according to this prompt: "This emotional response resonates with my emotional experience during the curricular change." Multidimensional scaling and hierarchical cluster analyses were used to generate emotional profiles and compare them across stakeholders. Findings Of 335 stakeholders invited, 123 contributed to brainstorming (36.7%), 153 completed rating (45.7%) and 33 completed sorting (9.9%). Participants generated six themes of emotional responses to curricular change: enthusiastic, apprehensive, overwhelmed, missed opportunities, uncertain, and abandoned. The enthusiastic theme overall had the highest mean statement ratings while the abandoned theme had the lowest. Demographic subgroup analysis revealed new curriculum students (Class of 2021) were most enthusiastic while legacy curriculum students (Class of 2020) were more likely to feel abandoned. Overall, faculty and administrative staff were more enthusiastic than students whereas students rated the five other themes higher than faculty and administrative staff. InsightsCurricular change is emotionally taxing. Students in both curricula experienced greater uncertainty, apprehension, sense of missed opportunities, and feeling overwhelmed than did faculty and administrative staff. Legacy curriculum students rated statements in the abandoned cluster highest while new curriculum students rated statements in the enthusiastic cluster highest. Given the ubiquity of curricular change which often includes a legacy cohort, medical schools embarking on this journey must carefully attend to the varied emotional responses of their different stakeholder groups. The very activities recommended by organizational change models used in medical education, such as communicating wins early and often, could alienate legacy students, creating emotional polarization. These findings suggest that tailored communication strategies are necessary during change implementation to optimize success.

Integrated clinical case discussions - a fully student-organized peer-teaching program on internal medicine

BACKGROUND

In response to students´ poor ratings of emergency remote lectures in internal medicine, a team of undergraduate medical students initiated a series of voluntary peer-moderated clinical case discussions. This study aims to describe the student-led effort to develop peer-moderated clinical case discussions focused on training cognitive clinical skill for first and second-year clinical students.

METHODS

Following the Kern Cycle a didactic concept is conceived by matching cognitive learning theory to the competence levels of the German Medical Training Framework. A 50-item survey is developed based on previous evaluation tools and administered after each tutorial. Educational environment, cognitive congruence, and learning outcomes are assessed using pre-post-self-reports in a single-institution study.

RESULTS

Over the course of two semesters 19 tutors conducted 48 tutorials. There were 794 attendances in total (273 in the first semester and 521 in the second). The response rate was 32%. The didactic concept proved successful in attaining all learning objectives. Students rated the educational environment, cognitive congruence, and tutorials overall as "very good" and significantly better than the corresponding lecture. Students reported a 70%-increase in positive feelings about being tutored by peers after the session.

CONCLUSION

Peer-assisted learning can improve students´ subjective satisfaction levels and successfully foster clinical reasoning skills. This highlights successful student contributions to the development of curricula.

Creating or taking opportunity: Strategies for implementing expert by experience positions in mental health academia

WHAT IS KNOWN ON THE SUBJECT?: Experts by experience involvement in the education of health professionals demonstrate positive attitudinal change. Meaningful positions for Experts by Experience are limited and ad hoc, due to attitudinal and other barriers to innovation within the higher education sector. Experiences of allies who have supported the implementation of Expert by Experience positions have not been researched. This is important knowledge that could be utilized by potential allies. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Academic allies to experts by experience have a crucial role to play in identifying opportunities to establish, implement and sustain expert by experience positions. Allies who have successfully implemented positions for experts by experience have identified influential factors including: right person, right role, collaboration and coproduction, support, and career pathways. Understanding these factors can provide an important basis for other academics to support a widespread increase in academic roles for experts by experience in mental health education. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Establishing and maintaining genuine relationships with service users require significant attitudinal change on the part of mental health professionals. Involving experts by experience in mental health education provides an innovative approach to the challenging of attitudes and the enhancement of more collegial relationships with service users as colleagues in the workplace. This paper demonstrates the importance of allyship to the establishment, implementation and sustainability of expert by experience roles, and highlights critical factors allies have utilized in support of such roles. Nurses and other mental health professional academics have the potential to become allies and support change and innovation. ABSTRACT: Introduction Experts by experience in academia have demonstrated more positive student attitudes towards relationships with service users. Notwithstanding this supportive evidence, academic positions for EBE have not grown substantially. Enhanced understanding of positions that have been implemented is important knowledge for others with similar aspirations. Aim To enrich understanding of the role of allies in identifying and pursuing opportunities to support academic positions for experts by experience. Methods Qualitative exploratory approach, involving In-depth interviews with allies with expertise in supporting academic positions for experts by experience. Results Participants were enthusiastic about creating or taking opportunities to secure expert by experience involvement within their programs. Factors facilitating success included right person, right role, collaboration and coproduction, support and career pathways. Conclusions Significant barriers have prevented proliferation of academic roles for experts by experience. Despite barriers, allies have been successful in supporting the implementation and sustaining of positions, and gained considerable expertise, which may be invaluable to academics with similar aspirations. Implications for practice Realization of policy goals regarding service user involvement in mental health services requires health professionals with the will to embrace partnerships. By creating and taking opportunities, allies have developed expertise to facilitate implementation of positions more widely.

A Student-Led Global Shared Medical Curriculum

Students can be change agents in transforming medical education. The Medical Student Alliance for Global Education (MeSAGE) aims to establish a worldwide shared medical curriculum through open-access content focused on emerging global health issues. MeSAGE modules are novel tools for integration of ideas and topics important to medical students.

Curriculum Design and Scholarship for New Educators: A Professional Development Workshop for Medical Students

INTRODUCTION

Medical students' professional development includes their role as educators. Despite greater opportunities to join medical education curriculum development, medical students' engagement in these activities remains limited. A recent national study on student leadership in curricular change revealed a formal lack of leadership and training in medical education as significant barriers. Medical students' unawareness of how to disseminate curricula as educational scholarship and its value to their careers also restricts the fullness of their formation as educators.

METHODS

We designed a 3-hour, interactive, project-focused conference workshop for medical students without prior knowledge in curriculum development. Of participants, 64 worked in 10 groups creating medical curricula using Kern's six-step approach in student-facilitated breakout sessions. Completed group projects were presented, including brief action plans for transforming their work into scholarship. The workshop was evaluated using a mixed-methods approach.

RESULTS

Of survey respondents, 44 mostly medical students, faculty, and administrators from different institutions rated the workshop as a very positive experience, and the pacing of the breakout groups as effective. A notable increase in self-reported mastery, as measured by learning objectives aligned with Kern's six-step model, was recorded from student respondents as compared to faculty. A sense of readiness to participate in curricular decisions either at the home institution or in individual career paths was evident from narrative comments.

DISCUSSION

Our workshop provided medical students with a foundation in curriculum development and educational scholarship. Session design provided flexibility in the pace of breakout sessions and allowed in-depth discussion of educational topics.

How to create a faculty-centered curriculum support system: Launching the Academic Support Center (ASC) to inspire excellence in curriculum change

PURPOSE

To define faculty needs and services requested for the implementation of a faculty-centered curriculum support system (i.e., Academic Support Center [ASC]) to assist curriculum redesign.

METHODS

Faculty and students were invited to participate in 60-min, one-on-one interviews to describe pain points in teaching and identify possible support services needed. Benchmarking through surveys of academic deans was also conducted to determine what services other institutions offer. Qualitative memos from interviews and survey data were analyzed to identify salient challenges and outline possible services that could benefit the school. This information was used to create a strategic plan for the ASC. Full-time faculty were requested to evaluate the ASC 6 and 12 months following the launch of the center in 2019.

RESULTS

Fifty interviews were conducted with department chairs (n = 10), full-time faculty (n = 36), and students (n = 4). Six pain points identified by participants were time, resources, knowledge, confidence, organizational structure, and organizational culture. Participants generated solutions related to supporting teaching and learning, enhancing faculty experience, and assisting educational evaluation. Twenty-two schools responded to the benchmarking survey-approximately half acknowledged a centralized curriculum support service (n = 12, 54.5% of respondents). Services often focused on instructional design, education technology, and faculty onboarding to education. Faculty feedback following the ASC launch was generally positive and demonstrating progress toward the three priorities.

CONCLUSION

Needs assessment and benchmarking data can inform the design and implementation of centers that offer faculty-centered support structures around teaching, educational scholarship, and curriculum change.

"I don't think the problem's the student…I think it's us": Engaging faculty in curriculum innovation

PURPOSE

The need to innovate predoctoral dental education is well established; however, there are few recent reports to guide substantial curriculum transformation. The purpose of this study was to describe faculty perspectives on their vision of future graduates, curriculum needs, and potential barriers to a successful redesign. This information would be used to inform strategic planning for the predoctoral curriculum transformation.

METHODS

Eighty full-time faculty from the University of North Carolina Adams School of Dentistry participated in 60-minute focus groups in March 2018. Focus group questions were developed to elicit perceptions about the current curriculum, what the dental graduate should know in 2040, and what is needed to engage faculty in curriculum change. Transcripts of the focus group sessions were analyzed by a third-party research group using qualitative thematic analysis to identify pertinent themes shared by participants.

RESULTS

Faculty identified that developing clinical skill that engages multiple specialties, student time to engage in advocacy activities, and opportunities to integrate biomedical, clinical, and behavioral sciences as critical features of the curriculum. They believed the 2040 graduate should be able to critically evaluate literature, exhibit strong leadership skills, and adapt to the changing healthcare environment. To better engage faculty in curriculum change, there needs to be dedicated time, sufficient resources, a clear plan, and greater collaboration across the school.

CONCLUSION

When embarking on curriculum transformation, engagement with faculty is a critical component of the change process. Focus groups can be used as a technique to better understand faculty perspectives about curricular needs and the overall vision.

Faculty development and partnership with students to integrate sustainable healthcare into health professions education

There is an urgent need for health professionals to address the impacts of accelerating global environmental change. Healthcare faculty therefore have to educate the rising generation of health professionals in subjects unfamiliar to themselves, such as planetary health and sustainable healthcare. This creates a new paradigm where faculty have to learn a new subject area and incorporate and teach it within their own material. It is important to develop faculty knowledge and confidence to integrate education for sustainable healthcare into their educational practice, as faculty can rapidly acquire and build on these skills. Partnership between students and faculty can enhance this faculty development as students bring fresh ideas and possibly greater knowledge of the climate and ecological crisis. Under supervision, they can co-create the necessary new learning. Students can also act as partners in advocating for social and environmental fairness and systemic change toward a sustainable healthcare system. We summarize the impact of various activities of health professions students around the world which advocate for institutional change and enhance faculty development in education for sustainable healthcare. Through diverse case studies from different countries, we illustrate faculty development in education for sustainable healthcare, highlighting student involvement which has enhanced educators' learning.