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Hirsh DA, Crampton PES, Osman NY. Applying self-determination theory to stem medical schools' clinical teacher sustainability crisis. MEDICAL EDUCATION 2024; 58:118-128. [PMID: 37593835 DOI: 10.1111/medu.15181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/19/2023]
Abstract
THE PROBLEM Medical schools require highly skilled and committed clinical faculty to teach, assess, supervise and mentor students' clinical care. Medical education is facing a crisis in recruiting and sustaining these clinical teachers. Faced with multiple demands and responsibilities in fast-paced clinical environments, teachers may not have the time, resources or stamina to sustain these critical roles. Medical school leaders must commit to and provide structures and processes to attract, sustain and retain clinical teachers. CONCEPTUAL FRAMEWORK The authors use the lens of self-determination theory to frame approaches to support teacher sustainability. Self-determination theory describes sources of human motivation. The theory and its evidence base characterise three human psychological needs: autonomy, competence, and relatedness. This theory can bridge individual psychological and institutional leadership perspectives to help medical school leaders anticipate and respond to their clinical teachers' needs. The authors propose three practical steps: practices to advance employee-centredness, processes to align individual and institutional values, and restructuring education to support clinical teachers' needs alongside student and patient needs. The authors describe limitations to this relational approach that focuses on leadership actions and consider individual agency as another key factor for sustainability. DISCUSSION Medical school leaders can develop and apply theory-driven approaches to advance sustainability. Sustainability now and in the future requires careful attention to the needs of clinical teachers and to their relationships with and within medical schools.
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Affiliation(s)
- David A Hirsh
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Paul E S Crampton
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Nora Y Osman
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Sousa N, Santa-Cruz A, Melo A, Sousa C, Marques F, Leite-Almeida H, Souza L, Marangoni M, Raia M, Santos M, Goncalves N, Morgado P, Souza P, Matos Sousa R, Gomes S, Santos W, Araújo B, Amaral E, Pereira V, Scoles P. A hitchhikers' guide to the terminology of accreditation processes for health professionals and institutions. MEDEDPUBLISH 2023; 13:11. [PMID: 38028656 PMCID: PMC10652034 DOI: 10.12688/mep.19566.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Accreditation processes for health care professions are designed to ensure that individuals and programs in these fields meet established standards of quality and effectiveness. The accelerating pace of globalization in the health care professions has increased the need for a shared understanding of the vocabulary of evaluation, assessment, and accreditation. The psychometric principles of valid and reliable assessment are commonly accepted, but the terminology is confusing. We believe that all stakeholders - evaluators, faculty, students but also the community - will benefit from a shared language and common set of definitions. We recognize that not all readers will agree with the definitions we propose, but we hope that this guide will help to ensure clarity, consistency, transparency, and fairness, and that it will promote through the stimulation of a debate greater collaboration across national and international boundaries.
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Affiliation(s)
- Nuno Sousa
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Andre Santa-Cruz
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Antonio Melo
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | | | - Fernanda Marques
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Hugo Leite-Almeida
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Lucimara Souza
- Santa Casa de Misericórdia de Belo Horizonte, Minas Gerais, Brazil
| | - Marco Marangoni
- Medical School, Integrado University Center, Campo Mourao, Brazil
| | - Marcia Raia
- School of Medicine, UniEduk group, UniMax Campus, Indaiatuba, Brazil
| | - Maurilio Santos
- School of Medicine, UniEduk group, UniMax Campus, Indaiatuba, Brazil
| | - Nuno Goncalves
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Pedro Morgado
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Pedro Souza
- Santa Casa de Misericórdia de Belo Horizonte, Minas Gerais, Brazil
| | - Rita Matos Sousa
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Sara Gomes
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Wilfredo Santos
- School of Medicine, UniEduk group, UniMax Campus, Indaiatuba, Brazil
| | - Beatriz Araújo
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Eliana Amaral
- School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Vitor Pereira
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
| | - Peter Scoles
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - MAPS
- School of Medicine, University of Minho, Portugal; Clinical Academic Center (2CA), Braga, Portugal
- Inspirali Education, Minas Gerais, Brazil
- Santa Casa de Misericórdia de Belo Horizonte, Minas Gerais, Brazil
- Medical School, Integrado University Center, Campo Mourao, Brazil
- School of Medicine, UniEduk group, UniMax Campus, Indaiatuba, Brazil
- School of Medical Sciences, University of Campinas, Campinas, Brazil
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
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Jamieson S. State of the science: Quality improvement of medical curricula-How should we approach it? MEDICAL EDUCATION 2023; 57:49-56. [PMID: 35950304 PMCID: PMC10087231 DOI: 10.1111/medu.14912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/30/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Quality improvement (QI) of the medical curriculum is generally regarded as a continuous process of evaluating whether the specific curriculum meets relevant educational and professional standards, implementing new activities or other measures to address perceived deficiencies, and subsequently re-evaluating the quality of the curriculum. QI is of consequence to medical learners, educators, patients, carers, specific disciplines and specialties, regulators and funders. METHODS To address how we should approach QI of medical curricula, a narrative review was undertaken, drawing mainly on medical/health professions education literature, identified through searches of the MEDLINE, EMBASE, PUBMED and ERIC databases, and also on exemplar curricular frameworks and evaluation reports. Assumptions and practices in QI of medical curricula were explored critically. RESULTS The review compares alternative conceptualisations of QI; asks questions about priorities and perspectives in what we choose to evaluate; reflects on standards used to guide QI; critically discusses methods, models and theoretical approaches to the generation of evaluation data; and considers ownership of, and engagement with QI of medical curricula. CONCLUSIONS Recommendations for curriculum teams include that discourse is necessary to achieve transparency and a shared understanding of continuous QI in a particular curricular context. Continuous QI requires data collection methods aligned to specific evaluation questions/foci; multiple methods for data collection, from different stakeholders; and appropriate evaluation models and theory to provide a framework for QI. Embracing a quality culture approach may increase the sense of ownership experienced by stakeholders. Mechanisms include creating democratic-collegiate cultures for multiple stakeholders to collaborate in QI; engaging stakeholders in QI activities and (e.g. SoTL) projects that contribute to holistic continuous QI; and proactively embedding quality in the (co-)creation of curriculum components and resources.
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Affiliation(s)
- Susan Jamieson
- School of Medicine, Dentistry & NursingUniversity of GlasgowGlasgowUK
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