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Dusing SC. Igniting the Fire of Discovery: Creating Partnerships Between Research, Education, and Practice. Phys Ther 2024; 104:pzae044. [PMID: 38537275 DOI: 10.1093/ptj/pzae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/01/2024] [Accepted: 03/08/2024] [Indexed: 06/29/2024]
Abstract
In the 28th H.P. Maley Lecture, Stacey Dusing, PT, PhD, FAPTA, shares a perspective on the importance of clinician-scientists in bridging the chasm that currently exists between scholarship and clinical practice. Describing herself as a clinician-scientist, or a qualified health care professional who functions mainly as a career scientist with the other portion of time dedicated to clinical practice, Dusing highlights the potential impact of limited training for clinician-scientists in the physical therapist profession and its impact on the future of physical therapy. She challenges all physical therapists to consider the impact of Commission on Accreditation in Physical Therapy Education requirements on scholarship and the lack of requirement for clinical practice while also recognizing that training programs for clinician-scientists are quite limited. Reviewing some historical data and highlighting possible areas for growth, Dusing calls physical therapists to action in 4 areas. This paper calls all physical therapists, especially educators and administrators, to consider the role of clinician-scientist in promoting physical therapy and knowledge translation. The author challenges the profession to consider whether we are helping to train or embed clinician-scientists in our clinical workplaces to promote knowledge translation. Suggestions are made to improve research and clinical training programs to increase the number of clinician-scientists in physical therapy.
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Affiliation(s)
- Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
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Schmidt M, Pinney B, Canby C, Vargus A, Pille M. An early-curricular team learning activity to foster integration of biochemical concepts and clinical sciences in undergraduate medical education. BIOCHEMISTRY AND MOLECULAR BIOLOGY EDUCATION : A BIMONTHLY PUBLICATION OF THE INTERNATIONAL UNION OF BIOCHEMISTRY AND MOLECULAR BIOLOGY 2024; 52:340-347. [PMID: 38358340 DOI: 10.1002/bmb.21821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 12/20/2023] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
The ability to connect key concepts of biochemistry with clinical presentations is essential for the development of clinical reasoning skills and adaptive expertise in medical trainees. To support the integration of foundational and clinical sciences in our undergraduate health science curricula, we developed a small group active learning exercise during which interprofessional groups of students use clinical cases to explore the biochemistry, diagnostic strategy, and evidence-based treatment options of inborn errors of metabolism (IEM). We designed multistage learning modules consisting of (1.) low-fidelity case simulations of pediatric patients presenting with IEMs, (2.) guided group discussions on clinical biochemistry, differential diagnoses, and diagnostic strategies, (3.) oral presentations of clinical reasoning strategies, and (4.) discussion of relevant evidence-based medicine topics related to the cases. These modules Scientific Knowledge Integrated in Patient Presentations (SKIPPs) were added to a first-semester foundational sciences course serving five health professions programs. The assessment of learning outcomes by students and faculty shows that SKIPPs sessions are well-received activities that significantly improve trainees' ability to integrate foundational science concepts into clinical scenarios, to practice interprofessional teamwork and to develop clinical reasoning skills.
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Affiliation(s)
- Martin Schmidt
- Biochemistry and Nutrition, Des Moines University, West Des Moines, Iowa, USA
| | - Brian Pinney
- Instructional Design and Educational Support Specialist, Center for Educational Enhancement, Des Moines University, West Des Moines, Iowa, USA
| | - Craig Canby
- Associate Dean for Academic Curriculum and Medical Programs, College of Osteopathic Medicine, Des Moines University, West Des Moines, Iowa, USA
| | - April Vargus
- Osteopathic Clinical Medicine, Des Moines University, West Des Moines, Iowa, USA
| | - Marianka Pille
- Specialty Medicine, Des Moines University, West Des Moines, Iowa, USA
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Gonzalo JD, Graaf D, Wolpaw DR, Lehman E, Thompson BM. Non-physician and physician preceptors in Landscapes of Practice: a mixed-methods study exploring learning for 1 st-year medical students in clinical experiences. MEDICAL EDUCATION ONLINE 2023; 28:2166386. [PMID: 36642918 PMCID: PMC9848231 DOI: 10.1080/10872981.2023.2166386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 02/22/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
Medical education has traditionally relied on physician educators. With expanding Health Systems Science competencies, non-physician healthcare providers are required. To investigate preceptor-role types, communication frequency, and importance of preceptors in value-added patient navigator roles (PN) and clinical preceptorships (CP). Using a mixed-methods approach, medical students participating in PN and CP during the first year of medical school (n=191) identified individuals with whom they communicated and communication frequency (1=never, 7=frequently), and importance of preceptors to work/education (1=not important, 7=extremely important; open-ended responses). Quantitative data were analyzed via repeated measures using a mixed-effects model and McNemar's test; effect size was calculated via Cohen's d or Cohen's h; qualitative data was analyzed using thematic analysis. Comparing ratings for non-physicians to physician healthcare professionals in PN, communication frequency (5.54 vs 3.65; p<0.001, d=1.18), importance to work (5.77 vs 4.28, p<0.001, d=0.89) and education (5.02 vs 4.12, p<0.001; d=0.49) were higher for non-physician educators. Comparing ratings for non-physicians to physician healthcare professionals in CP, communication frequency (4.93 vs. 6.48, p<0.001, d=1.33), importance to work (5.12 vs 6.61 vs, p<0.001, d=1.29) and education (4.32 vs 6.55, p<0.001, d=1.89) were higher for physician educators. Qualitative analysis indicated that non-physician healthcare providers in PN focused on Health Systems Science concepts, including social determinants of health and healthcare delivery. In PN, students observed collaboration from the perspective of multiple providers. In CP, healthcare providers, mainly physicians, focused on physician-centric clinical skills and interprofessional collaboration from the physician's perspective. Educational benefits of non-physician healthcare professionals related to Health Systems Science in work-based clinical settings - or Landscapes of Practice - can help students understand systems-based concepts such as social determinants of health, healthcare delivery systems, and interprofessional collaboration. Differences in the educational value of non-physician healthcare educators perceived by students should be further explored.
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Affiliation(s)
- Jed D. Gonzalo
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Deanna Graaf
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Daniel R. Wolpaw
- Department of Medicine, Penn State College of Medicine in Hershey, Pennsylvania, USA
| | - Erik Lehman
- Penn State College of Medicine, Hershey, Pennsylvania, USA
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Krishna LKR, Pisupati A, Ong YT, Teo KJH, Teo MYK, Venktaramana V, Quek CWN, Chua KZY, Raveendran V, Singh H, Wong SLCH, Ng VWW, Loh EKY, Yeoh TT, Owyong JLJ, Chiam M, Ong EK, Phua GLG, Hill R, Mason S, Ong SYK. Assessing the effects of a mentoring program on professional identity formation. BMC MEDICAL EDUCATION 2023; 23:799. [PMID: 37880728 PMCID: PMC10601320 DOI: 10.1186/s12909-023-04748-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 10/04/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Medical education has enjoyed mixed fortunes nurturing professional identity formation (PIF), or how medical students think, feel and act as physicians. New data suggests that structured mentoring programs like the Palliative Medicine Initiative (PMI) may offer a means of developing PIF in a consistent manner. To better understand how a well-established structured research mentoring program shapes PIF, a study of the experiences of PMI mentees is proposed. METHODOLOGY Acknowledging PIF as a sociocultural construct, a Constructivist approach and Relativist lens were adopted for this study. In the absence of an effective tool, the Ring Theory of Personhood (RToP) and Krishna-Pisupati Model (KPM) model were used to direct this dual Systematic Evidence-Based Approach (Dual-SEBA) study in designing, employing and analysing semi-structured interviews with PMI mentees and mentoring diaries. These served to capture changes in PIF over the course of the PMI's mentoring stages. Transcripts of the interviews and mentoring diaries were concurrently analysed using content and thematic analysis. Complementary themes and categories identified from the Split Approach were combined using the Jigsaw Approach and subsequently compared with mentoring diaries in the Funnelling Process. The domains created framed the discussion. RESULTS A total of 12 mentee interviews and 17 mentoring diaries were analysed, revealing two domains-PMI as a Community of Practice (CoP) and Identity Formation. The domains confirmed the centrality of a structured CoP capable of facilitating longitudinal mentoring support and supporting the Socialisation Process along the mentoring trajectory whilst cultivating personalised and enduring mentoring relationships. CONCLUSION The provision of a consistent mentoring approach and personalised, longitudinal mentoring support guided along the mentoring trajectory by structured mentoring assessments lay the foundations for more effective mentoring programs. The onus must now be on developing assessment tools, such as a KPM-based tool, to guide support and oversight of mentoring relationships.
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Affiliation(s)
- Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore.
- Health Data Science, University of Liverpool, 200 London Road, Liverpool, UK.
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, L3 9TA, Liverpool, UK.
- The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore.
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Kelly Jia Hui Teo
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Mac Yu Kai Teo
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Vaishnavi Venktaramana
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Chrystie Wan Ning Quek
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Vijayprasanth Raveendran
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Harpreet Singh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Sabine Lauren Chyi Hui Wong
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Victoria Wen Wei Ng
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Eleanor Kei Ying Loh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Ting Ting Yeoh
- Division of Oncology Pharmacy, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Assisi Hospice, Singapore, Singapore
- Office of Medical Humanities, SingHealth Medicine Academic Clinical Programme, Singapore, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Ruaraidh Hill
- Health Data Science, University of Liverpool, 200 London Road, Liverpool, UK
| | - Stephen Mason
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Rd, L3 9TA, Liverpool, UK
| | - Simon Yew Kuang Ong
- Division of Cancer Education, National Cancer Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
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Held N, Jimenez S, Lockspeiser T, Adams JE. Designing a Shortened Preclinical Basic Science Curriculum: Expert-Derived Recommendations. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:922-928. [PMID: 36972132 DOI: 10.1097/acm.0000000000005221] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE To generate an expert-derived list of recommendations for how medical schools should approach decisions about the placement of basic science topics within shortened preclinical curricula, which allow for early clinical immersion. METHOD A modified Delphi process was used to develop consensus on recommendations (March-November 2021). The authors performed semistructured interviews with national undergraduate medical education (UME) experts from institutions that previously underwent curricular reforms involving shortened preclinical curricula to elicit perspectives on how decisions were made at their institutions. The authors condensed the findings into a preliminary list of recommendations and distributed this list in 2 survey rounds to a larger group of national UME experts (from institutions that previously underwent curricular reforms or held positions of authority within national UME organizations) to gauge their level of agreement with each recommendation. Recommendations were revised based on participant comments, and those with at least 70% somewhat or strong agreement after the second survey were included in the final comprehensive list of recommendations. RESULTS Interviews were conducted with 9 participants and resulted in 31 preliminary recommendations that were then sent via survey to the 40 recruited participants. Seventeen/40 (42.5%) participants completed the first survey, after which 3 recommendations were removed, 5 were added, and 5 were revised based on comments-resulting in 33 recommendations. Twenty-two/38 (57.9%) participants responded to the second survey, after which all 33 recommendations met inclusion criteria. The authors removed 3 recommendations that did not directly address the curriculum reform process and consolidated the final 30 recommendations into 5 succinct, actionable takeaways. CONCLUSIONS This study generated 30 recommendations (summarized by the authors in 5 succinct takeaways) for medical schools designing a shortened preclinical basic science curriculum. These recommendations reinforce the importance of vertically integrating basic science instruction with explicit clinical relevance into all curricular phases.
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Affiliation(s)
- Natalie Held
- N. Held is currently assistant professor in pulmonary sciences and critical care medicine, University of Colorado School of Medicine, Aurora, Colorado. At the time of the study, she was a pulmonary and critical care fellow and a Department of Medicine medical education fellow, University of Colorado School of Medicine, Aurora, Colorado
| | - Sheilah Jimenez
- S. Jimenez is a research services senior professional and curriculum research assistant, Office of Assessment, Evaluation, and Outcomes, Office of Medical Education, University of Colorado School of Medicine, Aurora, Colorado
| | - Tai Lockspeiser
- T. Lockspeiser is associate professor of pediatrics and assistant dean of medical education for assessment, evaluation, and outcomes, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer E Adams
- J.E. Adams is professor of medicine and assistant dean of medical education for clinical curriculum, University of Colorado School of Medicine, Aurora, Colorado; ORCID: https://orcid.org/0000-0002-5433-8600
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Warman KL, Silver EJ. Get SMART: Teaching Pediatric Residents the 2020 Focused Asthma Updates' Recommendations for Symptom-Based Medication Increases. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11320. [PMID: 37441565 PMCID: PMC10333455 DOI: 10.15766/mep_2374-8265.11320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 03/15/2023] [Indexed: 07/15/2023]
Abstract
Introduction The 2020 Focused Asthma Updates introduced a paradigm shift in the treatment of asthma that includes symptom-based adjustments to outpatient asthma treatment that vary by age and severity. The length and complexity of the updates have made them challenging to adopt. Methods We implemented an educational session among pediatric residents to increase their familiarity with, comprehension of, and plans to adopt two evidence-based recommendations introduced in the 2020 Updates for symptom-based therapy. Facilitators led groups of four to six pediatric residents in cased-based discussions during a 30-minute, ambulatory care-based session. One week prior, participants and facilitators received synopses of the 2007 Guidelines for the Diagnosis and Management of Asthma and the 2020 Updates. Facilitators also received a guide and scripts explaining new concepts, providing supporting data, and highlighting learning objectives. Retrospective pre/post surveys assessed participants' familiarity with, comprehension of, and planned adoption of recommendations for intermittent steroids and single maintenance and reliever therapy (SMART) before and after the conference. The surveys also assessed prior exposure to the 2020 Updates and reflections on the educational session. Results There were 26 participants. Ratings of familiarity, comprehension, and adoption plans regarding the recommendations significantly improved (ps < .001, Wilcoxon signed rank test). The case-based approach was well received, and the material was deemed relevant. Discussion This educational session significantly increased pediatric residents' familiarity with, comprehension of, and plans to adopt two new evidence-based treatments. Dissemination of this educational session may improve outpatient asthma management.
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Affiliation(s)
- Karen L. Warman
- Associate Professor, Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine
| | - Ellen Johnson Silver
- Professor, Division of Academic General Pediatrics, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine
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Schubert S, Buus N, Monrouxe LV, Hunt C. The development of professional identity in clinical psychologists: A scoping review. MEDICAL EDUCATION 2023. [PMID: 36922739 DOI: 10.1111/medu.15082] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/16/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Our professional identity refers to our sense of who we are and how we should behave as professionals. Professional identities are developed through socialisation processes: Established ways of knowing and doing are acquired and reproduced. The professional identities of health care professionals have implications for the realisation of health care reforms that require new ways of being and doing from clinicians. Tension and frustration can arise when professional identities are incongruent with reform directions. More knowledge is required about the professional identities of mental health care professionals-including clinical psychologists-so that they can be supported to develop professional identities that align with health care system reforms. METHOD We undertook a scoping review of existing literature aiming to (i) identify the relevant literature; (ii) review the literature quality; (iii) thematically summarise the literature findings; (iv) consult with clinical psychologists; and (v) identify recommendations for research, training and practice. RESULTS A systematic database search (PsycINFO, CINAHL, Scopus and Web of Science) identified 24 relevant published articles and dissertations. Quantitative studies were excluded due to their markedly different research focus. Included studies were independently reviewed and findings summarised. Findings were organised around three themes: 'integration of personal and professional identities', 'intersectionality' and 'changes in professional identity over time'. Research quality issues were identified. The trustworthiness of the findings was corroborated in consultation with clinical psychologists. DISCUSSION Clinical psychologists recognise their professional identities as being interrelated with their personal identities and changing over time. They recognised professional identity as important yet inadequately considered in the profession. The research area is emerging yet remains undertheorised and requires improved research methodologies. Future theoretically informed research is required to build up a credible research base to better understand the development of clinical psychologists' professional identities so that this process can be facilitated to enable the realisation of health care reforms.
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Affiliation(s)
- Samantha Schubert
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Niels Buus
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Lynn V Monrouxe
- The Faculty of Medicine and Health, The University of Sydney-Waranara, Sydney, New South Wales, Australia
| | - Caroline Hunt
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
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Armstrong RW, Mantel M, Walraven G, Atwoli L, Ngugi AK. Medical education and population health-A framework in the design of a new undergraduate program. Front Public Health 2022; 10:1068092. [PMID: 36568761 PMCID: PMC9768212 DOI: 10.3389/fpubh.2022.1068092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Health sciences curricular planners are challenged to add new content to established education programs. There is increasing pressure for content in public health, health systems, global health, and planetary health. These important areas often compete for curricular time. What is needed is a convergence model that builds a common framework within which students can integrate areas and better align this knowledge to the individual client or patient who they have responsibility to support. A population health framework is proposed for health sciences education programs that supports a common conceptual understanding of population health. The framework links five thematic areas that have influence on health and wellbeing and a sixth element that defines the range of methodologies essential to understanding health and wellbeing, from the individual to the population. The five areas providing convergence are: (1) the biopsychosocial development of the individual, (2) the socioeconomic factors that influence health and wellbeing, (3) the physical natural and built environment including climate, (4) the continuum of public health and health care systems, and (5) the nation state and global relationships. Using this framework, students are encouraged to think and understand individual health and wellbeing in context to the population and to utilize the appropriate methodological tools to explore these relationships. Planning for a new undergraduate medicine program illustrates the curricular elements that will be used to support student learning with foundation knowledge applied and tracked throughout the program. The proposed framework has application across health sciences disciplines and serves to build a common understanding that supports cross professional communication and collaboration.
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Affiliation(s)
- Robert W. Armstrong
- Medical College, Aga Khan University, Nairobi, Kenya,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada,The Health Associates Ltd, Berlin, Germany
| | | | | | - Lukoye Atwoli
- Department of Medicine, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Anthony K. Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya,*Correspondence: Anthony K. Ngugi
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Yu C, Liu Q, Wang W, Xie A, Liu J. Professional Identity of 0.24 Million Medical Students in China Before and During the COVID-19 Pandemic: Three Waves of National Cross-Sectional Studies. Front Public Health 2022; 10:868914. [PMID: 35400047 PMCID: PMC8989960 DOI: 10.3389/fpubh.2022.868914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Professional identity (PI) influences the doctor's thoughts and behaviors. Thus, PI formation (PIF) plays an important role in medical students' education. Major changes to the learning environment could impact PIF, but the influence of the novel coronavirus disease 2019 (COVID-19) pandemic on medical students' PI had confusing conclusions in previous studies. We aimed to compare PI of medical students by using the data from three waves of national cross-sectional surveys conducted in China in 2019, 2020, and 2021, and to examine factors that influence PIF. Method We used data from the China Medical Student Survey (CMSS) which has conducted three national cross-sectional surveys. From 2019 to 2021, CMCC retrieved data on PI from a nationally representative sample of medical students from 33, 121, and 123 colleges, respectively. We analyzed the data using Chi-square test, analysis of variance, and multivariable logistic regression according to sociodemographic characteristics, pre-university experience, college characteristics, and college experience. Results A total of 244,040 medical students in China participated in the surveys. The overall score of PI increased from 3.80 in 2019 to 3.85 in 2021. Medical students with family medical background, high intrinsic and extrinsic motivation of major selection, teachers' positive role model, and high personal comprehensive quality ranking were more likely to have higher PI (all p < 0.05). The more attention students paid to the COVID-19 pandemic, the higher PI they would have (aOR 1.93, 95% CI 1.67-2.24 for more attention; aOR 2.31, 95% CI 2.00-2.68 for the most attention). However, parents' participation on the front lines of COVID-19 pandemic negatively influenced the PI of medical students (aOR 0.72, 95% CI 0.57-0.93). Conclusions PI of medical students increased during the COVID-19 pandemic. The impact of the pandemic on PI was complex. To improve the PI of medical students, the education sector, health sector and the society need to make concerted efforts.
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Affiliation(s)
- Chen Yu
- National Center for Health Professions Education Development, Peking University, Beijing, China.,Department of Medical Education, Peking University, Beijing, China
| | - Qiao Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Weimin Wang
- National Center for Health Professions Education Development, Peking University, Beijing, China.,Department of Medical Education, Peking University, Beijing, China.,Peking University Health Science Center, Beijing, China
| | - Ana Xie
- National Center for Health Professions Education Development, Peking University, Beijing, China.,Department of Medical Education, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Department of Global Health and Development, Peking University, Beijing, China
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Nguyen B, Athauda G, Kashan SB, Weiler T, Toonkel RL. Osteoporosis: A Small-Group Case-Based Learning Activity. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2021; 17:11176. [PMID: 34527808 PMCID: PMC8403690 DOI: 10.15766/mep_2374-8265.11176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Osteoporosis is the most common bone disease in the world. Approximately 50% of women and 20% of men over 50 will suffer an osteoporosis-related fracture. Future health care providers must be equipped to prevent, recognize, and treat osteoporosis-related fractures. METHODS To supplement instruction on osteoporosis, we designed a case-based session. Groups of 10-12 second-year medical students worked with a single facilitator in a roundtable discussion. The 120-minute session integrated foundational sciences (pathology, physiology, pharmacology) and clinical disciplines (clinical skills, radiology, geriatrics, evidence-based medicine). Knowledge gains were assessed by performance on nine session-relevant multiple-choice questions (MCQs) on the final exam. Student satisfaction was assessed by an anonymous postsession survey. RESULTS There were 121 students that participated, and their average performance on nine session-relevant final exam MCQs was 84%. After removal of a single outlier MCQ (15% correct), average performance on the remaining eight MCQs was 93%. A total of 107 students (88%) responded to the postsession survey. On a 5-point Likert scale, 101 of 107 students (94%) agreed or strongly agreed with the statement "The basic science-clinical combination lecture on osteoporosis followed by the small-group case discussion on osteoporosis prepared me adequately to understand the topic" (M = 4.56, SD = 0.63). DISCUSSION We developed a case-based learning activity for preclinical medical students to enhance the clinical scaffolding of basic science and medical knowledge around osteoporosis. Students performed well on session-relevant exam questions, demonstrating competency in the educational objectives. Student satisfaction was high, with most students feeling well prepared.
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Affiliation(s)
- Bianca Nguyen
- Medical Student, Florida International University Herbert Wertheim College of Medicine
| | - Gagani Athauda
- Associate Professor, Department of Cellular Biology and Pharmacology, Florida International University Herbert Wertheim College of Medicine
| | - Sanaz B. Kashan
- Assistant Professor, Department of Humanities, Health, and Society, Florida International University Herbert Wertheim College of Medicine
| | - Tracey Weiler
- Associate Professor, Department of Human and Molecular Genetics, Florida International University Herbert Wertheim College of Medicine
| | - Rebecca L. Toonkel
- Associate Professor, Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine
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Balmer DF, Teunissen PW, Devlin MJ, Richards BF. Stability and Change in the Journeys of Medical Trainees: A 9-Year, Longitudinal Qualitative Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:906-912. [PMID: 32852322 DOI: 10.1097/acm.0000000000003708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
PURPOSE It takes many years for trainees to become physicians-so long that their individual journeys through medical school and residency are seldom systematically studied and thus not well understood. Lack of understanding hinders effective support of future physicians' development across traditional time-bound phases of medical education. The authors initiated a longitudinal qualitative study, tracing a cohort of 6 trainees through the same medical school and 6 different residencies. They asked, how do stability and change characterize the lived experience of trainees through time? METHOD From 2010 to 2019, the authors conducted in-depth interviews every 6 to 12 months with 6 trainees, using reflective prompts about formative events and prior interviews. Data were inductively coded and analyzed in an iterative fashion. By scrutinizing data via time-ordered displays of codes, the authors identified 3 patterns of stability and change, particularly related to constructing careers in medicine. The study originated at a private medical school in New York, New York. RESULTS Patterns in the balance between stability and change were shaped by trainees' career interests. Trainees motivated by stable clinical interests perceived their journey as a "series of stepping-stones." Trainees motivated by evolving clinical interests described disruptive change or "upsets"; however, they were still accommodated by medical education. In contrast, trainees motivated by stable nonclinical (i.e., social science) interests perceived their journey as a "struggle" in residency because of the clinically heavy nature of that phase of training. CONCLUSIONS Based on this descriptive, 9-year study of a small number of trainees, medical education seems to accommodate trainees whose journeys are motivated by clinical interests, even if those clinical interests change through time. Medical education could consider alternatives to time-bound frames of reference and focus on the right time for trainees to integrate clinical and social sciences in medical training.
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Affiliation(s)
- Dorene F Balmer
- D.F. Balmer is associate professor of pediatrics, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; ORCID: http://orcid.org/0000-0001-6805-4062
| | - Pim W Teunissen
- P.W. Teunissen is professor of workplace learning in healthcare, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, and gynecologist, Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Michael J Devlin
- M.J. Devlin is professor of clinical psychiatry, Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Boyd F Richards
- B.F. Richards is professor of pediatrics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Norris ME, Cachia MA, Johnson MI, Martin CM, Rogers KA. Are Clerks Proficient in the Basic Sciences? Assessment of Third-Year Medical Students' Basic Science Knowledge Prior to and at the Completion of Core Clerkship Rotations. MEDICAL SCIENCE EDUCATOR 2021; 31:709-722. [PMID: 34457921 PMCID: PMC8368550 DOI: 10.1007/s40670-021-01249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 06/13/2023]
Abstract
Basic sciences are a cornerstone of undergraduate medical education (UME), yet research indicates that students' basic science knowledge is not well retained. Many UME curricula are increasing the integration between the basic and clinical sciences with the goal of enhancing students' knowledge levels; however, the impact of clerkship training on students' basic science knowledge remains inconclusive. Thus, using clerkship directors' expectations as framework, we aimed to assess third-year medical students' basic science knowledge during clerkship training and evaluate the influence of clerkship training on their basic science knowledge. Using concepts deemed necessary by clerkship directors, we created a basic science assessment for each clerkship rotation. Assessments were distributed to third-year medical students as a pre- and post-test to assess their basic science knowledge prior to and at the completion of each rotation. On average, students retained ≥ 60% of relevant basic science knowledge from pre-clerkship, and neither clerkship rotation order, nor the basic science discipline being assessed, impacted students' basic science knowledge levels. Post-test data revealed that students, on average, reinforced fundamental concepts during clerkship. Interestingly, even though lower-performing students demonstrated the greatest post-test improvement, they still left each rotation with knowledge deficits compared with their highest-performing peers, suggesting that the clinical experience of clerkship appears to be particularly beneficial for lower-performing students, in regard to enhancing their basic science knowledge. Overall, results indicate that earlier exposure to clinical learning in UME, along with integration of basic science education into clerkship, could promote students' basic science knowledge acquisition and retention.
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Affiliation(s)
- Madeleine E. Norris
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON Canada
| | - Mark A. Cachia
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON Canada
| | - Marjorie I. Johnson
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON Canada
| | - Charys M. Martin
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON Canada
| | - Kem A. Rogers
- Department of Anatomy and Cell Biology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON Canada
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Gupta M, Forlini C, Laneuville L. The Hidden Curriculum in Ethics and its Relationship to Professional Identity Formation: A Qualitative Study of Two Canadian Psychiatry Residency Programs. CANADIAN JOURNAL OF BIOETHICS 2020. [DOI: 10.7202/1073550ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The residency years comprise the last period of a physician’s formal training. It is at this stage that trainees consolidate the clinical skills required for independent practice and achieve a level of ethical development essential to their work as physicians, a process known as professional identity formation (PIF). Ethics education is thought to contribute to ethical development and to that end the Royal College of Physicians and Surgeons of Canada (RCPSC) requires that formal ethics education be integrated within all postgraduate specialty training programs. However, a formal ethics curriculum can operate in parallel with informal and hidden ethics curricula, the latter being more subtle, pervasive, and influential in shaping learner attitudes and behavior. This paper reports on a study of the formal, informal, and hidden ethics curricula at two postgraduate psychiatry programs in Canada. Based on the analysis of data sources, we relate the divergences between the formal, informal, and hidden ethics curricula to two aspects of professional identity formation (PIF) during psychiatry residency training. The first is the idea of group membership. Adherence to the hidden curriculum in certain circumstances determines whether residents become part of an in-group or demonstrate a sense of belonging to that group. The second aspect of PIF we explore is the ambiguous role of the resident as a student and a practitioner. In ethically challenging situations, adherence to the messages of the hidden curriculum is influenced by and influences whether residents act as students, practitioners, or both. This paper describes the hidden curriculum in action and in interaction with PIF. Our analysis offers a complementary, empirical perspective to the theoretical literature concerning PIF in medical education. This literature tends to position sound ethical decision-making as the end result of PIF. Our analysis points out that the mechanism works in both directions: how residents respond to hidden curriculum in ethics can be a driver of professional identity formation.
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Affiliation(s)
- Mona Gupta
- Département de Psychiatrie et d’Addictologie, Université de Montréal, Montréal, Quebec, Canada
| | - Cynthia Forlini
- School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
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14
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Demiroren M, Atilgan B, Tasdelen Teker G, Turan S. From the lens of the clinical residents: undergraduate to postgraduate medical education and the transition process. Postgrad Med J 2020; 97:547-555. [PMID: 32938757 DOI: 10.1136/postgradmedj-2020-138502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 11/03/2022]
Abstract
The concept of continuity in medical education reflects the progressive professional and personal development that physicians need in education. The aim of this study is investigating the views of the residents about the adequacy of undergraduate and postgraduate education in the context of preparing them for the next stage and their perceptions about the transition period. This phenomenological study was conducted at Hacettepe University Medical School. The study group consisted of medical and surgical sciences residents in the first year and last year of postgraduate medical education. Four focus group interviews were held with the participation of 21 residents. The participants emphasised that practising with real patients under supervision by taking an active role in healthcare teams was important for their preparation for the next stage in their carrier. However, their educational experiences during undergraduate medical education differed in community-based education, scientific research training, learning in small groups, internship and guidance of clinical educators. The transition period has been expressed with the concepts of identity change, high responsibilities and expectations required by the new identity, adaptation to the healthcare team, institution, and health system, meeting the expectations in an overly busy work environment, and feelings of incompetence. Participants pointed out that curriculum, which was declared and taught, educational environments, assessment approaches, consultancy systems and practices differed between the clinical departments. In line with the principles of competency-based education, practices related to the development and assessment of the competencies with all professional aspects in postgraduate medical education can be strengthened.
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Affiliation(s)
- Meral Demiroren
- Medical Education and Informatics, Hacettepe University, Ankara, Turkey
| | - Burge Atilgan
- Medical Education and Informatics, Hacettepe University, Ankara, Turkey
| | | | - Sevgi Turan
- Medical Education and Informatics, Hacettepe University, Ankara, Turkey
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15
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Witter S, Hamza MM, Alazemi N, Alluhidan M, Alghaith T, Herbst CH. Human resources for health interventions in high- and middle-income countries: findings of an evidence review. HUMAN RESOURCES FOR HEALTH 2020; 18:43. [PMID: 32513184 PMCID: PMC7281920 DOI: 10.1186/s12960-020-00484-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/28/2020] [Indexed: 05/28/2023]
Abstract
Many high- and middle-income countries face challenges in developing and maintaining a health workforce which can address changing population health needs. They have experimented with interventions which overlap with but have differences to those documented in low- and middle-income countries, where many of the recent literature reviews were undertaken. The aim of this paper is to fill that gap. It examines published and grey evidence on interventions to train, recruit, retain, distribute, and manage an effective health workforce, focusing on physicians, nurses, and allied health professionals in high- and middle-income countries. A search of databases, websites, and relevant references was carried out in March 2019. One hundred thirty-one reports or papers were selected for extraction, using a template which followed a health labor market structure. Many studies were cross-cutting; however, the largest number of country studies was focused on Canada, Australia, and the United States of America. The studies were relatively balanced across occupational groups. The largest number focused on availability, followed by performance and then distribution. Study numbers peaked in 2013-2016. A range of study types was included, with a high number of descriptive studies. Some topics were more deeply documented than others-there is, for example, a large number of studies on human resources for health (HRH) planning, educational interventions, and policies to reduce in-migration, but much less on topics such as HRH financing and task shifting. It is also evident that some policy actions may address more than one area of challenge, but equally that some policy actions may have conflicting results for different challenges. Although some of the interventions have been more used and documented in relation to specific cadres, many of the lessons appear to apply across them, with tailoring required to reflect individuals' characteristics, such as age, location, and preferences. Useful lessons can be learned from these higher-income settings for low- and middle-income settings. Much of the literature is descriptive, rather than evaluative, reflecting the organic way in which many HRH reforms are introduced. A more rigorous approach to testing HRH interventions is recommended to improve the evidence in this area of health systems strengthening.
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Affiliation(s)
- Sophie Witter
- Queen Margaret University, Edinburgh, United Kingdom
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16
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Gonzalo JD, Davis C, Thompson BM, Haidet P. Unpacking Medical Students' Mixed Engagement in Health Systems Science Education. TEACHING AND LEARNING IN MEDICINE 2020; 32:250-258. [PMID: 31875724 DOI: 10.1080/10401334.2019.1704765] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Phenomenon: Medical education is better aligning with the needs of health systems. Health systems science competencies, such as high-value care, population health, and systems thinking, are increasingly being integrated into curricula, but not without challenges. One challenge is mixed receptivity by students, the underlying reasons of which have not been extensively explored. In this qualitative study, we explored the research question: "How do students perceive health systems science curricula across all four years, and how do such perceptions inform the reasons for mixed quality ratings?" Approach: Following large-scale health systems science curricular changes in their medical school, we used students' open-ended comments obtained from course evaluations related to 1st-, 2nd-, and 4th-year courses and performed a qualitative thematic analysis to explore students' perceptions. We identified themes, synthesized findings into a conceptual figure, and agreed upon results and quotations. Findings: Five themes were identified: (1) perceived importance and relevance of health systems science education, (2) tension between traditional and evolving health systems science-related professional identity, (3) dissatisfaction with redundancy of topics, (4) competition with basic and clinical science curricula, and, (5) preference for discrete, usable, testable facts over complexity and uncertainty. The relationship between themes is described along a continuum of competing agendas between students' traditional mindset (which focuses on basic/clinical science) and an emerging medical education approach (which focuses on basic, clinical, and health systems science). Insights: Health systems science education can be viewed by learners as peripheral to their future practice and not aligned with a professional identity that places emphasis on basic and clinical science topics. For some students, this traditional identity limits engagement in health systems science curricula. If health systems science is to achieve its full potential in medical education, further work is required to explore the adoption of new perspectives by students and create activities to accelerate the process.
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Affiliation(s)
- Jed D Gonzalo
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Christopher Davis
- Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Britta M Thompson
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paul Haidet
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Scudder DR, Sherry AD, Jarrett RT, Fernando S, Kuhn AW, Fleming AE. Fundamental Curriculum Change with 1-Year Pre-Clerkship Phase and Effect on Stress Associated with Residency Specialty Selection. MEDICAL SCIENCE EDUCATOR 2019; 29:1033-1042. [PMID: 34457581 PMCID: PMC8368347 DOI: 10.1007/s40670-019-00800-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Vanderbilt University School of Medicine recently changed from 2 pre-clerkship years (Traditional curriculum) to a 1.5-year pre-clerkship phase for one class (Hybrid curriculum) to a 1-year pre-clerkship phase (Curriculum 2.0). This study investigated the relationship between shortened pre-clerkship training and stress associated with selecting a residency field. The surveyed graduating medical student population included one cohort from the Traditional and Hybrid curricula, and the first two cohorts from Curriculum 2.0. The authors modeled recollected stress levels using a Zero-Inflated Linear Mixed Model with additional covariate and random effects adjustments. Specialty decision-related stress levels increased in the Hybrid curriculum by 10.208 points [p = 0.0115, 95% CI 2.293, 18.122] on a 0-100 point scale. Curriculum 2.0 students had an insignificant increase in stress of 4.062 points [p = 0.304, 95% CI - 3.690, 11.814] relative to the Traditional curriculum. Time since starting medical school and time when a specialty was chosen were the largest factors associated with stress. While this study only evaluated a single facet of the potential downstream effects of curricular change, these data should inspire confidence for reform efforts as a significant increase in specialty decision-related stress present in Hybrid curriculum resolved in both cohorts of Curriculum 2.0.
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Affiliation(s)
- David R. Scudder
- Vanderbilt University School of Medicine, Nashville, TN USA
- Departments of Internal Medicine and Pediatrics, University of Colorado School of Medicine, Aurora, CO USA
| | | | - Ryan T. Jarrett
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Shanik Fernando
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Andrew W. Kuhn
- Vanderbilt University School of Medicine, Nashville, TN USA
| | - Amy E. Fleming
- Vanderbilt University School of Medicine, Nashville, TN USA
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Keeley MG, Gusic ME, Morgan HK, Aagaard EM, Santen SA. Moving Toward Summative Competency Assessment to Individualize the Postclerkship Phase. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1858-1864. [PMID: 31169542 DOI: 10.1097/acm.0000000000002830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
In the move toward competency-based medical education, leaders have called for standardization of learning outcomes and individualization of the learning process. Significant progress has been made in establishing defined expectations for the knowledge, skills, attitudes, and behaviors required for successful transition to residency training, but individualization of educational processes to assist learners in reaching these competencies has been predominantly conceptual to date. The traditional time-based structure of medical education has posed a challenge to individualization within the curriculum and has led to more attention on innovations that facilitate transition from medical school to residency. However, a shift of focus to the clerkship-to-postclerkship transition point in the undergraduate curriculum provides an opportunity to determine how longitudinal competency-based assessments can be used to facilitate intentional and individualized structuring of the long-debated fourth year.This Perspective demonstrates how 2 institutions-the University of Virginia School of Medicine and the University of Michigan Medical School-are using competency assessments and applying standardized outcomes in decisions about individualization of the postclerkship learning process. One institution assesses Core Entrustable Professional Activities for Entering Residency, whereas the other has incorporated Accreditation Council for Graduate Medical Education core competencies and student career interests to determine degrees of flexibility in the postclerkship phase. Individualization in addition to continued assessment of performance presents an opportunity for intentional use of curriculum time to develop each student to be competently prepared for the transition to residency.
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Affiliation(s)
- Meg G Keeley
- M.G. Keeley is assistant dean for student affairs, director of the fourth-year program, and professor of pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia; ORCID: https://orcid.org/0000-0001-8602-2638. M.E. Gusic is senior advisor in educational affairs and professor of medical education, University of Virginia School of Medicine, Charlottesville, Virginia. H.K. Morgan is associate professor of learning health sciences and associate professor of obstetrics and gynecology, University of Michigan Medical School, Ann Arbor, Michigan. E.M. Aagaard is senior associate dean for education and professor of medicine, Washington University School of Medicine, St. Louis, Missouri. S.A. Santen is senior associate dean for assessment, evaluation, and scholarship and professor of emergency medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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Friedman K, Lester J, Young JQ. Clinician-Educator Tracks for Trainees in Graduate Medical Education: A Scoping Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1599-1609. [PMID: 31169537 DOI: 10.1097/acm.0000000000002814] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Clinician-educator tracks (CETs) appear to be increasing in prevalence in graduate medical education (GME) and may play an important role in medical education workforce development. The authors conducted a scoping review to characterize the current state of knowledge about CETs' structure, content, and outcomes. METHOD Six databases were searched in January 2018 for English-language peer-reviewed articles published through 2017 to identify articles describing CETs in GME. To be included, the CET had to target GME learners (residents/fellows), be longitudinal, have the primary aim of developing trainees into clinician-educators (CEs), and address at least one CE core competency (direct teaching, curriculum development, mentorship/advising, leadership, assessment, educational scholarship). The authors extracted and analyzed data from included articles. RESULTS Of 1,434 articles identified, 19 were included in the review, representing 18 separate CETs. All but 2 CETs (11%) were specialty-specific. Most included a core curriculum with classroom-based sessions (18; 100%), workplace-based opportunities to practice skills (17; 94%), and a required scholarly project (16; 89%). Seventeen (94%) focused on skills related to direct teaching. Four (22%) identified mentoring/advising as a core curriculum focus. Five (28%) required project dissemination. Time spent in CETs varied widely (median: 166 hours; range: 8 hours/4-month period to 1,288 hours/2-year period). The most common reported outcomes were learner reactions (7; 39%) and career tracking (11; 61%). CONCLUSIONS This review yields a composite picture of the current state of CETs in GME. The results highlight the paucity of outcomes data and areas for potential standardization and future research.
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Affiliation(s)
- Karen Friedman
- K. Friedman is associate professor of medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York. J. Lester is reference and education librarian, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York. J.Q. Young is professor of psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Henschen BL, Ryan ER, Evans DB, Truong A, Wayne DB, Bierman JA, Cameron KA. Perceptions of Patient-Centered Care among First-Year Medical Students. TEACHING AND LEARNING IN MEDICINE 2019; 31:26-33. [PMID: 29847155 DOI: 10.1080/10401334.2018.1468260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Phenomenon: Teaching patient-centered care (PCC) is a key component of undergraduate medical curricula. Prior frameworks of PCC describe multiple domains of patient-centeredness, ranging from interpersonal encounters to systems-level issues. Medical students' perceptions of PCC are thought to erode as they progress through school, but little is known about how students view PCC toward the beginning of training. This study explores the perceptions of PCC among 1st-year medical students to inform curricular development and evaluation. Approach: Medical students participated in semistructured, in-person interviews within 4 months of starting medical school as part of a longitudinal study. Transcripts were analyzed using a grounded theory approach and the constant comparative method to describe responses and characterize emergent themes. Transcripts were reviewed to compare codes and compile a final codebook. Findings: Thirty-eight students completed interviews. Students provided heterogeneous definitions of PCC, including perceptions that PCC is implicit and obvious. Many students were unable to provide a concrete definition of PCC, juxtaposing PCC with other priorities such as profit- or physician-centered care, whereas others thought the term was jargon. Some participants defined PCC as upholding patient values using hypothetical examples centered around physician behavior. Insights: Although students appeared to enter medical school with a range of perceptions about PCC, many of their descriptions were limited and only scratch the surface of existing frameworks. Rather than their perceptions of PCC eroding during medical school, students may never fully develop a foundational understanding of PCC. Our findings reinforce the need for authentic, clinically experiential learning opportunities that promote PCC from the earliest stages of medical education.
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Affiliation(s)
- Bruce L Henschen
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Elizabeth R Ryan
- b Department of Family and Community Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Daniel B Evans
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Ashley Truong
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Diane B Wayne
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Jennifer A Bierman
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
| | - Kenzie A Cameron
- a Division of General Internal Medicine and Geriatrics, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , Illinois , USA
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21
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Fischel JE, Olvet DM, Iuli RJ, Lu WH, Chandran L. Curriculum reform and evolution: Innovative content and processes at one US medical school. MEDICAL TEACHER 2019. [PMID: 29527967 DOI: 10.1080/0142159x.2018.1444268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIM Curriculum reform in medical schools continues to be an ever-present and challenging activity in medical education. This paper describes one school's experiences with specific curricular innovations that were developed or adapted and targeted to meet a clear set of curricular goals during the curriculum reform process. Those goals included: (a) promoting active learning and learner engagement; (b) establishing early professional identity; and (c) developing physician competencies in an integrated and contextual manner while allowing for individualized learning experiences for the millennial student. METHODS Six specific innovations championed by the school are described in detail. These included Themes in Medical Education, Translational Pillars, Stony Brook Teaching Families, Transition Courses, Educational Continuous Quality Improvement Processes, and our Career Advising Program. Development of the ideas and design of the innovations were done by faculty and student teams. RESULTS We discuss successes and ongoing challenges with these innovations which are currently in the fourth year of implementation. CONCLUSIONS Our curriculum reform has emphasized the iterative process of curriculum building. Based on our experience, we discuss general and practical guidelines for curriculum innovation in its three phases: setting the stage, implementation, and monitoring for the achievement of intended goals.
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Affiliation(s)
- Janet E Fischel
- a Department of Pediatrics , Stony Brook University School of Medicine , Stony Brook , NY , USA
| | - Doreen M Olvet
- b Office of Academic and Faculty Affairs , Stony Brook University School of Medicine , Stony Brook , NY , USA
| | - Richard J Iuli
- b Office of Academic and Faculty Affairs , Stony Brook University School of Medicine , Stony Brook , NY , USA
| | - Wei-Hsin Lu
- b Office of Academic and Faculty Affairs , Stony Brook University School of Medicine , Stony Brook , NY , USA
| | - Latha Chandran
- b Office of Academic and Faculty Affairs , Stony Brook University School of Medicine , Stony Brook , NY , USA
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Borah BF. Longitudinal Service Learning in Medical Education: An Ethical Analysis of the Five-Year Alternative Curriculum at Stritch School of Medicine. THE JOURNAL OF MEDICAL HUMANITIES 2018; 39:407-416. [PMID: 30079441 DOI: 10.1007/s10912-018-9529-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this article, the author explores a model of alternative medical education being pioneered at Loyola University Chicago Stritch School of Medicine. The five-year Global Health Fieldwork Fellowship (GHFF) track allows two students per year to complete an extra year of medical education while living and working in a free rural clinic in the jungle lowlands of Bolivia. This alternative curricular track is unique among other existing models in that it is (a) longitudinally immersive for at least one full additional year of medical education, (b) grounded in clinical and service learning, and (c) heavily focused upon global health and the social components of medicine. Studies have shown that both longitudinal alternative medical curricular tracks and short-term global health electives have long-term benefits upon the professional development of participants, suggesting that the GHFF is likely to do the same. The author also argues that the GHFF is an advantageous model of global health education compared to standard offerings and provides a unique curricular model by which to foster the development of social values-such as professionalism, advocacy, and social justice-that are widely considered lacking in today's medical education.
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Affiliation(s)
- Brian F Borah
- Internal Medicine Resident, University of Illinois at Chicago, 1108 N. Damen Ave. Apt #2F, Chicago, IL, 60622, USA.
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Heiman HL, O'Brien CL, Curry RH, Green MM, Baker JF, Kushner RF, Thomas JX, Corbridge TC, Corcoran JF, Hauser JM, Garcia PM. Description and Early Outcomes of a Comprehensive Curriculum Redesign at the Northwestern University Feinberg School of Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:593-599. [PMID: 28953569 DOI: 10.1097/acm.0000000000001933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In 2012, the Northwestern University Feinberg School of Medicine launched a redesigned curriculum addressing the four primary recommendations in the 2010 Carnegie Foundation for the Advancement of Teaching report on reforming medical education. This new curriculum provides a more standardized evaluation of students' competency achievement through a robust portfolio review process coupled with standard evaluations of medical knowledge and clinical skills. It individualizes learning processes through curriculum flexibility, enabling students to take electives earlier and complete clerkships in their preferred order. The new curriculum is integrated both horizontally and vertically, combining disciplines within organ-based modules and deliberately linking elements (science in medicine, clinical medicine, health and society, professional development) and threads (medical decision making, quality and safety, teamwork and leadership, lifestyle medicine, advocacy and equity) across the three phases that replaced the traditional four-year timeline. It encourages students to conduct research in an area of interest and commit to lifelong learning and self-improvement. The curriculum formalizes the process of professional identity formation and requires students to reflect on their experiences with the informal and hidden curricula, which strongly shape their identities.The authors describe the new curriculum structure, explain their approach to each Carnegie report recommendation, describe early outcomes and challenges, and propose areas for further work. Early data from the first cohort to progress through the curriculum show unchanged United States Medical Licensing Examination Step 1 and 2 scores, enhanced student research engagement and career exploration, and improved student confidence in the patient care and professional development domains.
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Affiliation(s)
- Heather L Heiman
- H.L. Heiman is associate professor, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. C.L. O'Brien is instructor, Department of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. R.H. Curry is professor, Departments of Medicine and Medical Education, and senior associate dean for educational affairs, University of Illinois College of Medicine, Chicago, Illinois. M.M. Green is associate professor, Departments of Medicine and Medical Education, and senior associate dean for medical education, Augusta Webster Office of Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. J.F. Baker is professor, Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. R.F. Kushner is professor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. J.X. Thomas is professor, Departments of Physiology and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. T.C. Corbridge is professor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. J.F. Corcoran is adjunct associate professor, Departments of Surgery and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois. J.M. Hauser is assistant professor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. P.M. Garcia is professor, Departments of Obstetrics and Gynecology and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Nothelle SK, Christmas C, Hanyok LA. First-Year Internal Medicine Residents' Reflections on Nonmedical Home Visits to High-Risk Patients. TEACHING AND LEARNING IN MEDICINE 2018; 30:95-102. [PMID: 29220589 DOI: 10.1080/10401334.2017.1387552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PROBLEM Patients who are high utilizers of care often experience health-related challenges that are not readily visible in an office setting but paramount for residents to learn. A nonmedical home visit performed at the beginning of residency training may help residents better understand social underpinnings related to their patient's health and place subsequent care within the context of the patient's life. INTERVENTION First-year internal medicine residents completed a nonmedical home visit to an at-risk patient prior to seeing the patient in the office for his or her first medical visit. CONTEXT We performed a thematic analysis of internal medicine interns' (n = 16) written narratives on their experience of getting to know a complex patient in his or her home prior to seeing the patient for a medical visit. Narratives were written by the residents immediately following the visit and then again at the end of the intern year, to assess for lasting impact of the intervention. Residents were from an urban academic residency program in Baltimore, Maryland, USA. OUTCOME We identified four themes from the submitted narratives. Residents discussed the visit's impact on future practice, the effect of the community and support system on health, the impact on the depth of the relationship, and the visit as a source of professional fulfillment. Whereas the four themes were present at both time points, the narratives completed immediately following the visit focused more on the themes of impact of future practice and the effect of the community and support system on health. The influence of the home visit on the depth of the relationship was a more prevalent theme in the end-of-the-year narratives. LESSONS LEARNED Although there is evidence to support the utility of learners completing medical home visits, this exploratory study shows that a nonmedical home visit can be rewarding and formative for early resident physicians. Future studies could examine the patient's perspective on the experience and whether a nonmedical home visit is a valuable tool in other patient populations.
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Affiliation(s)
- Stephanie K Nothelle
- a Department of Medicine , Johns Hopkins Bayview Medical Center , Baltimore , Maryland , USA
| | - Colleen Christmas
- a Department of Medicine , Johns Hopkins Bayview Medical Center , Baltimore , Maryland , USA
| | - Laura A Hanyok
- a Department of Medicine , Johns Hopkins Bayview Medical Center , Baltimore , Maryland , USA
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Ginossar T, Heckman CJ, Cragun D, Quintiliani LM, Proctor EK, Chambers DA, Skolarus T, Brownson RC. Bridging the Chasm: Challenges, Opportunities, and Resources for Integrating a Dissemination and Implementation Science Curriculum into Medical Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2018; 5:2382120518761875. [PMID: 29707648 PMCID: PMC5892792 DOI: 10.1177/2382120518761875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/07/2018] [Indexed: 05/31/2023]
Abstract
BACKGROUND Physicians are charged with implementing evidence-based medicine, yet few are trained in the science of Dissemination and Implementation (D&I). In view of the potential of evidence-based training in D&I to help close the gap between research and practice, the goal of this review is to examine the importance of D&I training in medical education, describe challenges to implementing such training, and provide strategies and resources for building D&I capacity. METHODS We conducted (1) a systematic review to identify US-based D&I training efforts and (2) a critical review of additional literature to inform our evaluation of the challenges and opportunities of integrating D&I training in medical education. RESULTS Out of 269 unique articles reviewed, 11 described US-based D&I training. Although vibrant and diverse training opportunities exist, their capacity is limited, and they are not designed to meet physicians' needs. Synthesis of relevant literature using a critical review approach identified challenges inherent to changing medical education, as well as challenges related to D&I science. Finally, selected strategies and resources are available for facilitating incorporation of D&I training into medical education and overcoming existing challenges. CONCLUSIONS Integrating D&I training in the medical education curriculum, and particularly in residency and fellowship training, holds promise for bridging the chasm between scientific discoveries and improved patient care and outcomes. However, unique challenges should be addressed, including the need for greater evidence.
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Affiliation(s)
- Tamar Ginossar
- Department of Communication & Journalism and the Comprehensive Cancer Center, The University of New Mexico, Albuquerque, NM, USA
| | - Carolyn J Heckman
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Deborah Cragun
- Department of Global Health, College of Public Health, University of South Florida, Tampa, FL, USA
| | - Lisa M Quintiliani
- School of Medicine, Section of General Internal Medicine, Boston University, Boston, MA, USA
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Ted Skolarus
- Section Chief, Urology, VA Ann Arbor Healthcare System Associate Professor, Department of Urology, University of Michigan VA Ann Arbor HSR&D Center for Clinical Management Research
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
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Jensen GM, Hack LM, Nordstrom T, Gwyer J, Mostrom E. National Study of Excellence and Innovation in Physical Therapist Education: Part 2-A Call to Reform. Phys Ther 2017; 97:875-888. [PMID: 28586468 DOI: 10.1093/ptj/pzx062] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 06/03/2017] [Indexed: 02/09/2023]
Abstract
This perspective shares recommendations that draw from (1) the National Study of Excellence and Innovation in Physical Therapist Education research findings and a conceptual model of excellence in physical therapist education, (2) the Carnegie Foundation's Preparation for the Professions Program (PPP), and (3) research in the learning sciences. The 30 recommendations are linked to the dimensions described in the conceptual model for excellence in physical therapist education: Culture of Excellence, Praxis of Learning, and Organizational Structures and Resources. This perspective proposes a transformative call for reform framed across 3 core categories: (1) creating a culture of excellence, leadership, and partnership, (2) advancing the learning sciences and understanding and enacting the social contract, and (3) implementing organizational imperatives. Similar to the Carnegie studies, this perspective identifies action items (9) that should be initiated immediately in a strategic and systematic way by the major organizational stakeholders in physical therapist education. These recommendations and action items provide a transformative agenda for physical therapist education, and thus the profession, in meeting the changing needs of society through higher levels of excellence.
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Affiliation(s)
- Gail M Jensen
- Department of Physical Therapy, School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Omaha, NE 68178 (USA)
| | - Laurita M Hack
- Department of Physical Therapy, Temple University, Philadelphia, Pennsylvania
| | - Terrence Nordstrom
- Department of Physical Therapy, Samuel Merritt University, Oakland, California
| | - Janet Gwyer
- Physical Therapy Division, Duke University, Durham, North Carolina
| | - Elizabeth Mostrom
- Program in Physical Therapy, School of Rehabilitation and Medical Sciences, Central Michigan University, Mount Pleasant, Michigan
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Rosenblum ND, Kluijtmans M, Ten Cate O. Professional Identity Formation and the Clinician-Scientist: A Paradigm for a Clinical Career Combining Two Distinct Disciplines. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:1612-1617. [PMID: 27254011 DOI: 10.1097/acm.0000000000001252] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The clinician-scientist role is critical to the future of health care, and in 2010, the Carnegie Report on Educating Physicians focused attention on the professional identity of practicing clinicians. Although limited in number, published studies on the topic suggest that professional identity is likely a critical factor that determines career sustainability. In contrast to clinicians with a singular focus on clinical practice, clinician-scientists combine two major disciplines, clinical medicine and scientific research, to bridge discovery and clinical care. Despite its importance to advancing medical practice, the clinician-scientist career faced a variety of threats, which have been identified recently by the 2014 National Institutes of Health Physician Scientist Workforce. Yet, professional identity development in this career pathway is poorly understood. This Perspective focuses on the challenges to the clinician-scientist's professional identity and its development. First, the authors identify the particular challenges that arise from the different cultures of clinical care and science and the implications for clinician-scientist professional identity formation. Next, the authors synthesize insights about professional identity development within a dual-discipline career and apply their analysis to a discussion about the implications for clinician-scientist identity formation. Although not purposely developed to address identity formation, the authors highlight those elements within clinician-scientist training and career development programs that may implicitly support identity development. Finally, the authors highlight a need to identify empirically the elements that compose and determine clinician-scientist professional identity and the processes that shape its formation and sustainability.
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Affiliation(s)
- Norman D Rosenblum
- N.D. Rosenblum is professor and Canada Research Chair in Developmental Nephrology, Department of Paediatrics, and associate dean, Physician Scientist Training, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. M. Kluijtmans is program director, Master of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands. O. ten Cate is professor and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Balmer DF, Richards BF, Varpio L. How students experience and navigate transitions in undergraduate medical education: an application of Bourdieu's theoretical model. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2015; 20:1073-85. [PMID: 25633168 DOI: 10.1007/s10459-015-9588-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/22/2015] [Indexed: 05/28/2023]
Abstract
Using Bourdieu's theoretical model as a lens for analysis, we sought to understand how students experience the undergraduate medical education (UME) milieu, focusing on how they navigate transitions from the preclinical phase, to the major clinical year (MCY), and to the preparation for residency phase. Twenty-two medical students participated in this longitudinal case study. Students had similar preclinical and post-MCY experiences but different MCY experiences (rotational vs. longitudinal tracks). We interviewed students every 6 months in the preclinical phase, mid-way through MCY, and 7-8 months before graduation (101 total interviews). We inductively created codes, iteratively revised codes to best-fit the data, and thematically clustered codes into Bourdieu-informed categories: field (social structures), capital (resources) and habitus (dispositions). We found that students acclimated to shifts in the UME field as they moved through medical school: from medical school itself to the health system and back. To successfully navigate transitions, students learned to secure capital as medical knowledge and social connections in the preclinical and preparation for residency phases, and as reputable patient care and being noticed in the clinical phase. To obtain capital, and be well-positioned for the next phase of training, students consistently relied on dispositions of initiative and flexibility. In summary, students experience the complex context of medical school through a series of transitions. Efforts to improve UME would be well-served by greater awareness of the social structures (field) that students encounter, the resources to which they afford value (capital), and the dispositions which aid acquisition of these resources (habitus).
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Affiliation(s)
- Dorene F Balmer
- Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin Street, A188.03, Houston, TX, 77030, USA.
| | | | - Lara Varpio
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Dydykin S, Kapitonova M. The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia. ANATOMICAL SCIENCES EDUCATION 2015; 8:471-477. [PMID: 25688979 DOI: 10.1002/ase.1523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 01/05/2015] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia.
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Affiliation(s)
- Sergey Dydykin
- Department of Topographical Anatomy and Operative Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Marina Kapitonova
- Department of Anatomy, Faculty of Medicine, MARA University of Technology, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
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Stoddard HA, Borges NJ. A typology of teaching roles and relationships for medical education. MEDICAL TEACHER 2015; 38:280-285. [PMID: 26075952 DOI: 10.3109/0142159x.2015.1045848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Educational programs involve interactions between the instructors and the learners. In these interactions, instructors may play various roles. However, a nomenclature for relationships with learners appropriate to those roles has not been developed for medical education. AIMS This article presents a typology of instructor's roles to facilitate the connection of outcomes with instructional methods and to inform training sessions for instructors. METHOD Published articles in general education and medical education were searched for examples of terms used for instructor's roles in developmental interactions. Examples were grouped and classified to develop a two-dimensional typology. RESULTS The typology has eight categories on two dimensions. One dimension is the purpose for interaction: (1) knowledge transmission, (2) professional identity formation, (3) negotiating the institutional milieu, and (4) relationship building. The other dimension is dichotomous on whether the instructor is a member of the profession to which the learners aspire. Twelve terms were categorized: Advisor, Advocate, Buddy, Coach, Counselor, Facilitator, Guru, Master, Mentor, Role model, Teacher and Tutor. CONCLUSIONS Faculty instructors in medical education are often pressed for time, so clarifying role expectations is a low-cost scheme to enhance results. Using the typology can align instructor behavior with the desired learner outcomes and enhance efficient use of instructional time.
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Holden MD, Buck E, Luk J, Ambriz F, Boisaubin EV, Clark MA, Mihalic AP, Sadler JZ, Sapire KJ, Spike JP, Vince A, Dalrymple JL. Professional identity formation: creating a longitudinal framework through TIME (Transformation in Medical Education). ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:761-7. [PMID: 25853688 DOI: 10.1097/acm.0000000000000719] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The University of Texas System established the Transformation in Medical Education (TIME) initiative to reconfigure and shorten medical education from college matriculation through medical school graduation. One of the key changes proposed as part of the TIME initiative was to begin emphasizing professional identity formation (PIF) at the premedical level. The TIME Steering Committee appointed an interdisciplinary task force to explore the fundamentals of PIF and to formulate strategies that would help students develop their professional identity as they transform into physicians. In this article, the authors describe the task force's process for defining PIF and developing a framework, which includes 10 key aspects, 6 domains, and 30 subdomains to characterize the complexity of physician identity. The task force mapped this framework onto three developmental phases of medical education typified by the undergraduate student, the clerkship-level medical student, and the graduating medical student. The task force provided strategies for the promotion and assessment of PIF for each subdomain at each of the three phases, in addition to references and resources. Assessments were suggested for student feedback, curriculum evaluation, and theoretical development. The authors emphasize the importance of longitudinal, formative assessment using a combination of existing assessment methods. Though not unique to the medical profession, PIF is critical to the practice of exemplary medicine and the well-being of patients and physicians.
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Affiliation(s)
- Mark D Holden
- M.D. Holden is vice chair, Undergraduate and Continuing Medical Education, and professor and director, General Internal Medicine, University of Texas Medical Branch, Galveston, Texas. E. Buck is senior medical educator, Office of Educational Development, University of Texas Medical Branch, Galveston, Texas. J. Luk is assistant professor of medicine and assistant dean for interprofessional integration, University of Texas Dell Medical School, Austin, and clinical associate professor of pediatrics and assistant dean for regional medical education, University of Texas Medical Branch, Galveston, Texas. F. Ambriz is clinical assistant professor and chair, Physician Assistant Department, University of Texas Pan American, Edinburg, Texas. E.V. Boisaubin is distinguished teaching professor of medicine, University of Texas Medical School at Houston, Houston, Texas. M.A. Clark is visiting scholar, Lincoln Center for Applied Ethics, Arizona State University, Tempe, Arizona. A.P. Mihalic is associate dean for student affairs and professor of pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas. J.Z. Sadler is professor of psychiatry and clinical sciences and Daniel W. Foster, MD Professor of Medical Ethics, University of Texas Southwestern Medical Center, Dallas, Texas. K.J. Sapire is professor of anesthesiology and perioperative medicine, University of Texas MD Anderson Cancer Center, Houston, Texas. J.P. Spike is professor, McGovern Center for Humanities and Ethics, University of Texas Medical School at Houston, Houston, Texas. A. Vince is medical anthropologist and director, University Health Professions Office, University of Texas at San Antonio, San Antonio, Texas. J.L. Dalrymple is assistant dean for clinical integration, and associate professor and division director of gynecologic oncology, Department of Obstetrics and Gynecology, University of Texas Dell Medical School, Austin, Texas
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Crigger N, Godfrey N. From the Inside Out: A New Approach to Teaching Professional Identity Formation and Professional Ethics. J Prof Nurs 2014; 30:376-82. [DOI: 10.1016/j.profnurs.2014.03.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Indexed: 11/28/2022]
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An Evaluation of the Accuracy of Peer to Peer Surgical Teaching and the Role of the Peer Review Process. PHARMACY 2014. [DOI: 10.3390/pharmacy2020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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