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Sinha A, Slater CS, Lee A, Sridhar H, Gowda D. "The forest and the trees": a narrative medicine curriculum by residents for residents. Pediatr Res 2024:10.1038/s41390-024-03142-2. [PMID: 38519792 DOI: 10.1038/s41390-024-03142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
A 7-session narrative medicine (NM) curriculum was designed and facilitated by pediatrics residents for pediatrics residents in order to unpack challenging experiences during clinical training and strengthen relationships with colleagues and patients. The primary facilitator, a resident with a master's degree in NM, provided facilitator training to her co-residents with whom she co-led the workshops in the curriculum. We conducted, transcribed, and analyzed individual interviews of 15 residents, with three resultant themes: reflection on personal and professional identity; connection to others and community building; and reconceptualization of medical practice. Residents shared that they experienced greater solidarity, professional fulfillment, appreciation for multiple facets of their identities, recognition of holding space for vulnerability, and advocacy for marginalized populations. Our study highlights the feasibility and effectiveness of peer-led NM workshops to enhance clinical training through self-reflection, inclusion of persons from underrecognized backgrounds, and promotion of values consistent with humanistic care. IMPACT: A novel narrative medicine curriculum was designed and facilitated by pediatrics residents for pediatrics residents. The curriculum was feasible and acceptable to pediatrics residents and required a facilitator with content and methodology expertise in narrative medicine to train additional facilitators. Three themes emerged from resident interviews: reflection on personal and professional identity; connection to others and community building; and reconceptualization of medical practice on individual and global levels.
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Affiliation(s)
- Anoushka Sinha
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Carly S Slater
- Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Alyson Lee
- The University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Harini Sridhar
- The University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Deepthiman Gowda
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA
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Alexander SM, Dallaghan GLB, Birch M, Smith KL, Howard N, Shenvi CL. What Makes a Near-Peer Learning and Tutoring Program Effective in Undergraduate Medical Education: a Qualitative Analysis. MEDICAL SCIENCE EDUCATOR 2022; 32:1495-1502. [PMID: 36415502 PMCID: PMC9672576 DOI: 10.1007/s40670-022-01680-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 06/09/2023]
Abstract
UNLABELLED Peer tutoring can benefit both learners and peer teachers that are distinct from the learning that occurs in expert-guided learning environments. This study sought to evaluate the peer tutoring program at a large public medical school to determine the strengths and weaknesses of a near-peer tutoring program and its benefits beyond students' typical classroom-based learning. This was a survey-based study of learners and tutors participating in the peer tutoring program. Fifty-six learners and 20 tutors participated in the survey; most learners received tutoring in the preclinical phase of the curriculum. Narrative responses were thematically analyzed to identify themes for both groups. Learners' responses about the benefit of the near-peer tutoring program were in three primary categories: creating a safe learning environment, direct coaching skills, and pitfalls around the need for individualized direction. Tutors' responses about what made a successful tutoring relationship centered around crucial activities used to engage with learners, beneficial intrinsic qualities of learners such as motivation, and qualifications of tutors that were most helpful such as knowledge base. Peer tutoring programs should emphasize individualized feedback for learners that focuses on metacognitive, content-based, and socio-emotional support. In doing so, such programs can provide a well-structured approach to improve learner success. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01680-0.
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Affiliation(s)
- Seth McKenzie Alexander
- UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514 USA
- Harvard Graduate School of Education, Harvard University, Cambridge, MA 02138 USA
| | - Gary L. Beck Dallaghan
- UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514 USA
| | - Michele Birch
- Wake Forest University School of Medicine, Charlotte, NC USA
| | - Kelly Lacy Smith
- UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514 USA
| | - Neva Howard
- UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514 USA
| | - Christina L. Shenvi
- UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27514 USA
- Wake Forest University School of Medicine, Charlotte, NC USA
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Huang K, Mak D, Hafferty FW, Eva KW. The Advice Given During Near-Peer Interactions Before and After Curriculum Change. TEACHING AND LEARNING IN MEDICINE 2022; 34:351-359. [PMID: 34524067 DOI: 10.1080/10401334.2021.1957685] [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: 01/06/2021] [Accepted: 07/02/2021] [Indexed: 06/13/2023]
Abstract
PhenomenonNear-peer interactions (NPIs) provide formal and informal mentorship that can allow medical students to share strategies for successful training. Such capacity to convey valuable advice, however, may depend on the similitude of experiences. Given that many factors can disrupt homogeneity, including curriculum renewal, we must better understand whether junior trainees feel disadvantaged when they do not have more senior peers with similar experiences. This study was, therefore, conducted to examine the focus of, and engagement with, advice available through NPIs during curriculum renewal. Approach: We used a generic exploratory qualitative research approach. Twenty MD undergraduate students, seven from the Class of 2019 (the first cohort post-curriculum change), and thirteen from the Class of 2020 (the first cohort with access to more senior students in the new curriculum), participated in semi-structured interviews. Anonymized transcriptions were analyzed with open, axial, and selective coding to generate themes until saturation was attained. Findings: Participants from the Class of 2019 reported having particularly few reasons to seek advice; because curriculum renewal disrupted their near peers' capacity to provide critical insights, students exerted little effort to learn from them. That said, this vacuum was not generally cause for concern. Deeper probing illustrated why: advice given during NPIs in both classes more commonly focused on nonacademic (e.g., work-life balance issues) than academic advice; academic advice, when sought or offered, tended not to be aimed at improving understanding of curriculum dependent content; and, while students in both classes welcomed advice, both were wary of accepting it at face value, precluding a sense of dependence on senior peers. Insights: Students' skepticism about the overall utility of academic advice raises a number of important issues for medical education and training. Positively, it shielded students from feeling loss when advice from similarly trained students was not available, reducing concerns about disadvantage that could arise during periods of curriculum revision. On the other hand, knowing that what students perceive and what educators claim to be important aspects of training can be at odds and knowing that self-assessment is flawed makes it surprising and unsettling, respectively, that participants so readily treated the lessons learned by those who came before them as irrelevant.
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Affiliation(s)
- Kelly Huang
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Mak
- Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Frederic W Hafferty
- Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin W Eva
- Education Research and Scholarship, University of British Columbia, Vancouver, British Columbia, Canada
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Dyar A, Stenfors T, Lachmann H, Kiessling A. What about the supervisor? Clinical supervisors' role in student nurses' peer learning: A phenomenographic study. MEDICAL EDUCATION 2021; 55:713-723. [PMID: 33325543 PMCID: PMC8246972 DOI: 10.1111/medu.14436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Peer learning is increasingly used for healthcare students in the clinical setting. However, as peer learning between students involves students taking a teaching role, it is unclear what the supervisor's role then becomes. It is vital to determine the role of the supervisor in student peer learning to ensure high quality learning and patient safety. METHODS Semi-structured interviews were performed with 15 student nurse supervisors (nurses and assistant nurses) from two hospital wards that practice peer learning to investigate the different ways clinical supervisors view their role in students' peer learning. Transcribed data were coded and analysed using a phenomenographic approach. RESULTS Four hierarchical levels of the supervisor's understanding of their role in students' peer learning were identified: the teacher; the facilitator; the stimulator; and the team player. These categories represent an increasingly inclusive view of which people present on the ward play a role in enabling effective peer learning. CONCLUSIONS The various understandings of supervisor roles have implications for how supervision of peer learning could be implemented in the future.
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Affiliation(s)
- Anna Dyar
- Department of Clinical Sciences Danderyd HospitalKarolinska InstitutetStockholmSweden
| | - Terese Stenfors
- Department of Learning, Informatics and EthicsKarolinska InstitutetStockholmSweden
| | - Hanna Lachmann
- Department of Learning, Informatics and EthicsKarolinska InstitutetStockholmSweden
- The Swedish Red Cross University CollegeStockholmSweden
| | - Anna Kiessling
- Department of Clinical Sciences Danderyd HospitalKarolinska InstitutetStockholmSweden
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Balilah M, Babgi M, Alnemari W, Binjabi A, Zaini R, Abdulkhaliq A, Monjed A, Aldahlawi S, Almoallim H. A Proposed Framework to Develop, Describe and Evaluate Peer-Assisted Learning Programs. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:1005-1013. [PMID: 33376437 PMCID: PMC7764158 DOI: 10.2147/amep.s282582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
PHENOMENON Peer-assisted learning (PAL) is increasingly used in different fields of education, including medical education, due to its established advantages. However, there are scarce data about the best practice guidelines for PAL program evaluation. The aim of this work was to develop a framework that can describe and develop PAL programs and consequently provide a tool for evaluation and comparison of PAL programs among different institutions. APPROACH A thorough literature review was made for assessment of different PAL programs development and implementation strategies, and PAL leaders at the University of Umm Al-Qura in Saudi Arabia were interviewed for development and revision of a framework for PAL program development, description and evaluation. FINDINGS A framework of four sections was developed ie context, theory, implementation processes and outcomes, and emergence. The context includes the learning objectives and the logistics. The theory includes the content nature, program design, number of tutees and tutors, participation, program orientation, program duration and timing, tutor recruitment and preparation and faculty involvement. Implementation process and outcome section includes the feedback collection and the pre- and post-intervention students' assessment. The emergence includes tracking the program evolution. INSIGHTS Development of a clear well-defined framework for description, implementation and evaluation of a PAL educational program can provide a foundation to unify the terms organizations use to communicate the parameters of PAL programs and overcome the jargon about PAL in the literature. It also can provide comparisons between the programs in an attempt to set best practice guidelines in the future for PAL program developing and implementation.
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Affiliation(s)
- Mohammad Balilah
- Department of Medical Education, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammad Babgi
- Department of Cardiac Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Walaa Alnemari
- Department of Medical Education, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Ahmad Binjabi
- Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Rania Zaini
- Department of Medical Education, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Altaf Abdulkhaliq
- Department of Biochemistry, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Alaa Monjed
- Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
| | - Salwa Aldahlawi
- Department of basic and clinical oral sciences, Faculty of Dentistry, Umm Alqura University, Makkah, Saudi Arabia
| | - Hani Almoallim
- Department of Medicine, Faculty of Medicine, Umm Alqura University, Makkah, Saudi Arabia
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Visser CLF, Wouters A, Croiset G, Kusurkar RA. Scaffolding Clinical Reasoning of Health Care Students: A Qualitative Exploration of Clinicians' Perceptions on an Interprofessional Obstetric Ward. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520907915. [PMID: 32133416 PMCID: PMC7040925 DOI: 10.1177/2382120520907915] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 06/10/2023]
Abstract
PURPOSE Interprofessional education (IPE) on a ward supports students to generate interprofessional patient care plans as a means to learn about the roles, responsibilities, and clinical reasoning of other professions. We investigated how clinicians guide the clinical reasoning of students from their own and other professions and whether clinicians from nursing, midwifery, and medicine could scaffold students from all professions, that is, by providing just-in-time and tailored support. METHODS Nine supervising clinicians from medicine, nursing, and midwifery were interviewed and a repeat interview held 3 to 15 weeks later; one nurse supervisor was interviewed only once. Using conventional content analysis, themes were identified inductively. Next, we applied an existing scaffolding framework to conceptualise how clinicians supported the clinical reasoning in an IPE setting. RESULTS Themes were clinicians' interventions and intentions, results of interventions and of IPE, characteristics of students and clinicians, interactions between clinicians and students, and logistics. Clinicians applied various interventions and expressed several intentions to guide the learning of students from all professions. Clinicians stimulated students' clinical reasoning by structuring meetings, asking students to explain their thoughts to each other and through giving group assignments. Thus, clinicians used peer-assisted learning for the students. By collaborating with other supervising clinicians regarding the form and amount of guidance to give to the students, clinicians applied peer-assisted learning for themselves as well. CONCLUSION Clinicians can learn to scaffold the clinical reasoning of students from different professions, when they are provided with training, good examples, and structures. An existing scaffolding framework can serve as an overview of aims and interventions to provide just-in-time guidance to students from all professions. The scaffolding framework is useful for training clinicians and for depicting the pedagogical approach for IPE wards.
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Affiliation(s)
- Cora LF Visser
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amstel Academy, VU University Medical Center, Amsterdam, The Netherlands
| | - Anouk Wouters
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gerda Croiset
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
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