Addicts and Admits: Metonymy in Medical Students' Reflective Writing

The reporting of ethical review and ethical considerations in articles published in medical education journals: A literature review

BACKGROUND

Health professions education research (HPE-R) must be ethically sound. Ethical review decisions and other ethical considerations should be clearly reported in journal articles to allow readers to assess the ethical soundness of the research. We explored and evaluated how ethical review decisions and ethical considerations for HPE-R are reported in health professions education (HPE) journal articles.

METHODS

We identified a 1-year sample, for 2020, of eight HPE journals. We systematically assessed the reporting of ethical review and key ethical considerations in the articles in the sample.

RESULTS

The search yielded 2004 articles, of which 955 articles (47.7%) were eligible and were thus assessed. Most (83.4%) of the assessed articles mentioned a review by an ethical review board (ERB). In the category 'research articles', 92% articles reported the outcome of the ethical review. In the category 'other articles' (e.g. educational case reports), reporting of ethical processes was less common (32%). Overall, the reporting of key ethical considerations was limited, although these considerations were more reported in 'research articles' compared with 'other articles'.

CONCLUSIONS

ERB assessments and HPE-R approval was reported in most research articles. This finding is an improvement compared with previous evaluations of ethical research practice in HPE-R. All studies, particularly those that are exempted or not fully reviewed, should describe their key ethical considerations clearly to enable the HPE community to assess the ethical soundness. Our review revealed that the reporting of ethical considerations was limited and deserves attention from the research community.

Transformative Learning and Critical Consciousness: A Model for Preclerkship Medical School Substance Use Disorder Education

OBJECTIVE

Preparing medical students to provide compassionate person-centered care for people with substance use disorders (SUD) requires a re-envisioning of preclerkship SUD education to allow for discussions on stigma, social determinants of health, systemic racism, and healthcare inequities. The authors created a curricular thread that fosters the development of preclerkship medical students' critical consciousness through discussion, personal reflection, and inclusion of lived experiences.

METHODS

The authors used transformative learning theories to design and implement this thread in the 2021-2022 academic year in the Duke University School of Medicine preclerkship curriculum. Content included lectures, person-centered workshops, case-based learning, motivational interviewing of a standardized patient, and an opioid overdose simulation. Community advocates and people with SUD and an interdisciplinary faculty were involved in the thread design and delivery and modeled their lived experiences. Students wrote a 500-word critical reflection essay that examined their personal beliefs in the context of providing care for people with SUD.

RESULTS

One hundred and twenty-two students submitted essays and 30 (25%) essays were randomly selected for a qualitative analysis. Seven major themes emerged: race/racism, systemic barriers, bias and stigma, personal growth/transformation, language or word usage, future plans for advocacy, and existing poor outcomes. Students were able to link material with prior knowledge and experiences, and their attitudes towards advocacy and goals for future practice were positively influenced.

CONCLUSION

By aligning the thread design with the principals of transformative learning, students developed their critical consciousness toward people with SUD and cultivated a holistic understanding of SUD.

"He Bore it Like a Scarlet Letter": Medical Student Reflections on Substance Use Disorders

OBJECTIVE

Substance abuse in the context of the opioid crisis presents a major public health concern. Despite some evidence that medical students' attitudes towards substance use disorders worsen during medical school, very few studies have examined how students' early clinical experiences with substance use disorders shape their views of this clinical population. This study uses student reflective essays to explore these formative educational experiences.

METHODS

Using content analysis, the authors analyzed a collection of 802 medical student reflective essays written during core clerkships (excluding Psychiatry), coding for ethical and professional themes as well as descriptions of substance use disorders. In addition to the qualitative identification of themes, the authors used chi-square analysis to determine which themes had statistically significant associations with substance use disorders.

RESULTS

Fifty-three essays described patients with substance use disorders. The most common substances described were opioids (n = 25), alcohol (n = 18), and cocaine (n = 11). There were five themes statistically associated with substance use disorders (p < 0.05): (1) adequate treatment, (2) pain, (3) difficult patient, (4) jumping to conclusions, and (5) malingering.

CONCLUSIONS

In the sample, students found the treatment of pain to be a significant ethical challenge related to substance use disorders. In considering a comprehensive educational plan, medical educators may need to consider educational venues outside of the Psychiatry clerkship to address substance use disorders.