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Sarraf-Yazdi S, Pisupati A, Goh CK, Ong YT, Toh YR, Goh SPL, Krishna LKR. A scoping review and theory-informed conceptual model of professional identity formation in medical education. MEDICAL EDUCATION 2024. [PMID: 38597258 DOI: 10.1111/medu.15399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Professional identity formation (PIF) is a central tenet of effective medical education. However, efforts to support, assess and study PIF are hindered by unclear definitions and conceptualisations of what it means to 'think, act, and feel like a physician'. Gaps in understanding PIF, and by extension, its support mechanisms, can predispose individuals towards disengaged or unprofessional conduct and institutions towards short-sighted or reactionary responses to systemic issues. METHODS A Systematic Evidence-Based Approach-guided systematic scoping review of PIF theories was conducted related to medical students, trainees and practising doctors, published between 1 January 2000 and 31 December 2021 in PubMed, Embase, ERIC and Scopus databases. RESULTS A total of 2441 abstracts were reviewed, 607 full-text articles evaluated and 204 articles included. The domains identified were understanding PIF through the lens of pivotal theories and characterising PIF by delineating the underlying factors that influence it and processes that define it. CONCLUSIONS Based on regnant theories and frameworks related to self-concepts of identity and personhood, the relationships between key PIF influences, processes and outcomes were examined. A theory-backed integrated conceptual model was proposed to delineate the interconnected relationships among these, aiming to untangle some of the complexities inherent to PIF, to shed light on existing practices and to identify shortcomings in our understanding so as to develop mechanisms in support of its multifaceted, interlinked components.
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Affiliation(s)
| | - Anushka Pisupati
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Chloe Keyi Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - You Ru Toh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Suzanne Pei Lin Goh
- Duke-NUS Medical School, National University of Singapore, Singapore
- KK Women's and Children Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Duke-NUS Medical School, National University of Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, United Kingdom Cancer Research Centre, University of Liverpool, Liverpool, UK
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore
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Olajire A, Benton M. Narratives, Sensemaking, and Didactic Relationships in Longitudinal Integrated Clerkship Education. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241235007. [PMID: 38410121 PMCID: PMC10896064 DOI: 10.1177/23821205241235007] [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: 07/10/2023] [Accepted: 02/08/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To understand what longitudinal integrated clerkship (LIC) participants found meaningful and valuable about their experiences while grounded in a communicated narrative sensemaking (CNSM) framework. METHODS Semi-structured interviews were conducted with a cohort of 3 LIC students and 7 of their 12 preceptors. Interviews were designed to elicit narratives ie time-ordered accounts of events, experiences, or reflections. Narratives were identified and coded to understand aspects of experiences. RESULTS Participants made sense of their experiences by narrating stories of LIC length allowing relationships to grow over time in a way that gave students a holistic perspective on patient care, built deep relationships between students and preceptors, and grew student confidence. CONCLUSION Participants value longitudinal integration in LICs because it allows for unique perspectives on patient care and builds deep meaningful mentor relationships with preceptors. Relationships in LICs must be managed carefully because much LIC learning is facilitated by relationships. The clerkship is a crucial aspect of medical education of which sense will be made by physicians during their whole lives.
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Affiliation(s)
- Abigail Olajire
- Department of Communication, University of Missouri, Columbia, MO, USA
| | - Mark Benton
- Center for Health Policy, University of Missouri, Columbia, MO, USA
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Pinidiyapathirage J, Heffernan R, Carrigan B, Walters S, Fuller L, Brumpton K. Recruiting students to rural longitudinal integrated clerkships: a qualitative study of medical educationists' experiences across continents. BMC MEDICAL EDUCATION 2023; 23:974. [PMID: 38115001 PMCID: PMC10731800 DOI: 10.1186/s12909-023-04949-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Many health systems struggle in the provision of a sustainable and an efficient rural health workforce. There is evidence to suggest that Longitudinal Integrated Clerkships (LIC) placing student learners in rural community settings have positively impacted the provision of rural health care services The recruitment and engagement of students in rural LIC have significant challenges. This study explored best practice methods of recruiting and supporting the transition of medical students into rural LIC. METHODS The study took place during the 2021 Consortium of Longitudinal Integrated Clerkships Conference, a virtual event hosted by Stellenbosch University, South Africa. Participants consisted of delegates attending the Personally Arranged Learning Session (PeArLS) themed 'Secrets to success'. The session was recorded with the participants' consent and the recordings were transcribed verbatim. Data was uploaded to NVivo software and coded and analyzed using constant comparative analysis. Salient themes and patterns were identified. RESULTS Thirteen attendees participated in the PeArLS representing a range of countries and institutions. Strategically marketing the LIC brand, improving the LIC program profile within institutions by bridging logistics, and the need to scaffold the transition to the rural LIC learning environment emerged as key themes for success. The attendees highlighted their experiences of using peer groups, early exposure to rural LIC sites, and student allocation strategies for promotion. Unique learning styles adopted in LIC models, student anxiety and the importance of fostering supportive relationships with stakeholders to support students in their transition to the LIC environment were discussed. DISCUSSION This PeArLS highlighted successful systems and processes implemented in rural settings across different countries to recruit and manage the transition of medical students to rural LIC. The process proved to be a quick and efficient way to elicit rich information and may be of benefit to educationists seeking to establish similar programs or improve existing rural LIC.
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Affiliation(s)
- Janani Pinidiyapathirage
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia.
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia.
| | - Robert Heffernan
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia
| | - Brendan Carrigan
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia
| | - Sherrilyn Walters
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia
| | - Lara Fuller
- Rural Community Clinical School, School of Medicine, Deakin University, Geelong, Australia
| | - Kay Brumpton
- Rural Medical Education Australia, 190 Hume Street, Toowoomba, QLD, 4350, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast Campus, Southport, Australia
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Moll-Jongerius A, Langeveld K, Helmich E, Masud T, Kramer AWM, Achterberg WP. Becoming a physician for older patients: exploring the professional identity formation of medical students during a nursing home clerkship. A qualitative study. BMC MEDICAL EDUCATION 2023; 23:845. [PMID: 37936183 PMCID: PMC10631180 DOI: 10.1186/s12909-023-04835-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/01/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND To prepare medical students for the growing population of older patients, an appropriate professional identity formation is desirable. The community of practice of medical school is primarily hospital-based and disease-oriented which will lead to the development of a physician who is mainly focused on cure. This focus alone however is not always appropriate for older persons' health care. The aim of this study is to explore the influence of participating in a nursing home community of practice on the professional identity formation of medical students. METHODS A qualitative study based on a constructivist research paradigm was conducted, using individual semi-structured, in-depth interviews and a visual narrative method (drawing) as a prompt. Thematic analysis was applied to structure and interpret the data. The study population consisted of fifth-year medical students participating in a six-week nursing home clerkship. Thirteen participants were purposefully sampled. The clerkship took place in nursing homes in the South-West of the Netherlands. RESULTS The medical students described the nursing home as the living environment of the patients. Actively participating in the patients' care and experiencing the daily life of the patients was meaningful for the physician the students want to become in five ways: (1) a physician with a complete picture; (2) a physician who is close; (3) a physician who is in dialogue; (4) a physician who is able to let go and (5) a physican who collaborates. CONCLUSIONS Caring for older patients in the nursing home influences the professional identity formation of medical students. Patient-centeredness, personal, holistic and tailored care, approachability and collaboration are important characteristics in becoming a physician for older persons' health care. The context of this care provides relevant learning experiences for this development and the becoming of a physician in general.
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Affiliation(s)
- Annemarie Moll-Jongerius
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands.
| | - Kirsten Langeveld
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
| | - Esther Helmich
- Amsta Health Care Organization, Amsterdam, The Netherlands
| | - Tahir Masud
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Leiden, 2333 ZD, The Netherlands
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Dodsworth A, Munro K, Alberti H, Hirsh DA, Paes P, Illing J. Patient outcomes in a Longitudinal Integrated Clerkship: A systematic literature review. MEDICAL EDUCATION 2023; 57:820-832. [PMID: 36573064 DOI: 10.1111/medu.15013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
CONTEXT Patient-student relationships are at the heart of Longitudinal Integrated Clerkships (LICs). Outcomes for students and preceptors are beneficial, but patient outcomes remain unclear. This systematic literature review explored the current evidence base of patient outcomes in an LIC. Patient outcomes were defined as issues related to patient safety, clinical effectiveness or patient experience. METHODS Seven bibliographic databases were searched. A wider search strategy included a hand search of three medical education journals' previous issues and backward/forward citation searching of included studies and of a relevant systematic review. Included studies were quality appraised and assessed for their strength and level of evidence. A qualitative data synthesis was performed. RESULTS Databases searches identified 7237 titles. Following the removal of duplicates, titles and abstracts were reviewed against the inclusion criteria. Forty-eight studies had a full-text review. Nineteen met the inclusion criteria. Seven studies were included from the wider search strategy. From the 26 included studies, two major themes were identified. (1) 'A trusting patient-student relationship' contains the sub-themes: 'care and compassion', 'patient education and empowerment' and 'the loss of the student as 'my' doctor'. (2) 'The student acts as an agent of change for the patient' contains the sub-themes: 'patient advocacy', 'supporting the patient to navigate the healthcare system', 'communication between patient and healthcare professional' and 'enhancement of preceptors' care, healthcare services and communities'. CONCLUSIONS LICs provide educational continuity allowing the creation of a trusting patient-student relationship. This relationship leads to students becoming agents of change for patients by enhancing patient outcomes. This review provides further evidence on the benefits of having an LIC as part of the medical education curricula and implications for its successful delivery. Further research is needed to explore educationally induced benefits for patients and look at objective assessments of patient health outcomes.
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Affiliation(s)
- Alastair Dodsworth
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Northumbria General Practice Training Programme, Health Education England North East and Cumbria, Newcastle upon Tyne, UK
| | - Katie Munro
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - David A Hirsh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Paul Paes
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Jan Illing
- School of Medicine, Newcastle University, Newcastle upon Tyne, UK
- RCSI University of Medicine Health Sciences, Dublin, Ireland
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Consorti F, Consorti G. Elements and Determinants of Professional Identity During the Pandemic: A Hermeneutic Qualitative Study. TEACHING AND LEARNING IN MEDICINE 2023; 35:422-435. [PMID: 35711162 DOI: 10.1080/10401334.2022.2080068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
Phenomenon: The construct of professionalism in undergraduate medical education is a core outcome that is included in the wider concept of professional identity formation. The former is grounded in the more general concept of identity, intended as an internalized set of role expectations. Some have proposed frameworks based on psychological or sociological approaches, but empirical research is still scarce and often limited to the exploration of the role of specific learning activities. The pandemic imposed adaptations that produced an artificial setting for a social experiment, suitable to observe how the deprivation of the social component of a student's life, such as in presence teaching and practical training, unveiled the elements and determinants of the developing identity of medical students. Approach: This research was the extension of a previous phenomenological study about medical students' lived experience of distance learning during the lockdown phase in Italy. We adopted a hermeneutic approach to furtherly deepen the analysis of the phenomenon at stake, in dialogue with the relevant literature. Eight 6th year medical students underwent an in-depth interview, themes were inductively generated and used to identify elements and determinants of the developing identities. Findings: Four themes developed, synthetized in the overarching theme "From crawling to standing on your feet and walking toward an uncertain future". The themes were: "social places and practices that make me feel like a student and a medical student", "toward self-regulation", "an emotional journey", "threats to the identity". The elements of the perceived identity as a medical student were autonomy and learning self-regulation, professional knowledge, competence, and sense of belonging to a community. The determinant factors which influenced the identity as a medical student were living environment, learning spaces and architectures, the social networks, the attendance of the healthcare facilities, the relationship with teachers, the social acknowledgement as a medical student, and as a doctor. Insights: It was possible to identify the generation of both constitutive elements of identity and determinants influencing identity development and this distinction is an added value of the research. According Gilles Deleuze's concept of "empty square" (the sudden lack of an object one used to have at hand: sociality in this case), this research highlighted the ambivalent nature of identity. Individualization and socialization are the "uneven sides" of that same paradoxical object which is identity.
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Affiliation(s)
- Fabrizio Consorti
- Department of Surgical Sciences, University Sapienza of Rome, Rome, Italy
| | - Giacomo Consorti
- Clinical-Based Human Research Department, Centre for Osteopathic Medicine Collaboration, Pescara, Italy, Educational Department of Osteopathy, Istituto Superiore Osteopatia, Milan, Italy
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Teo KJH, Teo MYK, Pisupati A, Ong RSR, Goh CK, Seah CHX, Toh YR, Burla N, Koh NSY, Tay KT, Ong YT, Chiam M, Fong W, Wijaya L, Goh SPL, Krishna LKR. Assessing professional identity formation (PIF) amongst medical students in Oncology and Palliative Medicine postings: a SEBA guided scoping review. Palliat Care 2022; 21:200. [PMID: 36397067 PMCID: PMC9673314 DOI: 10.1186/s12904-022-01090-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Introduction to a multi-professional team who are working and caring for the dying, and facing complex moral and ethical dilemmas during Oncology and Palliative Medicine postings influence a medical student's professional identity formation (PIF). However, limited appreciation of PIF, inadequate assessments and insufficient support jeopardise this opportunity to shape how medical students think, feel and act as future physicians. To address this gap, a systematic scoping review (SSR) of PIF assessment methods is proposed. METHODS A Systematic Evidence-based Approach (SEBA) guided SSR of assessments of PIF in medical schools published between 1st January 2000 and 31st December 2021 in PubMed, Embase, ERIC and Scopus databases was carried out. Included articles were concurrently content and thematically analysed using SEBA's Split Approach and the themes and categories identified were combined using SEBA's Jigsaw Perspective. The review hinged on the following questions: "what is known about the assessment of professional identity formation amongst medical students?", "what are the theories and principles guiding the assessment of professional identity formation amongst medical students?", "what factors influence PIF in medical students?", "what are the tools used to assess PIF in medical students?", and "what considerations impact the implementation of PIF assessment tools amongst medical students?". RESULTS Two thousand four hundred thirty six abstracts were reviewed, 602 full-text articles were evaluated, and 88 articles were included. The 3 domains identified were 1) theories, 2) assessment, and 3) implementation in assessing PIF. Differing attention to the different aspects of the PIF process impairs evaluations, jeopardise timely and appropriate support of medical students and hinder effective implementation of PIF assessments. CONCLUSION The Krishna-Pisupati model combines current theories and concepts of PIF to provide a more holistic perspective of the PIF process. Under the aegis of this model, Palliative Care and Oncology postings are envisaged as Communities of Practice influencing self-concepts of personhood and identity and shaping how medical students see their roles and responsibilities as future physicians. These insights allow the forwarding of nine recommendations to improve assessments of PIF and shape the design of a PIF-specific tool that can direct timely and personalized support of medical students.
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Affiliation(s)
- Kelly Jia Hui Teo
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Mac Yu Kai Teo
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Anushka Pisupati
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Rui Song Ryan Ong
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Chloe Keyi Goh
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Claire Hui Xian Seah
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - You Ru Toh
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Neha Burla
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Natalie Song Yi Koh
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Kuang Teck Tay
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Yun Ting Ong
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Min Chiam
- grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Warren Fong
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,grid.163555.10000 0000 9486 5048Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore General Hospital, Singapore, 169854 Singapore
| | - Limin Wijaya
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,grid.163555.10000 0000 9486 5048Division of Infectious Disease, Singapore General Hospital, 16 College Road, Block 6 Level 7, Singapore General Hospital, Singapore, 169854 Singapore
| | - Suzanne Pei Lin Goh
- grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,KK Women’s and Children Hospital, 100 Bukit Timah Rd, Singapore, 229899 Singapore
| | - Lalit Kumar Radha Krishna
- grid.4280.e0000 0001 2180 6431Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228 Singapore ,grid.410724.40000 0004 0620 9745Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore ,grid.410724.40000 0004 0620 9745Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore ,grid.428397.30000 0004 0385 0924Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore ,grid.10025.360000 0004 1936 8470Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK ,grid.4280.e0000 0001 2180 6431Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore ,The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, PalC, 308436 Singapore ,grid.10025.360000 0004 1936 8470Health Data Science, University of Liverpool, Whelan Building, The Quadrangle, Brownlow Hill, Liverpool, L69 3GB UK
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Brown MEL, Ard C, Adams J, O'Regan A, Finn GM. Medical Student Identity Construction Within Longitudinal Integrated Clerkships: An International, Longitudinal Qualitative Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1385-1392. [PMID: 35507462 DOI: 10.1097/acm.0000000000004732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Longitudinal integrated clerkships (LICs) have been implemented worldwide to increase authentic student participation in patient care over time. Studies have shown benefits of the model include the ability of LICs to attract future practitioners to underserved areas, student engagement in advocacy, and development of an "ethic of caring." Less is known, however, about how LICs impart their benefits, although LICs may strengthen professional identity. As such, this study aimed to explore medical student professional identity construction through time within LICs internationally. METHOD This was a longitudinal qualitative study from 2019 to 2020, involving 33 students across 4 medical schools in the United Kingdom, Ireland, and the United States. The authors explored participating students' identity construction during LICs. Data collection involved 3 stages: individual, semistructured interviews at entry (n = 33) and exit of the LIC (n = 29), and audio diaries throughout. Data were analyzed inductively using a reflexive thematic approach. RESULTS Three themes were identified. Longitudinal relationships with patients and preceptors encouraged patient care ownership and responsibility; LIC students identified as patient advocates; and longitudinal relationships shaped students' social consciences. Themes were underpinned by continuity of relationships between students and patients, and students and tutors. CONCLUSIONS Though continuity is lauded as the cornerstone of LICs, these findings suggest that this is too broad a way of understanding the benefits of LICs. Instead, continuity should be seen as facilitating the development of important relationships within diverse communities of practice, which leads medical students to construct professional identities as responsible, compassionate advocates for underserved populations. This was the case across the institutions, nations, and LIC types in this study. By highlighting the ways in which LICs influence identity, these findings offer important insight relating to the future development and delivery of LICs.
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Affiliation(s)
- Megan E L Brown
- M.E.L. Brown is a teaching fellow in medical education research, Medical Education Innovation and Research Centre, Imperial College London, London. At the time of this research, she was a PhD candidate in medical education, Health Professions Education Unit, Hull York Medical School, York, United Kingdom; ORCID: http://orcid.org/0000-0002-9334-0922
| | - Catherine Ard
- C. Ard is an internal medicine resident, University of Colorado, Aurora, Colorado
| | - Jennifer Adams
- J. Adams is professor of medicine and assistant dean, medical education and clinical clerkships, University of Colorado School of Medicine, Aurora, Colorado, and internal medicine specialist, Denver Health and Hospital Authority, Denver, Colorado; ORCID: https://orcid.org/0000-0002-5433-8600
| | - Andrew O'Regan
- A. O'Regan is a general practitioner and senior lecturer in general practice, University of Limerick School of Medicine, Limerick, Ireland; ORCID: https://orcid.org/0000-0001-8470-2736
| | - Gabrielle M Finn
- G.M. Finn is professor of medical education and vice dean of teaching and learning, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, United Kingdom; ORCID: http://orcid.org/0000-0002-0419-694X
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El Brown M, Parekh R, Anderson K, Mayat N, McKeown A. 'It was the worst possible timing': the response of UK Longitudinal Integrated Clerkships to Covid-19. EDUCATION FOR PRIMARY CARE 2022; 33:288-295. [PMID: 35770614 DOI: 10.1080/14739879.2022.2079428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Covid-19 has altered medical education worldwide. Given recent events, UK Longitudinal Integrated Clerkships (LICs), which are relatively new innovations, may have changed in structure and delivery, or may have demonstrated resilience. Collating the responses and experiences of UK institutions may yield transferrable recommendations for institutions wishing to develop sustainable LICs. A mixed-methods survey concerning LIC prevalence, variety, and experiences of responses to Covid-19 was circulated to all 33 UK medical schools through academic networks. 25 survey responses were received, representing 20 institutions. 12 faculty completed follow up semi-structured interviews. 13 LICs were reported: 1 wasn't running during 2020, 5 were running unchanged, and 7 with alterations. 2 additional LICs were planned. Thematic analysis of free-text survey and interview responses revealed that relationships between faculty and institutions were central in facilitating recent adaptations to UK LICs. Given model flexibility, an increased drive to develop LICs was also evident. Barriers to adapting programmes included uncertainty regarding progression of Covid-19 restrictions and issues with secondary care access. Investing in faculty development and support networks could increase LIC sustainability. By highlighting the relative resilience of UK LIC placements during Covid-19, these findings offer important insight for the future delivery of sustainable LICs within, and beyond, the UK.
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Affiliation(s)
- Megan El Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK.,Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Kevin Anderson
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Nabilah Mayat
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK.,Undergraduate medicine, Barts and the London Medical School, London, UK
| | - Andy McKeown
- Faculty of medicine and health science, University of Buckingham, Buckingham, UK
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Ziv T, Wamsley M, Lai CJ, Griffiths EP, Maxey A, Kryzhanovskaya IE, Teherani A. A is for advocacy: How introducing student advocacy assessment impacts longitudinal integrated clerkship students and clinical supervisors. MEDICAL TEACHER 2022; 44:149-157. [PMID: 34433360 DOI: 10.1080/0142159x.2021.1967903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To improve health, physicians are increasingly called to advocate. Yet medical schools have only recently focused on health advocacy skill-building. Limited work to date addresses assessing medical student advocacy on behalf of patients. We describe how students and clinical supervisors (CS) in two urban longitudinal integrated clerkships (LIC) experience patient advocacy and how introducing a new advocacy assessment impacts them. Using a thematic approach, we analyzed transcripts of focus groups during 2018-2019. Seventeen of 24 (71%) students and 15 of 21 (71%) CS participated in the focus groups. We describe how students perceive their advocacy role as they accompany the patient, amplify their voice, and facilitate connection. The rationale for advocacy assessment includes that it (1) adds a novel dimension to the written and verbal assessment, (2) drives student learning, (3) aligns with the institutional goal to promote equity, and (4) impacts CS teaching and clinical practice. Challenges are the ambiguity of expectations, pressure to 'perform,' and a moral overlay to advocacy assessment. Findings demonstrate how educational alliances between students and CS and longitudinal relationships between LIC students and patients offer a constructive opportunity for advocacy assessment. We describe suggestions to hone and expand the reach of advocacy assessment.
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Affiliation(s)
- Tali Ziv
- Kaiser Permanente, Oakland, CA, USA
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Maria Wamsley
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Cindy J Lai
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Alexandra Maxey
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | - Arianne Teherani
- University of California San Francisco School of Medicine, San Francisco, CA, USA
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11
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Park KH, Kam BS, Yune SJ, Lee SY, Im SJ. Changes in self-reflective thinking level in writing and educational needs of medical students: A longitudinal study. PLoS One 2022; 17:e0262250. [PMID: 35061778 PMCID: PMC8782325 DOI: 10.1371/journal.pone.0262250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/21/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction The purpose of this study was to longitudinally examine the change in understanding of the self-reflection method, reflective thinking, and writing attitude and perception. Moreover, we investigated students’ educational needs and methods regarding self-reflection. Methods The subjects were 117, who were in the pre-medical course in 2017 and were promoted to the medical course in 2019. Questions concerning students’ understanding of self-reflection methods, their attitude and perception of reflective writing, and educational needs and methods regarding self-reflection were self-developed. For students’ reflective thinking level in writing, we used the approach developed by Galvez-Martin, Bowman, and Morrison and adapted by Kwon. For dada analysis, χ2 test, t-test, frequency analysis was used. Results We found that students’ level of understanding regarding self-reflection methods increases slightly, but not significant (χ2 = 2.238, p>0.05). There was no significant change in the level of reflective thinking in writing (χ2 = 8.003, p>0.05). The students’ attitude toward reflective writing decreased in the medical course than in the pre-medical course (t = 3.475, p<0.001). The perception that reflective writing was helpful for individual improvement decreased during the medical course (t = 4.931, p<0.001). The need for self-reflection education increased in the medical course (t = -2.659, p<0.001). They preferred implementation in the first year of the medical course as an instructor-led special lecture. Conclusion Self-reflective ability is not naturally developed as students’ progress through grade levels. Educational intervention is needed to help students understand approaches to self-reflection and its importance in enabling them to develop their abilities as well as to participate actively in reflective writing.
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Affiliation(s)
- Kwi Hwa Park
- Department of Medical Education, Gachon University College of Medicine, Incheon, South Korea
| | - Bee Sung Kam
- Department of Medical Education, Pusan National University School of Medicine, Busan, South Korea
| | - So Jung Yune
- Department of Medical Education, Pusan National University School of Medicine, Busan, South Korea
- * E-mail:
| | - Sang Yeoup Lee
- Department of Medical Education, Pusan National University School of Medicine, Busan, South Korea
| | - Sun Ju Im
- Department of Medical Education, Pusan National University School of Medicine, Busan, South Korea
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12
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Yang X, Gao L, Zhang S, Zhang L, Zhang L, Zhou S, Qi M, Chen J. The Professional Identity and Career Attitude of Chinese Medical Students During the COVID-19 Pandemic: A Cross-Sectional Survey in China. Front Psychiatry 2022; 13:774467. [PMID: 35242061 PMCID: PMC8886109 DOI: 10.3389/fpsyt.2022.774467] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although professional identity is a strong predictor of career choice, only a few studies have reported on medical students' career attitude during a public health emergency. This study investigates the changes in medical students' professional identity and career attitude during the COVID-19 pandemic, evaluates their mental health and social support system under stress, and explores the relationship between their career attitude and other factors. METHODS An online survey of 6,226 Chinese medical students was conducted to collect information on demographics, professional identity, and career attitude. The collected data were assessed using the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale, and the Social Support Rating Scale. RESULTS The results revealed that most (80.8%) of the participants did not change their career attitude and the professional identity of most participants strengthened, and they preferred to participate on the frontline during the COVID-19 pandemic. The prevalence of depression and anxiety among medical students was 22.86% and 35.43%. Low social support, depressive symptoms, male gender, and higher grades were factors that negatively affected career attitude. CONCLUSIONS After the outbreak of the pandemic, it was necessary to conduct diversified professional identity research to support medical students, especially those with low social support and depressive symptoms.
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Affiliation(s)
- Xingjie Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Lan Gao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Suoyuan Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Libin Zhang
- Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University, Beijing, China
| | - Ligang Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Shuangjiang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Meng Qi
- Department of Applied Psychology, Chengde Medical College, Chengde, China
| | - Jingxu Chen
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
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13
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Brown MEL, Whybrow P, Kirwan G, Finn GM. Professional identity formation within longitudinal integrated clerkships: A scoping review. MEDICAL EDUCATION 2021; 55:912-924. [PMID: 33529395 DOI: 10.1111/medu.14461] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 05/14/2023]
Abstract
CONTEXT Although the uptake of Longitudinal Integrated Clerkships (LICs) is increasing worldwide, and there are documented benefits to participation, there is a lack of conceptual evidence regarding how LICs exert many of their benefits, including their influence on the recruitment and retention of practitioners to underserved areas or specialties. Whilst career choice and professional identity development have been previously connected within medicine, what is known about the ways in which LICs influence identity remains unclear. A scoping review was conducted to explore current knowledge and map directions for future research. METHOD In 2020, the authors searched nine bibliographic databases for articles discussing identity within the context of LICs using a systematic search strategy. Two reviewers independently screened all articles against eligibility criteria and charted the data. Eligible articles were analysed by quantitative and qualitative thematic analysis. RESULTS 849 articles were identified following an extensive search. 131 articles were selected for full-text review, with 27 eligible for inclusion. Over half of all articles originated from the United States or Canada, and research most frequently explored identity development from sociocultural orientations. Qualitatively, four themes were identified: (a) The importance of contextual continuities; (b) Symbiotic relationship of responsibility and identity development; (c) Becoming a competent carer; and (d) Influence of LICs on career identity. CONCLUSIONS This scoping review adds weight to the supposition that participation in LICs facilitates identity development, namely through contextual continuities and the responsibility students assume as they become co-providers of patient care. There are suggestions that LICs encourage the development of an 'ethic of caring'. As little research compares comprehensive LICs with other clerkship models, it remains difficult to say to what degree identity formation is facilitated above and beyond other models. Future comparative research, and research exploring identity formation from diverse theoretical perspectives would add depth.
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Affiliation(s)
- Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Paul Whybrow
- Academy for Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | | | - Gabrielle M Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Gonzalez CM, Noah YS, Correa N, Archer-Dyer H, Weingarten-Arams J, Sukhera J. Qualitative analysis of medical student reflections on the implicit association test. MEDICAL EDUCATION 2021; 55:741-748. [PMID: 33544914 PMCID: PMC8119345 DOI: 10.1111/medu.14468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Health professions educators use the Implicit Association Test (IAT) to raise awareness of implicit bias in learners, often engendering strong emotional reactions. Once an emotional reaction ensues, the gap between learner reaction and strategy identification remains relatively underexplored. To better understand how learners may identify bias mitigation strategies, the authors explored perspectives of medical students during the clinical portion of their training to the experience of taking the IAT, and the resulting feedback. METHODS Medical students in Bronx, NY, USA, participated in one 90-minute session on implicit bias. The focus of analysis for this study is the post-session narrative assignment inviting them to take the race-based IAT and describe both their reaction to and the implications of their IAT results on their future work as physicians. The authors analysed 180 randomly selected de-identified essays completed from 2013 to 2019 using an approach informed by constructivist grounded theory methodology. RESULTS Medical students with clinical experience respond to the IAT through a continuum that includes their reactions to the IAT, acceptance of bias along with a struggle for strategy identification, and identification of a range of strategies to mitigate the impact of bias on clinical care. Results from the IAT invoked deep emotional reactions in students, and facilitated a questioning of previous assumptions, leading to paradigm shifts. An unexpected contrast to these deep and meaningful reflections was that students rarely chose to identify a strategy, and those that did provided strategies that were less nuanced. CONCLUSION Despite accepting implicit bias in themselves and desiring to provide unbiased care, students struggled to identify bias mitigation strategies, a crucial prerequisite to skill development. Educators should endeavour to expand instruction to bridge the chasm between students' acceptance of bias and skill development in management of bias to improve the outcomes of their clinical encounters.
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Affiliation(s)
- Cristina M Gonzalez
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Yuliana S Noah
- Department of Pediatrics, Jacobi Medical Center, Bronx, NY, USA
| | - Nereida Correa
- Department of Obstetrics and Gynecology, Albert Einstein College of Medicine and Jacobi Medical Center, Bronx, NY, USA
| | - Heather Archer-Dyer
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Javeed Sukhera
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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O'Doherty J, Hyde S, O'Connor R, Brown MEL, Hayes P, Niranjan V, Culhane A, O'Dwyer P, O'Donnell P, Glynn L, O'Regan A. Development and sustainment of professional relationships within longitudinal integrated clerkships in general practice (LICs): a narrative review. Ir J Med Sci 2021; 191:447-459. [PMID: 33641086 DOI: 10.1007/s11845-021-02525-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/20/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Longitudinal integrated clerkships (LICs) are a relatively new model of clinical medical education, whereby students participate in patient care over time and develop relationships with those patients', their clinicians, and other health care staff involved in the care of those patients. It has been called 'relationship-based education' but, to date, no review has investigated the development and impact of these central relationships within this curricula model. AIMS The aim of this study is to review the literature pertaining to relationships in LICs, specifically to understand how they come about and how they affect learning. METHODS The search strategy systematically explored PubMed, ERIC (EBSCO) and Academic Search Complete, using key words and MESH terms. Original research published in peer-reviewed journals between January 2007 and August 2020 that were written in the English language were included in the review. RESULTS After applying set inclusion and exclusion criteria, 43 studies were included in this review. A qualitative thematic analysis was undertaken, and results were synthesised narratively. Four distinct categories were identified: defining relationships in LICs, developing relationships in LICs, relationship maintenance and multi-stakeholder impact. CONCLUSIONS The longitudinal integrated clerkship model of clinical education facilitates the development of meaningful triangular relationships between student, clinical teacher and patient, which are the central drivers of successful learning within the context of an LIC. These relationships are nested in a set of important supporting relationships involving other supervisors, the medical school and university, the practice clinical and administrative team and peers.
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Affiliation(s)
- Jane O'Doherty
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland.
| | - Sarah Hyde
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Raymond O'Connor
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
- Mid-West Specialist Training Programme in General Practice, University of Limerick, Plassey, Limerick, Ireland
| | - Megan E L Brown
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Peter Hayes
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Vikram Niranjan
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Aidan Culhane
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Pat O'Dwyer
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
| | - Patrick O'Donnell
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
| | - Andrew O'Regan
- School of Medicine, University of Limerick, Plassey, Limerick, Ireland
- Health Research Institute, University of Limerick, Plassey, Limerick, Ireland
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