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Doukas DJ. Promoting professionalism through humanities-based transformation. Ann Med 2024; 56:2386039. [PMID: 39101221 DOI: 10.1080/07853890.2024.2386039] [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: 01/30/2024] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION In the last two decades, academic medical centers in the United States have faced a new challenge, dealing with breaches of medical professionalism in their staff, house staff, and medical students. Medical education settings have largely directed their professionalism efforts toward responding reactively to negative outliers. DISCUSSION This paper contends that the warrant of medical education mandates a transformative path forward. While negative behavior must be responded to meaningfully, so, too, must positive role models of professional behavior be publicly lauded for their consequential culture change in their institutions, and promoted as positive role models. Further, the promotion of medical professionalism must be part of this culture by proactively engaging all learners and health care providers with medical ethics and humanities-based knowledge, critical thinking skills, and role modeling. CONCLUSION Professionalism programs should be vested with the authority to implement an affirmative educational program intended to nurture and promote medical professionalism in each medical student, resident, fellow, and attending and utilize methods to that end employing both virtue and care ethics.
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Affiliation(s)
- David J Doukas
- Program in Medical Ethics and Human Values, Tulane University School of Medicine, and IntegratedEthics Program Officer, Southeast LA Veterans Health Care System, New Orleans, LA, USA
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2
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Bernard J, Sonnadara R, Saraco AN, Mitchell JP, Bak AB, Bayer I, Wainman BC. Automated grading of anatomical objective structured practical examinations using decision trees: An artificial intelligence approach. ANATOMICAL SCIENCES EDUCATION 2024; 17:967-978. [PMID: 37322819 DOI: 10.1002/ase.2305] [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: 05/07/2021] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/17/2023]
Abstract
An Objective Structured Practical Examination (OSPE) is an effective and robust, but resource-intensive, means of evaluating anatomical knowledge. Since most OSPEs employ short answer or fill-in-the-blank style questions, the format requires many people familiar with the content to mark the examinations. However, the increasing prevalence of online delivery for anatomy and physiology courses could result in students losing the OSPE practice that they would receive in face-to-face learning sessions. The purpose of this study was to test the accuracy of Decision Trees (DTs) in marking OSPE questions as a first step to creating an intelligent, online OSPE tutoring system. The study used the results of the winter 2020 semester final OSPE from McMaster University's anatomy and physiology course in the Faculty of Health Sciences (HTHSCI 2FF3/2LL3/1D06) as the data set. Ninety percent of the data set was used in a 10-fold validation algorithm to train a DT for each of the 54 questions. Each DT was comprised of unique words that appeared in correct, student-written answers. The remaining 10% of the data set was marked by the generated DTs. When the answers marked by the DT were compared to the answers marked by staff and faculty, the DT achieved an average accuracy of 94.49% across all 54 questions. This suggests that machine learning algorithms such as DTs are a highly effective option for OSPE grading and are suitable for the development of an intelligent, online OSPE tutoring system.
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Affiliation(s)
- Jason Bernard
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ranil Sonnadara
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Anthony N Saraco
- Education Program in Anatomy, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Josh P Mitchell
- Education Program in Anatomy, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alex B Bak
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ilana Bayer
- Education Program in Anatomy, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bruce C Wainman
- Education Program in Anatomy, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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Mäurer I, Drescher R, Hammersen J, Dieckmann N, Gremme Y, Sturm MJ, McLean AL, McLean ACL, Senft C, Wittig A, Klingner C, von Sass C, Mäurer M, Kamp MA. Development and implementation of a student tumor board as a teaching format for medical students. J Cancer Res Clin Oncol 2023; 149:16087-16096. [PMID: 37698680 PMCID: PMC10620267 DOI: 10.1007/s00432-023-05336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Tumor boards serve as established platforms for interdisciplinary expert discussions and therapeutic recommendations tailored to individual patient characteristics. Despite their significance, medical students often lack exposure to such interdisciplinary discussions as tumor boards are currently not integrated into medical curricula. To address this, we aimed to enhance future physicians' interdisciplinary communication skills and subject-specific knowledge by introducing an interactive series of five linked tumor board seminars within the domain of neuro-oncology. METHODS We developed a neuro-oncological student tumor board using a flipped-classroom format. The primary objectives of this case-centered approach included fostering an understanding of the tumor board process, active participation in multidisciplinary case discussions, honing appropriate communication strategies, and creating personalized therapy plans that consider inputs from all relevant disciplines, individual patient factors, and ethical considerations. To gauge the effectiveness of the seminar series, we administered structured pre- and post-course questionnaires. RESULTS Fourteen medical students in third to fifth year participated in the pilot series. Despite its organizational complexity, the interdisciplinary seminars were feasible. Students demonstrated significant growth in competence, aligned with predefined learning objectives. Notably, they appreciated the supportive learning environment and interactive teaching format, which kindled their interest in interdisciplinary oncology. CONCLUSION Active participation in a student tumor board can empower students to tackle the diverse challenges of caring for cancer patients within an interdisciplinary team during the early stages of their careers. The student tumor board represents an innovative, learner-centered approach to teach interdisciplinary cancer treatment, communication strategies, and ethical aspects of medical practice.
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Affiliation(s)
- Irina Mäurer
- Department of Neurology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
- Neuro-Oncological Center, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Advanced Clinician Scientist Program "AntiAge", Jena University Hospital, 07747, Jena, Germany
| | - Robert Drescher
- Department of Nuclear Medicine, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Jakob Hammersen
- Department for Haematology and Medical Oncology, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Nora Dieckmann
- Department of Radiation Oncology, University Medical Center Jena, Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Yvonne Gremme
- Department of Radiation Oncology, University Medical Center Jena, Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Max-Johann Sturm
- Department of Radiation Oncology, University Medical Center Jena, Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Aaron Lawson McLean
- Neuro-Oncological Center, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Department for Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Anna C Lawson McLean
- Neuro-Oncological Center, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Department for Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Christian Senft
- Neuro-Oncological Center, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Department for Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Andrea Wittig
- Neuro-Oncological Center, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Department of Radiation Oncology, University Medical Center Jena, Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Caroline Klingner
- Department of Neurology, Jena University Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Christiane von Sass
- Neuro-Oncological Center, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Department for Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Centre for Palliative Care and Neuropalliative Care, Brandenburg Medical School Theodor Fontane, Campus Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Institute for Health Services and Health System Research, Campus Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany
| | - Matthias Mäurer
- Neuro-Oncological Center, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany.
- Department of Radiation Oncology, University Medical Center Jena, Hospital, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
- Clinician Scientist Program "OrganAge", Jena University Hospital, 07747, Jena, Germany.
| | - Marcel A Kamp
- Neuro-Oncological Center, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Department for Neurosurgery, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Centre for Palliative Care and Neuropalliative Care, Brandenburg Medical School Theodor Fontane, Campus Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Institute for Health Services and Health System Research, Campus Rüdersdorf, Seebad 82/83, 15562, Rüdersdorf, Germany
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Roy S, Shah MH, Ahluwalia A, Harky A. Analyzing the Evolution of Medical Ethics Education: A Bibliometric Analysis of the Top 100 Cited Articles. Cureus 2023; 15:e41411. [PMID: 37416085 PMCID: PMC10321571 DOI: 10.7759/cureus.41411] [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] [Accepted: 07/05/2023] [Indexed: 07/08/2023] Open
Abstract
Ethics education plays a pivotal role in healthcare by providing professionals and students with the essential competencies to navigate intricate ethical challenges. This study conducts a comprehensive bibliometric analysis of the most-cited articles on ethics education, investigating parameters such as citation count, document types, geographical origin, journal analysis, publication year, author analysis, and keyword usage. The findings reveal a substantial impact characterized by high citation counts and the influence of a prominent publication focusing on the hidden curriculum and structure of medical education. Moreover, the analysis demonstrates a discernible increase in research output since 2000, signaling a growing recognition of the significance of ethics education in the healthcare domain. Notably, specific journals, particularly those dedicated to medical education and ethics, emerge as major contributors in this field, publishing many articles. Renowned authors have made noteworthy contributions, and emerging themes encompass the ethical implications of virtual reality and artificial intelligence in healthcare education. Additionally, undergraduate medical education garners significant attention, emphasizing the importance of establishing ethical values and professionalism early. Overall, this study highlights the imperative of interdisciplinary collaboration and the necessity for effective ethics education programs to equip healthcare professionals with the requisite skills to navigate complex ethical challenges. The findings inform educators, curriculum developers, and policymakers about enhancing ethics education and ensuring the ethical competence of future healthcare practitioners.
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Affiliation(s)
- Sakshi Roy
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Muhammad Hamza Shah
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Arjun Ahluwalia
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Amer Harky
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
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Problem-Based Learning in der Ethiklehre am Beispiel des Bachelorstudiums Pflege. Ethik Med 2022. [DOI: 10.1007/s00481-022-00691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Doukas DJ, Ozar DT, Darragh M, de Groot JM, Carter BS, Stout N. Virtue and care ethics & humanism in medical education: a scoping review. BMC MEDICAL EDUCATION 2022; 22:131. [PMID: 35219311 PMCID: PMC8881825 DOI: 10.1186/s12909-021-03051-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE This scoping review explores how virtue and care ethics are incorporated into health professions education and how these factors may relate to the development of humanistic patient care. METHOD Our team identified citations in the literature emphasizing virtue ethics and care ethics (in PubMed, NLM Catalog, WorldCat, EthicsShare, EthxWeb, Globethics.net , Philosopher's Index, and ProQuest Central) lending themselves to constructs of humanism curricula. Our exclusion criteria consisted of non-English articles, those not addressing virtue and care ethics and humanism in medical pedagogy, and those not addressing aspects of character in health ethics. We examined in a stepwise fashion whether citations: 1) Contained definitions of virtue and care ethics; 2) Implemented virtue and care ethics in health care curricula; and 3) Evidenced patient-directed caregiver humanism. RESULTS Eight hundred eleven citations were identified, 88 intensively reviewed, and the final 25 analyzed in-depth. We identified multiple key themes with relevant metaphors associated with virtue/care ethics, curricula, and humanism education. CONCLUSIONS This research sought to better understand how virtue and care ethics can potentially promote humanism and identified themes that facilitate and impede this mission.
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Affiliation(s)
- David J Doukas
- Department of Family and Community Medicine, James A. Knight Chair of Humanities and Ethics in Medicine, Program in Medical Ethics and Human Values, Tulane University School of Medicine, 1430 Tulane Ave, #8033, New Orleans, LA, USA.
| | | | | | | | | | - Nathan Stout
- Department of Family and Community Medicine, James A. Knight Chair of Humanities and Ethics in Medicine, Program in Medical Ethics and Human Values, Tulane University School of Medicine, 1430 Tulane Ave, #8033, New Orleans, LA, USA
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McLean MR, Bottrell MM. Combining Ethics Inquiry and Clinical Experience in a Premedical Health Care Ethics Internship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:78-83. [PMID: 33788790 DOI: 10.1097/acm.0000000000004084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM The professional formation of physicians begins in the premedical years, and educators are now recommending that medical ethics and humanities courses be considered essential components to becoming a physician rather than elective prerequisites for medical school admission. As a result, questions have arisen about how to teach students ethical reasoning skills before their professional training, as they have limited opportunities now to develop these skills and the related competencies in a real-world medical context. APPROACH The authors describe Santa Clara University's Health Care Ethics Internship (HCEI), an undergraduate college experience that emphasizes ethical inquiry and immerses students in health care settings to foster deep learning. The HCEI includes mentored clinical rotations integrated with classroom inquiry into ethical theory, structured reflection, and professional development considerations. A survey of former students (academic years 2001-2002 to 2017-2018) explored their perceptions of these program components and the impact of the experience on their preprofessional readiness, career choice, and professional capabilities. OUTCOMES Of 185 former students who could be contacted, 89 (48.1%) completed the survey. Students reported that the HCEI: (1) assisted them in gaining admission to medical school, (2) had a positive influence on their career decisions, (3) increased their professional capabilities, (4) helped them develop preprofessional competencies, (5) gave them knowledge and experience they used in their personal and professional ethical decision making, and (6) increased their moral sensitivity and ethical responsibility. NEXT STEPS Integrating clinical rotations into ethics education exposes premedical students to real-world ethical questions, helps them develop a nuanced understanding of a health care career, and prepares them for the medical school admissions process. Other universities should consider implementing a similar program to prime their students for continued professional and moral development during medical school and residency.
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Affiliation(s)
- Margaret R McLean
- M.R. McLean is associate director, Markkula Center for Applied Ethics, and senior lecturer, Religious Studies, Santa Clara University, Santa Clara, California
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Fassier T, Rapp A, Rethans JJ, Nendaz M, Bochatay N. Training Residents in Advance Care Planning: A Task-Based Needs Assessment Using the 4-Component Instructional Design. J Grad Med Educ 2021; 13:534-547. [PMID: 34434514 PMCID: PMC8370360 DOI: 10.4300/jgme-d-20-01263.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residents may learn how to perform advance care planning (ACP) through informal curriculum. Task-based instructional designs and recent international consensus statements for ACP provide opportunities to explicitly train residents, but residents' needs are poorly understood. OBJECTIVE We assessed residents' training needs in ACP at the Geneva University Hospitals in Geneva, Switzerland. METHODS Qualitative data were collected and analyzed iteratively between December 2017 and September 2019. Transcripts were coded using both a deductive content analysis based on the 4-Component Instructional Design (4C/ID) model and an inductive thematic analysis. RESULTS Out of 55 individuals contacted by email, 49 (89%) participated in 7 focus groups and 10 individual interviews, including 19 residents, 18 fellows and attending physicians, 4 nurses, 1 psychologist, 1 medical ethics consultant, 3 researchers, and 3 patients. Participants identified 3 tasks expected of residents (preparing, discussing, and documenting ACP) and discussed why training residents in ACP is complex. Participants described knowledge (eg, prognosis), skills (eg, clinical and ethical reasoning), and attitudes (eg, reflexivity) that residents need to become competent in ACP and identified needs for future training. In terms of the 4C/ID, these needs revolved around: (1) learning tasks (eg, workplace practice, simulated scenarios); (2) supportive information (eg, videotaped worked examples, cognitive feedback); (3) procedural information (eg, ACP pocket-sized information sheet, corrective feedback); and (4) part-task practice (eg, rehearsal of communication skills, simulation). CONCLUSIONS This study provides a comprehensive description of tasks and competencies to train residents in ACP.
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Affiliation(s)
- Thomas Fassier
- Thomas Fassier, MD, MPH, PhD, is Director, Interprofessional Simulation Center, Geneva, Switzerland, Faculty, Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland, and Attending Physician, Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Amandine Rapp
- Amandine Rapp, MSc, is Research Assistant, UDREM, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jan-Joost Rethans
- Jan-Joost Rethans, MD, is Professor of Human Simulation, Skillslab, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Mathieu Nendaz
- Mathieu Nendaz, MD, MHPE, is Director, UDREM, Faculty of Medicine, and Vice Dean, School of Medicine, University of Geneva, Geneva, Switzerland, and Professor, Internal Medicine Department, Geneva University Hospitals, Geneva, Switzerland
| | - Naïke Bochatay
- Naïke Bochatay, MSc, PhD, is Postdoctoral Scholar, Department of Pediatrics, University of California, and Research Assistant, UDREM, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Ghaffari R, Taghizadieh A, Behshid M, Somi MH, Mirzazadeh A, Baradaran HR, Huntington M, Emami Razavi SH, Baghban Rezvan F, Salek Ranjbarzadeh F. Accountability in medical education from theory to practice Tabriz 2018 statement: A step towards the implementation of this social necessity. Med J Islam Repub Iran 2020; 34:93. [PMID: 33315967 PMCID: PMC7722974 DOI: 10.34171/mjiri.34.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background: To implement the education reform package on accountability in medical education, the Education Development Center (EDC) of Tabriz University of Medical Sciences has held the first national conference on accountability in medical education, and the present statement is the result of scientific interactions and exchanges in the conference.
Methods: For implementation of the accountability in medical education, there was a need to inform faculty members and other stakeholders about their responsibility in education and health care needs. The provision of such platform was provided by holding a specialized conference on accountability in medical education by Tabriz University of Medical Sciences. Steps of preparing the draft version of the Tabriz 2018 Statement were as follow: Formation the scientific committee; Division of the responsibility for drafting the statement between various workgroups; and Preparation and primary approval of the draft of Tabriz 2018 Statement.
Results: Steps of preparing the draft version of the Tabriz 2018 Statement were: Formation of the scientific committee, Division of the responsibility for drafting the statement between the various workgroups and Preparation and primary approval of the draft of Tabriz 2018 Statement.
Conclusion: Establishing an educational accreditation model and reviewing accreditation standards based on social accountability can be an effective step to strengthen accountability towards community needs.
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Affiliation(s)
- Reza Ghaffari
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Taghizadieh
- Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mozhgan Behshid
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Husein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azim Mirzazadeh
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Baradaran
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Mark Huntington
- Department of Family Medicine, School of Medicine, University of South Dakota Sanford, 414 E. Clark Street, Vermillion, SD 57069, United States
| | - Seyed Hasan Emami Razavi
- Neuroscience Institute, Brain and Spinal Cord Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran
| | - Flora Baghban Rezvan
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Salek Ranjbarzadeh
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Ghaffarifar S, Asghari-Khatooni A, Akbarzadeh A, Pourabbas A, Farshad MS, Masoomi R, Akbarzadeh F. Teaching professionalism in medical residency programs: a scoping review protocol. Syst Rev 2020; 9:281. [PMID: 33278905 PMCID: PMC7719236 DOI: 10.1186/s13643-020-01529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Professionalism is a core competency of medical residents in residency programs. Unprofessional behavior has a negative influence on patient safety, quality of care, and interpersonal relationships. The objective of this scoping review is to map the range of teaching methods of professionalism in medical residency programs (in all specialties and in any setting, whether in secondary, primary, or community care settings). For doing so, all articles which are written in English in any country, regardless of their research design and regardless of the residents' gender, year of study, and ethnic group will be reviewed. METHODS This proposed scoping review will be directed in agreement with the methodology of the Joanna Briggs Institute for scoping reviews. The six steps of Arksey and O'Malley methodological framework for conducting scoping reviews, updated by Levac et al. (Implement. Sci. 5(1): 69, 2010) will be followed. The findings from this study will be merged with those of the previous Best Evidence Medical Education (BEME) systematic review. All published and unpublished studies from 1980 until the end of 2019 will be reviewed, and the previous BEME review will be updated by the findings of the articles from the beginning of 2010 until the end of 2019. All research designs and all credible evidence will be included in this review. CONCLUSIONS Conducting this scoping review will map the teaching methods of professionalism and will provide an inclusive evidence base to help the medical teachers in the choosing for proper teaching methods for use in their teaching practice. SYSTEMATIC REVIEW REGISTRATION Not registered.
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Affiliation(s)
- Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Amirhossein Akbarzadeh
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Pourabbas
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehran Seif Farshad
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rasoul Masoomi
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariborz Akbarzadeh
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Costa M, Kangasjarvi E, Charise A. Beyond empathy: a qualitative exploration of arts and humanities in pre-professional (baccalaureate) health education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2020; 25:1203-1226. [PMID: 32100196 PMCID: PMC7704487 DOI: 10.1007/s10459-020-09964-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/17/2020] [Indexed: 06/10/2023]
Abstract
For nearly four decades, researchers have explored the integration of arts and humanities content into health professions education (HPE). However, enduring controversies regarding the purpose, efficacy, and implementation of humanities initiatives suggest that the timing and context of trainees' exposure to such content is a key, but seldom considered, factor. To better understand the affordances of introducing humanities-based health curriculum prior to the HPE admissions gateway, we conducted a qualitative instrumental case study with participants from Canada's first Health Humanities baccalaureate program. Fully anonymized transcripts from semi-structured interviews (n = 11) and focus groups (n = 14) underwent an open-coding procedure for thematic narrative analysis to reveal three major temporal domains of described experience (i.e., prior to, during, and following their participation in a 12-week semester-long "Introduction to Health Humanities" course). Our findings demonstrate that perceptions of arts- and humanities content in health education are generated well in advance of HPE admission. Among other findings, we define a new concept-epistemological multicompetence-to describe participants' emergent capability to toggle between (and advocate for the role of) multiple disciplines, arts and humanities particularly, in health-related teaching and learning at the pre-professional level. Improved coordination of baccalaureate and HPE curricula may therefore enhance the development of capabilities associated with arts and humanities, including: epistemological multicompetence, aesthetic sensibility, and other sought-after qualities in HPE candidates. In conclusion, attending to the pre-professional admissions gateway presents a new, capabilities-driven approach to enhancing both the implementation and critical understanding of arts and humanities' purpose, role, and effects across the "life course" of health professions education.
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Affiliation(s)
- Marcela Costa
- Federal University of Pernambuco, Recife, Brazil
- SCOPE: The Health Humanities Learning Lab, University of Toronto Scarborough, Scarborough, Canada
| | - Emilia Kangasjarvi
- Centre for Faculty Development, Faculty of Medicine, University of Toronto at St. Michael’s Hospital, Toronto, Canada
| | - Andrea Charise
- SCOPE: The Health Humanities Learning Lab, University of Toronto Scarborough, Scarborough, Canada
- Interdisciplinary Centre for Health & Society (ICHS), University of Toronto Scarborough, 1265 Military Trail, c/o Highland Hall Rm. 220, Toronto, ON M1C 1A4 Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
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Kesselheim J, Baker JN, Kersun L, Lee-Miller C, Moerdler S, Snaman JM, Warwick A, Weng S, Zhang Z. Humanism and professionalism training for pediatric hematology-oncology fellows: Results of a multicenter randomized trial. Pediatr Blood Cancer 2020; 67:e28308. [PMID: 32729211 DOI: 10.1002/pbc.28308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Although humanism and professionalism are central tenets to the practice of medicine, few formal curricula exist for medical trainees. Following a national needs assessment among pediatric hematology-oncology (PHO) fellows, we created a novel curriculum entitled "Humanism and Professionalism for Pediatric Hematology-Oncology" (HP-PHO). In this study, we measure outcomes of this curricular intervention. METHOD We cluster-randomized 20 PHO fellowship programs to deliver usual training in humanism and professionalism (UT) or the novel curriculum (intervention) during the 2016-2017 academic year. The primary outcome measure was the Pediatric Hematology-Oncology Self-Assessment in Humanism (PHOSAH). Secondary measures included the Maslach Burnout Inventory, Patient-Provider Orientation Scale, Empowerment at Work Scale, and a 5-point satisfaction scale. Participating fellows completed pre- and posttests at the beginning and end of the academic year, respectively, and we calculated change scores for each study instrument. RESULTS Cluster randomization yielded 59 intervention and 41 UT fellows. The nine intervention sites administered 33 of 36 modules. Change scores on the PHOSAH were not significantly different between the UT and intervention arms. However, fellows on the intervention arm gave significantly higher ratings on several items within the satisfaction scale related to physician burnout, physician depression, balancing professional duties and personal life, and humanism overall. CONCLUSIONS Exposure to the HP-PHO curriculum did not alter fellows' self-assessed humanism and professionalism skills. However, intervention fellows expressed significantly higher levels of satisfaction in their humanism training, indicating the curriculum's potential for positive impact on the fellows' perceived learning environment.
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Affiliation(s)
- Jennifer Kesselheim
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Justin N Baker
- Department of Oncology, Division of Quality of Life and Palliative Care, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Leslie Kersun
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cathy Lee-Miller
- Department of Oncology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Scott Moerdler
- Department of Pediatrics, The Children's Hospital at Montefiore, New York City, New York
| | - Jennifer M Snaman
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Ann Warwick
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Shicheng Weng
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
| | - Zilu Zhang
- Department of Population Sciences, Dana-Farber Cancer Institute, Boston, MA
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Torda A. CLASSIE teaching - using virtual reality to incorporate medical ethics into clinical decision making. BMC MEDICAL EDUCATION 2020; 20:326. [PMID: 32967692 PMCID: PMC7509501 DOI: 10.1186/s12909-020-02217-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 08/31/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Teaching medical ethics (ME) in the clinical environment is often difficult, uncalibrated and medical students get variable exposure to skilled educators. Explicit discussion of ethical dimensions of patient management is often neglected, as clinical teachers may feel inadequately skilled to do this. METHODS We developed a suite of online modules. Each consisted of a clinical scenario filmed using virtual reality (VR) technology, linked to an adaptive, interactive, online tutorial which explicitly discussed the relevant ethical issues and guidelines. These were embedded in clinical placements of students to encourage the transfer of knowledge from these modules to clinical skill competency. We conducted a pilot study to evaluate these modules which examined student engagement, knowledge gains (self-perceived and measured) and user experience. We also reviewed reflections to assess the incorporation of these modules and transfer of knowledge into the clinical learning and skill development of the students. RESULTS Engagement and self-perceived knowledge gains were extremely high. Students found these modules realistic, interesting and helpful. The measured knowledge gains (module exit quiz) were moderate. User experience was positive overall, although students were intolerant of any technical glitches. There was mixed feedback on whether the VR aspect of the clinical scenarios added value. Student reflections showed high level incorporation of these modules into clinical practice of the students and evidence of knowledge transfer (level 3 Kirkpatrick model of evaluation) in over ¾ of students. CONCLUSIONS This study showed that the use VR clinical scenarios combined with interactive online learning modules resulted in demonstrable high-level student engagement and learning gains in medical ethics and transfer of knowledge to clinical application. It standardised and ensured the student experience of high-quality educational deliverables in clinical years of medical education. This use of VR and online technology can be adapted for use in many areas of the medical curricula where we need to ensure the delivery of well calibrated, high quality, educational deliverables at scale for students.
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Affiliation(s)
- Adrienne Torda
- Faculty of Medicine, UNSW Sydney, Kensington, NSW, 2052, Australia.
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Lee J, Lee J, Jung IY. An integrated humanities-social sciences course in health sciences education: proposed design, effectiveness, and associated factors. BMC MEDICAL EDUCATION 2020; 20:117. [PMID: 32306973 PMCID: PMC7168810 DOI: 10.1186/s12909-020-02022-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous research has not provided enough direction regarding effective content design of courses integrating the humanities and social sciences in medical and dental education. This study aims at exploring how an Integrated Medical/Dental Humanities-Social Medicine/Dentistry course may be designed; how effective it may be in terms of student growth in knowledge, attitudes, skills, and aspirations; and associated factors. METHODS The course was designed by distilling commonalities in the international standards for medical/dental education proposed by seven major health organizations. This analysis resulted in a curriculum covering nine major topics: history, professionalism, communication, ethics, management, policy, insurance, law, and research methodology. During the 2017 calendar year, data was collected and statistically analyzed from 68 third-year pre-doctoral students enrolled in the resulting MDHS 13-week course. RESULTS Participants showed growth in skills, aspirations, knowledge, and attitudes, with the greatest change occurring in skills, then aspirations, knowledge, and attitudes. Knowledge growth was the only variable significantly related to student achievement of course objectives (β = 0.635, t (63) = 3.394, p = 0.001). The topics that students perceived as most critical were insurance, policy, management, and law. The perceived importance of research was most common among participants and was significantly related to all learning outcomes (For knowledge, β = 0.213, t (63) = 2.203, p = 0.031; for attitudes, β = 0.784, t (63) = 10.257, p = 0.000; for skills, β = 0.769, t (63) = 9.772, p = 0.000; and aspirations β = 0.639, t (63) = 7.595, p = 0.000). CONCLUSIONS This study proposed a framework for humanities-social sciences education in health sciences education and analyzed its implementation. The empirical evaluation of its effectiveness and factors related to successful outcomes found that students perceived gains in their knowledge, attitudes, skills, and aspirations for humanistic and social aspects of dentistry/medicine. In addition, their recognition of the importance of research was associated with the greatest growth in all four learning outcomes. This study may contribute to the improved design of integrated humanities-social sciences courses.
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Affiliation(s)
- Jihyun Lee
- Department of Dental Education, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jueyeun Lee
- Department of Preventive Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Il Young Jung
- Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Republic of Korea
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Sholas MG. The actual and potential impact of the novel 2019 coronavirus on pediatric rehabilitation: A commentary and review of its effects and potential disparate influence on Black, Latinx and Native American marginalized populations in the United States. J Pediatr Rehabil Med 2020; 13:339-344. [PMID: 32716335 DOI: 10.3233/prm-200722] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic has had a significant health impact around the world. In the United States, there has been a difference in infection and death rates for Black Americans and other marginalized groups as compared to White Americans. Although children do not seem to be suffering infection, morbidity and mortality to the same degree as adults, there is concern that COVID-19 could have a disparate impact on children with acquired or congenital disabilities when analyzed through the lens of race and equity. The possibility that there could be a differential effect on rehabilitation services relates to: the risk of familial/parental exposure leading to secondary infection, the negative economic impact of public health measures required to control disease spread, and the pre-existing social factors that impact access to healthcare. Finally, the psychosocial stresses imposed by COVID-19 inflame risk factors for non-accidental injury, which could lead to an increased need for pediatric rehabilitation services in vulnerable populations. It is critical that individual providers, as well as the health systems in which they practice, actively focus on mitigating personal and systemic causes of racial and ethnic health outcome disparities. These efforts need to move beyond a race neutral construct to specifically anti-racist activity.
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Ethical Issues Encountered During the Medical Student Surgical Clerkship. J Surg Res 2019; 244:272-277. [PMID: 31302325 DOI: 10.1016/j.jss.2019.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 06/04/2019] [Accepted: 06/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Data regarding ethical issues encountered by medical students during the surgical clerkship are sparse. Identification of such issues facilitates development of an ethics curriculum that ensures student preparation for issues most frequently encountered on the surgical rotation. To better understand these issues, we performed content analysis of reflections written by medical students about ethical issues encountered during their surgical clerkship. MATERIALS AND METHODS All medical students on the surgical clerkship at a university hospital from 4/2017 to 6/2018 submitted a written reflection regarding an ethical issue encountered during the clerkship. Two investigators performed content analysis of each reflection. References to ethical principles (beneficence, nonmaleficence, justice, autonomy) were tabulated. Ethical issues were classified into main categories and subcategories, based on a modified version of a previously published taxonomy. RESULTS 134 reflections underwent content analysis. Nonmaleficence was the most frequently mentioned ethical principle. 411 specific ethical issues were identified. Ethical issues were distributed across ten main categories: decision-making (28%), communication among health care team members (14%), justice (12%), communication between providers, patients, and families (9%), issues in the operating room (9%), informed consent (9%), professionalism (5%), supervision/student-specific issues (5%), documentation (1%), and miscellaneous/other (8%). We identified two ethical issues infrequently discussed in previous reports: delivery of efficient yet high-quality care and poor communication between services/consultants. CONCLUSIONS Students encounter diverse ethical issues during their surgical clerkships. Ethical and contextual considerations related to these issues should be incorporated into a preclinical/clinical surgical ethics curriculum to prepare students to understand and engage the challenges they face during the clerkship.
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Doukas DJ. Promoting Professionalism Through Virtue Ethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:37-39. [PMID: 30676906 DOI: 10.1080/15265161.2018.1545879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- David John Doukas
- a Tulane University School of Medicine, New Orleans VA Medical Center, and The Academy for Professionalism in Health Care
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Sarıoğlu Büke A, Karabilgin Öztürkçü ÖS, Yılmaz Y, Sayek İ. Core Professionalism Education in Surgery: A Systematic Review. Balkan Med J 2018; 35:167-173. [PMID: 29553464 PMCID: PMC5863255 DOI: 10.4274/balkanmedj.2017.0534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Professionalism education is one of the major elements of surgical residency education. AIMS To evaluate the studies on core professionalism education programs in surgical professionalism education. STUDY DESIGN Systematic review. METHODS This systematic literature review was performed to analyze core professionalism programs for surgical residency education published in English with at least three of the following features: program developmental model/instructional design method, aims and competencies, methods of teaching, methods of assessment, and program evaluation model or method. A total of 27083 articles were retrieved using EBSCOHOST, PubMed, Science Direct, Web of Science, and manual search. RESULTS Eight articles met the selection criteria. The instructional design method was presented in only one article, which described the Analysis, Design, Development, Implementation, and Evaluation model. Six articles were based on the Accreditation Council for Graduate Medical Education criterion, although there was significant variability in content. The most common teaching method was role modeling with scenario- and case-based learning. A wide range of assessment methods for evaluating professionalism education were reported. The Kirkpatrick model was reported in one article as a method for program evaluation. CONCLUSION It is suggested that for a core surgical professionalism education program, developmental/instructional design model, aims and competencies, content, teaching methods, assessment methods, and program evaluation methods/models should be well defined, and the content should be comparable.
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Affiliation(s)
- Akile Sarıoğlu Büke
- Emeritus Professor of Paediatric Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | | | - Yusuf Yılmaz
- Department of Medical Education, Ege University School of Medicine, İzmir, Turkey
| | - İskender Sayek
- Emeritus Professor of Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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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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Doukas DJ, Volpe RL. Why Pull the Arrow When You Cannot See the Target? Framing Professionalism Goals in Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1610-1612. [PMID: 29697430 DOI: 10.1097/acm.0000000000002264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Professionalism is essential for a successful physician-patient relationship and widely acknowledged as an intrinsic and important component of medical education for learners at all levels, from medical school to residency to continuing medical education. The problem is defining the educational end points for learners and then determining how to assess these outcomes. This Invited Commentary focuses on what medical educators can and should do to refine the vision of professionalism in medical education. The authors propose a multistep process in which learners, educators, and the public are engaged in articulating clearly and definitively the end points of professionalism education.
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Affiliation(s)
- David J Doukas
- D.J. Doukas is James A. Knight Chair of Humanities and Ethics in Medicine, director, Program in Medical Ethics and Human Values, and professor of family and community medicine, Tulane University School of Medicine, New Orleans, Louisiana; ORCID: http://orcid.org/0000-0002-5665-2214. R.L. Volpe is assistant professor and vice chair for education, Department of Humanities, Penn State College of Medicine, and director, Clinical Ethics Consultation Service, Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Perspectives on the development of professionalism as experienced by radiography students. Radiography (Lond) 2018; 24:110-114. [DOI: 10.1016/j.radi.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022]
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McCarthy MW, Real de Asua D, Fins JJ. The Rise of Hospitalists: An Opportunity for Clinical Ethics. THE JOURNAL OF CLINICAL ETHICS 2017. [DOI: 10.1086/jce2017284325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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de la Garza S, Phuoc V, Throneberry S, Blumenthal-Barby J, McCullough L, Coverdale J. Teaching Medical Ethics in Graduate and Undergraduate Medical Education: A Systematic Review of Effectiveness. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:520-525. [PMID: 27644429 DOI: 10.1007/s40596-016-0608-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/12/2016] [Indexed: 05/17/2023]
Abstract
OBJECTIVE One objective was to identify and review studies on teaching medical ethics to psychiatry residents. In order to gain insights from other disciplines that have published research in this area, a second objective was to identify and review studies on teaching medical ethics to residents across all other specialties of training and on teaching medical students. METHODS PubMed, EMBASE, and PsycINFO were searched for controlled trials on teaching medical ethics with quantitative outcomes. Search terms included ethics, bioethics, medical ethics, medical students, residents/registrars, teaching, education, outcomes, and controlled trials. RESULTS Nine studies were found that met inclusion criteria, including five randomized controlled trails and four controlled non-randomized trials. Subjects included medical students (5 studies), surgical residents (2 studies), internal medicine house officers (1 study), and family medicine preceptors and their medical students (1 study). Teaching methods, course content, and outcome measures varied considerably across studies. Common methodological issues included a lack of concealment of allocation, a lack of blinding, and generally low numbers of subjects as learners. One randomized controlled trial which taught surgical residents using a standardized patient was judged to be especially methodologically rigorous. CONCLUSIONS None of the trials incorporated psychiatry residents. Ethics educators should undertake additional rigorously controlled trials in order to secure a strong evidence base for the design of medical ethics curricula. Psychiatry ethics educators can also benefit from the findings of trials in other disciplines and in undergraduate medical education.
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Hefler J, Ramnanan CJ. Can CanMEDS competencies be developed in medical school anatomy laboratories? A literature review. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8. [PMID: 28650843 PMCID: PMC5511744 DOI: 10.5116/ijme.5929.4381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES The purpose of this literature review was to identify potential ways in which undergraduate medical anatomy education may be relevant to the CanMEDS Roles, a competency-based framework used throughout Canadian medical training. METHODS A scoping review of medical education literature was conducted in March 2017 for English language publications that included key words related to anatomy education and to key competencies formally described for each of the Roles in the CanMEDS 2015 framework. Indicated benefits were then collated, characterized, and synthesized for each CanMEDS Role. RESULTS There were 71 studies identified describing original findings. Perceived benefits of anatomy education were most often identified for competencies related to the Medical Expert Role. Multiple studies also cited benefits related to the Scholar, Professional and Collaborator Roles. There was a lack of literature related to the Health Advocate, Communicator, and Leader Roles. The majority of benefits defined in the literature were limited to student perceptions rather than objectively measured outcomes. CONCLUSIONS There is some evidence to suggest that anatomy education can facilitate the development of core competencies related to several CanMEDS Roles, outside of simply developing medical knowledge in the Medical Expert Role. Future studies need to develop methods to objectively assess outcomes related to these competencies.
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Affiliation(s)
- Joshua Hefler
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Canada
| | - Christopher J. Ramnanan
- Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Canada
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Ferreira-Padilla G, Ferrández-Antón T, Lolas-Stepke F, Almeida-Cabrera R, Brunet J, Bosch-Barrera J. Ethics competences in the undergraduate medical education curriculum: the Spanish experience. Croat Med J 2017; 57:493-503. [PMID: 27815940 PMCID: PMC5141466 DOI: 10.3325/cmj.2016.57.493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim To investigate if there are differences in medical ethics education between different schools of medicine in Spain, specifically between private and public schools and between recently founded schools and older ones. Method The curricula of medical degrees from all Spanish faculties were reviewed for the 2014/2015 academic year, identifying subjects concerning bioethics, deontology, and ethics. We identified the type of teaching, format and method of the course, the number of credits and hours, and the school year of each subject. An analysis with descriptive parameters and the Cohen’s coefficient (d) was performed. Results All medical schools in Spain (n = 44) were included. A mean of 3.64 European Credit Transfer and Accumulation System (ECTS) credits was specifically devoted to ethical values teaching in Spain. Private medical schools offered more credits than public ones (6.51 ECTS vs 2.88 ECTS, relevant difference: d = 2.06>>0.8), and the 10 most recently founded medical schools offered more credits than the 10 oldest (5.86 ECTS vs 2.63 ECTS, relevant difference: d = 1.43 > 0.8). A mean of 36.75 hours was dedicated to ethics education. Conclusions Although ethics education is incorporated into the training of future Spanish physicians, there is still notable heterogeneity between different medical schools in the time devoted to this topic.
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Affiliation(s)
| | | | | | | | | | - Joaquim Bosch-Barrera
- Joaquim Bosch-Barrera, Department of Medical Oncology, Catalan Institute of Oncology Doctor Josep Trueta University Hospital, Avinguda de Franca S/N, 17007 Girona, Spain,
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Laxe S. La dificultad en la toma de decisiones subrogadas en la atrofia muscular espinal. An Pediatr (Barc) 2016; 85:165. [DOI: 10.1016/j.anpedi.2016.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/03/2016] [Accepted: 04/05/2016] [Indexed: 11/25/2022] Open
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Abstract
Ethics and professionalism education has become increasingly recognized as important and incorporated into graduate medical education. However, such education has remained largely unstructured and understudied in neonatology. Neonatal-perinatal fellowship training programs have generally grappled with how best to teach and assess ethics and professionalism knowledge, skills, and behavior in clinical practice, particularly in light of accreditation requirements, milestones, and competencies. This article reviews currently available teaching methods, pedagogy, and resources in medical ethics, professionalism, and communication, as well as assessment strategies and tools, to help medical educators and practicing clinicians ensure trainees achieve and maintain competency. The need for consensus and future research in these domains is also highlighted.
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Affiliation(s)
- Christy L Cummings
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Hunnewell 437, Boston, MA.
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Mallory LA, Calaman S, Lee White M, Doughty C, Mangold K, Lopreiato J, Auerbach M, Chang TP. Targeting Simulation-Based Assessment for the Pediatric Milestones: A Survey of Simulation Experts and Program Directors. Acad Pediatr 2016; 16:290-7. [PMID: 26456040 DOI: 10.1016/j.acap.2015.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/22/2015] [Accepted: 09/30/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine which of the 21 general pediatrics milestone subcompetencies are most difficult to assess using traditional methodologies and which are best suited to simulation-based assessment. METHODS We surveyed 2 samples: pediatric simulation experts and pediatric program directors. Respondents were asked about current use of simulation for assessment and to select 5 of the 21 pediatric subcompetencies most difficult to assess using traditional methods and the 5 best suited to simulation-based assessment. Spearman rank correlation was used to determine a correlation between how the 2 samples ranked the subcompetencies. RESULTS Forty-eight percent (29 of 60) simulation experts and 20% (115 of 571) program directors completed the survey. Few respondents reported using simulation for summative assessment. There are clear differences across the pediatric subcompetencies in perceived difficulty of assessment and suitability to simulation-based assessment. The 3 most difficult to assess subcompetencies were "recognize ambiguity," "demonstrate emotional insight," and "identify one's own strengths and deficiencies." The subcompetencies most suitable to assessment using simulation were "interprofessional teamwork," "clinical decision making," and "effective communication." Program directors and simulation experts had high agreement for both questions: difficult to assess (rho = 0.76, P < .001) and suitable to simulation-based assessment (rho = 0.94, P < .001). CONCLUSIONS Several general pediatrics milestone subcompetencies were identified by pediatric simulation experts and pediatric program directors as difficult to assess using current methodologies and as amenable to simulation-based assessment. The pediatric simulation community should target development of simulation-based assessment tools to these areas.
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Affiliation(s)
- Leah A Mallory
- Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine/The Barbara Bush Children's Hospital at Maine Medical Center, Portland, Maine.
| | - Sharon Calaman
- Division of Pediatric Critical Care, Department of Pediatrics, Drexel University College of Medicine/St Christopher's Hospital for Children, Philadelphia, Pa
| | - Marjorie Lee White
- Division of Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Cara Doughty
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Tex
| | - Karen Mangold
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago/Feinberg School of Medicine at Northwestern University, Chicago, Ill
| | - Joseph Lopreiato
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md
| | - Marc Auerbach
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn
| | - Todd P Chang
- Division of Emergency Medicine and Transport, Department of Pediatrics, Children's Hospital Los Angeles/Keck School of Medicine at University of Southern California, Los Angeles, Calif
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Hudon A, Perreault K, Laliberté M, Desrochers P, Williams-Jones B, Ehrmann Feldman D, Hunt M, Durocher E, Mazer B. Ethics teaching in rehabilitation: results of a pan-Canadian workshop with occupational and physical therapy educators. Disabil Rehabil 2016; 38:2244-54. [PMID: 26750086 DOI: 10.3109/09638288.2015.1123308] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Ethical practice is an essential competency for occupational and physical therapists. However, rehabilitation educators have few points of reference for choosing appropriate pedagogical and evaluation methods related to ethics. The objectives of this study were to: (1) identify priority content to cover in ethics teaching in occupational therapy (OT) and physical therapy (PT) programmes and (2) explore useful and innovative teaching and evaluation methods. METHOD Data for this qualitative descriptive study were collected during a 1-d knowledge exchange workshop focused on ethics teaching in rehabilitation. RESULTS Twenty-three educators from 11 OT and 11 PT Canadian programmes participated in the workshop. They highlighted the importance of teaching foundational theoretical/philosophical approaches and grounding this teaching in concrete examples drawn from rehabilitation practice. A wide range of teaching methods was identified, such as videos, blogs, game-based simulations and role-play. For evaluation, participants used written assignments, exams, objective structured clinical examinations and reflective journals. The inclusion of opportunities for student self-evaluation was viewed as important. CONCLUSION The CREW Day provided ethics educators the opportunity to share knowledge and begin creating a community of practice. This space for dialogue could be expanded to international rehabilitation ethics educators, to facilitate a broader network for sharing of tacit and experiential knowledge. Implications for Rehabilitation According to the study participants, rehabilitation ethics education should include learning about foundational knowledge related to ethical theory; be grounded in examples and cases drawn from clinical rehabilitation practice; and contribute to building professional competencies such as self-knowledge and critical thinking in students. Regardless of the methods used by occupational therapy (OT) and physical therapy (PT) educators for teaching and evaluation, the value of creating spaces that support open discussion for students (e.g. protected discussion time in class, peer-discussions with the help of a facilitator, use of a web discussion forum) was consistently identified as an important facet. Educators from OT and PT programmes should work with various professionals involved in OT and PT student training across the curricula (e.g. clinical preceptors, other educators) to extend discussions of how ethics can be better integrated into the curriculum outside of sessions specifically focused on ethics. The CREW Day workshop was the first opportunity for Canadian rehabilitation ethics educators to meet and discuss their approaches to teaching and evaluating ethics for OT and PT students. Including international rehabilitation ethics educators in this dialogue could positively expand on this initial dialogue by facilitating the sharing of tacit and experiential knowledge amongst a larger and more diverse group of ethics educators.
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Affiliation(s)
- Anne Hudon
- a Rehabilitation Sciences, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada ;,b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada
| | - Kadija Perreault
- c Department of Rehabilitation, Faculty of Medicine , Université Laval , Quebec City , Québec , Canada
| | - Maude Laliberté
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,d Department of Social and Preventive Medicine, École De Santé Publique , University of Montreal , Montreal , Québec , Canada
| | - Pascal Desrochers
- e Department of Physical Therapy, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada
| | - Bryn Williams-Jones
- d Department of Social and Preventive Medicine, École De Santé Publique , University of Montreal , Montreal , Québec , Canada
| | - Debbie Ehrmann Feldman
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,e Department of Physical Therapy, School of Rehabilitation, Faculty of Medicine , University of Montreal , Montreal , Québec , Canada
| | - Matthew Hunt
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
| | - Evelyne Durocher
- f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
| | - Barbara Mazer
- b Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) , Montreal , Québec , Canada ;,f School of Physical and Occupational Therapy , McGill University , Montreal , Québec , Canada
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Shapiro J, Nixon LL, Wear SE, Doukas DJ. Medical professionalism: what the study of literature can contribute to the conversation. Philos Ethics Humanit Med 2015; 10:10. [PMID: 26122270 PMCID: PMC4484639 DOI: 10.1186/s13010-015-0030-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 06/23/2015] [Indexed: 05/30/2023] Open
Abstract
Medical school curricula, although traditionally and historically dominated by science, have generally accepted, appreciated, and welcomed the inclusion of literature over the past several decades. Recent concerns about medical professional formation have led to discussions about the specific role and contribution of literature and stories. In this article, we demonstrate how professionalism and the study of literature can be brought into relationship through critical and interrogative interactions based in the literary skill of close reading. Literature in medicine can question the meaning of "professionalism" itself (as well as its virtues), thereby resisting standardization in favor of diversity method and of outcome. Literature can also actively engage learners with questions about the human condition, providing a larger context within which to consider professional identity formation. Our fundamental contention is that, within a medical education framework, literature is highly suited to assist learners in questioning conventional thinking and assumptions about various dimensions of professionalism.
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Affiliation(s)
- Johanna Shapiro
- Family Medicine and Director of the Program in Medical Humanities & Arts, University of California-Irvine, School of Medicine, 101 City Dr. South, Rte 81, Bldg 200, Ste 835, Orange, CA, 92868, USA.
| | - Lois L Nixon
- Internal Medicine, Division of Ethics and Humanities, University of South Florida School of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, USA.
| | - Stephen E Wear
- Center for Clinical Ethics and Humanities in Healthcare, Departments of Medicine, Gynecology-Obstetrics, and Philosophy, University at Buffalo SUNY School of Medicine, Buffalo, NY, USA.
| | - David J Doukas
- William Ray Moore Endowed Chair of Family Medicine and Medical Humanism, and Division of Medical Humanism and Ethics, Department of Family and Geriatric Medicine, University of Louisville, 2301S 3rd St, Louisville, KY, 40292, USA.
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