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Ding H, Homer M. Tailoring support following summative assessments: a latent profile analysis of student outcomes across five medical specialities. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10357-9. [PMID: 39042360 DOI: 10.1007/s10459-024-10357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/30/2024] [Indexed: 07/24/2024]
Abstract
Summative assessments are often underused for feedback, despite them being rich with data of students' applied knowledge and clinical and professional skills. To better inform teaching and student support, this study aims to gain insights from summative assessments through profiling students' performance patterns and identify those students missing the basic knowledge and skills in medical specialities essential for their future career. We use Latent Profile Analysis to classify a senior undergraduate year group (n = 295) based on their performance in applied knowledge test (AKT) and OSCE, in which items and stations are pre-classified across five specialities (e.g. Acute and Critical Care, Paediatrics,…). Four distinct groups of students with increasing average performance levels in the AKT, and three such groups in the OSCE are identified. Overall, these two classifications are positively correlated. However, some students do well in one assessment format but not in the other. Importantly, in both the AKT and the OSCE there is a mixed group containing students who have met the required standard to pass, and those who have not. This suggests that a conception of a borderline group at the exam-level can be overly simplistic. There is little literature relating AKT and OSCE performance in this way, and the paper discusses how our analysis gives placement tutors key insights into providing tailored support for distinct student groups needing remediation. It also gives additional information to assessment writers about the performance and difficulty of their assessment items/stations, and to wider faculty about student overall performance and across specialities.
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Affiliation(s)
- Huiming Ding
- School of Medicine, University of Leeds, Leeds, UK.
| | - Matt Homer
- School of Medicine, University of Leeds, Leeds, UK
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Godschalx-Dekker JA, Gerritse FL, Pronk SA, Duvivier RJ, van Mook WNKA. Is insufficient introspection a reason to terminate residency training? - Scrutinising introspection among residents who disputed dismissal. MEDICAL TEACHER 2024:1-8. [PMID: 38506085 DOI: 10.1080/0142159x.2024.2323175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/21/2024] [Indexed: 03/21/2024]
Abstract
INTRODUCTION Insufficient introspection as part of the 4I's model of medical professionalism (introspection, integrity, interaction, and involvement) is considered an important impediment in trainees. How insufficient introspection relates to decisions to terminate residency training remains unclear. Insights into this subject provide opportunities to improve the training of medical professionals. METHODS We analysed the Dutch Conciliation Board decisions regarding residents dismissed from training between 2011 and 2020. We selected the decisions on residents deemed 'insufficient' regarding introspection as part of the CanMEDS professional domain and compared their characteristics with the decisions about residents without reported insufficiencies on introspection. RESULTS Of the 120 decisions, 86 dismissed residents were unable to fulfil the requirements of the CanMEDS professional domain. Insufficient introspection was the most prominent insufficiency (73/86). These 73 decisions described more residents' insufficiencies in CanMEDS competency domains compared to the rest of the decisions (3.8 vs. 2.7 p < 0.001), without significant differences regarding gender or years of training. CONCLUSIONS Insufficient introspection in residents correlates with competency shortcomings programme directors reported in dismissal disputes. The 4I's model facilitates recognition and description of unprofessional behaviours, opening avenues for assessing and developing residents' introspection, but further research is needed for effective implementation in medical education.
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Affiliation(s)
| | - Frank L Gerritse
- Department of Hospital Psychiatry, Tergooi MC, Hilversum, The Netherlands
| | - Sebastiaan A Pronk
- Academy for Postgraduate Medical Training, Maastricht UMC+, Maastricht, The Netherlands
| | - Robbert J Duvivier
- Center for Education Development And Research in Health Professions (CEDAR), UMC Groningen, Groningen, The Netherlands
- Emergency Services, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Walther N K A van Mook
- Academy for Postgraduate Medical Training, Maastricht UMC+, Maastricht, The Netherlands
- Department of Intensive Care Medicine, Maastricht UMC+, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Altshuler L, Wilhite JA, Hardowar K, Crowe R, Hanley K, Kalet A, Zabar S, Gillespie C, Ark T. Understanding medical student paths to communication skills expertise using latent profile analysis. MEDICAL TEACHER 2023; 45:1140-1147. [PMID: 36961759 DOI: 10.1080/0142159x.2023.2193303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE To describe patterns of clinical communication skills that inform curriculum enhancement and guide coaching of medical students. MATERIALS AND METHODS Performance data from 1182 consenting third year medical students in 9 cohorts (2011-2019), on a 17-item Clinical Communication Skills Assessment Tool (CCSAT) completed by trained Standardized Patients as part of an eight case high stakes Comprehensive Clinical Skills Exam (CCSE) were analyzed using latent profile analysis (LPA). Assessment domains included: information gathering (6 items), relationship development (5 items), patient education (3 items), and organization/time management (3 items). LPA clustered learners with similar strength/weakness into profiles based on item response patterns across cases. One-way analysis of variance (ANOVA) assessed for significant differences by profile for CCSAT items. RESULTS Student performance clustered into six profiles in three groups, high performing (HP1 and HP2-Low Patient Education, 15.7%), average performing (AP1 and AP2-Interrupters, 40.9%), and lower performing profiles (LP1-Non-interrupters and LP2, 43.4%) with adequate model fit estimations and similar distribution in each cohort. We identified 3 CCSAT items that discriminated among learner's skill profiles. CONCLUSION Clinical communication skill performance profiles provide nuanced, benchmarked guidance for curriculum improvement and tailoring of communication skills coaching.
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Affiliation(s)
- Lisa Altshuler
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Jeffrey A Wilhite
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Khemraj Hardowar
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Ruth Crowe
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Kathleen Hanley
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Adina Kalet
- Kern Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sondra Zabar
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA
| | - Colleen Gillespie
- Institute for Innovations in Medical Education, NYU Grossman School of Medicine, New York, NY, USA
| | - Tavinder Ark
- Kern Institute, Medical College of Wisconsin, Milwaukee, WI, USA
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Keshmiri F, Raadabadi M. Perception and engagement in unprofessional behaviors of medical students and residents: a mixed-method study. BMC PRIMARY CARE 2023; 24:191. [PMID: 37723441 PMCID: PMC10506320 DOI: 10.1186/s12875-023-02153-y] [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: 08/03/2022] [Accepted: 09/06/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND The present study aimed to investigate perception and engagement in unprofessional behavior of residents and medical interns and explore the factors affecting their engagement in unprofessional behavior. METHOD This study has an explanatory (quantitative-qualitative) mixed-method design. This study was conducted at Shahid Sadoughi University of Medical Sciences in 2022-2023. Participants, including residents and medical interns (n = 169), were entered by stratified random sampling. A survey was conducted in the quantitative step. A by an unprofessional behavior in clinical practice questionnaire (29 items) was used. For each behavior, the participants were asked to report whether they (a) participated in the behavior and (b) stated that the behavior Is unprofessional. In the qualitative step, 17 participants contributed. The qualitative data were collected by semi-structured interviews and analyzed according to the conventional content analysis approach Graneheim and Lundman introduced. RESULTS The highest ratio of participants' engagement in unprofessional behavior was reported in 'failure to introduce yourself and nurses and physician assistants to the patient and his family' (n = 145 (85.8%)). The results showed the proportion of participants who engaged in unprofessional behavior more than those who did not participate. There were associations between participants' engagement in each behavior and their perception of that particular behavior as unprofessional. (p = 0.0001). In the following behaviors, although the participants acknowledged that these behaviors were unprofessional, those who participated in the unprofessional behaviors were significantly more than those who did not participate: failure to comply with clinic regulations and policy (p = 0.01), eating or drinking in the hallway of the clinic (p = 0.01), medical negligence in duties in the clinic setting (p = 0.04) and failure to perform duties in teamwork (p = 0.04). The qualitative results were explored in a theme entitled "internalized unprofessional culture," including three categories "encouraging contextual risk factors towards unprofessionalism," "suppressing of unprofessionalism reporting," and "disbelieving professionalism as a key responsibility." CONCLUSION The results indicated that most participants engaged in unprofessional behaviors. The findings resulted from the internalized unprofessional culture in the workplace. The findings showed that engagement in unprofessional behaviors resulted from personal and systemic factors. The weakness of responsibility recognition and identity formation as a professional facilitated the engagement in unprofessional behaviors at the personal level. Furthermore, systemic factors including the contextual risk factors (such as deficiency of explicit and hidden curriculum), and the suppression of unprofessionalism reporting mechanism as a hidden factor played an important role in normalizing unprofessional behavior and promoting engagement in unprofessional behaviors among the participants. Recognition of the nature and extent of students' unprofessional behaviors facilitates educational discussion among teachers and students in this field. The results might assist to establish an assessment system and feedback mechanism to solve the problem of the "failure to fail" problem. In addition, these results provide medical educators insights into the development of professional courses that equip learners with adherence to professionalism and coping skills to deal with unprofessionalism in the healthcare system.
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Affiliation(s)
- Fatemeh Keshmiri
- Medical Education Department, Educational Developmental Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- National Agency for Strategic Research in Medical Education, Tehran, Iran.
| | - Mehdi Raadabadi
- National Agency for Strategic Research in Medical Education, Tehran, Iran
- Health Policy and Management Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Debets MPM, Tummers FHMP, Silkens MEWM, Huizinga CRH, Lombarts KMJMH, van der Bogt KEA. Doctors' alertness, contentedness and calmness before and after night shifts: a latent profile analysis. HUMAN RESOURCES FOR HEALTH 2023; 21:68. [PMID: 37605244 PMCID: PMC10441714 DOI: 10.1186/s12960-023-00855-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: 02/26/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND While night shifts are crucial for patient care, they threaten doctors' well-being and performance. Knowledge of how the impact of night shifts differs for doctors is needed to attenuate the adverse effects of night shifts. This study aimed to obtain more precise insight into doctors' feelings surrounding night shift by: identifying profiles based on doctors' alertness, contentedness and calmness scores before and after night shifts (research question (RQ) 1); assessing how doctors' pre- and post-shift profiles change (RQ2); and determining associations of doctors' demographics and shift circumstances with alertness, contentedness and calmness change (RQ3). METHODS Latent Profile Analysis using doctors' pre- and post-shift self-rated alertness, contentedness and calmness scores was employed to identify pre- and post-shift profiles (RQ1). A cross-tabulation revealed pre- and post-shift profile changes (RQ2). Multiple regressions determined associations of demographics (i.e. age, sex, specialty) and night shift circumstances (i.e. hours worked pre-call, hours awake pre-call, shift duration, number of consecutive shifts, total hours of sleep) with alertness, contentedness and calmness change (RQ3). RESULTS In total, 211 doctors participated with a mean age of 39.8 ± 10 years; 47.4% was male. The participants included consultants (46.4%) and trainees (53.6%) of the specialties surgery (64.5%) and obstetrics/gynaecology (35.5%). Three pre-shift (Indifferent, Ready, Engaged) and four post-shift profiles (Lethargic, Tired but satisfied, Excited, Mindful) were found. Most doctors changed from Ready to Tired but satisfied, with alertness reducing most. Age, specialty, sleep, shift duration and the number of consecutive shifts associated with alertness, contentedness and calmness changes. CONCLUSIONS The results provided nuanced insight into doctors' feelings before and after night shifts. Future research may assess whether specific subgroups benefit from tailored interventions.
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Affiliation(s)
- Maarten P M Debets
- Research Group Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Fokkedien H M P Tummers
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Gyneacology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Milou E W M Silkens
- Department of Health Services Research and Management, City University of London, London, United Kingdom
| | - Coen R H Huizinga
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kiki M J M H Lombarts
- Research Group Professional Performance and Compassionate Care, Department of Medical Psychology, Amsterdam University Medical Centres, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Koen E A van der Bogt
- Centre for Human Drug Research, Leiden, The Netherlands
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Surgery, Haaglanden Medical Centre, The Hague, The Netherlands
- University Vascular Centre Leiden, The Hague, The Netherlands
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Tabatabaei ZS, Mirzazadeh A, Amini H, Mafinejad MK. What we think about professional and unprofessional behaviors: differences between the perception of clinical faculty members and medical students. BMC MEDICAL EDUCATION 2022; 22:866. [PMID: 36517813 PMCID: PMC9749347 DOI: 10.1186/s12909-022-03874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Differences in the viewpoints of clinical faculty members and medical students about prioritizing professional norms accepted by the professional community and lack of alignment of these views can lead to distortion of understanding, problems in learning and assessment of professionalism, and failure in students' professional identity formation. This study aimed to identify the differences in viewpoints of clinical faculty members and medical students about prioritizing the importance and prevalence of professional and unprofessional behaviors among undergraduate medical students. METHODS A multi-stage qualitative study was conducted at Tehran University of Medical Sciences during 2020-2021. At first, a systematic search was conducted to identify professional and unprofessional behaviors using the directional content analysis method. A panel of experts was formed to check the codes obtained from reviewing the literature and to evaluate its compliance with the context. Then, the modified nominal group technique sessions were held with clinical faculty members and medical students to strengthen the codes extracted from the studies and systematically integrate their views to achieve a comprehensive list of professional and unprofessional behaviors in accordance with the context. Finally, a consensus was made among them about prioritizing the importance and prevalence of these behaviors in undergraduate medical students. RESULTS A total of 490 codes of professional behaviors and 595 unprofessional behavior codes were identified in the literature review. In the following sessions of the modified nominal group, 13 clinical faculty members listed 105 codes of professional and unprofessional behaviors, and 51 medical students also listed 313 codes. The results of the modified nominal group technique showed that the faculty members reported the importance of unprofessional behaviors higher than professional ones. At the same time, students rated the importance of professional behaviors higher than unprofessional ones. Both faculty members and students rate the prevalence of professional behaviors as high and the prevalence of unprofessional behaviors as low. CONCLUSION The results showed a difference of views between clinical faculty members and medical students about prioritizing professional and unprofessional behaviors. It is essential to align their viewpoints to understand, learn and value professionalism to develop a professional identity.
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Affiliation(s)
- Zahra Sadat Tabatabaei
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Education Development Office, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azim Mirzazadeh
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoun Amini
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Khabaz Mafinejad
- Health Professions Education Research Center, Education Development Center, Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
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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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Barnhoorn PC, Nierkens V, Mak-van der Vossen MC, Numans ME, van Mook WNKA, Kramer AWM. Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty. BMC FAMILY PRACTICE 2021; 22:249. [PMID: 34930146 PMCID: PMC8686537 DOI: 10.1186/s12875-021-01609-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. METHODS We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. RESULTS Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. CONCLUSIONS The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation.
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Affiliation(s)
- Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine and Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, the Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
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9
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Kusurkar RA, Mak-van der Vossen M, Kors J, Grijpma JW, van der Burgt SME, Koster AS, de la Croix A. 'One size does not fit all': The value of person-centred analysis in health professions education research. PERSPECTIVES ON MEDICAL EDUCATION 2021; 10:245-251. [PMID: 33284407 PMCID: PMC8368141 DOI: 10.1007/s40037-020-00633-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 10/07/2020] [Accepted: 11/05/2020] [Indexed: 05/10/2023]
Abstract
Health professions education (HPE) research is dominated by variable-centred analysis, which enables the exploration of relationships between different independent and dependent variables in a study. Although the results of such analysis are interesting, an effort to conduct a more person-centred analysis in HPE research can help us in generating a more nuanced interpretation of the data on the variables involved in teaching and learning. The added value of using person-centred analysis, next to variable-centred analysis, lies in what it can bring to the applications of the research findings in educational practice. Research findings of person-centred analysis can facilitate the development of more personalized learning or remediation pathways and customization of teaching and supervision efforts. Making the research findings more recognizable in practice can make it easier for teachers and supervisors to understand and deal with students. The aim of this article is to compare and contrast different methods that can be used for person-centred analysis and show the incremental value of such analysis in HPE research. We describe three methods for conducting person-centred analysis: cluster, latent class and Q‑sort analyses, along with their advantages and disadvantage with three concrete examples for each method from HPE research studies.
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Affiliation(s)
- Rashmi A Kusurkar
- Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands.
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Marianne Mak-van der Vossen
- Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Joyce Kors
- Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan-Willem Grijpma
- Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- LEARN! Academy, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Andries S Koster
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Anne de la Croix
- Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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Cleland JA, Jamieson S, Kusurkar RA, Ramani S, Wilkinson TJ, van Schalkwyk S. Redefining scholarship for health professions education: AMEE Guide No. 142. MEDICAL TEACHER 2021; 43:824-838. [PMID: 33826870 DOI: 10.1080/0142159x.2021.1900555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Scholarship is an integral aspect of academia. It shapes the practice of individuals and the field and is often used to inform career progression decisions and policies. This makes it high stakes. Yet it is complex, and ambiguous. Definitions vary and the term does not necessarily translate well across contexts. In this AMEE guide, our aim is to establish a contemporary definition of scholarship which is appropriate to health professions education (HPE). Our specific objectives are to provide guidance to support colleagues in their career development as professional educators and to challenge biases and assumptions about scholarship which may still exist in educational systems and structures. Ultimately, we hope that this work will advance the stature/standing of scholarship in the field. We provide a general definition of scholarship and how this relates to the scholarship of teaching (and learning) (SoT[L]) and scholarly teaching. Drawing on Boyer's seminal work, we describe different types of scholarship and reflect on how these apply to HPE, before moving on to describe different types of engagement with scholarship in HPE, including scope of contribution and influence. Using cases and examples, we illustrate differences in scholarly engagement across stages of a career, contexts, and ways of engaging. We provide guidance on how to assess 'quality' of scholarship. We offer practical advice for health professions' educators seeking academic advancement. We advocate that institutional leaders consider their systems and structures, so that these align with faculty work patterns, and judge teaching and professional practice appropriately. We conclude by offering a new definition of scholarship in HPE.
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Affiliation(s)
- Jennifer A Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Susan Jamieson
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Rashmi A Kusurkar
- Amsterdam UMC, Faculty of Medicine, Vrije Universiteit Amsterdam, Research in Education, Amsterdam, The Netherlands
- LEARN! Research Institute for Learning and Education, Faculty of Psychology and Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Subha Ramani
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tim J Wilkinson
- Otago Medical School, University of Otago, Christchurch, New Zealand
| | - Susan van Schalkwyk
- Faculty of Medicine and Health Sciences, Centre for Health Professions Education, Stellenbosch University, Stellenbosch, South Africa
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Kaslow NJ, Ammirati RJ. Reflective practice: Finding synergy between psychological science and competency‐based frameworks. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Beydoun HA, Butt C, Beydoun MA, Eid SM, Zonderman AB, Johnstone B. Two latent classes of diagnostic and treatment procedures among traumatic brain injury inpatients. Sci Rep 2020; 10:10825. [PMID: 32616834 PMCID: PMC7331666 DOI: 10.1038/s41598-020-67576-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/26/2020] [Indexed: 11/26/2022] Open
Abstract
To characterize latent classes of diagnostic and/or treatment procedures among hospitalized U.S. adults, 18-64 years, with primary diagnosis of TBI from 2004-2014 Nationwide Inpatient Samples, latent class analysis (LCA) was applied to 10 procedure groups and differences between latent classes on injury, patient, hospital and healthcare utilization outcome characteristics were modeled using multivariable regression. Using 266,586 eligible records, LCA resulted in two classes of hospitalizations, namely, class I (n = 217,988) (mostly non-surgical) and class II (n = 48,598) (mostly surgical). Whereas orthopedic procedures were equally likely among latent classes, skin-related, physical medicine and rehabilitation procedures as well as behavioral health procedures were more likely among class I, and other types of procedures were more likely among class II. Class II patients were more likely to have moderate-to-severe TBI, to be admitted on weekends, to urban, medium-to-large hospitals in Midwestern, Southern or Western regions, and less likely to be > 30 years, female or non-White. Class II patients were also less likely to be discharged home and necessitated longer hospital stays and greater hospitalization charges. Surgery appears to distinguish two classes of hospitalized patients with TBI with divergent healthcare needs, informing the planning of healthcare services in this target population.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA.
| | - Catherine Butt
- Intrepid Spirit Center, Defense and Veterans Brain Injury Center, Fort Belvoir, VA, USA
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Shaker M Eid
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Brick Johnstone
- Intrepid Spirit Center, Defense and Veterans Brain Injury Center, Fort Belvoir, VA, USA
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Mak-van der Vossen M, Teherani A, van Mook W, Croiset G, Kusurkar RA. How to identify, address and report students' unprofessional behaviour in medical school. MEDICAL TEACHER 2020; 42:372-379. [PMID: 31880194 DOI: 10.1080/0142159x.2019.1692130] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students' unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the 'failure to fail' phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions.
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Affiliation(s)
- Marianne Mak-van der Vossen
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arianne Teherani
- Department of Medicine and Center for Faculty Educators, University of California, School of Medicine, San Francisco, CA, USA
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Gerda Croiset
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- Department of Research in Education, Faculty of Medicine VU University Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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15
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Tay KT, Ng S, Hee JM, Chia EWY, Vythilingam D, Ong YT, Chiam M, Chin AMC, Fong W, Wijaya L, Toh YP, Mason S, Krishna LKR. Assessing Professionalism in Medicine - A Scoping Review of Assessment Tools from 1990 to 2018. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520955159. [PMID: 33150208 PMCID: PMC7580192 DOI: 10.1177/2382120520955159] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/11/2020] [Indexed: 05/17/2023]
Abstract
BACKGROUND Medical professionalism enhances doctor-patient relationships and advances patient-centric care. However, despite its pivotal role, the concept of medical professionalism remains diversely understood, taught and thus poorly assessed with Singapore lacking a linguistically sensitive, context specific and culturally appropriate assessment tool. A scoping review of assessments of professionalism in medicine was thus carried out to better guide its understanding. METHODS Arksey and O'Malley's (2005) approach to scoping reviews was used to identify appropriate publications featured in four databases published between 1 January 1990 and 31 December 2018. Seven members of the research team employed thematic analysis to evaluate the selected articles. RESULTS 3799 abstracts were identified, 138 full-text articles reviewed and 74 studies included. The two themes identified were the context-specific nature of assessments and competency-based stages in medical professionalism. CONCLUSIONS Prevailing assessments of professionalism in medicine must contend with differences in setting, context and levels of professional development as these explicate variances found in existing assessment criteria and approaches. However, acknowledging the significance of context-specific competency-based stages in medical professionalism will allow the forwarding of guiding principles to aid the design of a culturally-sensitive and practical approach to assessing professionalism.
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Affiliation(s)
- Kuang Teck Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shea Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jia Min Hee
- National University Hospital, National University Health System, Singapore
| | | | - Divya Vythilingam
- School of Medicine, International Medical University Malaysia, Kuala Lumpur, Malaysia
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Limin Wijaya
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
- Duke-NUS Graduate Medical School, Singapore
| | - Ying Pin Toh
- Department of Family Medicine, National University Health System, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, Liverpool, UK
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Singapore
- Duke-NUS Graduate Medical School, Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education
- Lalit Kumar Radha Krishna, Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
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Mak-van der Vossen MC, de la Croix A, Teherani A, van Mook WNKA, Croiset G, Kusurkar RA. Developing a two-dimensional model of unprofessional behaviour profiles in medical students. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:215-232. [PMID: 30387053 PMCID: PMC6484089 DOI: 10.1007/s10459-018-9861-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/23/2018] [Indexed: 05/12/2023]
Abstract
Standardized narratives or profiles can facilitate identification of poor professional behaviour of medical students. If unprofessional behaviour is identified, educators can help the student to improve their professional performance. In an earlier study, based on opinions of frontline teachers from one institution, the authors identified three profiles of medical students' unprofessional behaviour: (1) Poor reliability, (2) Poor reliability and poor insight, and (3) Poor reliability, poor insight and poor adaptability. The distinguishing variable was Capacity for self-reflection and adaptability. The current study used Nominal Group Technique and thematic analysis to refine these findings by synthesizing experts' opinions from different medical schools, aiming to develop a model of unprofessional behaviour profiles in medical students. Thirty-one experienced faculty, purposively sampled for knowledge and experience in teaching and evaluation of professionalism, participated in five meetings at five medical schools in the Netherlands. In each group, participants generated ideas, discussed them, and independently ranked these ideas by allocating points to them. Experts suggested ten different ideas, from which the top 3 received 60% of all ranking points: (1) Reflectiveness and adaptability are two distinct distinguishing variables (25%), (2) The term reliability is too narrow to describe unprofessional behaviour (22%), and (3) Profiles are dynamic over time (12%). Incorporating these ideas yielded a model consisting of four profiles of medical students' unprofessional behaviour (accidental behaviour, struggling behaviour, gaming-the-system behaviour and disavowing behaviour) and two distinguishing variables (reflectiveness and adaptability). The findings could advance educators' insight into students' unprofessional behaviour, and provide information for future research on professionalism remediation.
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Affiliation(s)
- Marianne C Mak-van der Vossen
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Anne de la Croix
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- LEARN! Academy, Vrije Universiteit, Amsterdam, The Netherlands
| | - Arianne Teherani
- Center for Faculty Educators, School of Medicine, University of California San Francisco, San Francisco, USA
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Gerda Croiset
- Faculty of Medical Sciences, University Medical Center Groningen, Groningen, The Netherlands
| | - Rashmi A Kusurkar
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam UMC, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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Mak-van der Vossen MC, de la Croix A, Teherani A, van Mook WNKA, Croiset G, Kusurkar RA. A Road Map for Attending to Medical Students' Professionalism Lapses. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:570-578. [PMID: 30489285 DOI: 10.1097/acm.0000000000002537] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE To develop a road map for educators attending to medical students' professionalism lapses, aiming to offer an empirical base for approaching students who display such lapses. METHOD Between October 2016 and January 2018, 23 in-depth interviews with 19 expert faculty responsible for remediation from 13 U.S. medical schools were conducted about the way they handle students' professionalism lapses. Three researchers independently completed three rounds of coding. Data collection, coding, and analysis were performed in a constant comparative process. A constructivist grounded theory approach was used to develop an explanatory model for attending to students' professionalism lapses. RESULTS Based on participants' descriptions, the authors developed a three-phase approach for attending to professionalism lapses. In phase 1, experts enacted the role of concerned teacher, exploring the lapse from the student's perspective. In phase 2, they functioned as supportive coach, providing feedback on professionalism values, improving skills, creating reflectiveness, and offering support. In phase 3, if the student did not demonstrate reflectiveness and improvement, and especially if (future) patient care was potentially compromised, participants assumed an opposite role: gatekeeper of the profession. CONCLUSIONS An explanatory model for attending to professionalism lapses that fits in the overarching "communities of practice" framework was created. Whereas phase 1 and 2 aim at keeping students in the medical community, phase 3 aims at guiding students out. These findings provide empirical support to earlier descriptive, opinion-based models and may offer medical educators an empirical base for attending to students who display professionalism lapses.
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Affiliation(s)
- Marianne C Mak-van der Vossen
- M.C. Mak-van der Vossen is general physician, coordinator of professional behavior, and PhD student, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0001-7810-6575. A. de la Croix is assistant professor, LEARN! Academy, Vrije Universiteit, and researcher, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands. A. Teherani is professor of medicine and education researcher, Center for Faculty Educators, School of Medicine, University of California, San Francisco, San Francisco, California. W.N.K.A. van Mook is internist/intensivist, Department of Intensive Care Medicine, postgraduate dean, Maastricht University Medical Center, and professor of medical education, Maastricht University, Maastricht, The Netherlands. G. Croiset is professor of education and training, Health and Life Sciences, and dean of education and training, University Medical Center Groningen, Groningen, The Netherlands. R.A. Kusurkar is associate professor of medical education and head, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands; ORCID: https://orcid.org/0000-0002-9382-0379
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Barnhoorn PC, Houtlosser M, Ottenhoff-de Jonge MW, Essers GTJM, Numans ME, Kramer AWM. A practical framework for remediating unprofessional behavior and for developing professionalism competencies and a professional identity. MEDICAL TEACHER 2019; 41:303-308. [PMID: 29703096 DOI: 10.1080/0142159x.2018.1464133] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The relatively new term "Professional Identity Formation" (PIF) complements behavior-based and attitude-based perspectives on professionalism. Unprofessional behavior and its remediation should also be addressed from this perspective. However, a framework is needed to guide discussion and remediation of unprofessional behavior, which can encompass behavior-based, attitude-based, and identity-based perspectives on professionalism. To this end, the authors propose a multi-level professionalism framework which describes, apart from professional behavior, more levels which influence professional performance: environment, competencies, beliefs, values, identity, and mission. The different levels can provide tools for educators to address and discuss unprofessional behavior with their students in a comprehensive way. By reflecting on all the different levels of the framework, educators guard themselves against narrowing the discussion to either professional behavior or professional identity. The multi-level professionalism framework can help educators and students to gain a better understanding of the root of unprofessional behavior, and of remediation strategies that would be appropriate. For despite the recent emphasis on PIF, unprofessional behavior and its remediation will remain important issues in medical education.
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Affiliation(s)
- Pieter C Barnhoorn
- a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands
| | - Mirjam Houtlosser
- b Department of Medical Ethics and Health Law , Leiden University Medical Center , Leiden , The Netherlands
| | | | - Geurt T J M Essers
- c The Netherlands' Network of the GP Specialty Training Institutes , Utrecht , The Netherlands
| | - Mattijs E Numans
- a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands
| | - Anneke W M Kramer
- a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands
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de Leng WE, Stegers‐Jager KM, Born MP, Themmen APN. Integrity situational judgement test for medical school selection: judging 'what to do' versus 'what not to do'. MEDICAL EDUCATION 2018; 52:427-437. [PMID: 29349804 PMCID: PMC5901405 DOI: 10.1111/medu.13498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/10/2017] [Accepted: 10/23/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Despite their widespread use in medical school selection, there remains a lack of clarity on exactly what situational judgement tests (SJTs) measure. OBJECTIVES We aimed to develop an SJT that measures integrity by combining critical incident interviews (inductive approach) with an innovative deductive approach. The deductive approach guided the development of the SJT according to two established theoretical models, of which one was positively related to integrity (honesty-humility [HH]) and one was negatively related to integrity (cognitive distortions [CD]). The Integrity SJT covered desirable (HH-based) and undesirable (CD-based) response options. We examined the convergent and discriminant validity of the Integrity SJT and compared the validity of the HH-based and CD-based subscores. METHODS The Integrity SJT was administered to 402 prospective applicants at a Dutch medical school. The Integrity SJT consisted of 57 scenarios, each followed by four response options, of which two represented HH facets and two represented CD categories. Three SJT scores were computed, including a total, an HH-based and a CD-based score. The validity of these scores was examined according to their relationships with external integrity-related measures (convergent validity) and self-efficacy (discriminant validity). RESULTS The three SJT scores correlated significantly with all integrity-related measures and not with self-efficacy, indicating convergent and discriminant validity. In addition, the CD-based SJT score correlated significantly more strongly than the HH-based SJT score with two of the four integrity-related measures. CONCLUSIONS An SJT that assesses the ability to correctly recognise CD-based response options as inappropriate (i.e. what one should not do) seems to have stronger convergent validity than an SJT that assesses the ability to correctly recognise HH-based response options as appropriate (i.e. what one should do). This finding might be explained by the larger consensus on what is considered inappropriate than on what is considered appropriate in a challenging situation. It may be promising to focus an SJT on the ability to recognise what one should not do.
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Affiliation(s)
- Wendy E de Leng
- Institute of Medical Education Research RotterdamErasmus Medical CentreRotterdamThe Netherlands
| | - Karen M Stegers‐Jager
- Institute of Medical Education Research RotterdamErasmus Medical CentreRotterdamThe Netherlands
| | - Marise Ph Born
- Department of PsychologyErasmus University RotterdamRotterdamThe Netherlands
| | - Axel P N Themmen
- Institute of Medical Education Research RotterdamErasmus Medical CentreRotterdamThe Netherlands
- Department of Internal MedicineErasmus Medical CentreRotterdamThe Netherlands
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Kaslow NJ, Grus CL, Allbaugh LJ, Shen-Miller D, Bodner KE, Veilleux J, Van Sickle K. Trainees with Competence Problems in the Professionalism Domain. ETHICS & BEHAVIOR 2018. [DOI: 10.1080/10508422.2018.1438897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nadine J. Kaslow
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | - Lucy J. Allbaugh
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | | | - Kimberly E. Bodner
- Thompson Center for Autism & Neurodevelopmental Disorders, University of Missouri
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Bernabeo EC, Chesluk B, Lynn L. Tiny Moments Matter: Promoting Professionalism in Everyday Practice. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 38:110-116. [PMID: 29782368 DOI: 10.1097/ceh.0000000000000202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Professionalism rests upon a number of individual, environmental, and societal level factors, leading to specific professional behavior in specific situations. Focusing on professional lapses to identify and remediate unprofessional physicians is incomplete. We explored professionalism in practicing internal medicine physicians in the context of everyday practice, to highlight how typical experiences contribute to positive, yet often unnoticed, professional behavior. METHODS In-depth interviews were used to uncover 13 physicians' most meaningful experiences of professionalism. Data were collected and analyzed using a grounded theory approach. RESULTS Results revealed several themes around which physicians embody professionalism in their daily lives. Physicians feel most professional when they are able to connect and establish trust with patients and colleagues and when they serve as positive role models to others. Physicians conceptualize professionalism as a dynamic and evolving competency, one that requires a lifelong commitment and that provides opportunities for lifelong learning. DISCUSSION Focusing on actual perceptions of experiences in practice offers important insights into how physicians think about professionalism beyond a traditional remediation and lapses perspective. Physicians often go out of their way to connect with patients and colleagues, serving and modeling for others, often at the expense of their own work-life balance. These moments help to infuse energy and positivity into physician practices during a time when physicians may feel overburdened, overscheduled, and overregulated. Understanding professionalism as developmental helps frame professionalism as a lifelong competency subject to growth and modification over time.
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Liu Z, Zhang Y, Tian L, Sun B, Chang Q, Zhao Y. Application of latent class analysis in assessing the competency of physicians in China. BMC MEDICAL EDUCATION 2017; 17:208. [PMID: 29132410 PMCID: PMC5683211 DOI: 10.1186/s12909-017-1039-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/02/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The physicians' competency is an important public health issue around the world. Several international organizations have taken the lead in examining the competencies required to be a physician. The purpose of this study is to identify subgroups of physicians' competency based upon the importance results of competency evaluation and provide a scientific basis for the qualitative research of the competency of physicians. METHODS A cross-sectional study was conducted on a large population-based sample in 31 provinces, autonomous regions and municipalities directly under the central government in China. The latent class analysis was performed to identify patterns of physicians' competency using M-plus software. RESULTS In this study, the latent class analysis was adopted to identify the appropriate number of distinct latent classes of physicians' competency based on eight competency dimensions, and a four-class model best fit the data, which are excellent competency group, lack of professionalism competency group, individual competency driven group, and lack of competency cognitive group. Therefore, 6247 physicians can be divided into four latent classes based on the importance results of competency evaluation, and the number of each class is 5684, 284, 215 and 64, respectively. CONCLUSION These findings suggested that latent class analysis can be used to study the competency of physicians, and four distinct subgroups were identified. Therefore, we can effectively understand the patterns of physicians' competency, and the health administrative departments could utilize more specific measures according to their different competency subgroups, and providing individualized training schemes in the future training and management of physicians.
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Affiliation(s)
- Zhuang Liu
- School of Public Health, China Medical University, Shenyang, Liaoning China
| | - Yue Zhang
- School of Public Health, China Medical University, Shenyang, Liaoning China
| | - Lei Tian
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning China
| | - Baozhi Sun
- Research Center for Medical Education, China Medical University, Shenyang, Liaoning China
| | - Qing Chang
- Department of Clinical Epidemiology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Heping District, Shenyang, Liaoning Province 110004 People’s Republic of China
| | - Yuhong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital, China Medical University, No.36, Sanhao Street, Heping District, Shenyang, Liaoning Province 110004 People’s Republic of China
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Mak-van der Vossen M, van Mook W, Croiset G, Kusurkar R. In Reply to Bynum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:424-425. [PMID: 28350589 DOI: 10.1097/acm.0000000000001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Marianne Mak-van der Vossen
- Medical educator and PhD candidate in medical education, VUmc School of Medical Sciences, Amsterdam, the Netherlands; . Associate professor, internist/intensivist, and dean for postgraduate medical training, Maastricht University Medical Center, Maastricht, the Netherlands. Professor in medical education and director, VUmc School of Medical Sciences, Amsterdam, the Netherlands. Associate professor and head, Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
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Bynum WE. Assessing for Learner Shame Should Be a Routine Part of Remediation for Unprofessional Behavior. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:424. [PMID: 28350588 DOI: 10.1097/acm.0000000000001585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- William E Bynum
- Attending faculty, National Capital Consortium Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, Virginia;
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