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Gause SA, Vranas KC. Workforce Diversity and Equity Among Critical Care Physicians. Crit Care Clin 2024; 40:767-787. [PMID: 39218485 DOI: 10.1016/j.ccc.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Health disparities persist among minoritized populations. A diverse clinician workforce may help address these disparities and improve patient outcomes; however, diversity in the critical are workforce (particularly among women and those historically underrepresented in medicine (URiM)) is lacking. This review describes factors contributing to low respresentation of women and URiM in critical care medicine, and proposes strategies to overcome those barriers.
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Affiliation(s)
- Sherie A Gause
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Kelly C Vranas
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA; Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, 3710 Southwest US Veterans Hospital Road, Portland, OR 97239, USA.
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2
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Quicksall MS. Inclusive Mentorship for the Next Generation of Veterinary Professionals. Vet Clin North Am Small Anim Pract 2024:S0195-5616(24)00068-8. [PMID: 39244443 DOI: 10.1016/j.cvsm.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
Veterinary medicine is one of the least diverse professions in terms of race and ethnicity. Inclusive mentorship has the potential to increase representation and retention of BIPOC (black, indigenous, people of color) individuals and individuals with other marginalized identities in the field. Inclusive mentorship benefits not only the mentors and mentees but also the veterinary profession and the communities we serve. It is critical to incorporate inclusion principles throughout the mentoring relationship, starting with creating an inclusive environment and considering inclusion in program design and mentor training. Inclusion is an ongoing process that requires dedication and maintenance.
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Cohen JB, Feldman-Brillembourg JA, Cheng J, Rangrass G. Safety amid the scalpels: creating psychological safety in the operating room. Curr Opin Anaesthesiol 2024:00001503-990000000-00231. [PMID: 39248012 DOI: 10.1097/aco.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
PURPOSE OF REVIEW We briefly review the concept of psychological safety and discuss the actions that can create it in the anesthesiologist's work environment. RECENT FINDINGS The interest in psychological safety has grown in popularity since the publication of Amy Edmondson's book The Fearless Organization in 2018. While the concept and its benefits are described in the healthcare literature, the specific actions necessary to create it are often not. SUMMARY To ensure patient safety, we want members of the teams we lead to be comfortable sharing emerging problems that they see before we become aware of them. As educators, we want trainees to approach us when they do not understand something and openly participate and contribute without the fear of how others will perceive them. These scenarios require an environment of psychological safety - the ability to ask for help, admit mistakes, and be respectfully forthright with unpopular beliefs without the fear of being ostracized or ignored. Methods for creating an environment of psychological safety will be discussed.
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Affiliation(s)
| | | | - Jason Cheng
- Kaiser Permanente, National Safety Director-The Permanente Federation, Pasadena, California
| | - Govind Rangrass
- SSM Health Saint Louis University Hospital, Saint Louis, Missouri, USA
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4
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Zvonar I, Jauregui J, Welsh LA. Posttraumatic growth for long-term success: Organizational strategies for supporting residents after medical error. AEM EDUCATION AND TRAINING 2024; 8:e10991. [PMID: 38765710 PMCID: PMC11099761 DOI: 10.1002/aet2.10991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Affiliation(s)
- Ivan Zvonar
- Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Joshua Jauregui
- Emergency MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Laura A. Welsh
- Emergency Medicine at the Chobanian & Avedisian School of MedicineBoston UniversityBostonMassachusettsUSA
- Boston Medical Center Emergency Medicine Residency ProgramBostonMassachusettsUSA
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Abahuje E, Yang S, Hu YY, Alam HB, Rosenblatt A, Ballard H, Slocum JD, Stey AM, Johnson JK. Mixed-methods Assessment of Incivility During Surgical Mortality and Morbidity Conference. Ann Surg 2024; 279:993-999. [PMID: 37638402 PMCID: PMC11259161 DOI: 10.1097/sla.0000000000006080] [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] [Indexed: 08/29/2023]
Abstract
OBJECTIVE This study assessed incivility during mortality and morbidity (M&M) conference. BACKGROUND A psychologically safe environment at M&M conference enables generative discussions to improve care. Incivility and exclusion demonstrated by "shame and blame" undermine generative discussion. METHODS We used a convergent mixed-methods design to collect qualitative data through nonparticipant observations of M&M conference and quantitative data through standardized survey instruments of M&M participants. The M&M conference was attended by attending surgeons (all academic ranks), fellows, residents, medical students on surgery rotation, advanced practice providers, and administrators from the department of surgery. A standardized observation guide was developed, piloted and adapted based on expert nonparticipant feedback. The Positive and Negative Affect Schedule Short-Form (PANAS) and the Uncivil Behavior in Clinical Nursing Education (UBCNE) survey instruments were distributed to the Department of Surgery clinical faculty and categorical general surgery residents in an academic medical center. RESULTS We observed 11 M&M discussions of 30 cases, over 6 months with 4 different moderators. Case presentations (virtual format) included clinical scenario, decision-making, operative management, complications, and management of the complications. Discussion was free form, without a standard structure. The central theme was that limited discussion participation from attending surgeon of record, as well as absence of a systems-approach led to blame and then blame then set the stage for incivility. Among 147 eligible to participate in the survey, 54 (36.7%) responded. Assistant professors had a 2.60 higher Negative Affect score ( P =0.02), a 4.13 higher Exclusion Behavior score ( P =0.03), and a 7.6 higher UBCNE score ( P =0.04) compared with associate and full professors. Females had a 2.7 higher Negative Affect Score compared with males ( P =0.04). CONCLUSION Free-form M&M discussions led to incivility. Structuring discussion to focus upon improving care may create inclusion and more generative discussions to improve care.
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Affiliation(s)
- Egide Abahuje
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shae Yang
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Yue-Yung Hu
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Pediatric Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, IL
| | - Hasan B. Alam
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Audrey Rosenblatt
- Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, IL
| | - Heather Ballard
- Department of Pediatric Anesthesiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, IL
| | - John D. Slocum
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Anne M. Stey
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Julie K. Johnson
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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6
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Sahiti Q, Shearer C, Thomson C, Sutherland L, Bowes D. Addressing medical resident mistreatment: A resident-centred approach. MEDICAL TEACHER 2024; 46:769-775. [PMID: 37972586 DOI: 10.1080/0142159x.2023.2279903] [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: 11/19/2023]
Abstract
INTRODUCTION Mistreatment negatively impacts the wellbeing of medical learners and is related to worse patient outcomes and team functioning. Resident perspectives on improving mistreatment reporting structures and investigations have not been explored. We aimed to understand residents' views on safe reporting structures, investigations, and resolution processes. METHOD We conducted an exploratory sequential mixed method study beginning with a series of qualitative interviews to inform an anonymous online survey to all Dalhousie University residents (N = 645). RESULTS When interviewed, residents (N = 10) discussed personal experiences with mistreatment, barriers to reporting, and how these processes could better serve them. Themes from the interviews were imbedded in an anonymous online survey to explore their prevalence among a larger group. Residents (N = 120; 19%) completed the online survey and revealed that mistreatment was very common yet underreported. Barriers to reporting included confidentiality concerns, perceptions that reporting would not change anything, and fear of retaliation. Desired outcomes for perpetrators depended on the perpetrator's position and incident severity, and most prefer a remedial approach. CONCLUSION Resident mistreatment remains prevalent and current processes of dealing with reports may be inadequate. Residents have thoughtful insights for improving institutional policies and procedures and should be meaningfully engaged.
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Affiliation(s)
| | - Cindy Shearer
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
| | - Carolyn Thomson
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Family Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Office of Resident Affairs, Dalhousie University, Halifax, Canada
| | - Lisa Sutherland
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Office of Resident Affairs, Dalhousie University, Halifax, Canada
| | - David Bowes
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Postgraduate Medical Education, Dalhousie University, Halifax, Canada
- Faculty of Medicine, Department of Radiation Oncology, Dalhousie University, Halifax, Canada
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7
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Mand SK, Cico SJ, Haas MRC, Schnabel NE, Schnapp BH. Let's get active: The use of technology-enhanced audience interaction to promote active learning. AEM EDUCATION AND TRAINING 2024; 8:S50-S55. [PMID: 38774823 PMCID: PMC11102944 DOI: 10.1002/aet2.10950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/04/2023] [Accepted: 12/27/2023] [Indexed: 05/24/2024]
Affiliation(s)
- Simanjit K. Mand
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Stephen J. Cico
- Department of Clinical SciencesUniversity of Central Florida College of MedicineOrlandoFloridaUSA
| | - Mary R. C. Haas
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Nicole E. Schnabel
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Benjamin H. Schnapp
- BerbeeWalsh Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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8
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Valestrand EA, Whelan B, Eliassen KER, Schei E. Alienation in the Teaching Hospital: How Physician Non-Greeting Behaviour Impacts Medical Students' Learning and Professional Identity Formation. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:239-249. [PMID: 38638636 PMCID: PMC11025575 DOI: 10.5334/pme.1185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
Introduction Clinical workplaces offer unrivalled learning opportunities if students get pedagogic and affective support that enables them to confidently participate and learn from clinical activities. If physicians do not greet new students, the learners are deprived of signals of social respect and inclusion. This study explored how physicians' non-greeting behaviour may impact medical students' participation, learning, and professional identity formation in clinical placements. Methods We analysed 16 senior Norwegian medical students' accounts of non-greeting behaviours among their physician supervisors in a reflexive thematic analysis of focus group interview data. Results The main themes were: A) Descriptions of non-greeting. Not being met with conduct signalling rapport, such as eye contact, saying hello, using names, or introducing students at the workplace, was perceived as non-greeting, and occurred across clinical learning contexts. B) Effects on workplace integration. Non-greeting was experienced as a rejection that hurt students' social confidence, created distance from the physician group, and could cause avoidance of certain workplace activities or specific medical specialties. C) Impact on learning. Non-greeting triggered avoidance and passivity, reluctance to ask questions or seek help or feedback, and doubts about their suitability for a medical career. Conclusion Medical students' accounts of being ignored or treated with disdain by physician superiors upon entering the workplace suggest that unintended depersonalising behaviour is ingrained in medical culture. Interaction rituals like brief eye contact, a nod, a "hello", or use of the student's name, can provide essential affective support that helps medical students thrive and learn in the clinic.
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Affiliation(s)
- Eivind Alexander Valestrand
- Center for Medical Education, Faculty of Medicine, University of Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
| | - Beth Whelan
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
- Student Health and Wellness Center, Memorial University, St. John's, NL, Canada
| | | | - Edvin Schei
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Norway
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Moquin RW, Pinney B. Twelve tips for supporting medical learners through high-stakes assessment challenges. MEDICAL TEACHER 2024:1-6. [PMID: 38615688 DOI: 10.1080/0142159x.2024.2339405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
Learners across the medical education continuum will encounter numerous high-stakes exams and assessments. Effectively preparing for and performing well on these types of assessments can be challenging for learners for a wide variety of reasons. It is imperative that medical educators provide appropriate support for learners who experience challenges with high-stakes exams, particularly given the complexity of factors like life circumstances of individual learners and the significance of these assessments for career advancement/progression. Grouped into areas including educator mindset, information-gathering, and developing and executing a study plan, the following 12 tips will help medical educators be better prepared to meaningfully support learners in need of assessment remediation and guidance.
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Affiliation(s)
- Rachel W Moquin
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Brian Pinney
- Center for Educational Enhancement, Des Moines University, Des Moines, IA, USA
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10
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Kassab SE, Hamdy H, Mamede S, Schmidt H. Influence of tutor interventions and group process on medical students' engagement in problem-based learning. MEDICAL EDUCATION 2024. [PMID: 38563548 DOI: 10.1111/medu.15387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Student engagement is influenced by several variables, among which are the teaching styles employed by faculty. In problem-based learning (PBL), the role of faculty is to facilitate the learning of the tutorial group as they work through clinical problems. However, the influence of tutor intervention styles and group process on engagement of students in PBL tutorials is unclear. METHODS The study was conducted with year 2 and 3 medical students (n = 176) in PBL tutorial groups at the end of an integrated PBL course. Students evaluated their behavioural, cognitive and emotional engagement in PBL tutorials using a pre-validated 11-item questionnaire. Students also filled in a modified version of a previously published tutor intervention profile (TIP) questionnaire. The modified TIP questionnaire represents three constructs (1) steering the learning process (6 items), (2) stimulating student autonomy (4 items) and (3) establishing relatedness with students (3 items). In addition, PBL group process was evaluated using a 5-item nominal scale: (1) tutorial atmosphere, (2) listening and information sharing, (3) group performance, (4) decision making and (5) reaction to leadership. RESULTS Establishing sense of relatedness in the group by PBL tutors was the most important predictor of emotional engagement (F = 41.213, ΔR2 = 0.191, β = 0.438, P = 0.000). On the other hand, steering the learning process was a significant predictor of behavioural engagement (F = 19.0, ΔR2=0.098, β = 0.314, P = 0.000). However, stimulating student autonomy was not a significant predictor of student engagement in PBL tutorials. On the other hand, enhancing the group process in PBL tutorials significantly predicts student engagement with strong impact on emotional and cognitive engagement of students. CONCLUSIONS Establishing the sense of relatedness in the group and steering the learning process by PBL tutors as well as improving PBL group process are significant predictors of student engagement in PBL tutorials with emotional and cognitive engagement being the most sensitive variables affected.
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Affiliation(s)
- Salah Eldin Kassab
- Gulf Medical University, Ajman, United Arab Emirates
- Department of Physiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hossam Hamdy
- Gulf Medical University, Ajman, United Arab Emirates
| | - Silvia Mamede
- Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, The Netherlands
| | - Henk Schmidt
- Gulf Medical University, Ajman, United Arab Emirates
- Institute of Medical Education Research Rotterdam, Erasmus MC, Rotterdam, The Netherlands
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11
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Brown W, Santhosh L, Stewart NH, Adamson R, Lee MM. The ABCs of Cultivating Psychological Safety for Clinical Learner Growth. J Grad Med Educ 2024; 16:124-127. [PMID: 38993303 PMCID: PMC11234300 DOI: 10.4300/jgme-d-23-00589.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Affiliation(s)
- Wade Brown
- is Assistant Professor of Medicine and Associate Program Director, Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Lekshmi Santhosh
- is Associate Professor of Medicine and Associate Program Director, Divisions of Pulmonary and Critical Care Medicine and Hospital Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Nancy H Stewart
- is Assistant Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Rosemary Adamson
- is Staff Physician, Pulmonary and Critical Care Medicine, Veterans Affairs Puget Sound Healthcare System, and Associate Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington School of Medicine, Seattle, Washington, USA; and
| | - May M Lee
- is Associate Professor of Medicine and Program Director, Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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12
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Kumar S. Psychological Safety: What It Is, Why Teams Need It, and How to Make It Flourish. Chest 2024; 165:942-949. [PMID: 37977265 DOI: 10.1016/j.chest.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023] Open
Abstract
In health care, transforming individuals with diverse skills into an effective, cohesive team is fundamental to delivering and advancing patient care. All teams, however, are not created the same. Psychological safety has emerged as a critical feature of high-performing teams across many industries, including health care. It facilitates patient safety, quality improvement, learning, and innovation. This review presents an overview of psychological safety in medicine, describing its impact on learning, patient safety, and quality improvement. The review also explores interventions and essential leadership behaviors that foster psychological safety in teams.
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Affiliation(s)
- Santhi Kumar
- Division of Pulmonary, Critical Care, and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
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13
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Bullock JL, Sukhera J, Del Pino-Jones A, Dyster TG, Ilgen JS, Lockspeiser TM, Teunissen PW, Hauer KE. 'Yourself in all your forms': A grounded theory exploration of identity safety in medical students. MEDICAL EDUCATION 2024; 58:327-337. [PMID: 37517809 DOI: 10.1111/medu.15174] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Identity threats, such as stereotype threat and microaggressions, impair learning and erode well-being. In contrast to identity threat, less is known about how learners experience feelings of safety regarding their identity. This exploratory study aims to develop a theory of identity safety in the clinical learning environment. METHODS This multi-institutional, qualitative interview study was informed by constructivist grounded theory and critical pedagogy. Participants were clinical students at three public medical schools in the United States in 2022. Investigators purposively sampled participants for interviews based on their responses to an 11-item survey with an open-ended question soliciting students' personal identities and responses to both the racial/ethnic and gender Stereotype Vulnerability Scales. The investigators interviewed, coded, constantly compared and continued sampling until the codes could be developed into categories, then concepts and finally into a theory. The team engaged in critical reflexivity throughout the analytic process to enrich data interpretations. RESULTS Sixteen diverse students were interviewed. We organised their identity-salient experiences into identity threat, threat mitigation and identity safety. Participants experienced identity threat through unwelcoming learning environments, feeling compelled to change their behaviour in inauthentic ways or sociopolitical threat. Threat mitigation occurred when a participant or supervisor intervened against an identity threat, dampening but not eliminating the threat impact. Participants characterised identity safety as the ability to exist as their authentic selves without feeling the need to monitor how others perceive their identities. Identity safety manifested when participants demonstrated agency to leverage their identities for patient care, when others upheld their personhood and saw them as unique individuals and when they felt they belonged in the learning environment. DISCUSSION Attending to identity safety may lead to educational practices that sustain and leverage team members' diverse identities. Identity safety and threat mitigation may work together to combat identity threats in the learning environment.
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Affiliation(s)
- Justin L Bullock
- Division of Nephrology, University of Washington School of Medicine, Seattle, Washington, USA
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
| | - Javeed Sukhera
- Department of Psychiatry at Hartford Hospital, Institute of Living, Hartford, Connecticut, USA
| | - Amira Del Pino-Jones
- Department of Medicine, Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Timothy G Dyster
- School of Medicine, Division of Pulmonary, and Critical Care Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan S Ilgen
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tai M Lockspeiser
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pim W Teunissen
- School of Health Professions Education, Maastricht University, Maastricht, Netherlands
- Maastricht University Medical Centre, Maastricht, Netherlands
| | - Karen E Hauer
- University of California, San Francisco, San Francisco, California, USA
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14
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Sharma N, Steinhagen E, Marks JM, Ammori JB. Development of a Competency Framework Defining Effective Surgical Educators. JOURNAL OF SURGICAL EDUCATION 2024; 81:388-396. [PMID: 38142151 DOI: 10.1016/j.jsurg.2023.11.017] [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: 04/03/2023] [Revised: 10/13/2023] [Accepted: 11/24/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE The objective of this study is to develop a practical framework of competencies and behaviors which define an effective surgical educator. DESIGN A modified Delphi approach was used. A literature review and series of discussions with surgical education experts led to creation of a survey instrument which was sent to surgical faculty and trainees from a single academic institution. The results from this initial survey informed the creation of the subsequent survey instrument which was also sent to surgical faculty and trainees. Focus groups with surgical faculty and residents were conducted separately, transcribed, deidentified, and then evaluated for recurring themes. A competency framework was developed. SETTING The surveys were administered and focus groups were conducted at the University Hospitals Cleveland Medical Center, a tertiary care academic institution. PARTICIPANTS Residents, fellows, and faculty surgeons from the fields of general surgery, plastic surgery, vascular surgery, orthopedic surgery, otolaryngology, neurosurgery, and urology. RESULTS There were 115 responses (31.3%) from 367 faculty surgeons, residents, and fellows invited to complete the initial survey examining 50 competencies. Eighteen competencies received a mean Likert score of at least 4 by both faculty and residents and were included in the subsequent survey instrument which was completed by 72 participants (19.6%). Focus groups were held separately with 6 faculty surgeons and 6 residents. Analysis of the survey results and focus group discussions identified several themes which informed the development of a competency framework consisting of 5 overarching competencies as well as 16 specific behaviors. CONCLUSIONS A practical framework was developed consisting of 5 competencies and 16 behaviors which define an effective surgical educator. The 5 competencies are: 1) fosters psychological safety, 2) displays exemplary medical knowledge and patient care, 3) diagnoses the learner and adjusts teaching, 4) communicates thought process to trainee, and 5) displays learner-centeredness. Based on the competency framework, residency leadership may specifically tailor faculty development initiatives to improve surgical education programming.
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Affiliation(s)
- Neha Sharma
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, Ohio
| | - Jeffrey M Marks
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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15
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Hopson LR, Branzetti J, Gisondi MA, Regan L. What the experts see: A qualitative analysis of the behaviors of master adaptive learners in emergency medicine. AEM EDUCATION AND TRAINING 2024; 8:e10943. [PMID: 38504804 PMCID: PMC10950025 DOI: 10.1002/aet2.10943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/13/2023] [Accepted: 12/03/2023] [Indexed: 03/21/2024]
Abstract
Objectives The Master Adaptive Learner (MAL) model postulates that learners develop adaptive expertise through cycles of self-regulated learning. Despite a robust theoretical basis, the actual observable behaviors of MALs are not well characterized. We sought to define behaviors that characterize MALs within emergency medicine (EM) training. Methods Using a constructivist grounded theory approach, we analyzed semistructured interviews with expert EM educators. These experts reflected on observable behaviors as well as factors in the clinical learning environment that may modulate these behaviors. We recruited using purposive sampling until thematic saturation. Results We identified four overall themes, of which three described groups of learner behaviors and a fourth described modifiers of these behaviors. Learner behaviors include: (1) critical interrogation of practice, (2) intellectual risk-taking, and (3) intentional curation of a learning network. Critical interrogation of practice encompasses several observable behaviors including learner-driven feedback conversations, independent synthesis of clinical information, appropriate deviation from algorithms based on their conceptual understanding of core principles, intentional use of case variation and hypothetical questioning, and continuous refinement of decisions. MALs also engage in intellectual risk-taking for their development by communicating clinical decision-making processes even at the risk of being wrong, openly addressing errors and gaps, and intentionally seeking out uncomfortable experiences. Intentional curation of a learning network is the deliberate development of a consortium of trusted individuals who serve as mentors and sounding boards. We also identified a fourth theme related to the expression of learner behaviors: learning environment modulates behaviors. Active promotion of psychological safety is necessary for learners to express these behaviors. This safety is mediated through trusting relationships and expert supervisors who serve as colearners and role models. Conclusions We present several behaviors that allow identification of MALs among EM trainees. These data expand our understanding of MALs and the critical influence of the learning environment. Identification of these behaviors may allow for more precise categorization of targeted curricular interventions and meaningful learning outcomes.
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Affiliation(s)
- Laura R. Hopson
- Department of Emergency MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | - Michael A. Gisondi
- Department of Emergency MedicineStanford School of MedicinePalo AltoCaliforniaUSA
| | - Linda Regan
- Johns Hopkins University School of MedicineBaltimoreMarylandUSA
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Consorti F, Borcea MC, Melcarne R, Giacomelli L. Peer assisted learning: a meta-ethnographic synthesis of qualitative studies and recommendations for cardiovascular training, practice, and research. Minerva Cardiol Angiol 2024; 72:11-23. [PMID: 37158626 DOI: 10.23736/s2724-5683.23.06265-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
INTRODUCTION Peer assisted learning (PAL) is a common method to complement more traditional teaching. Several systematic reviews and meta-analyses described the most used ways of implementation and showed that it is effective in fostering learning. A synthesis of qualitative data is missing, to highlight the perceived value by the students and to drive a successful implementation. EVIDENCE ACQUISITION The search was performed in Pubmed, Scopus and ERIC databases, with a combination of the search strings. The quality of the retrieved articles was assessed through the Critical Appraisal Skills Checklist. The analysis was performed according to the meta-ethnographic method. Fifteen articles were considered for the analysis, saturation was reached after 12 articles. EVIDENCE SYNTHESIS Three main themes emerged from the analysis: PAL is effective when implemented in a safe environment, PAL is a driver of development of students' abilities and identity, and the "dark side" of PAL. Nine sub-themes emerged as components of the themes. The final line of argument highlighted the ambivalence of PAL, as an expression of the ambivalence of the still developing professional identity of students. CONCLUSIONS This meta-ethnographic synthesis summarizes the elements of success and the threats of PAL, a method that is particularly suitable for the cardiovascular domain. It must be implemented according to some precautions, such as organization and protected time, tutor selection, training and support, a clear integration and endorsement in the framework of the medical curriculum.
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Affiliation(s)
| | - M Carola Borcea
- Department of General and Specialist Surgery, Sapienza University, Rome, Italy
| | - Rossella Melcarne
- Department of General and Specialist Surgery, Sapienza University, Rome, Italy
| | - Laura Giacomelli
- Department of General and Specialist Surgery, Sapienza University, Rome, Italy
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Newell AD, Foldes CA, Haddock AJ, Ismail N, Moreno NP. Twelve tips for using the Understanding by Design ® curriculum planning framework. MEDICAL TEACHER 2024; 46:34-39. [PMID: 37334694 PMCID: PMC10728343 DOI: 10.1080/0142159x.2023.2224498] [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] [Indexed: 06/20/2023]
Abstract
BACKGROUND Health professions faculty engaged in curriculum planning or redesign can struggle with developing courses or programs that align desired learner outcomes, such as competencies to be applied in a clinical setting, with assessment and instruction. AIMS Our medical school implemented the Understanding by Design (UbD) framework to achieve alignment of outcomes, assessments and teaching during the renewal of our four-year curriculum. This article shares our strategies and practices for implementing UbD with teams of faculty curriculum developers. DESCRIPTION The UbD framework is a 'backward' approach to curriculum development that begins by identifying learner outcomes, followed by the development of assessments that demonstrate achievement of competencies and concludes with the design of active learning experiences. UbD emphasizes the development of deep understandings that learners can transfer to novel contexts. CONCLUSIONS We found UbD to be a flexible, adaptable approach that aligns program and course-level outcomes with learner-centred instruction and principles of competency-based medical education and assessment.
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Affiliation(s)
- Alana D. Newell
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
| | - Cara A. Foldes
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alison J. Haddock
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nadia Ismail
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nancy P. Moreno
- Department of Education, Innovation and Technology, Baylor College of Medicine, Houston, TX, USA
- School of Health Professions, Baylor College of Medicine, Houston, TX, USA
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
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18
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Deva M, Beck Dallaghan GL, Howard N, Roman BJ. Faculty bridging individual and organizational resilience: results of a qualitative analysis. MEDICAL EDUCATION ONLINE 2023; 28:2184744. [PMID: 36861292 PMCID: PMC9987755 DOI: 10.1080/10872981.2023.2184744] [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: 10/07/2022] [Revised: 01/05/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Medical student burnout and anxiety has received growing attention in the past decade. The culture of competition and assessment has resulted in increasing stress levels amongst medical students, causing a decline in their academic performance and overall mental health. The objective of this qualitative analysis was to characterize recommendations from educational experts to aid students' academic progress. METHODS At an international meeting in 2019, worksheets were completed by medical educators during a panel discussion. Participants responded to four scenarios representing common challenges medical students face in school (eg. Postponing Step 1, failing clerkships, etc.). For each case, participants addressed what students, faculty and medical schools could do to mitigate the challenge. Inductive thematic analysis was conducted by two authors followed by deductive categorization using an individual-organizational resilience model. RESULTS Across the four cases, common suggestions made for students, faculty and medical schools were aligned to a resilience model representing the complex interplay between individuals and organizations and the impact on student wellbeing. DISCUSSION Using suggestions from medical educators from across the US, we were able to identify recommendations for students, faculty, and medical schools to help students succeed in medical school. By applying a model of resilience, faculty serve as a critical bridge to connect students to the medical school administration. Our findings also support a pass/fail curriculum to ease the competition and burden students place on themselves.
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Affiliation(s)
- Meera Deva
- School of Medicine, University of North Carolina, Chapel Hill, USA
| | | | - Neva Howard
- School of Medicine, University of North Carolina, Chapel Hill, USA
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Somerville SG, Harrison NM, Lewis SA. Twelve tips for the pre-brief to promote psychological safety in simulation-based education. MEDICAL TEACHER 2023; 45:1349-1356. [PMID: 37210674 DOI: 10.1080/0142159x.2023.2214305] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
It is recognised that simulation-based education can be stressful, and this can impact negatively on learning. A fundamental aspect of facilitating simulation is creating a safe educational environment. Edmondson's seminal work on creating psychological safety among interpersonal teams has been embraced by the healthcare simulation community. Psychological safety is an underpinning philosophy for creating simulation experiences in which learners can develop within a stimulating and challenging yet supportive social atmosphere. Through careful design and thoughtful delivery, the introductory phase of simulation, the pre-briefing, can effectively prepare learners for simulation, reduce learner anxiety, and promote psychological safety, to enhance learning experiences. These twelve tips provide guidance for conducting a pre-brief and promoting a psychologically safe environment for simulation-based education.
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Affiliation(s)
| | - Neil Malcolm Harrison
- Clinical Skills Centre, Dundee Institute for Healthcare Simulation, School of Medicine, University of Dundee, Dundee, Scotland
| | - Steven Anthony Lewis
- Clinical Skills Centre, Dundee Institute for Healthcare Simulation, School of Medicine, University of Dundee, Dundee, Scotland
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20
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Marthyman A, Nimmon L. Exploring how immigrant international medical graduates successfully manage complex sociocultural challenges. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:40-50. [PMID: 38226312 PMCID: PMC10787855 DOI: 10.36834/cmej.76244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background While immigrant international medical graduates (I-IMGs) contribute significantly to the physician workforce in North America, researchers have highlighted the myriad of ways sociocultural challenges can negatively impact their success. Conceptual understanding that unpacks the complex processes of how I-IMGs effectively manage sociocultural challenges is relatively sparse. In addressing this critical knowledge gap, this study explored how I-IMGs successfully manage sociocultural differences as postgraduate residents. Methods We interviewed eleven I-IMGs from diverse backgrounds who are in training or recently trained in a distributed multi-site postgraduate medical training program in Canada. We used the lens of sociocultural learning theory to gain insights into the processes of how I-IMGs describe successful management of sociocultural challenges. Results The overarching storyline of participants emphasized that their experiences were humbling as they grappled with inner struggles, emotions, and vulnerabilities while embracing the ambiguity of not knowing what was expected of them. The following dominant themes from their narratives encapsulate the salient processes for how I-IMGs conceptualize and successfully manage sociocultural challenges: 1) successfully navigating transitions; 2) resisting or altering elements of prior sociocultural norms while embracing the new; 3) living and being in community and having supportive social networks; 4) risk taking to self-advocate and actively seek help. Conclusion Understanding the strengths and positive strategies for how I-IMGs interface with complex sociocultural challenges has application for medical training institutions. Our insights suggest the need for practical, effective, and continuous assistance within I-IMG training programs to better support future trainees dealing with sociocultural challenges.
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Affiliation(s)
- Azaria Marthyman
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Laura Nimmon
- Centre for Health Education Scholarship (CHES), Faculty of Medicine, University of British Columbia, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, British Columbia, Canada
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21
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Rubisch HPK, Blaschke AL, Berberat PO, Fuetterer CS, Haller B, Gartmeier M. Student mistakes and teacher reactions in bedside teaching. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1523-1556. [PMID: 37170035 PMCID: PMC10174607 DOI: 10.1007/s10459-023-10233-y] [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: 02/14/2022] [Accepted: 04/20/2023] [Indexed: 05/13/2023]
Abstract
We analyse interactions between teachers and students during video-recorded bedside teaching sessions in internal medicine, orthopaedics and neurology. Multiple raters used a high-inference categorical scheme on 36 sessions. Our research questions concern the types of student mistakes, clinical teachers' reactions to them and if they use different strategies to address different types of mistakes. We used a Poisson model and generalized mixed models to analyse these research questions. Most frequently, students made reproduction mistakes. Relatively high rates of rejection and a similar prevalence of low and high levels of elaboration and correction time for students were observed. Reproduction mistakes were associated with the highest level of rejection and the lowest level of elaboration. High levels of elaboration were observed when students were applying skills in new situations. Students were most often allowed time to correct when mistakes in the areas of analysis or application of skills and knowledge had occurred. There is a decrease in the rate of making mistakes for neurology and orthopaedics compared to internal medicine. Reproduction mistakes influence significantly the outcome feedback compared to application mistakes. Analytic and reproduction mistakes influence elaboration significantly compared to application mistakes. We found a significant effect whether the lecturer allows time for correction of reproduction mistakes compared to application mistakes. These results contribute to the understanding of interactive, patient-centred clinical teaching as well as student mistakes and how teachers are reacting to them. Our descriptive findings provide an empirical basis for clinical teachers to react to student mistakes in didactically fruitful ways.
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Affiliation(s)
- Hannah P K Rubisch
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Anna-Lena Blaschke
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Pascal O Berberat
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany
| | - Cornelia S Fuetterer
- Institute of AI and Informatics in Medicine, Technical University of Munich (TUM), TUM School of Medicine, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, Technical University of Munich (TUM), TUM School of Medicine, Munich, Germany
| | - Martin Gartmeier
- Lehrstuhl für Medizindidaktik, medizinische Lehrentwicklung und Bildungsforschung Technical University of Munich (TUM), TUM School of Medicine, TUM Medical Education Center, Ismaninger Straße 22, 81675, Munich, Germany.
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22
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Kulkarni VT. Psychological Safety in Cardiovascular Fellowship Training. J Am Coll Cardiol 2023; 82:2063-2067. [PMID: 37968022 DOI: 10.1016/j.jacc.2023.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Vivek T Kulkarni
- Cardiovascular Disease Fellowship Program, Cooper University Hospital, Camden, New Jersey, USA; Department of Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA.
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23
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Jaconia G, Naus C, Lee A. Anesthesiology resident preferences regarding learning to perform epidural anesthesia procedures in obstetrics: a qualitative phenomenological study. Int J Obstet Anesth 2023; 56:103923. [PMID: 37708742 DOI: 10.1016/j.ijoa.2023.103923] [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: 03/28/2023] [Revised: 06/20/2023] [Accepted: 07/30/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Learning to perform neuraxial techniques in obstetrics is considered one of the most difficult skills for anesthesiology trainees to acquire and no consensus exists regarding the best practices for teaching these procedures. Utilizing a qualitative, phenomenological approach, we aimed to explore what trainees perceive as the best approaches to teaching epidural anesthesia techniques; identify how these perceptions align or differ from those of faculty anesthesiologists; and examine how these approaches fit into the cognitive apprenticeship framework, which describes a process of reflection on how learning occurs in the authentic environment. METHODS Semi-scripted interviews were conducted with 10 residents and three faculty members from the division of obstetric anesthesiology at an academic center. Interviews were transcribed, de-identified, fragmented, and coded. A thematic analysis was conducted, and codes re-organized into the cognitive apprenticeship framework of (1) content, (2) method (including subcategories modeling, coaching, scaffolding, articulation, reflection, and exploration), (3) sequence, and (4) sociology (including situated learning and culture of expert practice). RESULTS Trainees valued a staged approach to learning epidural techniques, independent trouble-shooting, graded independence, focused feedback, and a calm instructor. The challenges of learning and teaching epidural techniques identified by trainees and instructors included the tactile nature of the procedure, teaching on awake, non-sedated patients, limited teaching time, and creating an environment of psychological safety. CONCLUSION Trainee and instructor preferences for teaching epidural procedures in obstetrics aligned with the cognitive apprenticeship framework. These concepts may be applied to curriculum design, evaluation, feedback, self-assessment and faculty development.
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Affiliation(s)
- G Jaconia
- Columbia University Irving Medical Center, New York, NY, USA
| | - C Naus
- Columbia University Irving Medical Center, New York, NY, USA
| | - A Lee
- Columbia University Irving Medical Center, New York, NY, USA.
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24
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McClintock AH, Fainstad T, Blau K, Jauregui J. Psychological safety in medical education: A scoping review and synthesis of the literature. MEDICAL TEACHER 2023; 45:1290-1299. [PMID: 37266963 DOI: 10.1080/0142159x.2023.2216863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Psychological safety (PS) is the belief that the environment is safe for risk taking. Available data point to a lack of PS in medical education. Based on literature in other fields, PS in clinical learning environments (CLEs) could support trainee well-being, belonging, and learning. However, the literature on PS in medical education has not been broadly assessed. MATERIALS AND METHODS In 2020, authors searched PubMed, Web of Science, CINAHL, Scopus, ERIC, PsycInfo, and JSTOR for articles published prior to January 2020. Authors screened all search results for eligibility using specific criteria. Data were extracted and thematic analysis performed. RESULTS Fifty-two articles met criteria. The majority focused on graduate medical education (45%), and 42% of studies took place within a CLE. Articles addressed organizational and team level constructs (58%), with fewer descriptions of specific behaviors of team members that promote or hinder safety. The impacts of safe environments for trainees and patients are areas in need of more exploration. DISCUSSION Future research should focus on defining specific organizational and interpersonal leader behaviors that promote PS, seek to understand how PS is determined by individual trainees, and measure the impact of PS on learners, learning, and patient care outcomes.
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Affiliation(s)
- Adelaide H McClintock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Tyra Fainstad
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kevin Blau
- Department of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Joshua Jauregui
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA
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25
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Shaw T, LaDonna KA, Hauer KE, Khalife R, Sheu L, Wood TJ, Montgomery A, Rauscher S, Aggarwal S, Humphrey-Murto S. Having a Bad Day Is Not an Option: Learner Perspectives on Learner Handover. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S58-S64. [PMID: 37983397 DOI: 10.1097/acm.0000000000005433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
PURPOSE Learner handover is the sharing of learner-related information between supervisors involved in their education. The practice allows learners to build upon previous assessments and can support the growth-oriented focus of competency-based medical education. However, learner handover also carries the risk of biasing future assessments and breaching learner confidentiality. Little is known about learner handover's educational impact, and what is known is largely informed by faculty and institutional perspectives. The purpose of this study was to explore learner handover from the learner perspective. METHOD Constructivist grounded theory was used to explore learners' perspectives and beliefs around learner handover. Twenty-nine semistructured interviews were completed with medical students and residents from the University of Ottawa and University of California, San Francisco. Interviews took place between April and December 2020. Using the constant comparative approach, themes were identified through an iterative process. RESULTS Learners were generally unaware of specific learner handover practices, although most recognized circumstances where both formal and informal handovers may occur. Learners appreciated the potential for learner handover to tailor education, guide entrustment and supervision decisions, and support patient safety, but worried about its potential to bias future assessments and breach confidentiality. Furthermore, learners were concerned that information-sharing may be more akin to gossip rather than focused on their educational needs and feared unfair scrutiny and irreversible long-term career consequences from one shared mediocre performance. Altogether, these concerns fueled an overwhelming pressure to perform. CONCLUSIONS While learners recognized the rationale for learner handover, they feared the possible inadvertent short- and long-term impact on their training and future careers. Designing policies that support transparency and build awareness around learner handover may mitigate unintended consequences that can threaten learning and the learner-supervisor relationship, ensuring learner handover benefits the learner as intended.
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Affiliation(s)
- Tammy Shaw
- T. Shaw is assistant professor, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kori A LaDonna
- K.A. LaDonna is associate professor, Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
| | - Roy Khalife
- R. Khalife is assistant professor, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Leslie Sheu
- L. Sheu is a physician, Private Medical, San Francisco, California
| | - Timothy J Wood
- T.J. Wood is professor, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne Montgomery
- A. Montgomery is associate program director, Washington Regional, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Scott Rauscher
- S. Rauscher is project coordinator, Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
| | - Simran Aggarwal
- S. Aggarwal is a first-year resident in pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Susan Humphrey-Murto
- S. Humphrey-Murto is associate professor, Department of Medicine and Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada
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LaDonna KA, Cowley L, Ananny L, Regehr G, Eva KW. When Feedback is Not Perceived as Feedback: Challenges for Regulatory Body-Mandated Peer Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S72-S78. [PMID: 37983399 DOI: 10.1097/acm.0000000000005362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Safe and competent patient care depends on physicians recognizing and correcting performance deficiencies. Generating effective insight depends on feedback from credible sources. Unfortunately, physicians often have limited access to meaningful guidance. To facilitate quality improvement, many regulatory authorities have designed peer-facilitated practice enhancement programs. Their mandate to ensure practice quality, however, can create tension between formative intentions and risk (perceived or otherwise) of summative repercussions. This study explored how physicians engage with feedback when required to undergo review. METHOD Between October 2018 and May 2020, 30 physicians representing various specialties and career stages were interviewed about their experiences with peer review in the context of regulatory body-mandated programs. Twenty had been reviewees and reviewers and, hence, spoke from both vantage points. Interview transcripts were analyzed using a 3-stage coding process informed by constructivist grounded theory. RESULTS Perceptions about the learning value of mandated peer review were mixed. Most saw value but felt anxiety about being selected due to being wary of regulatory bodies. Recognizing barriers such perceptions could create, reviewers described techniques for optimizing the value of interactions with reviewees. Their strategies aligned well with the R2C2 feedback and coaching model with which they had been trained but did not always overcome reviewees' concerns. Reasons included that most feedback was "validating," aimed at "tweaks" rather than substantial change. CONCLUSIONS This study establishes an intriguing and challenging paradox: feedback appears often to not be recognized as feedback when it poses no threat, yet feedback that carries such threat is known to be suboptimal for inducing performance improvement. In efforts to reconcile that tension, the authors suggest that peer review for individuals with a high likelihood of strong performance may be more effective if expectations are managed through feedforward rather than feedback.
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Affiliation(s)
- Kori A LaDonna
- K.A. LaDonna is associate professor, Department of Innovation in Medical Education and Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; ORCID: http://orcid.org/0000-0003-4738-0146
| | - Lindsay Cowley
- L. Cowley is a research assistant, Department of Medicine, Faculty of Medicine, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ORCID: http://orcid.org/0000-0002-0077-444X
| | - Lesley Ananny
- L. Ananny was formerly affiliated with the Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Glenn Regehr
- G. Regehr is professor, Department of Surgery, and scientist, Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: http://orcid.org/0000-0002-3144-331X
| | - Kevin W Eva
- K.W. Eva is professor and director of education research and scholarship, Department of Medicine, and associate director and scientist, Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada; ORCID: http://orcid.org/0000-0002-8672-2500
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Readlynn JK, Goulet D, Pahwa AK. Supporting improvement to help learners reach their potential. J Hosp Med 2023; 18:948-952. [PMID: 37449869 DOI: 10.1002/jhm.13164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Jennifer K Readlynn
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Delaney Goulet
- Department of Medicine, Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Amit K Pahwa
- Departments of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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28
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Lusk P. Emotion, ethics, epistemology: What can shame 'do' in medical education? J Eval Clin Pract 2023; 29:1135-1142. [PMID: 36317709 DOI: 10.1111/jep.13782] [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: 04/22/2022] [Revised: 08/22/2022] [Accepted: 10/04/2022] [Indexed: 03/21/2023]
Abstract
BACKGROUND Recent empirical studies have described and theorized a culture of shame within medical education in the Anglo-American context (Bynum). Shame is universal and highly social human emotion characterized by a sense of feeling objectified and judged negatively, in contrast to one's own self-concept. Shame has both an embodied and a relational dimension. Shame is considered especially relevant in healthcare settings (Dolezal and Lyons), and the tenets of patient care within the medical profession include respecting the dignity and upholding the safety of patients. However, shame is frequently deployed as a teaching tool within medical training. METHOD Here I ask, what can shame do in medical education (Ahmed)? What epistemic and relational conditions does it construct? I draw from philosophical voices in higher education to illuminate how shaming practices in medical education can undermine dignity safety (Callan), preclude inclusivity, and in the context of the hierarchical and marginalizing medical system, propagate epistemic injustice (Fricker). DISCUSSION This argument shows how shame in education can be both phenomenologically and normatively problematic and may act differently upon students who experience marginalization and those who are majoritized. I further suggest that a medical education system which upholds the epistemological and relational frameworks of power, shame, and epistemic injustice, underscores those frameworks in the medical system at large, disserving individual patients who are already at risk of suffering epistemic injustice (Carel), and society at large. CONCLUSION This analysis of shame in medical education focuses on the highly relational and interpersonal elements of learning to live and work in the medical system, highlighting the need for respect, trust, and resistance to reorient the relational learning environment toward individual and systemic forms of justice.
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Affiliation(s)
- Penelope Lusk
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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29
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Robb KA, Rosenbaum ME, Peters L, Lenoch S, Lancianese D, Miller JL. Feedback conversations: First things first? PATIENT EDUCATION AND COUNSELING 2023; 115:107849. [PMID: 37393684 DOI: 10.1016/j.pec.2023.107849] [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: 02/01/2023] [Revised: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE This study explores medical students' perceptions regarding the order in which feedback is given and its impact on how that feedback is received. METHODS Medical students were interviewed regarding their feedback experiences during medical school and preferred order in which to receive feedback. Thematic analysis was applied to interview transcripts to identify salient themes in students' comments related to feedback order. RESULTS Twenty-five students entering their second, third, and fourth years of medical school participated in the study. Students indicated that the order in which feedback was conveyed influenced their receptivity to its content, but varied in their specific order preferences. Most students indicated that they preferred feedback conversations that started with positive observations. Only the most senior students expressed a preference for feedback based on self-assessment. CONCLUSION Feedback conversations are complicated interactions. Students' responses to feedback are influenced by a variety of factors, including the order in which feedback is delivered. PRACTICE IMPLICATIONS Educators should recognize that students' feedback needs may be influenced by a variety of factors, and should aim to tailor feedback and the order of its delivery to the learner.
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Affiliation(s)
- Katharine A Robb
- Department of Pediatrics, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA.
| | - Marcy E Rosenbaum
- Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Lauren Peters
- Department of Communication Studies, University of Iowa, Iowa City, IA, USA
| | - Susan Lenoch
- Office of Consultation and Research in Medical Education, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Donna Lancianese
- Office of Consultation and Research in Medical Education, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
| | - Jane L Miller
- Department of Family Medicine, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, IA, USA
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Kassab SE, Taylor D, Hamdy H. Student engagement in health professions education: AMEE Guide No. 152. MEDICAL TEACHER 2023; 45:949-965. [PMID: 36306374 DOI: 10.1080/0142159x.2022.2137018] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This guide aims to support our colleagues to have comprehensive understanding of student engagement in health professions education. Despite the universal agreement about the significance of student engagement, there is lack of uniformity in conceptualizing and operationalizing this emerging construct. We review the theoretical basis explaining student engagement from three main perspectives: behavioral, psychological, and socio-cultural. In addition, we propose a contemporary and comprehensive framework for the student engagement in higher education, which is applicable to health professions education contexts. Drawing from this framework, we explain the conceptualization of the construct and its preceding factors, mediators, dimensions, spheres, and outcomes of student engagement. The proposed framework introduces student 'engagement through partnerships' as a novel component compared with the existing models of student engagement in higher education. This way, we are proposing a mixed model that not only considers the student as a 'customer' but also as a 'partner' in education. Engagement of students through partnerships include four areas: (1) provision of the education program, (2) scholarly research, (3) governance and quality assurance, and (4) community activities. This guide will provide practical applications on how to improve student engagement in health professions education. Finally, we highlight the current gaps in areas of research in the student engagement literature and suggested plans for future directions.[Box: see text].
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Affiliation(s)
- Salah Eldin Kassab
- Department of Physiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
- Department of Basic Medical Sciences, College of Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - David Taylor
- Gulf Medical University, Ajman, United Arab Emirates
| | - Hossam Hamdy
- Gulf Medical University, Ajman, United Arab Emirates
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John M, Camac E. Group Feedback for Faculty: Turning the Wheels of Change. ATS Sch 2023; 4:247-249. [PMID: 37795126 PMCID: PMC10547033 DOI: 10.34197/ats-scholar.2023-0059ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Affiliation(s)
- Mira John
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington; and
| | - Erin Camac
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Kentucky, Lexington, Kentucky
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Onumah CM, Pincavage AT, Lai CJ, Levine DL, Ismail NJ, Alexandraki I, Osman NY. Strategies for Advancing Equity in Frontline Clinical Assessment. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S57-S63. [PMID: 37071692 DOI: 10.1097/acm.0000000000005246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Educational equity in medicine cannot be achieved without addressing assessment bias. Assessment bias in health professions education is prevalent and has extensive implications for learners and, ultimately, the health care system. Medical schools and educators desire to minimize assessment bias, but there is no current consensus on effective approaches. Frontline teaching faculty have the opportunity to mitigate bias in clinical assessment in real time. Based on their experiences as educators, the authors created a case study about a student to illustrate ways bias affects learner assessment. In this paper, the authors use their case study to provide faculty with evidence-based approaches to mitigate bias and promote equity in clinical assessment. They focus on 3 components of equity in assessment: contextual equity, intrinsic equity, and instrumental equity. To address contextual equity, or the environment in which learners are assessed, the authors recommend building a learning environment that promotes equity and psychological safety, understanding the learners' contexts, and undertaking implicit bias training. Intrinsic equity, centered on the tools and practices used during assessment, can be promoted by using competency-based, structured assessment methods and employing frequent, direct observation to assess multiple domains. Instrumental equity, focused on communication and how assessments are used, includes specific, actionable feedback to support growth and use of competency-based narrative descriptors in assessments. Using these strategies, frontline clinical faculty members can actively promote equity in assessment and support the growth of a diverse health care workforce.
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Affiliation(s)
- Chavon M Onumah
- C.M. Onumah is associate professor, Department of Medicine, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Amber T Pincavage
- A.T. Pincavage is professor, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Cindy J Lai
- C.J. Lai is professor and director of medical student clinical education, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California
| | - Diane L Levine
- D.L. Levine is professor and vice chair for education, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | - Nadia J Ismail
- N.J. Ismail is professor, Department of Medicine and Department of Education, Innovation and Technology, and vice dean, Baylor College of Medicine, Houston, Texas
| | - Irene Alexandraki
- I. Alexandraki is professor and senior associate dean, academic affairs, Office of Academic Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Nora Y Osman
- N.Y. Osman is associate professor, Harvard Medical School, and director of undergraduate medical education, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Sullivan C, Quaintance J, Myers T, Rogers B, Gaddis M, Pirani N. A Framework to Support Medical Students' Professional Development During Large-Scale Societal Events. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:422-427. [PMID: 37237084 PMCID: PMC10218768 DOI: 10.1007/s40596-023-01795-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Christine Sullivan
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | | | - Trenton Myers
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Brenda Rogers
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Monica Gaddis
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Nurbanu Pirani
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Ulmer F, Krings R, Häberli C, Bally R, Schuchmann M, Huwendiek S, Kabitz HJ. [Patient safety 4.0: "Failure of the Week" It's all about role modelling!]. Dtsch Med Wochenschr 2023. [PMID: 37308082 PMCID: PMC10361823 DOI: 10.1055/a-2061-1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The rate of mistakes and near misses in clinical medicine remains staggering. The tendency to cover up mistakes is rampant in "name-blame-shame" cultures. The need for safe forums where mistakes can be openly discussed in the interest of patient safety is evident. Following a comprehensive review of the literature, a semi-structured weekly conference, named "mistake of the week" (MOTW), was introduced, enabling physicians to voluntarily discuss their mistakes and near-misses. The MOTW is intended to encourage cultural change in how physicians approach, process, accept and learn from their own and their peers' mistakes. This study seeks to assess if physicians appreciate, benefit from and are motivated to participate in MOTW. METHODS Physicians and medical students of the I. and II. Medizinische Klinik at the Academic Teaching Hospital Klinikum Konstanz (Germany) were eligible to participate voluntarily. Four groups of physicians (n=3-6) and one group of medical students (n=5) volunteered to participate in focus group interviews, which were videotaped, transcribed and analyzed. RESULTS The following success factors are crucial for dealing with and voluntarily disclosing mistakes and near-misses: 1. Exemplification ("follow the boss's lead"), 2. Fixed time slots and a clear forum, 3. Reporting mistakes without fear of penalty or punishment, 4. A trusting working atmosphere. The key effects of the MOTW approach are: 1. People report their mistakes more, 2. Relief, 3. Psychological safety, 4. Lessons learned/errors (potentially) reduced. DISCUSSION The MOTW conference models an ideal forum to mitigate hierarchy and promote a sustainable organizational dynamic in which mistakes and near misses can be discussed in an environment free from "name-blame-shame", with the ultimate goal of potentially improving patient care and safety.
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Affiliation(s)
- Francis Ulmer
- Pädiatrische Intensivbehandlung, Universitätsklinik für Kinderheilkunde, Inselspital CH-3010 Bern, Schweiz
| | - Rabea Krings
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Mittelstr. 43, 3012 Bern, Schweiz
| | - Christoph Häberli
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Mittelstr. 43, 3012 Bern, Schweiz
| | - Romina Bally
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Mittelstr. 43, 3012 Bern, Schweiz
| | - Marcus Schuchmann
- I. Medizinische Klinik - Gastroenterologie, Onkologie, Nephrologie - Klinikum Konstanz GLKN, Mainaustraße 35, 78464 Konstanz
| | - Sören Huwendiek
- Institut für Medizinische Lehre, Abteilung für Assessment und Evaluation, Mittelstr. 43, 3012 Bern, Schweiz
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Coakley N, Wiese A, O'Leary P, Bennett D. Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study. BMJ Open 2023; 13:e069101. [PMID: 37137555 PMCID: PMC10163558 DOI: 10.1136/bmjopen-2022-069101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
CONTEXT Factors contributing to the stressful transition from student to doctor include issues with preparedness for practice, adjusting to new status and responsibility, and variable support. Existing transitional interventions provide inconsistent participation, responsibility and legitimacy in the clinical environment. Enhanced support by near peers for new doctors may ease the transition. Irish medical graduates of 2020 commenced work early, creating an unprecedented period of overlap between new graduates and the cohort 1 year ahead. OBJECTIVE To explore the experience of commencing practice for these new doctors with this increased near-peer support. DESIGN We used interpretive phenomenological analysis as our methodological approach, informed by the cognitive apprenticeship model, to explore the experience of enhanced near-peer support at the transition to practice. Participants recorded audio diaries from their commencement of work, and a semistructured interview was conducted with each, after 3 months, concerning their experience of their overlap with the previous year's interns. SETTING University College Cork, one of six medical schools in Ireland. PARTICIPANTS Nine newly qualified medical doctors. MAIN OUTCOME MEASURES An exploration of their experience of transition to clinical practice, in the context of this enhanced near-peer support, will inform strategies to ease the transition from student to doctor. RESULTS Participants felt reassured by having a near-peer in the same role and safe to seek their support. This empowered them to gradually assume increasing responsibility and to challenge themselves to further their learning. Participants perceived that commencing work before the annual change-over of other grades of doctor-in-training enhanced their professional identities and improved patient safety. CONCLUSIONS Enhanced near-peer support for new doctors offers a potential solution to the stressful transition to practice. Participants were legitimate members of the community of practice, with the status and responsibility of first-year doctors. Furthermore, this study reinforces the benefit of asynchronous job change-over for doctors-in-training.
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Affiliation(s)
- Niamh Coakley
- Department of Medicine, University College Cork, Cork, Ireland
| | - Anel Wiese
- Medical Education Unit, University College Cork, Cork, Ireland
| | - Paula O'Leary
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, Cork, Ireland
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Hitchner L, Yore M, Burk C, Mason J, Sawtelle Vohra S. The resident experience with psychological safety during interprofessional critical event debriefings. AEM EDUCATION AND TRAINING 2023; 7:e10864. [PMID: 37013133 PMCID: PMC10066498 DOI: 10.1002/aet2.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Interprofessional feedback and teamwork skills training are important in graduate medical education. Critical event debriefing is a unique interprofessional team training opportunity in the emergency department. While potentially educational, these varied, high-stakes events can threaten psychological safety for learners. This is a qualitative study of emergency medicine resident physicians' experience of interprofessional feedback during critical event debriefing to characterize factors that impact their psychological safety. METHODS The authors conduced semistructured interviews with resident physicians who were the physician team leader during a critical event debriefing. Interviews were coded and themes were generated using a general inductive approach and concepts from social ecological theory. RESULTS Eight residents were interviewed. The findings suggest that cultivating a safe learning environment for residents during debriefings involves the following: (1) allowing space for validating statements, (2) supporting strong interprofessional relationships, (3) providing structured opportunities for interprofessional learning, (4) encouraging attendings to model vulnerability, (5) standardizing the process of debriefing, (6) rejecting unprofessional behavior, and (7) creating the time and space for the process in the workplace. CONCLUSIONS Given the numerous intrapersonal, interpersonal, and institutional factors at play, educators should be sensitive to times when a resident cannot engage due to unaddressed threats to their psychological safety. Educators can address these threats in real time and over the course of a resident's training to enhance psychological safety and the potential educational impact of critical event debriefing.
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Affiliation(s)
- Lily Hitchner
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Mackensie Yore
- UCLA National Clinician Scholars Program, Department of Emergency MedicineGreater Los Angeles VA Medical CenterCaliforniaLos AngelesUSA
| | - Charney Burk
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
| | - Jessica Mason
- Department of Emergency MedicineJohn Peter Smith HospitalFort WorthTexasUSA
| | - Stacy Sawtelle Vohra
- Department of Emergency MedicineUCSF Fresno Medical Education ProgramFresnoCaliforniaUSA
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McLeod E, Gupta S. The Role of Psychological Safety in Enhancing Medical Students' Engagement in Online Synchronous Learning. MEDICAL SCIENCE EDUCATOR 2023; 33:423-430. [PMID: 36846079 PMCID: PMC9942012 DOI: 10.1007/s40670-023-01753-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 05/31/2023]
Abstract
Background The COVID-19 pandemic instigated a global change in the delivery of undergraduate medical education, with an eminent shift from in-person to online teaching. The virtual methods that were utilised to a limited extent previously have now become the mainstay in education. The concept of psychological safety has been studied previously within medical education, but not in the distance learning context. The aim of the study was to explore students' experiences of online learning and to gain an understanding of the factors affecting psychological safety and its subsequent impact on their learning. Methods A qualitative, social constructivist approach was adopted in this research. Data collection involved semi-structured interviews with 15 medical students from the University of Dundee. There was a representation from each year group on the undergraduate medical course. Data was transcribed verbatim and analysed thematically. Results Five key themes were identified as motivation for learning, engagement with learning, fear of judgement, group learning and adjustment to online learning. Each of these comprised of interlinked subthemes related to peer and tutor interactions. Conclusions Drawing on students' experiences, the paper presents the significant interplay of group interactions and tutor attributes operating in the virtual synchronous learning environment. The relevance of psychological safety in student learning and experience, and strategies to foster it in online classrooms are discussed in the context of existing literature and proposed future developments.
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Affiliation(s)
- Emma McLeod
- School of Medicine, University of Dundee, Dundee, UK
| | - Shalini Gupta
- School of Medicine, University of Dundee, Dundee, UK
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Sasek CA. Implications of Entrustable Professional Activities for Motivation and Learning. J Physician Assist Educ 2023; 34:15-19. [PMID: 36723431 DOI: 10.1097/jpa.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION This study sought to explore the experience of entrustable professional activity-based assessment and its effect on self-determination, a well-supported measure of motivation. The goal was to understand EPA-based assessment's implications for student motivation, learning, and wellbeing. METHODS A qualitative case study design was utilized through a standardized simulation activity with EPA-based assessment. An analysis of interviews and reflection journals was completed by the coding of emergent themes and significant statements with a subsequent thematic analysis framed in self-determination theory (SDT). RESULTS Entrustment was found to be an affectively and interpersonally impactful metric that provided the learner with a clear understanding of clinical performance. Quality entrustment feedback supported participants' sense of competence and increased their confidence in their ability to be autonomous as well as a valuable part of the healthcare team. DISCUSSION EPAs appeared to support learners' sense of competence and to provide a bridge to support autonomy and the ability to relate to others. To the extent that entrustment supported learners' sense of competence, other SDT propositions could be subsequently bolstered as well. Self-determination and intrinsic motivation were uniquely supported by EPA-based assessment, if implemented effectively. Further research is needed to better define effective implementation, faculty development, and feedback strategies.
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Affiliation(s)
- Cody A Sasek
- Cody A. Sasek, PhD, PA-C, is program director and assistant professor for the Butler University DMS Bridge Program in Indianapolis, Indiana
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Turner S, Harder N, Martin D, Gillman L. Psychological safety in simulation: Perspectives of nursing students and faculty. NURSE EDUCATION TODAY 2023; 122:105712. [PMID: 36669303 DOI: 10.1016/j.nedt.2023.105712] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 12/05/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND As simulation education continues to grow, more consideration has been given to creating and maintaining a psychologically safe simulation learning environment. It is known that failing to provide psychological safety can lead to feelings of incompetence and a lack of confidence with students. However, it is essential to understand what makes and maintains psychological safety in simulation from both student and facilitator's perspectives. In further understanding psychological safety, nursing educators can challenge students to think beyond that of task attainment and into the deeper realm of critical thinking and critical reflection. OBJECTIVES The aim of this study was to understand students' and facilitators perspectives of psychological safety in simulation. METHODS Participants in this qualitative interpretive description study were seven students and four faculty that were chosen using convenience sampling. The data was collected over a 2-week period where semi-structured interviews were used to collect the participants perspectives. Data analysis was continuous and iterative and used inductive analysis. RESULTS There were two student themes which focused on the student-facilitator interaction: 1) dynamic interaction, 2) student self-efficacy. The facilitators results showed two themes which focused on 1) simulation design and 2) trust. CONCLUSION Diverging thoughts are present between faculty and students in what constitutes psychological safety. In describing both the similarities and differences, we have a better understanding on how to create and maintain psychological safety thereby, providing students with the best learning experience possible.
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Affiliation(s)
- Sufia Turner
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada.
| | - Nicole Harder
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada
| | - Donna Martin
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, Manitoba R3T 2N2, Canada
| | - Lawrence Gillman
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Department of Surgery, Canada
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Chen A, Kwendakwema N, Vande Vusse LK, Narayanan M, Strizich L, Albert T, Wu C. Outcomes in quality improvement and patient safety training: moving from in-person to synchronous distance education. BMJ Open Qual 2023; 12:bmjoq-2022-002176. [PMID: 36927629 PMCID: PMC10030926 DOI: 10.1136/bmjoq-2022-002176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/08/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic necessitated increased synchronous distance education (SDE) in graduate medical education, presenting challenges for Quality Improvement and Patient Safety (QIPS) best practices, which call for integration with daily clinical care and investigation of real patient safety events. OBJECTIVE To evaluate educational outcomes for QIPS training after conversion of a mature, in-person curriculum to SDE. METHODS 68 postgraduate year (PGY)-1 residents were surveyed before and after the SDE Culture of Patient Safety training in June 2020, and 59 PGY-2s were administered the Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) before and after the SDE QIPS seminar series in July-August 2020. Values before and after training were compared using sign tests for matched pairs (PGY-1) and Wilcoxon signed-rank tests (PGY-2). RESULTS 100% (68 of 68) of PGY-1s and 46% (27 of 59) of PGY-2s completed precourse and postcourse surveys. Before the course, 55 PGY-1s (81%) strongly agreed that submitting patient safety event reports are a physician's responsibility, and 63 (93%) did so after (15% increase, p=0.004). For PGY-2s, the median composite QIKAT-R score was 17 (IQR 14.5-20) before and 22.5 (IQR 20-24.5) after the seminars, with a median difference of 4.5 (IQR 1.5-7), a 32% increase in QIPS competency (p=0.001). CONCLUSIONS Patient safety attitudes and quality improvement knowledge increased after SDE QIPS training at comparable levels to previously published results for in-person training, supporting SDE use in future hybrid curricula to optimise educational value and reach.
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Affiliation(s)
- Anders Chen
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
| | - Natasha Kwendakwema
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa K Vande Vusse
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Maya Narayanan
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lindee Strizich
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tyler Albert
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
| | - Chenwei Wu
- Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Medicine, Veterans Affairs Puget Sound Heathcare System, Seattle, Washington, USA
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Chen K, Tan K. How video games saved me during the pandemic: A gamer's guide to psychological safety. J Med Imaging Radiat Sci 2023; 54:S10-S14. [PMID: 36646546 DOI: 10.1016/j.jmir.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/16/2023]
Affiliation(s)
- Kayli Chen
- Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Canada; Medical Radiation Sciences Program, the Michener Institute of Education at UHN, Canada.
| | - Kieng Tan
- Department of Radiation Oncology, Temerty Faculty of Medicine, University of Toronto, Canada; Princess Margaret Cancer Centre, Radiation Medicine Program, Canada
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Perifanou D, Konstantinou E, Nyman S, Nikula A, Ahokas A, Casas–Baroy J, Cavani D, Ferri P, Galbany-Estragués P, Gradellini C, Grendova K, Machajova M, Romero-Mas M, Mecugni D, Palomar-Aumatell X, Prnova J, Pujol CR, Thomander H, Sakellari E. Education on Vaccination Competence: an Intensive Course for Skillful Health Science Students. Mater Sociomed 2023; 35:312-318. [PMID: 38380289 PMCID: PMC10875935 DOI: 10.5455/msm.2023.35.312-318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024] Open
Abstract
Background Vaccination is one of the most successful and cost-effective interventions for public health. Studies have shown that health professionals who have good knowledge and positive attitudes towards vaccination are more likely to provide effective vaccination protection to people, including themselves. Therefore, health science students must acquire evidence-based knowledge during their education to meet the challenges of healthcare. Objective The aim of this study was to investigate the knowledge, attitudes and feedback of health science students who participated in the Educating Vaccination Competence (EDUVAC) Intensive Course. Methods A five-day Intensive Course was implemented for health science students, which included a pre-assignment. The EDUVAC Intensive Course used different teaching methods (lectures, workshops, interactive games, discussions), group work, study visits, and cultural programs to encourage students' motivation. For the purpose of the study, students filled out an online questionnaire after giving informed consent. Results Sample consisted of 31 health science students from five European Higher Institutions. They had very good knowledge on most knowledge questions. In the post measurement it was significantly greater and equal to 81%, p<0.001. Almost all students (93.5%) totally agreed that "It is important for adults to receive all recommended vaccines according to national guidelines". The statement "I have had an active attitude and participation in the Intensive Course" received 80.6% total agreement. Over 90.3% rated the Intensive Course as "excellent" or "above average". Conclusions After completing the EDUVAC Intensive Course, students felt confident in their vaccination knowledge and skills, which benefited their professional development.
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Affiliation(s)
- Dimitra Perifanou
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece
| | - Eleni Konstantinou
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece
| | - Sari Nyman
- School of Health Care, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Anne Nikula
- School of Health Care, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Aija Ahokas
- School of Health Care, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Joan–Carles Casas–Baroy
- Experimental Sciences and Methodology Department, University of Vic, Central University of Catalonia, Spain
| | - Daniela Cavani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Ferri
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Galbany-Estragués
- Department of Fundamental and Medical-Surgical Nursing, School of Nursing, University of Barcelona, Spain
| | - Cinzia Gradellini
- Department of Surgery, Medicine, Dentistry, Morphological Sciences, with Transplant, and Regenerative Medicine Interest, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Montse Romero-Mas
- Faculty of Health Sciences and Welfare, University of Vic, Central University of Catalonia, Spain
| | - Daniela Mecugni
- Department of Surgery, Medicine, Dentistry, Morphological Sciences, with Transplant, and Regenerative Medicine Interest, University of Modena and Reggio Emilia, Modena, Italy
| | - Xavier Palomar-Aumatell
- Department of Applied Health Sciences, University of Vic- Central University of Catalonia, Spain
| | - Janka Prnova
- Department of Public Health, Trnava University, Trnava, Slovakia
| | - Carme Roure Pujol
- Department of Social Sciences and Community Health, Research Group on Mental Health and Social Innovation (SaMIS,) University of Vic-Central University of Catalonia, Spain
| | - Heli Thomander
- School of Rehabilitation and Examination, Metropolia University of Applied Sciences, Helsinki, Finland
| | - Evanthia Sakellari
- Department of Public and Community Health, Laboratory of Hygiene and Epidemiology, School of Public Health, University of West Attica, Athens, Greece
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Ruedas-Gracia N, Botham CM, Moore AR, Peña C. Ten simple rules for creating a sense of belonging in your research group. PLoS Comput Biol 2022; 18:e1010688. [PMID: 36480509 PMCID: PMC9731414 DOI: 10.1371/journal.pcbi.1010688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nidia Ruedas-Gracia
- College of Education, University of Illinois at Urbana-Champaign, Champaign, Illinois, United States of America
| | - Crystal M. Botham
- Stanford Biosciences Grant Writing Academy, Stanford University, Stanford, California, United States of America
| | - Amber R. Moore
- Stanford Biosciences Grant Writing Academy, Stanford University, Stanford, California, United States of America
| | - Courtney Peña
- Stanford Biosciences Grant Writing Academy, Stanford University, Stanford, California, United States of America
- * E-mail:
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Jeon MK, Lee I, Lee MY. The multiple mediating effects of grit and learning agility on academic burnout and learning engagement among Korean university students: a cross-sectional study. Ann Med 2022; 54:2710-2724. [PMID: 36190716 PMCID: PMC9543061 DOI: 10.1080/07853890.2022.2122551] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION This article reports the results of a study conducted to assess the mediating effects of grit and learning agility on the relationship between academic burnout and learning engagement among undergraduate students. METHODS A cross-sectional survey was conducted using a self-report questionnaire. Undergraduate students (N = 344) were recruited from one university in South Korea (58.0% female; average age 21.43) to complete assessments of academic burnout, grit, learning agility, and learning engagement. Data were analysed using descriptive statistics, Pearson's correlation coefficient, hierarchical regression and bootstrapping to verify the multiple parallel mediation effect. RESULTS We found that the direct effect of academic burnout on learning engagement (B= -0.26, p<.001) and the indirect effect of academic burnout as mediated by learning agility (B= -0.13; 95% CI, -0.20∼-0.06) were significant. This finding confirmed that 33.3% of the total effect of academic burnout on learning engagement was the result of indirect effects via learning agility. CONCLUSION These results indicate the necessity of developing an educational programme that focuses not only on reducing academic burnout but also on improving learning agility to increase undergraduate students' learning engagement. This study contributes to the development of a curriculum aimed at increasing the effectiveness of university education, promoting learning engagement, and reducing academic burnout.KEY MESSAGEOur study reports that academic burnout has both a direct effect on learning engagement and an indirect effect via learning agility. Learning agility mediates the relationship between academic burnout and learning engagement among undergraduate students.Although grit has been reported by many previous studies to mediate the relationship between the tendency to pursue happiness and the willingness to continue learning and effectively improving one's academic achievement and ability, our study did not find any mediating effect via grit in this context.
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Affiliation(s)
- Mi-Kyeong Jeon
- Department of Nursing, Changwon National University, Changwon, Republic of Korea
| | - Insook Lee
- Department of Nursing, Changwon National University, Changwon, Republic of Korea
| | - Mi-Young Lee
- Nursing Department, College of Health and Welfare, Woosong University, Dong-gu, Daejeon, South Korea, Uijeongbu, Republic of Korea
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Aquino JF, Riss RR, Multerer SM, Mogilner LN, Turner TL. A step-by-step guide for mentors to facilitate team building and communication in virtual teams. MEDICAL EDUCATION ONLINE 2022; 27:2094529. [PMID: 35762578 PMCID: PMC9248936 DOI: 10.1080/10872981.2022.2094529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
As collaborative work in medical education has increasingly moved online, team mentors have had to adapt their practices into the virtual environment. Fostering connection, communication and productivity on virtual teams requires specific skills and deliberate practice that differ from in-person teamwork. Drawing from best practices in business, education and medicine and also from our own experience as a virtual team, we present a guide for mentors to create and sustain successful virtual teams. Grounded in Tuckman's Five Stage Model of Team Development, we offer specific strategies for virtual team mentors to promote team cohesion, mitigate conflict, maintain productivity and leverage the benefits of the virtual environment.
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Affiliation(s)
- Julia F Aquino
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Robert R Riss
- Department of Pediatrics, Children’s Mercy Hospital, University of Missouri at Kansas City, Kansas City, KS, USA
| | - Sara M Multerer
- Department of Pediatrics, Norton Children’s Medical Group affiliated with University of Louisville, Louisville, KY, USA
| | - Leora N Mogilner
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Teri L Turner
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
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Gorgone M, O’Connor TP, Maximous SI. How I Teach: Ultrasound-guided Peripheral Venous Access. ATS Sch 2022; 3:598-609. [PMID: 36726710 PMCID: PMC9886173 DOI: 10.34197/ats-scholar.2022-0029ht] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/19/2022] [Indexed: 12/31/2022] Open
Abstract
Ultrasound-guided peripheral intravenous (IV) placement is often required for patients with difficult IV access and is associated with a reduction in central line placement. Despite the importance, there is no standardized technical approach, and there is limited ability to attain mastery through simulation. We describe our step-by-step approach for teaching ultrasound-guided IV placement at the bedside using short-axis dynamic guidance, with emphasis on advancing the needle and catheter device almost entirely into the vessel before threading the catheter. Our teaching approach allows the opportunity for trainees to maximize the learning potential of a single insertion experience, which includes focused preprocedure hands-on practice, instruction with real-time feedback at the bedside, and a post-procedure debrief with reinforcement of concepts.
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Affiliation(s)
- Matthew Gorgone
- Division of Pulmonary, Allergy, and
Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical
Center, Pittsburgh, Pennsylvania; and
| | - Timothy P. O’Connor
- University of Rochester Medical Center,
Department of Emergency Medicine, Rochester, New York
| | - Stephanie I. Maximous
- Division of Pulmonary, Allergy, and
Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical
Center, Pittsburgh, Pennsylvania; and
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47
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Deitte LA, Lewis PJ, Gadde JA, Harris S. Strategies to Create a Psychologically Safe Radiology Learning Space. J Am Coll Radiol 2022; 20:473-475. [PMID: 36436777 DOI: 10.1016/j.jacr.2022.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Lori A Deitte
- Vice Chair of Education, Department of Radiology and Radiological Sciences, and Vice President of Continuous Professional Development, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Petra J Lewis
- Vice Chair of Education, Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Judith A Gadde
- Director of Academic Innovation, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Steven Harris
- Associate Program Director, Diagnostic Radiology Residency Program, Vanderbilt University Medical Center, Nashville, Tennessee
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McClintock AH, Fainstad TL, Jauregui J. Clinician Teacher as Leader: Creating Psychological Safety in the Clinical Learning Environment for Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:S46-S53. [PMID: 35947474 DOI: 10.1097/acm.0000000000004913] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Psychological safety is the perception that a group environment is safe for interpersonal risk taking, exposing vulnerability, and contributing perspectives without fear of negative consequences. The presence of psychological safety has been tied to wellness, retention, and inclusiveness. National data demonstrate that many of the fundamental components of psychological safety are lacking in clinical learning environments. There is evidence that leadership behaviors can create psychological safety in traditional work environments. The authors sought to understand how clinical teachers' leadership behaviors can create, destroy, and rescue psychological safety in the clinical learning environment. METHOD This was a multicenter, cross-sectional, qualitative study of fourth-year medical students from 2 institutions using semistructured interviews. Verbatim transcripts underwent constant comparison and iterative data reduction and analysis, continuing beyond thematic sufficiency. RESULTS Eighteen students participated in interviews. Participants described key themes of relationships, an emphasis on learning, clear expectations, autonomy, and frequent feedback as promoting psychological safety. Safe environments lead to a sense of belonging and agency. They reported educator disinterest in students, dismissal of questions, lack of autonomy, and unclear expectations as destructive of psychological safety. Unsafe environments lead to withdrawal and a high extraneous cognitive load. Most students were unable to describe a time psychological safety was restored if lost. CONCLUSIONS Clinical teachers' leadership behaviors can directly impact students' perception of psychological safety in the clinical learning environment. Psychological safety increases students' sense of belonging, self-efficacy, and engagement. The findings demonstrate that while it is difficult to repair an atmosphere that is psychologically unsafe, there are several actions that can be put into motion early on to ensure the learning environment is safe and remains so. Future research should investigate whether psychologically safe environments lead to meaningful differences in assessments of student learning and effective cultural change.
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Affiliation(s)
| | - Tyra Leigh Fainstad
- T.L. Fainstad is associate professor of medicine, University of Colorado Anschutz School of Medicine, Aurora, Colorado
| | - Joshua Jauregui
- J. Jauregui is associate professor of emergency medicine, University of Washington, Seattle, Washington
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Roze des Ordons AL, Ellaway RH, Eppich W. The many spaces of psychological safety in health professions education. MEDICAL EDUCATION 2022; 56:1060-1063. [PMID: 35981976 DOI: 10.1111/medu.14919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Amanda L Roze des Ordons
- Department of Critical Care Medicine; Division of Palliative Medicine, Department of Oncology; Department of Anesthesiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rachel H Ellaway
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Walter Eppich
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Ajjawi R, Bearman M, Sheldrake M, Brumpton K, O'Shannessy M, Dick ML, French M, Noble C. The influence of psychological safety on feedback conversations in general practice training. MEDICAL EDUCATION 2022; 56:1096-1104. [PMID: 35852726 DOI: 10.1111/medu.14881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Fostering trainee psychological safety is increasingly being recognised as necessary for effective feedback conversations. Emerging literature has explored psychological safety in peer learning, formal feedback and simulation debrief. Yet, the conditions required for psychologically safe feedback conversations in clinical contexts, and the subsequent effects on feedback, have not been explored. METHODS We conducted a qualitative study using interviews and longitudinal audio-diaries with 12 rural general practice trainees. The data were analysed using framework thematic analysis to identify factors across the data and as individual participant case studies with illustrative vignettes of dynamic interleaving of factors in judgements about feedback conversations. FINDINGS Findings identify the influence of intrapersonal (e.g. confidence and comfort to seek help), interpersonal (e.g. trust and relationship) and sociocultural factors (e.g. living and working in a rural community) that contribute to psychological safety in the context of everyday feedback conversations. Multiple factors interplayed in feedback conversations where registrars could feel safe and unsafe within one location and even at the one time. DISCUSSION Participants felt psychologically safe to engage their educators in sanctioned systems of conversation related to the immediate care of the patient and yet unsafe to engage in less patient related performance conversations despite the presence of multiple positive interpersonal factors. The concept of a safe 'container' (contained space) is perhaps idealised when it comes to feedback conversations about performance in the informal and emergent spaces of postgraduate training. More research is needed into understanding how clinical environments can sanction feedback conversations in clinical environments.
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Affiliation(s)
- Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
| | | | - Kay Brumpton
- Rural Clinical School, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Rural Medical Education Australia (RMEA), Toowoomba, Queensland, Australia
| | - Megan O'Shannessy
- Rural Clinical School, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Rural Medical Education Australia (RMEA), Toowoomba, Queensland, Australia
| | - Marie-Louise Dick
- General Practice Training Queensland, Brisbane, Queensland, Australia
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Matthew French
- General Practice Training Queensland, Brisbane, Queensland, Australia
- Rural Medical Education Australia (RMEA), Toowoomba, Queensland, Australia
| | - Christy Noble
- Academy for Medical Education, The University of Queensland, Brisbane, Queensland, Australia
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