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Cianciolo AT, O'Brien BC, Klamen DL, Mellinger J. Building on Strengths: An Affirmational and Systems-Level Approach to Revisiting Character in Medicine. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:708-715. [PMID: 38466581 DOI: 10.1097/acm.0000000000005670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
ABSTRACT Although U.S. medical education has continued to place increased emphasis on defining competency standards and ensuring accountability to the public, health care inequities have persisted, several basic health outcomes have worsened, public trust in the health care system has eroded, and moral distress, burnout, and attrition among practicing physicians have escalated. These opposing trends beg the question of how the "good doctor" concept may be strengthened. In this perspective, the authors argue that revisiting the construct of physician character from an affirmational perspective could meaningfully improve medical education's impact on overall health by more holistically conceptualizing what-and who-a good doctor is. The authors introduce positive psychology's framework of character strengths, probe the distinction between character strengths and medical professionalism, and summarize the role of character strengths in promoting physician engagement and well-being in health care work. They contend that a systems-level approach to cultivating character strengths will foster physician moral agency and well-being and, by extension, transformational change in health care. Consistent with best practice in modern character education, the authors propose that institutions mindfully cultivate moral community among all stakeholders (students, faculty, staff, postgraduate trainees, and patients) and that moral community interaction centers on each member's personal aspirations with respect to living a good life, guided by the character strengths framework and informed by patient perspectives.
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Kassam A, Page S, Lauzon J, Hay R, Coret M, Mitchell I. Ethical issues in residency education related to the COVID-19 pandemic: a narrative inquiry study. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-108917. [PMID: 38925879 DOI: 10.1136/jme-2023-108917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories. METHOD We used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed. RESULTS 11 residents participated across several programmes. Three main themes emerged from the participants' stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants' journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together. DISCUSSION Cases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics. CONCLUSION Efforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems.
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Affiliation(s)
- Aliya Kassam
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stacey Page
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Julie Lauzon
- Medical Genetics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Rebecca Hay
- Pediatric Critical Care Medicine, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Marian Coret
- Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian Mitchell
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Araújo-Neto FDC, Prado FO, Dosea AS, Fonseca FLD, Araújo DCSAD, Brito GDC, Mesquita AR, Lyra-Jr DPD. Assessment of Professionalism in Pharmacists and Pharmacy Students: Scoping Review of Instruments and Validity Evidence. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100733. [PMID: 38866371 DOI: 10.1016/j.ajpe.2024.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/31/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
OBJECTIVE To characterize which instruments have been developed to assess professionalism in the field of pharmacy. FINDINGS A scoping review was conducted to answer which instruments have been developed to assess professionalism in the field of Pharmacy. The databases consulted were EMBASE, ERIC, PUBMED/Medline, Scopus, and Web of Science. No restrictions on language or year of publication were made. Only studies about development or translation of instruments for professionalism assessment were included. The methodological quality of studies was verified by the Questionnaire Cross-Cultural Adaptation Guideline and the COnsensus-based Standards for the selection of health Measurement INstruments. Seven studies met the eligibility criteria and were included in this scoping review. In general, the instruments were developed from ideological elements assigned to professionalism by pharmaceutical and medical entities, in addition to theoretical references that came from social sciences. Regarding the evaluation of validation and psychometric property evidence, the studies generally adopted distinct procedures which highlights some destandardization, although the methodological quality was accepted. SUMMARY More studies on the professionalism field should be conducted to characterize professionalism and develop pharmaceutical practices in line with societal demands and expectations.
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Affiliation(s)
- Fernando de Castro Araújo-Neto
- Federal University of Sergipe, Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Sergipe, Brazil.
| | - Fernanda Oliveira Prado
- Federal University of Sergipe, Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Sergipe, Brazil.
| | - Aline Santana Dosea
- Federal University of Sergipe, Health Sciences Graduate Program, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Sergipe, Brazil.
| | - Francielly Lima da Fonseca
- Federal University of Sergipe, Graduate Program in Pharmaceutical Sciences, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Sergipe, Brazil
| | - Dyego Carlos Souza Anacleto de Araújo
- Federal University of Espírito Santo, Department of Pharmaceutical Sciences, Laboratory for Innovation in Health Care, Vitória, Espírito Santo, Brazil.
| | - Giselle de Carvalho Brito
- Federal University of Sergipe, Laboratory of Studies in Pharmaceutical Care, Department of Pharmacy, Lagarto, Sergipe, Brazil.
| | - Alessandra Rezende Mesquita
- Federal University of Sergipe, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Sergipe, Brazil.
| | - Divaldo Pereira de Lyra-Jr
- Federal University of Sergipe, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Sergipe, Brazil.
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Teo YH, Peh TY, Abdurrahman ABHM, Lee ASI, Chiam M, Fong W, Wijaya L, Krishna LKR. A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore. Singapore Med J 2024; 65:313-325. [PMID: 34823327 PMCID: PMC11232710 DOI: 10.11622/smedj.2021224] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Nurturing professional identities instils behavioural standards of physicians, and this in turn facilitates consistent professional attitudes, practice and patient care. Identities are socioculturally constructed efforts; therefore, we must account for the social, cultural and local healthcare factors that shape physicians' roles, responsibilities and expectations. This study aimed to forward a programme to nurture professionalism among physicians in Singapore. METHODS A three-phase, evidenced-based approach was used. First, a systematic scoping review (SSR) was conducted to identify professionalism elements. Second, a questionnaire was created based on the findings of the SSR. Third, a modified Delphi approach, which involved local experts to identify socioculturally appropriate elements to nurture professionalism, was used. RESULTS A total of 124 articles were identified from the SSR; these articles revealed definitions, knowledge, skills and approaches to nurturing professionalism. Through the modified Delphi approach, we identified professional traits, virtues, communication, ethical, self-care, teaching and assessment methods, and support mechanisms. CONCLUSION The results of this study formed the basis for a holistic and longitudinal programme focused on instilling professional traits and competencies over time through personalised and holistic support of physicians. The findings will be of interest to medical communities in the region and beyond.
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Affiliation(s)
- Yao Hao Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Tan Ying Peh
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- Assisi Hospice, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, Singapore
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
- The Palliative Care Centre for Excellence in Research and Education, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, United Kingdom
- Centre of Biomedical Ethics, National University of Singapore, Singapore
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Lorenzo M, Bailly P, Lépine C. Should we add patients in concordance of judgment learning tool panels? - An analysis between patients and primary care physicians. MEDICAL TEACHER 2024; 46:697-704. [PMID: 37917989 DOI: 10.1080/0142159x.2023.2274285] [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: 11/04/2023]
Abstract
INTRODUCTION The Concordance of Judgment Learning Tool (CJLT) has been developed for distance asynchronous learning of professionalism in health sciences education. The learning of professionalism is induced by a student's comparison of their own responses with those of the panel members. Whilst CJLT programs typically include same profession experts in their panels, we believe that they could also include patients. Accordingly, we conducted a study aimed at comparing CJLT response patterns between two groups of primary care physicians (PCPs) and patients. METHODS We conducted a mixed prospective study of responses to a CJLT program based on a group of PCPs and a group of patients: an analysis of the response patterns of the two groups and a qualitative analysis of justifications. RESULTS A total of 110 participants were included in the study: 70 patients and 40 PCPs. We found a significant difference in response patterns between the PCP and patient groups for nine of the fifteen questions (60%). The qualitative analysis of justifications between groups allowed us to comprehend patients' views on the professionalism of PCPs. CONCLUSIONS Including patients in CJLT panels can enrich the feedback offered to students in these online training programs.
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Affiliation(s)
- Mathieu Lorenzo
- Department of General practice, Faculty of Medicine, Strasbourg, France
- Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, Strasbourg, France
| | - Pierre Bailly
- Department of General practice, Faculty of Medicine, Strasbourg, France
| | - Camille Lépine
- Department of General practice, Faculty of Medicine, Strasbourg, France
- Centre for Training and Research in Health Sciences Education (CFRPS), Faculty of Medicine, Strasbourg, France
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Buhumaid R, Otaki F, Czabanowska K, Stanley A, Ezimokhai M, Jackson L, Ho SB. Professionalism-training in undergraduate medical education in a multi-cultural, multi-ethnic setting in the Gulf Region: an exploration of reflective essays. BMC MEDICAL EDUCATION 2024; 24:117. [PMID: 38321450 PMCID: PMC10848390 DOI: 10.1186/s12909-024-05103-z] [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: 12/28/2023] [Accepted: 01/27/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Despite the established need to prioritize professionalism-training in developing future physicians, very few medical programs in the Gulf Region embed in their curricula discrete contextualized courses aimed at developing the corresponding competencies, while fostering self-directed learning. This study aims at exploring the perception of undergraduate medical students in a multi-cultural, multi-ethnic setting regarding their understanding of, and personal experience with professionalism through their engagement with the content of an innovative curriculum-based professionalism course, offered at a Medical School in Dubai, United Arab Emirates. METHODS The study used a qualitative phenomenological research design. Out of 33 students, 29 students had submitted reflective essays. The content of these essays was inductively analyzed following a six-step framework for conducting thematic analysis. The framework's steps include familiarizing oneself with the data, generating initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report. FINDINGS The inductive qualitative analysis generated the Professionalism Learning Journey model. This conceptual model includes four interconnected themes: Awareness, Acknowledgement, Realization, and Application. The generated model depicts the trajectory that the learners appear to experience while they are engaging with the content of the course. CONCLUSION Integrating a professionalism-training course into an undergraduate medical curriculum is likely to be positively appraised by the learners. It raises their awareness, enables them to value the subject matter and the sophistication of its application, and empowers them to put into practice the taught principles, on an individual basis and collectively. This is especially true when the course is entrenched in constructivism experiential learning theory and designed to foster self-directed learning. The introduced conceptual model, in conjunction with the innovative professionalism-training course curriculum, can serve as a template for other competencies and other schools.
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Affiliation(s)
- Rasha Buhumaid
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates.
| | - Farah Otaki
- Strategy and Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Katarzyna Czabanowska
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine, and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Department of Health Policy Management, Faculty of Health Care, Institute of Public Health, Jagiellonian University, Kraków, Poland
| | - Adrian Stanley
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Mutairu Ezimokhai
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Lisa Jackson
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
| | - Samuel B Ho
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
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Zeigler SM, Starnes SL, Sade RM. Should a questionably competent resident be allowed to continue in the program? J Thorac Cardiovasc Surg 2024; 167:283-288. [PMID: 36357222 DOI: 10.1016/j.jtcvs.2022.10.013] [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: 08/29/2022] [Revised: 09/27/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Sanford M Zeigler
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Sandra L Starnes
- Section of Cardiothoracic Surgery, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Robert M Sade
- Division of Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC.
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Imamura T, Narang N, Kinugawa K. Earlier First Publication Is Associated with More Future Publication. Int Heart J 2023; 64:870-874. [PMID: 37704404 DOI: 10.1536/ihj.23-259] [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: 09/15/2023]
Abstract
Participation in clinical research has served clinicians to develop academic careers, as well as to deepen clinical insights, implement evidence-based medicine practices, and even inspire new clinical questions. Early engagement in academic pursuits may better prepare clinicians to maintain long-term research productivity, rather than starting later in their careers.We included medical doctors who graduated from a medical university and retrospectively followed them for 10 years after graduation. The impact of at least one publication within the first 5 years on the achievement of ≥ 5 publications within 10 years was evaluated.A total of 79 medical doctors, including 60 (76%) men, were included. During the first 5 years, 21 (27%) published at least one paper. Overall, 25 (32%) achieved the primary outcome. At least one publication during the first 5 years was an independent predictor of the primary outcome (odds ratio 30.4, 95% confidence interval 2.68-251, P = 0.002). Medical doctors with at least one publication within the first 5 years had significantly higher cumulative 10-year publications compared to no publications within the first 5 years (9 [5, 13] versus 0 [0, 3], P < 0.001).In this retrospective study, we demonstrated that an early involvement in research defined by academic output was associated with higher odds of multiple publications later in a career. Prospective studies to validate our findings by involving young medical doctors in academic pursuits are needed to understand the longitudinal effects of early career academic productivity.
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Anees A, McAlister EG, Garber AM, Calderon AS, Butler J, Mallin E, Levine D, Sanders ML, Kwan B, Clewing JM, Barczi S, Mateja C, Ismail N. Bridging the Gap in Competency Assessment During Transition from Undergraduate Medical Education to Graduate Medical Education: A Perspective Piece. Am J Med 2023; 136:941-945.e1. [PMID: 37339726 DOI: 10.1016/j.amjmed.2023.06.001] [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: 05/18/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Amna Anees
- Department of Medicine, Charleston Area Medical Center/WVU-Charleston Division, Charleston, WV.
| | | | - Adam M Garber
- Virginia Commonwealth University School of Medicine, Richmond
| | | | | | - Emily Mallin
- Department of Medicine, University of Arizona College of Medicine - Phoenix and Banner - University Medical Center Phoenix
| | | | - M Lee Sanders
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City
| | | | - J Marietta Clewing
- Weill Cornell Medical College, Department of Medical Education, Texas A&M College of Medicine, College Station
| | - Steven Barczi
- University of Wisconsin School of Medicine and Public Health, Madison; Madison VA Geriatric Research Education and Clinical Center, Wm. S. Middleton Memorial VA Hospital, Madison, Wis
| | | | - Nadia Ismail
- Baylor College of Medicine School of Medicine, Houston, Texas
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Amick AE, Schrepel C, Bann M, Watsjold B, Jauregui J, Ilgen JS, Lu DW, Sebok-Syer SS. From Battles to Burnout: Investigating the Role of Interphysician Conflict in Physician Burnout. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1076-1082. [PMID: 37043749 DOI: 10.1097/acm.0000000000005226] [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
PURPOSE Despite the recognized importance of collaborative communication among physicians, conflict at transitions of care remains a pervasive issue. Recent work has underscored how poor communication can undermine patient safety and organizational efficiency, yet little is known about how interphysician conflict (I-PC) impacts the physicians forced to navigate these tensions. The goal of this study was to explore the social processes and interpersonal interactions surrounding I-PC and their impact, using conversations regarding admission between internal medicine (IM) and emergency medicine (EM) as a lens to explore I-PC in clinical practice. METHOD The authors used constructivist grounded theory to explore the interpersonal and social dynamics of I-PC. They used purposive sampling to recruit participants, including EM resident and attending physicians and IM attending physicians. The authors conducted hour-long, semistructured interviews between June and October 2020 using the Zoom video conferencing platform. Interviews were coded in 3 phases: initial line-by-line coding, focused coding, and recording. Constant comparative analysis was used to refine emerging codes, and the interview guide was iteratively updated. RESULTS The authors interviewed 18 residents and attending physicians about how engaging in I-PC led to both personal and professional harm. Specifically, physicians described how I-PC resulted in emotional distress, demoralization, diminished sense of professional attributes, and job dissatisfaction. Participants also described how emotional residue attached to past I-PC events primed the workplace for future conflict. CONCLUSIONS I-PC may represent a serious yet underrecognized source of harm, not only to patient safety but also to physician well-being. Participants described both the personal and professional consequences of I-PC, which align with the core tenets of burnout. Burnout is a well-established threat to the physician workforce, but unlike many other contributors to burnout, I-PC may be modifiable through improved education that equips physicians with the skills to navigate I-PC throughout their careers.
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Affiliation(s)
- Ashley E Amick
- A.E. Amick is assistant professor, Department of Emergency Medicine and Department of Internal Medicine, University of Washington, Seattle, Washington
| | - Caitlin Schrepel
- C. Schrepel is assistant professor, Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Maralyssa Bann
- M. Bann is assistant professor, Department of Medicine, University of Washington, Seattle, Washington
| | - Bjorn Watsjold
- B. Watsjold is assistant professor, Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Joshua Jauregui
- J. Jauregui is associate professor, Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Jonathan S Ilgen
- J.S. Ilgen is professor, Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Dave W Lu
- D.W. Lu is associate professor, Department of Emergency Medicine, University of Washington, Seattle, Washington
| | - Stefanie S Sebok-Syer
- S.S. Sebok-Syer is assistant professor, Department of Emergency Medicine, Stanford University, Stanford, California
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Wang M, Wang Y, Fang M, Zhang S, Li Y, Cao D, Jin Y. Style and influencing factors of tutors-postgraduates' interactions in Chinese medical colleges: a cross-sectional survey in Heilongjiang Province. BMC MEDICAL EDUCATION 2023; 23:305. [PMID: 37131172 PMCID: PMC10152608 DOI: 10.1186/s12909-023-04291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES This study assesses the style of tutor-postgraduate interactions in Chinese medical colleges and explores the association between postgraduates' demographic factors and tutors' demographic characteristics. METHODS With the stratified sampling method, a cross-sectional online survey was used. A total of 813 medical postgraduates were recruited as participants, with an effective response rate of 85.49%. The two dimensions of "Professional Ability Interaction" and "Comprehensive Cultivation Interaction" in the self-developed "Instructor-Graduate Interaction Scale for Medical Colleges" were used as dependent variables. And tutors' demographic characteristics and postgraduates' demographic characteristics were taken as independent variables. Logistic regression analysis was used to explore the influencing factors of Tutor-Postgraduates Interactions in medical colleges. RESULTS The Tutor-Postgraduates Interaction scale consists of 14 items from the two dimensions of "Professional Ability Interaction" and "Comprehensive Cultivation Interaction". The results of the logistic regression analysis show the reasons for selecting the mentor students (industry recognition, the tutor's research direction, charm in attracting mentors, and recommendations for mentor selection); student to mentor satisfaction; student to study life satisfaction; and regular academic seminars. Indirect guidance and a high postgraduate grade high are the protective factors of interaction between tutors and postgraduates of medical colleges and universities postgraduates. Older mentors and more graduate tutors are the risk factors for Tutor-Postgraduates Interaction in medical colleges (P < 0.05). CONCLUSION The current study proposes that managers should pay more attention to the double-track promotion of "Professional Ability Interaction" and "Comprehensive Cultivation Interaction". We should not only pay attention to the cultivation of postgraduates' professional ability but also pay more attention to the comprehensive cultivation including postgraduates' mental and psychological aspects. The interaction between tutors and postgraduates in medical colleges is generally good, but much attention should be given to the dual-track promotion mentioned above. Regular academic seminars play an important role in the process of postgraduate training. The research findings, including the influencing factors regarding tutor-postgraduate interactions, the Professional Ability Interaction and Comprehensive Cultivation Interaction, are very informative and can contribute to strategies for postgraduate management systems that enhance this relationship.
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Affiliation(s)
- Mingsi Wang
- Graduate School of Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
- Department of Health Economics, College of Health Management of Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
| | - Yanping Wang
- Department of Health Management, School of Health Management, Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
| | - Ming Fang
- Graduate School of Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
| | - Shue Zhang
- Department of Health Management, School of Health Management, Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China
| | - Yilan Li
- Department of Cardiology, the Second Affiliated Hospital of Harbin Medical University, 148# Bao Jian Road, Harbin, 150000, China
| | - Depin Cao
- Department of Health Management, School of Health Management, Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China.
| | - Yan Jin
- Graduate School of Harbin Medical University, 157# Bao Jian Road, Harbin, 150081, China.
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Competency Assessment in Physical Medicine and Rehabilitation Resident Education: A Systematic Review. Am J Phys Med Rehabil 2022; 101:1111-1116. [PMID: 35121682 DOI: 10.1097/phm.0000000000001983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this systematic review was to examine the scope and quality of research in physical medicine and rehabilitation resident education as it pertains to the six core competencies defined by the Accreditation Council for Graduate Medical Education. DESIGN All indexed years of Medline, Embase, and ERIC were searched using key words related to physical medicine and rehabilitation and medical education. Data were extracted on core competencies, content categories, teaching interventions, and study quality. RESULTS From a sample of 2544 articles, 62 studies were included in this review. Frequencies of core competencies studied were: patient care 62.9%, medical knowledge 56.5%, systems-based practice 22.6%, practice-based learning and improvement 14.5%, professionalism 25.8%, and interpersonal and communication skills 22.6%. Musculoskeletal and pain medicine was the most frequently studied content category (33.9%). There was no significant difference in quality of studies between the six core competency groups ( P = 0.31). CONCLUSIONS Available research is highly concentrated in patient care and medical knowledge competencies and in the musculoskeletal and pain medicine content category. This systematic review outlines the current state of education literature and highlights areas for further inquiry. This is an important step toward the translation of research into evidence-based educational practices.
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Bhardwaj A. Medical Professionalism in the Provision of Clinical Care in Healthcare Organizations. J Healthc Leadersh 2022; 14:183-189. [PMID: 36320452 PMCID: PMC9618247 DOI: 10.2147/jhl.s383069] [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] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Medical professionalism is critical toward provision of safe, effective, patient-centered, timely, efficient, and equitable clinical care delivery. The basic tenets of medical professionalism are deeply embedded in the historical context via oaths and expectations. However, standardization of professional conduct and its integration by providers have been a challenge due to the evolving complexity of healthcare organizations (HCOs) and academic medical institutions (AMIs). Increasing heterogeneity of the workforce leads to greater complexity in collaborative teamwork. In this evolving landscape, violations of professional conduct demand closer scrutiny along professional and personal lines. Likewise, actions among minority groups pose challenges between integration and inclusion of certain professional interactions and conduct. Recently, in American HCOs and AMIs, there has been a renewed emphasis on accountability and managing unprofessional behaviors in the delivery of clinical care. This descriptive literature-based treatise explicates the professionalism construct in its historical milieu, underscores key facets of professionalism, highlights principal drivers of unprofessional behaviors, and posits solutions for enhancing and nurturing professionalism in the delivery of clinical care in HCOs and AMIs by a diverse workforce of healthcare providers.
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Affiliation(s)
- Anish Bhardwaj
- Departments of Neurology, Neurosurgery, and Neurobiology, University of Texas Medical Branch (UTMB), Galveston, TX, 77555, USA,Correspondence: Anish Bhardwaj, University of Texas Medical Branch (UTMB), 9.128 John Sealy Annex, Route 0539, 301 University Blvd, Galveston, TX, 77555, USA, Tel +1-409-772-8068, Email
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Haney S, Rowland P, Ginsburg S. Patients' perspectives on medical students' professionalism: Blind spots and opportunities. MEDICAL EDUCATION 2022; 56:724-735. [PMID: 35098573 DOI: 10.1111/medu.14735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/09/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research has acknowledged the value of patients as essential stakeholders in medical education, yet educators have not adequately incorporated patients' perspectives into medical students' developing professionalism. Our purpose was to explore patients' perceptions of professional behaviour in medical students as a first step to considering patients' potential roles in assessing professionalism. METHODS Building on the existing framework of the 'disavowed curriculum', we used a constructivist grounded theory approach to interview and analyse data from 19 patients (11 W, 8 M) at one urban hospital. Each participant watched five video scenarios that depict professionally challenging situations commonly faced by medical students, after which they were asked to put themselves in the position of both the patient and the student depicted in each scenario, and to discuss what they felt would be appropriate or inappropriate behaviours from each perspective. RESULTS Patients' responses replicated all elements of the disavowed curriculum, including principles of professionalism, the student's affect or internal factors, and potential implications of actions. Their responses reflected avowed, unavowed and disavowed rationales. Participants also identified novel principles, including hide dissension in the ranks, respect privacy, advocate for yourself and have trust in the system. Patients conveyed an understanding of the multiple competing factors students must balance (e.g., providing optimal care while maximising educational opportunities) and appeared to empathise with some of the pressures students face. CONCLUSIONS Our findings point to significant blind spots in previous research based on faculty and student perspectives of professionalism. Knowing what patients perceive as important will allow educational and assessment efforts to be refined to reflect their values. Our work begins the process of understanding how best to include patients in the assessment of medical learners.
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Affiliation(s)
- Simon Haney
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paula Rowland
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Medicine, Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Shiphra Ginsburg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, University of Toronto and University Health Network, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
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Schrepel C, Amick AE, Bann M, Watsjold B, Jauregui J, Ilgen JS, Sebok-Syer SS. Who's on your team? Specialty identity and inter-physician conflict during admissions. MEDICAL EDUCATION 2022; 56:625-633. [PMID: 34942027 DOI: 10.1111/medu.14715] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/01/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
PURPOSE Despite the implementation of professionalism curricula and standardised communication tools, inter-physician conflict persists. In particular, the interface between emergency medicine (EM) and internal medicine (IM) has long been recognised as a source of conflict. The social nuances of this conflict remain underexplored, limiting educators' ability to comprehensively address these issues in the clinical learning environment. Thus, the authors explored EM and IM physicians' experiences with negotiating hospital admissions to better understand the social dynamics that contribute to inter-physician conflict and provide foundational guidance for communication best practices. METHODS Using a constructivist grounded theory (CGT) approach, the authors conducted 18 semi-structured interviews between June and October 2020 with EM and IM physicians involved in conversations regarding admissions (CRAs). They asked participants to describe the social exchanges that influenced these conversations and to reflect on their experiences with inter-physician conflict. Data collection and analysis occurred iteratively. The relationships between the codes were discussed by the research team with the goal of developing conceptual connections between the emergent themes. RESULTS Participants described how their approaches to CRAs were shaped by their specialty identity, and how allegiance to members of their group contributed to interpersonal conflict. This conflict was further promoted by a mutual sense of disempowerment within the organisation, misaligned expectations, and a desire to promote their group's prerogatives. Conflict was mitigated when patient care experiences fostered cross-specialty team formation and collaboration that dissolved traditional group boundaries. CONCLUSIONS Conflict between EM and IM physicians during CRAs was primed by participants' specialty identities, their power struggles within the broader organisation, and their sense of duty to their own specialty. However, formation of collaborative inter-specialty physician teams and expansion of identity to include colleagues from other specialties can mitigate inter-physician conflict.
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Affiliation(s)
- Caitlin Schrepel
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Ashley E Amick
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Maralyssa Bann
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Bjorn Watsjold
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Joshua Jauregui
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Jonathan S Ilgen
- Department of Emergency Medicine, University of Washington, Seattle, Washington, USA
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Moniz T, Melro CM, Warren A, Watling C. Dual and duelling purposes: An exploration of educators' perspectives on the use of reflective writing to remediate professionalism in residency. MEDICAL EDUCATION 2022; 56:176-185. [PMID: 34437727 PMCID: PMC9297876 DOI: 10.1111/medu.14625] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Professionalism lapses have high stakes for learners and educators. Problems with professionalism, unless appropriately and effectively remediated, may portend serious problems in practice. Yet, remediation for unprofessional behaviour is particularly challenging-and understudied. Increasingly, educators are turning to reflective writing as a remediation strategy in residency, yet little is known about what educators expect reflective writing to accomplish, how they choose reflective writing tasks, why they use reflective writing, or how they evaluate whether a learner has met expectations. We aimed to understand why and how postgraduate medical educators use reflective writing as an educational intervention to remediate professionalism. METHOD In this constructivist grounded theory study, we interviewed 13 medical education professionals with experience using reflective writing to remediate professionalism across five Canadian medical schools. Data collection and analysis occurred iteratively using constant comparison to identify themes and to understand the relationships among them. RESULTS Medical educators reported using reflective writing as a learning tool to develop insight and as an assessment tool to unearth evidence of insight. The goal of learning may compete with the goal of assessment, creating tension that leads to uncertainty about the sincerity, quality and effectiveness of reflective writing as well as concerns about learner safety. Educators reported uncertainty about whether learners write to pass or to introspect and about how to judge the effectiveness of reflective writing as a learning tool. They expressed concern about creating a safe environment for learners-one that enables the genuine reflection required for insight development-while meeting requirements of remediation. CONCLUSIONS Educators express ambivalence about using reflective writing to remediate professionalism in residency. Understanding the potential and pitfalls of reflective writing may inform more tailored and effective approaches to remediate professionalism.
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Affiliation(s)
- Tracy Moniz
- Department of Communication StudiesMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | | | - Andrew Warren
- Department of Pediatrics, Faculty of MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - Chris Watling
- Departments of Oncology and Clinical Neurological Sciences, Schulich School of Medicine and DentistryUniversity of Western OntarioLondonOntarioCanada
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Barnhoorn PC, Nierkens V, Mak-van der Vossen MC, Numans ME, van Mook WNKA, Kramer AWM. Unprofessional behaviour of GP residents and its remediation: a qualitative study among supervisors and faculty. BMC FAMILY PRACTICE 2021; 22:249. [PMID: 34930146 PMCID: PMC8686537 DOI: 10.1186/s12875-021-01609-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. METHODS We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. RESULTS Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. CONCLUSIONS The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation.
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Affiliation(s)
- Pieter C Barnhoorn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | | | - Mattijs E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine and Academy for Postgraduate Medical Training, Maastricht University Medical Centre, Maastricht, the Netherlands
- School of Health Professions Education, Maastricht University, Maastricht, the Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Hippocratespad 21, Zone V0-P, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Song X, Jiang N, Li H, Ding N, Wen D. Medical professionalism research characteristics and hotspots: a 10-year bibliometric analysis of publications from 2010 to 2019. Scientometrics 2021; 126:8009-8027. [PMID: 34248230 PMCID: PMC8256397 DOI: 10.1007/s11192-021-03993-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
An abundance of publications on medical professionalism have been published in recent years. Our study aimed to analyze the external characteristics of publications on professionalism using bibliometrics, to describe its current developments and trends, and to explore professionalism research hotspots using co-word analysis. We retrieved literature on professionalism published from 2010 to 2019 from the Web of Science database. Histcite and CiteSpace were used to analyze external characteristics of publications, including publication trends and distributions of publications by country/region, institution, author, and journal. Co-word analysis was conducted to analyze research hotspots, using the Bibliographic Item Co-Occurrence Matrix Builder and Graphical Clustering Toolkit. We constructed a strategic diagram to show the state of each research hotspot and the relationship between the various hotspots in this field. Results showed publications on professionalism increased in number year by year as a whole. The USA, including its institutions and authors, maintained the top position worldwide in terms of numbers of publications and citations. Among scholarly journals, Academic Medicine has published more articles and has had higher citations per paper than any other journal. Six research hotspots on professionalism were identified, visualized, and expounded. Of these, the theme of "measurement and evaluation of clinical competence" received the most attention in the field of professionalism. The reporting of quantifiable knowledge on the characteristics and research hotspots of publications could help inform gaps in the field of medical professionalism and provide evidence and guidance for future work for researchers, physicians, and educators.
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Affiliation(s)
- Xinzhi Song
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
| | - Nan Jiang
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
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Medisauskaite A, Griffin A, Viney R, Rashid A, Rich A. Changing professional behaviours: mixed methods study utilising psychological theories to evaluate an educational programme for UK medical doctors. BMC MEDICAL EDUCATION 2021; 21:92. [PMID: 33546673 PMCID: PMC7866444 DOI: 10.1186/s12909-021-02510-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Theory of Planned Behaviour (TPB) has been proposed as a useful framework to investigate professional behaviour, however, was not yet applied to the evaluation of an educational intervention. This study will address this gap by utilising the TPB to evaluate the effectiveness of an education programme delivered by the professional regulator for UK doctors in enhancing three professional behaviours: raising concerns, engaging in reflective practice, and use of regulator confidentiality guidance. METHODS This is a comprehensive mixed methods study combining qualitative (interviews) and quantitative (quasi-experiment) data. Intervention participants were asked to complete a survey measuring the variables in the TPB (attitudes, subjective norms, perceived behavioural control, and intention) for the three professional behaviours before, immediately post, and 3-months later following the education programme. Ninety-four doctors completed the survey pre/post intervention and 38 at all three times. One hundred and eleven doctors from the same hospital trust who did not take part in the intervention completed the survey at two time points and formed the control group. Forty-two interviews were conducted with intervention participants. RESULTS The quantitative study revealed that the educational intervention significantly improved attitudes (raising concerns, using confidentiality guidance), subjective norms (raising concerns, reflective practice, using confidentiality guidance), perceived control (raising concerns, using confidentiality guidance), and intentions (using confidentiality guidance) (Group and Time interaction; Fs ≥ 3.996, ps ≤ .047, ηp2 ≥ .020). Non-UK graduate doctors' subjective norms towards raising concerns and confidentiality guidance increased significantly after the intervention (Fs ≤ 6.602, ps ≥ .011, ηp2 = .032 F = 6.602, p = .011, ηp2 = .032), but not UK graduates (p > .05). Interviews revealed that doctors had positive views about professional behaviours but also mentioned numerous barriers to actually engage in more complex, context dependent behaviours. CONCLUSIONS This study demonstrates that an educational intervention was successful in improving the TPB variables of three professional behaviours. It also revealed that teaching professionalism does not happen in isolation and, therefore, personal and contextual factors are crucial to consider. To change complex professional behaviours, barriers at all levels i.e., personal, organisational and system, should be addressed.
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Affiliation(s)
- Asta Medisauskaite
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, Room GF/664, London, NW3 2PF, UK.
| | - Ann Griffin
- Research Department of Medical Education, UCL Medical School, 74 Huntley Street, London, WC1E 6AU, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, Room GF/664, London, NW3 2PF, UK
| | - Ahmed Rashid
- Research Department of Medical Education, UCL Medical School, 74 Huntley Street, London, WC1E 6AU, UK
| | - Antonia Rich
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, Room GF/664, London, NW3 2PF, UK
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Cameron C, Lunn TM, Lanos C, Batt AM. Dealing with dying – progressing paramedics’ role in grief support. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2020.1856634] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Cheryl Cameron
- Emergency Health Services, Alberta Health, Alberta, Canada
- McNally Project for Paramedic Research, Ontario, Canada
| | - Tyne M. Lunn
- Mobile Integrated Healthcare, Alberta Health Services Emergency Medical Services, Alberta, Canada
| | - Chelsea Lanos
- McNally Project for Paramedic Research, Ontario, Canada
- County of Renfrew Paramedic Service, Ontario, Canada
| | - Alan M. Batt
- McNally Project for Paramedic Research, Ontario, Canada
- Paramedic Programs, Fanshawe College, Ontario, Canada
- Paramedic Science, CQUniversity, QLD, Australia
- Department of Paramedicine, Monash University, VIC, Australia
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Ghaffarifar S, Asghari-Khatooni A, Akbarzadeh A, Pourabbas A, Farshad MS, Masoomi R, Akbarzadeh F. Teaching professionalism in medical residency programs: a scoping review protocol. Syst Rev 2020; 9:281. [PMID: 33278905 PMCID: PMC7719236 DOI: 10.1186/s13643-020-01529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Professionalism is a core competency of medical residents in residency programs. Unprofessional behavior has a negative influence on patient safety, quality of care, and interpersonal relationships. The objective of this scoping review is to map the range of teaching methods of professionalism in medical residency programs (in all specialties and in any setting, whether in secondary, primary, or community care settings). For doing so, all articles which are written in English in any country, regardless of their research design and regardless of the residents' gender, year of study, and ethnic group will be reviewed. METHODS This proposed scoping review will be directed in agreement with the methodology of the Joanna Briggs Institute for scoping reviews. The six steps of Arksey and O'Malley methodological framework for conducting scoping reviews, updated by Levac et al. (Implement. Sci. 5(1): 69, 2010) will be followed. The findings from this study will be merged with those of the previous Best Evidence Medical Education (BEME) systematic review. All published and unpublished studies from 1980 until the end of 2019 will be reviewed, and the previous BEME review will be updated by the findings of the articles from the beginning of 2010 until the end of 2019. All research designs and all credible evidence will be included in this review. CONCLUSIONS Conducting this scoping review will map the teaching methods of professionalism and will provide an inclusive evidence base to help the medical teachers in the choosing for proper teaching methods for use in their teaching practice. SYSTEMATIC REVIEW REGISTRATION Not registered.
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Affiliation(s)
- Saeideh Ghaffarifar
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Amirhossein Akbarzadeh
- Research Center for Evidence-Based Medicine, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Pourabbas
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehran Seif Farshad
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rasoul Masoomi
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariborz Akbarzadeh
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Ong YT, Kow CS, Teo YH, Tan LHE, Abdurrahman ABHM, Quek NWS, Prakash K, Cheong CWS, Tan XH, Lim WQ, Wu J, Tan LHS, Tay KT, Chin A, Toh YP, Mason S, Radha Krishna LK. Nurturing professionalism in medical schools. A systematic scoping review of training curricula between 1990-2019. MEDICAL TEACHER 2020; 42:636-649. [PMID: 32065016 DOI: 10.1080/0142159x.2020.1724921] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Introduction: Professionalism is an evolving, socioculturally informed multidimensional construct that influences doctor-patient relationships, patient satisfaction and care outcomes. However, despite its clinical significance there is little consistency in how professionalism is nurtured amongst medical students. To address this gap a systemic scoping review of nurturing professionalism in medical schools, is proposed.Methods: Levac's framework and the PRISMA-P 2015 checklist underpinned a 6-stage systematic review protocol. Concurrent use of Braun and Clarke's approach to thematic analysis and directed content analysis was used to identify the key elements in nurturing professionalism.Results: 13921 abstracts were identified from six databases, 854 full-text articles reviewed, and 162 full-text included articles were included. The 4 themes identified through thematic analysis are consistent with findings of the directed content analysis. These were the definition of professionalism, the approaches, content, barriers and enablers to teaching professionalism.Conclusion: Informed by a viable definition of professionalism and clear milestones nurturing professionalism nurturing professionalism begins with culturally appropriate training in clinical competence, humanistic qualities and reflective capacity. This process requires effective evaluations of professional identity formation, and the impact of the learning environment underlining the need for longitudinal assessments of the training process.
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Affiliation(s)
- Yun Ting Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheryl Shumin Kow
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yao Hao Teo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lorraine Hui En Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ahmad Bin Hanifah Marican Abdurrahman
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Wei Sheng Quek
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kishore Prakash
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarissa Wei Shuen Cheong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xiu Hui Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wei Qiang Lim
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiaxuan Wu
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Laura Hui Shuen Tan
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kuang Teck Tay
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Annelissa Chin
- Medical Library, National University of Singapore Libraries, National University of Singapore, Singapore, Singapore
| | - Ying Pin Toh
- Family Medicine Residency, National University Health System, Singapore, Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, Liverpool, England
| | - Lalit Kumar Radha Krishna
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Palliative Care Institute Liverpool, Academic Palliative and End of Life Care Centre, University of Liverpool, Liverpool, England
- Education Department, Duke-NUS Graduate Medical School, Singapore, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore
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Roberts LW. High Road, Low Road: Professionalism, Trust, and Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:817-818. [PMID: 32452849 DOI: 10.1097/acm.0000000000003297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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