1
|
Finn GM, Brown MEL, Tiffin PA. Four year medical degrees in the UK. BMJ 2024; 386:q1630. [PMID: 39089848 DOI: 10.1136/bmj.q1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Affiliation(s)
| | | | - Paul A Tiffin
- Health Professions Education Unit (HPEU), Hull York Medical School, University of York, UK
| |
Collapse
|
2
|
Beattie J, Binder M, Beks H, Fuller L. Influence of a rural Longitudinal Integrated Clerkship on medical graduates' geographic and specialty decisions: a constructivist grounded theory study. BMC MEDICAL EDUCATION 2024; 24:795. [PMID: 39049054 PMCID: PMC11267796 DOI: 10.1186/s12909-024-05793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Like many countries, Australia is suffering from a longstanding and persistent medical workforce maldistribution with fewer doctors per capita in rural locations and a trend towards sub-specialisation. Longitudinal Integrated Clerkships (LIC), a medical education model, are more likely than other clerkship models to produce graduates who work rurally, in communities of increasing remoteness and in primary care. While this quantitative data is essential, there has been a dearth of program-specific evidence explaining this phenomenon. METHODS To address this knowledge gap, a constructivist qualitative grounded theory approach was employed to identify how the Deakin University comprehensive rural LIC influences graduates' (2011-2020) career decisions in terms of both medical specialty and geographic practice location. RESULTS Thirty-nine graduates participated in qualitative interviews. The Rural LIC Career Decision Making Framework was developed, postulating that an alignment of personal and program factors under the central concept of 'choosing to participate' can influence graduates' geographic and specialist career decisions, both individually and symbiotically. Once embedded in the clerkship, participation was augmented by the concepts of learning design affordance and learning in place, providing the participants with longitudinal opportunities to experience and compare medical disciplines in an integrated manner. CONCLUSIONS The developed framework presents contextual elements of the program that were deemed influential on graduates' subsequent career decisions. The alignment of these elements with the program's mission statement has the capacity to enhance the program's rural workforce goals. Regardless of graduates' willingness to participate in the program, a transformation occurred. Transformation occurs through reflection, either challenging or confirming the graduate's pre-conceived ideas about career decisions and in turn influencing professional identity formation.
Collapse
Affiliation(s)
- Jessica Beattie
- School of Medicine, Deakin University, Rural Community Clinical School, PO Box 713, Colac, Vic, 3250, Australia.
| | - Marley Binder
- School of Medicine, Department of Rural Health, Deakin University Princess Hwy, Warrnambool, 3280, Australia
| | - Hannah Beks
- School of Medicine, Department of Rural Health, Deakin University Princess Hwy, Warrnambool, 3280, Australia
| | - Lara Fuller
- School of Medicine, Deakin University, Rural Community Clinical School, PO Box 713, Colac, Vic, 3250, Australia
| |
Collapse
|
3
|
Kirtchuk L, Markless S. Communities of practice: A theoretical framework for undergraduate longitudinal placements. CLINICAL TEACHER 2024; 21:e13692. [PMID: 37957816 DOI: 10.1111/tct.13692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND There has been a global shift towards longitudinal placements in undergraduate medicine, which are believed to play an important role in supporting medical student learning and professional identity formation. A better understanding of how learning occurs on such placements is needed, and community of practice (CoP), a social learning theory, has been proposed to form their pedagogical foundations. However, empirical research exploring learning through CoPs on longitudinal placements is limited. METHODS Case study methodology triangulating data from interviews, written reflections and routine evaluations was undertaken to explore how second-year students on an undergraduate longitudinal General Practice placement participated within CoPs and the factors enabling this participation. FINDINGS Routine evaluation data were available for 57% (n239) of students and in-depth interviews were carried out with five students and three tutors across eight placements. Themes identified through inductive thematic analysis were (i) participation within CoPs, (ii) enablers of legitimate peripheral participation and (iii) socialising agents. Student legitimate peripheral participation was greatly facilitated by making contributions to patient care, a welcoming clinical environment, access to the informal spaces and repertoires of the practice and effective brokerage of educational activities by tutors. DISCUSSION CoP is a theory that allows us to make tangible the somewhat abstract when deepening our understanding of how students learn on longitudinal placements. The extent to which students become legitimate peripheral participants varies, and this theoretical framework allows us to consider the factors that can enable such participation, with implications for how educators design curricula and placement infrastructure.
Collapse
Affiliation(s)
- Liza Kirtchuk
- King's Undergraduate Medical Education in the Community, Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Sharon Markless
- Centre for Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
4
|
Lönn A, Weurlander M, Seeberger A, Hult H, Thornberg R, Wernerson A. The impact of emotionally challenging situations on medical students' professional identity formation. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1557-1578. [PMID: 37184676 PMCID: PMC10184105 DOI: 10.1007/s10459-023-10229-8] [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: 09/10/2021] [Accepted: 04/09/2023] [Indexed: 05/16/2023]
Abstract
In their interactions with patients and health care professionals during work-based learning, medical students are known to experience emotionally challenging situations that can evoke negative feelings. Students have to manage these emotions. Students learn and develop their professional identity formation through interactions with patients and members of the healthcare teams. Earlier studies have highlighted the issues involved with processing emotionally challenging situations, although studies concerning learning and professional identity formation in response to these experiences are rare. In this study, we explored medical students' experiences of emotionally challenging situations in work-based learning, and the impact these experiences had on forming medical students' professional identities. We conducted an analysis of narrative data (n = 85), using a constructivist grounded theory approach. The narratives were made up of medical students' reflective essays at the end of their education (tenth term). The analysis showed that students' main concern when facing emotionally challenging situations during their work-based education was the struggle to achieve and maintain a professional approach. They reported different strategies for managing their feelings and how these strategies led to diverse consequences. In the process, students also described arriving at insights into their own personal needs and shortcomings. We consider this development of self-awareness and resulting self-knowledge to be an important part of the continuously ongoing socialization process of forming a professional identity. Thus, experiencing emotionally challenging situations can be considered a unique and invaluable opportunity, as well as a catalyst for students' development. We believe that highlighting the impact of emotions in medical education can constitute an important contribution to knowledge about the process of professional identity formation. This knowledge can enable faculty to provide students with more effective and sufficient support, facilitating their journey in becoming physicians.
Collapse
Affiliation(s)
- Annalena Lönn
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden.
| | - Maria Weurlander
- Department of Education, Stockholm University, Stockholm, Sweden
| | - Astrid Seeberger
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden
| | - Håkan Hult
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden
| | - Robert Thornberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Annika Wernerson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Alfred Nobels Allé 8, 141 52, Huddinge, Stockholm, Sweden
| |
Collapse
|
5
|
Brown MEL, Ahuja N, Sivam V, Khanna A, Parekh R. A qualitative evaluation of the impact of a medical student school outreach project on both medical students and school pupils. BMJ Open 2023; 13:e070508. [PMID: 37989372 PMCID: PMC10668267 DOI: 10.1136/bmjopen-2022-070508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 10/31/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE To explore medical student and school pupil experiences of an outreach school teaching project. SETTING Community engagement is increasingly commonplace within medical school. Secondary schools offer ample opportunities for community engagement as medical students teach and engage in service learning. There is a lack of research regarding the impact of school community engagement projects and the impact on pupils, as critical stakeholders in the service medical students provide. In this qualitative study, we explore the perspectives of medical students and school pupils involved in a school teaching project. PARTICIPANTS Ten medical students participated in individual interviews, and 17 school pupils across three schools participated in group interviews. Data were analysed using thematic analysis and the concept of service learning. RESULTS For medical students, the project fostered communication and teaching skills, but a lack of reflection hampered further benefit. For school pupils, experiences varied - learning about careers in medicine could be inspiring, but content pitched at the incorrect level disengaged some pupils. The conflict between session timing and medical students' exams negatively influenced engagement. CONCLUSIONS To shift the focus of community engagement projects that promote service-learning towards mutual benefit, designing in partnership with relevant community stakeholders and integrating opportunities to reflect on these experiences are critical.
Collapse
Affiliation(s)
- Megan E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- School of Medicine, Newcastle University, Newcastle, UK
| | - Neha Ahuja
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Vanessa Sivam
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Alisha Khanna
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
| |
Collapse
|
6
|
Brown MEL, Parekh R, Collin V, Sivam V, Ahuja N, Kumar S. Learning machines or the key to care: a qualitative study exploring the impact of the hidden curriculum on medical students' longitudinal experiences in primary care. BMJ Open 2023; 13:e074227. [PMID: 37730387 PMCID: PMC10514660 DOI: 10.1136/bmjopen-2023-074227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE Longitudinal learning often faces implementation challenges within UK medical schools. Some have suggested that the hidden curriculum may be implicated, but there is little evidence regarding how the hidden curriculum influences student experiences of, and engagement with longitudinal learning. Given this, our objective was to explore the impact of the hidden curriculum on student experiences of a longitudinal curriculum based in primary care at a research-intensive medical school. DESIGN We conducted a longitudinal qualitative study. Students participated in three serial, in-depth semistructured interviews. We conducted a longitudinal thematic analysis. SETTING One research-intensive medical school based in the UK. Data collection occurred in 2021-2022. PARTICIPANTS 12 penultimate year medical students taking part in a longitudinal primary care placement for 1 day a week over the course of one academic year. RESULTS We constructed four themes capturing insights on how hidden curricula influenced students' experiences: (1) A culture which stresses assessment influences student engagement with longitudinal learning; (2) Longitudinal relationships can challenge the hidden curriculum; (3) Support and continuity within primary care improves skills and can influence belonging and (4) Logistical issues influence engagement with longitudinal learning. CONCLUSIONS The hidden curriculum, particularly related to assessment, plays a large role in student perceptions of educational value and subsequent engagement with curricula. In a research-intensive institution, longitudinal learning, particularly within primary care, was perceived as at odds with what was important for assessments. Where longitudinal relationships were successfully established, students became more aware of the benefits of person-centred practice. For primary care longitudinal education to succeed in more research-intensive institutions, there must first be advocacy for greater representation of primary care and person-centred values within organisational structures to ensure meaningful curricular alignment.
Collapse
Affiliation(s)
- Megan E L Brown
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Ravi Parekh
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Victoria Collin
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Vanessa Sivam
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Neha Ahuja
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | | |
Collapse
|
7
|
Lin S, Zimmerman E, Datta S, Selby M, Chan T, Fant A. Curated collections for educators: Nine key articles and article series for teaching qualitative research methods. AEM EDUCATION AND TRAINING 2023; 7:e10862. [PMID: 37013134 PMCID: PMC10066497 DOI: 10.1002/aet2.10862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/23/2023] [Indexed: 06/19/2023]
Abstract
Background Qualitative research explains observations, focusing on how and why phenomena and experiences occur. Qualitative methods go beyond quantitative data and provide critical information inaccessible through quantitative methods. However, at all levels of medical education, there is insufficient exposure to qualitative research. As a result, residents and fellows complete training ill-equipped to appraise and conduct qualitative studies. As a first step to increasing education in qualitative methods, we sought to create a curated collection of papers for faculty to use in teaching qualitative research at the graduate medical education (GME) level. Methods We conducted literature searches on the topic of teaching qualitative research to residents and fellows and queried virtual medical education and qualitative research communities for relevant articles. We searched the reference lists of all articles found through the literature searches and online queries for additional articles. We then conducted a three-round modified Delphi process to select papers most relevant to faculty teaching qualitative research. Results We found no articles describing qualitative research curricula at the GME level. We identified 74 articles on the topic of qualitative research methods. The modified Delphi process identified the top nine articles or article series most relevant for faculty teaching qualitative research. Several articles explain qualitative methods in the context of medical education, clinical care, or emergency care research. Two articles describe standards of high-quality qualitative studies, and one article discusses how to conduct the individual qualitative interview to collect data for a qualitative study. Conclusions While we identified no articles reporting already existing qualitative research curricula for residents and fellows, we were able to create a collection of papers on qualitative research relevant to faculty seeking to teach qualitative methods. These papers describe key qualitative research concepts important in instructing trainees as they appraise and begin to develop their own qualitative studies.
Collapse
Affiliation(s)
- Sophia Lin
- Department of Emergency MedicineWeill Cornell MedicineNew YorkNew YorkUSA
| | - Elise Zimmerman
- Division of Emergency Medicine, Department of PediatricsUniversity of California at San DiegoSan DiegoCaliforniaUSA
| | - Suchismita Datta
- Department of Emergency MedicineNew York University Long Island School of MedicineMineolaNew YorkUSA
| | - Maurice Selby
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Teresa Chan
- Division of Emergency Medicine, Division of Education and Innovation, Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Abra Fant
- Department of Emergency MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| |
Collapse
|
8
|
George RE, Brown MEL. Understanding integrated care through patient journeys. CLINICAL TEACHER 2023:e13561. [PMID: 36717203 DOI: 10.1111/tct.13561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Riya E George
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Megan E L Brown
- University of Buckingham & Research Fellow at Medical Education Innovation and Research Centre, Imperial College London, London, UK
| |
Collapse
|