The patient panel conference experience: what patients can teach our residents about competency issues

A modified Delphi approach to nurturing professionalism in postgraduate medical education in Singapore

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.

Practical tips for moving your patient panel online

Patient panels are an inspiring, highly rated educational tool to complement course goals and objectives for students in medical education programs. The COVID-19 pandemic brought challenges on the ability to successfully host in-person patient panels. These challenges resulted in the need to pivot in-person patient panels to online platforms, while still ensuring the quality and intimacy of patient narratives. In this 12 tips article, we share lessons learned in transitioning patient panels in our health systems science curriculum to an online experience for students enrolled in a pre-clinical medical education program.

Patient references in the 2005 and 2015 CanMEDS frameworks

Background

Patient involvement in postgraduate medical education (PGME) can help residents improve their communication, professionalism, and collaboration. The CanMEDS Framework defines such competencies for physicians and informs teaching and assessment activities in PGME. However, it is unclear how patients are referenced in the CanMEDS Framework and if these references encourage the active involvement of patients in PGME. To inform how patients are referenced in the revisions of the CanMEDS Framework, scheduled for publication in 2025, our aim was to determine how patients are referenced in each the 2005 and 2015 CanMEDS Frameworks.

Methods

We used document analysis to examine how the term 'patient(s)' is referenced in the 2005 and 2015 CanMEDS Frameworks.

Results

Several 2005 and 2015 CanMEDS Roles include patients in the descriptions but do not reference them in the competencies. Others do not reference patients in the descriptions or competencies, potentially detracting from the importance of involving patients. As it stands, the 2015 Health Advocate is the only Role that describes and references patients working with physicians as partners in care, facilitating potential opportunities for patient involvement in PGME.

Conclusion

There are inconsistencies in how patients are described and referenced as potential partners in PGME throughout past and present CanMEDS Frameworks. Understanding these inconsistencies can inform the revision of CanMEDS that is scheduled for publication in 2025.

An assessment of patient experiences as teachers of cultural sensitivity in an interprofessional setting

BACKGROUND AND PURPOSE

The importance of cultural sensitivity training in pharmacy education is well-recognized, though best practices are not well described. Traditional teaching approaches such as faculty lectures may result in overgeneralization, lack of nuance, or tokenization. Utilizing patients from diverse special populations as teachers of cultural sensitivity may mitigate these risks. However, faculty must ensure patients feel comfortable, empowered, valuable, and prepared to serve as partners in education.

EDUCATIONAL ACTIVITY AND SETTING

Patients were used as teachers of cultural sensitivity in an interprofessional education panel activity at two colleges of pharmacy over two years. Patient experiences with training and preparation for the activity as well as their perceived benefits of partnering in student education were assessed.

FINDINGS

Overall, patients reported that training was adequate, and the educational activity provided a sufficient platform for sharing their knowledge with students. Patients felt they provided meaningful contributions to student education, learned valuable information in the process, and formed sincere relationships with each other and faculty.

SUMMARY

Faculty at other institutions may wish to adapt this activity to meet the needs of their own institution and empower patients to contribute to the education of health professions students. Practical recommendations are provided for promoting a positive patient experience. A comprehensive training program prepared and empowered patients to teach cultural sensitivity principles to an interprofessional group of health care students.

The Involvement of Adolescents With Chronic Health Conditions in Medical Education: An Exploratory Qualitative Study

OBJECTIVES

In this study, we explored the involvement of adolescents with chronic health conditions in medical education. We focused specifically on adolescents' desired level of involvement in the education of medical students and residents, strategies for involving them in it, and topics on which they would feel comfortable educating these learners.

METHODS

We used a community-based participatory research approach and qualitative one-on-one semistructured interviews. Adolescents (ages 13-18) with chronic health conditions lasting >3 months who were admitted on inpatient wards and were well enough to participate in an interview were eligible. Two investigators analyzed the interview transcripts to identify common categories across the interview data.

RESULTS

A total of 17 adolescents participated. Data analysis revealed that adolescents want to be regularly involved in medical education, compensated in some way for their time and effort, and receive support and oversight in their activities. Adolescents discussed the following 5 strategies for involving them in the education of medical students and residents: face-to-face presentations, shadowing and mentoring, videos, handouts and books, and assessment feedback. Adolescents want to educate learners on their experiences and coping strategies as well as on how to interact and develop rapport with adolescents.

CONCLUSIONS

The adolescents with chronic health conditions who participated in this study want to be actively involved in medical education and can provide innovative insights and strategies for doing so. However, future researchers need to explore the benefits and limitations of such involvement.

A Qualitative Study of Independent Home Visits by Hospice Fellows: Addressing Gaps in ACGME Milestones by Fostering Reflection and Self-Assessment

BACKGROUND

With the rapid growth in the number of fellowship programs in Hospice and Palliative Medicine (HPM), many are in the process of developing ways to demonstrate that fellows are attaining educational milestones. Reflection and self-assessment are key components of 2 Accreditation Council for Graduate Medical Education (ACGME) competencies, practice-based learning and improvement, and systems-based practice, which have both been historically challenging to learn and assess.

OBJECTIVE

This article describes results of a content analysis of narrative data collected from HPM fellows' self-assessments as they performed hospice home visits independently in a new clinical rotation.

DESIGN

This was a prospective qualitative study.

SETTINGS/PARTICIPANTS

Eight fellows completed 217 unsupervised hospice home visits from 2014 to 2016.

MEASUREMENTS

Fellows completed weekly self-assessment forms, which captured both clinical visit information and practice data elicited from responses to open-ended reflection prompts.

RESULTS

Analysis of 29 self-assessment forms generated 6 themes: patient- and family-centered care, self-efficacy, systems-based care, commitment to doing their best, catalyst for professional growth, and purpose and meaning in work. The fellows recognized numerous barriers distinct to providing care in homes. All fellows felt prepared to perform home visits throughout the rotation and after training.

CONCLUSIONS

Narrative data collected during the independent home visit rotation provided evidence that HPM fellows detected gaps in their performance, planned for practice improvements in subsequent visits, and valued working within an interprofessional team. Built-in opportunities for fellows to reflect during training are critical in meeting ACGME milestones, and are integral to their professional development.

Assessing systems-based practice

The conceptual definition of systems-based practice (SBP) does not easily translate into directly observable actions or behaviors that can be easily assessed. At the Academic Emergency Medicine consensus conference on education research in emergency medicine (EM), a breakout group presented a review of the literature on existing assessment tools for SBP, discussed the recommendations for research tool development during breakout sessions, and developed a research agenda based on this discussion.

Systems-based practice in graduate medical education: systems thinking as the missing foundational construct

BACKGROUND

Since 2001, residencies have struggled with teaching and assessing systems-based practice (SBP). One major obstacle may be that the competency alone is not sufficient to support assessment. We believe the foundational construct underlying SBP is systems thinking, absent from the current Accreditation Council for Graduate Medical Education competency language.

SUMMARY

Systems thinking is defined as the ability to analyze systems as a whole. The purpose of this article is to describe psychometric issues that constrain assessment of SBP and elucidate the role of systems thinking in teaching and assessing SBP.

CONCLUSION

Residency programs should incorporate systems thinking models into their curricula. Trainees should be taught to understand systems at an abstract level, in order to analyze their own healthcare systems, and participate in quality and patient safety activities. We suggest that a developmental trajectory for systems thinking be developed, similar to the model described by Dreyfus and Dreyfus.

Students learn systems-based care and facilitate system change as stakeholders in a free clinic experience

Systems-based practice (SBP) is rarely taught or evaluated during medical school, yet is one of the required competencies once students enter residency. We believe Texas A&M College of Medicine students learn about systems issues informally, as they care for patients at a free clinic in Temple, TX. The mandatory free clinic rotation is part of the Internal Medicine clerkship and does not include formal instruction in SBP. During 2008-2009, a sample of students (n = 31) on the IMED clerkship's free clinic rotation participated in a program evaluation/study regarding their experiences. Focus groups (M = 5 students/group) were held at the end of each outpatient rotation. Students were asked: "Are you aware of any system issues which can affect either the delivery of or access to care at the free clinic?" Data saturation was reached after six focus groups, when investigators noted a repetition of responses. Based upon investigator consensus opinion, data collection was discontinued. Based upon a content analysis, six themes were identified: access to specialists, including OB-GYN, was limited; cost containment; lack of resources affects delivery of care; delays in care due to lack of insurance; understanding of larger healthcare system and free clinic role; and delays in tests due to language barriers. Medical students were able to learn about SBP issues during free clinic rotations. Students experienced how SBP issues affected the health care of uninsured individuals. We believe these findings may be transferable to medical schools with mandatory free clinic rotations.