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Salajegheh M, Sandars J, Mirzazadeh A, Gandomkar R. Understanding the capacity development of faculty development programs: a sequential explanatory mixed methods study. BMC MEDICAL EDUCATION 2024; 24:744. [PMID: 38987781 PMCID: PMC11234744 DOI: 10.1186/s12909-024-05715-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Faculty development programs can bring about both individual and organizational capacity development by enhancing individuals' attitudes, values, and skillsto enable them to implement organizational change. Understanding how faculty development programs produce capacity development, and the influencing factors, requires further understanding. This study aimed to explore the perceptions of the participants of a faculty development program about the capacity development features of the program and the influencing factors. METHODS A sequential explanatory mixed methods design was used. Faculty members were surveyed about their perspectives on capacity development of faculty development. Subsequently, 22 interviews were conducted with the respondents to deepem understanding of the survey results. Interview transcripts underwent conventional content analysis. RESULTS A total of 203 completed the questionnaire. Most of the faculty highly agreed that the faculty development programs had produced capacity development. The combined data identified (a) "quality of faculty development programs", underscoring the significance of robust and comprehensive initiatives, (b) "development in instruction", emphasizing the importance of continuous improvement in pedagogical approaches (c) "development in professionalism", highlighting the necessity for cultivating a culture of professionalism among faculty members, (d) "development in attitude towards education", emphasizing the role of mindset in fostering effective teaching practices, and (e) "supporting faculty development programs", with fostering organizational growth and innovation. Important barriers and facilitators of the capacity development process included several organizational, interpersonal, and individual factors. CONCLUSION The study identified specific features of the capacity development process in the context of a faculty development program and highlighted the importance of these programs in producing changes in both individuals and within the wider organizational system. Several factors that enabled and constrained the capacity development process were also identified. The findings of the study can inform future implementation of faculty development programs for capacity development.
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Affiliation(s)
- Mahla Salajegheh
- Department of Medical Education, Medical Education Development Center, Kerman University of Medical Sciences, Kerman, Iran
| | - John Sandars
- Edge Hill University Medical School, Ormskirk, UK
| | - Azim Mirzazadeh
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Roghayeh Gandomkar
- Health Professions Education Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, No. 57, Hojatdoust St., Keshavarz Blvd, Tehran, 1416633591, Iran.
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Mawdsley A, Magola-Makina E, Willis SC. Towards addressing the awarding gap-Using critical race theory to contextualise the role of intersectionality in Black pharmacy student attainment. MEDICAL EDUCATION 2024. [PMID: 38938192 DOI: 10.1111/medu.15460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 05/01/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION The awarding gap between White and Black students in UK health curricula is well established. Critical race theory (CRT) is a lens to deconstruct pedagogic practice and consider the intersectionality of Black student lived experience to provide a realist critique of the phenomenon of Whiteness in higher education and the impact this has on Black attainment. Using one UK pharmacy programme as a case study, this paper aims to explore Black lived experience as a means of problematising and disrupting structural oppressions. METHODS Sixteen Black students from one UK pharmacy degree programme were purposively recruited to the study. Love and breakup letter methodology (LBM) was used to facilitate sharing experiences of intersectionality in relation to their undergraduate education, with data thematically analysed through the lens of CRT. RESULTS Two meta-themes (identity and inclusion; and cultural capital) and four subthemes (social capital; access; family expectations; and help-seeking) were identified. The intersectionality of Black students was articulated as not possessing the social capital and the 'language' to succeed within the White structures of the curriculum. The conflict of capital and the absence of Black culture gave rise to confined help-seeking behaviours. Whilst Black students experienced equality of access to the curriculum, an absence of rights to legitimate involvement (inclusion) worked to diminish participation in the curriculum. DISCUSSION This is the first study to consider the intersectionality of Black pharmacy students in relation to academic awarding gaps and has found that oppressive educational structures marginalise and other Black experience. Black students experience the curriculum as a place where their social and cultural capital is undervalued, and as a White space where they lack the artefacts to succeed, leading to peripheral participation and detachment. The approach used in this study can be adopted across medical and health education as a means to problematise racial inequality through the exemplar of White:Black awarding gaps.
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Affiliation(s)
- Andrew Mawdsley
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | | | - Sarah C Willis
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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Johnston M, O'Mahony M, O'Brien N, Connolly M, Iohom G, Kamal M, Shehata A, Shorten G. The feasibility and usability of mixed reality teaching in a hospital setting based on self-reported perceptions of medical students. BMC MEDICAL EDUCATION 2024; 24:701. [PMID: 38937764 PMCID: PMC11212163 DOI: 10.1186/s12909-024-05591-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: 07/18/2023] [Accepted: 05/22/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Clinical teaching during encounters with real patients lies at the heart of medical education. Mixed reality (MR) using a Microsoft HoloLens 2 (HL2) offers the potential to address several challenges: including enabling remote learning; decreasing infection control risks; facilitating greater access to medical specialties; and enhancing learning by vertical integration of basic principles to clinical application. We aimed to assess the feasibility and usability of MR using the HL2 for teaching in a busy, tertiary referral university hospital. METHODS This prospective observational study examined the use of the HL2 to facilitate a live two-way broadcast of a clinician-patient encounter, to remotely situated third and fourth year medical students. System Usability Scale (SUS) Scores were elicited from participating medical students, clinician, and technician. Feedback was also elicited from participating patients. A modified Evaluation of Technology-Enhanced Learning Materials: Learner Perceptions Questionnaire (mETELM) was completed by medical students and patients. RESULTS This was a mixed methods prospective, observational study, undertaken in the Day of Surgery Assessment Unit. Forty-seven medical students participated. The mean SUS score for medical students was 71.4 (SD 15.4), clinician (SUS = 75) and technician (SUS = 70) indicating good usability. The mETELM Questionnaire using a 7-point Likert Scale demonstrated MR was perceived to be more beneficial than a PowerPoint presentation (Median = 7, Range 6-7). Opinion amongst the student cohort was divided as to whether the MR tutorial was as beneficial for learning as a live patient encounter would have been (Median = 5, Range 3-6). Students were positive about the prospect of incorporating of MR in future tutorials (Median = 7, Range 5-7). The patients' mETELM results indicate the HL2 did not affect communication with the clinician (Median = 7, Range 7-7). The MR tutorial was preferred to a format based on small group teaching at the bedside (Median = 6, Range 4-7). CONCLUSIONS Our study findings indicate that MR teaching using the HL2 demonstrates good usability characteristics for providing education to medical students at least in a clinical setting and under conditions similar to those of our study. Also, it is feasible to deliver to remotely located students, although certain practical constraints apply including Wi-Fi and audio quality.
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Affiliation(s)
- Michael Johnston
- Peripheral Nerve Block Fellow, Cork University Hospital, Cork, Ireland.
| | | | - Niall O'Brien
- Department of Anaesthesia, University College Cork, Cork, Ireland
| | - Murray Connolly
- Coombe Women's and Infants University Hospital, Dublin, Ireland
| | - Gabriella Iohom
- Anaesthesiologist Cork University Hospital, University College Cork, Cork, Ireland
| | - Mohsin Kamal
- Peripheral Nerve Block Fellow, Cork University Hospital, Cork, Ireland
| | - Ahmed Shehata
- Peripheral Nerve Block Fellow, Cork University Hospital, Cork, Ireland
| | - George Shorten
- Anaesthesiologist Cork University Hospital, University College Cork, Cork, Ireland
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Iyizoba-Ebozue Z, Fatimilehin A, Kayani M, Khan A, McMahon M, Stewart S, Croney C, Sritharan K, Khan M, Obeid M, Igwebike O, Batool R, A-Hakim R, Aghadiuno T, Ruparel V, O'Reilly K. Unveiling Disparities: Exploring Differential Attainment in Postgraduate Training Within Clinical Oncology. Clin Oncol (R Coll Radiol) 2024; 36:e119-e127. [PMID: 38582627 DOI: 10.1016/j.clon.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/06/2024] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
AIMS Differential attainment (DA) in post graduate medical training is a recognised challenge and refers to unexplained variation across groups when split by several protected characteristics. The Royal College of Radiology is committed to fostering diversity, inclusivity, and equality with the goal of narrowing existing gaps and improving training outcomes. MATERIALS AND METHODS This was a mixed methods study aiming to understand the causes of DA with view to helping the RCR develop strategies to address this. A cross-sectional survey was completed by 140 clinical oncology trainees in September 2022. Trainees and trainers (17 and 6 respectively) from across England, Scotland, Wales and Northern Ireland, took part in focus group and interviews from August to December 2022. Quantitative and qualitative data merged and interpreted. RESULT Results showed international medical graduates and trainees from ethnic minority backgrounds were more likely to encounter challenges. The qualitative findings were used to identify three themes through which these problems could be framed. The trainee as a "space invader," the hidden curriculum of clinical oncology training and the process of navigating and tacking the training journey. CONCLUSION Differential attainment is the product of a complex interplay between the trainee, trainer, and the training environment. Therefore, interventions must be tailored to different people and contexts. At a national level, the RCR can adopt general policies to promote this such as mentorship programmes, protected time for supervision and cultural competency training. Efficacy of proposed interventions for trial and their impact on DA should be evaluated to drive evidence-based changes.
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Affiliation(s)
- Z Iyizoba-Ebozue
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK.
| | - A Fatimilehin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - M Kayani
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - A Khan
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - M McMahon
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - S Stewart
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - C Croney
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - K Sritharan
- Department of Clinical Oncology, University College London Hospital, London, UK
| | - M Khan
- Department of Clinical Oncology, Northern Ireland Cancer Centre, Northern Ireland, UK
| | - M Obeid
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - O Igwebike
- Department of Clinical Oncology, Western Park Cancer Centre, Sheffield, UK
| | - R Batool
- Department of Clinical Oncology, The University Hospital Coventry, West midlands, UK
| | - R A-Hakim
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - T Aghadiuno
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, Wales, UK
| | - V Ruparel
- Department of Clinical Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland UK
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Dijk SW, Findyartini A, Cantillon P, Cilliers F, Caramori U, O'Sullivan P, Leslie KM. Developing a programmatic approach to faculty development and scholarship using the ASPIRE criteria: AMEE Guide No. 165. MEDICAL TEACHER 2024; 46:732-745. [PMID: 37783204 DOI: 10.1080/0142159x.2023.2259062] [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: 10/04/2023]
Abstract
Faculty Development (FD) has become essential in shaping design, delivery and quality assurance of health professions education. The growth of FD worldwide has led to a heightened expectation for quality and organizational integrity in the delivery of FD programmes. To address this, AMEE, An International Association for Health Professions Education, developed quality standards for FD through the development of the AMEE ASPIRE to Excellence criteria. This guide uses the ASPIRE criteria as a framework for health professions educators who wish to establish or expand approaches to FD delivery and scholarship within their institutions.
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Affiliation(s)
- Stijntje W Dijk
- Department of Epidemiology, Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Peter Cantillon
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Francois Cilliers
- Centre for Teaching and Learning, Stellenbosch University, Stellenbosch, South Africa
| | - Ugo Caramori
- School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Patricia O'Sullivan
- Office of Medical Education and Departments of Medicine and Surgery, University of California, San Francisco, CA, USA
| | - Karen M Leslie
- Department of Paediatrics, University of Toronto, Toronto, Canada
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Erschens R, Skrypski I, Festl-Wietek T, Herrmann-Werner A, Adam SH, Schröpel C, Nikendei C, Zipfel S, Junne F. Insights into discrepancies in professional identities and role models in undergraduate medical education in the context of affective burden. Front Psychiatry 2024; 15:1358173. [PMID: 38757136 PMCID: PMC11097199 DOI: 10.3389/fpsyt.2024.1358173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/22/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction International evidence strongly suggests that medical students are at high risk of mental health problems. This distress, which can be mediated by a variety of individual, interpersonal and contextual factors within the curriculum, can be mitigated by effective coping strategies and interventions. Central to this discourse is the recognition that the challenges of professional identity formation can contribute significantly to medical students' distress. The focus of our study is therefore to examine discrepancies in professional identities and role models in undergraduate medical education in relation to affective burden. Methods Medical students at different stages of university education and high school graduates intending to study medicine were surveyed in a cross-sectional study. The study employed Osgood and Hofstätter's polarity profile to evaluate the self-image of participants, the image of an ideal and real physician, and their correlation with depression (PHQ-9) and anxiety (GAD-7). Results Out of the 1535 students recruited, 1169 (76.2%) participated in the study. Students rated their self-image as somewhere between a more critical real image of physicians and a more positive ideal image. Medical students at all training levels consistently rated the ideal image as remaining constant. Significant correlations were found between the professional role models of medical students and affective symptoms, particularly for the discrepancy between the ideal image of a physician and their self-image. Furthermore, 17% and nearly 15% reported significant symptoms of depression and anxiety, respectively. Discussion Our study adds to the growing body of knowledge on professional identity formation in medicine and socialisation in the medical environment. The study highlights the importance of discrepancies between self-image and ideal image in the experience of depressive and anxiety symptoms. Primary prevention-oriented approaches should incorporate these findings to promote reflective competence in relation to professional role models and strengthen the resilience of upcoming physicians in medical training.
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Affiliation(s)
- Rebecca Erschens
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Isabelle Skrypski
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education, University of Tübingen, Tübingen, Germany
| | - Anne Herrmann-Werner
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Tübingen Institute for Medical Education, University of Tübingen, Tübingen, Germany
| | - Sophia Helen Adam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Carla Schröpel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
| | - Christoph Nikendei
- Department for General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Deanery of Students’ Affairs, University’s Faculty of Medicine, Tuebingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, University of Tübingen, Tübingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Otto von Guericke University Magdeburg, University Hospital Magdeburg, Magdeburg, Germany
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van Schalkwyk S, Blitz J. Curriculum renewal towards critically conscious graduates: Implications for faculty development. MEDICAL EDUCATION 2024; 58:299-307. [PMID: 37699795 DOI: 10.1111/medu.15216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/24/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Globally, faculty development initiatives in support of health professions (HP) educators continue to extend their remit. This work becomes more critical as HP curriculum renewal activities are influenced by needing to move beyond a biomedical focus attending to issues such as social accountability, social justice and health equity. This raises questions about how best to support our HP educators who may need to change their teaching practice as they embrace these more complex, social constructs. METHODS The research question for this qualitative study was: What implications are there for faculty development that can support HP educators as they are expected to incorporate the principles of critical consciousness and social accountability into their teaching as part of a curriculum renewal process? Data from 11 focus group discussions and 11 subsequent individual interviews with HP educators from two undergraduate programmes were thematically analysed after which further analysis focussed on the implications of these findings for faculty development. Transformative learning theory and models about change provided a sensitising framework. RESULTS Our findings pointed to an expanded role for HP educators and consequently also for those responsible for faculty development. Three main ideas were highlighted: Curriculum renewal catalyses a renewed need for faculty development, the nature of faculty development that can enable change and new foci for faculty development. CONCLUSIONS Faculty development can make a significant contribution to enabling change, including in the context of curriculum renewal that often extends the roles and responsibilities of HP educators. When renewal seeks to shift fundamental curriculum principles, providing support to embrace this expanded remit results in an equally expanded remit for faculty developers-one that calls for initiatives that enable critical, dialogic encounters that might foster critical consciousness, leading to change in HP education. This challenges us, as faculty developers, to turn the mirror on ourselves to consider the nature of such expanded support.
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Affiliation(s)
- Susan van Schalkwyk
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Julia Blitz
- Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Vaid U, Lundgren H, Watkins KE, Ziring D, Alcid GA, Marsick VJ, Papanagnou D. Making decisions "in the dark": Learning through uncertainty in clinical practice during Covid-19. AEM EDUCATION AND TRAINING 2023; 7:e10909. [PMID: 37791137 PMCID: PMC10543116 DOI: 10.1002/aet2.10909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 10/05/2023]
Abstract
Purpose The purpose of this study was to explore how decision making and informal and incidental learning (IIL) emerged in the clinical learning environment (CLE) during the height of the Covid-19 pandemic. The authors' specific interest was to better understand the IIL that took place among frontline physicians who had to navigate a CLE replete with uncertainty and complexity with the future goal of creating experiences for medical students that would simulate IIL and use uncertainty as a catalyst for learning. Method Using a modified constructivist, grounded theory approach, we describe physicians' IIL while working during times of heightened uncertainty. Using the critical incident technique, we conducted 45-min virtual interviews with seven emergency department (ED) and five intensive care unit (ICU) physicians, who worked during the height of the pandemic. The authors transcribed and restoried each interview before applying inductive, comparative analysis to identify patterns, assertions, and organizing themes. Results Findings showed that the burden of decision making for physicians was influenced by the physical, emotional, relational, and situational context of the CLE. The themes that emerged for decision making and IIL were interdependent. Prominent among the patterns for decision making were ways to simplify the problem by applying prior knowledge, using pattern recognition, and cross-checking with team members. Patterns for IIL emerged through trial and error, which included thoughtful experimentation, consulting alternative sources of information, accumulating knowledge, and "poking at the periphery" of clinical practice. Conclusions Complexity and uncertainty are rife in clinical practice and this study made visible decision-making patterns and IIL approaches that can be built into formal curricula. Making implicit uncertainty explicit by recognizing it, naming it, and practicing navigating it may better prepare learners for the uncertainty posed by the clinical practice environment.
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Affiliation(s)
- Urvashi Vaid
- Division of Pulmonary and Critical Care MedicineSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Henriette Lundgren
- Human Resource Development, Department of Organization and LeadershipTeachers College at Columbia UniversityNew YorkNew YorkUSA
| | - Karen E. Watkins
- Department of Lifelong Education, Administration, and PolicyUniversity of GeorgiaAthensGeorgiaUSA
| | - Deborah Ziring
- Department of MedicineSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Grace A. Alcid
- Adult Learning and Leadership Program, Department of Organization and LeadershipTeachers College at Columbia UniversityNew YorkNew YorkUSA
| | - Victoria J. Marsick
- Department of Organization and LeadershipTeachers College at Columbia UniversityNew YorkNew YorkUSA
| | - Dimitrios Papanagnou
- Department of Emergency MedicineSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
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Sick B, Radosevich DM, Pittenger AL, Brandt B. Development and validation of a tool to assess the readiness of a clinical teaching site for interprofessional education (InSITE). J Interprof Care 2023; 37:S105-S115. [PMID: 30739518 DOI: 10.1080/13561820.2019.1569600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 12/02/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
Interprofessional education within clinical teaching sites is a key part of training for pre-professional students. However, the necessary characteristics of these interprofessional clinical teaching sites is unclear. We developed a tool, the Interprofessional Education Site Readiness, or InSITE, tool, for individuals at a site to use as a self-assessment of the site's current readiness for providing interprofessional education. The tool progressed through six stages of development, collecting evidence for validity and reliability, resulting in a final tool with 23 questions distributed across five domains. Data from 94 respondents from a variety of national sites were used for the item analysis showing acceptable item-to-total correlations. Internal reliability testing gave a Cronbach's coefficient alpha of more than 0.70 for each group level comparison. Known groups validity testing provides strong evidence for its responsiveness in detecting differences in sites where IPE is implemented. The results of the testing lead us to conclude that the InSITE tool has acceptable psychometric properties. Additionally, we discovered that the process in which the InSITE tool was used demonstrated that it can facilitate learning in practice for the health professionals and can help make implicit, informal workplace learning and the hidden curriculum explicit.
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Affiliation(s)
- Brian Sick
- Internal Medicine, University of Minnesota, Minneapolis, USA
| | - David M Radosevich
- Epidemiology and Biostatistics, University of Minnesota, Minneapolis, USA
| | - Amy L Pittenger
- Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, USA
| | - Barbara Brandt
- National Center for Interprofessional Practice and Education, University of Minnesota, Minneapolis, USA
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Lee CA, Wilkinson TJ, Timmermans JA, Ali AN, Anakin MG. Revealing the impact of the hidden curriculum on faculty teaching: A qualitative study. MEDICAL EDUCATION 2023; 57:761-769. [PMID: 36740234 DOI: 10.1111/medu.15026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION In health professions education, faculty may feel frustrated or challenged by aspects of their teaching. The concept of a hidden curriculum for students describes the expectations and assumptions enacted in educational programmes that tacitly impact students' learning experiences. A hidden curriculum has been suggested as a possible influence on faculty but has not been well explored. The aim of this study was to explain how a hidden curriculum might operate for faculty in health professions education. METHODS An interpretivist perspective was used to frame this qualitative study that examined one-on-one interview data generated with 16 faculty members from six different health care professions. Participants were asked to describe teaching experiences that they perceived as demanding. Using a hidden curriculum framework, descriptions of demanding teaching experiences were analysed inductively to identify relationships between a teacher's intended practice and what they could accomplish. These relationships were interpreted as the possible ways that a hidden curriculum was operating for faculty. RESULTS A hidden curriculum for faculty was found to operate in three ways by undervaluing the importance of having teaching expertise, undermining teaching goals through institutional conventions and perpetuating feelings of isolation. DISCUSSION A hidden curriculum for faculty can be represented as multiple overlapping domains and shape how faculty experience their teaching roles. The results provide examples that reveal how a hidden curriculum may operate for faculty. Faculty developers may find the insights provided by this study useful to make the hidden curriculum visible and help their faculty make sense of and navigate demanding teaching experiences.
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Affiliation(s)
- Ciara Ann Lee
- Department of General Practice and Rural Health at the Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | | | | | | | - Megan Grayce Anakin
- Education Unit at the Dunedin School of Medicine at the University of Otago, Dunedin, New Zealand
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Wang SXY, Chi K, Shankar M, Israni ST, Verghese A, Zulman DM. Teaching Anti-Racism in the Clinical Environment: The Five-Minute Moment for Racial Justice in Healthcare. Am J Med 2023; 136:345-349. [PMID: 36566895 DOI: 10.1016/j.amjmed.2022.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Dismantling racism in health care demands that medical education promote racial justice throughout all stages of medical training. However, racial bias can be fostered unintentionally, influencing the way we make decisions as clinicians with downstream effects on patient health and health equity. The development of any anti-racism curriculum in medicine requires the ability to identify racial bias in practices we have not previously recognized as explicitly racist or unjust. This has limited the creation and delivery of effective anti-racism education in health care.
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Affiliation(s)
| | - Kevin Chi
- Department of Pediatrics, Stanford University, Calif
| | - Megha Shankar
- Division of General Internal Medicine, University of California San Diego
| | | | | | - Donna M Zulman
- Division of Primary Care and Population Health, Stanford University School of Medicine, Calif
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Loosveld LM, Driessen EW, Vanassche E, Artino AR, Van Gerven PWM. Mentoring is in the 'I' of the beholder: supporting mentors in reflecting on their actual and preferred way of mentoring. BMC MEDICAL EDUCATION 2022; 22:638. [PMID: 35999559 PMCID: PMC9396759 DOI: 10.1186/s12909-022-03690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND An important strategy to support the professional development of mentors in health professions education is to encourage critical reflection on what they do, why they do it, and how they do it. Not only the 'how' of mentoring should be covered, but also the implicit knowledge and beliefs fundamental to the mentoring practice (a mentor's personal interpretative framework). This study analyzed the extent to which mentors perceive a difference between how they actually mentor and how they prefer to mentor. METHODS The MERIT (MEntor Reflection InstrumenT) survey (distributed in 2020, N = 228), was used to ask mentors about the how, what, and why of their mentoring in two response modes: (1) regarding their actual mentoring practice and (2) regarding their preferred mentoring practice. With an analysis of covariance, it was explored whether potential discrepancies between these responses were influenced by experience, profession of the mentor, and curriculum-bound assessment requirements. RESULTS The averaged total MERIT score and averaged scores for the subscales 'Supporting Personal Development' and 'Monitoring Performance' were significantly higher for preferred than for actual mentoring. In addition, mentors' experience interacted significantly with these scores, such that the difference between actual and preferred scores became smaller with more years of experience. CONCLUSIONS Mentors can reflect on their actual and preferred approach to mentoring. This analysis and the potential discrepancy between actual and preferred mentoring can serve as input for individual professional development trajectories.
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Affiliation(s)
- Lianne M Loosveld
- School of Health Professions Education, Department of Educational Development & Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands.
| | - Erik W Driessen
- School of Health Professions Education, Department of Educational Development & Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands
| | - Eline Vanassche
- Faculty of Psychology and Educational Sciences, University of Leuven, Campus Kulak, Etienne Sabbelaan 51, P.O. Box 7654, 8500, Kortrijk, Belgium
| | - Anthony R Artino
- Department of Health, Human Function, and Rehabilitation Sciences, School of Medicine and Health Sciences, The George Washington University, 2600 Virginia Avenue NW, Suite 104, Washington, DC, USA
| | - Pascal W M Van Gerven
- School of Health Professions Education, Department of Educational Development & Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands
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13
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Papanagnou D, Watkins KE, Lundgren H, Alcid GA, Ziring D, Marsick VJ. Informal and Incidental Learning in the Clinical Learning Environment: Learning Through Complexity and Uncertainty During COVID-19. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1137-1143. [PMID: 35476789 PMCID: PMC9311294 DOI: 10.1097/acm.0000000000004717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the time of the COVID-19 pandemic, where clinical environments are plagued by both uncertainty and complexity, the importance of the informal and social aspects of learning among health care teams cannot be exaggerated. While there have been attempts to better understand the nuances of informal learning in the clinical environment through descriptions of the tacit or hidden curriculum, incidental learning in medical education has only been partially captured in the research. Understood through concepts borrowed from the Cynefin conceptual framework for sensemaking, the early stages of the pandemic immersed clinical teams in complex and chaotic situations where there was no immediately apparent relationship between cause and effect. Health care teams had to act quickly amidst the chaos: they had to first act, make sense of, and respond with intentionality. Informal and incidental learning (IIL) emerged as a byproduct of acting with the tools and knowledge available in the moment. To integrate the informal, sometimes haphazard nature of emergence among health care teams, educators require an understanding of IIL. This understanding can help medical educators prepare health professions learners for the cognitive dissonance that accompanies uncertainty in clinical practice. The authors introduce IIL as an explanatory framework to describe how teams navigate complexity in the clinical learning environment and to better inform curricular development for health professions training that prepares learners for uncertainty. While further research in IIL is needed to illuminate tacit knowledge that makes learning explicit for all audiences in the health professions, there are opportunities to cultivate learners' skills in formal curricula through various learning interventions to prime them for IIL when they enter complex clinical learning environments.
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Affiliation(s)
- Dimitrios Papanagnou
- D. Papanagnou is professor and vice chair for education, Department of Emergency Medicine, and associate dean for faculty development, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, and a 2020 Macy Faculty Scholar, Josiah Macy Jr. Foundation, New York, New York
| | - Karen E. Watkins
- K.E. Watkins is professor of learning, leadership, and organization development, Department of Lifelong Education, Administration, and Policy, University of Georgia, Athens, Georgia
| | - Henriette Lundgren
- H. Lundgren is an international scholar, Human Resource Development, Department of Organization and Leadership, Teachers College at Columbia University, New York, New York
| | - Grace A. Alcid
- G.A. Alcid is an EdD candidate, Adult Learning and Leadership Program, Department of Organization and Leadership, Teachers College at Columbia University, New York, New York
| | - Deborah Ziring
- D. Ziring is clinical associate professor, Department of Medicine, and senior associate dean for academic affairs, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Victoria J. Marsick
- V.J. Marsick is professor of adult learning and leadership, Department of Organization and Leadership, Teachers College at Columbia University, New York, New York
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14
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Fantaye AW, Gnyra C, Lochnan H, Wiesenfeld L, Hendry P, Whiting S, Kitto S. Prioritizing Clinical Teaching Excellence: A Hidden Curriculum Problem. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:204-210. [PMID: 36007518 DOI: 10.1097/ceh.0000000000000442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Abstract:
There have been many initiatives to improve the conditions of clinical teachers to enable them to achieve clinical teaching excellence in Academic Medical Centres (AMC). However, the success of such efforts has been limited due to unsupportive institutional cultures and the low value assigned to clinical teaching in comparison to clinical service and research. This forum article characterizes the low value and support for clinical teaching excellence as an expression of a hidden curriculum that is central to the cultural and structural etiology of the inequities clinical teachers experience in their pursuit of clinical teaching excellence. These elements include inequity in relation to time for participation in faculty development and recognition for clinical teaching excellence that exist within AMCs. To further compound these issues, AMCs often engage in the deployment of poor criteria and communication strategies concerning local standards of teaching excellence. Such inequities and poor governance can threaten the clinical teaching workforce's engagement, satisfaction and retention, and ultimately, can create negative downstream effects on the quality of patient care. While there are no clear normative solutions, we suggest that the examination of local policy documents, generation of stakeholder buy-in, and a culturally sensitive, localized needs assessment and integrated knowledge translation approach can develop a deeper understanding of the localized nature of this problem. The findings from local interrogations of structural, cultural and process problems can help to inform more tailored efforts to reform and improve the epistemic value of clinical teaching excellence. In conclusion, we outline a local needs assessment plan and research study that may serve as a conceptually generalizable foundation that could be applied to multiple institutional contexts.
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Affiliation(s)
- Arone Wondwossen Fantaye
- Mr. Fantaye: Research Associate, Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. Ms. Gnyra: Medical Student, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. Dr. Lochnan: Assistant Dean, Office of Continuing Professional Development, Faculty of Medicine; Professor, Department of Medicine, University of Ottawa; Head, Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, ON, Canada. Dr. Wiesenfeld: Vice-Dean, Postgraduate Medical Education, Faculty of Medicine; Assistant Professor, Department of Emergency Medicine, University of Ottawa; Attending Staff, Department of Emergency Medicine, The Ottawa Hospital, Ottawa, ON, Canada. Dr. Hendry: Vice-Dean, Office of Continuing Professional Development, Faculty of Medicine; Professor, Department of Surgery, University of Ottawa, Ottawa, ON, Canada. Dr. Whiting: Vice-Dean, Faculty Affairs, Faculty of Medicine; Associate Professor, Department of Pediatrics, University of Ottawa; Staff Physician, Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. Dr. Kitto: Professor, Department of Innovation in Medical Innovation; Director of Research, Office of Continuing Professional Development, University of Ottawa, Ottawa, ON, Canada
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15
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Cantillon P, De Grave W, Dornan T. The social construction of teacher and learner identities in medicine and surgery. MEDICAL EDUCATION 2022; 56:614-624. [PMID: 34993973 PMCID: PMC9305233 DOI: 10.1111/medu.14727] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 05/16/2023]
Abstract
INTRODUCTION There are growing concerns about the quality and consistency of postgraduate clinical education. In response, faculty development for clinical teachers has improved formal aspects such as the assessment of performance, but informal work-based teaching and learning have proved intractable. This problem has exposed a lack of research into how clinical teaching and learning are shaped by their cultural contexts. This paper explores the relationship between teacher-learner identity, educational practice and the workplace educational cultures of two major specialties: internal medicine and surgery. METHODS This was a secondary analysis of a large dataset, comprising field notes, participant interviews, images and video-recordings gathered in an ethnographic study. The lead author embedded himself in four clinical teams (two surgical and two medical) in two different hospitals. The authors undertook a critical reanalysis of the observational dataset, using Dialogism and Figured Worlds theory to identify how teachers and postgraduate learners figured and authored their professional identities in the specialty-specific cultural worlds of surgery and internal medicine. RESULTS Surgery and internal medicine privileged different ways of being, knowing and talking in formal and informal settings, where trainees authored themselves as capable practitioners. The discourse of surgical education constructed proximal coaching relationships in which trainees placed themselves at reputational risk in a closely observed, embodied practice. Internal medicine constructed more distal educational relationships, in which trainees negotiated abstract representations of patients' presentations, which aligned to a greater or lesser degree with supervisors' representations. CONCLUSIONS Our research suggests that clinical education and the identity positions available to teachers and learners were strongly influenced by the cultural worlds of individual specialties. Attempts to change work-based learning should be founded on situated knowledge of specialty-specific clinical workplace cultures and should be done in collaboration with the people who work there, the clinicians.
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Affiliation(s)
- Peter Cantillon
- Discipline of General PracticeNational University of IrelandGalwayIreland
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
| | - Willem De Grave
- School of Health Professions EducationMaastricht UniversityMaastrichtThe Netherlands
| | - Tim Dornan
- School of Medicine, Dentistry and Biomedical SciencesQueens University BelfastBelfastUK
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16
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Fantaye AW, Kitto S, Hendry P, Wiesenfeld L, Whiting S, Gnyra C, Fournier K, Lochnan H. Attributes of excellent clinician teachers and barriers to recognizing and rewarding clinician teachers' performances and achievements: a narrative review. CANADIAN MEDICAL EDUCATION JOURNAL 2022; 13:57-72. [PMID: 35572019 PMCID: PMC9099178 DOI: 10.36834/cmej.73241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Over the last 31 years, there have been several institutional efforts to better recognize and reward clinician teachers. However, the perception of inadequate recognition and rewards by clinician teachers for their clinical teaching performance and achievements remains. The objective of this narrative review is two-fold: deepen understanding of the attributes of excellent clinician teachers considered for recognition and reward decisions and identify the barriers clinician teachers face in receiving recognition and rewards. METHODS We searched OVID Medline, Embase, Education Source and Web of Science to identify relevant papers published between 1990 and 2020. After screening for eligibility, we conducted a content analysis of the findings from 43 relevant papers to identify key trends and issues in the literature. RESULTS We found the majority of relevant papers from the US context, a paucity of relevant papers from the Canadian context, and a declining international focus on the attributes of excellent clinician teachers and barriers to the recognition and rewarding of clinician teachers since 2010. 'Provides feedback', 'excellent communication skills', 'good supervision', and 'organizational skills' were common cognitive attributes considered for recognition and rewards. 'Stimulates', 'passionate and enthusiastic', and 'creates supportive environment', were common non-cognitive attributes considered for recognition and rewards. The devaluation of teaching, unclear criteria, and unreliable metrics were the main barriers to the recognition and rewarding of clinician teachers. CONCLUSIONS The findings of our narrative review highlight a need for local empirical research on recognition and reward issues to better inform local, context-specific reforms to policies and practices.
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Affiliation(s)
| | - Simon Kitto
- Office of Continuing Professional Development, University of Ottawa, Ontario, Canada
- Department of Innovation in Medical Education, University of Ottawa, Ontario, Canada
| | - Paul Hendry
- Office of Continuing Professional Development, University of Ottawa, Ontario, Canada
- University of Ottawa Heart Institute, Ontario, Canada
| | - Lorne Wiesenfeld
- Department of Emergency Medicine, University of Ottawa, Ontario, Canada
- Postgraduate Medical Education, University of Ottawa, Ontario, Canada
| | - Sharon Whiting
- Children's Hospital of Eastern Ontario, Ontario, Canada
- Office of Faculty of Affairs, University of Ottawa, Ontario, Canada
| | | | - Karine Fournier
- Health Sciences Library, University of Ottawa, Ontario, Canada
| | - Heather Lochnan
- Office of Continuing Professional Development, University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ottawa, Ontario
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Boscardin CK, Bullock J, O'Sullivan P, Hauer K. Profiles for Success: Examining the Relationship between Student Profiles and Clerkship Performance Using Latent Profile Analysis. TEACHING AND LEARNING IN MEDICINE 2022; 34:145-154. [PMID: 35349389 DOI: 10.1080/10401334.2021.1937180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 06/14/2023]
Abstract
PHENOMENON Learning is a complex phenomenon in which learners can vary in their learning orientation, learning approaches, and perception of the learning environment. Learners may be characterized as mastery oriented or performance oriented, and this learning orientation can influence their learning approaches, such as whether to seek feedback or ask for help. The learning environment includes institutional assessment policies and informal interactions that emphasize outcomes and differentiation among students. When learners perceive the learning environment as performance oriented, they feel competition from other learners and fear negative feedback. This complex interplay of learning orientation, its influence on feedback-seeking behavior, and the environmental influence and reinforcement of both can be captured through learner profiles. APPROACH In this multi-institutional cross-sectional survey study of students from six U.S. medical schools, we investigated learner profiles that characterize how these domains manifest together across individual learners. We then determined how these profiles are associated with students' clerkship grades. Measures included the Patterns of Adaptive Learning for learning orientation, self-reports for learning approaches, and perceptions of the learning environment. We used latent profile analysis to cluster students who share common characteristics around orientation, behavior, and environment. The relationship between these profiles and the percentage of honors earned was examined using multiple regression analysis. FINDINGS We found four distinct learner profiles within 666 of 974 (68%) analyzable responses: (1) performance oriented with negative perceptions of environment, (2) mastery oriented with desirable learning approaches, (3) "average" group, and (4) mastery orientation only. Profile 1 (M = 39%) and Profile 4 (M = 38%) students received fewer clerkship honors compared with other profiles. Profile 2 students earned a significantly higher percentage of honors grades (M = 54%) compared with other students. Profile 3 students (average group) earned the second highest percentage of honors (M = 46%). Effect sizes comparing the percentage of honors varied from 0.32 to 0.65, indicating medium to large differences. INSIGHTS The highest performers, as measured by clerkship honors grades, were mastery oriented, perceived a more positive learning environment, and were comfortable asking questions and seeking feedback for their learning. The lowest performing students were performance oriented and had negative perceptions of their learning environments. Contrary to previous findings, we found that the relationship between mastery orientation and learning approaches is not unidirectional but rather seems to be mediated by perceptions of the learning environment.
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Affiliation(s)
- Christy K Boscardin
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California, USA
| | - Justin Bullock
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Patricia O'Sullivan
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
| | - Karen Hauer
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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18
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Newsom KD, Carter GA, Hille JJ. Assessing Whether Medical Students Consistently Ask Patients About Sexual Orientation and Gender Identity as a Function of Year in Training. LGBT Health 2022; 9:142-147. [PMID: 35104423 DOI: 10.1089/lgbt.2021.0109] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The Institute of Medicine has suggested that teaching health care providers to inquire about and document the sexual orientation and gender identity (SOGI) of their patients will provide more accurate epidemiological data and allow for more patient-centered care, thus improving sexual and gender minority health. The purpose of this study was to determine whether medical students are asking about SOGI and to identify reasons why students were opting not to ask. Methods: In July 2020, an online survey was made available to second-, third-, and fourth-year medical students at a Midwestern medical school. Respondents were asked whether they consistently inquired about the SOGI of their patients, and the reasons they do not ask. The number of students asking about SOGI and reasons for not asking were analyzed using chi-square analyses as a function of year in training. Results: Of 1089 eligible participants, 364 completed the survey (33.4%). The number of students asking about sexual orientation significantly decreased with every year of training (92.8%, 82.2%, and 52.7%). The number of students asking about gender identity significantly decreased after the second year of training (69.9%, 40.6%, and 26.4%). Reasons that significantly increased across training included believing SOGI is irrelevant to encounters, limiting inquiries to patients with sexual health complaints only, and negative influence from their attendings. Conclusion: As medical students progressed into the clinical years of their training, they were less likely to ask their patients about SOGI and more likely to cite negative influence from their attendings and question the relevance of obtaining SOGI.
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Affiliation(s)
- Keeley D Newsom
- Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Gregory A Carter
- Department of Community and Health Systems, Indiana University School of Nursing, Indiana University, Bloomington, Indiana, USA
| | - Jessica J Hille
- Kinsey Institute, Indiana University, Bloomington, Indiana, USA
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van Braak M, Veen M, Muris J, van den Berg P, Giroldi E. A professional knowledge base for collaborative reflection education: a qualitative description of teacher goals and strategies. PERSPECTIVES ON MEDICAL EDUCATION 2022; 11:53-59. [PMID: 34403121 PMCID: PMC8733139 DOI: 10.1007/s40037-021-00677-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/23/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION For several decades, educational experts have promoted reflection as essential to professional development. In the medical setting, collaborative reflection has gained significant importance across the curriculum. Collaborative reflection has a unique edge over individual reflection, but many medical teachers find facilitating group reflection sessions challenging and there is little documentation about the didactics of teaching in such collaborative reflection settings. To address this knowledge gap, we aim to capture the professional knowledge base for facilitating collaborative reflection by analyzing the formal and perceived goals and strategies of this practice. METHODS The professional knowledge base consists of formal curricular materials as well as individual teacher expertise. Using Template Analysis, we analyzed the goals and strategies of collaborative reflection reported in institutional training documents and video-stimulated interviews with individual teachers across all Dutch general practitioner training institutes. RESULTS The analysis resulted in a highly diverse overview of educational goals for residents during the sessions, teacher goals that contribute to those educational goals, and a myriad of situation-specific teacher strategies to accomplish both types of goals. Teachers reported that the main educational goal was for residents to learn and develop and that the teachers' main goal was to facilitate learning and development by ensuring everyone's participation in reflection. Key teacher strategies to that end were to manage participation, to ensure a safe learning environment, and to create conditions for learning. DISCUSSION The variety of strategies and goals that constitute the professional knowledge base for facilitating collaborative reflection in postgraduate medical education shows how diverse and situation-dependent such facilitation can be. Our analysis identifies a repertoire of tools that both novice and experienced teachers can use to develop their professional skill in facilitating collaborative reflection.
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Affiliation(s)
- Marije van Braak
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Mario Veen
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jean Muris
- Department of Family Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Pieter van den Berg
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Esther Giroldi
- Department of Family Medicine, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
- Department of Educational Development and Research, Maastricht University, School of Health Professions Education (SHE), Maastricht, The Netherlands
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Chan TM, Ruan B, Lu D, Lee M, Yilmaz Y. Systems to support scholarly social media: a qualitative exploration of enablers and barriers to new scholarship in academic medicine. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:14-27. [PMID: 35003427 PMCID: PMC8740247 DOI: 10.36834/cmej.72490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION As academia begins to incorporate modern communication technologies into its scholarly structures, there are both enablers and barriers which foster academics' uptake of these innovations. Those who are early adopters of academic social media - whether it be for education, research-related networking, or knowledge translation - may therefore be best positioned to highlight both enablers and barriers within their work environments. METHODS The authors conducted a constructivist grounded theory study to discern what prominent practitioners of academic social media (e.g. Twitter) have encountered in their careers. Participants were recruited via a snowball sampling technique and invited to participate in semi-structured interviews. Three investigators engaged in constant comparative analysis of incoming transcripts. To enhance rigour, we conducted an audit of the analysis and a participant member check. RESULTS Seventeen emerging influencers in the field of academic social media were recruited. After axial coding, the 30 enablers and 21 barriers to academic social media use were mapped to three spheres of influence: personal, institutional, and virtual. The investigators propose a framework that organizes these enablers and barriers around a tipping point where sustainability becomes possible. CONCLUSIONS Multiple enablers and barriers were described to influence social media users within academic medicine. By organizing these facets into a personal, institutional, and virtual framework along a spectrum, we can begin to understand the underlying structures that potentiate the academic ecosystems in which social media and similar innovations may flourish.
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Affiliation(s)
| | | | - Daniel Lu
- University of British Columbia, British Columbia, Canada
| | - Mark Lee
- McMaster University, Ontario, Canada
| | - Yusuf Yilmaz
- McMaster University, Ontario, Canada
- Department of Medicine, Ege University, Izmir Turkey
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Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. MEDICAL EDUCATION 2021; 55:894-902. [PMID: 33651450 PMCID: PMC8359828 DOI: 10.1111/medu.14520] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 05/26/2023]
Abstract
CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
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Affiliation(s)
- Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Center for Health Professions EducationDepartment of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
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22
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Weiss J, Balasuriya L, Cramer LD, Nunez-Smith M, Genao I, Gonzalez-Colaso R, Wong AH, Samuels EA, Latimore D, Boatright D, Sharifi M. Medical Students' Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity. JAMA Netw Open 2021; 4:e2112795. [PMID: 34086032 PMCID: PMC8178710 DOI: 10.1001/jamanetworkopen.2021.12795] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity. OBJECTIVE To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020. MAIN OUTCOMES AND MEASURES Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables. RESULTS Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08). CONCLUSIONS AND RELEVANCE In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.
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Affiliation(s)
- Jasmine Weiss
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Lilanthi Balasuriya
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Laura D. Cramer
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Inginia Genao
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Elizabeth A. Samuels
- Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Darin Latimore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dowin Boatright
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mona Sharifi
- National Clinician Scholars Program, Yale School of Medicine, New Haven, Connecticut
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Cantillon P, De Grave W, Dornan T. Uncovering the ecology of clinical education: a dramaturgical study of informal learning in clinical teams. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2021; 26:417-435. [PMID: 32951128 PMCID: PMC8041675 DOI: 10.1007/s10459-020-09993-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 09/08/2020] [Indexed: 05/28/2023]
Abstract
Off-the-job faculty development for clinical teachers has been blighted by poor attendance, unsatisfactory sustainability, and weak impact. The faculty development literature has attributed these problems to the marginalisation of the clinical teacher role in host institutions. By focusing on macro-organisational factors, faculty development is ignoring the how clinical teachers are shaped by their everyday participation in micro-organisations such as clinical teams. We set out to explore how the roles of clinical teacher and graduate learner are co-constructed in the context of everyday work in clinical teams. Using an ethnographic study design we carried out marginal participant observation of four different hospital clinical teams. We assembled a dataset comprising field notes, participant interviews, images, and video, which captured day-to-day working and learning encounters between team members. We applied the dramaturgical sensitising concepts of impression management and face work to a thematic analysis of the dataset. We found that learning in clinical teams was largely informal. Clinical teachers modelled, but rarely articulated, an implicit curriculum of norms, standards and expectations. Trainees sought to establish legitimacy and credibility for themselves by creating impressions of being able to recognise and reproduce lead clinicians' standards. Teachers and trainees colluded in using face work strategies to sustain favourable impressions but, in so doing, diminished learning opportunities and undermined educational dialogue. These finding suggest that there is a complex interrelationship between membership of clinical teams and clinical learning. The implication for faculty development is that it needs to move beyond its current emphasis on the structuring effects of institutional context to a deeper consideration of how teacher and learner roles are co-constructed in clinical teams.
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Affiliation(s)
- Peter Cantillon
- Discipline of General Practice, National University of Ireland, Galway, Republic of Ireland.
| | - Willem De Grave
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Tim Dornan
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
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Fischer IC, Frankel RM. "If your feelings were hurt, I'm sorry…": How Third-Year Medical Students Observe, Learn From, and Engage in Apologies. J Gen Intern Med 2021; 36:1352-1358. [PMID: 33034017 PMCID: PMC8131483 DOI: 10.1007/s11606-020-06263-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Apologies may play a significant role in medical care, especially in the context of patient safety, medical error disclosure, and malpractice. Studies have shown that when state laws, institutional policies, and individual skills align-including the ability to offer a sincere apology-patients and families benefit. However, little is known about how, and under what conditions, physicians offer apologies in day-to-day care. Even less is known about what medical students learn about apologies from observing their superiors in these settings. OBJECTIVE Characterize third-year medical students' experiences of observing and engaging in apologies. DESIGN Qualitative descriptive analysis of student professionalism narratives. PARTICIPANTS Third-year medical students at Indiana University School of Medicine. APPROACH A search of 7,384 unique narratives yielded 238 with apologies. A rubric based on four key elements of genuine apologies ((1) acknowledgement, (2) explanation, (3) regret/remorse, and (4) reparation) was used to classify the kind of apology offered. Apology completeness, impact, and timing were also coded. KEY RESULTS Seventeen percent of all apologies were complete (i.e., contained all four elements). Over 40% were coded as incomplete or "non-apology" apologies (i.e., those with only the first two elements). A significant relationship between apology completeness and positive student experience was found. Most apologies were offered by the attending physician or resident to patients and family members. Students were generally positive about their experiences, but one in five were coded as negative. Some students were distressed enough to offer apologies on behalf of the faculty. Apology timing did not make a significant difference in terms of student experience. CONCLUSIONS Few education programs target apologies in the context of routine practice. With little formal instruction, students may rely on adopting what their seniors do. Faculty have an important role to play in modeling the apology process when harms-both great and small-occur.
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Affiliation(s)
- Ian C Fischer
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Richard M Frankel
- Indiana University School of Medicine, Indianapolis, IN, USA. .,VA Center for Health Information and Communication, Indianapolis, IN, USA. .,Cleveland Clinic, Cleveland, OH, USA.
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Almairi SOA, Sajid MR, Azouz R, Mohamed RR, Almairi M, Fadul T. Students' and Faculty Perspectives Toward the Role and Value of the Hidden Curriculum in Undergraduate Medical Education: a Qualitative Study from Saudi Arabia. MEDICAL SCIENCE EDUCATOR 2021; 31:753-764. [PMID: 34457924 PMCID: PMC8368115 DOI: 10.1007/s40670-021-01247-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/08/2021] [Indexed: 06/13/2023]
Abstract
A hidden medical curriculum is defined as the unwritten, unofficial, and unintended learning that students experience in medical school along with more formal aspects of education. This term describes the behaviours, attitudes, assumptions and beliefs conveyed by teachers, peers and the surrounding environment. However, more research is needed to evaluate its impact on student and faculty interactions in this context. We conducted this qualitative study utilizing focus group and semi-structured interviews of students and faculty to evaluate the perspectives of medical students and faculty toward the role and impact of the hidden medical curriculum in medical education at Alfaisal University, Riyadh, Saudi Arabia. Data was analysed using open-, axial- and selective-coding using thematic framework analysis. Interviewees consisted of 24 students in years 1-3 during the spring semester 2018-2019, 8 faculty members and 4 teaching assistants. We identified six core themes of hidden curriculum at Alfaisal University (Appendix). Role and behavioural modelling, value-based teaching, interpersonal faculty-student interactions, effects of diversity and socialization, teaching methodologies and hidden curriculum, mentoring and student support systems. Although some of the themes identified in these focus group interviews were similar to previously published studies, the novel themes that we identified were diversity, socialization and interpersonal faculty-student interactions. We conclude that identifying the issues pertaining to hidden curriculum is important for the development of medical students and for nurturing and upholding the values that we want to instil in our future physicians.
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Affiliation(s)
| | - Muhammad Raihan Sajid
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
| | - Rand Azouz
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
| | - Reem Ramadan Mohamed
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
| | - Mohammed Almairi
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
| | - Tarig Fadul
- Department of Pathology, Alfaisal University, Takhassusi street, Riyadh, Saudi Arabia
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Mordang SBR, Leep Hunderfund AN, Smeenk FWJM, Stassen LPS, Könings KD. High-Value, Cost-Conscious Care Attitudes in the Graduate Medical Education Learning Environment: Various Stakeholder Attitudes That Residents Misjudge. J Gen Intern Med 2021; 36:691-698. [PMID: 33140278 PMCID: PMC7947056 DOI: 10.1007/s11606-020-06261-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/21/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND Training residents in delivering high-value, cost-conscious care (HVCCC) is crucial for a sustainable healthcare. A supportive learning environment is key. Yet, stakeholders' attitudes toward HVCCC in residents' learning environment are unknown. OBJECTIVE We aimed to measure stakeholders' HVCCC attitudes in residents' learning environment, compare these with resident perceptions of their attitudes, and identify factors associated with attitudinal differences among each stakeholder group. DESIGN We conducted a cross-sectional survey across the Netherlands between June 2017 and December 2018. PARTICIPANTS Participants were 312 residents, 305 faculty members, 53 administrators, and 1049 patients from 66 (non)academic hospitals. MAIN MEASURES Respondents completed the Maastricht HVCCC Attitude Questionnaire (MHAQ), containing three subscales: (1) high-value care, (2) cost incorporation, (3) perceived drawbacks. Additionally, resident respondents estimated the HVCCC attitudes of other stakeholders, and answered questions on job demands and resources. Univariate and multivariate analyses were used to analyze data. KEY RESULTS Attitudes differed on all subscales: faculty and administrators reported more positive HVCCC attitudes than residents (p ≤ 0.05), while the attitudes of patients were less positive (p ≤ 0.05). Residents underestimated faculty's (p < 0.001) and overestimated patients' HVCCC attitudes (p < 0.001). Increasing age was, among residents and faculty, associated with more positive attitudes toward HVCCC (p ≤ 0.05). Lower perceived health quality was associated with less positive attitudes among patients (p < 0.001). The more autonomy residents perceived, the more positive their HVCCC attitude (p ≤ 0.05). CONCLUSIONS Attitudes toward HVCCC vary among stakeholders in the residency learning environment, and residents misjudge the attitudes of both faculty and patients. Faculty and administrators might improve their support to residents by more explicitly sharing their thoughts and knowledge on HVCCC and granting residents autonomy in clinical practice.
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Affiliation(s)
- Serge B. R. Mordang
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | | | - Frank W. J. M. Smeenk
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Pulmonary Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Laurents P. S. Stassen
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karen D. Könings
- Department of Educational Development and Research, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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van Lankveld T, Thampy H, Cantillon P, Horsburgh J, Kluijtmans M. Supporting a teacher identity in health professions education: AMEE Guide No. 132. MEDICAL TEACHER 2021; 43:124-136. [PMID: 33153338 DOI: 10.1080/0142159x.2020.1838463] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This guide provides an understanding of what teacher identity is and how it can be developed and supported. Developing a strong teacher identity in the context of health professions education is challenging, because teachers combine multiple roles and the environment usually is more supportive to the identity of health practitioner or researcher than to that of teacher. This causes tensions for those with a teaching role. However, a strong teacher identity is important because it enhances teachers' intention to stay in health professions education, their willingness to invest in faculty development, and their enjoyment of the teaching role. The guide offers recommendations on how to establish workplace environments that support teacher identity rather than marginalise it. Additionally, the guide offers recommendations for establishing faculty development approaches that are sensitive to teacher identity issues. Finally, the guide provides suggestions for individual teachers in relation to what they can do themselves to nurture it.
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Affiliation(s)
- Thea van Lankveld
- Department of Education, Utrecht University, Utrecht, The Netherlands
| | | | - Peter Cantillon
- Discipline of General Practice, School of Medicine, Galway, Ireland
| | - Jo Horsburgh
- Centre for Higher Education Research and Scholarship, Imperial College, South Kensington, London
| | - Manon Kluijtmans
- Center for Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Burgess A, van Diggele C, Roberts C, Mellis C. Key tips for teaching in the clinical setting. BMC MEDICAL EDUCATION 2020; 20:463. [PMID: 33272257 PMCID: PMC7712575 DOI: 10.1186/s12909-020-02283-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Teaching with real patients in the clinical setting lies at the heart of health professional education, providing an essential component to clinical training. This is true of all the health disciplines - particularly medicine, nursing, dentistry, physiotherapy, and dietetics. Clinical tutorials orientate students to the culture and social aspects of the healthcare environment, and shape their professional values as they prepare for practice. These patient-based tutorials introduce students to the clinical environment in a supervised and structured manner, providing opportunities to participate in communication skills, history taking, physical examination, clinical reasoning, diagnosis and management. It is only through participation that new practices are learnt, and progressively, new tasks are undertaken. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and key tips for teaching in the clinical setting. Although there are many competencies developed by students in the clinical setting, our tips for teaching focus on the domains of medical knowledge, interpersonal and communication skills, and professionalism.
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Affiliation(s)
- Annette Burgess
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School - Education Office, The University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia.
- The University of Sydney, Faculty of Medicine and Health, Sydney Health Professional Education Research Network, The University of Sydney, Sydney, Australia.
| | - Christie van Diggele
- The University of Sydney, Faculty of Medicine and Health, Sydney Health Professional Education Research Network, The University of Sydney, Sydney, Australia
- The University of Sydney, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chris Roberts
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School - Education Office, The University of Sydney, Edward Ford Building A27, Sydney, NSW, 2006, Australia
- The University of Sydney, Faculty of Medicine and Health, Sydney Health Professional Education Research Network, The University of Sydney, Sydney, Australia
| | - Craig Mellis
- The University of Sydney, Faculty of Medicine and Health, Sydney Medical School - Central Clinical School, The University of Sydney, Sydney, Australia
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Gilligan C, Loda T, Junne F, Zipfel S, Kelly B, Horton G, Herrmann-Werner A. Medical identity; perspectives of students from two countries. BMC MEDICAL EDUCATION 2020; 20:420. [PMID: 33172441 PMCID: PMC7654572 DOI: 10.1186/s12909-020-02351-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The development of professional identity is a fundamental element of medical education. There is evidence that in Germany, students' perceptions of the ideal and real doctor differ, and that of themselves as physicians falls between these constructs. We sought to compare students' perceptions of themselves, the ideal doctor, and the 'real' doctor and investigate differences from first to final year in the relationships between these constructs, as well as differences between Australian and German cohorts. METHOD Students in the first and final years of their medical program at one Australian and one German university were invited to complete the Osgood and Hofstatter polarity profile, involving the description of their mental image of the ideal and real doctor, and the doctor they hope to become, with adjectives provided. RESULTS One hundred sixty-seven students completed the survey in Australia (121 year 1, 46 year 5) and 188 in Germany (164 year 1, 24 year 6). The perception of the ideal doctor was consistent across all respondents, but that of the real doctor and self-image differed between country and year. Differences existed between country cohorts in perceptions of 'confidence', 'strength', 'capability' and 'security'. CONCLUSIONS The pattern previously reported among German students was maintained, but a different pattern emerged among Australian students. Differences between countries could reflect cultural differences or variations in the overt and hidden curricula of medical schools. Some of the constructs within the profiles are amenable to educational interventions to improve students' confidence and sense of capability.
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Affiliation(s)
- Conor Gilligan
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Teresa Loda
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany.
- School of Medicine, University of Tuebingen, Tuebingen, Germany.
| | - Florian Junne
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany
- School of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Stephan Zipfel
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany
- School of Medicine, University of Tuebingen, Tuebingen, Germany
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Graeme Horton
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Anne Herrmann-Werner
- Medical Department VI/Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Osianderstr. 5, D-72076, Tuebingen, Germany
- School of Medicine, University of Tuebingen, Tuebingen, Germany
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Yazdani S, Andarvazh MR, Afshar L. What is hidden in hidden curriculum? a qualitative study in medicine. J Med Ethics Hist Med 2020; 13:4. [PMID: 33088431 PMCID: PMC7569532 DOI: 10.18502/jmehm.v13i4.2843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Indexed: 11/24/2022] Open
Abstract
The hidden curriculum is considered to be between the designed and experienced curricula. One of the challenges that medical educators face is to understand what students learn in real clinical settings. The aim of the present study was to answer this question: What is hidden in hidden medical curriculum? This study was a qualitative content analysis. Participants were selected through purposive sampling. Data collection was performed through unstructured interviews and continued until data saturation. Data were analyzed simultaneously with data collection using MAXQDA10 software. Data validity was confirmed based on the proposed Lincoln and Guba criteria. The main theme that emerged in this study was implicit learning. Professional ethics, spiritual, social and cultural issues, and clinical skills are the five major themes that were presented in this study. These themes and their subthemes are transferred during an implicit learning experience in hidden curriculum. Since a wide range of issues are mostly transferred by hidden curriculum, it is essential to have a dynamic approach to educational environments. This is especially important in clinical settings, as the process of learning is constantly happening in the backyard.
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Affiliation(s)
- Shahram Yazdani
- Professor, School of Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Andarvazh
- PhD Graduate of Medical Education, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Assistant Professor, Nasibeh School of Nursing and Midwifery, Educational Development Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Leila Afshar
- Associate Professor, Department of Medical Ethics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Crist K, Bajzer M, Wichser L. An Inpatient Case Conference to Take DSM Criteria Out of the Classroom and onto the Wards. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:437-439. [PMID: 32162169 DOI: 10.1007/s40596-020-01211-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
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van Bruggen L, Ten Cate O, Chen HC. Developing a Novel 4-C Framework to Enhance Participation in Faculty Development. TEACHING AND LEARNING IN MEDICINE 2020; 32:371-379. [PMID: 32251617 DOI: 10.1080/10401334.2020.1742124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: Universities offer a variety of voluntary faculty development to ensure quality education, but face inconsistent faculty participation. Therefore, all Dutch universities require all faculty to obtain a teaching qualification certificate. Yet, like other medical centers, University Medical Center Utrecht continued to struggle with faculty nonparticipation. It has been postulated that clinician teachers may face unique challenges with responsibilities for patient care in addition to teaching and research, challenges that cannot be overcome by merely mandating faculty development or a teaching certificate. This project was conducted to gain insight into factors that hinder faculty participation and better understand what is needed to enhance faculty engagement in their professional development as teachers. Approach: UMC Utrecht has had a teaching certificate requirement for over 20 years. In 2015-2016, we conducted a local needs assessment, gathering faculty perspectives about the teaching certification process. To convey seriousness of purpose and promote commitment to change, we formally engaged key stakeholders from the outset, obtained grant funding for the needs assessment, and had an outside consultant lead the project. Faculty who were stalled or never started were questioned via semi-structured interviews. A focus group with those actively in the process of obtaining their certificate discussed perceived challenges in the process and recommended solutions. Faculty who obtained their teaching certificate completed an anonymous evaluation form. All evaluation comments and transcripts were thematically analyzed using open and axial coding. A literature review was performed to contextualize our findings and identify potential solutions. We compared our initial themes to these findings and found key challenge/solution categories, which we subsequently developed into a novel framework. Findings from the study and literature review were organized using this framework and shared with different stakeholders, all of whom engaged in problem-solving. Ideas and potential solutions were incorporated into a final report with recommendations for improving faculty support and provided to the institutional leadership. Findings: Of 23 faculty teachers approached, 8 (34.8%) agreed to be interviewed; 7 of 25 (28.0%) participated in the focus group; and 83 of 156 (53.2%) completed the evaluation. From the transcripts and evaluation comments, three themes emerged related to context and barriers: (a) skill development versus certification; (b) workplace priorities and culture, and (c) visibility and feasibility of the teacher's role. Triangulation of these themes with the literature revealed four challenge/solution categories - Competence, Context, Community, and Career. This 4-C framework facilitated communication of findings, structured the development of an action plan in response to the findings, and assured implementation of new initiatives for faculty support beyond competence development. Insights: Simply adopting requirements for faculty development may be insufficient and even invoke resistance. Improving faculty participation in faculty development and the quality of education requires institutional attention to not just faculty Competence needs, but also the factors of Context, Community, and Career that together comprise the culture experienced by faculty teachers. With institutional buy-in and commitment to change, the 4-C framework can help focus institutional attention on existing gaps in all four domains and guide the development of comprehensive solutions.
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Affiliation(s)
- Lisette van Bruggen
- Center for Research and Development of Education, University Medical Center, Utrecht, Netherlands
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center, Utrecht, Netherlands
| | - H Carrie Chen
- Department of Pediatrics, School of Medicine, Georgetown University, Washington, DC, USA
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Haruta J, Ozone S, Hamano J. Doctors' professional identity and socialisation from medical students to staff doctors in Japan: narrative analysis in qualitative research from a family physician perspective. BMJ Open 2020; 10:e035300. [PMID: 32665385 PMCID: PMC7365484 DOI: 10.1136/bmjopen-2019-035300] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Becoming a doctor involves transforming a lay person into a medical professional, which is known as professional socialisation. However, few studies have clarified differences in the professional socialisation process in detail. The aim of this study was to clarify the process of professional socialisation of medical students to residents to staff doctors. DESIGN We used narrative analysis in qualitative research as a theoretical framework. SETTING This study was conducted in Japan. PARTICIPANTS Participants were collected using a purposive sample of doctors with over 7 years of medical experience. We conducted semistructured interviews from September 2015 to December 2016, then used a structured approach to integrate the sequence of events into coherent configurations. RESULTS Participants were 13 males and 8 females with medical careers ranging from 8 to 30 years. All participants began to seriously consider their own career and embodied their ideal image of a doctor through clinical practice. As residents, the participants adapted as a member of the organisation of doctors. Subsequently, doctors exhibited four patterns: first, they smoothly transitioned from 'peripheral' to 'full' participation in the organisation; second, they could no longer participate peripherally but developed a professional image from individual social interactions; third, they were affected by outsiders' perspectives and gradually participated peripherally; fourth, they could not regard the hospital as a legitimate organisation and could not participate fully. CONCLUSION The professional socialisation process comprises an institutional theory, professional persona, legitimate peripheral participation and threshold concepts. These findings may be useful in supporting professional development.
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Affiliation(s)
- Junji Haruta
- Medical Education Center, Keio University, Shinjuku, Tokyo, Japan
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Sachiko Ozone
- Department of General Medicine and Primary Care, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Bajwa NM, De Grasset J, Audétat MC, Jastrow N, Richard-Lepouriel H, Dominicé Dao M, Nendaz MR, Junod Perron N. Training junior faculty to become clinical teachers: The value of personalized coaching. MEDICAL TEACHER 2020; 42:663-672. [PMID: 32130055 DOI: 10.1080/0142159x.2020.1732316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Junior clinical faculty require institutional support in the acquisition of feedback and clinical supervision skills of trainees. We tested the effectiveness of a personalized coaching versus guided self-reflection format of a faculty development program at improving faculty skills and self-efficacy.Methods: Participants were evaluated both before and after the program using a four-station Objective Structured Teaching Exercise (OSTE). A gain-score analysis, one-way ANOVA, and paired t-tests were used to evaluate both groups. The impact on the learning environment was measured by resident ratings of the Maastricht Clinical Teaching Questionnaire.Results: One hundred and twenty-seven participants completed the study over a three-year period. Both groups had significant improvements in self-efficacy. Participants in the coaching group demonstrated superior performance in encouraging learner self-reflection, teaching effectiveness, verifying learner understanding, exploring feelings/needs, and defining learning objectives. Over a 5-year period, the overall institutional learning climate significantly improved concerning faculty role-modeling, coaching, articulation, and explorations skills.Conclusion: Offering a contextualized faculty-development program using OSTEs that provides multiple opportunities for feedback and is focused on creating a community of practice is an effective method to facilitate the transfer of skills to the clinical environment, supports teacher identity development, and favorably impacts the learning climate.
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Affiliation(s)
- Nadia M Bajwa
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Jehanne De Grasset
- Institute of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie-Claude Audétat
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Nicole Jastrow
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | | | - Melissa Dominicé Dao
- Division of Primary Care Medicine, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu R Nendaz
- Faculty of Medicine, Unit of Development and Research in Medical Education (UDREM), University of Geneva, Geneva, Switzerland
| | - Noëlle Junod Perron
- Department of community medicine and primary care, Geneva University Hospitals, Geneva, Switzerland
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Sarikhani Y, Shojaei P, Rafiee M, Delavari S. Analyzing the interaction of main components of hidden curriculum in medical education using interpretive structural modeling method. BMC MEDICAL EDUCATION 2020; 20:176. [PMID: 32487128 PMCID: PMC7269001 DOI: 10.1186/s12909-020-02094-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/28/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Hidden curriculum (HC) is considered as unintended learning experiences in medical education (ME). This may include values, norms, beliefs, skills, and knowledge which could potentially influence learning outcomes. HC has key components that must be identified and considered properly by individuals and organizations involved in ME. OBJECTIVES This study aimed to determine the main components of hidden curriculum in medical education (HCME) and the interrelationships among them. METHODS In this mixed-method study initially we performed a scoping review and determined the main components of HCME using qualitative content analysis approach. Then, the interrelationships among these components were investigated using Interpretive Structural Modeling (ISM). RESULTS Ten key components for HCME were identified in scoping review. We classified them into four main categories including structural, educational, cultural, and social factors. The ISM analysis revealed that organizational rules and structure, dominant culture of educational environments, teaching and assessment approaches, as well as clinical and educational physical setting were the independent or driving factors. While, social components were dependent and influenced by basic components. CONCLUSION The ISM model indicated that role modeling behaviors and interpersonal relationships (social factors) are under influence of underlying organizational and educational factors. These results should be considered at all stages of educational management including planning process, implementation of the programs, and development of formal curricula. According to the importance of contextual factors, components of HC must be analyzed and interpreted based on the specific conditions of each educational institution.
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Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Payam Shojaei
- Department of Management, School of Economics, Management and Social Sciences, Shiraz University, Shiraz, Iran
| | - Mohammad Rafiee
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Rothlind E, Fors U, Salminen H, Wändell P, Ekblad S. The informal curriculum of family medicine - what does it entail and how is it taught to residents? A systematic review. BMC FAMILY PRACTICE 2020; 21:49. [PMID: 32160865 PMCID: PMC7066821 DOI: 10.1186/s12875-020-01120-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/28/2020] [Indexed: 12/03/2022]
Abstract
Background The informal curriculum is a seemingly well-explored concept in the realm of medical education. However, it is a concept with multiple definitions and the term “the hidden curriculum” is often used interchangeably. In short, they both refer to the implicit learning taking place outside the formal curriculum, encompassing both a trickling down effect of organizational values and attitudes passed on by a mentor or colleague. While the informal curriculum is a recurrent theme in medical education literature; it is seldom discussed in Family Medicine. As the informal curriculum is likely to be highly influential in the forming of future family practitioners, our aim was to explore the area further, with respect to the following: which elements of the informal curriculum are applicable in a Family Medicine context and what educational interventions for Family Medicine residents, visualizing the various educational elements of it, have been performed? Methods We conducted a systematic review comprising iterative literature searches and a narrative synthesis of the results. Results Twenty articles, published between 2000 and 2019, were included in the analysis which resulted in three partly interrelated themes comprising the informal curriculum in Family Medicine: gaining cultural competence, achieving medical professionalism and dealing with uncertainty. The themes on cultural competence and uncertainty seemed to be more contextual than professionalism, the latter being discussed in relation to the informal curriculum across other medical disciplines as well. Formalized training for Family Medicine residents in aspects of the informal curriculum appeared to be lacking, and in general, the quality of the few interventional studies found was low. Conclusions Important aspects of being a family practitioner, such as cultural competence and dealing with uncertainty, are learned through a context-dependent informal curriculum. In order to ensure a more uniform base for all residents and to reduce the impact of the individual supervisor’s preferences, complementary formalized training would be beneficial. However, to date there are too few studies published to conclude how to best teach the informal curriculum. Trial registration The systematic review was registered with Prospero; registration number CRD42018104819.
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Affiliation(s)
- Erica Rothlind
- Culture Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
| | - Uno Fors
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - Helena Salminen
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Per Wändell
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Solvig Ekblad
- Culture Medicine, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
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Firn J, O’Neil T. The Role of Self-Care in Clinical Ethics Consultation: Clinical Ethicists’ Risk for Burnout, Potential Harms, and What Ethicists Can Do. THE JOURNAL OF CLINICAL ETHICS 2020. [DOI: 10.1086/jce2020311048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kachel T, Huber A, Strecker C, Höge T, Höfer S. Development of Cynicism in Medical Students: Exploring the Role of Signature Character Strengths and Well-Being. Front Psychol 2020; 11:328. [PMID: 32174874 PMCID: PMC7056910 DOI: 10.3389/fpsyg.2020.00328] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/11/2020] [Indexed: 12/30/2022] Open
Abstract
Reports of medical students experiencing burnout-related symptoms (e.g., cynicism) have increased in recent years. Little is known about the developmental process of this phenomenon and its relations with signature character strengths and well-being. The aim of this longitudinal analysis was to explore changes in the level of cynicism of medical students while in preclinical education. We further examined how the applicability of signature character strengths and well-being are related to this developmental process. Medical students (N = 99) participated in three online surveys over 3 years during medical school. Latent growth modeling, latent class growth modeling, general mixed modeling was conducted, and post hoc mixed ANOVA, Friedman test and Welch test analyses were examined. The results showed an increase in cynicism among medical students from first to last measurement. Two groups with distinct developmental trajectory patterns of cynicism were identified. Students with high levels of cynicism (high-level group) and students with changing levels of cynicism (increasing group) perceived higher applicability of signature character strengths in private life compared to the study context. Moreover, the high-level group experienced significantly lower psychological well-being (in particular mastery, optimism, and relationship) in their first year of medical education. This explorative study offers a comprehensive understanding of cynicism development in medical students during medical school and its relations to the applicability of signature character strengths and well-being. Prospective replication studies are needed to replicate the results obtained in this study.
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Affiliation(s)
- Timo Kachel
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Alexandra Huber
- Department of Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
| | - Cornelia Strecker
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Thomas Höge
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Stefan Höfer
- Department of Medical Psychology, Medical University Innsbruck, Innsbruck, Austria
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Castañeda-Motta C, Vega-Peña NV. Reuniones de morbilidad y mortalidad, ¿una estrategia de aprendizaje? IATREIA 2020. [DOI: 10.17533/udea.iatreia.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Las reuniones o conferencias de morbilidad y mortalidad (M&M), una práctica común en todo el mundo, buscan evaluar los eventos adversos y las complicaciones relacionadas con la atención médica, desde una perspectiva académica y considerando un mejoramiento en la calidad de la atención hospitalaria. Sin embargo, en nuestro país, su ejecución es un desafío metodológico debido a la dificultad para su conceptualización, implementación, evaluación de su efectividad y utilidad como herramienta educativa; al estar carente de una estructura formalizada que considere estos temas.
El objetivo de este trabajo es evaluar su papel desde una perspectiva académica individual e institucional, considerando diferentes teorías y modelos que podrían apoyar el M&M (teoría del aprendizaje experimental, teoría de la actividad en el aprendizaje sociocultural, cultura justa, teoría de la seguridad del modelo y teoría de la segunda víctima), con el fin de responder la pregunta: ¿son las reuniones de M&M una estrategia de aprendizaje?
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Wang XM, Swinton M, You JJ. Medical students' experiences with goals of care discussions and their impact on professional identity formation. MEDICAL EDUCATION 2019; 53:1230-1242. [PMID: 31750573 DOI: 10.1111/medu.14006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/07/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end-of-life care. In previous research, medical learners have reported insufficient training and emotional distress about end-of-life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students' experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. METHODS Using purposive sampling at one Canadian medical school, individual semi-structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. RESULTS Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants' emotional distress. Participants' coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. CONCLUSIONS GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students' PIF positively.
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Affiliation(s)
- Xuyi Mimi Wang
- Division of Geriatric Medicine Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Centre for Healthy Aging, St Peter's Hospital, Hamilton, Ontario, Canada
| | - Marilyn Swinton
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - John J You
- Division of General Internal and Hospitalist Medicine, Department of Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Jaffe LE, Lindell D, Sullivan AM, Huang GC. Clear skies ahead: optimizing the learning environment for critical thinking from a qualitative analysis of interviews with expert teachers. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:289-297. [PMID: 31562637 PMCID: PMC6820647 DOI: 10.1007/s40037-019-00536-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The learning environment refers to the physical, pedagogical, and psychosocial contexts in which learning occurs and critically influences the educational experience of trainees in the health professions. However, the manner in which individual faculty explicitly organize the educational setting to facilitate learning of essential competencies such as critical thinking deserves more examination; lack of attention to this component can undermine the formal curriculum. The purpose of our study was to examine how faculty shape the learning environment to advance their learners' development of critical thinking. METHODS We took a constructivist grounded theory approach using the framework method for qualitative content analysis. Data were derived from interviews conducted with 44 faculty identified as skilled teachers of critical thinking at eight academic health professions institutions. RESULTS Three major themes emerged regarding participants' descriptions of their experiences of how they optimized the learning environment to support critical thinking: 1) Setting the atmosphere (establishing ground rules, focusing on process rather than answers, and building trust), 2) Maintaining the climate (gently pushing learners, tolerating discomfort, and adjusting to learner level), and 3) Weathering the storm (responses to challenges to learning critical thinking, including time and effort, negative evaluations, and resistance to effortful learning). DISCUSSION An optimal learning environment for critical thinking was actively created by faculty to establish a safe environment and shared understanding of expectations. Understanding how to produce a conducive learning climate is paramount in teaching essential topics such as critical thinking. These findings have potential utility for faculty development initiatives to optimize the learning environment.
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Affiliation(s)
- Lynn E Jaffe
- Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers, FL, USA
| | - Deborah Lindell
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Amy M Sullivan
- Carl J. Shapiro Institute for Education and Research, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Program in Medical Education, Harvard Medical School, Boston, MA, USA
| | - Grace C Huang
- Carl J. Shapiro Institute for Education and Research, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Cantillon P, Dornan T, De Grave W. Becoming a Clinical Teacher: Identity Formation in Context. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1610-1618. [PMID: 30113365 DOI: 10.1097/acm.0000000000002403] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
PURPOSE Most clinical teachers have not been trained to teach, and faculty development for clinical teachers is undermined by poor attendance, inadequate knowledge transfer, and unsustainability. A crucial question for faculty developers to consider is how clinicians become teachers "on the job." Such knowledge is important in the design of future workplace-based faculty development initiatives. The authors conducted a scoping review of research on the relationship between becoming a clinical teacher and the clinical environments in which those teachers work. METHOD In June 2017, using the scoping review design described by Levac et al (2010), the authors searched 12 databases. They subjected the articles discovered to four phases of screening, using iteratively developed inclusion/exclusion criteria. They charted data from the final selection of articles and used thematic analysis to synthesize findings. RESULTS Thirty-four research reports met the inclusion criteria. Most (n = 24) took an individualist stance toward identity, focusing on how teachers individually construct their teacher identity in tension with their clinician identities. Only 10 studies conceptualized clinical teacher identity formation as a social relational phenomenon, negotiated within hierarchical social structures. Twenty-nine of the included studies made little or no use of explicit theoretical frameworks, which limited their rigor and transferability. CONCLUSIONS Clinicians reconciled their identities as teachers with their identities as clinicians by juggling the two, finding mutuality between them, or forging merged identities that minimized tensions between educational and clinical roles. They did so in hierarchical social settings where patient care and research were prioritized above teaching.
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Affiliation(s)
- Peter Cantillon
- P. Cantillon is professor of primary care, Discipline of General Practice, National University of Ireland, Galway, Galway, Ireland; ORCID: https://orcid.org/0000-0003-3776-9537. T. Dornan is professor of medical education, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, Northern Ireland, United Kingdom; ORCID: http://orcid.org/0000-0001-7830-0183. W. De Grave is an educational psychologist, School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
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Walsh G, Hayes B, Freeney Y, McArdle S. Doctor, how can we help you? Qualitative interview study to identify key interventions to target burnout in hospital doctors. BMJ Open 2019; 9:e030209. [PMID: 31492785 PMCID: PMC6731950 DOI: 10.1136/bmjopen-2019-030209] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To identify priority interventions for the prevention and reduction of work stress and burnout in hospital doctors through analysis of (1) doctors' experiences of work stress and burnout and (2) their preferences with respect to interventions. DESIGN Qualitative design using semistructured interviews analysed with deductive thematic analysis. SETTING Hospitals in Ireland. PARTICIPANTS 32 hospital doctors (16 practising consultants and 16 doctors in training) from a range of specialties, career stages, hospital types and locations. RESULTS Practical, system-focused interventions were found to be most needed. Challenges with basic entitlements, that is, accessing statutory leave, knowing in advance when leave can be taken and being adequately covered when on leave were identified as requiring urgent attention. Other priority interventions identified were the integration of psychological support in the everyday working environment, time and training for clinical line managers to perform key management activities such as debriefing and education interventions which highlight work stress risks and care pathways, teach self-care and train doctors in how to support one another. CONCLUSIONS Hospital doctors are feeling the effects of greater demand and fewer resources. What they most urgently need is adequate staffing levels, access to statutory leave and adequate cover when on leave. Doctors do not receive the support they need from their clinical line managers, who lack the skills and time to excel as people managers. Organisations should focus on developing clinical management skills across the system. The culture of medicine needs to change from stigmatisation and competitiveness to compassion and collaboration. Organisations, medical schools and professional bodies can steer this change through education.
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Affiliation(s)
- Gillian Walsh
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
- Research, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Blánaid Hayes
- Research, Royal College of Physicians of Ireland, Dublin, Ireland
- Occupational Health, Beaumont Hospital, Dublin, Ireland
| | - Yseult Freeney
- Business School, Dublin City University, Dublin, Ireland
| | - Siobhain McArdle
- School of Health and Human Performance, Dublin City University, Dublin, Ireland
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Phelan SM, Burke SE, Cunningham BA, Perry SP, Hardeman RR, Dovidio JF, Herrin J, Dyrbye LN, White RO, Yeazel MW, Onyeador IN, Wittlin NM, Harden K, van Ryn M. The Effects of Racism in Medical Education on Students' Decisions to Practice in Underserved or Minority Communities. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1178-1189. [PMID: 30920443 DOI: 10.1097/acm.0000000000002719] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE The purpose of this study was to examine the relationship between manifestations of racism in medical school and subsequent changes in graduating medical students' intentions to practice in underserved or minority communities, compared with their attitudes and intentions at matriculation. METHOD The authors used repeated-measures data from a longitudinal study of 3,756 students at 49 U.S. medical schools that were collected from 2010 to 2014. They conducted generalized linear mixed models to estimate whether manifestations of racism in school curricula/policies, school culture/climate, or student attitudes/behaviors predicted first- to fourth-year changes in students' intentions to practice in underserved communities or primarily with minority populations. Analyses were stratified by students' practice intentions (no/undecided/yes) at matriculation. RESULTS Students' more negative explicit racial attitudes were associated with decreased intention to practice with underserved or minority populations at graduation. Service learning experiences and a curriculum focused on improving minority health were associated with increased intention to practice in underserved communities. A curriculum focused on minority health/disparities, students' perceived skill at developing relationships with minority patients, the proportion of minority students at the school, and the perception of a tense interracial environment were all associated with increased intention to care for minority patients. CONCLUSIONS This study provides evidence that racism manifested at multiple levels in medical schools was associated with graduating students' decisions to provide care in high-need communities. Strategies to identify and eliminate structural racism and its manifestations in medical school are needed.
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Affiliation(s)
- Sean M Phelan
- S.M. Phelan is associate professor, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota. S.E. Burke is assistant professor, Department of Psychology, Syracuse University, Syracuse, New York. B.A. Cunningham is assistant professor, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota. S.P. Perry is assistant professor, Departments of Psychology and Medical Social Sciences, Institute for Policy Research, Northwestern University, Evanston, Illinois. R.R. Hardeman is assistant professor, Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota. J.F. Dovidio is professor, Department of Psychology, Yale University, New Haven, Connecticut. J. Herrin is assistant professor, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. L.N. Dyrbye is professor, Department of Medicine, Mayo Clinic, Rochester, Minnesota. R.O. White is assistant professor, Department of Community Internal Medicine, Mayo Clinic, Jacksonville, Florida. M.W. Yeazel is professor, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota. I.N. Onyeador is postdoctoral fellow, Department of Psychology, Yale University, New Haven, Connecticut. N.M. Wittlin is a PhD candidate, Department of Psychology, Yale University, New Haven, Connecticut. K. Harden is senior program coordinator, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota. M. van Ryn is distinguished professor, School of Nursing, Oregon Health & Science University, and founder/president, Institute for Equity & Inclusion Sciences, Portland, Oregon
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Kesselheim JC, Clayton CP, Fritz J, Smith RE, Gitlin SD, Reid E, Zuckerman KS, Kahn MJ. The American Society of Hematology (ASH) Medical Educators Institute: a Pilot Faculty Development Project for Hematology Educators. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:719-724. [PMID: 29682694 DOI: 10.1007/s13187-018-1363-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Clinician educators at academic medical centers often lack the community, mentorship, and faculty development to support their missions around education scholarship and teaching. Inadequate support for clinician educators can lead to professional dissatisfaction and slowed academic advancement. In 2014, ASH conducted a needs assessment of medical school hematology course directors, hematology-oncology fellowship program directors, and other ASH members identified as educators to determine this community's desire for faculty development in medical education. These data furthered the development of an annual faculty development program for hematology educators offering an interactive curriculum and support for an educational scholarly project. The needs assessment indicated that over 70% of respondents would be personally interested in a faculty development opportunity for hematology educators and only 11% had previously participated in such a program. A steering committee designed an intervention blending didactics, interactive small group exercises, webinars, mentorship for a scholarly project, 360-degree feedback for each participant, and a forum to discuss common career development goals. Of 42 applicants, 20 participants were chosen for the inaugural workshop. Following successful execution of the workshop, participants reported significant increase in confidence in the knowledge, skills, and attitudes targeted by the curriculum. A series of follow-up webinars have been developed to deliver additional content not covered during the workshop and to continue mentorship relationships. The curriculum will be further refined based on feedback from faculty and participants. Long-term outcome measurement will include tracking all participants' publications and presentations, time to promotion, and involvement in national medical education initiatives.
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Affiliation(s)
- Jennifer C Kesselheim
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | | | - Josel Fritz
- Training and Evaluation, American Society of Hematology, Washington, DC, USA
| | - Roy E Smith
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Scott D Gitlin
- University of Michigan Health System and Veterans Affairs Ann Arbor Health System, Ann Arbor, MI, USA
| | - Erin Reid
- UC San Diego Moores Cancer Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Marc J Kahn
- Tulane University School of Medicine, New Orleans, LA, USA
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Schei E, Fuks A, Boudreau JD. Reflection in medical education: intellectual humility, discovery, and know-how. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:167-178. [PMID: 30460425 DOI: 10.1007/s11019-018-9878-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Reflection has been proclaimed as a means to help physicians deal with medicine's inherent complexity and remedy many of the shortcomings of medical education. Yet, there is little agreement on the nature of reflection nor on how it should be taught and practiced. Emerging neuroscientific concepts suggest that human thought processes are largely nonconscious, in part inaccessible to introspection. Our knowledge of the world is fraught with uncertainty, ignorance and indeterminacy, and influenced by emotion, biases and illusions, including the illusion of not having illusions. Neuroscience also documents that lifelong learning processes may hone nonconscious cognition to high levels of sophistication, allowing rapid and precise perceptions, judgments and actions in complex situations. We argue that knowledge of mechanisms underlying human thought may be useful in designing educational programs to foster desired attributes such as curiosity, critical self-awareness and intuitive acumen in medical professionals. The juxtaposition of neuroscientific insights with ideas from Kant on reflective judgement, van Manen on tact, and Aristotle on phronésis, supports a concept of reflection that manifests as wise practice. We suggest that reflection in medical education should be (a) an imperative for educators seeking to guide learners to manage the complexity and "messiness" of medical practice, and (b) a role-modelling mode of medical practice characterized by self-correcting behaviors that culminate in good and right professional actions. An example illustrates reflective practice in the teaching and learning of physicianship.
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Affiliation(s)
- Edvin Schei
- Department of Global Public Health and Primary Care, Center for Medical Education, University of Bergen, Kalfarv, 31, 5034, Bergen, Norway.
| | - Abraham Fuks
- Department of Medicine, McGill University, Montreal, Canada
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Clay M, Hiraki LT, Lamot L, Medhat BM, Sana S, Small AR. Developing Reflection and Collaboration in Translational Medicine Toward Patients and Unmet Medical Needs. Front Med (Lausanne) 2019; 6:94. [PMID: 31131280 PMCID: PMC6509800 DOI: 10.3389/fmed.2019.00094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 04/16/2019] [Indexed: 11/13/2022] Open
Abstract
This perspective article aims to highlight the importance of values-driven personal reflection and collaboration for effective translational medicine training. We frame the dilemma in translational medicine and provide an approach for solution emphasizing collaboration and co-creation for innovative change in translational medicine. We cite the science in transition literature suggesting why personal reflection and a collaborative approach is important. We identify the problem with publication pressures and the bibliometric mindset. We focus on motivation to seek and find results that really matter for patients and individuals to maintain health in the real world. We review how the international EUREKA Institute for Translational Medicine (established in 2007) works with students, to harness their core values and develop personal growth skills to improve their leadership effectiveness, to work toward collaborative gain and potentially more meaningful results for patients and medical needs. We describe how the EUREKA Institute's unique setting, curriculum and hidden curriculum aspects effectively train program participants. The article highlights creating an immersive safe space, personal reflection, connection, structured brainstorming, group problem solving, collaboration and co-creation to facilitate innovation in translational medicine. The article relates program features to their theoretical underpinnings such as Theory U, Mediation Theory and Strategic Innovation Theory. The six authors from different global regions, ages, career stages, translational medicine contexts and years of attendance at the EUREKA Institute provide their reflections on training impact. Lessons learned and recommendations for research and application are discussed.
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Affiliation(s)
- Moira Clay
- Moira Clay Consulting, University of Western Australia, Perth, WA, Australia
| | - Linda T Hiraki
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lovro Lamot
- Department of Paediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia.,Department of Paediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Basma M Medhat
- Rheumatology and Rehabilitation Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Anita R Small
- Small LANGUAGE CONNECTIONS, Toronto, ON, Canada.,Linguistics, University of Toronto Scarborough, Toronto, ON, Canada
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Held FP, Roberts C, Daly M, Brunero C. Learning relationships in community-based service-learning: a social network analysis. BMC MEDICAL EDUCATION 2019; 19:113. [PMID: 31023298 PMCID: PMC6482529 DOI: 10.1186/s12909-019-1522-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/17/2019] [Indexed: 05/09/2023]
Abstract
BACKGROUND Little is known about the social learning of students within community-based clinical placements and ways in which it can be supported. In an allied health service-learning program, we analysed students' learning relationships to quantify what, and from whom students learnt. METHODS We conducted a social learning network survey in four domains of learning (clinical knowledge, procedural skills, professional development, and complex determinants of health) to explore learning relationships (ties) with other people (alters) that students (egos) formed during their placement. We quantified how different roles (supervisors, health professionals, administrators, peers, schoolteachers, and clients) contributed to the students' learning in each of the four domains. We used exponential random graph models (ERGMs) to test which relational processes contributed to the structure of the observed learning networks. RESULTS Data was available from a complete cohort of 10 students on placement in a network of 69 members, thus providing information on 680 potential learning relations. Students engaged in similar ways in the domains of clinical knowledge, procedural skills, and professional development. Learning relations with academic supervisors were significantly more likely. Also students reported reciprocal learning relations with peers - i.e. they formed learning pairs. This effect was absent in learning networks about complex determinants of health (including socio-economic and cultural factors). Instead, local administrative staff were significantly more often the source of learning about the local contextual factors. CONCLUSIONS Understanding the structure of student learning networks through social network analysis helps identify targeted strategies to enhance learning in community-based service-learning programs. Our findings suggest students recognised important learning from each other and from administrative personnel that is unrelated to the content of their placement. Based on this insight clinical educators could prepare students to become agentic learners, learning with each other and from sources outside their program.
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Affiliation(s)
- Fabian P. Held
- Office of the Deputy Vice-Chancellor (Education), University of Sydney, Sydney, Australia
| | - Chris Roberts
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Michele Daly
- University of Sydney, Rural Clinical School (Broken Hill), Sydney, Australia
| | - Claire Brunero
- University of Sydney, Rural Clinical School (Broken Hill), Broken Hill, Australia
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Conway-Hicks S, de Groot JM. Living in two worlds: Becoming and being a doctor among those who identify with "not from an advantaged background". Curr Probl Pediatr Adolesc Health Care 2019; 49:92-101. [PMID: 31060911 DOI: 10.1016/j.cppeds.2019.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aim to deepen understanding of the experiences of becoming and being a physician among those in medicine who are 'not from advantaged backgrounds'. Despite modest success with institutional efforts to increase the diversity of medical school students, individuals with this less visible dimension of diversity remain under-represented across North America and the UK. Further, little is known about their experiences and contributions following medical school entry. In-depth interviews were carried out with twelve participants, including eight medical students, a resident and three physicians to explore experiences in medicine among those who self-identify with 'not from an advantaged background'. Reflection on the meaning of those experiences was encouraged. Intersectional identifications were common in relation to 'not from an advantaged background'. For some, the latter was background to identification with upbringings that were rural, influence by ethnicity, personal or parental immigration, and parents who were single or had limited education. Themes that arose in relation to being and becoming a doctor for these participants included: (1) the hidden curriculum's contribution to silencing markers of socioeconomic under-privilege; (2) limited formal curriculum opportunities to discuss socio-economic difference; (3) professional identity construction including empathy for the varied challenges of low-income patients in clinical situations and (4) living in two worlds: with a tension between the medical world and one's original world of socializing with friends and family from a non-advantaged upbringing. This study offered a unique, welcome opportunity to reflect on professional identity development in relation to one's family's socio-economic status. Safe, inclusive pedagogical opportunities to discuss socio-economic status and its intersectional elements, may support professional identity development that includes empathy and responsiveness to health inequities. The open dialogue, although perhaps uncomfortable, may be valuable to enhance cultural humility among medical students. The assessment of such initiatives in relation to professional identity formation is an important next step.
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Affiliation(s)
- Siobhan Conway-Hicks
- Family Physician and MD psychotherapist in private practice, Saskatoon, Saskatchewan, Canada.
| | - Janet M de Groot
- Staff Psychiatrist, Foothills Medical Centre, Calgary, AB, Canada; Staff Psychiatrist, Tom Baker Cancer Centre, Calgary, AB, Canada; Associate Professor, Cumming School of Medicine, University of Calgary, AB, Canada.
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Kemp S, Hu W, Bishop J, Forrest K, Hudson JN, Wilson I, Teodorczuk A, Rogers GD, Roberts C, Wearn A. Medical student wellbeing - a consensus statement from Australia and New Zealand. BMC MEDICAL EDUCATION 2019; 19:69. [PMID: 30832630 PMCID: PMC6399899 DOI: 10.1186/s12909-019-1505-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 02/22/2019] [Indexed: 05/20/2023]
Abstract
BACKGROUND Medical student wellbeing - a consensus statement from Australia and New Zealand outlines recommendations for optimising medical student wellbeing within medical schools in our region. Worldwide, medical schools have responsibilities to respond to concerns about student psychological, social and physical wellbeing, but guidance for medical schools is limited. To address this gap, this statement clarifies key concepts and issues related to wellbeing and provides recommendations for educational program design to promote both learning and student wellbeing. The recommendations focus on student selection; learning, teaching and assessment; learning environment; and staff development. Examples of educational initiatives from the evidence-base are provided, emphasising proactive and preventive approaches to student wellbeing. MAIN RECOMMENDATIONS The consensus statement provides specific recommendations for medical schools to consider at all stages of program design and implementation. These are: Design curricula that promote peer support and progressive levels of challenge to students. Employ strategies to promote positive outcomes from stress and to help others in need. Design assessment tasks to foster wellbeing as well as learning. Provide mental health promotion and suicide prevention initiatives. Provide physical health promotion initiatives. Ensure safe and health-promoting cultures for learning in on-campus and clinical settings. Train staff on student wellbeing and how to manage wellbeing concerns. CONCLUSION A broad integrated approach to improving student wellbeing within medical school programs is recommended. Medical schools should work cooperatively with student and trainee groups, and partner with clinical services and other training bodies to foster safe practices and cultures. Initiatives should aim to assist students to develop adaptive responses to stressful situations so that graduates are prepared for the realities of the workplace. Multi-institutional, longitudinal collaborative research in Australia and New Zealand is needed to close critical gaps in the evidence needed by medical schools in our region.
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Affiliation(s)
- Sandra Kemp
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, Western Australia
| | - Wendy Hu
- School of Medicine, Western Sydney University, Penrith, New South Wales Australia
| | - Jo Bishop
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland Australia
| | - Kirsty Forrest
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland Australia
| | - Judith N. Hudson
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
| | - Ian Wilson
- School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales Australia
| | - Andrew Teodorczuk
- School of Medicine, Griffith University, Gold Coast, Queensland Australia
| | - Gary D. Rogers
- School of Medicine, Griffith University, Gold Coast, Queensland Australia
| | - Chris Roberts
- Northern Clinical and Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales Australia
| | - Andy Wearn
- Medical Programme Directorate, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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