Achievement of non-cognitive goals of undergraduate medical education: perceptions of medical students, residents, faculty and other health professionals

Development of affective learning in dietetics graduates: A qualitative longitudinal study

BACKGROUND

The development of affective learning during healthcare student education is essential for professional practice. Current studies are limited to short-term studies with medicine and nursing students. Longitudinal studies are emerging; however, the research within allied health students remains scant. The present study investigates the value of simulation-based learning activities in relation to affective learning among dietetic students.

METHODS

A double hermeneutic, interpretative phenomenological approach (IPA) approach was employed, followed by an analysis of the trajectory of participants' affective learning across three-interview time points via the application of Krathwohl's affective learning levels.

RESULTS

The simulation developed affective learning in four of the six participants, specifically in relation to their view of themselves as practitioners and their understanding of their future responsibilities to patient care. Three key themes were identified in the participants: (1) feeling of workforce readiness, (2) valuing lifelong learning and (3) attitudes towards interprofessional teamwork.

CONCLUSIONS

This IPA methodology described dietetic students' affective learning development as they transitioned to practice as graduate health professionals. Simulation-based learning is one activity that enhances students' learning in the affective domain and educators should consider its value within their programs.

Definition of character for medical education based on expert opinions in Korea

PURPOSE

This follow-up study focused on 3 overarching questions: what keywords can be extracted from experts’ definitions of character?; what is the operational definition of character for medical students?; and what possible solutions can be suggested to address the issues of character education that were identified in the previous study?

METHODS

Sixty-three medical education experts recruited through expert sampling and 19 non-medical education experts recruited through snowball sampling answered a questionnaire that addressed the 3 major questions of the study. The responses were analyzed for descriptive statistics with supplementary keyword extraction tools, including the Cortical and Monkey keyword extractors.

RESULTS

A total of 93 definitional statements were counted, and 138 keyword terms were extracted. The top 5 keyword terms mentioned by the medical education experts were “patient”, “empathy”, “qualities”, “attitude”, and “ability”. These keyword terms were quite different from those mentioned by the non-medical education experts. Based on the extracted keywords, an operational definition of character education by the medical education expert group was presented as follows: the basic qualities and ability to empathize with patients affected by illness based on respect for patients and others. Various methods were proposed to solve the issue of character education, and many of them pointed to curriculum development, such as improvements in teaching and learning methods and evaluation methods, including role modeling.

CONCLUSION

A clear statement of the concept of character education is the start to resolve issues of character education. Character education improvements will be possible at the institutional level according to the above results.

Have medical students' attitudes towards clinical communication skills changed over a 12- year period? A comparative long-term study

BACKGROUND

Attitudes towards learning clinical communication skills at the end of medical school are likely to reflect the students' training and motivation for the continued development of their skills as doctors. Students from two Norwegian medical schools, one with a traditional, and the other with an integrated curriculum, were approached in 2003 and 2015; with regard to changes in students' attitudes towards acquiring communication skills in two diverse learning environments. This comparison might reveal the effects of the training programs from a long-term perspective, as neither of the medical schools made any major curriculum changes within the study period.

METHODS

The samples comprised final-year medical students. Two separate cross-sectional surveys performed 12 years apart (2003 and 2015) used items from the Communication Skills Attitude Scale in addition to age and gender. The traditional curriculum included only theoretical teaching and no contact with patients was made during the first 2 to 2.5 years of medical school. However, the integrated curriculum combined training in theoretical and clinical communication skills with early patient contact from the beginning.

RESULTS

Attitudes improved from the first to the second survey at both schools, however, students from the integrated school reported more positive attitudes than those from the traditional school. Female students from the integrated school contributed the most to the difference in attitudes in both surveys.

CONCLUSIONS

Students in both traditional and integrated curricula improved their attitudes from the first to the second assessment. However, compared with the traditional curriculum, the integrated one fostered even higher levels of positive attitudes towards acquiring communication skills, and a pronounced influence was observed on female students. These findings suggest that an educational program with greater emphasis on improving attitudes among male students may be required.

Recognition of Core Elements of Medical Professionalism among Medical Students and Faculty Members

OBJECTIVES

Medical students and future physicians have chosen to pursue a profession that requires personal integrity, compassion and a constant awareness of the commitment made by them. Professionalism includes personal behaviors, knowledge, and competency. It includes the attitudes and values one holds and that run through the profession as a whole. Medical students learn professionalism during the course by either direct teaching or experiential learning. We conducted this study to estimate the self-reported level of practice of the core elements of professionalism by medical students and medical faculty and compared the two groups.

METHODS

One-hundred and nine students and 83 faculty members of Oman Medical College completed a professionalism questionnaire. The survey questions related to core elements of professionalism and were grouped under professional knowledge, professional skills, professional attitude, and qualities essential for professionalism.

RESULTS

The response rate was 65.6% (109 of 166) among students and 75.5% (83 of 110) from faculty members. Response to the questions on professional skills between the student and faculty group was significantly different (p < 0.001). Similarly, there was a significant difference in the responses related to professional attitude between the student and faculty group (p < 0.001). Students and faculty members have a significant difference in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency (p = 0.024). Similarly, significant differences in opinion regarding up to date knowledge of basic and clinical sciences and clinical competency in clinical and basic sciences faculty members (p = 0.001). Students identified good communication skills (82.6%), and faculty staff identified up to date professional knowledge (62.7%) as the most important aspect of professionalism.

CONCLUSIONS

Both students and teaching faculty agreed that the top most professional elements are up to date knowledge, good communication skills, and teamwork. Hence, it is important that faculty members encourage their students to improve their professional skills and attitude.

Patients' assessment of professionalism and communication skills of medical graduates

BACKGROUND

Professionalism and communication skills constitute important components of the integral formation of physicians which has repercussion on the quality of health care and medical education. The objective of this study was to assess medical graduates' professionalism and communication skills from the patients' perspective and to examine its association with patients' socio-demographic variables.

METHODS

This is a hospital based cross-sectional study. It involved 315 patients and 105 medical graduates selected by convenient sampling method. A modified and validated version of the American Board of Internal Medicine's (ABIM) Patient Assessment survey questionnaire was used for data collection through a face to face interview. Data processing and analysis were performed using the Statistical Package for Social Science (SPSS) 16.0. Mean, frequency distribution, and percentage of the variables were calculated. A non-parametric Kruskal Wallis test was applied to verify whether the patients' assessment was influenced by variables such as age, gender, education, at a level of significance, p ≤ 0.05.

RESULTS

Female patients constituted 46% of the sample, whereas males constituted 54%. The mean age was 36 ± 16. Patients' scoring of the graduate's skills ranged from 3.29 to 3.83 with a mean of 3.64 on a five-point Likert scale. Items assessing the "patient involvement in decision-making" were assigned the minimum mean values, while items dealing with "establishing adequate communication with patient" assigned the maximum mean values. Patients, who were older than 45 years, gave higher scores than younger ones (p < 0.001). Patients with higher education reported much lower scores than those with lower education (p = 0.003). Patients' gender did not show any statistically significant influence on the rating level.

CONCLUSION

Generally patients rated the medical graduates' professionalism and communication skills at a good level. Patients' age and educational level were significantly associated with the rating level.

Caring for attitudes as a means of caring for patients--improving medical, pharmacy and nursing students' attitudes to each other's professions by engaging them in interprofessional learning

INTRODUCTION

Negative attitudes between pharmacists, doctors and nurses can impact adversely on patients' medicines management. A seven-week interprofessional learning (IPL) intervention was delivered to foster positive attitudes.

METHODS

First-year pharmacy, nursing and medical students' attitudes were assessed using the Attitudes to Health Professionals Questionnaire before and after IPL intervention.

RESULTS

Students viewed pharmacists, doctors and nurses as more 'caring' after IPL. Nurses were viewed as most 'caring'. Nursing and pharmacy students perceived doctors as least 'caring' before and after IPL whereas medical students viewed pharmacists as least 'caring'. Students perceived their own profession as more 'caring' than others did. The three-way analysis of variance showed a significant difference between student groups (p<0.0001), professions (p<0.0001) and before-and-after IPL (p<0.005).

CONCLUSION

Findings suggest that students' attitudes are more positive after they have worked together during seven weeks of IPL. Each student group view their own profession more positively than others. Views become more aligned after this IPL intervention. Time may be an important factor in allowing for attitudes to change. IPL can help foster positive attitudes between doctors, pharmacists and nurses, which may facilitate effective collaboration and thus enhance patients' medicines management.

Can personal qualities of medical students predict in-course examination success and professional behaviour? An exploratory prospective cohort study

BACKGROUND

Over two-thirds of UK medical schools are augmenting their selection procedures for medical students by using the United Kingdom Clinical Aptitude Test (UKCAT), which employs tests of cognitive and non-cognitive personal qualities, but clear evidence of the tests' predictive validity is lacking. This study explores whether academic performance and professional behaviours that are important in a health professional context can be predicted by these measures, when taken before or very early in the medical course.

METHODS

This prospective cohort study follows the progress of the entire student cohort who entered Hull York Medical School in September 2007, having taken the UKCAT cognitive tests in 2006 and the non-cognitive tests a year later. This paper reports on the students' first and second academic years of study. The main outcome measures were regular, repeated tutor assessment of individual students' interpersonal skills and professional behaviour, and annual examination performance in the three domains of recall and application of knowledge, evaluation of data, and communication and practical clinical skills. The relationships between non-cognitive test scores, cognitive test scores, tutor assessments and examination results were explored using the Pearson product-moment correlations for each group of data; the data for students obtaining the top and bottom 20% of the summative examination results were compared using Analysis of Variance.

RESULTS

Personal qualities measured by non-cognitive tests showed a number of statistically significant relationships with ratings of behaviour made by tutors, with performance in each year's objective structured clinical examinations (OSCEs), and with themed written summative examination marks in each year. Cognitive ability scores were also significantly related to each year's examination results, but seldom to professional behaviours. The top 20% of examination achievers could be differentiated from the bottom 20% on both non-cognitive and cognitive measures.

CONCLUSIONS

This study shows numerous significant relationships between both cognitive and non-cognitive test scores, academic examination scores and indicators of professional behaviours in medical students. This suggests that measurement of non-cognitive personal qualities in applicants to medical school could make a useful contribution to selection and admission decisions. Further research is required in larger representative groups, and with more refined predictor measures and behavioural assessment methods, to establish beyond doubt the incremental validity of such measures over conventional cognitive assessments.

Evidence for validity of a survey to measure the learning environment for professionalism

BACKGROUND

With the emphasis on professionalism in academic health settings, including recently added accreditation requirements for US medical schools, there is a need for a valid and feasible method to assess the learning environment for professionalism.

AIM

 This article describes the development and investigation of the validity of a brief measure, the learning environment for professionalism (LEP) survey, designed to assess medical student perceptions of professionalism among residents and faculty during clinical rotations.

METHOD

 Two successive cohorts of third-year medical students completed the 22-item LEP survey at the conclusion of clerkship rotations, providing a total of 902 responses for scale reliability and principal components factor analysis, as well as assessment of changes in scores over time and correlations with a related clerkship evaluation item.

RESULTS

 The internal structure of the LEP survey was consistent with intended goals to assess both positive and negative professionalism behaviors. Acceptable internal consistency, sensitivity to change over time, and positive relationships between LEP scores and a concurrent measure of professionalism were observed.

CONCLUSIONS

 Use of the instrument could help identify clinical learning environments for professionalism that represent either best practices or areas in need of improvement, assess the impact of professionalism initiatives, and help satisfy accreditation requirements.

Development of a method to investigate medical students' perceptions of their personal and professional development

Personal and Professional Development (PPD) is now key to the undergraduate medical curriculum and requires provision of appropriate learning experiences. In order to achieve this, it is essential that we ascertain students' perceptions of what is important in their PPD. We required a methodological approach suitable for a large medical school, which defines constructs used by the students to describe their PPD, and is not constrained by a researcher's predetermined line of questioning. It should also quantify the saliencies of these constructs in the student population and indicate how they gauge their own PPD. The instrument should also be suitable for administration at key stages of the students' learning experience. Here we describe the first stages in developing a novel method, which fulfils these requirements. It is based on a modified self repertory grid, the "Ideal Self" Inventory. All first year students (N = 379), provided five descriptors of a "good medical student" and of a not very good medical student, which generated 1,531 'ideal' qualities. To define underlying themed constructs, 49 randomly selected descriptors, were grouped together by self selected students (n = 55), using commonly held assumptions. Frequency of item co-occurrence was tabulated by multidimensional scaling. Themed clusters of 'ideal' qualities, defined by hierarchical cluster analysis, were overlaid onto the multidimensional scaling to generate a concept map. This revealed seven themed constructs; Personal Welfare, Time and Self Management Committed Work Ethic, Learning Skills, Personal Development/Reflection, Personal and Professional Conduct and Teamwork. We then analysed the 1,531 'ideal' qualities, by determining the frequency with which students used each construct and the proportion of students who used a construct at least once. Personal and Professional Conduct, Committed Work Ethic and Time and Self Management were the most frequently used, implying that they were the most salient for the first year students.

Longitudinal integrated clerkships for medical students: an innovation adopted by medical schools in Australia, Canada, South Africa, and the United States

PURPOSE

Integrated clinical clerkships represent a relatively new and innovative approach to medical education that uses continuity as an organizing principle, thus increasing patient-centeredness and learner-centeredness. Medical schools are offering longitudinal integrated clinical clerkships in increasing numbers. This report collates the experiences of medical schools that use longitudinal integrated clerkships for medical student education in order to establish a clearer characterization of these experiences and summarize outcome data, when possible.

METHOD

The authors sent an e-mail survey with open text responses to 17 medical schools with known longitudinal integrated clerkships.

RESULTS

Sixteen schools in four countries on three continents responded to the survey. Fifteen institutions have active longitudinal integrated clerkships in place. Two programs began before 1995, but the others are newer. More than 2,700 students completed longitudinal integrated clerkships in these schools. The median clerkship length is 40 weeks, and in 15 of the schools, the core clinical content was in medicine, surgery, pediatrics, and obstetrics-gynecology. Eleven schools reported supportive student responses to the programs. No differences were noted in nationally normed exam scores between program participants and those in the traditional clerkships. Limited outcomes data suggest that students who participate in these programs are more likely to enter primary care careers.

CONCLUSIONS

This study documents the increasing use of longitudinal integrated clerkships and provides initial insights for institutions that may wish to develop similar clinical programs. Further study will be needed to assess the long-term impact of these programs on medical education and workforce initiatives.

A situational judgement test of professional behaviour: development and validation

AIMS

To describe the development of a single best answer multiple choice situational judgement test (SJT) to assess medical students' ability to judge professional behaviour; to present results of an expert validation of the SJT; to describe experiences with two different validation formats.

METHODS

Based on educational objectives and work situations concerning professional behaviour, a SJT with 17 vignettes and 35 questions was developed. Best answers were developed according to available evidence. Forty-four experts validated the answers using either a rank order or a rating scale.

RESULTS

For sixteen questions in the rating group, thirteen questions in the ranking group and twelve questions in both groups more than two thirds of the experts agreed on a best answer. In the ranking group some experts found it difficult to commit themselves to a single best answer as instructed. In the rating group some experts did not mark any of the proposed answer options as adequate.

DISCUSSION

The definition of the construct of and experts for professional behaviour remain a challenge. Both validation scales have advantages and disadvantages. The two thirds criterion is somewhat arbitrary and lower or higher agreement may be acceptable or necessary depending on the purpose of the assessment.

Medical students' cognitive and affective attitudes towards learning and using communication skills--a nationwide cross-sectional study

AIMS

We wanted to explore cognitive and affective attitudes towards communication skills among students in Norwegian medical schools.

METHOD

1833 (60% response rate) medical students at the four medical schools in Norway filled in questionnaires by the end of term in May 2003. The Communication Skills Attitudes Scale (CSAS) was used for assessing affective and cognitive attitudes separately.

RESULTS AND CONCLUSIONS

Medical students have positive attitudes towards learning and using communication skills. Cognitive and affective attitudes displayed different patterns. Being female and having worked in the health services before admission to the medical school predicted more positive scores both towards cognitive and affective attitudes. Having worked as a junior doctor during medical school predicted more positive cognitive attitudes. Cognitive attitudes towards communication skills did not vary significantly between year groups in any of the medical schools. Scores reflecting affective attitudes gradually fell for each year in all schools, but rose again in the final year in two of them. Implications for curriculum design are discussed.

Authentic community as an educational strategy for advancing professionalism: a national evaluation of the Healer's Art course

BACKGROUND

Efforts to promote medical professionalism often focus on cognitive and technical competencies, rather than professional identity, commitment, and values. The Healer's Art elective is designed to create a genuine community of inquiry into these foundational elements of professionalism.

OBJECTIVE

Evaluations were obtained to characterize course impact and to understand students' conceptions of professionalism.

DESIGN

Qualitative analysis of narrative course evaluation responses.

PARTICIPANTS

Healer's Art students from U.S. and Canadian medical schools.

APPROACH

Analysis of common themes identified in response to questions about course learning, insights, and utility.

RESULTS

In 2003-2004, 25 schools offered the course. Evaluations were obtained from 467 of 582 students (80.2%) from 22 schools participating in the study. From a question about what students learned about the practice of medicine from the Healer's Art, the most common themes were "definition of professionalism in medicine" and "legitimizing humanism in medicine." The most common themes produced by a question about the most valuable insights gained in the course were "relationship between physicians and patients" and "creating authentic community." The most common themes in response to a question about course utility were "creating authentic community" and "filling a curricular gap."

CONCLUSIONS

In legitimizing humanistic elements of professionalism and creating a safe community, the Healer's Art enabled students to uncover the underlying values and meaning of their work--an opportunity not typically present in required curricula. Attempts to teach professionalism should address issues of emotional safety and authentic community as prerequisites to learning and professional affiliation.

The influence of personal and environmental factors on professionalism in medical education

BACKGROUND

Professionalism is a critical quality for physicians to possess. Physician professionalism has received increased attention in recent years, with many authorities suggesting that professionalism is in decline. An understanding of the factors contributing to professionalism may allow the development of more effective approaches to promoting this quality in medical education.

DISCUSSION

We propose a model of personal and environmental factors that contribute to physician professionalism. Personal factors include distress/well-being, individual characteristics, and interpersonal qualities. Environmental factors include institutional culture, formal and informal curricula, and practice characteristics. Promotion of professionalism requires efforts directed at each of these elements.

SUMMARY

One responsibility of medical education is to foster the development of professionalism among its learners. Both personal and environmental factors play a role in physician professionalism. Accordingly, institutions should consider these factors as efforts to promote physician professionalism evolve.

Defining medical professionalism: a qualitative study

BACKGROUND

Elements of professionalism are well-described in the literature and medical schools continue to struggle with how to teach these concepts effectively.

PURPOSE

The purpose of this study was to investigate the meaning of medical professionalism to medical students, residents, academic faculty and patients and to determine areas of congruence and difference.

METHODS

In this qualitative study we conducted 8 focus groups to discover subjects' beliefs, perceptions and expectations of medical professionals. Sessions were audiotaped and transcribed, and themes identified through an immersion/crystallisation process. Concept maps were prepared to aid understanding.

RESULTS

Recurring primary themes of knowledge/technical skills, patient relationship and character virtues were identified. Secondary themes were medicine as a unique profession, personal congruence and the importance of peer relationships. There was a shift in emphasis reflecting differing stages in the learner continuum. Although patients desired skilled technicians, their themes focused on relationships. Several unique themes were also identified.

CONCLUSIONS

Some elements of professionalism are embraced by learners at all stages and by patients. Notably, when compared to components of the American Board of Internal Medicine Physician Charter, themes relating to social justice elements were lacking. Differences in emphasis by learner groups reflect the inherent challenges to teaching professionalism successfully. Future studies investigating these differing perceptions are needed to help clarify our teaching mission.

The Professionalism Mini-evaluation Exercise: a preliminary investigation

BACKGROUND

As the evaluation of professional behaviors has been identified as an area for development, the Professionalism Mini-Evaluation Exercise (P-MEX) was developed using the mini-Clinical Examination Exercise (mini-CEX) format.

METHOD

From a set of 142 observable behaviors reflective of professionalism identified at a McGill workshop, 24 were converted into an evaluation instrument modeled on the mini-CEX. This instrument, designed for use in multiple settings, was tested on clinical clerks in medicine, surgery, obstetrics and gynecology, psychiatry, and pediatrics. In all, 211 forms were completed on 74 students by 47 evaluators.

RESULTS

Results indicate content and construct validity. Exploratory factor analysis yielded 4 factors: doctor-patient relationship skills, reflective skills, time management, and interprofessional relationship skills. A decision study showed confidence intervals sufficiently narrow for many measurement purposes with as few as 8 observations. Four items frequently marked below expectations may be identifiers for "problem" students.

CONCLUSION

This preliminary study suggests that the P-MEX is a feasible format for evaluating professionalism in clinical training.