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Taylor AWR, Anderson ES, Gay S. 'It's a gamble': A phenomenological exploration of medical students' learning experiences as newcomers to clinical communities of practice. CLINICAL TEACHER 2024; 21:e13708. [PMID: 38058032 DOI: 10.1111/tct.13708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 10/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Medical students become members of the clinical team through participation in their activities, as described by Lave and Wenger's situated learning theory. While there is research into how medical students cognitively engage in clinical learning, there is limited work on clinical experiences using a social theoretical lens such as situated learning theory. METHOD This study explored third year medical students' lived experience as newcomers to clinical teams using a qualitative phenomenological approach. Medical students completed in-depth, semi-structured interviews in 2021. Interpretive phenomenological analysis (IPA) using Lave and Wenger's theory of situated learning was applied to understand students' experiences. RESULTS Seven students discussed their variable placement experiences. Learning related to three elements: conditions for participation, modes of participation and products of participation. When certain conditions were met relating to student, clinician and activity, students learned. This drove identity and relationship formation. The findings related and led to a self-perpetuating cycle with potential to advance student learning. When the conditions for participation were not met, the cycle stopped, leading to student disengagement. CONCLUSION Passivity in students is a result of modifiable factors in the workplace. To encourage proactivity, clinicians must enable students to move from observation to participation as their competence increases. Participation should be supervised, challenging and should contribute to patient care. Time pressures can make this difficult; one solution is to nominate a clinician to direct students and account for this in their workload or to employ a clinical fellow to assist with student training.
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Affiliation(s)
| | | | - Simon Gay
- University of Leicester School of Medicine, Leicester, UK
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2
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Le HV. Factors impeding university students' participation in English extracurricular activities: Time constraints and personal obstacles. Heliyon 2024; 10:e27332. [PMID: 38495142 PMCID: PMC10943383 DOI: 10.1016/j.heliyon.2024.e27332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/08/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024] Open
Abstract
The incorporation of extracurricular activities (ECAs) that focus on the English language is of utmost importance in higher education as it serves to improve students' interpersonal abilities and proficiency in language. The objective of this study is to ascertain the primary variables that serve as deterrents to the active engagement of university students in these activities. The results highlight notable barriers, including limited time availability and individual issues such as diminished self-assurance in social engagements and restricted competency in the English language. The findings of this study have significant significance for individuals learning a new language and organizers of English language immersion programmes. The research provides valuable insights into the creation of immersive environments that effectively facilitate language acquisition, experiential learning, and enhanced social interactions among students.
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Affiliation(s)
- Ha Van Le
- FPT University, Ho Chi Minh Campus, Viet Nam
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3
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Wijbenga MH, Duvivier RJ, Driessen EW, Ramaekers SPJ, Teunissen PW. Challenges, coping and support during student placement abroad: A qualitative study. MEDICAL TEACHER 2023; 45:1373-1379. [PMID: 37272113 DOI: 10.1080/0142159x.2023.2218542] [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: 06/06/2023]
Abstract
BACKGROUND During placements abroad, healthcare students are confronted with different personal and professional challenges, related to participation in practice. This study investigates when and how students respond to such challenges, and which coping and support mechanisms students use to overcome these. METHODS Twenty-five international students shared their experiences about physiotherapy placement in The Netherlands. Using a critical incident technique, we asked participants to recall events where participation was affected by an unforeseen situation, in or outside the clinic. Further, we explored students' strategies of seeking support within their social network to overcome individual challenges. Two researchers applied thematic analysis to the interview data, following an iterative approach. Team discussions supported focused direction of data collection and analysis, before conceptualizing results. RESULTS Participants described a wide range of challenges. The scope and impact level of challenges varied widely, including intercultural differences, language barriers and inappropriate behaviour in the workplace, students' personal context and wellbeing. Mechanisms employed by students to overcome these challenges depended on the type of event (personal or professional), making purposeful use of their available network. CONCLUSION Students involve clinical staff, peers, family and friends during placement abroad, to make deliberate use of their support network to overcome challenges in participation, whereas the academic network remains distant. Findings may help reflect on the roles and responsibilities of academic staff and other professionals involved with placements abroad. Healthcare programmes should ensure support before, during and after placement is within students' reach.
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Affiliation(s)
- Miriam H Wijbenga
- European School of Physiotherapy/Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life sciences, Maastricht University, Maastricht, The Netherlands
| | - Robbert J Duvivier
- Center for Education Development and Research in Health Professions (CEDAR), UMC Groningen, Groningen, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Erik W Driessen
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life sciences, Maastricht University, Maastricht, The Netherlands
| | - Stephan P J Ramaekers
- European School of Physiotherapy/Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Pim W Teunissen
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life sciences, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics & Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
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Xia J, Wu H, Cheng H, Jiang Z. The impact of student engagement on satisfaction with medical education in china: a supplementary perspective. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1265-1288. [PMID: 37052739 DOI: 10.1007/s10459-023-10219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/19/2023] [Indexed: 06/19/2023]
Abstract
As one of the indicators reflecting student well-being in medical education practice, student satisfaction is no doubt an important topic. Instead of exploring student satisfaction from the perspectives of education quality and organizational factors, this study focused on student engagement to explore the impact of it on student satisfaction with medical education in China. Student engagement refers to students' actions, efforts and persistence, indicating both time and energy students invested in educationally purposeful activities, especially academic activities. The data used in this study came from the first national survey of clinical undergraduates-the China Medical Student Survey-in which 10,062 clinical medical undergraduates in 33 medical schools participated. We developed a model of medical student engagement and satisfaction and utilized descriptive statistics, ordered logit regression, and path analysis to describe the relationship between medical student engagement and satisfaction. In this study, student engagement was categorized into behavioral, emotional and cognitive dimensions. The findings showed that medical student satisfaction was relatively low and was significantly affected by student satisfaction, especially the behavioral engagement in clinical rotations and professional identity of emotional engagement. These findings could put a supplementary perspective on improving student satisfaction through student engagement, and offer notable implications for future research and practice.
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Affiliation(s)
- Jie Xia
- Faculty of Education, The Open University of China, Beijing, China
| | - Hongbin Wu
- Institute of Medical Education, National Center for Health Professions Education Development, Peking University, Beijing, China.
| | - Huaqin Cheng
- Institute of Medical Education, National Center for Health Professions Education Development, Peking University, Beijing, China
| | - Zhehan Jiang
- Institute of Medical Education, National Center for Health Professions Education Development, Peking University, Beijing, China
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Wilson OWA, Broman P, Tokolahi E, Andersen P, Brownie S. Learning Outcomes from Participation in Student-Run Health Clinics: A Systematic Review. J Multidiscip Healthc 2023; 16:143-157. [PMID: 36700175 PMCID: PMC9869697 DOI: 10.2147/jmdh.s385709] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023] Open
Abstract
Student-run clinics (SRCs) offer unique opportunities for students to engage in healthcare delivery, but the student learning outcomes of such clinics have not yet been systematically examined in a comprehensive manner. The purpose of this review was to appraise and synthesize existing literature pertaining to student learning outcomes associated with participation in SRCs. A systematic review was undertaken using PubMed, CINAHL, and Web of Science databases. The quality of articles that met inclusion criteria articles was appraised using the Mixed Methods Appraisal Tool (MMAT). Study details, such as learning outcomes, were also extracted. Ninety-two studies met inclusion criteria. Most studies were conducted in North America (n = 73, 79.3%), and related to clinics involving solely medical students (n = 35, 38.0%) or multi-professional clinics (n = 34, 37.0%). Demonstrated learning outcomes of SRC participation include clinical skills, interprofessional skills, empathy/compassion for underserved patients, and leadership. SRC participation had little apparent impact on students' future career directions. Quality appraisal via the MMAT found mixed levels of research quality amongst reviewed studies. In summary, while SRC participation appears to offer benefits for student learning, improved study design and research outside of North American contexts would further advance knowledge.
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Affiliation(s)
- Oliver W A Wilson
- Centre for Health and Social Practice, Waikato Institute of Technology Te Pūkenga, Hamilton, New Zealand,Department of Kinesiology, Pennsylvania State University, University Park, PA, USA,Te Hau Kori, Victoria University of Wellington, Wellington, New Zealand
| | - Patrick Broman
- Centre for Health and Social Practice, Waikato Institute of Technology Te Pūkenga, Hamilton, New Zealand
| | - Ema Tokolahi
- Centre for Health and Social Practice, Waikato Institute of Technology Te Pūkenga, Hamilton, New Zealand,School of Occupational Therapy, Otago Polytechnic Te Pūkenga, Dunedin, New Zealand
| | - Patrea Andersen
- Centre for Health and Social Practice, Waikato Institute of Technology Te Pūkenga, Hamilton, New Zealand,School of Nursing, Midwifery and Social Science, CQUniversity, Rockhampton, QLD, Australia,School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy DownsQLD, Australia
| | - Sharon Brownie
- Centre for Health and Social Practice, Waikato Institute of Technology Te Pūkenga, Hamilton, New Zealand,School of Health Sciences, Swinburne University, Hawthorne, VIC, Australia,School of Medicine & Dentistry, Griffith University, BrisbaneQLD, Australia,Correspondence: Sharon Brownie, School of Health Sciences, Swinburne University, Hawthorne, VIC, Australia, Email
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Brown MEL, Lim JH, Horsburgh J, Pistoll C, Thakerar V, Maini A, Johnson C, Beaton L, Mahoney C, Kumar S. Identity Development in Disorientating Times: the Experiences of Medical Students During COVID-19. MEDICAL SCIENCE EDUCATOR 2022; 32:995-1004. [PMID: 35936649 PMCID: PMC9340721 DOI: 10.1007/s40670-022-01592-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Professional identity development is a central aim of medical education, which has been disrupted during COVID-19. Yet, no research has qualitatively explored COVID-19's impact across institutions or countries on medical students' identities. Kegan proposes a cognitive model of identity development, where 'disorientating dilemmas' prompt student development. Given the potential of COVID-related disruption to generate disorientating dilemmas, the authors investigated the ways in which COVID-19 influenced students' identity development. METHODS The authors conducted an international qualitative study with second year medical students from Imperial College London, and third year students from Melbourne Medical School. Six focus groups occurred 2020-2021, with three to six students per group. Authors analysed data using reflexive thematic analysis, applying Kegan's model as a sensitising theoretical lens. RESULTS COVID-19 has resulted in a loss of clinical exposure, loss of professional relationships, and a shift in public perception of physicians. Loss of exposure to clinical practice removed the external validation from patients and seniors many students depended on for identity development. Students' experiences encouraged them to assume the responsibilities of the profession and the communities they served, in the face of conflicting demands and risk. Acknowledging and actioning this responsibility facilitated identity development as a socially responsible advocate. CONCLUSIONS Educators should consider adapting medical education to support students through Kegan's stages of development. Measures to foster relationships between students, patients, and staff are likely necessary. Formal curricula provisions, such as spaces for reflection and opportunities for social responsibility, may aid students in resolving the conflict many have recently experienced. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01592-z.
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Affiliation(s)
- Megan E. L. Brown
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Jun Hua Lim
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Chance Pistoll
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Viral Thakerar
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Arti Maini
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
| | - Caroline Johnson
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Laura Beaton
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Claire Mahoney
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Parkville, VIC Australia
| | - Sonia Kumar
- Medical Education Innovation and Research Centre (MEdIC), Imperial College London, London, UK
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Xu X, Bos NA, Wu H. The relationship between medical student engagement in the provision of the school's education programme and learning outcomes. MEDICAL TEACHER 2022; 44:900-906. [PMID: 35439086 DOI: 10.1080/0142159x.2022.2047168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Student engagement in the provision of the school's education programme (educational student engagement) plays an important role in quality assurance in medical education. However, little is known whether this specific type of student engagement has effects on the learning outcomes for the involved medical students. METHODS This study was based on a national-wide survey in China among medical students with 123,055 responses. The questionnaire was designed using international and Chinese national standards. T-test, analysis of variance, multivariate regression, and regression with interaction terms were used. RESULTS Educational student engagement was positively associated with medical students' learning outcomes in Clinical Practice, Science and Scholarship, Health and Society, and Professionalism. Besides, the influence was heterogeneous among participants at different learning phases. Learning outcomes in Clinical Practice were strongly associated with educational student engagement efficiently at the Clinical Medical Education and the Clerkship Rotation phases, and learning outcomes in Science and Scholarship were best correlated with the Clerkship Rotation phase. CONCLUSION Educational student engagement is positively associated with the learning outcomes, with the greatest effect on learning outcomes in Clinical Practice and the least effect in Professionalism. Besides, it has a greater impact on medical students at senior learning phases.
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Affiliation(s)
- Xiaoming Xu
- Center for Educational Development and Research in health sciences (CEDAR), LEARN, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - N A Bos
- Center for Educational Development and Research in health sciences (CEDAR), LEARN, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hongbin Wu
- National Centre for Health Professions Education Development/Institute of Medical Education, Peking University, Beijing, China
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Chiel L, Winthrop Z, Huth K, Gross CJ, Gomez A, Marcus CH, Winn AS. Bridge Builders: A Qualitative Study of Fellows' Successful Supervision of Residents. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:1195-1202. [PMID: 35385408 DOI: 10.1097/acm.0000000000004687] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE Clinical fellows, those training to become subspecialists in a program certified by the Accreditation Council for Graduate Medical Education, supervise residents on inpatient subspecialty rotations. Unlike for supervising residents or for faculty, there is a paucity of literature describing fellows' supervision of residents. The aim of this study was to understand residents' and fellows' perception of successful supervision of residents by fellows on inpatient subspecialty rotations to inform the development of curricula to support fellows as supervisors. METHOD Using grounded theory methodology, the authors held focus groups in May 2020 of pediatric residents and pediatric subspecialty fellows at Boston Children's Hospital, Boston, Massachusetts. Focus groups were conducted until thematic saturation was achieved. Deidentified transcripts were independently coded by 2 authors. The author team consolidated the codes into themes and developed an interpretive model for fellows' successful supervision of residents. Key results were confirmed via member checking. RESULTS The authors conducted 4 resident focus groups, composed of 16 pediatric residents, and 4 fellow focus groups, composed of 13 pediatric subspecialty fellows. Participants perceived that fellows who provided successful resident supervision advanced residents' professional growth and supported residents' development along 5 "bridges": (1) generalist to subspecialist, (2) trainee to autonomous practitioner, (3) individual to member of the interprofessional team, (4) emerging physician to patient-facing care provider, and (5) newcomer to engaged clinical learner. Fellows can further residents' growth in these areas by demonstrating approachability, empathy, appreciation, and kindness. CONCLUSIONS As newcomers on inpatient subspecialty rotations, residents engage in legitimate peripheral participation. Fellows who are successful supervisors move residents toward full participation in their profession via the bridge model. The fellow-resident dynamic carries advantages of near-peer learning. Fellows can harness their role, subspecialty knowledge, and familiarity with the training environment to enhance resident supervision.
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Affiliation(s)
- Laura Chiel
- L. Chiel is a fellow, Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zachary Winthrop
- Z. Winthrop is chief resident, Boston Combined Residency Program, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, and Department of Pediatrics, Boston Medical School and Boston University School of Medicine, Boston, Massachusetts
| | - Kathleen Huth
- K. Huth is assistant professor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Caroline J Gross
- C.J. Gross is a fellow, Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Amanda Gomez
- A. Gomez is a fellow, Division of Gastroenterology, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carolyn H Marcus
- C.H. Marcus is an instructor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ariel S Winn
- A.S. Winn is assistant professor, Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Rupert DD, Alvarez GV, Burdge EJ, Nahvi RJ, Schell SM, Faustino FL. Student-Run Free Clinics Stand at a Critical Junction Between Undergraduate Medical Education, Clinical Care, and Advocacy. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2022; 97:824-831. [PMID: 34817408 PMCID: PMC9678019 DOI: 10.1097/acm.0000000000004542] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Student-run free clinics (SRFCs) act as primary care providers that bring health care to populations in need and are an important source of undergraduate medical education (UME), guiding trainees through the art of history taking and physical examination. However, they are also social justice and advocacy initiatives-addressing disparity in access to care and educating medical trainees with firsthand exposure to socioeconomic determinants of health as well as language and medical illiteracy barriers. Here, the authors review academic literature examining the impact of SRFCs in their 3 roles: as medical care providers, as components of medical education, and as advocacy organizations. Based on the evidence of that literature and decades of direct SRFC leadership experience, the authors make the case that SRFCs are an undersupported means by which UME institutions contribute to correcting health care disparities and to serving social justice reform.
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Affiliation(s)
- Deborah D Rupert
- D.D. Rupert is a seventh-year MD-PhD student, Medical Scientist Training Program, Stony Brook University, Stony Brook, New York, and Department of Neuroscience, Cold Spring Harbor Laboratory, Cold Spring Harbor, New York; ORCID: https://orcid.org/0000-0002-3426-3912
| | - George V Alvarez
- G.V. Alvarez is resident physician, Department of Family Medicine, Northwell Glen Cove Hospital, Glen Cove, New York
| | - Eric J Burdge
- E.J. Burdge is a fourth-year medical student, Long Island School of Medicine, New York University, Mineola, New York; ORCID: https://orcid.org/0000-0002-4724-0226
| | - Roxanna J Nahvi
- R.J. Nahvi is a sixth-year MD-PhD student, School of Medicine and Department of Biochemistry and Molecular Biology, New York Medical College, Valhalla, New York; ORCID: https://orcid.org/0000-0002-7512-9736
| | - Spencer M Schell
- S.M. Schell is resident physician, Department of Family Medicine, OhioHealth Grant Medical Center, Columbus, Ohio; ORCID: https://orcid.org/0000-0002-2212-3760
| | - Francis L Faustino
- F.L. Faustino is assistant professor and chair, Department of Family Medicine, NYU Langone Hospital-Long Island, Mineola, New York
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Identification and evaluation of medication-related issues relating to patient’s own drugs by pharmacy students while on placement in a tertiary hospital. Int J Clin Pharm 2022; 44:575-579. [DOI: 10.1007/s11096-021-01370-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/14/2021] [Indexed: 11/05/2022]
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Bremer AE, van de Pol MHJ, Laan RFJM, Fluit CRMG. How an EPA-based curriculum supports professional identity formation. BMC MEDICAL EDUCATION 2022; 22:48. [PMID: 35057788 PMCID: PMC8781044 DOI: 10.1186/s12909-022-03116-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/07/2022] [Indexed: 05/16/2023]
Abstract
BACKGROUND Entrustable professional activities (EPAs) are widely used in medical education, and they might be an important incentive to stimulate professional identity formation (PIF) of medical students, by actively encouraging participation in the workplace. The goal of this study was to explore the effects of an EPA-based curriculum on the PIF of medical students in undergraduate curricula. METHODS In this study at the Radboud University Medical Center in Nijmegen, the Netherlands, the authors interviewed twenty-one medical students in three focus group interviews (November 2019), and conducted a thematic analysis based on both the synthesizing concepts PIF, communities of practice and EPAs, and newly defined themes. RESULTS Four central themes proved crucial for understanding the influence of EPAs on PIF: creating learning opportunities, managing feedback, dealing with supervision in context and developing confidence. EPAs helped students to create learning opportunities and to choose activities purposefully, and the use of EPAs stimulated their feedback-seeking behavior. The context and way of supervision had a great impact on their development, where some contexts offer better learning opportunities than others. EPAs helped them develop trust and self-confidence, but trust from supervisors hardly appears to result from using EPAs. CONCLUSIONS An EPA-based curriculum does stimulate PIF in the complex context of working and learning by supporting participation in the workplace and by encouraging feedback-seeking behavior. Striking the right balance between participation, feedback-seeking behavior and choosing learning activities is essential. TRIAL REGISTRATION This study was approved by the ethics committee of the Netherlands Association of Medical Education (NVMO, case number 2019.5.12).
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Affiliation(s)
- Anne E. Bremer
- Department of Radboudumc Health Academy, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | | | - Roland F. J. M. Laan
- Department of Radboudumc Health Academy, Postbus 9101, 6500 HB Nijmegen, The Netherlands
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Acker S, Noelke A, Huckabee M, Rieck KM. Development of the Proposed 13 Entrustable Professional Activities for Physician Assistant Graduates. J Physician Assist Educ 2021; 32:232-236. [PMID: 34731874 DOI: 10.1097/jpa.0000000000000387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Competency-based training has not consistently produced medical professionals who are ready to practice. To address this situation, entrustable professional activities (EPAs) have been introduced as a means to assess medical trainee readiness for their next phase of training or practice. Thirteen EPAs were developed by the Physician Assistant Education Association (PAEA) Presidents Commission in 2016 to indicate what activities they thought future physician assistant (PA) students should be expected to perform at the completion of their PA education. The 13 EPAs as proposed by the PAEA Presidents Commission were adopted by the Mayo Clinic PA program and further developed through multiple steps, including (1) Discovery and Alignment; (2) EPA Development; (3) Curriculum Development; (4) Assessment and Rubric Development, and (5) Implementation.
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Affiliation(s)
- Shekitta Acker
- Shekitta Acker, MS, PA-C, is academic co-director of the Mayo Clinic Physician Assistant Program, Rochester, Minnesota
- Ashley Noelke, MBA, is an operations specialist for the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
- Michael Huckabee, PhD, PA-C, is director of the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
- Katie M. Rieck, MD, MHA, is the medical director for the Mayo Clinic Physician Assistant Program and a hospitalist for the Mayo Clinic, Division of Hospital Internal Medicine, Rochester, Minnesota
| | - Ashley Noelke
- Shekitta Acker, MS, PA-C, is academic co-director of the Mayo Clinic Physician Assistant Program, Rochester, Minnesota
- Ashley Noelke, MBA, is an operations specialist for the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
- Michael Huckabee, PhD, PA-C, is director of the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
- Katie M. Rieck, MD, MHA, is the medical director for the Mayo Clinic Physician Assistant Program and a hospitalist for the Mayo Clinic, Division of Hospital Internal Medicine, Rochester, Minnesota
| | - Michael Huckabee
- Shekitta Acker, MS, PA-C, is academic co-director of the Mayo Clinic Physician Assistant Program, Rochester, Minnesota
- Ashley Noelke, MBA, is an operations specialist for the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
- Michael Huckabee, PhD, PA-C, is director of the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
- Katie M. Rieck, MD, MHA, is the medical director for the Mayo Clinic Physician Assistant Program and a hospitalist for the Mayo Clinic, Division of Hospital Internal Medicine, Rochester, Minnesota
| | - Katie M Rieck
- Shekitta Acker, MS, PA-C, is academic co-director of the Mayo Clinic Physician Assistant Program, Rochester, Minnesota
- Ashley Noelke, MBA, is an operations specialist for the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
- Michael Huckabee, PhD, PA-C, is director of the Mayo Clinic Physician Assistant Program, Mayo Clinic School of Health Sciences, Rochester, Minnesota
- Katie M. Rieck, MD, MHA, is the medical director for the Mayo Clinic Physician Assistant Program and a hospitalist for the Mayo Clinic, Division of Hospital Internal Medicine, Rochester, Minnesota
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Wijbenga MH, Teunissen PW, Ramaekers SPJ, Driessen EW, Duvivier RJ. Initiation of student participation in practice: An audio diary study of international clinical placements. MEDICAL TEACHER 2021; 43:1179-1185. [PMID: 33956558 DOI: 10.1080/0142159x.2021.1921133] [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: 06/12/2023]
Abstract
BACKGROUND Differences in professional practice might hinder initiation of student participation during international placements, and thereby limit workplace learning. This study explores how healthcare students overcome differences in professional practice during initiation of international placements. METHODS Twelve first-year physiotherapy students recorded individual audio diaries during the first month of international clinical placement. Recordings were transcribed, anonymized, and analyzed following a template analysis approach. Team discussions focused on thematic interpretation of results. RESULTS Students described tackling differences in professional practice via ongoing negotiations of practice between them, local professionals, and peers. Three themes were identified as the focus of students' orientation and adjustment efforts: professional practice, educational context, and individual approaches to learning. Healthcare students' initiation during international placements involved a cyclical process of orientation and adjustment, supported by active participation, professional dialogue, and self-regulated learning strategies. CONCLUSIONS Initiation of student participation during international placements can be supported by establishing a continuous dialogue between student and healthcare professionals. This dialogue helps align mutual expectations regarding scope of practice, and increase understanding of professional and educational practices. Better understanding, in turn, creates trust and favors meaningful students' contribution to practice and patient care.
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Affiliation(s)
- Miriam H Wijbenga
- European School of Physiotherapy/Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Pim W Teunissen
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics & Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephan P J Ramaekers
- European School of Physiotherapy/Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Erik W Driessen
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Robbert J Duvivier
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Center for Education Development and Research in Health Professions (CEDAR), UMC Groningen, Groningen, The Netherlands
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Nazar H, Rathbone AP, Richardson C, Livsey L, Husband AK. Young@Heart clinic: a feasibility study of an undergraduate pharmacy student-led blood pressure and healthy lifestyle clinic. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:277-284. [PMID: 33885748 DOI: 10.1093/ijpp/riab008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/23/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Student-led clinics offer a work-based learning (WBL) opportunity for undergraduate healthcare students to engage with professional activities in a real-life setting. Participation is posited to provide experiential learning and prepare students for clinical practice. This study aims to assess the feasibility of establishing and engaging undergraduate students in one such initiative through the collaboration between one School of Pharmacy and local authority. METHODS The clinic was developed using a logic model and delivered in 2019-2020. A service specification and training were developed and provided to volunteering undergraduate pharmacy students. Anonymised service data were collected and process outcomes around student and public engagement were recorded to assess feasibility for longer-term embedding into the undergraduate programme. KEY FINDINGS The clinic was operational for 20 days from November 2019 to February 2020. Student volunteers (n = 43, 36.7%) were trained and provided blood pressure screening and healthy living advice to 131 members of the public. Student drop-out occurred due to the voluntary nature of the initiative. CONCLUSIONS Collaborative working with the local authority facilitated this WBL experience outside conventional clinical environments. The study demonstrated the potential for students to participate in service provision. This offers value to the local population through a health prevention service when a structured approach to the design and delivery of the educational experience is undertaken. The study provides insight into how the WBL can work, what it requires (e.g. resource, preparation), and learning to inform the wider implementation of this WBL into the undergraduate curriculum.
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Affiliation(s)
- Hamde Nazar
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Adam P Rathbone
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Charlotte Richardson
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Lynne Livsey
- Adult and Integrated Services, Newcastle City Council, Newcastle upon Tyne, UK
| | - Andrew Kenneth Husband
- School of Pharmacy, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
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15
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Hawkins N, Younan HC, Fyfe M, Parekh R, McKeown A. Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on-call simulation. BMC MEDICAL EDUCATION 2021; 21:165. [PMID: 33731104 PMCID: PMC7972243 DOI: 10.1186/s12909-021-02605-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/05/2021] [Indexed: 05/28/2023]
Abstract
BACKGROUND Current research shows that many UK medical graduates continue to feel underprepared to work as a junior doctor. Most research in this field has focused on new graduates and employed the use of retrospective self-rating questionnaires. There remains a lack of detailed understanding of the challenges encountered in preparing for clinical practice, specifically those faced by medical students, where relevant educational interventions could have a significant impact. Through use of a novel on-call simulation, we set out to determine factors affecting perceived preparation for practice in final year medical students and identify ways in which we may better support them throughout their undergraduate training. METHODS 30 final year medical students from Imperial College London participated in a 90-minute simulation on hospital wards, developed to recreate a realistic on-call experience of a newly qualified doctor. Students partook in pairs, each observed by a qualified doctor taking field notes on their decisions and actions. A 60-minute semi-structured debrief between observer and student pair was audio-recorded for analysis. Field notes and students' clinical documentation were used to explore any challenges encountered. Debrief transcripts were thematically analysed through a general inductive approach. Cognitive Load Theory (CLT) was used as a lens through which to finalise the evolving themes. RESULTS Six key themes emerged from the on-call simulation debriefs: information overload, the reality gap, making use of existing knowledge, negative feelings and emotions, unfamiliar surroundings, and learning 'on the job'. CONCLUSIONS The combination of high fidelity on-call simulation, close observation and personalised debrief offers a novel insight into the difficulties faced by undergraduates in their preparation for work as a junior doctor. In using CLT to conceptualise the data, we can begin to understand how cognitive load may be optimised within this context and, in doing so, we highlight ways in which undergraduate curricula may be adapted to better support students in their preparation for clinical practice. Recommendations are centred around enhancing the expertise of the learner through 'whole task' training approaches and integrated learning, as well as navigating negative emotions and supporting lifelong 'learning while working'.
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Affiliation(s)
- Nichola Hawkins
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK.
| | - Helen-Cara Younan
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Molly Fyfe
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Ravi Parekh
- Department of Primary Care & Public Health, School of Public Health, Imperial College London, W6 8RP, London, UK
| | - Andrew McKeown
- University of Buckingham Medical School, Hunter Street, MK18 1EG, Buckingham, UK
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van den Broek S, Querido S, Wijnen-Meijer M, van Dijk M, Ten Cate O. Social Identification with the Medical Profession in the Transition from Student to Practitioner. TEACHING AND LEARNING IN MEDICINE 2020; 32:271-281. [PMID: 32075422 DOI: 10.1080/10401334.2020.1723593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Phenomenon: This study explores professional identity formation during a final year of medical school designed to ease the transition from student to practitioner. Although still part of the undergraduate curriculum, this "transitional year" gives trainees more clinical responsibilities than in earlier rotations. Trainees are no longer regarded as regular clerks but work in a unique position as "semi-physicians," performing similar tasks as a junior resident during extended rotations. Approach: We analyzed transcripts from interviews with 21 transitional-year medical trainees at University Medical Center Utrecht about workplace experiences that affect the development of professional identity. We used Social Identity Approach as a lens for analysis. This is a theoretical approach from social psychology that explores how group memberships constitute an important component of individual self-concepts in a process called 'social identification.' The transcripts were analyzed using thematic analysis, with a focus on how three dimensions of social identification with the professional group emerge in the context of a transitional year: cognitive centrality (the prominence of the group for self-definition), in-group affect (positivity of feelings associated with group membership) and in-group ties (perception of fit and ties with group members). Findings: Students were very aware of being a practitioner versus a student in the position of semi-physician and performing tasks successfully (i.e., cognitive centrality). Students experienced more continuity in patient care in transitional-year rotations than in previous clerkships and felt increased clinical responsibility. As a semi-physician they felt they could make a significant contribution to patient care. Students experienced a sense of pride and purpose when being more central to their patients' care (i.e., in-group affect). Finally, in extended rotations, the trainees became integrated into daily social routines with colleagues, and they had close contact with their supervisors who could confirm their fit with the group, giving them a sense of belonging (i.e., in-group ties). Insights: Using the three-dimension model of social identification revealed how students come to identify with the social group of practitioners in the context of a transitional year with extended rotations, increased clinical responsibilities, and being in the position of a "semi-physician." These findings shed light on the identity transition from student to practitioner within such a curricular structure.
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Affiliation(s)
| | - Sophie Querido
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marjo Wijnen-Meijer
- School of Medicine, Technical University of Munich, TUM Medical Education Center, Munich, Germany
| | - Marijke van Dijk
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Wijbenga MH, Duvivier RJ, Sheehan DC, Ramaekers SPJ, Teunissen PW, Driessen EW. Finding your feet: student participation during initiation of international clinical placements : Student participation during initiation. PERSPECTIVES ON MEDICAL EDUCATION 2020; 9:41-48. [PMID: 32016811 PMCID: PMC7012961 DOI: 10.1007/s40037-020-00561-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION International placements challenge students to find the right level of participation, as local practices, language and time pressure may affect their engagement in patient-related tasks or team activities. This study sought to unpack the initiation process during international clinical placements with the ultimate aim to achieve active student participation. METHODS Following a constructivist grounded theory approach, we conducted two individual interviews with 15 undergraduate healthcare students (before departure and whilst on placement). To identify emerging themes, we applied an iterative process of data collection and constant comparative analysis. Several team discussions informed further analysis, allowing us to reach a more conceptual level of theory. RESULTS From our findings we constructed a four-phase model of healthcare students' initiation of international clinical placements, which brings into focus how the phases of 'orientation', 'adjustment' and 'contribution to patient care' build up towards a 'sense of belonging'. We identified several factors that induced active student participation in practice, such as a favourable workplace setting, opportunities for learning and a local support network. DISCUSSION Active student participation is aimed at different goals, depending on the four phases of initiation that eventually lead to a sense of belonging and support workplace learning.
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Affiliation(s)
- Miriam H Wijbenga
- European School of Physiotherapy/Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.
| | - Robbert J Duvivier
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life sciences, Maastricht University, Maastricht, The Netherlands
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Dale C Sheehan
- College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
| | - Stephan P J Ramaekers
- European School of Physiotherapy/Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Pim W Teunissen
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life sciences, Maastricht University, Maastricht, The Netherlands
- Department of Obstetrics & Gynaecology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Erik W Driessen
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life sciences, Maastricht University, Maastricht, The Netherlands
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Lundh P, Palmgren PJ, Stenfors T. Perceptions about trust: a phenomenographic study of clinical supervisors in occupational therapy. BMC MEDICAL EDUCATION 2019; 19:404. [PMID: 31684926 PMCID: PMC6829846 DOI: 10.1186/s12909-019-1850-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 10/22/2019] [Indexed: 05/31/2023]
Abstract
BACKGROUND Finding the best way to facilitate student learning in clinical practice can be challenging for clinical supervisors. While high levels of trust might jeopardize patient safety, low trust might hinder student learning; however, carrying out professional activities is necessary for students to develop professional competence. There is a dearth of scholarly literature regarding the concept of trust among clinical supervisors in occupational therapy education. A better understanding of how trust is created between the supervisor and student may thus aid in facilitating student learning. The aim of this study, therefore, was to explore occupational therapy clinical supervisors' perception of trust and how it is formed. METHODS A qualitative method deploying a phenomenographic approach was chosen. Twelve clinical supervisors were interviewed, and the data were analyzed according to the seven-step phenomenographic approach. RESULTS Three qualitatively different ways of thinking about trust were found: (1) that trust is about the student and is rather static; (2) trust as a dynamic process based on student performance; and (3) trust as something mutual and interrelated. The findings indicate that trust can be understood in various ways, such as being something inherent in the student or, alternatively, about the student, the supervisor, the relationship between them, and the surrounding context, including the tasks performed. Furthermore, the study shows that trust can be seen either as something static or as a dynamic process. CONCLUSIONS This study contributes to a deeper understanding of the variation of ways in which the concept of trust is understood among clinical supervisors in occupational therapy. The study corroborates the prior research finding that trust can be understood as a multifaceted construct. It contributes novel insights about the role of the supervisor as an influential factor in the trust-building process. A deep understanding of the possible differences in the ways of conceptualizing something can help supervisors support learning by building on this understanding. The results from this study contribute to our knowledge of the drivers behind entrusted decisions in clinical education in various professional contexts. We suggest that the results be used in the continuing professional development of clinical supervisors.
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Affiliation(s)
- Pernilla Lundh
- Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care sciences and Society, Karolinska Institutet, 141 86 Huddinge, Stockholm, Sweden
| | - Per J. Palmgren
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77 Stockholm, Sweden
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Oosterom N, Floren LC, Ten Cate O, Westerveld HE. A review of interprofessional training wards: Enhancing student learning and patient outcomes. MEDICAL TEACHER 2019; 41:547-554. [PMID: 30394168 DOI: 10.1080/0142159x.2018.1503410] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Background: In an interprofessional training ward (ITW), students from different health professions collaboratively perform patient care with the goal of improving patient care. In the past two decades, ITWs have been established world-wide and studies have investigated their benefits. We aimed to compare ITWs with respect to their logistics, interprofessional learning outcomes and patient outcomes. Methods: We explored PubMed, CINAHL, Web of Science and EMBASE (1990-June 2017) and included articles focusing on interprofessional, in-patient training wards with student teams of medical and other health professions students. Two independent reviewers screened studies for eligibility and extracted data. Results: Thirty-seven articles from twelve different institutions with ITWs were included. ITWs world-wide are organized similarly with groups of 2-12 students (i.e. medical, nursing, physiotherapy, occupational therapy, and pharmacy) being involved in patient care, usually for a period of two weeks. However, the type of clinical ward and the way supervisors are trained differ. Conclusions: ITWs show promising results in short-term student learning outcomes and patient satisfaction rates. Future ITW studies should measure students' long-term interprofessional competencies using standardized tools. Furthermore, a research focus on the impact of ITWs on patient satisfaction and relevant patient care outcomes is important.
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Affiliation(s)
- N Oosterom
- a Center for Research and Development of Education, University Medical Center Utrecht , Utrecht , the Netherlands
| | - L C Floren
- b Department of Bioengineering and Therapeutic Sciences, School of Pharmacy , University of California , San Francisco , CA , USA
| | - O Ten Cate
- a Center for Research and Development of Education, University Medical Center Utrecht , Utrecht , the Netherlands
- b Department of Bioengineering and Therapeutic Sciences, School of Pharmacy , University of California , San Francisco , CA , USA
| | - H E Westerveld
- c Department of Internal Medicine , University Medical Center Utrecht , Utrecht , the Netherlands
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20
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Schutte T, Tichelaar J, Donker E, Richir MC, Westerman M, van Agtmael MA. Clarifying learning experiences in student-run clinics: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:244. [PMID: 30367661 PMCID: PMC6204044 DOI: 10.1186/s12909-018-1352-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 10/16/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Student-run clinics (SRCs) are outpatient clinics run and organized by undergraduate medical students. While these clinics offer participating students multiple learning opportunities, little is known about how participation in an SRC contributes to learning and how this learning is influenced. METHODS In this qualitative clarification study, we conducted semi-structured interviews with a purposive sample of 20 students and student-coordinators participating in our learner-centred SRC (LC-SRC), to gain in-depth insight into their experiences and learning. These interviews were analysed using Glaser's approach to grounded theory. RESULTS Analysis revealed that responsibility, authenticity, and collaboration described how SRC participation contribute to learning. Responsibility encompassed the responsibility students had for their patients and the responsibility that the student coordinators had for the students. Authenticity reflected the context and tasks in the LC-SRC. Collaboration covered collaboration with other students, with student coordinators, and with clinical supervisors. These three themes are interrelated, and together enhanced motivation and promoted patient-centred learning in both the LC-SRC and the regular curriculum. CONCLUSIONS Learning in an LC-SRC is highly dependent on students' feelings of responsibility for real authentic tasks and is stimulated by extensive collaboration with fellow students and supervising doctors.
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Affiliation(s)
- Tim Schutte
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands.
- Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands.
| | - Jelle Tichelaar
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Erik Donker
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Michiel Westerman
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research in Education, VUmc School of Medical Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
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Gonzalo JD, Graaf D, Ahluwalia A, Wolpaw DR, Thompson BM. A practical guide for implementing and maintaining value-added clinical systems learning roles for medical students using a diffusion of innovations framework. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2018; 23:699-720. [PMID: 29564583 DOI: 10.1007/s10459-018-9822-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 03/14/2018] [Indexed: 05/22/2023]
Abstract
After emphasizing biomedical and clinical sciences for over a century, US medical schools are expanding experiential roles that allow students to learn about health care delivery while also adding value to patient care. After developing a program where all 1st-year medical students are integrated into interprofessional care teams to contribute to patient care, authors use a diffusion of innovations framework to explore and identify barriers, facilitators, and best practices for implementing value-added clinical systems learning roles. In 2016, authors conducted 32 clinical-site observations, 29 1:1 interviews with mentors, and four student focus-group interviews. Data were transcribed verbatim, and a thematic analysis was used to identify themes. Authors discussed drafts of the categorization scheme, and agreed upon results and quotations. Of 36 sites implementing the program, 17 (47%) remained, 8 (22%) significantly modified, and 11 (31%) withdrew from the program. Identified strategies for implementing value-added roles included: student education, patient characteristics, patient selection methods, activities performed, and resources. Six themes influencing program implementation and maintenance included: (1) educational benefit, (2) value added to patient care from student work, (3) mentor time and site capacity, (4) student engagement, (5) working relationship between school, site, and students, and, (6) students' continuity at the site. Health systems science is an emerging focus for medical schools, and educators are challenged to design practice-based roles that enhance education and add value to patient care. Health professions' schools implementing value-added roles will need to invest resources and strategize about best-practice strategies to guide efforts.
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Affiliation(s)
- Jed D Gonzalo
- Medicine and Public Health Sciences, Health Systems Education, Penn State College of Medicine, Hershey, PA, USA.
- Division of General Internal Medicine, Penn State Hershey Medical Center - HO34, 500 University Drive, Hershey, PA, 17033, USA.
| | - Deanna Graaf
- Office of Medical Education, Penn State College of Medicine, Hershey, PA, USA
| | | | - Dan R Wolpaw
- Medicine and Humanities, Penn State College of Medicine, Hershey, PA, USA
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Leep Hunderfund AN, Starr SR, Dyrbye LN, Gonzalo JD, George P, Miller BM, Morgan HK, Hoffman A, Baxley EG, Allen BL, Fancher TL, Mandrekar J, Skochelak SE, Reed DA. Value-Added Activities in Medical Education: A Multisite Survey of First- and Second-Year Medical Students' Perceptions and Factors Influencing Their Potential Engagement. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1560-1568. [PMID: 29794526 DOI: 10.1097/acm.0000000000002299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE To describe attitudes of first- and second-year U.S. medical students toward value-added medical education, assess their self-reported desire to participate in value-added activities, and identify potentially modifiable factors influencing their engagement. METHOD The authors conducted a cross-sectional survey of first- and second-year students at nine U.S. medical schools in 2017. Survey items measured students' attitudes toward value-added medical education (n = 7), desire to participate in value-added activities (n = 20), and factors influencing potential engagement (n = 18). RESULTS Of 2,670 students invited to participate, 1,372 (51%) responded. Seventy-six percent (1,043/1,368) moderately or strongly agreed they should make meaningful contributions to patient care. Students' desire to participate was highest for patient care activities approximating those traditionally performed by physicians, followed by systems improvement activities and lowest for activities not typically performed by physicians. Factors increasing desire to participate included opportunities to interact with practicing physicians (1,182/1,244; 95%), patients (1,177/1,246; 95%), and residents or fellows (1,166/1,246; 94%). Factors decreasing desire to participate included making changes to the health care system (365/1,227; 30%), interacting with patients via phone or electronic communication (410/1,243; 33%), and lack of curricular time (634/1,233; 51%). CONCLUSIONS First- and second-year medical students agree they should add value to patient care, but their desire to participate in value-added activities varies depending on the nature of the tasks. Medical schools may be able to increase students' desire to participate by enabling face-to-face interactions with patients, embedding students in health care teams, and providing dedicated curricular time.
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Affiliation(s)
- Andrea N Leep Hunderfund
- A.N. Leep Hunderfund is assistant professor of neurology, Mayo Clinic, and associate director, Mayo Clinic Program in Professionalism and Values, Rochester, Minnesota. S.R. Starr is associate professor of pediatrics and director, Science of Health Care Delivery Education, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota. L.N. Dyrbye is professor of medical education and medicine, Mayo Clinic, Rochester, Minnesota. J.D. Gonzalo is associate professor of medicine and public health sciences and associate dean, Health Systems Education, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. P. George is associate professor of family medicine and associate professor of medical science, Alpert Medical School, Brown University, Providence, Rhode Island. B.M. Miller is professor of medical education and administration and professor of clinical surgery, associate vice chancellor, Health Affairs, and senior associate dean, Health Sciences Education, Vanderbilt University School of Medicine, Nashville, Tennessee. H.K. Morgan is associate clinical professor of obstetrics and gynecology and learning health sciences, University of Michigan Medical School, Ann Arbor, Michigan. A. Hoffman is assistant clinical professor of medicine, Division of Hospital Medicine, University of California, San Francisco School of Medicine, San Francisco, California. E.G. Baxley is professor of family medicine and senior associate dean, Academic Affairs, Brody School of Medicine, East Carolina University, Greenville, North Carolina. B.L. Allen is associate professor of clinical medicine and senior associate dean, Medical Student Education, Indiana University School of Medicine, Indianapolis, Indiana. T.L. Fancher is associate professor of medicine, University of California, Davis School of Medicine, Sacramento, California. J. Mandrekar is professor of biostatistics and neurology, Mayo Clinic, Rochester, Minnesota. S.E. Skochelak is group vice president for medical education, American Medical Association, Chicago, Illinois. D.A. Reed is associate professor of medical education and medicine and senior associate dean, Academic Affairs, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, Minnesota
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Cate OT. A primer on entrustable professional activities. KOREAN JOURNAL OF MEDICAL EDUCATION 2018; 30:1-10. [PMID: 29510603 PMCID: PMC5840559 DOI: 10.3946/kjme.2018.76] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 12/26/2017] [Accepted: 01/03/2018] [Indexed: 05/09/2023]
Abstract
Entrustable professional activities (EPAs) have become a popular topic within competency-based medical education programs in many countries and hundreds of publications within only a few years. This paper was written to introduce the ins and outs of EPAs. After a brief historical overview, the rational of EPAs, as a bridge between a competency framework and daily clinical practice, is explained. Next, entrustment decision-making as a form of assessment is elaborated and framework of levels of supervision is presented. For readers interested to apply the concept in practice a stepwise approach to curriculum development is proposed. The paper concludes with an overview of the state of the art of working with EPAs in across disciplines, professions and countries.
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Affiliation(s)
- Olle ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
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Gonzalo JD, Thompson BM, Haidet P, Mann K, Wolpaw DR. A Constructive Reframing of Student Roles and Systems Learning in Medical Education Using a Communities of Practice Lens. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017. [PMID: 28640036 DOI: 10.1097/acm.0000000000001778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Health systems are in the midst of a transformation that is being driven by a variety of forces. This has important implications for medical educators because clinical practice environments play a key role in learning and professional development, and evolving health systems are beginning to demand that providers have "systems-ready" knowledge, attitudes, and skills. Such implications provide a clear mandate for medical schools to modify their goals and prepare physicians to practice flexibly within teams and effectively contribute to the improvement of health care delivery. In this context, the concepts of value-added medical education, authentic student roles, and health systems science are emerging as increasingly important. In this Article, the authors use a lens informed by communities of practice theory to explore these three concepts, examining the implications that the communities of practice theory has in the constructive reframing of educational practices-particularly common student roles and experiences-and charting future directions for medical education that better align with the needs of the health care system. The authors apply several key features of the communities of practice theory to current experiential roles for students, then propose a new approach to students' clinical experiences-value-added clinical systems learning roles-that provides students with opportunities to make meaningful contributions to patient care while learning health systems science at the patient and population level. Finally, the authors discuss implications for professional role formation and anticipated challenges to the design and implementation of value-added clinical systems learning roles.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is assistant professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania; ORCID: http://orcid.org/0000-0003-1253-2963. B.M. Thompson is professor of medicine and associate dean for learner assessment and program evaluation, Penn State College of Medicine, Hershey, Pennsylvania. P. Haidet is professor of medicine, humanities, and public health sciences and director of medical education research, Penn State College of Medicine, Hershey, Pennsylvania. K. Mann was professor emeritus, Division of Medical Education, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. D.R. Wolpaw is professor of medicine and humanities, senior consultant for education innovation, Regional Medical Campus, and director, Doctors Kienle Center for Humanistic Medicine, Penn State College of Medicine, Hershey, Pennsylvania
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ten Cate O, Hoff RG. From case-based to entrustment-based discussions. CLINICAL TEACHER 2017; 14:385-389. [DOI: 10.1111/tct.12710] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Olle ten Cate
- Centre for Research and Development of Education; University Medical Centre Utrecht; the Netherlands
| | - Reinier G Hoff
- Department of Anaesthesiology; University Medical Centre Utrecht; the Netherlands
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Hu T, Cox KA, Nyhof-Young J. Investigating student perceptions at an interprofessional student-run free clinic serving marginalised populations. J Interprof Care 2017; 32:75-79. [PMID: 28956683 DOI: 10.1080/13561820.2017.1363724] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Many health profession schools have student-run free clinics (SRFCs), but their educational relevance has not been well studied. The aim of this study was to evaluate the learning experiences and skills developed among interprofessional healthcare students at an SRFC serving marginalised populations, in order to provide data for ongoing programme improvement and recommendations for other SRFCs based on lessons learned. Under 1:1 supervision with a preceptor, interprofessional students completed three clinical shifts at an SRFC and attended a reflection session. A total of 101 out of 105 participants answered semi-structured pre- and post-programme surveys (response rate: 96%). Descriptive statistics and descriptive thematic analyses were used for quantitative and qualitative data, respectively. Numerous skills derived from learning objectives common to many healthcare professions were addressed while participating at the SRFC. Valued programme elements included working with and learning about inner city populations in an interprofessional care model. Interprofessional SRFCs encourage student learning about resources for inner city populations and interprofessional collaboration while providing an opportunity to develop skills related to the formal curriculum. This may provide a workable strategy to address an interprofessional education gap in the healthcare professional curriculum.
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Affiliation(s)
- Tina Hu
- a Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Kelly Anne Cox
- a Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada
| | - Joyce Nyhof-Young
- a Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada.,b Office of Evaluations, Faculty of Medicine , University of Toronto , Toronto , Ontario , Canada.,c Centre for Ambulatory Care Education , Women's College Hospital , Toronto , Ontario , Canada
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Starr SR, Agrwal N, Bryan MJ, Buhrman Y, Gilbert J, Huber JM, Leep Hunderfund AN, Liebow M, Mergen EC, Natt N, Patel AM, Patel BM, Poole KG, Rank MA, Sandercock I, Shah AA, Wilson N, Johnson CD. Science of Health Care Delivery: An Innovation in Undergraduate Medical Education to Meet Society's Needs. Mayo Clin Proc Innov Qual Outcomes 2017; 1:117-129. [PMID: 30225408 PMCID: PMC6135021 DOI: 10.1016/j.mayocpiqo.2017.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this special article is to describe a new, 4-year Science of Health Care Delivery curriculum at Mayo Clinic School of Medicine, including curricular content and structure, methods for instruction, partnership with Arizona State University, and implementation challenges. This curriculum is intended to ensure that graduating medical students enter residency prepared to train and eventually practice within person-centered, community- and population-oriented, science-driven, collaborative care teams delivering high-value care. A Science of Health Care Delivery curriculum in undergraduate medical education is necessary to successfully prepare physicians so as to ensure the best clinical outcomes and patient experience of care, at the lowest cost.
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Affiliation(s)
- Stephanie R Starr
- Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Neera Agrwal
- Division of Hospital Internal Medicine, Mayo Clinic Hospital, Phoenix, AZ
| | - Michael J Bryan
- Department of Family Medicine, Mayo Clinic Hospital, Phoenix, AZ
| | - Yuna Buhrman
- School for the Science of Health Care Delivery, College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Jack Gilbert
- School for the Science of Health Care Delivery, College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Jill M Huber
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Mark Liebow
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Emily C Mergen
- Enterprise Portfolio Management Office, Mayo Clinic, Rochester, MN
| | - Neena Natt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Ashokakumar M Patel
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Bhavesh M Patel
- Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, AZ
| | - Kenneth G Poole
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology and Division of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ
| | - Irma Sandercock
- School for the Science of Health Care Delivery, College of Health Solutions, Arizona State University, Phoenix, AZ
| | - Amit A Shah
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Natalia Wilson
- School for the Science of Health Care Delivery, College of Health Solutions, Arizona State University, Phoenix, AZ
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Gonzalo JD, Lucey C, Wolpaw T, Chang A. Value-Added Clinical Systems Learning Roles for Medical Students That Transform Education and Health: A Guide for Building Partnerships Between Medical Schools and Health Systems. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:602-607. [PMID: 27580433 DOI: 10.1097/acm.0000000000001346] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
To ensure physician readiness for practice and leadership in changing health systems, an emerging three-pillar framework for undergraduate medical education integrates the biomedical and clinical sciences with health systems science, which includes population health, health care policy, and interprofessional teamwork. However, the partnerships between medical schools and health systems that are commonplace today use health systems as a substrate for learning. Educators need to transform the relationship between medical schools and health systems. One opportunity is the design of authentic workplace roles for medical students to add relevance to medical education and patient care. Based on the experiences at two U.S. medical schools, the authors describe principles and strategies for meaningful medical school-health system partnerships to engage students in value-added clinical systems learning roles. In 2013, the schools began large-scale efforts to develop novel required longitudinal, authentic health systems science curricula in classrooms and workplaces for all first-year students. In designing the new medical school-health system partnerships, the authors combined two models in an intersecting manner-Kotter's change management and Kern's curriculum development steps. Mapped to this framework, they recommend strategies for building mutually beneficial medical school-health system partnerships, including developing a shared vision and strategy and identifying learning goals and objectives; empowering broad-based action and overcoming barriers in implementation; and generating short-term wins in implementation. Applying this framework can lead to value-added clinical systems learning roles for students, meaningful medical school-health system partnerships, and a generation of future physicians prepared to lead health systems change.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is assistant professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania. C. Lucey is professor of medicine and vice dean for education, University of California, San Francisco School of Medicine, San Francisco, California. T. Wolpaw is professor of medicine and vice dean for educational affairs, Penn State College of Medicine, Hershey, Pennsylvania. A. Chang is professor of medicine and Gold-headed Cane Endowed Education Chair in Internal Medicine, University of California, San Francisco School of Medicine, San Francisco, California
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Young J, Egan T, Jaye C, Williamson M, Askerud A, Radue P, Penese M. Shared care requires a shared vision: communities of clinical practice in a primary care setting. J Clin Nurs 2017; 26:2689-2702. [DOI: 10.1111/jocn.13762] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jessica Young
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
| | - Tony Egan
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
| | - Martyn Williamson
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
| | | | - Peter Radue
- Department of General Practice and Rural Health; University of Otago; Dunedin New Zealand
- Mornington Health Centre; Dunedin New Zealand
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Schutte T, Tichelaar J, Dekker RS, Thijs A, de Vries TPGM, Kusurkar RA, Richir MC, van Agtmael MA. Motivation and competence of participants in a learner-centered student-run clinic: an exploratory pilot study. BMC MEDICAL EDUCATION 2017; 17:23. [PMID: 28122557 PMCID: PMC5264437 DOI: 10.1186/s12909-017-0856-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND The Learner-Centered Student-run Clinic (LC-SRC) was designed to teach and train prescribing skills grounded in a real-life context, to provide students with early clinical experience and responsibility. The current studies' theoretical framework was based on the Self-determination Theory. According to the Self-determination Theory, early involvement in clinical practice combined with a high level of responsibility makes the LC-SRC an environment that can stimulate intrinsic motivation. We investigated the different types of motivation and the proficiency in CanMEDS competencies of the participating students. METHOD Type of motivation was measured using the Academic Motivation Scale and Intrinsic Motivation Inventory. CanMEDS competencies were evaluated by faculty using a mini-clinical examination and by the students themselves using a post-participation questionnaire. RESULTS The 29 participating students were highly intrinsic motivated for this project on all subscales of the Intrinsic Motivation Inventory. Motivation for medical school on the Academic Motivation Scale was high before and was not significantly changed after participation. Students considered that their CanMEDS competencies "Collaborator", "Communicator", "Academic", and "Medical expert" had improved. Their actual clinical team competence was judged by faculty to be at a junior doctor level. CONCLUSION Students showed a high level of intrinsic motivation to participate in the LC-SRC and perceived an improvement in competence. Furthermore their actual clinical competence was at junior doctor level in all CanMEDS competencies. The stimulating characteristics of the LC-SRC, the high levels of intrinsic motivation and the qualitative comments of the students in this study makes the LC-SRC an attractive place for learning.
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Affiliation(s)
- Tim Schutte
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands.
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands.
| | - Jelle Tichelaar
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Ramon S Dekker
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
| | - Abel Thijs
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Theo P G M de Vries
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- School of Medical Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
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Young J, Jaye C, Egan T, Williamson M, Askerud A, Radue P, Penese M. Communities of clinical practice in action: Doing whatever it takes. Health (London) 2017; 22:109-127. [DOI: 10.1177/1363459316688515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Burgeoning numbers of patients with long-term conditions requiring complex care have placed pressures on healthcare systems around the world. In New Zealand, complex patients are increasingly being managed within the community. The Community of Clinical Practice concept identifies the network of carers around an individual patient whose central participants share a common purpose of increasing that patient’s well-being. We conducted a focused ethnography of nine communities of clinical practice in one general practice setting using participant observation and interviews, and examined the patients’ medical records. Data were analysed using a template organising style. Communities of clinical practice were interprofessional and included informal supports, services and non-professionals. These communities of clinical practice mediate practice, utilising informal networks to cut across boundaries, bureaucracy, mandated clinical pathways and professional jurisdictions to achieve optimum patient-centred care. Communities of clinical practice’s repertoires are characterised by care and are driven by the moral imperative to care. They do ‘whatever it takes’, although there is a cost to this form of care. Well-functioning communities of clinical practice use patient’s well-being as a guiding light and, by sharing a vision of care through trusting and respectful relationships, avoid fragmentation of care. The Community of Clinical Practice (CoCP) model is particularly useful in accounting for the ‘messiness’ of community-based care.
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Affiliation(s)
| | | | | | | | | | - Peter Radue
- University of Otago, New Zealand; Mornington Health Centre, New Zealand
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Gonzalo JD, Dekhtyar M, Starr SR, Borkan J, Brunett P, Fancher T, Green J, Grethlein SJ, Lai C, Lawson L, Monrad S, O'Sullivan P, Schwartz MD, Skochelak S. Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:123-131. [PMID: 27049541 DOI: 10.1097/acm.0000000000001177] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories. METHOD In phase 1, to identify domains, grant submissions were analyzed and coded using constant comparative analysis. In phase 2, a detailed review of all existing and planned syllabi and curriculum documents at the grantee schools was performed, and content in the core curricular domains was coded into subcategories. The lead investigators reviewed and discussed drafts of the categorization scheme, collapsed and combined domains and subcategories, and resolved disagreements via group discussion. RESULTS Analysis yielded three types of domains: core, cross-cutting, and linking. Core domains included health care structures and processes; health care policy, economics, and management; clinical informatics and health information technology; population and public health; value-based care; and health system improvement. Cross-cutting domains included leadership and change agency; teamwork and interprofessional education; evidence-based medicine and practice; professionalism and ethics; and scholarship. One linking domain was identified: systems thinking. CONCLUSIONS This broad framework aims to build on the traditional definition of systems-based practice and highlight the need for medical and other health professions schools to better align education programs with the anticipated needs of the systems in which students will practice. HSS will require a critical investigation into existing curricula to determine the most efficient methods for integration with the basic and clinical sciences.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is assistant professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania. M. Dekhtyar is senior research assistant, Medical Education Outcomes, American Medical Association, Chicago, Illinois. S.R. Starr is assistant professor of pediatric and adolescent medicine and director of science of health care delivery education, Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minnesota. J. Borkan is chair and professor of family medicine and assistant dean for primary care-population health program planning, Alpert Medical School of Brown University, Providence, Rhode Island. P. Brunett is clinical professor, Department of Emergency Medicine, and associate dean for graduate medical education, Oregon Health & Science University School of Medicine, Portland, Oregon. T. Fancher is associate professor, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California. J. Green is assistant professor of medicine and pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee. S.J. Grethlein is professor of clinical medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. C. Lai is professor of medicine, University of California San Francisco School of Medicine, San Francisco, California. L. Lawson is assistant dean for curriculum, assessment, and clinical academic affairs and assistant professor of emergency medicine, Brody School of Medicine at East Carolina University, Greenville, North Carolina. S. Monrad is clinical assistant professor, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan. P. O'Sullivan is professor of medicine and director of research and development in medical education, University of California San Francisco School of Medicine, San Francisco, California. M.D. Schwartz is professor of population health and medicine and vice chair for education and faculty affairs, Department of Population Health, New York University School of Medicine, New York, New York. S. Skochelak is group vice president of medical education, American Medical Association, Chicago, Illinois
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Gonzalo JD, Haidet P, Papp KK, Wolpaw DR, Moser E, Wittenstein RD, Wolpaw T. Educating for the 21st-Century Health Care System: An Interdependent Framework of Basic, Clinical, and Systems Sciences. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:35-39. [PMID: 26488568 DOI: 10.1097/acm.0000000000000951] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In the face of a fragmented and poorly performing health care delivery system, medical education in the United States is poised for disruption. Despite broad-based recommendations to better align physician training with societal needs, adaptive change has been slow. Traditionally, medical education has focused on the basic and clinical sciences, largely removed from the newer systems sciences such as population health, policy, financing, health care delivery, and teamwork. In this article, authors examine the current state of medical education with respect to systems sciences and propose a new framework for educating physicians in adapting to and practicing in systems-based environments. Specifically, the authors propose an educational shift from a two-pillar framework to a three-pillar framework where basic, clinical, and systems sciences are interdependent. In this new three-pillar framework, students not only learn the interconnectivity in the basic, clinical, and systems sciences but also uncover relevance and meaning in their education through authentic, value-added, and patient-centered roles as navigators within the health care system. Authors describe the Systems Navigation Curriculum, currently implemented for all students at the Penn State College of Medicine, as an example of this three-pillar educational model. Simple adjustments, such as including occasional systems topics in medical curriculum, will not foster graduates prepared to practice in the 21st-century health care system. Adequate preparation requires an explicit focus on the systems sciences as a vital and equal component of physician education.
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Affiliation(s)
- Jed D Gonzalo
- J.D. Gonzalo is assistant professor of medicine and public health sciences and associate dean for health systems education, Penn State College of Medicine, Hershey, Pennsylvania. P. Haidet is professor of medicine, humanities, and public health sciences and director of medical education research, Penn State College of Medicine, Hershey, Pennsylvania. K.K. Papp is adjunct professor of medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania. D.R. Wolpaw is professor of medicine and humanities, vice chair for educational affairs, Department of Medicine, and director, Kienle Center for Humanistic Medicine, Penn State College of Medicine, Hershey, Pennsylvania. E. Moser is associate professor of medicine and associate dean for medical education, Penn State College of Medicine, Hershey, Pennsylvania. R.D. Wittenstein is assistant professor of public health sciences, Penn State College of Medicine, and chief operating officer, Penn State Hershey Health System, Hershey, Pennsylvania. T. Wolpaw is professor of medicine and vice dean for educational affairs, Penn State College of Medicine, Hershey, Pennsylvania
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Gonzalo JD, Haidet P, Blatt B, Wolpaw DR. Exploring challenges in implementing a health systems science curriculum: a qualitative analysis of student perceptions. MEDICAL EDUCATION 2016; 50:523-31. [PMID: 27072441 DOI: 10.1111/medu.12957] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 07/30/2015] [Accepted: 10/19/2015] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Although a critical component of educational reform involves the inclusion of knowledge of and skills in health systems science (HSS) (including population health, health system improvement and high-value care) many undergraduate medical education programmes focus primarily on traditional basic and clinical sciences. In this study, we investigated students' perceptions of the barriers to, challenges involved in and benefits of the implementation of a HSS curriculum. METHODS In 2014, we conducted 12 focus groups with 50 medical students across all years of medical school. Group interviews were audio-recorded and transcribed verbatim. We used thematic analysis to explore students' perceptions of a planned HSS curriculum, which was to include both a classroom-based course and an experiential component. We then identified themes and challenges from the students' perspective and agreed upon results and quotations. RESULTS Students identified four barrier-related themes, including (i) medical-board licensing examinations foster a view of basic science as 'core', (ii) systems concepts are important but not essential, (iii) students lack sufficient knowledge and skills to perform systems roles and (iv) the culture of medical education and clinical systems does not support systems education. Students also identified several perceived benefits of a systems curriculum, including acquisition of new knowledge and skills, enhanced understanding of patients' perspectives and improved learning through experiential roles. The major unifying challenge related to students' competing priorities; one to perform well in examinations and match into preferred residencies, and another to develop systems-based skills. CONCLUSIONS Students' intrinsic desire to be the best physician possible is at odds with board examinations and desired residency placements. As a result, HSS is viewed as peripheral and non-essential, greatly limiting student engagement. New perspectives are needed to effectively address this challenge.
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Affiliation(s)
- Jed D Gonzalo
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paul Haidet
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Barbara Blatt
- Office of Medical Education, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Daniel R Wolpaw
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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Gonzalo JD, Graaf D, Johannes B, Blatt B, Wolpaw DR. Adding Value to the Health Care System: Identifying Value-Added Systems Roles for Medical Students. Am J Med Qual 2016; 32:261-270. [DOI: 10.1177/1062860616645401] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To catalyze learning in Health Systems Science and add value to health systems, education programs are seeking to incorporate students into systems roles, which are not well described. The authors sought to identify authentic roles for students within a range of clinical sites and explore site leaders’ perceptions of the value of students performing these roles. From 2013 to 2015, site visits and interviews with leadership from an array of clinical sites (n = 30) were conducted. Thematic analysis was used to identify tasks and benefits of integrating students into interprofessional care teams. Types of systems roles included direct patient benefit activities, including monitoring patient progress with care plans and facilitating access to resources, and clinic benefit activities, including facilitating coordination and improving clinical processes. Perceived benefits included improved value of the clinical mission and enhanced student education. These results elucidate a framework for student roles that enhance learning and add value to health systems.
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Affiliation(s)
| | - Deanna Graaf
- Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Barbara Blatt
- Penn State College of Medicine, Hershey, Pennsylvania
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Chen HC, McNamara M, Teherani A, Cate OT, O'Sullivan P. Developing Entrustable Professional Activities for Entry Into Clerkship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2016; 91:247-55. [PMID: 26556295 DOI: 10.1097/acm.0000000000000988] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE Despite the growing emphasis on early clinical experiences, preceptors still face challenges integrating preclerkship medical students into their practices. Entrustable professional activities (EPAs), which frame competencies in the context of clinical workplace activities, may provide explicit guidance on appropriate student roles and activities. This study aimed to develop and appraise content validity evidence for EPAs for clerkship entry. METHOD The authors employed a multistep process from November 2012 to June 2014. They identified EPA content domains using study data, student focus groups, and preceptor interviews. They then mapped each domain to preclerkship course objectives, graduation competencies, and resident-level EPAs to ensure relevancy and adequacy. Next, they developed seven-part EPA descriptions for each domain with specifications/limitations; expected knowledge, skills, and attitudes; associated competencies; and assessment information. Subsequently, they conducted local, national, and international workshops to verify the appropriateness of the content and supervision level, before finalizing each EPA with additional expert and stakeholder review. RESULTS This process resulted in five EPAs for entry into clerkship: (1) information gathering, (2) information integration for a differential diagnosis and plan, (3) health care team communication, (4) information sharing with patients, and (5) resource identification. Workshop participants approved and refined the content for each EPA and agreed that a single level of supervision (practice under reactive supervision) was appropriate. CONCLUSIONS The development of these EPAs indicates support for setting a standard for entry into clerkship, provides guidance for engaging preclerkship students in clinical workplace activities, and can be adapted for use by any institution.
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Affiliation(s)
- H Carrie Chen
- H.C. Chen is professor of pediatrics, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California. M. McNamara is professor of pediatrics, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California. A. Teherani is professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. O. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands, and adjunct professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. P. O'Sullivan is professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
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Chen HC, ten Cate O, O'Sullivan P, Boscardin C, Eidson-Ton WS, Basaviah P, Woehrle T, Teherani A. Students' goal orientations, perceptions of early clinical experiences and learning outcomes. MEDICAL EDUCATION 2016; 50:203-13. [PMID: 26812999 DOI: 10.1111/medu.12885] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/16/2015] [Accepted: 08/10/2015] [Indexed: 05/15/2023]
Abstract
CONTEXT Workplace learning is optimised when learners engage in the activities of the workplace; learner engagement is influenced by workplace affordances and learner agency. Learner agency can be operationalised through achievement goal theory, which explains that students can have different goal orientations as they enter learning situations: mastery (learn and improve), performance approach (demonstrate competence) or performance-avoid (avoid demonstrating incompetence). Mastery-orientated, compared with performance-orientated, students approach curricular experiences as opportunities for developing rather than demonstrating competence. This study explored the relationships among students' achievement goal orientations, workplace affordances and learning outcomes in the context of early clinical experiences. METHODS Students who completed their preclerkship curricula at four medical schools answered a questionnaire about their personal goal orientation and the perceived goal structure and workplace affordances of their preceptorship experiences. All items used a 5-point scale (1 = strongly disagree/not at all true, 5 = strongly agree/very true). Students were evaluated by their preceptors and completed standardised-patient exams at the end of their pre-clerkship curricula. Analyses included descriptive statistics and mediation analysis. RESULTS Of 517 students, 296 (57.3%) responded and 253 (85.5%) had linked performance data. Student goal orientation means were: mastery, mean = 4.27 (SD = 0.65); performance-approach, 2.41 (0.76); performance-avoid, 2.84 (0.88). Student goal orientation and performance on preceptor evaluations (PEval) or standardised-patient exams (SPExam) were not significantly related. Perceptions of a mastery-structured curriculum and inviting workplace were associated with higher SPExam (β = 0.28, p = 0.02) and PEval (β = 0.51, p = 0.00) scores, respectively. Student mastery goal orientation was positively associated with perceptions of a mastery-structured curriculum (β = 0.59, p = 0.00) and positive workplace affordances (β = 0.25-0.29, p ≤ 0.01). CONCLUSIONS Students held a predominant mastery goal orientation towards their early clinical experiences. Mastery-orientated students perceived preceptorships as mastery-structured with positive workplace affordances, and those perceiving a mastery-structured or inviting preceptorship performed better. Clinical experiences should be structured to emphasise learning rather than demonstration of skills to promote learning outcomes.
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Affiliation(s)
- H Carrie Chen
- Department of Pediatrics, School of Medicine, University of California, San Francisco, California, USA
| | - Olle ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Patricia O'Sullivan
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - Christy Boscardin
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
| | - W Suzanne Eidson-Ton
- Departments of Family and Community Medicine and Obstetrics and Gynecology, School of Medicine, University of California, Davis, California, USA
| | - Preetha Basaviah
- Department of Medicine, School of Medicine, Stanford University, Stanford, California, USA
| | - Theresa Woehrle
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Arianne Teherani
- Department of Medicine, School of Medicine, University of California, San Francisco, California, USA
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Vaughan K. Vocational thresholds: developing expertise without certainty in general practice medicine. J Prim Health Care 2016; 8:99-105. [DOI: 10.1071/hc15027] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract
INTRODUCTION
This paper argues that particular experiences in the workplace are more important than others and can lead to transformational learning. This may enable practitioners to cross ‘vocational thresholds’ to new ways of being.
AIM
A notion of ‘vocational thresholds’ is developed, aiming to help build an understanding of the most powerful learning experiences of general practitioners (GPs). Vocational thresholds takes its cue from the idea of ‘threshold concepts’ - concepts that transform perspectives and integrate previously disconnected or hidden knowledge, sometimes in ways that are ‘troublesome’ to previously held beliefs.
METHODS
The paper is based on a thematic analysis of 57 GPs’ brief written accounts of a particularly powerful learning experience during their development. Accounts were provided in a conference session about an ongoing study of workplace-based structured learning arrangements in the fields of general practice medicine, engineering, and building.
FINDINGS
Most GPs’ accounts focused on development of dispositional attributes that moved them to a new understanding of themselves in relation to their work and patients. Just under two-thirds picked out informal and formal collegial relationships within purposeful learning arrangements as pivotal. A third picked out direct experiences with patients as shifting their perspective.
CONCLUSION
The emergent idea of vocational thresholds is offered as a way to frame the most important learning experiences identified by GPs. It supports a focus in early and ongoing development beyond accumulating clinical expertise and skills (knowing and doing), to dispositional capability (being) - vital for practitioners negotiating inherent and daily uncertainty.
KEYWORDS
General practitioners; Medical education; Vocational education; Identity; Learning experiences; Threshold concepts
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Chen HC, Teherani A. Workplace affordances to increase learner engagement in the clinical workplace. MEDICAL EDUCATION 2015; 49:1184-6. [PMID: 26611182 DOI: 10.1111/medu.12888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Henschen BL, Bierman JA, Wayne DB, Ryan ER, Thomas JX, Curry RH, Evans DB. Four-Year Educational and Patient Care Outcomes of a Team-Based Primary Care Longitudinal Clerkship. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:S43-S49. [PMID: 26505100 DOI: 10.1097/acm.0000000000000897] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Longitudinal clerkships show promise in improving undergraduate primary care education. This study examines the Education-Centered Medical Home (ECMH), a longitudinal clerkship embedding teams of students across all four years into primary care clinics to provide patient care and serve as health coaches for high-risk patients. METHOD All students graduating in 2015 were surveyed to assess attitudes, experiences, and preferences regarding primary care education. ECMH students were compared with students receiving their primary care training in a traditional curriculum (TC) using paired measures of comparison. To assess the impact of the ECMH on patient care quality, authors performed a detailed chart review at one site. RESULTS Seventy-six percent of eligible students participated in the study. ECMH students (n = 69) and TC students (n = 68) had similar baseline academic performance and career interests. ECMH students reported more continuity-of-care experiences, higher satisfaction with their primary care learning climate (86% versus 61% in the EMCH and TC cohorts, respectively), more confidence in their quality improvement skills, and scored higher on measures of perceived patient centeredness. Students from both groups recommended the ECMH (91% and 57%, respectively). Student involvement at one ECMH site was correlated with increased patient contacts and improved delivery of recommended preventive care. CONCLUSIONS Incorporating students longitudinally into primary care clinics is highly rated by students. The ECMH model led to improved continuity, improved perceptions of the learning climate, and higher patient centeredness. Preliminary data suggest that students add value and improve patient outcomes during longitudinal clinical experiences.
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Hauer KE, Boscardin C, Fulton TB, Lucey C, Oza S, Teherani A. Using a Curricular Vision to Define Entrustable Professional Activities for Medical Student Assessment. J Gen Intern Med 2015; 30:1344-8. [PMID: 26173516 PMCID: PMC4539334 DOI: 10.1007/s11606-015-3264-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The new UCSF Bridges Curriculum aims to prepare students to succeed in today's health care system while simultaneously improving it. Curriculum redesign requires assessment strategies that ensure that graduates achieve competence in enduring and emerging skills for clinical practice. AIM To design entrustable professional activities (EPAs) for assessment in a new curriculum and gather evidence of content validity. SETTING University of California, San Francisco, School of Medicine. PARTICIPANTS Nineteen medical educators participated; 14 completed both rounds of a Delphi survey. PROGRAM DESCRIPTION Authors describe 5 steps for defining EPAs that encompass a curricular vision including refining the vision, defining draft EPAs, developing EPAs and assessment strategies, defining competencies and milestones, and mapping milestones to EPAs. A Q-sort activity and Delphi survey involving local medical educators created consensus and prioritization for milestones for each EPA. PROGRAM EVALUATION For 4 EPAs, most milestones had content validity indices (CVIs) of at least 78 %. For 2 EPAs, 2 to 4 milestones did not achieve CVIs of 78 %. DISCUSSION We demonstrate a stepwise procedure for developing EPAs that capture essential physician work activities defined by a curricular vision. Structured procedures for soliciting faculty feedback and mapping milestones to EPAs provide content validity.
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Affiliation(s)
- Karen E Hauer
- San Francisco School of Medicine, University of California, San Francisco, CA, USA,
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Dekker RS, Schutte T, Tichelaar J, Thijs A, van Agtmael MA, de Vries TPGM, Richir MC. A novel approach to teaching pharmacotherapeutics--feasibility of the learner-centered student-run clinic. Eur J Clin Pharmacol 2015; 71:1381-7. [PMID: 26268444 PMCID: PMC4613888 DOI: 10.1007/s00228-015-1916-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/23/2015] [Indexed: 12/02/2022]
Abstract
ᅟ Medical students should be better prepared for their future role as prescribers. A new educational concept to achieve this is learning by doing. This encompasses legitimate, context-based training and gives students responsibility as early as possible in their medical education. Student-run clinics (SRCs) are an example of this concept. Aim Describe the development of a new SRC for insured patients, primarily focused on medical (pharmacotherapy) education, the learner-centered student-run clinic (LC-SRC), and its feasibility. Methods Teams each comprising of three students (first, third, and fifth year) performed consultations including proposing management plans, all under the supervision of an internist. Patients were voluntary selected from the internal medicine outpatient clinic for follow-up in the LC-SRC. Feasibility was evaluated using a set of questionnaires for patients, supervisors, and students. Results In total, 31 consultations were conducted; 31 students and 4 clinical specialists participated. A pharmacotherapeutic treatment plan was drawn up in 33 % of the consultations. Patients were content with the care provided and rated the consultation with a 7.9 (SD 1.21) (1(min)-10(max)). Supervisors regarded LC-SRC safe for patients with guaranteed quality of care. They found the LC-SRC a valuable tool in medical education although it was time-consuming. Students appreciated their (new) responsibility for patient care and considered the LC-SRC a very valuable extracurricular activity. Discussion The LC-SRC is feasible, and all participants considered it to be a valuable educational activity. It offers students the opportunity to learn in a real interprofessional and longitudinal setting for their future role as prescriber in clinical practice. The benefits and learner effects need to be investigated in a larger study with a longer follow-up. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1916-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ramon S Dekker
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Tim Schutte
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands.
| | - Jelle Tichelaar
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Abel Thijs
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Theo P G M de Vries
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
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Ten Cate O, Peters M. Who can do without patients? PERSPECTIVES ON MEDICAL EDUCATION 2015; 4:98-99. [PMID: 25822122 PMCID: PMC4404459 DOI: 10.1007/s40037-015-0171-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
| | - Max Peters
- Center for Research and Development of Education, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
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Chen HC, van den Broek WES, ten Cate O. The case for use of entrustable professional activities in undergraduate medical education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2015; 90:431-6. [PMID: 25470310 DOI: 10.1097/acm.0000000000000586] [Citation(s) in RCA: 251] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Many graduate medical education (GME) programs have started to consider and adopt entrustable professional activities (EPAs) in their competency frameworks. Do EPAs also have a place in undergraduate medical education (UME)? In this Perspective article, the authors discuss arguments in favor of the use of EPAs in UME. A competency framework that aligns UME and GME outcome expectations would allow for better integration across the educational continuum. The EPA approach would be consistent with what is known about progressive skill development. The key principles underlying EPAs, workplace learning and trust, are generalizable and would also be applicable to UME learners. Lastly, EPAs could increase transparency in the workplace regarding student abilities and help ensure safe and quality patient care. The authors also outline what UME EPAs might look like, suggesting core, specialty-specific, and elective EPAs related to core clinical residency entry expectations and learner interest. UME EPAs would be defined as essential health care activities with which one would expect to entrust a resident at the beginning of residency to perform without direct supervision. Finally, the authors recommend a refinement and expansion of the entrustment and supervision scale previously developed for GME to better incorporate the supervision expectations for UME learners. They suggest that EPAs could be operationalized for UME if UME-specific EPAs were developed and the entrustment scale were expanded.
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Affiliation(s)
- H Carrie Chen
- Dr. Chen is professor of clinical pediatrics, Department of Pediatrics, University of California, San Francisco, School of Medicine, San Francisco, California. Dr. van den Broek is a PhD candidate in medical education, University Medical Center Utrecht, Utrecht, the Netherlands. Dr. ten Cate is professor of medical education and director, Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, the Netherlands, and adjunct professor of medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California
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Schutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries TPGM, Richir MC. Learning in student-run clinics: a systematic review. MEDICAL EDUCATION 2015; 49:249-263. [PMID: 25693985 DOI: 10.1111/medu.12625] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/22/2014] [Accepted: 09/12/2014] [Indexed: 06/04/2023]
Abstract
CONTEXT Student-run clinics (SRCs) have existed for many years and may provide the most realistic setting for context-based learning and legitimate early clinical experiences with responsibility for patient care. We reviewed the literature on student outcomes of participation in SRCs. METHODS A systematic literature review was performed using the PubMed, EMBASE, PsycINFO and ERIC databases. Included articles were reviewed for conclusions and outcomes; study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS A total of 42 articles met the inclusion criteria and were included in the quantitative synthesis. The effects of participation on students' attitudes were mainly positive: students valued the SRC experience. Data on the effects of SRC participation on students' skills and knowledge were based mainly on expert opinions and student surveys. Students reported improved skills and indicated that they had acquired knowledge they were unlikely to have gained elsewhere in the curriculum. The quality of specific aspects of care delivered by students was comparable with that of regular care. CONCLUSIONS The suggestion that students should be trained as medical professionals with responsibility for patient care early in the curriculum is attractive. In an SRC this responsibility is central. Students valued the early training opportunity in SRCs and liked participating. However, little is known about the effect of SRC participation on students' skills and knowledge. The quality of care provided by students seemed adequate. Further research is needed to assess the effect of SRC participation on students' skills, knowledge and behaviour.
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Affiliation(s)
- Tim Schutte
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands; Pharmacotherapy Section, Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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Tintinalli JE. Mid-level providers and emergency care: let's not lose the force. Emerg Med Australas 2014; 26:403-7. [PMID: 25065770 DOI: 10.1111/1742-6723.12263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2014] [Indexed: 11/29/2022]
Abstract
The progressive rise of ED visits globally, and insufficient numbers of emergency physicians, has resulted in the use of mid-level providers as adjuncts for the provision of emergency care, especially in the US and Canada. Military medics, midwives, aeromedical paramedics, EMT-Ps, flight nurses, forensic nurses, sexual assault nurse examiner nurses--are some examples of well-established mid-level provider professionals who achieve their clinical credentials through accredited training programmes and formal certification. In emergency medicine, however, mid-level providers are trained for general care, and typically acquire emergency medicine skills through on-the-job experience. There are very few training programmes for NPs and PAs in emergency care. The manpower gap for physicians in general, and emergency physicians specifically, will not be eliminated in the reasonable future. Mid-level providers--ENTs, paramedics, NPs, PAs--are an excellent addition to the emergency medicine workforce. However, the specialty of emergency medicine developed because specific and focused training was needed for physicians to practice safe and qualify emergency care. This same principle applies to mid-level providers. Emergency Medicine needs to develop a vision and a plan to train emergency medicine specialist NPs and PAs, and explore other innovations to expand our emergency care workforce.
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Affiliation(s)
- Judith E Tintinalli
- Department of Emergency Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Young JQ, Van Merrienboer J, Durning S, Ten Cate O. Cognitive Load Theory: implications for medical education: AMEE Guide No. 86. MEDICAL TEACHER 2014; 36:371-84. [PMID: 24593808 DOI: 10.3109/0142159x.2014.889290] [Citation(s) in RCA: 394] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Cognitive Load Theory (CLT) builds upon established models of human memory that include the subsystems of sensory, working and long-term memory. Working memory (WM) can only process a limited number of information elements at any given time. This constraint creates a "bottleneck" for learning. CLT identifies three types of cognitive load that impact WM: intrinsic load (associated with performing essential aspects of the task), extraneous load (associated with non-essential aspects of the task) and germane load (associated with the deliberate use of cognitive strategies that facilitate learning). When the cognitive load associated with a task exceeds the learner's WM capacity, performance and learning is impaired. To facilitate learning, CLT researchers have developed instructional techniques that decrease extraneous load (e.g. worked examples), titrate intrinsic load to the developmental stage of the learner (e.g. simplify task without decontextualizing) and ensure that unused WM capacity is dedicated to germane load, i.e. cognitive learning strategies. A number of instructional techniques have been empirically tested. As learners' progress, curricula must also attend to the expertise-reversal effect. Instructional techniques that facilitate learning among early learners may not help and may even interfere with learning among more advanced learners. CLT has particular relevance to medical education because many of the professional activities to be learned require the simultaneous integration of multiple and varied sets of knowledge, skills and behaviors at a specific time and place. These activities possess high "element interactivity" and therefore impose a cognitive load that may surpass the WM capacity of the learner. Applications to various medical education settings (classroom, workplace and self-directed learning) are explored.
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Affiliation(s)
- John Q Young
- Hofstra North Shore-LIJ School of Medicine , USA
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Gonzalo JD, Haidet P, Wolpaw DR. Authentic clinical experiences and depth in systems: toward a 21st century curriculum. MEDICAL EDUCATION 2014; 48:104-5. [PMID: 24528389 DOI: 10.1111/medu.12400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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