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Soklaridis S, Zaheer R, Scully M, Shier R, Williams B, Dang L, Daniel SJ, Sockalingam S, Tremblay M. 'We are in for a culture change': continuing professional development leaders' perspectives on COVID-19, burn-out and structural inequities. BMJ LEADER 2024; 8:142-146. [PMID: 37739772 DOI: 10.1136/leader-2023-000837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/09/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION The COVID-19 pandemic positioned healthcare systems in North America at the epicentre of the crisis, placing inordinate stress on clinicians. Concurrently, discussions about structural racism, social justice and health inequities permeated the field of medicine, and society more broadly. The confluence of these phenomena required rapid action from continuing professional development (CPD) leaders to respond to emerging needs and challenges. METHODS In this qualitative study, researchers conducted 23 virtual semistructured interviews with CPD leaders in Canada and the USA. Interview audiorecordings were transcribed, deidentified and thematically analysed. RESULTS This study revealed that the CPD leaders attributed the pandemic as illuminating and exacerbating problems related to clinician wellness; equity, diversity and inclusion; and health inequities already prevalent in the healthcare system and within CPD. Analysis generated two themes: (1) From heroes to humans: the shifting view of clinicians and (2) Melding of crises: an opportunity for systemic change in CPD. DISCUSSION The COVID-19 pandemic increased recognition of burn-out and health inequities creating momentum in the field to prioritise and restrategise to address these converging public health crises. There is an urgent need for CPD to move beyond mere discourse on these topics towards holistic and sustainable actionable measures.
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Affiliation(s)
- Sophie Soklaridis
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Rabia Zaheer
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michelle Scully
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rowen Shier
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Betsy Williams
- Department of Psychiatry, University of Kansas School of Medicine, Kansas City, Kansas, USA
- Professional Renewal Centre, Lawrence, Kansas, USA
| | - Linda Dang
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sam J Daniel
- Department of Pediatric Surgery, McGill University, Montreal, Québec, Canada
| | - Sanjeev Sockalingam
- Education Services, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Martin Tremblay
- Continuing Professional Development Department, Fédération des médecins spécialistes du Québec, Montreal, Québec, Canada
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Zielina M, Škoda J, Ivanová K, Dostál D, Juríčková L, Anthony Procházka D, Straka B, Doležal A. Exploring moral competence regression: a narrative approach in medical ethics education for medical students. BMC Med Ethics 2024; 25:73. [PMID: 38907238 PMCID: PMC11191321 DOI: 10.1186/s12910-024-01073-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 06/14/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Studies from different countries report a stagnation or regression of moral competence in medical students between the first and the last year of their studies, and the value of various educational interventions remains uncertain. METHODS We used Moral Competence Test (MCT) to measure C-scores of moral competence to determine the change in the MCT C-scores between the first- and the fifth-year medical students from two medical schools in the Czech Republic in the academic year 2022/2023 and to analyze factors associated with the C-scores (observational study). In addition, for the first-year students, we compared the results of the MCT before and after an intervention in medical ethics curriculum (interventional study). We used a cross-sectional and descriptive design for the observational study. Students completed the MCT, consisting of two moral dilemmas (Worker´s Dilemma and Doctor´s Dilemma), the results measured by the C-score, which represents moral competence. RESULTS In total, 685 students participated in the observational study. Objective 1: based on the analysis of the C-score, we observed a decrease in moral competence between the first and the fifth-year medical students (p < .001). Objective 2: we did not observe a statistically significant effect of gender (p = .278), or self-rated religiosity (p = .163). Objective 3: in the interventional study, 440 students participated in the pretest and 422 students participated in the posttest. The test of statistical significance found no improvement in students' moral competence after the intervention (p = .253). CONCLUSION Medical students show a regression in moral competence during medical education; it was lower in medical students in their fifth year, compared to the first-year medical students without the effect of gender, or self-rated religiosity. Although educational intervention consisting of multiple tools of medical ethics teaching (PBL, CBL, KMDD and StorED) did not lead to increase in moral competence, the longitudinal effect of such intervention remains to be seen.
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Affiliation(s)
- Martin Zielina
- Department of Medical Ethics and Humanities, Second Faculty of Medicine, Charles University, V Úvalu 84, Prague, 15006, Czech Republic.
| | - Jaromír Škoda
- Department of Medical Ethics and Humanities, Second Faculty of Medicine, Charles University, V Úvalu 84, Prague, 15006, Czech Republic
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Kateřina Ivanová
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Daniel Dostál
- Department of Psychology, Faculty of Arts, Palacký University Olomouc, Olomouc, Czech Republic
| | - Lubica Juríčková
- Department of Public Health, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - David Anthony Procházka
- First Faculty of Medicine, Institut for Medical Humanities, Charles University, Prague, Czech Republic
| | - Barbora Straka
- Department of Medical Ethics and Humanities, Second Faculty of Medicine, Charles University, V Úvalu 84, Prague, 15006, Czech Republic
- Department of Paediatric Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Adam Doležal
- Department of Medical Ethics and Humanities, Second Faculty of Medicine, Charles University, V Úvalu 84, Prague, 15006, Czech Republic
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Waters HM, Oswald A, Constantin E, Thoma B, Dagnone JD. Physician Humanism in CanMEDS 2025. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:13-17. [PMID: 36998505 PMCID: PMC10042789 DOI: 10.36834/cmej.75536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Heather M Waters
- Department of Family Medicine, McMaster University, Ontario, Canada
| | - Anna Oswald
- Department of Medicine, University of Alberta, Alberta, Canada
- Royal College of Physicians and Surgeons of Canada, Ontario, Canada
| | | | - Brent Thoma
- University of Saskatchewan, Saskatchewan, Canada
| | - J Damon Dagnone
- Department of Emergency Medicine, Queen’s University, Ontario, Canada
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Dagnone JD, Glover-Takahashi S, Spadafora S, Whitehead C. Time's up for prioritizing Physician Humanism into CanMEDS. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:123-124. [PMID: 36998484 PMCID: PMC10042780 DOI: 10.36834/cmej.75106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- JD Dagnone
- Department of Emergency Medicine, Queen's University, Ontario, Canada
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Tabatabaei ZS, Mirzazadeh A, Amini H, Mafinejad MK. What we think about professional and unprofessional behaviors: differences between the perception of clinical faculty members and medical students. BMC MEDICAL EDUCATION 2022; 22:866. [PMID: 36517813 PMCID: PMC9749347 DOI: 10.1186/s12909-022-03874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Differences in the viewpoints of clinical faculty members and medical students about prioritizing professional norms accepted by the professional community and lack of alignment of these views can lead to distortion of understanding, problems in learning and assessment of professionalism, and failure in students' professional identity formation. This study aimed to identify the differences in viewpoints of clinical faculty members and medical students about prioritizing the importance and prevalence of professional and unprofessional behaviors among undergraduate medical students. METHODS A multi-stage qualitative study was conducted at Tehran University of Medical Sciences during 2020-2021. At first, a systematic search was conducted to identify professional and unprofessional behaviors using the directional content analysis method. A panel of experts was formed to check the codes obtained from reviewing the literature and to evaluate its compliance with the context. Then, the modified nominal group technique sessions were held with clinical faculty members and medical students to strengthen the codes extracted from the studies and systematically integrate their views to achieve a comprehensive list of professional and unprofessional behaviors in accordance with the context. Finally, a consensus was made among them about prioritizing the importance and prevalence of these behaviors in undergraduate medical students. RESULTS A total of 490 codes of professional behaviors and 595 unprofessional behavior codes were identified in the literature review. In the following sessions of the modified nominal group, 13 clinical faculty members listed 105 codes of professional and unprofessional behaviors, and 51 medical students also listed 313 codes. The results of the modified nominal group technique showed that the faculty members reported the importance of unprofessional behaviors higher than professional ones. At the same time, students rated the importance of professional behaviors higher than unprofessional ones. Both faculty members and students rate the prevalence of professional behaviors as high and the prevalence of unprofessional behaviors as low. CONCLUSION The results showed a difference of views between clinical faculty members and medical students about prioritizing professional and unprofessional behaviors. It is essential to align their viewpoints to understand, learn and value professionalism to develop a professional identity.
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Affiliation(s)
- Zahra Sadat Tabatabaei
- Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Education Development Office, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azim Mirzazadeh
- Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Homayoun Amini
- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboobeh Khabaz Mafinejad
- Health Professions Education Research Center, Education Development Center, Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
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Taking the Big Leap: A Case Study on Implementing Programmatic Assessment in an Undergraduate Medical Program. EDUCATION SCIENCES 2022. [DOI: 10.3390/educsci12070425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The concept of programmatic assessment (PA) is well described in the literature; however, studies on implementing and operationalizing this systemic assessment approach are lacking. The present case study developed a local instantiation of PA, referred to as Assessment System Fribourg (ASF), which was inspired by an existing program. ASF was utilized for a new competency-based undergraduate Master of Medicine program at the State University of Fribourg. ASF relies on the interplay of four key principles and nine main program elements based on concepts of PA, formative assessment, and evaluative judgment. We started our journey in 2019 with the first cohort of 40 students who graduated in 2022. This paper describes our journey implementing ASF, including the enabling factors and hindrances that we encountered, and reflects on our experience and the path that is still in front of us. This case illustrates one possibility for implementing PA.
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Ng SL, Crukley J, Brydges R, Boyd V, Gavarkovs A, Kangasjarvi E, Wright S, Kulasegaram K, Friesen F, Woods NN. Toward 'seeing' critically: a Bayesian analysis of the impacts of a critical pedagogy. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:323-354. [PMID: 34973100 PMCID: PMC9117363 DOI: 10.1007/s10459-021-10087-2] [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: 05/16/2021] [Accepted: 11/14/2021] [Indexed: 05/30/2023]
Abstract
Critical reflection supports enactment of the social roles of care, like collaboration and advocacy. We require evidence that links critical teaching approaches to future critically reflective practice. We thus asked: does a theory-informed approach to teaching critical reflection influence what learners talk about (i.e. topics of discussion) and how they talk (i.e. whether they talk in critically reflective ways) during subsequent learning experiences? Pre-clinical students (n = 75) were randomized into control and intervention conditions (8 groups each, of up to 5 interprofessional students). Participants completed an online Social Determinants of Health (SDoH) module, followed by either: a SDoH discussion (control) or critically reflective dialogue (intervention). Participants then experienced a common learning session (homecare curriculum and debrief) as outcome assessment, and another similar session one-week later. Blinded coders coded transcripts for what (topics) was said and how (critically reflective or not). We constructed Bayesian regression models for the probability of meaning units (unique utterances) being coded as particular what codes and as critically reflective or not (how). Groups exposed to the intervention were more likely, in a subsequent learning experience, to talk in a critically reflective manner (how) (0.096 [0.04, 0.15]) about similar content (no meaningful differences in what was said). This difference waned at one-week follow up. We showed experimentally that a particular critical pedagogical approach can make learners' subsequent talk, ways of seeing, more critically reflective even when talking about similar topics. This study offers the field important new options for studying historically challenging-to-evaluate impacts and supports theoretical assertions about the potential of critical pedagogies.
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Affiliation(s)
- Stella L Ng
- University of Toronto Centre for Interprofessional Education at University Health Network, Toronto Western Hospital, 399 Bathurst St., Nassau Annex (Entrance), Toronto, ON, M5T 2S8, Canada.
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada.
- Wilson Centre, University of Toronto, Toronto, ON, Canada.
| | - Jeff Crukley
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Data Science and Statistics, Toronto, ON, Canada
| | - Ryan Brydges
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Education, Unity Health Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Victoria Boyd
- Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Adam Gavarkovs
- Institute of Health Policy, Management & Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | | | - Sarah Wright
- Department of Family and Community Medicine and Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Kulamakan Kulasegaram
- Department of Family and Community Medicine and Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
| | - Farah Friesen
- University of Toronto Centre for Interprofessional Education at University Health Network, Toronto Western Hospital, 399 Bathurst St., Nassau Annex (Entrance), Toronto, ON, M5T 2S8, Canada
| | - Nicole N Woods
- Department of Family and Community Medicine and Wilson Centre, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University of Toronto, Toronto, ON, Canada
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Rieffestahl AM, Risør T, Mogensen HO, Reventlow S, Morcke AM. Ignitions of empathy. Medical students feel touched and shaken by interacting with patients with chronic conditions in communication skills training. PATIENT EDUCATION AND COUNSELING 2021; 104:1668-1673. [PMID: 33376009 DOI: 10.1016/j.pec.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore what and how medical students learn from patients with chronic conditions in the context of communication skills training. METHODS Semi-structured interviews and focus groups with 32 medical students. Interviews were recorded, transcribed, analyzed inductively and organized into four main narrative themes. RESULTS Learning from patients provided medical students opportunities to see the world through the patients' eyes, understand the diversity of patients' needs, and recognize the importance of matching patients' and doctors' perspectives. Consequently, students expressed emotional responses on challenges in interactions with the patients related to performing the role as 'medical expert'. Difficulty empathizing became visible in the students' interaction with patients. CONCLUSION The patients' authentic contributions provided the students with unique opportunities to engage with their own emotions and capacity for empathy. However, for students to benefit from this affective practical training, they need guidance to balance professional and personal aspects in encounters. There is a need to introduce the 'doctor as person' in medical education. PRACTICE IMPLICATIONS Patients with chronic conditions strengthen students' learning of empathy as part of transformative learning. Doing so with patients is a challenging way of learning. Thus, faculty and educators must provide explicit guidance for students to benefit.
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Affiliation(s)
- Anne Marie Rieffestahl
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark, Denmark; Section of General Practice and the Research Unit for General Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Denmark.
| | - Torsten Risør
- Section of General Practice and the Research Unit for General Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Denmark; Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Norway
| | - Hanne O Mogensen
- Department of Anthropology, Faculty of Social Science, University of Copenhagen, Denmark
| | - Susanne Reventlow
- Section of General Practice and the Research Unit for General Practice, Department of Public Health, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Anne Mette Morcke
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark, Denmark
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Pan Y, Chen X, Wei Q, Zhao J, Chen X. Effects on applying micro-film case-based learning model in pediatrics education. BMC MEDICAL EDUCATION 2020; 20:500. [PMID: 33298040 PMCID: PMC7727213 DOI: 10.1186/s12909-020-02421-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 12/03/2020] [Indexed: 05/29/2023]
Abstract
BACKGROUND In view of the harsh reality Chinese paediatricians face, the challenge of paediatric education is about instilling not only knowledge and clinical skills but also resilience and beliefs. The aim of the study is to explore a more effective method than the traditional lecture-based learning (LBL) model for optimizing educational outcomes by establishing an innovative, comprehensive, case-based learning (CBL) model combined with the micro-film technique (MF + CBL). This approach has four important components: interests (attraction), knowledge application, competency, and scenario coping skills. METHODS Experimental research was conducted via a controlled parallel group study. The total sample of 104 senior-year students (Chinese) majoring in clinical medicine was randomly divided into two groups. The experimental group was exposed to the MF + CBL model and the control group to the LBL model. Overall, the results were assessed after an 8-week course via a student self-assessment questionnaire, a satisfaction survey and the final examination. RESULTS The experimental group generally performed better than the control group on the student self-assessment (P<0.05), satisfaction survey (P<0.05), and final examination (80.02 ± 3.77 vs 73.65 ± 3.69, P = 0.000). The open question at the end of the questionnaire revealed that a small number of students did not favour the MF + CBL model due to its time- and energy-consuming features. CONCLUSIONS Compared with LBL, the MF + CBL model was an innovative teaching method that promoted more comprehensive quality development. It represents an alternative model for optimizing the capacity of future paediatric doctors.
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Affiliation(s)
- Yuan Pan
- Department of Graduate Administration, Guangxi Medical University, Nanning, 22 Shuangyong Road, Nanning, Guangxi, People's Republic of China
- Department of Humanity and Social Sciences, Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Xiuqi Chen
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, People's Republic of China
| | - Qiuwen Wei
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, People's Republic of China
| | - Jinmin Zhao
- Department of Graduate Administration, Guangxi Medical University, Nanning, 22 Shuangyong Road, Nanning, Guangxi, People's Republic of China.
| | - Xun Chen
- Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Nanning, Guangxi, People's Republic of China.
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Professionalism for Physician Assistants. PHYSICIAN ASSISTANT CLINICS 2020. [DOI: 10.1016/j.cpha.2019.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lombardo L, Ehlers J, Lutz G. Is your mind set? - how are intra- and interpersonal competences dealt with in medical education? A multi-professional qualitative study. BMC MEDICAL EDUCATION 2019; 19:317. [PMID: 31438949 PMCID: PMC6704522 DOI: 10.1186/s12909-019-1748-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/12/2019] [Indexed: 05/16/2023]
Abstract
BACKGROUND Professional intrapersonal and interpersonal competences (IICs) form an important part of medical expertise but are given little attention during clinical training. In other professional fields such as psychotherapy, education and aviation, training in IICs is an integral part of education and practice. In medicine, IICs tend to actually decline during studies. To date it is unclear why IICs are given less attention in medicine, despite evidence for their importance in the treatment process. In view of this, the study examined the role of IICs in the treatment process, the current situation of IIC training in medicine and, most importantly, the reasons for the comparatively low focus on IICs in the clinical training of medical students. METHODS Semi-structured interviews were carried out with 21 experts from a variety of medical specialties and non-medical professions that provide a training with a stronger focus on IIC development. The interviews were evaluated using grounded theory. RESULTS The experts confirmed the idea that IICs are an equally important component in the treatment process, along with medical knowledge and technical skills. They also described large differences between the IICs possessed by physicians but noted a general developmental need. The key shortcoming was perceived to be a deep-seated defensiveness towards learning from mistakes and deficits e.g. through reflection and feedback. The interaction of different factors that seem to be reasons for this defensiveness and perpetuate it were identified: lack of support in dealing with insecurities in the face of responsibility; the notion of medicine as a science with the categories of right and wrong answers; and a range of pressures arising from the setting, such as hierarchical, economic and competition pressures. CONCLUSION Our study showed, that the defensive attitude towards learning from mistakes and deficits especially in the field of IICs appears to be a subtle but powerful obstacle for implementing IICs in medical training, in contrast to other professional fields. This obstacle is sustained by various underlying barrier factors. We therefore propose that changes should be made within a cultural transformation targeting this defensive mindset and culture and its presumed reasons.
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Affiliation(s)
- Lisa Lombardo
- Institute for Didactics and Educational Research in Health Care, Department of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Medical Theory, Integrative and Anthroposophic Medicine, Department of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
| | - Jan Ehlers
- Chair for Didactics and Educational Research in Health Care, Department of Medicine, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
| | - Gabriele Lutz
- Integrated Curriculum for Anthroposophic Medicine (ICURAM), Chair for Medical Theory, Integrative and Anthroposophic Medicine, Department of Medicine, Faculty of Health, Witten / Herdecke University, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
- Department of Psychosomatic Medicine, Gemeinschaftskrankenhaus Herdecke, Gerhard Kienle Weg 4, 58313 Herdecke, Germany
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Ng SL, Wright SR, Kuper A. The Divergence and Convergence of Critical Reflection and Critical Reflexivity: Implications for Health Professions Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1122-1128. [PMID: 30920447 DOI: 10.1097/acm.0000000000002724] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
As a field, health professions education (HPE) has begun to answer calls to draw on social sciences and humanities (SS&H) knowledge and approaches for curricular content, design, and pedagogy. Two commonly used SS&H concepts in HPE are critical reflection and critical reflexivity. But these are often conflated, misunderstood, and misapplied. Improved clarity of these concepts may positively affect both the education and practice of health professionals. Thus, the authors seek to clarify the origins of each, identify the similarities and differences between them, and delineate the types of teaching and assessment methods that fit with critical reflection and/or critical reflexivity. Common to both concepts is an ultimate goal of social improvement. Key differences include the material emphasis of critical reflection and the discursive emphasis of critical reflexivity. These similarities and differences result in some different and some similar teaching and assessment approaches, which are highlighted through examples. The authors stress that all scientific and social scientific concepts and methods imported into HPE must be subject to continued scrutiny both from within their originating disciplines and in HPE. This continued questioning is core to the ongoing development of the HPE field and also to health professionals' thinking and practice.
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Affiliation(s)
- Stella L Ng
- S.L. Ng is director of research, Centre for Faculty Development, and Arrell Family Chair in Health Professions Teaching, St. Michael's Hospital, scientist, Centre for Ambulatory Care Education and the Wilson Centre, and assistant professor, Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada. S.R. Wright is scientist, Michael Garron Hospital, Centre for Ambulatory Care Education and the Wilson Centre, and assistant professor, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada. A. Kuper is associate professor of medicine and faculty co-lead in person-centred care, Department of Medicine, scientist and associate director, Wilson Centre for Research in Education, University Health Network, University of Toronto, and staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Heaslip G, Vaillancourt A, Tatham P, Kovács G, Blackman D, Henry MC. Supply chain and logistics competencies in humanitarian aid. DISASTERS 2019; 43:686-708. [PMID: 31172577 DOI: 10.1111/disa.12361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The continuing incidence of disasters and their associated challenges has increased the demand for humanitarian logisticians. However, there is a dearth of research on their essential competencies. This paper proposes, therefore, a humanitarian logistics competency framework (HlCF) to assist with the professional development of humanitarian logisticians. In creating the HlCF, nine competency domains containing 29 specific competencies across four levels (entry to senior management) were identified. This study makes two key contributions to the literature: (i) it extends the discussion of competency frameworks in humanitarian logistics; and (ii) it presents a framework designed to support the human resource plans and practices of aid agencies. The HlCF allows not only individual humanitarian logisticians to develop the competencies necessary for career success, but also humanitarian organisations to map their own competency frameworks to a common standard. This will, in turn, facilitate workforce mobility and support the overall concept of a certified humanitarian logistics professional.
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Duitsman ME, Fluit CRMG, van der Goot WE, ten Kate-Booij M, de Graaf J, Jaarsma DADC. Judging residents' performance: a qualitative study using grounded theory. BMC MEDICAL EDUCATION 2019; 19:13. [PMID: 30621674 PMCID: PMC6325830 DOI: 10.1186/s12909-018-1446-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 12/28/2018] [Indexed: 05/12/2023]
Abstract
BACKGROUND Although program directors judge residents' performance for summative decisions, little is known about how they do this. This study examined what information program directors use and how they value this information in making a judgment of residents' performance and what residents think of this process. METHODS Sixteen semi-structured interviews were held with residents and program directors from different hospitals in the Netherlands in 2015-2016. Participants were recruited from internal medicine, surgery and radiology. Transcripts were analysed using grounded theory methodology. Concepts and themes were identified by iterative constant comparison. RESULTS When approaching semi-annual meetings with residents, program directors report primarily gathering information from the following: assessment tools, faculty members and from their own experience with residents. They put more value on faculty's comments during meetings and in the corridors than on feedback provided in the assessment tools. They are influenced by their own beliefs about learning and education in valuing feedback. Residents are aware that faculty members discuss their performance in meetings, but they believe the assessment tools provide the most important proof to demonstrate their clinical competency. CONCLUSIONS Residents think that feedback in the assessment tools is the most important proof to demonstrate their performance, whereas program directors scarcely use this feedback to form a judgment about residents' performance. They rely heavily on remarks of faculty in meetings instead. Therefore, residents' performance may be better judged in group meetings that are organised to enhance optimal information sharing and decision making about residents' performance.
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Affiliation(s)
- Marrigje E. Duitsman
- Department of Internal Medicine and Health Academy, Radboud Health Academy, Radboud University Medical Centre, Gerard van Swietenlaan 4, Postbus 9101, 6500 HB Nijmegen, the Netherlands
| | - Cornelia R. M. G. Fluit
- Health Academy, Department of Research in Learning and Education, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Wieke E. van der Goot
- Martini Hospital, Groningen, the Netherlands
- Centre for Education Development and Research in Health Professions, University Medical Centre Groningen, Groningen, the Netherlands
| | - Marianne ten Kate-Booij
- Department of Obstetrics and Gynaecology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jacqueline de Graaf
- Department of Internal Medicine, Radboudumc Nijmegen, Nijmegen, the Netherlands
| | - Debbie A. D. C. Jaarsma
- Centre for Education Development and Research in Health Professions, University Medical Centre Groningen, Groningen, the Netherlands
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Cristancho SM, Goldszmidt M, Lingard L, Watling C. Qualitative research essentials for medical education. Singapore Med J 2018; 59:622-627. [PMID: 30009321 DOI: 10.11622/smedj.2018093] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper offers a selective overview of the increasingly popular paradigm of qualitative research. We consider the nature of qualitative research questions, describe common methodologies, discuss data collection and analysis methods, highlight recent innovations and outline principles of rigour. Examples are provided from our own and other authors' published qualitative medical education research. Our aim is to provide both an introduction to some qualitative essentials for readers who are new to this research paradigm and a resource for more experienced readers, such as those who are currently engaged in a qualitative research project and would like a better sense of where their work sits within the broader paradigm.
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Affiliation(s)
- Sayra M Cristancho
- Department of Surgery and Faculty of Education, Schulich School of Medicine and Dentistry, Western University, Canada.,Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Canada
| | - Mark Goldszmidt
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Canada
| | - Christopher Watling
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, Canada.,Postgraduate Medical Education, Schulich School of Medicine and Dentistry, Western University, Canada
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Menezes N, Hawa R, Oswald R, Lee EK. Does One Size Truly Fit All? The COUPE Undergraduate Perspective on Competency-Based Medical Education in Psychiatry. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:356-360. [PMID: 29669434 PMCID: PMC5971410 DOI: 10.1177/0706743718758967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Natasja Menezes
- 1 Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario
| | - Raed Hawa
- 2 Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - Ron Oswald
- 3 Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Elliott Kyung Lee
- 4 Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario
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Bindels E, Verberg C, Scherpbier A, Heeneman S, Lombarts K. Reflection revisited: how physicians conceptualize and experience reflection in professional practice - a qualitative study. BMC MEDICAL EDUCATION 2018; 18:105. [PMID: 29747630 PMCID: PMC5946575 DOI: 10.1186/s12909-018-1218-y] [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: 12/20/2017] [Accepted: 04/27/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND For the purpose of continuous performance improvement, physicians are expected to reflect on their practice. While many reflection studies are theoretically oriented and often prescriptive in the sense that they conceptualize what reflection should look like, the current study starts with practicing physicians themselves and maps how these physicians conceptualize and experience reflection in daily professional practice. METHODS We conducted a qualitative study using in-depth interviews with 13 hospital-based physicians from various specialties and institutions. The interviews were transcribed verbatim and were analyzed iteratively, following the interpretative phenomenological analysis approach. RESULTS Data analysis resulted in the identification of three main topics: fuzziness, domain specificity and dialogical dynamics of reflection in professional practice. Reflection was conceptualized as a fuzzy process of contemplation and action, leading to change and hopefully improvement of personal performance and health care in general. Physicians' experiences with reflection were different for the patient domain and the team domain. Whereas experiences in the patient domain were recalled first and discussed in relatively clear terms, those in the team domain came second and were discussed in more ambiguous terms. In order to achieve improvement in daily practice, honest and open dialogues were perceived as necessary. These dialogues were regarded as the result of an interplay between an internal and an external dialogue. The internal dialogue required sensitivity and courage of the individual; the external dialogue required psychological safety and encouragement of the environment. Within the team domain however, handling the external dialogue effectively was not self-evident, underlining the importance of psychological safety. CONCLUSIONS This study draws attention to the interdependence between the individual and the collective contributions to reflective activity in professional practice. Apart from its importance to physicians' individual medical performance, reflective activity is also important to the functioning of a team of physicians. To allow reflection to rise from an individual activity to a team activity, it is necessary to invest in a safe environment in which people are encouraged to think, act, and be engaged.
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Affiliation(s)
- Elisa Bindels
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Professional Performance research group, Institute for Education and Training, Academic Medical Center (AMC-UvA), Amsterdam, the Netherlands
| | - Christel Verberg
- ICLON, Leiden University, Graduate School of Teaching, Leiden, the Netherlands
| | - Albert Scherpbier
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Sylvia Heeneman
- Department of Pathology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Kiki Lombarts
- Professional Performance research group, Institute for Education and Training, Academic Medical Center (AMC-UvA), Amsterdam, the Netherlands
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Mak-van der Vossen M, van Mook W, van der Burgt S, Kors J, Ket JC, Croiset G, Kusurkar R. Descriptors for unprofessional behaviours of medical students: a systematic review and categorisation. BMC MEDICAL EDUCATION 2017; 17:164. [PMID: 28915870 PMCID: PMC5603020 DOI: 10.1186/s12909-017-0997-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 09/04/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND Developing professionalism is a core task in medical education. Unfortunately, it has remained difficult for educators to identify medical students' unprofessionalism, because, among other reasons, there are no commonly adopted descriptors that can be used to document students' unprofessional behaviour. This study aimed to generate an overview of descriptors for unprofessional behaviour based on research evidence of real-life unprofessional behaviours of medical students. METHODS A systematic review was conducted searching PubMed, Ebsco/ERIC, Ebsco/PsycINFO and Embase.com from inception to 2016. Articles were reviewed for admitted or witnessed unprofessional behaviours of undergraduate medical students. RESULTS The search yielded 11,963 different studies, 46 met all inclusion criteria. We found 205 different descriptions of unprofessional behaviours, which were coded into 30 different descriptors, and subsequently classified in four behavioural themes: failure to engage, dishonest behaviour, disrespectful behaviour, and poor self-awareness. CONCLUSIONS This overview provides a common language to describe medical students' unprofessional behaviour. The framework of descriptors is proposed as a tool for educators to denominate students' unprofessional behaviours. The found behaviours can have various causes, which should be explored in a discussion with the student about personal, interpersonal and/or institutional circumstances in which the behaviour occurred. Explicitly denominating unprofessional behaviour serves two goals: [i] creating a culture in which unprofessional behaviour is acknowledged, [ii] targeting students who need extra guidance. Both are important to avoid unprofessional behaviour among future doctors.
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Affiliation(s)
- Marianne Mak-van der Vossen
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
- Department for General Practice and Elderly Care Management, VU Medical Center, Amsterdam, the Netherlands
| | - Walther van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Medical Education Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Stéphanie van der Burgt
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
| | - Joyce Kors
- AVAG Midwifery Academy Amsterdam Groningen, Amsterdam, the Netherlands
| | - Johannes C.F. Ket
- Medical Library, University Library, Vrije Universiteit, Amsterdam, the Netherlands
| | - Gerda Croiset
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
| | - Rashmi Kusurkar
- Department of Research in Education, VUmc School of Medical Sciences, Amsterdam, the Netherlands
- LEARN! Research Institute for Education and Learning, VU University, Amsterdam, the Netherlands
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20
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Halman M, Baker L, Ng S. Using critical consciousness to inform health professions education : A literature review. PERSPECTIVES ON MEDICAL EDUCATION 2017; 6:12-20. [PMID: 28050879 PMCID: PMC5285284 DOI: 10.1007/s40037-016-0324-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE To explore how, in health professions education (HPE), the concept of critical consciousness has been defined and discussed, and to consider and suggest how critical pedagogy could be applied in practice. This exploration responds to increasing calls in the literature for HPE to foster compassionate care and social consciousness through the social sciences and humanities. METHOD The authors searched Medline/PubMed, ERIC and Web of Science for articles focusing on critical consciousness and/or critical pedagogy involving health professions. A thematic analysis aimed to identify key themes of critical consciousness in HPE literature. RESULTS The authors included 30 papers in their review. Key themes related to defining and discussing core attributes of critical consciousness in HPE were: 1) appreciating context in education and practice; 2) illuminating power structures; 3) moving beyond 'procedural'; 4) enacting reflection; and 5) promoting equity and social justice. CONCLUSIONS Critical consciousness may inform an appropriate critical pedagogy for fostering compassionate, humanistic, socially conscious health professionals who act as agents of change. While the authors share critical teaching practices for educators, considerable care must be taken in efforts to use critical pedagogy within the current structures of HPE programmes. The authors suggest attending to the philosophical and theoretical origins of critical consciousness and those of the dominant models of contemporary HPE (e. g. competency-based approaches) in order to ensure the tenets of critical pedagogy can be enacted authentically.
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Affiliation(s)
- Mark Halman
- Department of Psychiatry, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
| | - Lindsay Baker
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stella Ng
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Kärreman D, Levay C. The interplay of text, meaning and practice: methodological considerations on discourse analysis in medical education. MEDICAL EDUCATION 2017; 51:72-80. [PMID: 27981655 DOI: 10.1111/medu.13212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 04/22/2016] [Accepted: 08/24/2016] [Indexed: 06/06/2023]
Abstract
CONTEXT The study of discourses (i.e. verbal interactions or written accounts) is increasingly used in social sciences to gain insight into issues connected to discourse, such as meanings, behaviours and actions. This paper situates discourse analysis in medical education, based on a framework developed in organisational discourse analysis and widely deployed in other social science disciplines. OBJECTIVES This paper aims to examine the constructs of 'discourse' and 'discourse analysis', and how various understandings of discourse and discourse analysis may play out in empirical and analytical settings, with a particular focus on the field of medical education. METHODS The study is based on a literature analysis of discourse analysis approaches published in Medical Education. RESULTS Findings suggest that empirical studies through discourse analysis can be heuristically understood in terms of the links between text, practices and meaning. CONCLUSIONS Discourse analysis provides a more strongly supported argument when it is possible to defend claims on three levels: practice, using observational data; meaning, using ethnographic data, and text, using conversational and textual data.
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Affiliation(s)
- Dan Kärreman
- Department of Intercultural Communication and Management, Copenhagen Business School, Frederiksberg, Denmark
- Department of School of Management, Faculty of Royal Holloway, Royal Holloway University of London, London, UK
| | - Charlotta Levay
- Department of Business Administration, University of Lund, Lund, Sweden
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22
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McIntyre-Hite L. A Delphi study of effective practices for developing competency-based learning models in higher education. ACTA ACUST UNITED AC 2016. [DOI: 10.1002/cbe2.1029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Ellaway R. CanMEDS is a theory. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2016; 21:915-917. [PMID: 27878472 DOI: 10.1007/s10459-016-9724-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 10/13/2016] [Indexed: 06/06/2023]
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van Loon KA, Teunissen PW, Driessen EW, Scheele F. The Role of Generic Competencies in the Entrustment of Professional Activities: A Nationwide Competency-Based Curriculum Assessed. J Grad Med Educ 2016; 8:546-552. [PMID: 27777665 PMCID: PMC5058587 DOI: 10.4300/jgme-d-15-00321.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Entrustable professional activities (EPAs) seek to translate essential physician competencies into clinical practice. Until now, it is not known whether EPA-based curricula offer enhanced assessment and feedback to trainees. OBJECTIVE This study examined program directors' and senior residents' justifications for entrustment decisions and what role generic, cross-specialty competencies (such as communication skills, collaboration, and understanding health care systems) play in these decisions. METHODS Entrustment decisions for all Dutch obstetrics and gynecology residents between January 2010 and April 2014 were retrieved from their electronic portfolios. Justifications for entrustment were divided into 4 categories: the resident's experience, his or her technical performance, the presence of a generic competency, and training. Template analysis was used to analyze in depth the types of justifications, which play a role in entrustment decisions. RESULTS A total of 5139 entrustment decisions for 375 unique residents were extracted and analyzed. In 59% of all entrustment decisions, entrusting a professional task to a resident was justified by the experience of the resident. Generic competencies were mentioned in 0.5% of all entrustment decisions. Template analysis revealed that the amount of exposure and technical skills are leading factors, while the quality of the performance was not reported to be of any influence. CONCLUSIONS Entrustment decisions only rarely are based on generic competencies, despite the introduction of competency frameworks and EPAs. For program directors, a leading factor in entrustment decisions is a resident's exposure to an activity, and the quality of a resident's performance appears to play only a minor role.
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Affiliation(s)
- Karsten A. van Loon
- Corresponding author: Karsten A. van Loon, MSc, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands,
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25
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Affiliation(s)
- Pim W Teunissen
- Department of Educational Development and Research, School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
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Rangel JC, Cartmill C, Kuper A, Martimianakis MA, Whitehead CR. Setting the standard: Medical Education's first 50 years. MEDICAL EDUCATION 2016; 50:24-35. [PMID: 26695464 DOI: 10.1111/medu.12765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/03/2015] [Accepted: 03/20/2015] [Indexed: 05/15/2023]
Abstract
CONTEXT By understanding its history, the medical education community gains insight into why it thinks and acts as it does. This piece provides a Foucauldian archaeological critical discourse analysis (CDA) of the journal Medical Education on the publication of its 50th Volume. This analysis draws upon critical social science perspectives to allow the examination of unstated assumptions that underpin and shape educational tools and practices. METHODS A Foucauldian form of CDA was utilised to examine the journal over its first half-century. This approach emphasises the importance of language, and the ways in which words used affect and are affected by educational practices and priorities. An iterative methodology was used to organise the very large dataset (12,000 articles). A distilled dataset, within which particular focus was placed on the editorial pieces in the journal, was analysed. RESULTS A major finding was the diversity of the journal as a site that has permitted multiple - and sometimes contradictory - discursive trends to emerge. One particularly dominant discursive tension across the time span of the journal is that between a persistent drive for standardisation and a continued questioning of the desirability of standardisation. This tension was traced across three prominent areas of focus in the journal: objectivity and the nature of medical education knowledge; universality and local contexts, and the place of medical education between academia and the community. CONCLUSIONS The journal has provided the medical education community with a place in which to both discuss practical pedagogical concerns and ponder conceptual and social issues affecting the medical education community. This dual nature of the journal brings together educators and researchers; it also gives particular focus to a major and rarely cited tension in medical education between the quest for objective standards and the limitations of standard measures.
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Affiliation(s)
- Jaime C Rangel
- Department of Sociology, University of Toronto, Toronto, ON, Canada
- Wilson Centre, University Health Network, Toronto, ON, Canada
| | - Carrie Cartmill
- Wilson Centre, University Health Network, Toronto, ON, Canada
| | - Ayelet Kuper
- Wilson Centre, University Health Network, Toronto, ON, Canada
- Department of Medicine, Sunnybrook Health Sciences, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Maria A Martimianakis
- Wilson Centre, University Health Network, Toronto, ON, Canada
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Cynthia R Whitehead
- Wilson Centre, University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Ambulatory Care Education, Women's College Hospital, Toronto, ON, Canada
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Law M, Mathai A, Veinot P, Webster F, Mylopoulos M. Exploring lesbian, gay, bisexual, and queer (LGBQ) people's experiences with disclosure of sexual identity to primary care physicians: a qualitative study. BMC FAMILY PRACTICE 2015; 16:175. [PMID: 26651342 PMCID: PMC4675062 DOI: 10.1186/s12875-015-0389-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 12/01/2015] [Indexed: 11/10/2022]
Abstract
Background It has been demonstrated that health disparities between lesbian, gay, bisexual and queer (LGBQ) populations and the general population can be improved by disclosure of sexual identity to a health care provider (HCP). However, heteronormative assumptions (that is, assumptions based on a heterosexual identity and experience) may negatively affect communication between patients and HCPs more than has been recognized. The aim of this study was to understand LGBQ patients’ perceptions of their experiences related to disclosure of sexual identity to their primary care provider (PCP). Methods One-on-one semi-structured telephone interviews were conducted, audio-recorded, and transcribed. Participants were self-identified LGBQ adults with experiences of health care by PCPs within the previous five years recruited in Toronto, Canada. A qualitative descriptive analysis was performed using iterative coding and comparing and grouping data into themes. Results Findings revealed that disclosure of sexual identity to PCPs was related to three main themes: 1) disclosure of sexual identity by LGBQ patients to a PCP was seen to be as challenging as coming out to others; 2) a solid therapeutic relationship can mitigate the difficulty in disclosure of sexual identity; and, 3) purposeful recognition by PCPs of their personal heteronormative value system is key to establishing a strong therapeutic relationship. Conclusion Improving physicians’ recognition of their own heteronormative value system and addressing structural heterosexual hegemony will help to make health care settings more inclusive. This will allow LGBQ patients to feel better understood, willing to disclose, subsequently improving their care and health outcomes.
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Affiliation(s)
- Marcus Law
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. .,Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Anila Mathai
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | | | - Fiona Webster
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, ON, M5G 1V7, Canada.
| | - Maria Mylopoulos
- Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 3157, Toronto, ON, M5S 1A8, Canada. .,The Wilson Centre, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada.
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Ng SL, Kinsella EA, Friesen F, Hodges B. Reclaiming a theoretical orientation to reflection in medical education research: a critical narrative review. MEDICAL EDUCATION 2015; 49:461-75. [PMID: 25924122 DOI: 10.1111/medu.12680] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/13/2014] [Accepted: 12/19/2014] [Indexed: 05/12/2023]
Abstract
CONTEXT Reflection and reflective practice have become popular topics of scholarly dialogue in medical education. This popularity has given rise to checklists, portfolios and other tools to inspire and document reflection. We argue that some of the common ways in which reflection has been applied are influenced by broader discourses of assessment and evidence, and divorced from original theories of reflection and reflective practice. METHODS This paper was developed using a critical narrative approach. First we present two theoretical lenses provided by theories of reflection. Next we present a summary of relevant literature, indexed in PubMed from 2004 to 2014, relating to the application of reflection or reflective practice to undergraduate and postgraduate medical education. We categorise these articles broadly by trends and problematise the trends relative to the two theoretical lenses of reflection. RESULTS Two relevant theoretical orientations of reflection for medical education are: (i) reflection as epistemology of practice, and (ii) reflection as critical social inquiry. Three prevalent trends in the application of reflection to medical education are: (i) utilitarian applications of reflection; (ii) a focus on the self as the object of reflection, and (iii) reflection and assessment. These trends align with dominant epistemological positions in medicine, but not with those that underpin reflection. CONCLUSIONS We argue for continued theorising of and theoretically informed applications of reflection, drawing upon epistemologies of practice and critical reflection as critical social inquiry. These directions offer medical education research broad and deep potential in theories of reflection, particularly in relation to knowledge creation within uncertain and complex situations, and challenging of dominant discourses and structures. Future work could explore how dominant epistemological positions and discourses in medicine influence theories from other disciplines when these theories are deployed in medical education.
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Affiliation(s)
- Stella L Ng
- Centre for Faculty Development, St Michael's Hospital, Toronto, Ontario, Canada; Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Ontario, Canada; Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Wilson Centre for Research in Education, University Health Network, Toronto, Ontario, Canada
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Whitehead CR, Kuper A, Hodges B, Ellaway R. Conceptual and practical challenges in the assessment of physician competencies. MEDICAL TEACHER 2015; 37:245-51. [PMID: 25523113 DOI: 10.3109/0142159x.2014.993599] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Abstract The shift to using outcomes-based competency frameworks in medical education in many countries around the world requires educators to find ways to assess multiple competencies. Contemporary medical educators recognize that a competent trainee not only needs sound biomedical knowledge and technical skills, they also need to be able to communicate, collaborate and behave in a professional manner. This paper discusses methodological challenges of assessment with a particular focus on the CanMEDS Roles. The paper argues that the psychometric measures that have been the mainstay of assessment practices for the past half-century, while still valuable and necessary, are not sufficient for a competency-oriented assessment environment. New assessment approaches, particularly ones from the social sciences, are required to be able to assess non-Medical Expert (Intrinsic) roles that are situated and context-bound. Realist and ethnographic methods in particular afford ways to address the challenges of this new assessment. The paper considers the theoretical and practical bases for tools that can more effectively assess non-Medical Expert (Intrinsic) roles.
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Whitehead C, Selleger V, van de Kreeke J, Hodges B. The 'missing person' in roles-based competency models: a historical, cross-national, contrastive case study. MEDICAL EDUCATION 2014; 48:785-795. [PMID: 25039735 DOI: 10.1111/medu.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/13/2013] [Accepted: 02/24/2014] [Indexed: 05/28/2023]
Abstract
CONTEXT The use of roles such as medical expert, advocate or communicator to define competencies is currently popular in health professions education. CanMEDS is one framework that has been subject to great uptake across multiple countries and professions. The examination of the historical and cultural choices of names for roles generates insight into the nature and construction of roles. One role that has appeared in and disappeared from roles-based frameworks is that of the 'person'. METHODS In order to examine the implications of explicitly including or excluding the role of the 'physician as person' in a competency framework, we conducted a contrastive analysis of the development of frameworks in Canada and the Netherlands. We drew upon critical social science theoretical understandings of the power of language in our analysis. RESULTS In Canada, the 'person' role was a late addition to the precursory work that informed CanMEDS, and was then excluded from the final set of CanMEDS role names. In the Netherlands, a 'reflector' role was added in some Dutch schools and programmes when CanMEDS was adopted. This was done in order to explicitly emphasise the importance of the 'person' of the trainee. CONCLUSIONS In analysing choices of names for roles, we have the opportunity to see how cultural and historical contexts affect conceptions of the roles of doctors. The taking up and discarding of the 'person' role in Canada and the Netherlands suggest that as medical educators we may need to further consider the ways in which we wish the trainee as a person to be made visible in the curriculum and in assessment tools.
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Affiliation(s)
- Cynthia Whitehead
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Ambulatory Care Education, Women's College Hospital, Toronto, Ontario, Canada
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