1
|
Naidu T, Cartmill C, Swanepoel S, Whitehead CR. Shapeshifters: Global South scholars and their tensions in border-crossing to Global North journals. BMJ Glob Health 2024; 9:e014420. [PMID: 38724078 PMCID: PMC11029397 DOI: 10.1136/bmjgh-2023-014420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/14/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Global South researchers struggle to publish in Global North journals, including journals dedicated to research on health professions education (HPE). As a consequence, Western perspectives and values dominate the international academic landscape of HPE. This study sought to understand Global South researchers' motivations and experiences of publishing in Global North journals. METHODS This study used a hermeneutic phenomenological perspective. Unstructured interviews were conducted with 11 authors from 6 Global South countries. Interview transcripts were analysed through a process of familiarisation, identifying significant statements, formulating meanings, clustering themes, developing exhaustive descriptions, producing a fundamental structure and seeking verification. RESULTS Participants described being motivated by local institutional expectations, to improve reputation, to meet Global North perceptions of quality and to draw attention to their Global South context. Participants described experiences where their work was deemed irrelevant to Global North audiences, they were unable to interpret rejections and had learnt to play the publishing game by attending to both local and global imperatives. These motivations and experiences revealed several practical, academic and transformational tensions that Global South authors faced. CONCLUSION The tensions and negotiations encountered by Global South authors who publish in HPE journals reflect a 'border consciousness' whereby authors must shift consciousness, or become 'shapeshifters', inhabiting two or more worlds as they cross borders between the Global South and Global North conventions. There is an added burden and risk in performing this shapeshifting, as Global South authors stand astride the borders of two worlds without belonging fully to either.
Collapse
Affiliation(s)
- Thirusha Naidu
- Behavioural Medicine, University of KwaZulu-Natal Nelson R Mandela School of Medicine, Durban, South Africa
- Public Health and Primary Care, University of Cambridge, UK
| | - Carrie Cartmill
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Sunitha Swanepoel
- University of KwaZulu-Natal College of Health Sciences, Durban, South Africa
| | - Cynthia Ruth Whitehead
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
| |
Collapse
|
2
|
Cavanagh N, Blanchard IE, Weiss D, Tavares W. Looking back to inform the future: a review of published paramedicine research. BMC Health Serv Res 2023; 23:108. [PMID: 36732779 PMCID: PMC9893690 DOI: 10.1186/s12913-022-08893-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Paramedicine has evolved in ways that may outpace the science informing these changes. Examining the scholarly pursuits of paramedicine may provide insights into the historical academic focus, which may inform future endeavors and evolution of paramedicine. The objective of this study was to explore the existing discourse in paramedicine research to reflect on the academic pursuits of this community. METHODS We searched Medline, Embase, CINAHL, Google Scholar and Web of Science from January, 2006 to April, 2019. We further refined the yield using a ranking formula that prioritized journals most relevant to paramedicine, then sampled randomly in two-year clusters for full text review. We extracted literature type, study topic and context, then used elements of qualitative content, thematic, and discourse analysis to further describe the sample. RESULTS The initial search yielded 99,124 citations, leaving 54,638 after removing duplicates and 7084 relevant articles from nine journals after ranking. Subsequently, 2058 articles were included for topic categorization, and 241 papers were included for full text analysis after random sampling. Overall, this literature reveals: 1) a relatively narrow topic focus, given the majority of research has concentrated on general operational activities and specific clinical conditions and interventions (e.g., resuscitation, airway management, etc.); 2) a limited methodological (and possibly philosophical) focus, given that most were observational studies (e.g., cohort, case control, and case series) or editorial/commentary; 3) a variety of observed trajectories of academic attention, indicating where the evolution of paramedicine is evident, areas where scope of practice is uncertain, and areas that aim to improve skills historically considered core to paramedic clinical practice. CONCLUSIONS Included articles suggest a relatively narrow topic focus, a limited methodological focus, and observed trajectories of academic attention indicating where research pursuits and priorities are shifting. We have highlighted that the academic focus may require an alignment with aspirational and direction setting documents aimed at developing paramedicine. This review may be a snapshot of scholarly activity that reflects a young medically directed profession and systems focusing on a few high acuity conditions, with aspirations of professional autonomy contributing to the health and social well-being of communities.
Collapse
Affiliation(s)
- N. Cavanagh
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - I. E. Blanchard
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - D. Weiss
- grid.413574.00000 0001 0693 8815Alberta Health Services, Emergency Medical Services, Edmonton, Alberta Canada
| | - W. Tavares
- grid.512795.dThe Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Department of Health and Society, University of Toronto, Toronto, Ontario Canada ,York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket, Ontario Canada
| |
Collapse
|
3
|
Grant J, Grant L. Quality and constructed knowledge: Truth, paradigms, and the state of the science. MEDICAL EDUCATION 2023; 57:23-30. [PMID: 35803477 DOI: 10.1111/medu.14871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT AND TRUTH Education is a social science. Social science knowledge is related to its context of origin. The concept of global 'truth' in education is therefore of limited use when truth is tempered by context. The wider applicability of our knowledge can only be judged if we look at the context in which that knowledge was produced and the assumptions that underpin it. This calls into question the idea that educational research is a quest for global 'truth', although in relation to programme evaluation, truth tied to context is an aim. An analysis is presented of the effects of social construction on research and evaluation processes, on the selection of paradigms, reporting and interpreting findings, and on the ethics of all this. QUALITY AND IMPROVEMENT Quality improvement is based on information selected, constructed and interpreted by those who gather, analyse or use it. The strength, and not the weakness, of our knowledge is that it is socially constructed, contextual and of its time. Increasingly looking for our own truth about educational quality, and not importing the truth of others, is crucial to the state of the science. In terms of quality development, using others' findings must be based on informed local judgement. In social science, those judgements are linked to social context and their associated ideologies. IMPLICATIONS FOR FUTURE WORK The hallmark of social science is not a narrowing of focus and the search for one truth, but is a broadening of concepts, theories, paradigms, reported experience and method, and an intention for each to tell their own truth well. This will lead to a wealth of diverse views and analysed experience. The science of medical education must seek many truths.
Collapse
Affiliation(s)
- Janet Grant
- Centre for Medical Education in Context (CenMEDIC), London, UK
| | - Leonard Grant
- Centre for Medical Education in Context (CenMEDIC), London, UK
| |
Collapse
|
4
|
Emery M, Wolff M, Merritt C, Ellinas H, McHugh D, Zaher M, Semiao ML, Gruppen LD. An outcomes research perspective on medical education: Has anything changed in the last 18 years? MEDICAL TEACHER 2022; 44:1400-1407. [PMID: 35856851 DOI: 10.1080/0142159x.2022.2099259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Medical education research focused on patient-centered outcomes holds the promise of improved decision-making by medical educators. In 2001, Prystowsky and Bordage demonstrated that patient-centered outcomes were evaluated in fewer than one percent of studies published in a survey of major medical education journals. Though many have called for increased inclusion of patient-centered outcomes in medical education literature, it remains uncertain to what degree this need has been addressed systematically. METHODS Using the same data sources as in the original report (Academic Medicine, Medical Education, and Teaching and Learning in Medicine), we sought to replicate Prystowsky and Bordage's study. We extracted data from original empirical research reports from these three journal sources for the years 2014-2016. We selected 652 articles that met the inclusion criteria for further analysis. RESULTS Study participants were largely trainees (64% of studies) or faculty (25% of studies). Only 2% of studies included patients as active or passive participants. Study outcomes reported were satisfaction (40% of studies), performance (39%), professionalism (20%), and cost (1%). CONCLUSIONS These results do not differ significantly from the original 2001 study. The medical education literature as represented in these three prominent journals has made little progress in placing a greater focus on patient-centered outcomes.
Collapse
Affiliation(s)
- Matt Emery
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Margaret Wolff
- Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Chris Merritt
- Department of Emergency Medicine & Pediatrics, Alpert Medical School of Brown University, Providence, RI, USA
| | - Herodotos Ellinas
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Douglas McHugh
- Frank H. Netter MD School of Medicine, Quinnipiac University, North Haven, CT, USA
| | - Mohammad Zaher
- Department of Academic and Training Affairs, Prince Mohammad Bin AbdulAziz Hospital, Riyadh, Saudi Arabia
| | - Meghan L Semiao
- Manager, Medical Simulation & Education Standardized Patient Program, Inova Health System, Falls Church, VA, USA
| | - Larry D Gruppen
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
5
|
Wang JJ, Singh RK, Miselis HH, Stapleton SN. Technology Literacy in Undergraduate Medical Education: Review and Survey of the US Medical School Innovation and Technology Programs. JMIR MEDICAL EDUCATION 2022; 8:e32183. [PMID: 35357319 PMCID: PMC9015763 DOI: 10.2196/32183] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/14/2022] [Accepted: 02/22/2022] [Indexed: 05/06/2023]
Abstract
BACKGROUND Modern innovations, like machine learning, genomics, and digital health, are being integrated into medical practice at a rapid pace. Physicians in training receive little exposure to the implications, drawbacks, and methodologies of upcoming technologies prior to their deployment. As a result, there is an increasing need for the incorporation of innovation and technology (I&T) training, starting in medical school. OBJECTIVE We aimed to identify and describe curricular and extracurricular opportunities for innovation in medical technology in US undergraduate medical education to highlight challenges and develop insights for future directions of program development. METHODS A review of publicly available I&T program information on the official websites of US allopathic medical schools was conducted in June 2020. Programs were categorized by structure and implementation. The geographic distribution of these categories across US regions was analyzed. A survey was administered to school-affiliated student organizations with a focus on I&T and publicly available contact information. The data collected included the founding year, thematic focus, target audience, activities offered, and participant turnout rate. RESULTS A total of 103 I&T opportunities at 69 distinct Liaison Committee on Medical Education-accredited medical schools were identified and characterized into the following six categories: (1) integrative 4-year curricula, (2) facilitated doctor of medicine/master of science dual degree programs in a related field, (3) interdisciplinary collaborations, (4) areas of concentration, (5) preclinical electives, and (6) student-run clubs. The presence of interdisciplinary collaboration is significantly associated with the presence of student-led initiatives (P=.001). "Starting and running a business in healthcare" and "medical devices" were the most popular thematic focuses of student-led I&T groups, representing 87% (13/15) and 80% (12/15) of respondents, respectively. "Career pathways exploration for students" was the only type of activity that was significantly associated with a high event turnout rate of >26 students per event (P=.03). CONCLUSIONS Existing school-led and student-driven opportunities in medical I&T indicate growing national interest and reflect challenges in implementation. The greater visibility of opportunities, collaboration among schools, and development of a centralized network can be considered to better prepare students for the changing landscape of medical practice.
Collapse
Affiliation(s)
- Judy Jiaqi Wang
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Rishabh K Singh
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Heather Hough Miselis
- Department of Family Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, United States
| | - Stephanie Nicole Stapleton
- Department of Emergency Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, United States
| |
Collapse
|
6
|
Schoenfeld-Tacher RM, M Alpi K. A 45-year Retrospective Content Analysis of JVME Articles. JOURNAL OF VETERINARY MEDICAL EDUCATION 2021; 48:729-746. [PMID: 33657333 DOI: 10.3138/jvme-2020-0073] [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
To study changes in Journal of Veterinary Medical Education (JVME) content, this article presents the results of an analysis of a purposeful sample (n = 537) and demographic analysis of all 1,072 articles published from 2005 to 2019. The findings were compared to a prior analysis of articles from 1974 to 2004. Article length increased, as did the number of authors and institutions per article. Female first author numbers grew at a greater rate than the proportion of female faculty at AAVMC-accredited colleges. Close to 85% of articles were by authors in the US, UK, Canada and Australia, while 40 other countries contributed the remainder. The primary topics of papers published from 2005 to 2019 were student affairs (17.3%), professional skills (15.1%), courses and curricula (12.7%), specialty/disciplinary training (12.5%), and technology/information resources (11.5%). The prevalence of articles with an identified research methodology grew from 14.2% in 1974-2004, to 55.9% (n = 300) in 2005-2019. Among research articles, 54.7% reported an intervention and 70.3% included a comparison. Random assignment to experimental or control conditions occurred in 32 articles (15.2%). Qualitative inquiry expanded, with 16.3% of research articles using this methodology alone. The most cited article was a review paper discussing the human-animal bond. Descriptions of courses and curricula constituted the majority of articles over the journal's lifespan, while no pattern was discerned between major reports in veterinary education and subsequent publications on that topic. Over the last 45 years, JVME has transitioned from a newsletter to a scholarly publication, with ongoing evolution.
Collapse
|
7
|
Jenkins TM, Underman K, Vinson AH, Olsen LD, E. Hirshfield L. The Resurgence of Medical Education in Sociology: A Return to Our Roots and an Agenda for the Future. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:255-270. [PMID: 34528486 PMCID: PMC8446898 DOI: 10.1177/0022146521996275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
From 1940 to 1980, studies of medical education were foundational to sociology, but attention shifted away from medical training in the late 1980s. Recently, there has been a marked return to this once pivotal topic, reflecting new questions and stakes. This article traces this resurgence by reviewing recent substantive research trends and setting the agenda for future research. We summarize four current research foci that reflect and critically map onto earlier projects in this subfield while driving theoretical development elsewhere in the larger discipline: (1) professional socialization, (2) knowledge regimes, (3) stratification within the profession, and (4) sociology of the field of medical education. We then offer six potential future directions where more research is needed: (1) inequalities in medical education, (2) socialization across the life course and new institutional forms of gatekeeping, (3) provider well-being, (4) globalization, (5) medical education as knowledge-based work, and (6) effects of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Tania M. Jenkins
- The University of North Carolina
at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | |
Collapse
|
8
|
Brydges R, Boyd VA, Tavares W, Ginsburg S, Kuper A, Anderson M, Stroud L. Assumptions About Competency-Based Medical Education and the State of the Underlying Evidence: A Critical Narrative Review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:296-306. [PMID: 33031117 DOI: 10.1097/acm.0000000000003781] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE As educators have implemented competency-based medical education (CBME) as a framework for training and assessment, they have made decisions based on available evidence and on the medical education community's assumptions about CBME. This critical narrative review aimed to collect, synthesize, and judge the existing evidence underpinning assumptions the community has made about CBME. METHOD The authors searched Ovid MEDLINE to identify empirical studies published January 2000 to February 2019 reporting on competence, competency, and CBME. The knowledge synthesis focused on "core" assumptions about CBME, selected via a survey of stakeholders who judged 31 previously identified assumptions. The authors judged, independently and in pairs, whether evidence from included studies supported, did not support, or was mixed related to each of the core assumptions. Assumptions were also analyzed to categorize their shared or contrasting purposes and foci. RESULTS From 8,086 unique articles, the authors reviewed 709 full-text articles and included 189 studies reporting evidence related to 15 core assumptions. Most studies (80%; n = 152) used a quantitative design. Many focused on procedural skills (48%; n = 90) and assessed behavior in clinical settings (37%; n = 69). On aggregate, the studies produced a mixed evidence base, reporting 362 data points related to the core assumptions (169 supportive, 138 not supportive, and 55 mixed). The 31 assumptions were organized into 3 categories: aspirations, conceptualizations, and assessment practices. CONCLUSIONS The reviewed evidence base is significant but mixed, with limited diversity in research designs and the types of competencies studied. This review pinpoints tensions to resolve (where evidence is mixed) and research questions to ask (where evidence is absent). The findings will help the community make explicit its assumptions about CBME, consider the value of those assumptions, and generate timely research questions to produce evidence about how and why CBME functions (or not).
Collapse
Affiliation(s)
- Ryan Brydges
- R. Brydges is research director, a scientist, and professor of technology-enabled education, Allan Waters Family Simulation Centre, St. Michael's Hospital, and associate professor, Department of Medicine and Wilson Centre for Research in Education, University of Toronto and University Health Network, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-5203-7049
| | - Victoria A Boyd
- V.A. Boyd is a PhD student, Institute of Health Policy, Management and Evaluation, University of Toronto, and a research fellow, Wilson Centre for Research in Education, University of Toronto and University Health Network, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0003-3602-8964
| | - Walter Tavares
- W. Tavares is a scientist, Wilson Centre for Research in Education, University of Toronto and University Health Network, and assistant professor, Post MD Education, Department of Medicine, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-8267-9448
| | - Shiphra Ginsburg
- S. Ginsburg is professor, Department of Medicine, University of Toronto, a scientist, Wilson Centre for Research in Education, University of Toronto and University Health Network, and Canada Research Chair in Health Professions Education, Mt Sinai Hospital, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0002-4595-6650
| | - Ayelet Kuper
- A. Kuper is associate professor and faculty co-lead, Person-Centred Care Education, Department of Medicine, University of Toronto, a scientist and associate director, Wilson Centre for Research in Education, University of Toronto and University Health Network, and a staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ORCID: http://orcid.org/0000-0001-6399-6958
| | - Melanie Anderson
- M. Anderson is an information specialist, University Health Network, Toronto, Ontario, Canada
| | - Lynfa Stroud
- L. Stroud is associate professor, Department of Medicine, University of Toronto, a Centre researcher, Wilson Centre for Research in Education, University of Toronto and University Health Network, and a staff physician, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Kearney GP, Corman MK, Hart ND, Johnston JL, Gormley GJ. Why institutional ethnography? Why now? Institutional ethnography in health professions education. PERSPECTIVES ON MEDICAL EDUCATION 2019; 8:17-24. [PMID: 30742252 PMCID: PMC6382621 DOI: 10.1007/s40037-019-0499-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This 'A Qualitative Space' article takes a critical look at Dorothy Smith's approach to inquiry known as institutional ethnography and its potentiality in contemporary health professions education research. We delve into institutional ethnography's philosophical underpinnings, setting out the ontological shift that the researcher needs to make within this critical feminist approach. We use examples of research into frontline healthcare, into the health work of patients and into education to allow the reader to consider what an institutional ethnography research project might offer. We lay out our vision for potential growth for institutional ethnography research within the health professions education field and explain why we see this as the opportune moment to adopt institutional ethnography to meet some of the challenges facing health professions education in a way that offers informed change.
Collapse
Affiliation(s)
- Grainne P Kearney
- Centre for Medical Education, Queen's University Belfast, Belfast, UK.
| | - Michael K Corman
- Department of Sociology & Anthropology, and Faculty of Nursing, The University of Prince Edward Island, Charlottetown, Canada
| | - Nigel D Hart
- Centre for Medical Education, Queen's University Belfast, Belfast, UK
| | | | - Gerard J Gormley
- Clinical Skills Education Centre, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| |
Collapse
|
10
|
Eva KW. Medical education research approaches. MEDICAL EDUCATION 2018; 52:1100-1102. [PMID: 30345681 DOI: 10.1111/medu.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Kevin W Eva
- Centre for Health Education Scholarship, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
11
|
Superdock AK, Barfield RC, Brandon DH, Docherty SL. Exploring the vagueness of Religion & Spirituality in complex pediatric decision-making: a qualitative study. BMC Palliat Care 2018; 17:107. [PMID: 30208902 PMCID: PMC6134505 DOI: 10.1186/s12904-018-0360-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 08/31/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Medical advances have led to new challenges in decision-making for parents of seriously ill children. Many parents say religion and spirituality (R&S) influence their decisions, but the mechanism and outcomes of this influence are unknown. Health care providers (HCPs) often feel unprepared to discuss R&S with parents or address conflicts between R&S beliefs and clinical recommendations. Our study sought to illuminate the influence of R&S on parental decision-making and explore how HCPs interact with parents for whom R&S are important. METHODS A longitudinal, qualitative, descriptive design was used to (1) identify R&S factors affecting parental decision-making, (2) observe changes in R&S themes over time, and (3) learn about HCP perspectives on parental R&S. The study sample included 16 cases featuring children with complex life-threatening conditions. The length of study for each case varied, ranging in duration from 8 to 531 days (median = 380, mean = 324, SD = 174). Data from each case included medical records and sets of interviews conducted at least monthly with mothers (n = 16), fathers (n = 12), and HCPs (n = 108). Thematic analysis was performed on 363 narrative interviews to identify R&S themes and content related to decision-making. RESULTS Parents from 13 cases reported R&S directly influenced decision-making. Most HCPs were unaware of this influence. Fifteen R&S themes appeared in parent and HCP transcripts. Themes most often associated with decision-making were Hope & Faith, God is in Control, Miracles, and Prayer. Despite instability in the child's condition, these themes remained consistently relevant across the trajectory of illness. R&S influenced decisions about treatment initiation, procedures, and life-sustaining therapy, but the variance in effect of R&S on parents' choices ultimately depended upon other medical & non-medical factors. CONCLUSIONS Parents consider R&S fundamental to decision-making, but apply R&S concepts in vague ways, suggesting R&S impact how decisions are made more than what decisions are made. Lack of clarity in parental expressions of R&S does not necessarily indicate insincerity or underestimation of the seriousness of the child's prognosis; R&S can be applied to decision-making in both functional and dysfunctional ways. We present three models of how religious and spiritual vagueness functions in parental decision-making and suggest clinical applications.
Collapse
Affiliation(s)
- Alexandra K. Superdock
- School of Medicine, Duke University, Durham, NC USA
- Pediatrics Residency Program, University of Pittsburgh Medical Center, 4401 Penn Avenue, Pittsburgh, 15224 PA USA
| | - Raymond C. Barfield
- Division of Pediatric Hematology and Oncology, Duke University School of Medicine, 2 Chapel Drive, 0034 Westbrook, Durham, NC 27708 USA
| | - Debra H. Brandon
- Department of Pediatrics, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710 USA
| | - Sharron L. Docherty
- Department of Pediatrics, Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710 USA
- School of Nursing, Duke University, 307 Trent Drive, Durham, NC 27710 USA
| |
Collapse
|
12
|
Boyd VA, Whitehead CR, Thille P, Ginsburg S, Brydges R, Kuper A. Competency-based medical education: the discourse of infallibility. MEDICAL EDUCATION 2018; 52:45-57. [PMID: 29076231 DOI: 10.1111/medu.13467] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/12/2017] [Accepted: 08/14/2017] [Indexed: 05/12/2023]
Abstract
BACKGROUND Over the last two decades, competency-based frameworks have been internationally adopted as the primary educational approach in medicine. Yet competency-based medical education (CBME) remains contested in the academic literature. We look broadly at the nature of this debate to explore how it may shape scholars' understanding of CBME, and its implications for medical education research and practice. In doing so, we deconstruct unarticulated discourses and assumptions embedded in the CBME literature. METHODS We assembled an archive of literature focused on CBME. The archive dates from 1996, the publication year of the first CanMEDS Physician Competency Framework. We then conducted a Foucauldian critical discourse analysis (CDA) to delineate the dominant discourses underpinning the literature. CDA examines the intersections of language, social practices, knowledge and power relations to highlight how entrenched ways of thinking influence what can or cannot be said about a topic. FINDINGS Detractors of CBME have advanced an array of conceptual critiques. Proponents have often responded with a recurring discursive strategy that minimises these critiques and deflects attention from the underlying concept of the competency-based approach. As part of this process, conceptual concerns are reframed as two practical problems: implementation and interpretation. Yet the assertion that these are the construct's primary concerns was often unsupported by empirical evidence. These practices contribute to a discourse of infallibility of CBME. DISCUSSION In uncovering the discourse of infallibility, we explore how it can silence critical voices and hinder a rigorous examination of the competency-based approach. These discursive practices strengthen CBME by constructing it as infallible in the literature. We propose re-approaching the dialogue surrounding CBME as a starting point for empirical investigation, driven by the aim to broaden scholars' understanding of its design, development and implementation in medical education.
Collapse
Affiliation(s)
- Victoria A Boyd
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia R Whitehead
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
- Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Thille
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
| | - Shiphra Ginsburg
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ryan Brydges
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
- St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ayelet Kuper
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Rangel JC, Cartmill C, Martimianakis MA, Kuper A, Whitehead CR. In search of educational efficiency: 30 years of Medical Education's top-cited articles. MEDICAL EDUCATION 2017; 51:918-934. [PMID: 28612400 DOI: 10.1111/medu.13349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/20/2016] [Accepted: 03/16/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Academic journals represent shared spaces wherein the significance of thematic areas, methodologies and paradigms are debated and shaped through collective engagement. By studying journals in their historical and cultural contexts, the academic community can gain insight into the ways in which authors and audiences propose, develop, harness, revise and discard research subjects, methodologies and practices. METHODS Thirty top-cited articles published in Medical Education between 1986 and 2014 were analysed in a two-step process. First, a descriptive classification of articles allowed us to quantify the frequency of content areas over the time span studied. Secondly, a discourse analysis was conducted to identify the continuities, disruptions and tensions within the three most prominent content areas. RESULTS The top-cited articles in Medical Education focused on three major areas of interest: problem-based learning, simulation and assessment. In each of these areas of interest, we noted a tension between the desire to produce and apply standardised tools, and the recognition that the contexts of medical education are highly variable and influenced by political and financial considerations. The general preoccupation with achieving efficiency may paradoxically jeopardise the ability of medical schools to address the contextual needs of students, teachers and patients. CONCLUSIONS Understanding the topics of interest for a journal's scholarly audience and how these topics are discursively positioned, provides important information for researchers in deciding how they wish to engage with the field, as well as for educators as they assess the relevance of educational products for their local contexts.
Collapse
Affiliation(s)
- J Cristian Rangel
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Carrie Cartmill
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
| | - Maria Athina Martimianakis
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto at SickKids Hospital, Toronto, Ontario, Canada
| | - Ayelet Kuper
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia R Whitehead
- The Wilson Centre, University Health Network, Toronto, Ontario, Canada
- Department of Family & Community Medicine, Faculty of Medicine, University of Toronto
- Department of Family & Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Paradis E, Pipher M, Cartmill C, Rangel JC, Whitehead CR. Articulating the ideal: 50 years of interprofessional collaboration in Medical Education. MEDICAL EDUCATION 2017; 51:861-872. [PMID: 28418117 DOI: 10.1111/medu.13331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/19/2016] [Accepted: 02/10/2017] [Indexed: 05/14/2023]
Abstract
CONTEXT Health care delivery and the education of clinicians have changed immensely since the creation of the journal Medical Education. In this project, we seek to answer the following three questions: How has the concept of collaboration changed over the past 50 years in Medical Education? Have the participants involved in collaboration shifted over time? Has the idea of collaboration itself been transformed over the past 50 years? METHODS Starting from a constructionist view of scientific discourse, we used directed content analysis to sample, code and analyse 144 collaboration-related articles over the 50-year life span of Medical Education. We developed an analytical framework to identify the key components of varying articulations of 'collaboration', with a focus on shifts in language and terminology over time. Our sample was drawn from an archive of 1221 articles developed to celebrate the 50th anniversary of Medical Education. RESULTS Interprofessional collaboration is conceptualised in three primary ways throughout our sample: as a psychometric property; as tasks or activities, and, more recently, as 'togetherness'. The first conceptualisation articulates collaboration as involving knowledge or skills that are teachable to individuals, the second as involving the education of teams to engage in structured meetings or task distribution, and the third as the building of networks of individuals who learn to form team identities. The 'leader' of collaboration is typically conceptualised as the doctor, who is consistently articulated by authors as the active agent of collaborative care. Other clinicians and students of other professions are, as the wording in this sentence suggests, usually positioned as 'others', and thus as more passive participants in, or even observers of, 'collaboration'. CONCLUSIONS In order to meet goals of meaningful collaboration leading to higher-quality care, it behoves us as a community of educators and researchers to heed the ways in which we teach, think and write about interprofessional collaboration, interrogating our own language and assumptions that may be betraying and reproducing harmful care hierarchies.
Collapse
Affiliation(s)
- Elise Paradis
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - Mandy Pipher
- Department of English, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada
| | - Carrie Cartmill
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
| | - J Cristian Rangel
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia R Whitehead
- Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada
- Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Cleland J, Gibson C, Jenkins J. Celebrating ASME's diamond anniversary: 60 years at the forefront of medical education. MEDICAL EDUCATION 2017; 51:674-675. [PMID: 28474372 DOI: 10.1111/medu.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Jennifer Cleland
- University of Aberdeen, Aberdeen, UK
- Association for the Study of Medical Education (ASME)
| | - Clive Gibson
- Association for the Study of Medical Education (ASME)
- University of Keele, Keele, UK
| | - John Jenkins
- Association for the Study of Medical Education (ASME)
| |
Collapse
|
16
|
Hodges BD. Rattling minds: the power of discourse analysis in a post-truth world. MEDICAL EDUCATION 2017; 51:235-237. [PMID: 28211149 DOI: 10.1111/medu.13255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
17
|
|
18
|
|