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Doukas DJ. Promoting professionalism through humanities-based transformation. Ann Med 2024; 56:2386039. [PMID: 39101221 DOI: 10.1080/07853890.2024.2386039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/22/2024] [Accepted: 06/05/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION In the last two decades, academic medical centers in the United States have faced a new challenge, dealing with breaches of medical professionalism in their staff, house staff, and medical students. Medical education settings have largely directed their professionalism efforts toward responding reactively to negative outliers. DISCUSSION This paper contends that the warrant of medical education mandates a transformative path forward. While negative behavior must be responded to meaningfully, so, too, must positive role models of professional behavior be publicly lauded for their consequential culture change in their institutions, and promoted as positive role models. Further, the promotion of medical professionalism must be part of this culture by proactively engaging all learners and health care providers with medical ethics and humanities-based knowledge, critical thinking skills, and role modeling. CONCLUSION Professionalism programs should be vested with the authority to implement an affirmative educational program intended to nurture and promote medical professionalism in each medical student, resident, fellow, and attending and utilize methods to that end employing both virtue and care ethics.
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Affiliation(s)
- David J Doukas
- Program in Medical Ethics and Human Values, Tulane University School of Medicine, and IntegratedEthics Program Officer, Southeast LA Veterans Health Care System, New Orleans, LA, USA
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Maher S, Ryan S, O'Brien C, Fraughen D, Spooner M, McElvaney NG. Examining the approach to medical remediation programmes-an observational study. Ir J Med Sci 2024; 193:2091-2096. [PMID: 38478182 PMCID: PMC11294257 DOI: 10.1007/s11845-024-03654-0] [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: 11/02/2023] [Accepted: 02/29/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Remediation of underperforming students is recognised as an important tool in medical education; however, there is no universally agreed approach. AIMS This study aimed to evaluate the effectiveness of a remediation program for final year medical students who failed their first long case assessment (LCA1) and to compare their academic performance with their peers who passed their first long case assessment. METHODS The study consisted of two phases. Phase 1 analysed the demographics and academic performance data for the 9% of the class in the remediation group. Phase 2 focused on collecting similar data for the remaining 91% of students in the non-remediation group. Statistical analyses including the Wilcoxon rank sum test and Pearson correlation coefficients were used to compare the groups. RESULTS Phase 1 showed 88% of students who participated in remediation successfully passed the second long case assessment (LCA2); however, 25% of this cohort ultimately failed the academic year due to poor results in other assessments. Phase 2 results revealed that non-remediation group students scored significantly higher in LCA2 (59.71% vs 52.07%, p < 0.001) compared to their remediation counterparts, despite 19% of them failing this assessment. Non-remediation group students consistently outperformed their remediation group counterparts in formative and summative assessments. Overall, 6.25% of the entire class failed the academic year. CONCLUSION This study demonstrates the need to focus on overall academic performance to identify struggling students rather than one high stakes exam. Most of the students in the remediation programme ultimately passed LCA2.
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Affiliation(s)
- Sean Maher
- University of Medical and Health Sciences, Royal College of Surgeons, Dublin, Ireland.
| | - Stephanie Ryan
- University of Medical and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Conor O'Brien
- University of Medical and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Daniel Fraughen
- University of Medical and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Muirne Spooner
- University of Medical and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Noel G McElvaney
- University of Medical and Health Sciences, Royal College of Surgeons, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
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McGurgan P, Calvert K, Celenza A, Nathan EA, Jorm C. The Schweitzer effect: The fundamental relationship between experience and medical students' opinions on professional behaviours. MEDICAL TEACHER 2024; 46:782-791. [PMID: 38048408 DOI: 10.1080/0142159x.2023.2284660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE We examined whether medical students' opinions on the acceptability of a behaviour were influenced by previously encountering a similar professionally challenging situation, assessed the magnitude of effect of 'experience' compared to other demographic factors which influence medical students' opinions, and evaluated whether opinions regarding some situations/behaviours were more susceptible to 'experience' bias? METHODS Confidential, on-line survey for medical students distributed to Australian and New Zealand (AUS/NZ) medical schools. Students submitted de-identified demographic information, provided opinions on the acceptability of a wide range of student behaviours in professionally challenging situations, and whether they had encountered similar situations. RESULTS 3171 students participated from all 21 Aus/NZ medical schools (16% of registered students). Medical students reported encountering many of the professionally challenging situations, with varying opinions on what was acceptable behaviour. The most significant factor influencing acceptability towards a behaviour was whether the student reported encountering a similar situation. The professional dilemmas most significantly influenced by previous experience typically related to behaviours that students could witness in clinical environments, and often involved breaches of trust. CONCLUSIONS Our results demonstrate the relationship between experience and medical students' opinions on professional behaviour- the 'Schweitzer effect'. When students encounter poor examples of professional behaviour, especially concerning trust breaches, it significantly influences their perception of the behaviour. These results highlight the importance of placing students in healthcare settings with positive professional role modelling/work cultures.
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Affiliation(s)
- Paul McGurgan
- Division of Obstetrics and Gynaecology, UWA Medical School, Perth, Australia
| | - Katrina Calvert
- Dept. of Post-Graduate Medical Education (PGME), K.E.M.H., Perth, Australia
| | - Antonio Celenza
- Division of Emergency Medicine, UWA Medical School, Perth, Australia
| | - Elizabeth A Nathan
- Division of Obstetrics and Gynaecology, UWA Medical School, Perth, Australia
| | - Christine Jorm
- School of Public Health, University of Sydney, Australia
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Montreuil J, Lacasse M, Audétat MC, Boileau É, Laferrière MC, Lafleur A, Lee S, Nendaz M, Steinert Y. Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review update: BEME Guide No. 85. MEDICAL TEACHER 2024:1-19. [PMID: 38589011 DOI: 10.1080/0142159x.2024.2331041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/12/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Clinical teachers often struggle to record trainee underperformance due to lacking evidence-based remediation options. OBJECTIVES To provide updated evidence-based recommendations for addressing academic difficulties among undergraduate and postgraduate medical learners. METHODS A systematic review searched databases including MEDLINE, CINAHL, EMBASE, ERIC, Education Source, and PsycINFO (2016-2021), replicating the original Best Evidence Medical Education 56 review strategy. Original research/innovation reports describing intervention(s) for medical learners with academic difficulties were included. Data extraction used Michie's Behaviour Change Techniques (BCT) Taxonomy and program evaluation models from Stufflebeam and Kirkpatrick. Quality appraised used the Mixed Methods Appraisal Tool (MMAT). Authors synthesized extracted evidence by adapting GRADE approach to formulate recommendations. RESULTS Eighteen articles met the inclusion criteria, primarily addressing knowledge (66.7%), skills (66.7%), attitudinal problems (50%) and learner's personal challenges (27.8%). Feedback and monitoring was the most frequently employed BCT. Study quality varied (MMAT 0-100%). We identified nineteen interventions (UG: n = 9, PG: n = 12), introducing twelve new thematic content. Newly thematic content addressed contemporary learning challenges such as academic procrastination, and use of technology-enhanced learning resources. Combined with previous interventions, the review offers a total dataset of 121 interventions. CONCLUSION This review offers additional evidence-based interventions for learners with academic difficulties, supporting teaching, learning, faculty development, and research efforts.
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Affiliation(s)
- Julie Montreuil
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Miriam Lacasse
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Marie-Claude Audétat
- University Institute for primary care (IuMFE), University of Geneva, Geneva, Switzerland
- Unit of Development and Research (UDREM), University of Geneva, Geneva, Switzerland
| | - Élisabeth Boileau
- Department of Family and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Shirley Lee
- Department of Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Mathieu Nendaz
- Unit of Development and Research (UDREM), University of Geneva, Geneva, Switzerland
- Department of Medicine, University Hospitals, Geneva, Switzerland
| | - Yvonne Steinert
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Canada
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Araújo-Neto FDC, Santos LGD, Tavares TMA, Fonseca FLD, Prado FO, Silva RDOS, Mesquita AR, Lyra DPD. Teaching Strategies for Professional Identity Education in Pharmacy: A Scoping Review. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100597. [PMID: 37805042 DOI: 10.1016/j.ajpe.2023.100597] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/08/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES To characterize which strategies of professional identity formation and professionalism are being used in Pharmacy. FINDINGS We gathered 5004 articles from 5 databases with the descriptors "pharmacy" "professionalism," "professional identity" and their synonyms. The professional identity is a set of values and behaviors common among professionals. Professionalism is the moral compass of these values, used as a strategy to own social authenticity. After excluding duplicate texts, analyzing titles, abstracts, and full articles, 17 studies met the inclusion criteria and presented strategies for the formation of professional identity and professionalism in pharmacy students. We did not find studies with pharmacists. The quality of reports was assessed using 2 instruments recommended by the literature. All studies were conducted from 2007 onwards, and the United States is the country with the most publications. The identified strategies consisted of extracurricular activities, thematic courses, lectures, and counseling sessions and did not follow standards of theoretical reference, method, execution, duration, and effectiveness of evaluation. SUMMARY The interest of Pharmacy about professional identity and professionalism has grown substantially in recent years. Teaching strategies are essential alternatives to improve professionalism, reinforce its importance, and acknowledge its heterogeneity and differences. For that, they must be in line with the aims of the profession in society. This review highlights the need to develop standardized and reproducible teaching strategies to guarantee the effectiveness of students' professional socialization during graduation, as well as to instruct professionals to deal with the changes in the profession, increasing the influence of Pharmacy in society.
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Affiliation(s)
- Fernando de Castro Araújo-Neto
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil; Hospital Universitary of Sergipe - Federal University of Sergipe - Campus Aracaju, Health Science Postgraduate Program, Aracaju, Brazil
| | - Lívia Gois Dos Santos
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil
| | - Thaís Maria Araújo Tavares
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil
| | - Francielly Lima da Fonseca
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil; Federal University of Sergipe - Campus São Cristóvão, Pharmacy Science Postgraduate Program, São Cristóvão, Brazil
| | - Fernanda Oliveira Prado
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil; Hospital Universitary of Sergipe - Federal University of Sergipe - Campus Aracaju, Health Science Postgraduate Program, Aracaju, Brazil
| | - Rafaella de Oliveira Santos Silva
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil
| | - Alessandra Rezende Mesquita
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil
| | - Divaldo Pereira de Lyra
- Federal University of Sergipe, Department of Pharmacy, Laboratory of Teaching and Research in Social Pharmacy (LEPFS), São Cristóvão, Brazil.
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Flier LA, Richards JB, Hacker MR, Hovaguimian A, Vanka A, Sullivan A, Royce CS. "Should I Say Something?": A Simulation Curriculum on Addressing Lapses in Professionalism to Improve Patient Safety. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11359. [PMID: 38089936 PMCID: PMC10713868 DOI: 10.15766/mep_2374-8265.11359] [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: 03/28/2023] [Accepted: 08/18/2023] [Indexed: 12/18/2023]
Abstract
Introduction Medical students may witness lapses in professionalism but lack tools to effectively address such episodes. Current professionalism curricula lack opportunities to practice communication skills in addressing professionalism lapses. Methods We designed a simulation curriculum to introduce professionalism expectations, provide communication tools using elements of the Agency for Healthcare Research and Quality TeamSTEPPS program, and address observed professionalism lapses involving patient safety in hierarchical patient care teams. Students were surveyed on knowledge, skills, and attitude regarding professionalism before, immediately after, and 6 months after participation. Results Of 253 students, 70 (28%) completed baseline and immediate postsurveys, and 39 (15%) completed all surveys. In immediate postsurveys, knowledge of communication tools (82% to 94%, p = .003) and empowerment to address residents (19% to 44%, p = .001) and attendings (15% to 39%, p < .001) increased. At 6 months, 96% of students reported witnessing a professionalism lapse. Discussion The curriculum was successful in reported gains in knowledge of communication tools and empowerment to address professionalism lapses, but few students reported using the techniques to address witnessed lapses in real life.
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Affiliation(s)
- Lydia A. Flier
- Instructor, Department of Medicine, Mount Auburn Hospital and Harvard Medical School
| | - Jeremy B. Richards
- Assistant Professor of Medicine, Harvard Medical School and Mount Auburn Hospital
| | - Michele R. Hacker
- Associate Professor, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Alexandra Hovaguimian
- Assistant Professor, Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Anita Vanka
- Assistant Professor, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Amy Sullivan
- Director of Education Research, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center and Harvard Medical School
| | - Celeste S. Royce
- Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, and Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center
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Dart J, Rees C, Ash S, McCall L, Palermo C. Shifting the narrative and practice of assessing professionalism in dietetics education: An Australasian qualitative study. Nutr Diet 2023. [PMID: 36916155 DOI: 10.1111/1747-0080.12804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 02/01/2023] [Indexed: 03/16/2023]
Abstract
AIM We aimed to explore current approaches to assessing professionalism in dietetics education in Australia and New Zealand, and asked the questions what is working well and what needs to improve? METHOD We employed a qualitative interpretive approach and conducted interviews with academic and practitioner (workplace-based) educators (total sample n = 78) with a key stake in dietetics education across Australia and New Zealand. Data were analysed using team-based, framework analysis. RESULTS Our findings suggest significant shifts in dietetics education in the area of professionalism assessment. Professionalism assessment is embedded in formal curricula of dietetics programs and is occurring in university and placement settings. In particular, advances have been demonstrated in those programs assessing professionalism as part of the programmatic assessment. Progress has been enabled by philosophical and curricula shifts; clearer articulation and shared understandings of professionalism standards; enhanced learner agency and reduced power distance; early identification and intervention of professionalism lapses; and increased confidence and capabilities of educators. CONCLUSIONS These findings suggest there have been considerable advances in professionalism assessment in recent years with shifts in practice in approaching professionalism through a more interpretivist lens, holistically and more student-centred. Professionalism assessment in dietetics education is a shared responsibility and requires further development and transformation to more fully embed and strengthen curricula approaches across programs. Further work should investigate strategies to build safer learning cultures and capacity for professionalism conversations and in strengthening approaches to remediation.
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Affiliation(s)
- Janeane Dart
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Charlotte Rees
- Head of School, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Monash Centre for Scholarship in Health Education (MCSHE), Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Susan Ash
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Louise McCall
- Department of Nutrition, Dietetics and Food, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Claire Palermo
- Office of the Deputy Dean Education, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Williams BW, Welindt D. Assisting physicians who exhibit disruptive behavior: Understanding the costs, contributors, and corrections. Australas Psychiatry 2023; 31:132-135. [PMID: 36749186 DOI: 10.1177/10398562231156477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of this article is to discuss the etiology, prevalence, impact, and management of disruptive behavior in physicians. These various aspects will be examined at both the individual and system level, to provide appropriate perspective and detail effective approaches to address these behaviors. METHOD Clinical experience and review of the authors' and other researchers' findings provide consensus on numerous key aspects of physician disruptive behavior. RESULTS Physicians demonstrating disruptive behavior are often distressed. The behavior should be understood as arising from biopsychosocial contributors, knowledge gaps, insight, and systems factors. These contributors are inclusive and may interact with each other. CONCLUSIONS A comprehensive approach is required which can include assessment/reassessment tools, individualized programming (therapy, coaching, instruction), deliberate practice, medical follow-up, and system intervention. Complications include the diversity of disruptive behaviors, the many contributory factors therein, disagreement about methodology/measurement, and the role of the system.
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Affiliation(s)
- Betsy W Williams
- Clinical Program Director, Professional Renewal Center®, Lawrence, KS, USA.,Director of Education, Wales Behavioral Assessment, Lawrence, KS, USA; Clinical Associate Professor, Department of Psychiatry, School of Medicine, University of Kansas, Lawrence, KS, USA
| | - Dillon Welindt
- Department of Psychology, 3265University of Oregon, Eugene, OR, USA
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Coronado-Vázquez V, Antón-Rodríguez C, Gómez-Salgado J, Ramírez-Durán MDV, Álvarez-Montero S. Evaluation of learning outcomes of humanities curricula in medical students. A meta-review of narrative and systematic reviews. Front Med (Lausanne) 2023; 10:1145889. [PMID: 37138737 PMCID: PMC10150636 DOI: 10.3389/fmed.2023.1145889] [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: 01/16/2023] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
Objectives To assess the expected learning outcomes of medical humanities subjects in medical studies curricula. To connect those expected learning outcomes with the types of knowledge to be acquired in medical education. Methods Meta-review of systematic and narrative reviews. Cochrane Library, MEDLINE (Pubmed), Embase, CINAHL, and ERIC were searched. In addition, references from all the included studies were revised, and the ISI Web of Science and DARE were searched. Results A total of 364 articles were identified, of which six were finally included in the review. Learning outcomes describe the acquisition of knowledge and skills to improve the relationship with patients, as well as the incorporation of tools to reduce burnout and promote professionalism. Programs that focus on teaching humanities promote diagnostic observation skills, the ability to cope with uncertainty in clinical practice, and the development of empathetic behaviors. Conclusion The results of this review show heterogeneity in the teaching of medical humanities, both in terms of content and at the formal level. Humanities learning outcomes are part of the necessary knowledge for good clinical practice. Consequently, the epistemological approach provides a valid argument for including the humanities in medical curricula.
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Affiliation(s)
- Valle Coronado-Vázquez
- B21-20R Group, Instituto Aragonés de Investigaciones Sanitarias, University of Zaragoza, Zaragoza, Spain
- Las Cortes Health Centre, Madrid Health Service, Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Program, Universidad Espíritu Santo, Guayaquil, Ecuador
- *Correspondence: Juan Gómez-Salgado,
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Surgical portfolios: A systematic scoping review. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Best Practices for Remediation in Pulmonary and Critical Care Medicine Fellowship Training. ATS Sch 2022; 3:485-500. [PMID: 36312805 PMCID: PMC9590524 DOI: 10.34197/ats-scholar.2022-0007re] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background Remediation of struggling learners in pulmonary and critical care fellowship
programs is a challenge, even for experienced medical educators. Objective This evidence-based narrative review provides a framework program leaders may
use to address fellows having difficulty achieving competency during
fellowship training. Methods The relevant evidence for approaches on the basis of each learner’s
needs is reviewed and interpreted in the context of fellowship training in
pulmonary medicine and critical care. Issues addressed include bias in
fellow assessments and remediation, the impacts of the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, the specific
challenges of pulmonary and critical care fellowship programs, a brief
review of relevant legal issues, guidance on building and leveraging program
resources, and a discussion of learner outcomes. Results This results in a concise, evidence-based toolkit for program leaders based
around four pillars: early identification, fellow assessment, collaborative
intervention, and reassessment. Important concepts also include the need for
documentation, clear and written communication, and fellow-directed
approaches to the creation of achievable goals. Conclusion Evidence-based remediation helps struggling learners in pulmonary and
critical care fellowship to improve their ability to meet Accreditation
Council for Graduate Medical Education (ACGME) milestones.
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Cheong CWS, Quah ELY, Chua KZY, Lim WQ, Toh RQE, Chiang CLL, Ng CWH, Lim EG, Teo YH, Kow CS, Vijayprasanth R, Liang ZJ, Tan YKI, Tan JRM, Chiam M, Lee ASI, Ong YT, Chin AMC, Wijaya L, Fong W, Mason S, Krishna LKR. Post graduate remediation programs in medicine: a scoping review. BMC MEDICAL EDUCATION 2022; 22:294. [PMID: 35443679 PMCID: PMC9020048 DOI: 10.1186/s12909-022-03278-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Recognizing that physicians may struggle to achieve knowledge, skills, attitudes and or conduct at one or more stages during their training has highlighted the importance of the 'deliberate practice of improving performance through practising beyond one's comfort level under guidance'. However, variations in physician, program, contextual and healthcare and educational systems complicate efforts to create a consistent approach to remediation. Balancing the inevitable disparities in approaches and settings with the need for continuity and effective oversight of the remediation process, as well as the context and population specific nature of remediation, this review will scrutinise the remediation of physicians in training to better guide the design, structuring and oversight of new remediation programs. METHODS Krishna's Systematic Evidence Based Approach is adopted to guide this Systematic Scoping Review (SSR in SEBA) to enhance the transparency and reproducibility of this review. A structured search for articles on remediation programs for licenced physicians who have completed their pre-registration postings and who are in training positions published between 1st January 1990 and 31st December 2021 in PubMed, Scopus, ERIC, Google Scholar, PsycINFO, ASSIA, HMIC, DARE and Web of Science databases was carried out. The included articles were concurrently thematically and content analysed using SEBA's Split Approach. Similarities in the identified themes and categories were combined in the Jigsaw Perspective and compared with the tabulated summaries of included articles in the Funnelling Process to create the domains that will guide discussions. RESULTS The research team retrieved 5512 abstracts, reviewed 304 full-text articles and included 101 articles. The domains identified were characteristics, indications, frameworks, domains, enablers and barriers and unique features of remediation in licenced physicians in training programs. CONCLUSION Building upon our findings and guided by Hauer et al. approach to remediation and Taylor and Hamdy's Multi-theories Model, we proffer a theoretically grounded 7-stage evidence-based remediation framework to enhance understanding of remediation in licenced physicians in training programs. We believe this framework can guide program design and reframe remediation's role as an integral part of training programs and a source of support and professional, academic, research, interprofessional and personal development.
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Affiliation(s)
- Clarissa Wei Shuen Cheong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Wei Qiang Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Rachelle Qi En Toh
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Christine Li Ling Chiang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Caleb Wei Hao Ng
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Elijah Gin Lim
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yao Hao Teo
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Cheryl Shumin Kow
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Raveendran Vijayprasanth
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Zhen Jonathan Liang
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Yih Kiat Isac Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Javier Rui Ming Tan
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Min Chiam
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Alexia Sze Inn Lee
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
| | - Yun Ting Ong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
| | - Annelissa Mien Chew Chin
- Medical Library, National University of Singapore Libraries, Blk MD6, Centre, 14 Medical Dr, #05-01 for Translational Medicine, Singapore, 117599 Singapore
| | - Limin Wijaya
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Infectious Diseases, Singapore General Hospital, Outram Road, Singapore, 169608 Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854 Singapore
| | - Stephen Mason
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, 1E Kent Ridge Road, 119228 NUHS Tower Block, Level, Singapore, 11 Singapore
- Division of Supportive Palliative and Care, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 16961 Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610 Singapore
- Duke-NUS Medical School, 8 College Road, Singapore, 169857 Singapore
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA UK
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597 Singapore
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC c/o Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436 Singapore
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Parsons AS, Warburton KM, Martindale JR, Rosenberg IL. Characterization of Clinical Skills Remediation: A National Survey of Medical Schools. South Med J 2022; 115:202-207. [PMID: 35237839 DOI: 10.14423/smj.0000000000001361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Clinical skills instruction is a standard part of medical school curricula, but how institutions address learners who struggle in this area is less clear. Although recommendations for the remediation of clinical skills at an institutional level have been published, how these recommendations are being implemented on a national scale is unknown. In this descriptive study, we characterize current clinical skills remediation practices at US medical schools and US-accredited Caribbean medical schools. METHODS We conducted a cross-sectional survey of medical educators who work with struggling students. From March 24, 2020 to April 9, 2020, the Directors of Clinical Skills Remediation Working Group conducted an e-mail survey incorporating four aspects of remediation program design and function: identification, assessment, active remediation, and ongoing evaluation. RESULTS In total, 92 individuals representing 45 institutions provided descriptive information about their respective remediation programs. The majority of respondents have a formal process of identifying (75%) and assessing (86%) students who are identified as struggling with clinical skills, but lack a standardized method of categorizing deficits. Fewer institutions have a standardized approach to active remediation and ongoing evaluation of struggling learners. Fifty-two percent of institutions provide training to faculty involved in the remediation process. CONCLUSIONS Although most institutions are able to identify struggling students, they lack a standardized approach to intervene. Remediation effectiveness is limited by a lack of student buy-in and institutional time, expertise, and resources. These findings highlight the need for more formalized structure and standardization in remediation program design and implementation.
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Affiliation(s)
- Andrew S Parsons
- From the Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, and the Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Karen M Warburton
- From the Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, and the Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - James R Martindale
- From the Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, and the Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
| | - Ilene L Rosenberg
- From the Departments of Medicine and Public Health Sciences, University of Virginia School of Medicine, Charlottesville, and the Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, Connecticut
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Song X, Li H, Jiang N, Song W, Ding N, Wen D. The mediating role of social support in the relationship between physician burnout and professionalism behaviors. PATIENT EDUCATION AND COUNSELING 2021; 104:3059-3065. [PMID: 33985846 DOI: 10.1016/j.pec.2021.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/08/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Burnout poses as an understudied challenge to professionalism, and social support may explain their relationship. We sought to investigate the role of social support (moderating or mediating) in the association between physician burnout and professionalism (with four behavioral domains: respect, integrity, excellence, responsibility). METHODS We invited 4100 physicians from nine tertiary hospitals in Liaoning province, China, during February 2017, to participate in a cross-sectional survey. Professionalism, burnout, and social support were respectively assessed using three standardized tools. Descriptive statistics, multivariable linear regression, and ordinal logistic regression were used to analyze the data. RESULTS 3506 physicians (85.5%) effectively completed the survey. After controlling for potential confounding factors, burnout was associated with lower professionalism (β = -0.65, SE = 0.07), particularly in respect (OR = 0.51, 95%CI: 0.41-0.64) and responsibility (OR=0.72, 95%CI: 0.57-0.90). However, there was no statistically significant association between burnout and integrity or excellence. Social support was associated with higher professionalism ((β = 0.24, SE = 0.02) and all of its behavioral domains and played a partial mediating effect on the association between burnout and professionalism. CONCLUSION Social support partially mediates the relationship between physician burnout and behavior-based professionalism. PRACTICE IMPLICATIONS Addressing burnout and promoting social support could be integral in fostering physician professionalism in the healthcare setting.
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Affiliation(s)
- Xinzhi Song
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, PR China.
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, PR China.
| | - Nan Jiang
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, PR China.
| | - Wenwen Song
- Office of Development and Planning, China Medical University, Shenyang, PR China.
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, PR China.
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, PR China.
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15
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Mills LM, Boscardin C, Joyce EA, Ten Cate O, O'Sullivan PS. Emotion in remediation: A scoping review of the medical education literature. MEDICAL EDUCATION 2021; 55:1350-1362. [PMID: 34355413 DOI: 10.1111/medu.14605] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Remediation can be crucial and high stakes for medical learners, and experts agree it is often not optimally conducted. Research from other fields indicates that explicit incorporation of emotion improves education because of emotion's documented impacts on learning. Because this could present an important opportunity for improving remediation, we aimed to investigate how the literature on remediation interventions in medical education discusses emotion. METHODS The authors used Arksey and O'Malley's framework to conduct a scoping literature review of records describing remediation interventions in medical education, using PubMed, CINAHL Complete, ERIC, Web of Science and APA PsycInfo databases, including all English-language publications through 1 May 2020 meeting search criteria. They included publications discussing remediation interventions either empirically or theoretically, pertaining to physicians or physician trainees of any level. Two independent reviewers used a standardised data extraction form to report descriptive information; they reviewed included records for the presence of mentions of emotion, described the mentions and analysed results thematically. RESULTS Of 1644 records, 199 met inclusion criteria and were reviewed in full. Of those, 112 (56%) mentioned emotion in some way; others focused solely on cognitive aspects of remediation. The mentions of emotion fell into three themes based on when the emotion was cited as present: during regular coursework or practice, upon referral for remediation and during remediation. One-quarter of records (50) indicated potential intentional incorporation of emotion into remediation programme design, but they were non-specific as to how emotions related to the learning process itself. CONCLUSION Even though emotion is omnipresent in remediation, medical educators frequently do not factor emotion into the design of remediation approaches and rarely explicitly utilise emotion to improve the learning process. Applications from other fields may help medical educators leverage emotion to improve learning in remediation, including strategies to frame and design remediation.
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Affiliation(s)
- Lynnea M Mills
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christy Boscardin
- Department of Anaesthesia and Perioperative Care and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth A Joyce
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patricia S O'Sullivan
- Departments of Medicine and Surgery, University of California, San Francisco, San Francisco, CA, USA
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Price T, Wong G, Withers L, Wanner A, Cleland J, Gale T, Prescott-Clements L, Archer J, Bryce M, Brennan N. Optimising the delivery of remediation programmes for doctors: A realist review. MEDICAL EDUCATION 2021; 55:995-1010. [PMID: 33772829 DOI: 10.1111/medu.14528] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 05/15/2023]
Abstract
CONTEXT Medical underperformance puts patient safety at risk. Remediation, the process that seeks to 'remedy' underperformance and return a doctor to safe practice, is therefore a crucially important area of medical education. However, although remediation is used in health care systems globally, there is limited evidence for the particular models or strategies employed. The purpose of this study was to conduct a realist review to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety. METHOD We conducted a realist literature review consistent with RAMESES standards. We developed a programme theory of remediation by carrying out a systematic search of the literature and through regular engagement with a stakeholder group. We searched bibliographic databases (MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL, ERIC, ASSIA and DARE) and conducted purposive supplementary searches. Relevant sections of text relating to the programme theory were extracted and synthesised using a realist logic of analysis to identify context-mechanism-outcome configurations (CMOcs). RESULTS A 141 records were included. The majority of the studies were from North America (64%). 29 CMOcs were identified. Remediation programmes are effective when a doctor's insight and motivation are developed and behaviour change reinforced. Insight can be developed by providing safe spaces, using advocacy to promote trust and framing feedback sensitively. Motivation can be enhanced by involving the doctor in remediation planning, correcting causal attribution, goal setting and destigmatising remediation. Sustained change can be achieved by practising new behaviours and skills, and through guided reflection. CONCLUSION Remediation can work when it creates environments that trigger behaviour change mechanisms. Our evidence synthesis provides detailed recommendations on tailoring implementation and design strategies to improve remediation interventions for doctors.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care, Health Sciences, University of Oxford, Oxford, UK
| | | | - Amanda Wanner
- NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Tom Gale
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Faculty of Medicine, Nursing and Healthcare, Monash University, Melbourne, Vic., Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
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Abstract
There are myriad types of problem learners in surgical residency and most have difficulty in more than 1 competency. Programs that use a standard curriculum of study and assessment are most successful in identifying struggling learners early. Many problem learners lack appropriate systems for study; a multidisciplinary educational team that is separate from the team that evaluates the success of remediation is critical. Struggling residents who require formal remediation benefit from performance improvement plans that clearly outline the issues of concern, describe the steps required for remediation, define success of remediation, and outline consequences for failure to remediate appropriately.
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Affiliation(s)
- Lilah F Morris-Wiseman
- University of Arizona, Department of Surgery, Division of Surgical Oncology, 1501 N. Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA
| | - Valentine N Nfonsam
- University of Arizona, Department of Surgery, Division of Surgical Oncology, 1501 N. Campbell Avenue, PO Box 245058, Tucson, AZ 85724-5058, USA.
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18
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Song X, Jiang N, Li H, Ding N, Wen D. Medical professionalism research characteristics and hotspots: a 10-year bibliometric analysis of publications from 2010 to 2019. Scientometrics 2021; 126:8009-8027. [PMID: 34248230 PMCID: PMC8256397 DOI: 10.1007/s11192-021-03993-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
An abundance of publications on medical professionalism have been published in recent years. Our study aimed to analyze the external characteristics of publications on professionalism using bibliometrics, to describe its current developments and trends, and to explore professionalism research hotspots using co-word analysis. We retrieved literature on professionalism published from 2010 to 2019 from the Web of Science database. Histcite and CiteSpace were used to analyze external characteristics of publications, including publication trends and distributions of publications by country/region, institution, author, and journal. Co-word analysis was conducted to analyze research hotspots, using the Bibliographic Item Co-Occurrence Matrix Builder and Graphical Clustering Toolkit. We constructed a strategic diagram to show the state of each research hotspot and the relationship between the various hotspots in this field. Results showed publications on professionalism increased in number year by year as a whole. The USA, including its institutions and authors, maintained the top position worldwide in terms of numbers of publications and citations. Among scholarly journals, Academic Medicine has published more articles and has had higher citations per paper than any other journal. Six research hotspots on professionalism were identified, visualized, and expounded. Of these, the theme of "measurement and evaluation of clinical competence" received the most attention in the field of professionalism. The reporting of quantifiable knowledge on the characteristics and research hotspots of publications could help inform gaps in the field of medical professionalism and provide evidence and guidance for future work for researchers, physicians, and educators.
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Affiliation(s)
- Xinzhi Song
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
| | - Nan Jiang
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122 People's Republic of China
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To H, Cargill A, Tobin S, Nestel D. Remediation of Underperformance in Surgical Trainees - A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2021; 78:1111-1122. [PMID: 33139216 DOI: 10.1016/j.jsurg.2020.10.010] [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: 07/29/2020] [Revised: 09/14/2020] [Accepted: 10/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Surgical trainees with significant underperformance require formal support to return to an expected standard, termed remediation. The aim of this scoping review was to define remediation interventions, approaches, and contexts. DESIGN Following scoping review protocols, we set out to identify the evidence-base for remediation of surgical trainees, outline key concepts and uncover areas to stimulate further research. RESULTS From a screen of 80 articles, 24 reported on remediation of surgical trainees. Most were from medical journals (n = 21, 88%) and published in the United States (n = 20, 83%). Ten articles (41%) reported outcomes of remediation of a trainee cohort and 7 (19%) were survey reports from surgical directors. The remainder were a mix of commentaries, editorials or reviews. Thirteen articles (54%) described trainees with deficiencies in multiple competencies, 8 articles (33%) had a singular focus on academic performance, and 1 article (3%) on technical skills. All articles used targeted individualized remediation strategies, a range of intervention methods (some multimodal) and recommended a 6- to 12-month period of remediation (n = 7, 29%). The program director was often the only supervisor (n = 12, 50%). One article reported trainees' perspective of the process and one used educational theory to inform remediation. CONCLUSIONS Data with clearly reported outcomes were limited, but we found that targeted, individualized, multimodal and long-term remediation covering a range of competencies have been reported in the literature for surgical trainees. There is a need for development of explicit frameworks, strengthen the support for supervisors and trainees and further apply educational theory to develop better interventions that remediate deficiencies for all competencies.
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Affiliation(s)
- Henry To
- University of Melbourne, Parkville, Australia.
| | | | - Stephen Tobin
- School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Debra Nestel
- Department of Surgery (Austin), University of Melbourne, Heidelberg, Australia; Monash Institute for Health & Clinical Education, Monash University, Clayton, Australia
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20
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Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J, Bryce M. Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.
Objectives
To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Design
A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.
Review methods
Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.
Results
A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.
Limitations
Limitations were the low quality of included literature and limited number of UK-based studies.
Future work
Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.
Study registration
This study is registered as PROSPERO CRD42018088779.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amanda Wanner
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Medicine, Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, VIC, Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
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Cui X, Ding N, Jiang N, Li H, Wen D. Preliminary study of the relationship between career choice motivation and understanding of professionalism in newly enrolled medical students in China: a cross-sectional study. BMJ Open 2021; 11:e041860. [PMID: 33619186 PMCID: PMC7903090 DOI: 10.1136/bmjopen-2020-041860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Early professionalism education for first-year students is important for generating sound knowledge and attitudes towards medical professionalism. Of the many factors affecting professionalism and professional identity formation in medical students, career choice motivation is an understudied one. This study aimed to explore the relationship between the career choice motivations of first-year medical students and their understanding of professionalism. SETTINGS AND PARTICIPANTS A cross-sectional survey of 940 first-year clinical medicine students was conducted at China Medical University in September 2017 to explore students' motivation to study medicine and its relationship with students' understanding of professionalism. Demographics, career choice motivation and professionalism were obtained through paper questionnaires. Logistic regression analysis was used to analyse the association between career choice motivation and understanding of professionalism while controlling for potential demographic confounders. RESULTS The most common career choice motivations for first-year medical students (N=843) were interested in the health sciences, income and social status and advocating altruism. The most mentioned subdimensions of professionalism were accountability, pursuit of excellence and compassion. There were significant differences in the understanding of professionalism among students with different career choice motivations. CONCLUSION First-year medical students with different motivations to study medicine also have different understandings of professionalism. Medical educators can explore motivations to learning medicine as a new entry point to providing professionalism education for newly enrolled medical students.
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Affiliation(s)
- Xuemei Cui
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Ning Ding
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Nan Jiang
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Honghe Li
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
| | - Deliang Wen
- Institute for International Health Professions Education and Research, China Medical University, Shenyang, Liaoning, China
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