1
|
Stalmeijer RE, Meeuwissen SNE. Cherry-picking learning tasks in the orchard of postgraduate medical education - a socio-cultural perspective. MEDICAL EDUCATION 2024; 58:277-279. [PMID: 37897249 DOI: 10.1111/medu.15261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Abstract
'@ReneeStalmeijer and @SNEMeeuwissen use a socio‐cultural perspective, empirical examples, and the cherry‐picking metaphor, to explore interactions between trainees and healthcare teams that impact trainees’ selection of learning tasks during workplace learning
Collapse
Affiliation(s)
- Renée E Stalmeijer
- School of Health Professions Education, Department of Educational Development and Research, Faculty of Health Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Stephanie N E Meeuwissen
- School of Health Professions Education, Department of Educational Development and Research, Faculty of Health Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
2
|
Scheepers RA, Boxem AJ, Blezer MMJ. Junior doctors receiving supervisor and peer support are more work-engaged professionals who express their voice for quality improvement. MEDICAL TEACHER 2024; 46:204-210. [PMID: 37506220 DOI: 10.1080/0142159x.2023.2240000] [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: 07/30/2023]
Abstract
PURPOSE In daily practice, junior doctors can contribute to quality improvement by providing innovative suggestions for change, referred to as voice behavior. Junior doctors are more likely to engage in voice behavior when they receive sufficient support from supervisors and peers. Such support has also been associated with less burnout and more work engagement. However, whether less burned-out and more work-engaged junior doctors demonstrate more voice behaviors in the face of sufficient supervisor and peer support is unclear. Therefore, we studied whether and how associations of supervisor and peer support with junior doctors' voice behaviors are mediated by burnout and work engagement. MATERIALS & METHODS Participants were 301 junior doctors that completed a web-based survey including validated questionnaires on supervisor and peer support, burnout, work engagement, and voice behavior. RESULTS Supervisor and peer support were associated with lower levels of burnout and higher levels of work engagement. Work engagement, but not burnout, mediated the associations of supervisor and peer support with voice behaviors. CONCLUSIONS Junior doctors who received more supervisor or peer support were more work-engaged and reported more voice behaviors. Thus, supervisor and peer support should be cultivated to facilitate junior doctors' roles as work-engaged professionals in quality improvement.
Collapse
Affiliation(s)
- Renée A Scheepers
- Department of Socio-Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University of Rotterdam, The Netherlands
| | - Aline J Boxem
- Department of Pediatrics and the Generation R Study Group (Na-29), Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Meike M J Blezer
- Foundation of the Young Doctor, Utrecht, The Netherlands
- Department of General Practice, Intellectual Disability Medicine of the Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Akbari-Kamrani M, Mortaz Hejri S, Ivan R, Yousefi-Nooraie R. Social Dynamics of Advice-Seeking: A Network Analysis of Two Residency Programs. TEACHING AND LEARNING IN MEDICINE 2024; 36:23-32. [PMID: 36688422 DOI: 10.1080/10401334.2023.2168671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/14/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Phenomenon: Residents interact with their peers and supervisors to ask for advice in response to complicated situations occurring during patient care. To provide a deeper understanding of workplace learning, this study explores the structure and dynamics of advice-seeking networks in two residency programs. Approach: We conducted a survey-based social network study. To develop the survey, we conducted focus group discussions and identified three main categories of advice: factual knowledge, clinical reasoning, and procedural skills. We invited a total of 49 emergency medicine and psychiatry residents who had completed at least six months of their training, to nominate their supervisors and peer residents, as their sources of advice, from a roster. Participants identified the number of occasions during the previous month that they turned to each person to seek advice regarding the three broad categories. We calculated the density, centrality, and reciprocity measures for each advice category at each department. Findings: The response rates were 100% (n = 21) and 85.7% (n = 24) in the emergency medicine and psychiatry departments, respectively. The advice network of emergency medicine residents was denser, less hierarchical, and less reciprocated compared to the psychiatry residents' network. In both departments, PGY-1s were the top advice-seekers, who turned to PGY-2s, PGY-3s, and supervisors for advice. The "procedural skills" network had the lowest density in both departments. There was less overlap in the sources of advice for different advice types in the psychiatry department, implying more selectivity of sources. Insights: Complex social structures and dynamics among residents vary by discipline and level of seniority. Program directors can develop tailored educational interventions informed by their departments' specific network patterns to promote a timely and effective advice-seeking culture which in turn, could lead to optimally informed patient care.
Collapse
Affiliation(s)
| | - Sara Mortaz Hejri
- Department of Medical Education, Tehran University of Medical Sciences, Tehran, Iran
| | - Rodica Ivan
- Department of Research, Acuity Insights, Toronto, Ontario, Canada
| | - Reza Yousefi-Nooraie
- Department of Public Health Sciences, University of Rochester, Rochester, New York, USA
| |
Collapse
|
4
|
Bock LA, Westra D, Noben CY, Essers BA, van Mook WN. A Social Network Analysis of Influences on Residents' Value-Based Decisions. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1304-1312. [PMID: 37332220 PMCID: PMC10589424 DOI: 10.1097/acm.0000000000005298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
PURPOSE To ensure a value-based health care system, it is becoming increasingly important that residents are trained in making value-based decisions. This study explored the social network influencing residents' value-based decisions. METHOD To explore the social network influencing residents' value-based decisions, the authors used a semistructured individual and mini-group interviewing approach and participatory visual mapping. In total, 17 residents across 13 different specialties were interviewed from the southeastern postgraduate medical education and training region of the Netherlands, May-November 2021. Two researchers independently coded the transcribed data using an integrated inductive thematic approach. Subsequently, social network analysis was used to visualize the results. RESULTS Residents indicated that their value-based decisions were influenced by direct actors who influenced decisions related to patients and indirect actors who shaped decisions related to patients without directly modifying them. Different interaction-aspects (i.e., personal, situational, and institutional) further affected residents' ability to make value-based decisions. Thus, residents' value-based decisions were a product of the interplay between various interactions with actors and different interaction-aspects. Residents defined value-based decisions differently, even within an interview. CONCLUSIONS These results suggest residents' value-based decisions are influenced by a multitude of actors, including hierarchically superior colleagues who can directly alter decisions and patients (and their families) and nurses with whom residents consider it important to maintain good relationships. In addition, more experienced actors, mainly from the medical and nursing profession, contribute most to learning. Furthermore, residents' value-based decisions are deeply underpinned by the hidden curriculum. However, many senior physicians may not have received sufficient training in the concept of value-based health care. Consequently, an approach of formally educating residents in value-based health care will likely have limited effects unless social influences in day-to-day clinical settings reinforce its importance.
Collapse
Affiliation(s)
- Lotte A. Bock
- L.A. Bock is a PhD student, Academy of Postgraduate Medical Education, Maastricht University Medical Centre, and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0001-5249-4522
| | - Daan Westra
- D. Westra is assistant professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-1791-3626
| | - Cindy Y.G. Noben
- C.Y.G. Noben is strategic and medical educational advisor, Academy of Postgraduate Medical Education, Maastricht University Medical Centre, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-2766-8057
| | - Brigitte A.B. Essers
- B.A.B. Essers is senior researcher, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0002-7703-7114
| | - Walther N.K.A. van Mook
- W.N.K.A. van Mook is medical doctor and full professor, Academy of Postgraduate Medical Education, Department of Intensive Care Medicine, Maastricht University Medical Centre, and School of Health Professions Education, Maastricht University, Maastricht, the Netherlands; ORCID: https://orcid.org/0000-0003-2398-8878
| |
Collapse
|
5
|
Miller KA, Nagler J, Wolff M, Schumacher DJ, Pusic MV. It Takes a Village: Optimal Graduate Medical Education Requires a Deliberately Developmental Organization. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:282-293. [PMID: 37520509 PMCID: PMC10377742 DOI: 10.5334/pme.936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023]
Abstract
Coaching is proposed as a means of improving the learning culture of medicine. By fostering trusting teacher-learner relationships, learners are encouraged to embrace feedback and make the most of failure. This paper posits that a cultural shift is necessary to fully harness the potential of coaching in graduate medical education. We introduce the deliberately developmental organization framework, a conceptual model focusing on three core dimensions: developmental communities, developmental aspirations, and developmental practices. These dimensions broaden the scope of coaching interactions. Implementing this organizational change within graduate medical education might be challenging, yet we argue that embracing deliberately developmental principles can embed coaching into everyday interactions and foster a culture in which discussing failure to maximize learning becomes acceptable. By applying the dimensions of developmental communities, aspirations, and practices, we present a six-principle roadmap towards transforming graduate medical education training programs into deliberately developmental organizations.
Collapse
Affiliation(s)
- Kelsey A. Miller
- Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Joshua Nagler
- Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Margaret Wolff
- Emergency Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel J. Schumacher
- Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Martin V. Pusic
- Pediatrics and Emergency Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
6
|
Coakley N, Wiese A, O'Leary P, Bennett D. Experience of enhanced near-peer support for new medical graduates of an Irish university: a phenomenological study. BMJ Open 2023; 13:e069101. [PMID: 37137555 PMCID: PMC10163558 DOI: 10.1136/bmjopen-2022-069101] [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: 05/05/2023] Open
Abstract
CONTEXT Factors contributing to the stressful transition from student to doctor include issues with preparedness for practice, adjusting to new status and responsibility, and variable support. Existing transitional interventions provide inconsistent participation, responsibility and legitimacy in the clinical environment. Enhanced support by near peers for new doctors may ease the transition. Irish medical graduates of 2020 commenced work early, creating an unprecedented period of overlap between new graduates and the cohort 1 year ahead. OBJECTIVE To explore the experience of commencing practice for these new doctors with this increased near-peer support. DESIGN We used interpretive phenomenological analysis as our methodological approach, informed by the cognitive apprenticeship model, to explore the experience of enhanced near-peer support at the transition to practice. Participants recorded audio diaries from their commencement of work, and a semistructured interview was conducted with each, after 3 months, concerning their experience of their overlap with the previous year's interns. SETTING University College Cork, one of six medical schools in Ireland. PARTICIPANTS Nine newly qualified medical doctors. MAIN OUTCOME MEASURES An exploration of their experience of transition to clinical practice, in the context of this enhanced near-peer support, will inform strategies to ease the transition from student to doctor. RESULTS Participants felt reassured by having a near-peer in the same role and safe to seek their support. This empowered them to gradually assume increasing responsibility and to challenge themselves to further their learning. Participants perceived that commencing work before the annual change-over of other grades of doctor-in-training enhanced their professional identities and improved patient safety. CONCLUSIONS Enhanced near-peer support for new doctors offers a potential solution to the stressful transition to practice. Participants were legitimate members of the community of practice, with the status and responsibility of first-year doctors. Furthermore, this study reinforces the benefit of asynchronous job change-over for doctors-in-training.
Collapse
Affiliation(s)
- Niamh Coakley
- Department of Medicine, University College Cork, Cork, Ireland
| | - Anel Wiese
- Medical Education Unit, University College Cork, Cork, Ireland
| | - Paula O'Leary
- School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, Cork, Ireland
| |
Collapse
|
7
|
Jansen I, Silkens MEWM, Galema G, Vermeulen H, Geerlings SE, Lombarts KMJMH, Stalmeijer RE. Exploring nurses' role in guiding residents' workplace learning: A mixed-method study. MEDICAL EDUCATION 2023; 57:440-451. [PMID: 36226355 DOI: 10.1111/medu.14951] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Understanding residents' workplace learning could be optimized by not only considering attending physicians' role but also the role of nurses. While previous studies described nurses' role during discrete activities (e.g. feedback), a more profound understanding of how nurses contribute to residents' learning remains warranted. Therefore, we used the educational concept of guidance and explored the extent to which residents' and nurses' perceptions align regarding nurses' guiding role and which reasons they provide for their perceptions. METHODS This mixed-method study was conducted at four Dutch university medical centres in 2021. We simultaneously collected quantitative and qualitative data from 103 residents and 401 nurses through a theory-informed questionnaire with a Likert-scale and open-ended questions. We analyzed quantitative data to explore respondents' perceptions of nurses' guiding role by using anova. The thematically analyzed qualitative open comments explored respondents' reasons for their perceptions. RESULTS Nurses indicated to provide significantly more support (p = .01) and guidance on learning from patient care (p < .01) than perceived by residents. Moreover, nurses indicated that attending physicians did not always involve them in guiding residents, whereas residents perceived nurses were being involved (p < .001). Themes suggest that nurses and residents could be divided into two groups: (i) respondents who felt that guiding was inextricably linked to good interprofessional collaboration and patient care and (ii) respondents who saw the guiding role as limited and emphasised the distinct fields of expertise between nurses and physicians. CONCLUSIONS Residents and nurses felt that nurses played an important role in guiding residents' workplace learning. However, some residents did not always perceive to be guided. To further capitalise on nurses' guiding role, we suggest that residents can be encouraged to engage in the learning opportunities nurses provide to achieve optimal team-based patient care.
Collapse
Affiliation(s)
- Iris Jansen
- Professional Performance and Compassionate Care Research Group, Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Milou E W M Silkens
- Centre for Healthcare Innovation Research, City University of London, London, UK
| | - Gerbrich Galema
- University Medical Center Groningen, Department of Anesthesiology, University of Groningen, Groningen, The Netherlands
| | - Hester Vermeulen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Suzanne E Geerlings
- Internal Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Kiki M J M H Lombarts
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Medical Psychology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Renée E Stalmeijer
- School of Health Professions Education, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
8
|
Kumar S, Tatarian T, Palazzo F. A surgeon's framework for the unplanned intraoperative consultation. Langenbecks Arch Surg 2023; 408:42. [PMID: 36656401 DOI: 10.1007/s00423-022-02733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/15/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Surgeons will likely be called to assist with or offer advice regarding an unanticipated intraoperative event or finding many times during their careers. Yet, there is no practical framework of how to respond to these consults nor is there any formal training in this area. The review of the limited literature and expert senior opinions can help explain the ethical components involved but does not address some of the practical aspects that the consulting surgeon may need to confront when responding to an unplanned intraoperative consultation. METHODS We reviewed the existing surgical literature on intraoperative consultation across surgical disciplines and interpreted it in light of our own experiences and the advice of senior surgical colleagues. RESULTS We present a framework for the minimum professional expectations of a surgeon responding to an intraoperative consultation. CONCLUSION In this manuscript, we present a selected review of the available literature on the topic, establish some of the guiding ethical principles, and offer an actionable and detailed framework that can support trainees and practicing surgeons dealing with these increasingly common and stressful unplanned circumstances.
Collapse
Affiliation(s)
- Sunjay Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Talar Tatarian
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Francesco Palazzo
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| |
Collapse
|
9
|
Gamborg ML, Jensen RD, Musaeus P, Mylopoulos M. Balancing closure and discovery: adaptive expertise in the workplace. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022; 27:1317-1330. [PMID: 36418756 DOI: 10.1007/s10459-022-10177-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
Residents must develop knowledge, skills, and attitudes to handle a rapidly developing clinical environment. To address this need, adaptive expertise has been suggested as an important framework for health professions education. However, research has yet to explore the relationship between workplace learning and adaptive expertise. This study sought to investigate how clinical supervision might support the development of adaptive expertise. The present study used a focused ethnography in two emergency departments. We observed 75 supervising situations with the 27 residents resulting in 116 pages of field notes. The majority of supervision was provided by senior physicians, but also included other healthcare professionals. We found that supervision could serve two purposes: closure and discovery. Supervision aimed at discovery included practices that reflected instructional approaches said to promote adaptive expertise, such as productive struggle. Supervision aimed at closure-included practices with instructional approaches deemed important for efficient and safe patient care, such as verifying information. Our results suggest that supervision is a shared practice and responsibility. We argue that setting and aligning expectations before engaging in supervision is important. Furthermore, results demonstrated that supervision was a dynamic process, shifting between both orientations, and that supervision aimed at discovery could be an an appropriate mode of supervision, even in the most demanding clinical situations.
Collapse
Affiliation(s)
- Maria Louise Gamborg
- Centre for Educational Development (CED), Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C., Denmark.
- MidtSim, Central Denmark Region, Aarhus, Denmark.
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N., Denmark.
| | - Rune Dall Jensen
- MidtSim, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N., Denmark
| | - Peter Musaeus
- Centre for Educational Development (CED), Aarhus University, Trøjborgvej 82-84, 8000, Aarhus C., Denmark
| | - Maria Mylopoulos
- The Wilson Centre, Faculty of Medicine, University of Toronto, 200 Elizabeth Street, 1ES-565, Toronto, ON, M5G 2C4, Canada
| |
Collapse
|
10
|
Stalmeijer RE, Varpio L. The wolf you feed: Challenging intraprofessional workplace-based education norms. MEDICAL EDUCATION 2021; 55:894-902. [PMID: 33651450 PMCID: PMC8359828 DOI: 10.1111/medu.14520] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/29/2021] [Accepted: 02/26/2021] [Indexed: 05/26/2023]
Abstract
CONTEXT The trajectory towards becoming a medical professional is strongly situated within the clinical workplace. Through participatory engagement, medical trainees learn to address complex health care issues through collaboration with the interprofessional health care team. To help explain learning and teaching dynamics within the clinical workplace, many scholars have relied on socio-cultural learning theories. In the field of medical education, this research has largely adopted a limited interpretation of a crucial dimension within socio-cultural learning theory: the expert who guides the trainee into the community is almost exclusively from the same profession. We contend that this narrow interpretation is not necessary. This limited focus is one we choose to maintain-be that choice intentional or implicit. In this cross-cutting edge paper, we argue that choosing an interprofessional orientation towards workplace learning and guidance may better prepare medical trainees for their future role in health care practice. METHODS By applying Communities of Practice and Landscapes of Practice , and supported by empirical examples, we demonstrate how medical trainees are not solely on a trajectory towards the Community of Physician Practice (CoPP) but also on a trajectory towards various Landscapes of Healthcare Practice (LoHCP). We discuss some of the barriers present within health care organisations and professions that have likely inhibited adoption of the broader LoHCP perspective. We suggest three perspectives that might help to deliberately and meaningfully incorporate the interprofessional learning and teaching dynamic within the medical education continuum. CONCLUSION Systematically incorporating Landscapes of Competence, Assessment, and Guidance in workplace-based education-in addition to our current intraprofessional approach-can better prepare medical trainees for their roles within the LoHCP. By advocating and researching this interprofessional perspective, we can embark on a journey towards fully harnessing and empowering the health care team within workplace-based education.
Collapse
Affiliation(s)
- Renée E. Stalmeijer
- School of Health Professions EducationFaculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Lara Varpio
- Center for Health Professions EducationDepartment of MedicineUniformed Services University of the Health SciencesBethesdaMDUSA
| |
Collapse
|