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Kassam A, Page S, Lauzon J, Hay R, Coret M, Mitchell I. Ethical issues in residency education related to the COVID-19 pandemic: a narrative inquiry study. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-108917. [PMID: 38925879 DOI: 10.1136/jme-2023-108917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The COVID-19 pandemic introduced new challenges to provide care and educate junior doctors (resident physicians). We sought to understand the positive and negative experiences of first-year resident physicians and describe potential ethical issues from their stories. METHOD We used narrative inquiry (NI) methodology and applied a semistructured interview guide with questions pertaining to ethical principles and both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio recorded and transcribed. Three members of the research team coded transcripts in duplicate to elicit themes. Discrepancies were resolved through discussion to attain consensus. A composite story with threads was constructed. RESULTS 11 residents participated across several programmes. Three main themes emerged from the participants' stories: (1) complexities in navigating intersecting healthcare and medical education systems, (2) balancing public health and the public good versus the individual and (3) fair health systems planning/healthcare delivery. Within these themes, participants' journeys through the first wave were elicited through the threads of (1) engage us, (2) because we see the need for the duty to treat and (3) we are all in this together. DISCUSSION Cases of the ethical issues that took place during the COVID-19 pandemic may serve as a foundation on which ethics teaching and future pandemic planning can take place. Principles of clinical ethics and their limitations, when applied to public health issues, could help in contrasting clinical ethics with public health ethics. CONCLUSION Efforts to understand how resident physicians can navigate public health emergencies along with the ethical issues that arise could benefit both residency education and healthcare systems.
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Affiliation(s)
- Aliya Kassam
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Office of Postgraduate Medical Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stacey Page
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Julie Lauzon
- Medical Genetics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Rebecca Hay
- Pediatric Critical Care Medicine, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada
| | - Marian Coret
- Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ian Mitchell
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Fix GM, Kaitz J, Herbst AN, Wiener RS, Crocker D, Miano D, Barker AM. Practical Strategies for Co-design: The Case of Engaging Patients in Developing Patient-Facing Shared-Decision Making Materials for Lung Cancer Screening. J Patient Exp 2024; 11:23743735241252247. [PMID: 38855653 PMCID: PMC11162119 DOI: 10.1177/23743735241252247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Co-design provides a meaningful way to engage patients in research. However, there is limited practical guidance. We used our co-design project to identify strategies for other researchers. An ethnographic case study design was used. Data included participant observation of co-design meetings, meeting minutes, analytic fieldnotes, qualitative patient interviews, and research team member self-reflections. Additionally, we got external feedback. We analyzed data iteratively. Our team included 5 patients and 6 researchers. We identified 3 strategies to include patients in co-design: (1) Deliberately build the team, from recruiting patients to specifying roles. (2) Tailor the meeting format to thoughtfully use patients' time and expertise. (3) Disrupt traditional hierarchies, to empower patients to actively participate. Researchers seeking to include patients as team members should consider: team composition and roles, leveraging meeting formats to optimize contributions and purposefully creating a culture of collaboration, so patient expertise informs the end product. Our work provides practical guidance for researchers to incorporate patient expertise in the co-design process and meaningfully involve them in their work.
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Affiliation(s)
- Gemmae M. Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jenesse Kaitz
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- Sleep Medicine, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Abigail N. Herbst
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, USA
- The Pulmonary Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Dave Crocker
- Veteran Consultant Network, CHOIR Bedford Veteran Consultant Network, Bedford, MA, USA
| | - Dani Miano
- Methodist Healthcare System, San Antonio, TX, USA
| | - Anna M. Barker
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford and VA Boston Healthcare System, Bedford/Boston, MA, USA
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Konopasky A, Ma TL, Wyatt TR. Pushing, standing and bringing to light: How medical trainees conceptualise professional resistance. MEDICAL EDUCATION 2024. [PMID: 38702993 DOI: 10.1111/medu.15400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Much of the literature on harm and injustice in medical education focuses on the impact of oppression rather than trainees' efforts to create change. To acknowledge and make visible these efforts, medical education professionals must grasp how trainees perceive resistance and their role in effecting change. Employing functional linguistic and 'everyday' resistance theories, this critical qualitative study aims to understand trainees' conceptions of resistance practices and their representational choices in moments when they talked about and conceptualised resistance. METHODS Gathering participants through professional networks and snowball sampling, this study employed in-depth interviews to explore the conceptualisations of resistance among North American medical trainees (9 medical students, 9 residents and fellows). With the use of an applied functional linguistic analysis framework, we analysed the representational metafunction in trainees' conceptualisation of their resistance efforts against social injustice. We began with open coding for 'everyday' acts of resistance and then shifted to focused coding on verbal process types in participants' language to characterise their conceptualisations of resistance. FINDINGS Participants conceptualised their resistance practices in three distinct ways: first, an almost physical pushing back, drawing largely on material process types (doing); second, an embodied standing up and being present, based predominantly on material and relational process types (being); and third, an epistemic bringing to light, grounded mostly in mental and verbal process types (thinking). These processes of resistance reflect participants' conceptualisations of their efforts to challenge the status quo around inequity, harm and injustice in medical education. CONCLUSION This study builds on resistance literature, offering a potential typology of resistance practices as pushing back, being and bringing to light. Because these are 'everyday' acts of resistance, these are tactics available to everyone, including faculty; we all have the power to resist, whether it is in teaching and learning or interacting with larger structures in medicine.
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Affiliation(s)
- Abigail Konopasky
- Department of Medical Education, Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Ting Lan Ma
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tasha R Wyatt
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Nemiroff S, Blanco I, Burton W, Fishman A, Joo P, Meholli M, Karasz A. Moral injury and the hidden curriculum in medical school: comparing the experiences of students underrepresented in medicine (URMs) and non-URMs. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:371-387. [PMID: 37382857 DOI: 10.1007/s10459-023-10259-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
Underrepresented students in medicine (URM) have more negative perceptions of the medical school learning environment (LE), a phenomenon that can contribute to higher rates of burnout and attrition in these populations. The hidden curriculum (HC)-defined as a set of values informally conveyed to learners through clinical role-modeling-is a LE socialization construct that has been critically examined for its role in shaping students' professional identities. Yet differences in how URMs and non-URMs experience the HC remain underexplored. The study used a pragmatic approach that drew on elements of grounded theory and employed both deductive and inductive reasoning. Investigators conducted qualitative, semi-structured interviews with a purposive sample of 13 URM and 21 non-URM participants at a Bronx, NY medical school. Interviews examined student experiences and reactions to the HC. Both cohorts witnessed patient disparagement and mistreatment. However, from these encounters, URM participants expressed more moral injury-the adverse emotional consequence of feeling pressured to accept ideologically incongruent values. URMs were also more likely to describe resisting the HC. Differences in group reactions appeared to arise from URMs' identity resonance with patients' lived experiences. Participants across cohorts emphasized increasing URM recruitment as one step toward mitigating these circumstances. URM participants experienced more distress and offered more resistance to the HC relative to non-URMs. The etiology of these differential reactions may stem from relative barriers in negotiating personal and professional identities. As such, URMs' perceptions of the LE may be adversely impacted given their more negative interactions with the HC.
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Affiliation(s)
- Samuel Nemiroff
- Albert Einstein College of Medicine, New York City, NY, USA.
- Mount Sinai Morningside-West, New York City, USA.
| | - Irene Blanco
- Medicine-Rheumatology, Clinical Research Ethics & Equity Consultative Service (CREEC), Northwestern University, Chicago, IL, USA
| | - William Burton
- Assessment, Evaluation and Quality Improvement in the Office of Medical Education, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ariel Fishman
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Pablo Joo
- Department of Family Medicine, University of California, Riverside, CA, USA
| | - Mimoza Meholli
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alison Karasz
- Department of Family Medicine and Community Health, Chan Medical School, University of Massachusetts, Worcester, MA, USA
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Rashid M, Goldszmidt M. Critical ethnography: implications for medical education research and scholarship. MEDICAL EDUCATION 2024. [PMID: 38600755 DOI: 10.1111/medu.15401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024]
Abstract
CONTEXT Medical education (ME) must rethink the dominant culture's fundamental assumptions and unintended consequences on less advantaged groups and society at large. Doing so, however, requires a robust understanding of what we are teaching, regardless of our intentions, and what is being learned across the multiple settings that our learners find themselves in, from classrooms to clinical spaces and beyond. APPROACH Gaining such understandings and fully exploring the extent to which we are rising to the challenges of today's society in authentic ways require robust methodologies. In this research approaches paper, we introduce unfamiliar readers to one such methodology-critical ethnography. By doing so, we hope to demonstrate its potential for helping ME both identify and gain novel insight into necessary solutions for many of today's educational challenges regarding healthcare disparities and inequities. CONCLUSION The readers of this paper will gain novel insights into how critical ethnographers see the world and ask questions, thereby changing the way they (the reader) see the world. At its heart, critical ethnography is about thinking differently and that is something that should be accessible to all. Doing so may also enhance our ability to both question dominant ways of thinking and, ultimately, to enact positive change in training and practices to enhance inclusivity and fairness for all regardless of their gender, race and status.
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Affiliation(s)
- Marghalara Rashid
- Department of Paediatrics, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Mark Goldszmidt
- Centre for Education Research and Innovation (CERI); Division of General Internal Medicine, Department of Medicine, Western University, London, Ontario, Canada
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McElroy C, Skegg E, Mudgway M, Murray N, Holmes L, Weller J, Hamill J. Psychological Safety and Hierarchy in Operating Room Debriefing: Reflexive Thematic Analysis. J Surg Res 2024; 295:567-573. [PMID: 38086257 DOI: 10.1016/j.jss.2023.11.054] [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: 06/17/2023] [Revised: 09/30/2023] [Accepted: 11/12/2023] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Debriefing is a team discussion in a constructive, supportive environment. Barriers exist to consistent, effective team debriefing in the clinical setting, especially in operating theaters. The purpose of this study was to gain insights from frontline workers on how to set up an effective debriefing policy for our operating room. METHODS This was a qualitative study in which we interviewed operating room workers in a tertiary children's hospital. Interviews were audio-recorded, transcribed, and coded. Data were analysed using the reflexive thematic analysis technique within a critical realism paradigm. RESULTS Interviews were analysed from 40 operating room staff: 14 nurses, seven anesthetic technicians, seven anaesthetists, and 12 surgeons; 25 (65%) were female. The three key themes were (1) "commitment to learning"-healthcare workers are committed to teamwork and quality improvement; (2) "it is a safe space"-psychological safety is a prerequisite for, and is enhanced by, debriefing; and (3) "natural leader"-the value of leadership, but also constructs around leadership that maintain hierarchies. CONCLUSIONS Psychological safety is both a prerequisite for and a product of debriefing. Leadership, if viewed as a collective responsibility, could help break down power structures. Given the results of this study and evidence in the literature, it is likely that routine debriefing, if well done, will improve psychological safety, facilitate team learning, reduce errors, and improve patient safety.
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Affiliation(s)
- Canice McElroy
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Emma Skegg
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Mercedes Mudgway
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Ngaire Murray
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Linda Holmes
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand
| | - Jennifer Weller
- Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand
| | - James Hamill
- Department of Paediatric Surgery, Starship Children's Hospital, Auckland, New Zealand; Centre for Medical and Health Sciences Education, The University of Auckland, Auckland, New Zealand; Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand.
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Butler K, Vanstone M, Yak A, Veltman A. "Will I be able to be myself? Or will I be forced to lie all the time?": How Trans and Non-Binary Students Balance Professionalism, Authenticity, and Safety in Canadian Medical Programs. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:119-129. [PMID: 38406648 PMCID: PMC10885831 DOI: 10.5334/pme.1199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 02/05/2024] [Indexed: 02/27/2024]
Abstract
Introduction Promoting the inclusion of trans and non-binary (TNB) medical trainees is a key step in building an inclusive health workforce well-positioned to provide high-quality healthcare to all patients. Existing data on the experiences of TNB physicians and trainees describe widespread challenges related to prejudice and discrimination, with most trainees concealing their gender identity for fear of discrimination. We aimed to understand how TNB medical students have experienced professionalism and professional identity formation. Methods This was a secondary analysis of data gathered in a constructivist grounded theory study. The authors conducted semi-structured qualitative interviews in 2017 with seven current or recently graduated TNB Canadian medical students. Results and Discussion From medical school application to graduation, TNB medical students reported feeling tensions between meeting expectations of professionalism, being their authentic selves, and seeking to avoid conscious and implicit biases. These tensions played out around issues of disclosure, foregrounding identity through impression management, and responding to identity exemplars. The tension between TNB trainees' desire to bring their whole selves to the practice of medicine and feeling pressured to de-emphasize their gender is ironic when considering the increased call for medical trainees from equity-seeking communities. The most commonly used behavioural frameworks of professionalism were inherited from prior generations and restrict students whose experiences and community-based knowledge are most needed. Demands of professionalism that are incompatible with authentic professional identity development place an inordinate burden on trainees whose identities have been excluded from normative concepts of the professional, including TNB trainees.
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Affiliation(s)
- Kat Butler
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, CA
| | | | | | - Albina Veltman
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, CA
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Stoddard HA, Lee AC, Gooding HC. Empowerment of Learners through Curriculum Co-Creation: Practical Implications of a Radical Educational Theory. TEACHING AND LEARNING IN MEDICINE 2024:1-7. [PMID: 38332636 DOI: 10.1080/10401334.2024.2313212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
Framing the Issue: Medical education programs in the U.S. rely on the aphorism that faculty own the curriculum; that is, the specialized knowledge, skills, and attitudes of a physician are the province of the faculty to be delivered to tuition-paying students. From this view, the learner's role is one of passivity and deference. A contrasting approach, termed curriculum co-creation, frames education as a bi-lateral partnership. Co-creation results from learners, in collaboration with instructors, taking an active role in creating the goals and processes of an educational program. Such a partnership requires substantial revision of the expectations for both learners and instructors. In this Observations article, the idea of co-creation is applied to medical education and an aspirational vision for the role and value of faculty-student co-creation is advocated. Description and Explication: Co-creation partnerships of faculty and students occur in many forms, varying in degree of departure from traditional educational practice. Co-creation principles and partnerships can be deployed for almost all aspects of training including selection and organization of content, effective methods of instruction, and assessment of student learning. The outcomes of co-creation occur at three levels. The most specific outcome of co-creation is characterized by increased student engagement and enhanced learning. Broader outcomes include improved efficacy and value in the educational program and institution while, at the farthest-reaching level, a co-creative process can modify the medical profession itself. Although some specific instructional techniques to promote student involvement and input have historically been deployed in medical education, there is little evidence that students have ever been permitted to share in ownership. Implications for Medical Education: When fully embraced, curricular co-creation will be recognizable through improved student engagement and learning along with a revised understanding of how faculty-student relationships can foment reform in medical education and the culture of the profession. Further scholarship and research will be indispensable to examine how co-creative partnerships can flatten hierarchies within medical education and inspire the medical profession to be more inclusive and effective. Following the model of co-creation is expected to inspire learners by empowering them to participate fully as co-owners of their own education and prepare them to lead medical education in a different direction for the future.
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Affiliation(s)
- Hugh A Stoddard
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Annika C Lee
- Department Medicine-Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Holly C Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
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Govender L, Church HR. When I say … 'non-clinical practice'. MEDICAL EDUCATION 2024; 58:183-184. [PMID: 37517429 DOI: 10.1111/medu.15177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
In recent years, we have seen the emergence of the term 'non-clinical practice' used in the literature and the healthcare field more broadly. However, there has not yet been a critical examination of what this term means and how it may subtly influence the social reality and culture of healthcare practice. Based on the available literature and the authors' lived experience, we position this article and the term 'non-clinical practice' relative to medical doctors. However, the tenets of the argument below are true for any healthcare practitioner. Taking a social constructivist approach, we critically analyse the term 'non-clinical practice' and explain why readers should challenge its use.
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Affiliation(s)
- Lynelle Govender
- Division of Anatomical Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Helen R Church
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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McKivett A, Paul D. Recreating the future-Indigenous research paradigms in health professional education research. MEDICAL EDUCATION 2024; 58:149-156. [PMID: 37329219 DOI: 10.1111/medu.15154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/27/2023] [Accepted: 06/05/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Health and self-determination are recognised as universal human rights. Health professional education research and practice hold the capacity to prioritise values, worldviews and agendas that envisage sustainable and equitable futures for the entire community served. This paper explores the need for the co-location of Indigenous research paradigms in health professional education research and teaching. Indigenous communities have a long history of science, research and sustainable living and are holders of ways of knowing, being and doing that can shape actions and priorities in health research that value equity and sustainability. DISCUSSION Knowledge construction in health professional education research does not occur in isolation nor is it value neutral. A continued dominance of the biomedical approach to health creates a system of innovation that is unbalanced and unable to deliver health outcomes demanded by contemporary society. As power and hierarchies are embedded in health professional education research and praxis, transformative action is required to bring forth marginalised voices in research processes. Critical reflexivity regarding the ontological, epistemological, axiological and methodological positioning of researchers is an important step towards creating and sustaining research structures that effectively value and co-locate different perspectives in knowledge production and translation. CONCLUSION Working towards more equitable and sustainable futures for Indigenous and non-Indigenous communities requires health care systems to be informed and guided by different knowledge paradigms. This can work to avoid the ongoing reproduction of inefficient biomedical structures and purposefully disrupt the status quo of health inequities. Realising this requires the effective co-location of Indigenous research paradigms and ways of working into health professional education research that centre relationality, wholism, interconnectedness and self-determination. This calls for a raising of the critical consciousness of health professional education research academies.
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Affiliation(s)
- Andrea McKivett
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David Paul
- Fremantle Medical Program, National School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Kerins J, Smith SE, Tallentire VR. "Ego massaging that helps": a framework analysis study of internal medicine trainees' interprofessional collaboration approaches. MEDICAL EDUCATION ONLINE 2023; 28:2243694. [PMID: 37535844 PMCID: PMC10402837 DOI: 10.1080/10872981.2023.2243694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Patient care depends on collaborative practice. Debate remains as to the best approach to providing education for collaboration, with educational interventions often far removed from the realities of the clinical workplace. Understanding the approaches used for collaboration in clinical practice could inform practical strategies for training. For internal medicine trainees, this involves collaboration with other professions but also with other specialties. This study aimed to explore the approaches that internal medicine trainees use for interprofessional collaboration and the ways that these approaches vary when internal medicine trainees interact with different healthcare provider groups. METHODS Following ethical approval and participant consent, interprofessional communication workshops between August 2020 and March 2021 were audio recorded and transcribed verbatim. Workshops involved groups of internal medicine trainees discussing collaboration challenges and the approaches they use in clinical practice. This framework analysis study used the interprofessional collaboration framework described by Bainbridge and Regehr (building social capital, perspective taking and negotiating priorities and resources), and cross-referenced the categorised data with the healthcare groups that trainees collaborate with, to look for patterns in the data. RESULTS Seventeen workshops, involving 100 trainees, were included. Trainees described relationship building, perspective taking and negotiating priorities and resources. Relationship building was a modification to the original framework domain of building social capital. Themes of power and civility transcended domains with evidence of using hierarchy as leverage when negotiating and employing civility as a tactical approach throughout. DISCUSSION This bi-dimensional analysis highlights patterns of perspective taking when collaborating with other specialties and professions, and the approaches to negotiation of courting favour and coercion when interacting with other specialties. This study provides evidence of the strategies currently utilised by internal medicine trainees, with different healthcare groups, and presents a modified framework which could inform the development of training for collaboration.
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Affiliation(s)
- Joanne Kerins
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Acute medicine, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Samantha Eve Smith
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Medical Education Directorate, NHS Lothian, Edinburgh, UK
| | - Victoria Ruth Tallentire
- Scottish Centre for Simulation and Clinical Human Factors, NHS Forth Valley, Larbert, UK
- Medical Education Directorate, NHS Lothian, Edinburgh, UK
- Medical Directorate, NHS Education for Scotland, Edinburgh, Scotland, UK
- College of Medicine and Vetinary Medicine, University of Edinburgh, Edinburgh, Scotland, UK
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Hayashi M, Breugelmans R, Nishiya K. Identity conflicts of student affairs officers in a medical university. MEDICAL EDUCATION ONLINE 2023; 28:2182216. [PMID: 36840965 PMCID: PMC9970241 DOI: 10.1080/10872981.2023.2182216] [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: 07/19/2022] [Revised: 11/24/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Collaboration between student affairs officers and the faculty is important in dealing with the recent rapid changes in medical education, and mutual understanding is essential to ensure that participants become a cohesive social group. This study explores the identity conflicts of student affairs officers in medical universities using the figured worlds theory. METHODS An exploratory qualitative case study was conducted with 24 student affairs officers at a private medical university in Japan. Data were collected through face-to-face, semi-structured interviews and analysed using thematic analysis from the perspective of a social constructivism paradigm. RESULTS Qualitative analysis revealed the following three themes regarding the identity conflicts of student affairs officers: differences in the perception of medical students, difficulties in building trusting relationships with the faculty, and resistance to the medical university's traditional atmosphere. Student affairs officers tended to provide support from a student-centred perspective when interacting with medical students, while the faculty employed a teacher-centred perspective. DISCUSSION To promote understanding between professions, it is necessary to set aside certain professional views and welcome dialogue with other professionals with different values, while also understanding the multi-layered context of medical education, so that conflicts can be handled optimally and relationships can be professionalised for social cohesion.
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Affiliation(s)
- Mikio Hayashi
- Center for Health Professions Education, Kansai Medical University, Osaka, Japan
- Master of Medical Sciences in Medical Education, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Katsumi Nishiya
- Center for Health Professions Education, Kansai Medical University, Osaka, Japan
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Wyatt TR, Jain V, Ma TL. 'When I stood up for something it's because I felt a… moral violation': Trainees' acts of resistance against social harm and injustice. MEDICAL EDUCATION 2023. [PMID: 37975514 DOI: 10.1111/medu.15256] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION As medical students around the world enter their chosen profession, they inherit a system that they did not design nor create, yet are still responsible for it. This system is rooted in centuries of social harm and inequity. This study examines trainees' professional acts of resistance to understand what trainees hope to accomplish in their resistance efforts, why they are resisting, and the tactics they use. METHODS Drawing on counter-storytelling and critical theory, we collected in-depth qualitative interviews from nine medical students and nine residents/fellows across North America. Using theoretical guidance on how to study acts of resistance, data were analysed using a combination of coding techniques to understand resistors' intentions in resisting and the tactics they used to understand what, why, and how trainees were resisting. The analysis was returned to participants for member checking. RESULTS Trainees described resisting systems of harm and injustice bequeathed to them by an older generation whose values and practices were reflective of a different time. Their motivations stemmed from deep-seated moral distress from the mistreatment of patients and learners. They hoped to re-envision medical education to be patient- and learner-centred. The tactics they chose depended on the level of power they had in the system and the extent to which they wished to have their efforts known. DISCUSSION Trainees described intentional and deliberate acts of resistance to the social harm and injustice embedded in the broader profession to re-create the profession. Given that these acts spanned a large geographical area, this study suggests that trainees may be part of a larger social movement aimed at creating widespread change within the profession.
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Affiliation(s)
- Tasha R Wyatt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Vinayak Jain
- Department of Internal Medicine, MedStar Health - Georgetown Washington Hospital Center, Washington, District of Columbia, USA
| | - Ting Lan Ma
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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McClintock AH, Fainstad T, Blau K, Jauregui J. Psychological safety in medical education: A scoping review and synthesis of the literature. MEDICAL TEACHER 2023; 45:1290-1299. [PMID: 37266963 DOI: 10.1080/0142159x.2023.2216863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE Psychological safety (PS) is the belief that the environment is safe for risk taking. Available data point to a lack of PS in medical education. Based on literature in other fields, PS in clinical learning environments (CLEs) could support trainee well-being, belonging, and learning. However, the literature on PS in medical education has not been broadly assessed. MATERIALS AND METHODS In 2020, authors searched PubMed, Web of Science, CINAHL, Scopus, ERIC, PsycInfo, and JSTOR for articles published prior to January 2020. Authors screened all search results for eligibility using specific criteria. Data were extracted and thematic analysis performed. RESULTS Fifty-two articles met criteria. The majority focused on graduate medical education (45%), and 42% of studies took place within a CLE. Articles addressed organizational and team level constructs (58%), with fewer descriptions of specific behaviors of team members that promote or hinder safety. The impacts of safe environments for trainees and patients are areas in need of more exploration. DISCUSSION Future research should focus on defining specific organizational and interpersonal leader behaviors that promote PS, seek to understand how PS is determined by individual trainees, and measure the impact of PS on learners, learning, and patient care outcomes.
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Affiliation(s)
- Adelaide H McClintock
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Tyra Fainstad
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kevin Blau
- Department of Medicine, University of Washington School of Medicine, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Joshua Jauregui
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, WA, USA
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O'Brien MT, Bullock JL, Minhas PK, Roman SA, Joshi P, Lupton KL, Hauer KE. From Eggshells to Action: A Qualitative Study of Faculty Experience Responding to Microaggressions Targeting Medical Students. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S79-S89. [PMID: 37983400 DOI: 10.1097/acm.0000000000005424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE Microaggressions targeting clinical learners cause harm and threaten learning. Clinical supervisors can be powerful allies by intervening when microaggressions occur. This study explored general and student-nominated skilled supervisors' perspectives on responding to microaggressions targeting clinical learners. METHOD This single-institution, qualitative study within a constructivist paradigm explored faculty supervisor experiences with bystander response to microaggressions targeting learners. Clinical supervisors in medicine and surgery departments and those across departments nominated by students as skilled microaggression responders were invited to discuss microaggression scenarios targeting students in semistructured focus groups in the U.S. in 2020-2021. Investigators applied the framework method of thematic analysis to identify themes. RESULTS Forty-two faculty (31 medicine and surgery ["general"], 11 "student-nominated" as skilled responders) joined 10 focus groups (6 "general," 3 "student-nominated," 1 mixed). Four themes characterized experiences responding to microaggressions targeting learners: bystander goals, noticing, acting, and continuous learning. Participants' response goals were protecting learners, safeguarding learning, and teaching microaggression response skills. Noticing was influenced by past experiences with microaggressions and acculturation to clinical environments. Bystander action stemmed from (1) microaggression type, (2) personal emotional vulnerability, (3) knowledge of student preferences for supervisor response, and (4) clinical and educational context. Bystander action was more common when participants regarded all microaggressions as harmful, understood student preferences for faculty response, expected to err (growth mindset), and framed microaggressions as opportunities for humble reflection, intellectual candor, and teaching. Microaggression response required continuous learning through informal and formal skills development. CONCLUSIONS Complex factors govern faculty bystander response to microaggressions targeting clinical learners. Efforts to strengthen faculty bystander response should incorporate skill-building around preemptive discussions with learners and using intellectual candor to promote psychological safety, learning, and bystander action. Additional investigation is needed on how to incorporate these skills into team workflows and to assess outcomes of specific response strategies.
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Affiliation(s)
- Meghan T O'Brien
- M.T. O'Brien is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0001-8741-2734
| | - Justin L Bullock
- J.L. Bullock was a third-year internal medicine resident, Department of Medicine, University of California, San Francisco, San Francisco, California, at the time of this study, and is now a fellow, Division of Nephrology, University of Washington School of Medicine, Seattle, Washington
| | - Prabhjot K Minhas
- P.K. Minhas was a fourth-year medical student, University of California, San Francisco, San Francisco, California, at the time of the study, and is now a first-year pediatrics resident, Boston Combined Residency Program in Pediatrics at Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts
| | - Sanziana A Roman
- S.A. Roman is professor, Department of Surgery and Medicine, University of California, San Francisco, San Francisco, California
| | - Priya Joshi
- P. Joshi is assistant professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Katherine L Lupton
- K.L. Lupton is professor, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Karen E Hauer
- K.E. Hauer is associate dean for competency assessment and professional standards and professor, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; ORCID: https://orcid.org/ORCID:0000-0002-8812-4045
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Looman N, Battal N, Vanstone M. No doctor is an island. MEDICAL EDUCATION 2023; 57:996-998. [PMID: 37490936 DOI: 10.1111/medu.15168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023]
Abstract
In this commentary, the authors highlight the importance of intraprofessional communities of practice (CoPs) for specialists and family physicians practicing comprehensive evidence‐based care. The authors explore how power dynamics can be meaningfully incorporated into continuing medical education to reap the multi‐perspectival benefit of intraprofessional CoPs for continuing professional development and medical education.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
| | - Noël Battal
- Academy for Psychology and Hypnotherapy, Battal & Looman, Deventer, The Netherlands
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Luhanga U, Tanneru A, Saeed A, Spradling EG, Sargeant D, Nicholas J, White D. Towards Inclusive Excellence for Stakeholders Within Health Professions Education Programs. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S208-S209. [PMID: 37983454 DOI: 10.1097/acm.0000000000005339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Ulemu Luhanga
- Author affiliations: U. Luhanga, D. White, Emory University School of Medicine; A. Tanneru, A. Saeed, E.G. Spradling, Emory College of Arts and Sciences; D. Sargeant, J. Nicholas, Emory Rollins School of Public Health
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Liao KC, Ajjawi R, Peng CH, Jenq CC, Monrouxe LV. Striving to thrive or striving to survive: Professional identity constructions of medical trainees in clinical assessment activities. MEDICAL EDUCATION 2023; 57:1102-1116. [PMID: 37394612 DOI: 10.1111/medu.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/15/2023] [Accepted: 05/30/2023] [Indexed: 07/04/2023]
Abstract
CONTEXT Assessment plays a key role in competence development and the shaping of future professionals. Despite its presumed positive impacts on learning, unintended consequences of assessment have drawn increasing attention in the literature. Considering professional identities and how these can be dynamically constructed through social interactions, as in assessment contexts, our study sought to understand how assessment influences the construction of professional identities in medical trainees. METHODS Within social constructionism, we adopted a discursive, narrative approach to investigate the different positions trainees narrate for themselves and their assessors in clinical assessment contexts and the impact of these positions on their constructed identities. We purposively recruited 28 medical trainees (23 students and five postgraduate trainees), who took part in entry, follow-up and exit interviews of this study and submitted longitudinal audio/written diaries across nine-months of their training programs. Thematic framework and positioning analyses (focusing on how characters are linguistically positioned in narratives) were applied using an interdisciplinary teamwork approach. RESULTS We identified two key narrative plotlines, striving to thrive and striving to survive, across trainees' assessment narratives from 60 interviews and 133 diaries. Elements of growth, development, and improvement were identified as trainees narrated striving to thrive in assessment. Neglect, oppression and perfunctory narratives were elaborated as trainees narrated striving to survive from assessment. Nine main character tropes adopted by trainees with six key assessor character tropes were identified. Bringing these together we present our analysis of two exemplary narratives with elaboration of their wider social implications. CONCLUSION Adopting a discursive approach enabled us to better understand not only what identities are constructed by trainees in assessment contexts but also how they are constructed in relation to broader medical education discourses. The findings are informative for educators to reflect on, rectify and reconstruct assessment practices for better facilitating trainee identity construction.
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Affiliation(s)
- Kuo-Chen Liao
- Division of Geriatrics and General Internal Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital (CGMH), Linkou, Taiwan (ROC)
- Chang Gung Medical Education Research Centre, CGMH, Linkou, Taiwan (ROC)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan (ROC)
| | - Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
| | - Chang-Hsuan Peng
- Chang Gung Medical Education Research Centre, CGMH, Linkou, Taiwan (ROC)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan (ROC)
| | - Chang-Chyi Jenq
- Chang Gung Medical Education Research Centre, CGMH, Linkou, Taiwan (ROC)
- Department of Nephrology, CGMH, Linkou, Taiwan (ROC)
- Medical Humanities Center, CGMH, Linkou, Taiwan (ROC)
- Department of Medical Humanities and Social Sciences, School of Medicine, College of Medicine, Chang Gung University, Taoyuan City, Taiwan (ROC)
| | - Lynn V Monrouxe
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Magnussen HJ, Kjeken I, Pinxsterhuis I, Sjøvold TA, Feiring M. Negotiating Professional Tasks in a Hospital: A Qualitative Study of Rheumatologists and Occupational Therapists in the Management of Hand Osteoarthritis. J Multidiscip Healthc 2023; 16:3057-3074. [PMID: 37873535 PMCID: PMC10590564 DOI: 10.2147/jmdh.s425640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/05/2023] [Indexed: 10/25/2023] Open
Abstract
Purpose Societal change and rise in demand for healthcare call for new health professional practices and task redistribution. Through negotiated order theory, this study explores how hospital rheumatologists (RT) and occupational therapists (OT) negotiate professional tasks in the clinical management of hand osteoarthritis. Methodology Fourteen qualitative interviews and 16 observations in clinical consultations were conducted in two hospitals specialized in rheumatology in Norway. Participants included eight OTs, six RTs, and patients in consultations. Data were analyzed using reflexive thematic analysis. Results Three themes were developed from codes: hierarchical ordering of hospital work impacts interprofessional negotiations; diagnostic organization of tasks preserves RT authority; and evidence-based recommendations in rheumatology enhance OT responsibilities. Overall, RTs and OTs enact tasks in succession where higher-ranking RTs establish a diagnosis and decide the subsequent in-hospital trajectory entrenched in a medical knowledge system. When medicine does not hold evidence-based treatment alternatives for patients, OTs respond by providing therapeutic interventions that are legitimized through international recommendations in rheumatology when they equip patients with tools to cope with chronic illness. Conclusion Negotiations over tasks do not take place from equal power positions when status and knowledge hierarchies frame professional practices. The enactment of tasks is concurrently highly influenced by the arena of the workplace, where the two professional groups both cross boundaries and work together in concert despite professional differences in order to meet patient interests and provide relevant healthcare.
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Affiliation(s)
- Hege Johanne Magnussen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingvild Kjeken
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- REMEDY - Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | - Irma Pinxsterhuis
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Marte Feiring
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Norwegian National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- REMEDY - Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
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Vanstone M, Cavanagh A, Molinaro M, Connelly CE, Bell A, Mountjoy M, Whyte R, Grierson L. How medical learners and educators decide what counts as mistreatment: A qualitative study. MEDICAL EDUCATION 2023; 57:910-920. [PMID: 36815430 DOI: 10.1111/medu.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/18/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The mistreatment or abuse (maltreatment) of medical learners by their peers and supervisors has been documented globally for decades, and there is significant research about the prevalence, sequelae and strategies for intervention. However, there is evidence that learners experience maltreatment as being less clear cut than do researchers, educators and administrators. This definitional ambiguity creates problems for understanding and addressing this issue. The objective of this study was to understand how medical learners and educators make sense of less-than-ideal interactions in the clinical learning environment, and to describe which factors influenced their perception that the encounter constituted maltreatment. METHODS Using constructivist grounded theory, we interviewed 16 medical students, 15 residents or fellows, and 18 educators associated with a single medical school (n = 49). Data collection began with the most junior learners, iterating with analysis as we progressed through the project. Constant comparative analysis was used to gather and compare stories of 'definitely', 'maybe' and 'definitely not' maltreatment across a variety of axes including experience level, clinical setting and type of interaction. RESULTS Our data show that learners and educators have difficulty classifying their experiences of negative interpersonal interaction, except in the most severe and concrete cases. While there was tremendous variation in the way they categorised similar experiences, there was consistency in the elements drawn upon to make sense of those experiences. Participants interpreted negative interpersonal interactions on an individual basis by considering factors related to the interaction, initiator and recipient. CONCLUSIONS Only the most negative behaviour is consistently understood as maltreatment; a complex process of individual sense-making is required to determine the acceptability of each interaction. The differences between how individuals judge these interactions highlight an opportunity for administrative, research and faculty development intervention.
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Affiliation(s)
- Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alice Cavanagh
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
- MD/PhD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Monica Molinaro
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
| | - Catherine E Connelly
- Michael G. DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Bell
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
- Undergraduate MD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Undergraduate MD Program, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert Whyte
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Grierson
- McMaster Program for Education Research, Innovation and Theory, Hamilton, Ontario, Canada
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Barak G, Dean A, Haq H, Falco C, Singhal G. The Senior Resident-Fellow Dynamic on Pediatric Hospital Medicine Teams: A Qualitative Study. Hosp Pediatr 2023; 13:912-921. [PMID: 37701970 DOI: 10.1542/hpeds.2022-006992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND AND OBJECTIVES With the Accreditation Council for Graduate Medical Education accreditation in place for pediatric hospital medicine (PHM) fellowships, fellows are playing a larger role in resident education. However, the impact of PHM fellows on pediatric residency training is not well described. We aimed to identify the factors that affect the dynamic between senior residents and fellows working together on PHM teams. METHODS In this qualitative study, we used purposive sampling and interviewed 15 senior residents and 8 PHM fellows between April and September 2020. We created a conceptual framework for the senior resident-fellow dynamic to develop the interview guide. Using verbatim transcripts uploaded into Dedoose software, 2 authors coded responses and identified themes using directed content analysis. RESULTS Twelve themes emerged as factors that impact the senior resident-fellow dynamic and fell into 6 categories: Team organization, role clarity, teaching, fellow approachability, decision-making, and attending involvement. Both senior residents and PHM fellows described an optimal dynamic in which a hierarchal approach to team structure, teaching, and decision-making is counterbalanced by fellow approachability. Role uncertainty, especially with increased attending involvement, led to conflict between residents and fellows. CONCLUSIONS This study demonstrated that a structured hierarchy surrounding supervision, decision-making, and teaching promoted level-appropriate autonomy for both senior residents and fellows. These findings can be used to design an intervention, such as a leadership curriculum for fellows and senior residents, to target behaviors that facilitate a stepwise approach to supervision and patient care.
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Affiliation(s)
- Gal Barak
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Andrea Dean
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Carla Falco
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
| | - Geeta Singhal
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
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Hu XM, Li ZX, Deng J, Han Y, Lu S, Zhang Q, Luo ZQ, Xiong K. Integration of Theory and Practice in Medical Morphology Curriculum in Postgraduate Training: A Flipped Classroom and Case-based Learning Exercise. Curr Med Sci 2023; 43:741-748. [PMID: 37455278 DOI: 10.1007/s11596-023-2759-9] [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: 01/20/2023] [Accepted: 02/27/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The integration of training in theory and practice across the medical education spectrum is being encouraged to increase student understanding and skills in the sciences. This study aimed to determine the deciding factors that drive students' perceived advantages in class to improve precision education and the teaching model. METHODS A mixed strategy of an existing flipped classroom (FC) and a case-based learning (CBL) model was conducted in a medical morphology curriculum for 575 postgraduate students. The subjective learning evaluation of the individuals (learning time, engagement, study interest and concentration, and professional integration) was collected and analyzed after FC-CBL model learning. RESULTS The results from the general evaluation showed promising results of the medical morphology in the FC-CBL model. Students felt more engaged by instructors in person and benefited in terms of time-saving, flexible arrangements, and professional improvement. Our study contributed to the FC-CBL model in Research Design in postgraduate training in 4 categories: 1) advancing a guideline of precision teaching according to individual characteristics; 2) revealing whether a learning background is needed for a Research Design course to guide setting up a preliminary course; 3) understanding the perceived advantages and their interfaces; and 4) barriers and/or improvement to implement the FC-CBL model in the Research Design class, such as a richer description of e-learning and hands-on practice. CONCLUSION Undertaking a FC-CBL combined model could be a useful addition to pedagogy for medical morphology learning in postgraduate training.
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Affiliation(s)
- Xi-Min Hu
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 410000, China
| | - Zhi-Xin Li
- Clinical Medicine Eight-year Program, 02 Class, 18 Grade, Xiangya School of Medicine, Central South University, Changsha, 410000, China
| | - Jing Deng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, 410000, China
| | - Yang Han
- Department of Physiology, School of Basic Medical Science, Central South University, Changsha, 410008, China
| | - Shuang Lu
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 410000, China
| | - Qi Zhang
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 410000, China
| | - Zi-Qiang Luo
- Department of Physiology, School of Basic Medical Science, Central South University, Changsha, 410008, China
| | - Kun Xiong
- Department of Anatomy and Neurobiology, School of Basic Medical Science, Central South University, Changsha, 410000, China.
- Hunan Key Laboratory of Ophthalmology, Changsha, 410000, China.
- Key Laboratory of Emergency and Trauma, Ministry of Education, College of Emergency and Trauma, Hainan Medical University, Haikou, 016000, China.
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Kozato A, Shikino K, Matsuyama Y, Hayashi M, Kondo S, Uchida S, Stanyon M, Ito S. A qualitative study examining the critical differences in the experience of and response to formative feedback by undergraduate medical students in Japan and the UK. BMC MEDICAL EDUCATION 2023; 23:408. [PMID: 37277728 PMCID: PMC10240445 DOI: 10.1186/s12909-023-04257-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/13/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Formative feedback plays a critical role in guiding learners to gain competence, serving as an opportunity for reflection and feedback on their learning progress and needs. Medical education in Japan has historically been dominated by a summative paradigm within assessment, as opposed to countries such as the UK where there are greater opportunities for formative feedback. How this difference affects students' interaction with feedback has not been studied. We aim to explore the difference in students' perception of feedback in Japan and the UK. METHODS The study is designed and analysed with a constructivist grounded theory lens. Medical students in Japan and the UK were interviewed on the topic of formative assessment and feedback they received during clinical placements. We undertook purposeful sampling and concurrent data collection. Data analysis through open and axial coding with iterative discussion among research group members was conducted to develop a theoretical framework. RESULTS Japanese students perceived feedback as a model answer provided by tutors which they should not critically question, which contrasted with the views of UK students. Japanese students viewed formative assessment as an opportunity to gauge whether they are achieving the pass mark, while UK students used the experience for reflective learning. CONCLUSIONS The Japanese student experience of formative assessment and feedback supports the view that medical education and examination systems in Japan are focused on summative assessment, which operates alongside culturally derived social pressures including the expectation to correct mistakes. These findings provide new insights in supporting students to learn from formative feedback in both Japanese and UK contexts.
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Affiliation(s)
- An Kozato
- Postgraduate Education Centre, Ipswich Hospital NHS Trust, Ipswich, UK.
- Ipswich Hospital, Heath Rd, IP4 5PD, Ipswich, UK.
| | - Kiyoshi Shikino
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | | | - Mikio Hayashi
- Center for Medical Education, Kansai Medical University, Osaka, Japan
- Master of Medical Sciences in Medical Education, Harvard Medical School, Boston, MA, USA
| | - Satoshi Kondo
- Department of Medical Education Studies, Graduate School of Medicine, International Research Center for Medical Education, The University of Tokyo, Tokyo, Japan
- Center for Medical Education and Career Development, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - Shun Uchida
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
| | - Maham Stanyon
- Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan
| | - Shoichi Ito
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
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Punchhi G, Shum K, Sukhera J. Anti-oppressive pedagogy in medical education: A qualitative study of trainees and faculty. MEDICAL EDUCATION 2023; 57:566-573. [PMID: 36581567 DOI: 10.1111/medu.15016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/10/2022] [Accepted: 12/27/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE Despite the proliferation of interest in health equity and justice in medical education, there is limited research into the practical implementation of pedagogical approaches that align with anti-oppressive practices. This study sought to explore how to integrate anti-oppressive pedagogy into medical education. METHODS Using constructivist grounded theory, the authors conducted 19 semi-structured interviews with a continuum of medical education stakeholders including learners and faculty in a Canadian context between June and August 2021. Transcripts were iteratively analysed using constant comparative analysis. RESULTS Findings suggest that existing approaches to anti-oppressive pedagogy in medical education are misaligned with the perceived values, priorities, pace, biomedical focus and hierarchical nature of medical education, and medical practice. Although some learners are motivated to advance anti-oppressive teaching, their motivations are often related to their personal experiences of oppression. Participants suggested that transformative and structural changes are required to effectively integrate anti-oppressive pedagogy into medical education. Suggestions included a shift to community-based learning while ensuring adequate compensation for educators and addressing resistance at individual and institutional levels. CONCLUSION Anti-oppressive pedagogy does not presently align with existing medical education practices. Effectively integrating anti-oppressive approaches will require individual and institutional reflection on the values and assumptions that underpin the field before progress can be made in a meaningful and sustainable way.
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Affiliation(s)
- Gopika Punchhi
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kathryn Shum
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Javeed Sukhera
- Psychiatry, Hartford Hospital Institute of Living, Hartford, Connecticut, USA
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25
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Richardson CL, Filan J, Lindsey L, Mundell A, Rathbone AP, Nazar H. Intersectional Identities: Making Sense of Skill Development on Clinical Placements. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100050. [PMID: 37288692 DOI: 10.1016/j.ajpe.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/29/2022] [Accepted: 01/11/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Little is known about the influence of personal experiences on learners' trajectories toward mastery. Newell's theory of constraints articulates the relationship between environmental, individual, and task-related factors for skill development. This study explores how undergraduate pharmacy students experience skill development on placements and what the barriers and facilitators are within Newell's framework. METHODS Year 3 undergraduate pharmacy students were invited to take part in focus groups exploring Newell's theory relative to skill development. Verbatim transcripts were analyzed using an interpretive phenomenological approach. RESULTS Five focus groups were conducted with 16 students. The placement task provided structure through entrustable professional activities (EPAs). The resulting skill development varied but included EPA expected behaviors and also skills for mastery, eg, self-reflection. Students' personal identities acted as both barriers and facilitators. For example, expecting or experiencing racial microaggressions limited participation; having a local accent facilitated rapport with patients. Students worked toward integration into the community of practice (the ward), where the staff was critical to inclusion. Where students had barriers related to their identities, they found it more difficult to access the community of practice. CONCLUSION Factors related to the community of practice (environment), students' identities (individual), and the EPA behaviors (task) can influence skill development during placement. For some students, these factors will be more prevalent, and elements of their identities may intersect and conflict, acting as both barriers and facilitators to skill development. Educators can consider the influence of intersectionality on student identity when designing and preparing new placements and assessing students.
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Affiliation(s)
- Charlotte Lucy Richardson
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom.
| | - Jack Filan
- Newcastle University, Faculty of Medical Sciences, School of Medical Education, Newcastle upon Tyne, United Kingdom
| | - Laura Lindsey
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
| | - Amy Mundell
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Adam Pattison Rathbone
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
| | - Hamde Nazar
- Newcastle University, Faculty of Medical Sciences, School of Pharmacy, Newcastle upon Tyne, United Kingdom
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26
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Fleming E, Smith CS, Quiñonez CR. Centring anti-oppressive justice: Re-envisioning dentistry's social contract. Community Dent Oral Epidemiol 2023. [PMID: 36966445 DOI: 10.1111/cdoe.12854] [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: 09/28/2022] [Revised: 02/14/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES We re-envision dentistry's social contract and elaborate on the idea that it is not neutral and free from such things as racism and white supremacy and can act as a tool of oppression. METHODS We critique social contract theory through examination of classical and contemporary contract theorists. More specifically, our analysis draws from the work of Charles W. Mills, a philosopher of race and liberalism, as well as the theoretical and praxis framework of intersectionality. RESULTS Social contract theory supports hierarchies and inequities that may be used to sustain unfair and unjust differences in oral health between social groups. When dentistry's social contract becomes a tool of oppression, its practice does not promote health equity but reinforces damaging social norms. CONCLUSION Dentistry must embrace an anti-oppression framing of equity and elevate the principle of justice to one of liberation and not just fairness. In doing so, the profession can better understand itself, act more equitably and empower practitioners to advocate for justice in health and healthcare in its fullest sense. Anti-oppressive justice supports health not as merely an obligation but as a human duty.
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Affiliation(s)
- Eleanor Fleming
- University of Maryland School of Dentistry, 650 West Baltimore Street, Baltimore, Maryland, 21230, USA
| | - Carlos S Smith
- Virgina Commonwealth University, 1101 E. Leigh Street, P.O. Box 980566, Richmond, Virginia, 23298-0566, USA
| | - Carlos R Quiñonez
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, N6A 5C1, Canada
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27
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Wisener K, Hart K, Driessen E, Cuncic C, Veerapen K, Eva K. Upward Feedback: Exploring Learner Perspectives on Giving Feedback to their Teachers. PERSPECTIVES ON MEDICAL EDUCATION 2023; 2:99-108. [PMID: 36969692 PMCID: PMC10038106 DOI: 10.5334/pme.818] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/10/2023] [Indexed: 05/05/2023]
Abstract
Introduction Feedback from learners is known to be an important motivator for medical teachers, but it can be de-motivating if delivered poorly, leaving teachers frustrated and uncertain. Research has identified challenges learners face in providing upward feedback, but has not explored how challenges influence learners' goals and approaches to giving feedback. This study explored learner perspectives on providing feedback to teachers to advance understanding of how to optimize upward feedback quality. Methods We conducted semi-structured interviews with 16 learners from the MD program at the University of British Columbia. Applying an interpretive description methodology, interviews continued until data sufficiency was achieved. Iterative analysis accounted for general trends across seniority, site of training, age and gender as well as individual variations. Findings Learners articulated well-intentioned goals in relation to upward feedback (e.g., to encourage effective teaching practices). However, conflicting priorities such as protecting one's image created tensions leading to feedback that was discordant with teaching quality. Several factors, including the number of feedback requests learners face and whether learners think their feedback is meaningful mediated the extent to which upward feedback goals or competing goals were enacted. Discussion Our findings offer a nuanced understanding of the complexities that influence learners' approaches to upward feedback when challenges arise. In particular, goal conflicts make it difficult for learners to contribute to teacher support through upward feedback. Efforts to encourage the quality of upward feedback should begin with reducing competition between goals by addressing factors that mediate goal prioritization.
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Affiliation(s)
- Katherine Wisener
- Faculty Development, Faculty of Medicine, University of British Columbia, Canada
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands
| | - Kimberlee Hart
- Faculty of Medicine, University of British Columbia, Canada
| | - Erik Driessen
- Department of Educational Development and Research, Faculty of Health Medicine & Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Cary Cuncic
- Division of General Internal Medicine, University of British Columbia, Vancouver. BC, Canada
| | - Kiran Veerapen
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Eva
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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28
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Legha RK, Martinek NN. White supremacy culture and the assimilation trauma of medical training: ungaslighting the physician burnout discourse. MEDICAL HUMANITIES 2023; 49:142-146. [PMID: 36241381 DOI: 10.1136/medhum-2022-012398] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 06/16/2023]
Abstract
The physician burnout discourse emphasises organisational challenges and personal well-being as primary points of intervention. However, these foci have minimally impacted this worsening public health crisis by failing to address the primary sources of harm: oppression. Organised medicine's whiteness, developed and sustained since the nineteenth century, has moulded training and clinical practice, favouring those who embody its oppressive ideals while punishing those who do not. Here, we reframe physician burnout as the trauma resulting from the forced assimilation into whiteness and the white supremacy culture embedded in medical training's hidden curriculum. We argue that 'ungaslighting' the physician burnout discourse requires exposing the history giving rise to medicine's whiteness and related white supremacy culture, rejecting discourses obscuring their harm, and using bold and radical frameworks to reimagine and transform medical training and practice into a reflective, healing process.
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29
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Blalock AE, Leal DR. Redressing injustices: how women students enact agency in undergraduate medical education. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:1-18. [PMID: 36394683 PMCID: PMC9672615 DOI: 10.1007/s10459-022-10183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
This study presents descriptions of epistemic injustice in the experiences of women medical students and provides accounts about how these students worked to redress these injustices. Epistemic injustice is both the immediate discrediting of an individual's knowledge based on their social identity and the act of persistently ignoring possibilities for other ways of knowing. Using critical narrative interviews and personal reflections over an eight-month period, 22 women students during their first year of medical school described instances when their knowledge and experience was discredited and ignored, then the ways they enacted agency to redress these injustices. Participants described three distinct ways they worked to redress injustices: reclaiming why they belong in medicine, speaking up and calling out the curriculum, and uplifting one another. This study has implications for recognizing medical students as whole individuals with lived histories and experiences and advocates for recognizing medical students' perspectives as valuable sources of knowledge.
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Affiliation(s)
- A Emiko Blalock
- Office of Medical Education Research and Development, Michigan State University College of Human Medicine, 964 Wilson Road, Fee Hall A214, East Lansing, MI, 48824, USA.
| | - Dianey R Leal
- Michigan State University College of Education, East Lansing, USA
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30
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Ajjawi R, Bearman M, Sheldrake M, Brumpton K, O'Shannessy M, Dick ML, French M, Noble C. The influence of psychological safety on feedback conversations in general practice training. MEDICAL EDUCATION 2022; 56:1096-1104. [PMID: 35852726 DOI: 10.1111/medu.14881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Fostering trainee psychological safety is increasingly being recognised as necessary for effective feedback conversations. Emerging literature has explored psychological safety in peer learning, formal feedback and simulation debrief. Yet, the conditions required for psychologically safe feedback conversations in clinical contexts, and the subsequent effects on feedback, have not been explored. METHODS We conducted a qualitative study using interviews and longitudinal audio-diaries with 12 rural general practice trainees. The data were analysed using framework thematic analysis to identify factors across the data and as individual participant case studies with illustrative vignettes of dynamic interleaving of factors in judgements about feedback conversations. FINDINGS Findings identify the influence of intrapersonal (e.g. confidence and comfort to seek help), interpersonal (e.g. trust and relationship) and sociocultural factors (e.g. living and working in a rural community) that contribute to psychological safety in the context of everyday feedback conversations. Multiple factors interplayed in feedback conversations where registrars could feel safe and unsafe within one location and even at the one time. DISCUSSION Participants felt psychologically safe to engage their educators in sanctioned systems of conversation related to the immediate care of the patient and yet unsafe to engage in less patient related performance conversations despite the presence of multiple positive interpersonal factors. The concept of a safe 'container' (contained space) is perhaps idealised when it comes to feedback conversations about performance in the informal and emergent spaces of postgraduate training. More research is needed into understanding how clinical environments can sanction feedback conversations in clinical environments.
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Affiliation(s)
- Rola Ajjawi
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning, Deakin University, Melbourne, Victoria, Australia
| | | | - Kay Brumpton
- Rural Clinical School, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Rural Medical Education Australia (RMEA), Toowoomba, Queensland, Australia
| | - Megan O'Shannessy
- Rural Clinical School, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Rural Medical Education Australia (RMEA), Toowoomba, Queensland, Australia
| | - Marie-Louise Dick
- General Practice Training Queensland, Brisbane, Queensland, Australia
- General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Matthew French
- General Practice Training Queensland, Brisbane, Queensland, Australia
- Rural Medical Education Australia (RMEA), Toowoomba, Queensland, Australia
| | - Christy Noble
- Academy for Medical Education, The University of Queensland, Brisbane, Queensland, Australia
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31
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Herrmann IK, Schlegel AA. Fostering Medical Materials Innovation. ACS MATERIALS AU 2022; 3:24-27. [PMID: 36647456 PMCID: PMC9837876 DOI: 10.1021/acsmaterialsau.2c00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/08/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
Close collaboration between basic researchers and clinicians is at the root of medical material and technology innovation. However, the distinctly different educational curricula and various boundary conditions put barriers on such interactions. This short perspective describes current challenges and provides subsequent solutions that may help research laboratories to overcome frequent hurdles and maximize interdisciplinary interactions. The involvement of various stakeholders is key to establishing an environment for barrier-free, effective collaboration, overcoming disciplinary boundaries and creating a strong source of inspiration and motivation for biomedical innovations with clinical impact.
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Affiliation(s)
- Inge K. Herrmann
- Nanoparticle
Systems Engineering Laboratory, Institute of Energy and Process Engineering
(IEPE), Department of Mechanical and Process Engineering (D-MAVT), ETH Zurich, Sonneggstrasse 3, 8092 Zurich, Switzerland,Particles-Biology
Interactions Laboratory, Department of Materials Meet Life, Swiss Federal Laboratories for Materials Science and
Technology (Empa), Lerchenfeldstrasse
5, 9014 St. Gallen, Switzerland, or . Phone: +41 (0)58 765 7153
| | - Andrea A. Schlegel
- Fondazione
IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Centre of Preclinical Research, Via Francesco Sforza, 35, Milan 20122, Italy,Department
of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
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32
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Cole AG, Camp ME. Supporting Our Parent-Trainees: Exploring Curricular and Cultural Challenges That Limit the Utilization of Parental Leave by Residents. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:157-161. [PMID: 35229245 PMCID: PMC8884516 DOI: 10.1007/s40596-022-01601-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | - Mary E Camp
- UT Southwestern Medical Center, Dallas, TX, USA
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33
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Brown MEL, Horsburgh J. I and thou: Challenging the barriers to adopting a relational approach to medical education. MEDICAL EDUCATION 2022; 56:14-16. [PMID: 34761420 DOI: 10.1111/medu.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Megan E L Brown
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
- Health Professions Education Unit, Hull York Medical School, University of York, York, UK
| | - Jo Horsburgh
- Medical Education Innovation and Research Centre, Imperial College London, London, UK
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34
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Wozniak H, Philip RL. Imagining the future: Social connections and new methodologies. MEDICAL EDUCATION 2022; 56:10-13. [PMID: 34761416 DOI: 10.1111/medu.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/17/2021] [Accepted: 10/21/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Helen Wozniak
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Robyn L Philip
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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