Promoting inclusivity in health professions education publishing

Medical Teacher's equity diversity inclusion policy

Medical Teacher is a leading international journal in health professions education. The Journal recognizes its responsibility to publish papers that reflect the breadth of topics that meet the needs of its readers around the globe including contributions from countries underrepresented in the health professions education arena. This paper sets out the Journal's policy with regard to Equity Diversity Inclusion (EDI) and the steps to be taken to implement the policy in practice.

The Inside Scoop: What We Learnt About Getting into Academic Publishing During Our Editorial Internship

The world of publication can seem intimidating and closed to the newcomer. How then does one even begin to get a foot in the door? In this paper, the authors draw from the literature and their recent lived experience as editorial interns to consider this challenge under the theme of access, and how it overlaps with the various components of academic publication. The main three components of the publication 'machine' are discussed in this article, authoring, reviewing, and editing. These are preceded by the first, and arguably foundational, interaction with academic journal publishing-reading. Without reading articles across different journals, and even in different disciplines, understanding the breadth of scholarship and its purpose is impossible. The subsequent components of authoring, reviewing, and editing, which are all enhanced by ongoing familiarity with current literature through further reading, are considered in further detail in the remainder of this article, with practical advice provided as to how to gain access and experience in each of these areas, for example, writing non-research article manuscripts, engaging in collaborative peer review, and applying for editorial opportunities (with perseverance) when the opportunity presents itself. Medical education publication can seem daunting and closed to entry-level academics. This article is written to dispel this view, and challenges the notion that the world of publication is reserved for experts only. On the contrary, newcomers to the field are essential for academic publications to retain relevance, dynamism, and innovation particularly in the face of the changing landscape of medical education.

Voices of Silence: Experiences in Disseminating Scholarship as a Global South Researcher

Issue: There is an unspoken requirement that medical education researchers living in the Global South must disseminate their work using dominant frames constructed by individuals living in the Global North. As such, the published literature in our field is dominated by researchers whose work primarily benefits the Western world, casting the rest of what is published as localized and unhelpful knowledge. In this article, we use Audre Lorde's conception of the Master's house as a metaphor to narrate the experiences of two South African medical education researchers trying to disseminate their work into North American venues. In addition to narrating these stories, we describe the personal and professional consequences they experienced as a result of their efforts. Evidence: For researchers working outside of the Global North, entering the Master's formidable house is daunting, and there is no clear pathway in. These narratives illustrate how reviewers and editorial staff act as gatekeepers, continuously shaping ideas about what it means to do acceptable research, and who is allowed to disseminate it within the field. These narratives also show that those who have been rejected by these gatekeepers are often conflicted about their position within the larger field of medical education. Implications: To begin to address this issue, we have made several suggestions for the research community to consider. First, medical education research journals need to create spaces for researchers publishing from the Global South. One suggestion is for journals to create a submission type that is dedicated to researchers working outside of North America. Second, journals should also include more Global South editors and reviewers to help with knowledge translation when articles are submitted from outside North America. If our collective goal is to improve the training of physicians and the health outcomes of humanity, then we need to renovate the Master's house and begin to break down the barriers that separate us from truly building together.

A qualitative study of social accountability translation: from mission to living it

BACKGROUND

Medical schools are increasingly adopting socially accountable mission and curricula, the realisation of which are dependent on engaging individuals to embody the mission's principles in their everyday activities as doctors. However, little is known about how graduates perceive the efforts taken by their medical school to sensitise them to social accountability values, and how they translate this into their working lives. Our aim was to explore and understand graduate perceptions of how their medical school influenced them to embody a social accountability mission in their working lives.

METHODS

This was a qualitative interview study carried out with graduates/alumni [n = 51] of Christian Medical College, Vellore [CMCV], India, a school with a long-established and explicit social-accountability mission. Data coding and analysis were initially inductive and thematic using Braun and Clarke's six step framework. MacIntyre's virtue ethics theory framed secondary analysis, allowing us to consider the relationships between individual and contextual factors.

RESULTS

Our participants perceived that CMCV invested heavily in selecting personal qualities aligned with the CMCV mission. They saw that these qualities were reinforced through various practices: [e.g., placements in resource limited and/or remote and rural settings]; community engagement and expectations [e.g., student self-governance]; role modelling [staff and more senior students]. Much emphasis was placed on sustaining these traditions and practices over time, creating a strong sense of identity and belonging among participants, traditions which were fostered further by the alumni network and continued engagement with CMCV post-graduation.

CONCLUSIONS

Ensuring social accountable medical education depends on alignment and interactions over time between context and structures, systems and human agents. Further studies are needed to extend understanding of how students from diverse contexts experience socially accountable medical education and translate their educational experience into their thinking and practice after graduation.

Tuition Costs of Master's of Health Professions Education Programs: A Cross-Sectional Analysis

PURPOSE

The increasing professionalization of medical education during the past 2 decades has ushered in an era in which formal degrees, particularly master's of health professions education (MHPE), have become important for career advancement in medical education. Although tuition costs can pose a substantial barrier for many seeking advanced degrees in health professions education, data on tuition associated with these programs are lacking. This study examines the accessibility of pertinent cost-related information available to prospective students and the variability of costs among programs worldwide.

METHOD

The authors conducted an Internet-based, cross-sectional study, augmented with emails and direct contact with educators, to extract tuition-related data for MHPE programs between March 29, 2022, and September 20, 2022. Costs were converted to an annual total within each jurisdiction's currency and converted to U.S. dollars on August 18, 2022.

RESULTS

Of the 121 programs included in the final cost analysis, only 56 had publicly available cost information. Excluding programs free to local students, the mean (SD) total tuition cost was $19,169 ($16,649), and the median (interquartile range) cost was $13,784 ($9,401- $22,650) (n = 109). North America had the highest mean (SD) tuition for local students ($26,751 [$22,538]), followed by Australia and New Zealand ($19,778 [$10,514]) and Europe ($14,872 [$7,731]), whereas Africa had the lowest ($2,598 [$1,650]). The region with the highest mean (SD) tuition for international students was North America ($38,217 [$19,500]), followed by Australia and New Zealand ($36,891 [$10,397]) and Europe ($22,677 [$10,010]), whereas Africa had the lowest ($3,237 [$1,189]).

CONCLUSIONS

There is substantial variability in the geographic distribution of MHPE programs and marked differences in tuition. Incomplete program websites and limited responsiveness from many programs contributed to a lack of transparency regarding potential financial implications. Greater efforts are necessary to ensure equitable access to health professions education.

Effects of a disability-simulating learning unit on ableism of final-year dental students - a pilot study

OBJECTIVES

This study aimed to describe a disability-simulating learning unit (DSLU) to raise dental students' awareness of the special needs of patients with disabilities as well as to measure the effect of the DSLU on ableism.

METHODS

A DSLU among final-year undergraduate dental students (n = 33), was developed and evaluated. The students were randomly divided into two groups (Group I, n = 17; Group II, n = 16). Group II only received conventional teaching (control group), whereas Group I was additionally exposed to the DSLU (intervention group). In the DSLU, typical physical restrictions and the associated difficulties in attending dental appointments were simulated with the help of simulation suits. Four different stations offered the opportunity to experience typical signs of disability in a dental context. About 2 months after the DSLU, both groups were asked to answer the Symbolic Ableism Scale (SAS). An analysis was conducted to examine the participants' average total score and several subscores. The Mann-Whitney U Test was employed to control the differences between the study groups.

RESULTS

Overall, the students in the intervention group had a significantly (p = .001) lower mean SAS summary score (median = .37; IQR .32-.42) than the students in the control group (median = .50; IQR .39-.53). For the components "individualism" (p < .0001) and "excessive demands" (p = .002) significant group differences could be observed.

CONCLUSION

The DSLU is a potentially feasible and effective method for influencing students' ableism attitude.

Representation in Health Professions Education: Striving for an Inclusive Health Professions Education Community

Author representation and inclusivity in health professions education (HPE) scholarship is receiving increasing attention in academic medicine, with multiple articles calling for greater equity related to gender, geographic, and institutional affiliations. Despite journal efforts to seek diversity, authors from high-income English-speaking countries are the most highly represented in HPE scholarship. Less attention, however, has been focused on the openness of medical education scholars, themselves, to engaging in international collaborations with authors and institutions from low-and-middle income countries. This eye-opener is inspired by the authors' personal experiences in HPE scholarship from an international medical educator perspective and advocates for the creation of an open and inclusive multinational medical education community. We offer suggestions that can help create opportunities for networking, collaboration, and promoting a sense of belonging among HPE scholars worldwide. As researchers, journal editors and associate editors, and faculty in HPE programs, we can work together to create a welcoming and accommodating environment that embraces non-dominant voices and perspectives, with the ultimate goal of achieving diversity and equity in HPE scholarship.

The voices of medical education scholarship: Describing the published landscape

INTRODUCTION

The voices of authors who publish medical education literature have a powerful impact on the field's discourses. Researchers have identified a lack of author diversity, which suggests potential epistemic injustice. This study investigates author characteristics to provide an evidence-based starting point for communal discussion with the intent to move medical education towards a future that holds space for, and values, diverse ways of knowing.

METHOD

The authors conducted a bibliometric analysis of all articles published in 24 medical education journals published between 2000 and 2020 to identify author characteristics, with an emphasis on author gender and geographic location and their intersection. Article metadata was downloaded from Web of Science. Genderize.io was used to predict author gender.

RESULTS

The journals published 37 263 articles authored by 62 708 unique authors. Males were more prevalent across all authorship positions (n = 62 828; 55.7%) than females (n = 49 975; 44.3%). Authors listed affiliations in 146 countries of which 95 were classified as Global South. Few articles were written by multinational teams (n = 3765; 16.2%). Global South authors accounted for 12 007 (11.4%) author positions of which 3594 (3.8%) were female.

DISCUSSION

This study provides an evidence-based starting point to discuss the imbalance of author voices in medical education, especially when considering the intersection of gender and geographical location, which further suggests epistemic injustice in medical education. If the field values a diversity of perspectives, there is considerable opportunity for improvement by engaging the community in discussions about what knowledge matters in medical education, the role of journals in promoting diversity, how to best use this baseline data and how to continue studying epistemic injustice in medical education.

"The sins of our forefathers": reimagining research in health professions education

As HPE begins to turn their attention to the lived experiences of minoritized groups in society, health professions education (HPE) researchers need to be aware of the history of social science research and the ways it contributes to creating systems of oppression. This is because as 'knowledge producers,' we make decisions about how to design our studies, analyze and interpret data, and report it in ways that are frequently oblivious to the harmful legacy of social science research, and how it continues to bring harm to minoritized communities. To not do so is to perpetuate a system that has historically served the dominant group at the expense of those who are limited in representing the world for themselves. This article proposes that HPE researchers engage in disruptive research practices by delinking with their disciplinary training, and reimagine their role in the research process. To accomplish this, I suggest that they engage in three strategies: attend to the research team's composition, embrace critical theory and investigate epistemological ignorance. These strategies are nowhere close to exhaustive, and they do not extend as far as the conversation must go in reimagining our role in the research enterprise. However, in providing some initial thoughts on this topic, I hope to invite the HPE community into discussion on how we might harness our collective responsibility to resist research practices that are harmful and unjust to minoritized communities.

Ethnic diversity in academic dentistry in the United Kingdom

Careers in academic dentistry are failing to attract a new generation of academics to steer dental education and research. Dental academia is further limited by inadequacies in levels of ethnic diversity. There is a stark contrast between the diversity of graduates entering the dental profession and those in academic positions, especially in senior ranks. Dentistry is not the only field in academia, which lacks representation and lessons may be drawn from other faculties. This paper focuses on what is known about dental academia in the United Kingdom, where there are formal research training pathways. There is an emerging recognition of the requirement for action, and it is hoped this will stimulate debate and impetus for research across Europe. The terminology used throughout this piece follows the United Kingdom Cabinet Office recommendations for writing about ethnicity (Writing about ethnicity, 2021; https://www.ethnicity-facts-figures.service.gov.uk/style-guide/writing-about-ethnicity). Where cited sources have employed less acceptable terms (Please don't call me BAME or BME!: Civil service, 2019; https://civilservice.blog.gov.uk/2019/07/08/please-dont-call-me-bame-or-bme/), these have been changed.

Joining the meta-research movement: A bibliometric case study of the journal Perspectives on Medical Education

PURPOSE

To conduct a bibliometric case study of the journal Perspectives on Medical Education (PME) to provide insights into the journal's inner workings and to "take stock" of where PME is today, where it has been, and where it might go.

METHODS

Data, including bibliographic metadata, reviewer and author details, and downloads, were collected for manuscripts submitted to and published in PME from the journal's Editorial Manager and Web of Science. Gender of authors and reviewers was predicted using Genderize.io. To visualize and analyze collaboration patterns, citation relationships and term co-occurrence social network analyses (SNA) were conducted. VOSviewer was used to visualize the social network maps.

RESULTS

Between 2012-2019 PME received, on average, 260 manuscripts annually (range = 73-402). Submissions were received from authors in 81 countries with the majority in the United States (US), United Kingdom, and the Netherlands. PME published 518 manuscripts with authors based in 31 countries, the majority being in the Netherlands, US, and Canada. PME articles were downloaded 717,613 times (mean per document: 1388). In total 1201 (55% women) unique peer reviewers were invited and 649 (57% women) completed reviews; 1227 (49% women) unique authors published in PME. SNA revealed that PME authors were quite collaborative, with most authoring articles with others and only a minority (n = 57) acting as single authors.

DISCUSSION

This case study provides a glimpse into PME and offers evidence for PME's next steps. In the future, PME is committed to growing the journal thoughtfully; diversifying and educating editorial teams, authors, and reviewers, and liberating and sharing journal data.